Introduction and UA Notes Flashcards
1
Q
For a typical chiropractic practice, a chiropractor must develop a chiropractic case management plan, which ___ consist of concurrent care by another health care provider
A
May
-Also include report of findings and informed consent
2
Q
If indications of an underlying disease exist, then a second opinion from another health care provider _____ necessary for concurrent care
A
Maybe
3
Q
Patient presents with mid back pain. History includes polyuria, dolydipsia, and family members with onset diabetes. Nervoscope shows subluxations at C1, T6, and the pelvis. What does the patient now need?
A
Concurrent care with endocrinologist as patients is showing signs of diabetes that also correlate with family history.
-Also order a fasting glucose test for Lab to help confirm/check for a Dx of diabetes
4
Q
You suspect a patient of having diabetes so you order a UA and FBS. Lab work shows the following:
- UA = +3 glucose with ketones
- FBS = 325 mg/dL
What is your clinical impression?
A
Both the UA and FBS are higher than normal and indicate diabetes and ketosis in addition to multiple subluxations.. Comanage the patient with an endocrinologist
-Scope of practice would mandate a second opinion for Dx, treatment, and concurrent care with endocrinologist.
5
Q
Governing body for lab facilities
A
CLIA
-Clinical Laboratory Improvement Amendments
6
Q
How do chiropractors use lab tests?
A
- Establish baseline data
- Screening (general or target)
- To determine Dx and prognosis
7
Q
S/S to order a UA
A
- Low back pain
- Painful urination
- Hematuria
- Suprapubic pain
- Urethral or vaginal discharge
- Frequent urination
- Inability to urinate
- Polydipsia
- Polyphagia
8
Q
Routine UA consists of what 3 reports
A
1) Physical properties
2) Chemical properties
3) Microscopic properties (not on every report)
9
Q
Functional unit of the kidney
A
Nephron
10
Q
The oldest clinical lab procedure. What people use to gaze into the body fluid for fortune telling purposes?
A
Urinalysis
-Urine gazers a.k.a. Pisse Prophets
11
Q
What chemical makes up 1/2 of the urine filtrate?
A
Urea
- Glomeular filtrate becomes urine after it leaves the distal convoluted tubules.
- Principle solutes of urine = urea, Na, K, Cl, Creatinine, uric acid, NH3
- Body excretes 60 grams of dissolved material/24 hr
12
Q
Urine is composed of __% water and __% dissolved solids
A
95% water 5% dissolved solids
-Daily average urine volume is 1,200-1,500 mL (normal range = 600-2,000 mL)
13
Q
>2,000 mL of urine output per 24 hours. What conditions could cause this?
A
Polyuria
- Diabetes mellitus
- Diabetes insipidus
- Large fluid intake
- Diuretics
14
Q
<500 mL of urine output per 24 hours. What conditions may cause this?
A
Oliguria
- Renal tubule dysfunction
- End stage renal disease
- Obstruction
- Edema
- Dehydration
- Diarrhea
- Vomiting
- Shock
15
Q
Absence of urine. What conditions may cause this?
A
Anuria
- Renal failure
- Obstruction
- Heart attack
16
Q
Excessive water intake
A
Polydipsia
17
Q
What time of day is best for a UA specimen?
A
Early morning
- Midstream clean catch on rising (urine has been in the bladder for hours)
- Most concentrated
- Decomp begins withing 30 mins. at room temp (4 hours in fridge)
18
Q
Most common and convenient type of urine specimen
A
Random sample
- Testing should be performed immediately or at least within 2 hours at room temperature
- Could do 24 hours sample with a preservative
19
Q
What changes does the urine undergo if unpreserved?
A
- Color becomes darker
- Turbidity increases
- Odor is more foul
- pH increases
- Glucose, ketones, bilirubin, and urobilinogen decrease
- Nitrites and bacteria increase
- RBC’s, WBC’s, and casts disintegrate (may lead to erroneous findings)
20
Q
Straw to amber colored urine indicates what?
