Exam II Study Guide Flashcards by Alex Olsen

How does the pH of urine relate to its hydrogen ion concentration?

inverse relationship
increase H+, decrease pH
decrease H+, increase pH

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Ketone bodies in the urine are suggestive of what?

elevated COH metabolism

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What causes myoglobinuria?

rhabdomyolysis, muscle destruction

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What color is positive nitrite on dipstick

pink

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What substance is most likely to be present in urine that could cause a false negative reaction on dipstick for glucose?

ascorbic acid, vitamin D

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What is SSA used for?

confirmatory test for proteins

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What test is used for detecting reducing sugars in the urine? What would be expected in microscopic exam?

Clinitest

nothing

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What two dipstick reactions are usually positive in pyelonephritis?

leukocytes and nitrite

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Conditions that could be indicated by elevated urinary urobilinogen

hepatitis
cirrhosis
liver disease
hemolytic anemia
PA

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Conditions that can cause hemoglobinuria

extensive burns
intravascular hemolysis
incompatible transfusions
PNH-paroxysmal nocturnal hemoglobinuria
infections; malaria, syphillis

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What is specificity in relation to the dipstick?

each zone should react specifically to the substance being tested and no other

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What does the test pad for ketones detect

acetoacetic acid

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Principle of the dipstick method for protein

“protein error of indicators” tetrabromphenol blue buffered at a constant pH of 3 w/o proteins is yellow, but in the presence of proteins, H+ is released by indicator dye causing color to change ranging from ylw-gr to bl-gr

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What unusual urinary protein is associated with Multiple Myeloma

Bence Jones protein

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What sugar, especially in infants, is most likely indicated by a neg dipstick reaction for glucose but a pos Clinitest

galactose

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WHat specimen is used to detect orthostatic proteinuria? When would you suspect this condition?

1st morning specimen (=) and specimen after patient has been erect for a few hours (+).

If protein is excreted sitting up but not laying down
seen in kids and adolescents

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What is the active ingredient in Ehrlich’s reagent?

paramethylamino benzaldehyde

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What reagent is used to detect bilirubin in the Ictotest?

2,4 - dichlorobenzene diazonium tetrachlorozincate

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Hemoglobin pad on reagent strip detects

hemoglobin
myoglobin
intact rbcs

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What is the action of the enzyme peroxidase?

to catalyze the oxidation of chromogen (3,3’,5,5’ - tetramethylbenzidine) by the O2 released from peroxidase on reagent pad to produce color change from yellow to green; sudoperoxidase acitivity

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Why is there normally no glucose in urine?

usually reabsorbed back into the blood through the renal convoluted tubules

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Advantage of using phase contrast microscopy in exam of urinary sedimentation? Relation to refractive index?

allows you to see unstained cellular components and casts

refractive index is similar to urine, enables you to see difficult to view formed elements

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What is the use of polarizing microscope in urince microscopics?

detects sediment that is birefringent (anisotropic) and confirm presence of fat and cholesterol crystals

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How are cells recorded

number per High (40x) power field

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How many fields should be examined?

lpf/hpf 10 fields; dependent on what the examiner is looking for

What is the most common type of WBC found in urinary sediment?

neutrophils

Whats usually pos when casts are present?

protein

Casts containing cells indicate problems in what part of the urinary tract

kidney

Where are transitional epi cells found

lining of renal calyces, renal pelvis, ureters and and bladder. urethra in males

Amorphous phosphates are found in what kind of urine?

alkaline

What disease is indicated when tyrosine and leucine crystals are found in urine

severe liver disease; overflow of aminoaciduria

What is characterized by lipiduria and proteinuria

Nephrotic syndrome

Casts which have at least two distinct compnents

mixed casts

How should casts be reported

lpf 10x

Which WBC is most likely to be found in a transplant rejection

lymphocyte

In what specific portion of the nephron are casts formed

distal convoluted tubule and collecting ducts

Types of diseases RBC cast are found

intrinsic renal disease | basement membrane where glomerulous is damages

Specific epi cells found in epi casts

renal tubular epi cells

Glitter cells seen in urines with

low SG

Epi cells indicative of vaginal contamination

squamous

Calcium oxalate crystals are seen in

acidic urine | low pH

Condition indicative by large numbers of uric acid crystals

gout | increase purine metabolism, such as treatment with cytotoxic drugs sued in leukemia

Candida albicans often seen in urine of pts with

diabetes mellitus

If flat, hexagonal, colorless crystals are found in urine, what constituent is suggested? What should be done prior to reporting?

Cystine | chemical confirmatory testing

How can rbc and yest be differentiated

2% acetic acid; lyse rbcs | toludine blue; stain S-M color reveal nuclear details

What is the appearance of waxy casts?

sharp, blunt uneven ends cracks or fissures from lateral margins and along axes high refractive index homogenous

Organisms that indicate contamination

parasites Trich sperm yeast

Order of aging process of casts

cellular, coarse granular, fine granular, waxy

Presence of elevated numbers of casts in urine

cylinduria

How can precipitate of amorphous phosphate (alkaline) crystals be removed

dissolve in diluted acetic acid

How can precipitate or amorphous urate (acidic) crystals be removed

dissolve in alkali or heat to 60C using warm water

What would the appearance of rbc in hypertonic urine be

crenated

Can the multistix detect a neg urobilinogen

neg is there is none in urine, but cannot detect a complete absence

How would you determine a neg nitrite but a pos bacteria

urine not in bladder long enough, nitrate to nitrite reductions hasnt occured bacteria pop is too high and nitrite has been further reduced to nitrogen no nitrite in diet leeching or runover of reagents

What type of casts may be found in the urine of normal pH

hyaline

What are shadow cells

rbc with nohgb

What is the significance of the shape and size of a cast

variable; helps in ID | cast type can distinguish kidney disease from lower urinary tract disease

Urine for testing should always be

room temp

Why use refractometer for SG instead of dipstick

dipstick detects ionic solutes only refractometer detects ionic solutes and non ionic solutes

How does Watson-Schwartz test differentiate between urobilinogen and porphobilinogen

red+chloroform = uronilinogen soluble in chloroform and butanol red+butanol = porphobilinogen soluble in aqueous layer

What is the principle of the automated instruments for dipstick reading

reflectence

Glucose in urine is referred to as

glycosuria | glucosuria

Two different forms of blood in the urine are known as

hematuria | hemoglobinuria

What reagent is used to differentiate urinary hgb and myoglobin

ammonium sulfate | precipitates hgb

What is the normal range for urinary urobilinogen

0.1-1 mg%

Which test is most sensitive for bulirubin

Ictotest

What is ketonuria

excessive amounts of ketone bodies in urine