A
Considered normal
- Light yellow to dark yellow
- early morning urine is darker, more concentrated
21
Q
Red, dark brown urine indicates what?
A
Excessive hemoglobin, RBC, or myoglobin associated with many things:
- Menses
- UTI
- Malignancy
- Prostate
etc.
22
Q
T/F Urine color roughly indicates the degree of hydration and concentration
A
True
23
Q
What can cause orange urine?
A
Found with dehydration from fever, vomiting, certain foods (rhubarb, Vit C., carrots), medications, etc.
24
Q
Bright yellow urine indicates what?
A
Excessive B vitamins
-Energy drinks
25
Black urine indicates what?
- Alkaptonuria (urine turns black as it sits)
- Melanin problems like malignant melanoma
26
Colorless urine indicates what?
- Diabetes insipidus associated with decreased pituitary ADH (head trauma)
- Overhydration associated with low specific gravity
27
X-ray finding of homogentric oxidase deficiency that mimics DJD/DDD everywhere in the spine and patient also has black urine
Ochronosis
28
Brownish yellow/green urine indicates what?
Liver problems
- Check bilirubin and urobilinogen (may also be referred to as dark yellow)
- May see jaundice of skin and sclera and other findings possible for hepatitis/liver disease
29
Milky urine is associated with what pathology?
Hyperlipidemia
-Risk factor for heart disease
30
Technician holds the urine up to the light and notices it is clear. What pathology is present?
None = Clear is normal
31
Urine that appears slightly hazy, but the sediment check is negative indicates what?
Normal urine
-If it appears hazy, but sediment check is negative = insignificant
32
Cloudy urine indicates what?
If associated with crystals, insignificant
-May also be pus, bacteria, RBC's, or spermatozoa
33
Hazy, cloudy urine is usually due to \_\_\_\_\_\_\_\_\_\_
Infection
- Milky = hyperlipidemia (need lipid profile to confirm)
- White frothy = proteins
- Yellow frothy = bile/billirubin in the urine
34
Evaluates the kidneys ability to concentrate urine. Inability to do so is an early sign of disease. What is the normal range for an adult?
Specific gravity
-Weight or urine compared to distilled water (SpG H2O = 1.000) 1.015 - 1.035 is normal range for adults
35
Low specific gravity
Hyposthenuria
36
High specific gravity
Hyperosthenuria
37
Fixed SpG of 1.010
-What does this indicate?
Isosthenuria
-Same value as protein free plasma and signifies end stage of renal failure
38
If someone has a SpG of 1.010, does this indicate a Dx of renal failure?
NO!!!
-Multiple SpG values of 1.010 indicates possible renal failure. If only one reading shows 1.010, that does not indicate renal failure, only hyposthenuria. Only when multiple tests show a constant hyposethenuria of 1.010, does that indicate Isosthenuria
39
You notice your patient has yellow urine, so you order a UA. Results show:
- pH = 5
- Urobilinogen = 0.01
- Sugar = +2
- SpG = 1.060
What is causing the hypersthenuria?
Lots of heavy sugar and protein molecules in the urine (urobilinogen and sugar) cause the SpG to increase
40
What can cause an increased SpG?
Anything that increases concentration in urine:
- Proteinuria or Glucosuria
- Dehydration
- Decreased renal blood flow (heart failure, renal artery stenosis)
41
Low SpG indicates what?
Dilute urine
- Decreased concentration
- Overhydration (polyuria)
- Glomerulonephritis (hematuria, blood casts)
- Pyleonephritis
- Diabetes insipidus
- Renal failure Anything that would prevent the kidney from being able to concentrate urine
42
Urine odor matching:
\_\_ Diabetes mellitus/ketosis
\_\_ Normal
\_\_ UTI
\_\_ Asparagus, enterobladder fistula
a) Feces odor
b) Foul, fishy
c) Aromatic
d) Fruity, sweet
d) Fruity, sweet = Diabetes mellitus/ketosis
c) Aromatic = Normal
b) Foul, Fishy = UTI
a) Feces odor = Asparagus, enterobladder fistula
43
Reagent strips utilized to detect excess amounts of substances in the urine
Dipsticks
44
pH is used to indicate the _______________ of the patient. What are the normal ranges?
Acid-Base Balance
Normal pH = 4.5 to 7.5
- Acidic pH = \< 7
- Neutral pH = 7
- Alkaline pH = \>7
45
Which of the following is NOT true with pH or urine?
a) Becomes acidic as it stands due to bacterial growth (like E. coli) and breakdown of urea
b) Changes in pH may first appear in the urine
c) Blood pH is 7.35 - 7.45 (more critical)
d) Normal pH is maintained primarily through reabsorption of Na and secretion of H and NH4
a) Becomes acidic as it stands due to bacterial growth and breakdown of urea
With E.coli, it becomes ALKALINE as it stands due to growth and breakdown of urea
46
What kinds of diets will typically produce acidic and alkaline urine?
- Diets high in animal products = typically acidic urine
- Diets high in citrus fruits and vegetables = typically alkaline
47
What conditions cause acidic urine?
Acidic urine = pH \> 7
- Respiratory acidosis =COPD, aasthma
- Metabolic acidosis
- Diabetes mellitus
- Large amounts of meats and cranberries
48
What conditions cause alkaline urine?
Alkaline pH = \>7
- Respiratory alkalosis = Hyperventilation
- Metabolic alkalosis
- UTI (E. coli, Bacillus proteus both love alkaline urine)
- Diets high in vegetables
- MC in females
49
What is the recommendation for someone with UTI's due to E. coli or B. proteus?
Drink cranberry or blueberry juice to increase the pH of the urine (preventative measure)
50
If a patient is complaining of dysuria and the UA shows:
pH = 8
Bacteria = +2
SSA = +1
WBC = Leukocytosis
-Would concurrent care be appropriate?
YES!
- Leukocytosis and SSA + indicates there is protein in the urine which points to a possible upper UTI that needs concurrent care with a nephrologist
- If no protein in the urine, could be handled conservatively
51
Acidic urine is associated with what types of stones?
Xanthine, cysteine, and uric acid stones
-Keep the urine alkaline
52
Alkaline urine is associated with what types of stone formation?
Calcium carbonate, calcium, and magnesium phosphate stones
-Keep the urine acidic
53
Dipsticks are maninly sensitive to what protein?
Albumin
- 1/3 of proteins in urine are albumin
- Reported as negative(ideal), trace, +1, +2, +3, +4 (worst)
- Some albumin is excreted, but normal is immeasurable
54
T/F Albuminuria is synonymous with proteinuria
True
55
Normally the glomerulus prevents _______ entering the glomerular filtrate.
Protein
-ALWAYS investigate proteinuria since it maybe the primary indicator of renal disease
56
T/F The dipstick test is used to confirm proteinuria
FALSE.
- Dipstick test is used to SCREEN for proteinuria
- SSA test is used to CONFIRM proteinuria from a positive Dipstick test
- SSA Test is + if Tech notices turbidity following SSA and centrifuge
- SSA Test = 3% sulfasalicyclic acid test used to confirm results from + Dipstick test
57
T/F Following a centrifuge of the urine, the protein remains in the supernatant
True
-WBC, RBC, etc. settle to the bottom as the precipitate
58
Proteinuria because of kidney disease usually indicates an \_\_\_\_\_\_\_\_\_\_\_\_
Upper UTI
Other causes of proteinuria:
-Diabetes, glomerulonephritis, nephrotic syndrome, preclampsia, trauma, strenuous exercise, exposure to cold, large abdomen, dehydration, pregnancy, febrile illness.
59
Female athlete, 13 year old sports physical
-Abnormal Findings:
pH 5
Protein +1
What are some possible explanations for her abnormal findings?
Could be a renal disease, strenuous exercise, or cold induced
- Correlate history with suspicions
- Worked out a lot? Don't exercise for 2 days and rerun UA
- Goes skiing a lot? Don't ski for 2 days and rerun UA
- If UA is still abnormal after eliminating other factors, do concurrent care with urologist or nephrologist
KEY POINT: There many causes of proteinuria, so DO NOT take it lightly and do due diligence to find what the etiology is!
60
Patient displays normal urine when supine and displays proteinuria when standing.
Orthostatic proteinuria
- Lie down for 1 hour and recheck urine
- MAYBE associated with exaggerated lumbar lordosis causing renal congestion
- MC in adolescents
- Likely caused by altered hemodynamic (still idiopathic)
61
Toxemia associated with 3rd trimester pregnancy that causes increased blood pressure and proteinuria if mild. May lead to seizures and/or coma if severe.
Preeclampsia
62
+2 protein, chest pain, and cardiac enzymes indicated what pathology has occured?
Heart condition (MI)
63
Massive proteinuria (protein +4). Urine appears very white and frothy. Patient has severe edema, especially around the eyes.
Nephrotic Syndrome
-Associated with toxins, bee stings, severe infections, and polycystic kidney
64
Should be run on all patients with 4+ protein. Should be considered if patient has back pain and X-ray shows large lytic changes, Rain Drop Skull, and/or pathologic fractures
Bence Jones Test
-To look for Bence Jones Proteins that may indicate multiple myeloma (50-80%)
65
Proliferating malignancy of plasma cells that produces monoclonal antibodies
Multiple Myeloma
66
DDx for a Pathologic Fracture
1) Osteoporosis (MC)
2) Lytic Metastasis (MC cancer)
3) Multiple Myeloma (MC primary cancer)
67
What should we do first to help DDx a pathologic fracture?
Obtain old films (from \> 2 years ago)
- Lesions is on old films = leave it alone/Osteoporosis
- Lesions are not on old films = NOT osteoporosis; need lab/history/imaging to DDx lytic mets from MM
68
Light chain portion of immunoglobulin that appears in the urine of someone with multiple myeloma. What test(s) is/are used to find these proteins?
Bence Jones Protein
- Urine protein electrophoresis (PEP) to find monoclonal immunoglobulin
- Immunofixation to find what specific type of Ig is present (A, E, G, M, etc.)
69
T/F Routine UA will be able to detect Bence Jones proteins
FALSE.
Need either Bence Jones Test (non-preferred) or Urine and/or Serum Protein Electrophoresis (preferred)
70
Which of the following is NOT associated with multiple myeloma?
a) Renal insufficiency
b) Thrombocytopenia
c) Pathologic Fractures
d) Immune deficiency
e) all are associated with MM
e) all are associated with MM
Nausea, fatigue, confusion, polyuria, hypercalcemia, renal insufficiency, anemia, bone lysis, dizziness, blurred vision, hyperviscosity
Usually Fatal From:
- Pulmonary infections/problems
- Anemia
- Kidney dysfunction
71
\_\_\_\_\_\_\_\_\_\_\_ more common in older populations and of course are at risk of fractures from weakened bones. Patients should have PEP done to confirm.
Multiple Myeloma
72
For multiple myeloma, dipstick is negative for Bence Jones. _______ test is SSA which is positive. _________ by urine electrophoresis. Why would the dipstick test be negative for multiple myeloma?
Screening test = SSA test (looks for proteins)
Confirmatory test = PEP (or Immunofixation)
Dipstick is negative for MM because Dipstick is looking for albumin protein and NOT globulin proteins that makes up Bence Jones Proteins.
73
Patients with suspected multiple myeloma need a 24-hour urinalysis with PEP to determine presence of \_\_\_\_\_\_\_\_\_\_\_\_\_\_
Bence Jones Proteinuria
74
CRAB for Multiple Myeloma
C = Calcium (elevated)
R = Renal dysfunction
A = Anemia
B = Bone loss (pathologic fractures)
75
For patients who may have Lytic Mets or Multiple myeloma, what is the algorithm for each?
Lytic Mets = Bone scan (find Hot Spots) --\> MRI "Hot Spots" --\> Biopsy (Dx type of cancer)
MM = PEP serum and urine (look for M-spike) --\> Skeletal survey (where else is it?) --\> MRI abnormal spots from survey --\> biopsy suspected spots from MRI
(May add PET scan at anytime for either)
76
T/F Bone scans are one of the key types of imaging to confirm presence of multiple myeloma
FALSE
-Bone scans usually do not contribute significantly because they rely on blastic activity while multiple myeloma is primarily a lytic activity pathology
77
What other test can be used to confirm Multiple Myeloma in patients who are negative for serum and urine M-spike?
Serum free light chain assay
-also good for monitoring patients response to treatment
78
Serum M protein \< 3 g/dL
Bone marrow plasma cells \< 10%
No CRAB
What is the Dx?
Monoclonal Gammopathy of Undetermined Significance (MGUS)
79
Serum M protein \>3g/dL
Bone marrow plasma cells \>10%
No CRAB
Dx:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Smoldering Multiple Myeloma
If patient presents with CRAB = Dx for Multiple Myeloma
80
What is the normal finding for sugar/glucose in the urine?
Negative
-If +, need a fasting blood sugar (FBS) and correlate to family history.
81
Normal RTV
RTV = Renal Threshold Value a.k.a. blood threshold value (beyond this causes glucose to spill into the urine)
Normal = 140-180 mg/dL
\>180 = may indicate diabetes
82
Classic association with glucosuria is \_\_\_\_\_\_\_\_\_\_. May also be seen with ________ which lowers the RTV
Diabetes mellitus (#1)
Renal disease may lower RTV causing glycosuria
83
What causes ketones to form?
Due to lack of available sugar getting to the cells due to lack of Insulin
-Byproduct of fat metabolism as a way for the body to make energy when glucose levels are inadequate
84
Normal value for ketones in the urine
Negative
-Abnormal = reported as trace, small, moderate, +1, +2, +3, +4
85
Ketones
- Acetone
- Beta-hydroxybutric acid
- Acetoacetic acid
86
What does ketonuria suggest in diabetic and nondiabetic patients?
1) Diabetic patients = poorly controlled disease (may warn of diabetic coma)
2) Non-diabetic patients = reduced carbohydrate metabolism and excessive fat metabolism
87
Normal value for bilirubin in the urine
Negative
-Billirubin is a breakdown product of RBC hemoglobin release. Needs to be processed by the liver before it can be released into the urine.
88
\_\_\_\_\_\_\_\_ billirubin is unable to pass the golmerular filter and can not be excreted in the urine (NOT water soluble).
Nonconjugated bilirubin binded to albumin in the blood stream from RBC hemoglobin
-Needs to be conjugated in the liver (adds glucuronic acid) before it can be excreted in the bile and small intestine
89
Bilirubin is acted on by bacteria to form _________ which is further reduced to _________ to give feces its brown color?
Bilirubin --\> Urobilinogen(some is handled by the kidneys and excreted) --\> Stercobiligen
90
Conjugated bilirubin in the urine indicates what?
Obstruction of bile flow from the liver (gall stones, tumor, pancreatic cancer, liver inflammation/infection, etc.)
91
What are possible s/s of bilirubin in the urine?
- Dark urine with a yellow foam (if shaken)
- Jaundice
- Pale colored feces (all point to bilirubinuria)
92
What does pre-hepatic abnormal bilirubin indicate?
- Anemia's
- Excessive breakdown of RBCs
93
What does hepatic abnormal bilirubin indicate?
- Hepatitis
- Cirrhosis
- Obstruction of biliary duct
- Toxic liver damage
etc.
94
What does post-hepatic abnormal bilirubin indicate?
Biliary tree obstruction etc.
95
Normal range for urobilinogen
0.1 - 1 mg/dL (Ehrlich units)
96
What protein gives the yellow color of urine and brown color of feces?
Stercobilinogen
97
How would liver disease and hemolytic conditions effect urobilinogen?
Urobilinogen is not re-excreted in the bile and increased levels accumulate in the urine
98
Liver/biliary dysfunction have what effect on urobilinogen and bilirubin?
Increases urobilinogen
Bilirubin will be found in the urine (+)
99
Biliary tract obstruction will have what effect on urobilinogen and bilirubin?
Decreased/absent urobilinogen
Bilirubin will be found in the urine (+)
100
Prehepatic disease or hemolytic anemia will have what effect on urobilinogen and bilirubin?
Increased urobilinogen
Bilirubin will be negative (can't conjugate it)
101
Dark yellow/brown/green colored urine indicates what?
Bilirubin is in the urine
Urobilinogen is in the urine
Think liver/biliary tract problem (gallstones)
-also look for jaundice, mid back discomfort, increased liver enzymes
102
Correct follow ups for gallstones
1) Expectant management ("wait and see")
2) Nonsurgical removal
3) Surgical removal
103
Normal range for occult blood present in the urine. What color will the urine be if occult blood is present?
Negative (none)
-Smoky colored
104
3 causes of occult blood seen from a Dipstick test
1) Hematuria
2) Hemoglobinuria
3) Myoglobinuria Lab:
- Increased RBC = hematuria
- Normal RBC = hemoglobinuria or myoglobinuria
105
Normal RBC and yellow urine that test + for occult blood indicates what?
Microhemogobinuria or Micromyogloninuria
-if RBC was normal and urine was red colored = hemoglobinuria or myoglobinuria
106
Causes of hematuria
- Malignancy
- Infection
- Stones
- Menses
- Trauma
- Exercise
etc.
107
35 year old female
- Color = smoky
- Character = Cloudy
- pH = 5
- Occult blood = +
- Urobilinogen = 0.8
- Nitrites (-)
- SpG = 1.020
- WBC/HPF = 2
- RBC/HPF = 15-20
What is the Dx?
Hematuria die to menses
- Color = smoky = occult blood
- Character = cloudy = take a look under a microscope
- WBC = 2 = within 1-3, NOT infection
- RBC = 15-20 = over 1-3, blood in urine (true hematuria)
Since it's a 35 year old female with no history to indicate trauma, menses is most likely
108
5 year old female
- Color = smoky
- Character = Cloudy
- pH = 5
- Occult blood = +
- Urobilinogen = 0.8
- Nitrites (-)
- SpG = 1.020
- RBC/HPF = 15-20
What is the Dx?
Hematuria due to either
- Sexual abuse
- Trauma (too young for menses)
109
T/F If sperm cells are found in the urine of a female, it should always be reported in the lab report
FALSE
- Adult female with no history of rape = no report
- Adult female who was raped = Report
- Child = REPORT (mandatory)
110
35 year old female
- Color = yellow
- Character = clear
- pH = 5
- Urobilinogen = 0.1
- Occult blood = +
- Nitrites (-)
- SpG = 1.018
- WBC/HPF = 2
- RBC/HPF = 2
What is the Dx?
Blood in urine due to either hemoglobin or myoglobin (microhemoglobinuria or micromyoglobinuria)
111
Causes of hemoglobinuria
Anything that increases RBC destruction
- Drugs
- Crushing injuries
- Transfusion reactions
- Burns
- Hemolytic anemia
112
Causes of myoglobinuria
Anything that causes muscle trauma/destruction
- Crushing injuries
- Myocardial infarction
113
Screening test used to detect WBC in the urine. What does a positive test suggest pathologically?
Leukocyte Esterase
-Suggest a UTI
\>5 WBC's = 50% (+) for UTI
\>10 WBC's = 90% (+) for UTI
114
Screening test for UTI. Normal is negative. Indicates the pH of the urine is changing due to the bacteria
Nitrites
-Gram (-) bacteria convert/reduce nitrates to nitrites which increases the pH of the urine (more alkaline) which favors most bacterial growth (E.coli MC)
115
T/F UA is negative for nitrites meaning that a UTI is not present
FALSE
- Negative for nitrites does not mean negative for bacteriuria
- Not all UTI's are caused by bacteria able to convert nitrates to nitrites
116
What 2 bacteria can cause a UTI and a negative test for nitrites?
Strep
Staph
117
What is the difference between LPF and HPF when testing for UA sediments?
LPF = Low Powered Field = used to screen
HPF = High Powered Field = used to confirm
118
Normal ranges for WBC/HPF and RBC/HPF
Both are 0-3
- Increased WBC = inflammation/infection
- Increased RBC = GMN, trauma, systemic or renal disease
119
TNTC
Too Numerous To Count
-Never a good sign
120
25 year old with 20-30 WBC/HPF, +2 bacteria, + nitrites
What does this indicate?
Lower UTI
- Self limiting usually; adjust, flush the system, monitor.
- If +1 protein, think upper UTI, need concurrent care
121
67 year old with TNTC WBC/HPF, cloudy, + nitrites, +2 bacteria, Diabetic. What does this indicate?
Severe UTI (WBC TNTC)
-Need concurrent care because her diabetes is also a complicating factor along with her age
122
Which of the following is most likely to develop a urolithiasis?
a) 25 year old female
b) 35 year old male
c) 35 year old female
d) 25 year old male
d) 25 year old male
- 5 to 10% of Americans develop urolithiasis (renal calculi, kidney stone)
- Peak age = 20-30
- Familial and hereditary tendencies as well as dietary
123
MC type of kidney stone
Calcium oxalate
- 15% are triple phosphate
- 6% are uric acid (Gout)
- Supersaturation, decreased urine volume, pH factors, foreign body seed to foster stone formation (crystals, debris, clot, etc.)
124
T/F Kidney stone can present with or without pain. Often discovered due to obstruction, ulceration, or bleeding (hematuria).
True
125
X-ray findings for a huge kidney stone that fills up most of the kidney
Staghorn Calculus
126
Special type of imaging used to appreciate the kidney
Intervenous Pyelogram (IVP)
127
What amino acid levels may be elevated in the urine in someone with liver disease?
- Tyrosine
- Leucine
- Cysteine
128
What type of crystals are seen in someone with Gout?
Uric acid crystals
-Correlate with high serum uric acid levels.
Phosphate crystals = parathyroid problems and malabsorption states
129
\_\_\_\_\_\_\_\_\_\_\_ epithelium cells are found in the lower 1/2 of the bladder and urethra and may end up in the urine sample. Least serious and most common type of epithelial cell found in the urine sample
Squamous epithelium
-if lab report just says "epithelial cells", assume it's squamous unless reported different
130
\_\_\_\_\_\_\_\_\_ epithelium cells are found in the upper 1/2 of the bladder and ureters while ________ epithelium is found in the kidney and indicates a more serious condition
Transitional epithelium = upper 1/2 of the bladder and ureters
Renal cell epithelium = kidneys
131
If you have bacteria and epithelial cells with no other bacterial findings (normal WBC, mucous, nitrites, etc.) it may indicate \_\_\_\_\_\_\_\_\_\_\_\_
Contamination (particularly vaginal)
132
26 year old female
- Color = yellow
- Appearance = cloudy
- Nitrites = None
- WBC = 2-3/HPF
- Epithelial cells = Frequent
- Bacteria = +2
What is the Dx?
Contamination or Infection
-+2 bacteria with no other obvious signs of infection or pathology indicate its probably contamination.
Need to rerun the UA and explain proper technique (wipe around first and catch the urine midstream, etc.).
Be aware it still may be infection, which is why we need to redo the UA
133
Normal report for mucus in the urine. What does it indicate if abnormal?
Negative.
Abnormal amount points to infection
134
Urinary sediments/casts are able to give us a picture/condition of what kidney structure?
The nephron
135
Kidney specific proteins (\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_) are produced in the tubules and may start to get primarily in the DCT and slough into the system causing it to appear in the urine. What are these proteins associated with?
Tamm-Horsfall proteins
-If found in the urine, indicates possible upper UTI, which is very serious (concurrent care)
136
T/F Only granular and hyaline casts can normally be found in the urine (0-2/LPF). With no other findings, they are considered insignificant
True
-With other findings, may become significant
137
T/F Casts come from the nephron and no where else.
True
138
What do RBC and WBC casts indicate?
RBC Cast = upper UTI bleeding
WBC Cast = upper UTI infection
139
With RBC casts, this indicates bleeding in the nephron as seen in conditions like _________________ where the renal filter becomes inflammed (upper UTI) usually _____________ related
Glomerulonephritis
Immune related (no organism is present)
140
What are some s/s seen with glomerulonephritis?
- RBC Casts
- Lots of RBC
- Lots of WBC
- Oliguria
- Red/smoky, cloudy urine
- Low SpG (kidney is not functioning properly)
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6 year old male
- Color = smoky
- Character = cloudy
- pH = 5
- Protein = +2
- Urobilinogen = 0.15
- Occult blood = moderate
- SpG = 1.004
- WBC/HPF = 4-6
- RBC/HPF = 30-40
- Casts = 1-2 RBC
- What is the Dx?
Glomeurlonephritis
Red Casts is almost always indicative of Glomerulonephritis
-Also correlate history
142
What pathology complications may lead to someone developing GMN?
Kid (MC 6-10) with Strep throat that lasted \>2 weeks may lead to an immune response causing GMN
Adult with SLE may cause an immune response that leads to GMN
143
Besides blood casts, what other lab finding may lead to the diagnosis of GMN? What is the prognosis?
HTN and elevated Antistreptolysin O titer
- Need to maintain electrolyte and water balance
- 95% of children recover totally
- Chronic GTN progresses slowly to death of the patient unless dialysis or transplant intervention
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WBC cast indicate \_\_\_\_\_\_\_\_\_\_\_\_\_, primarily of the kidney interstitium known as \_\_\_\_\_\_\_\_\_\_\_\_\_
Infection/Inflammation a.k.a. Pyelonephritis (upper UTI)
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What are some s/s that correlate with Pyelonephritis?
- Flank pain
- + Punch test
- Low grade fever, malaise, dysuria, burning sensation, urgency, frequency
- LAB: bacteria present, WBC's, WBC casts
146
28 year old female
- Color = yellow
- Character = cloudy
- pH = 5
- Protein = +2
- Urobilinogen = 0.25
- Leukocyte esterase = +
- Nitrites = +
- SpG = 1.018
- WBC/HPF = 30-40
- RBC/HPF = 1-2
- Bacteria = +2
- Casts = WBC 1-2, Hyaline 0-1
What is the Dx?
Pyelonephritis (upper UTI)
-Bacteria, WBC casts, and + protein all point to a upper UTI (especially with WBC casts)
NOTE: Hyaline casts are normally if 0-2 with NO OTHER signs of kidney problems
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Casts correlations:
- Bacteria indicate \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
- Clusters of WBC indicate \_\_\_\_\_\_\_\_\_\_\_\_\_\_
- Glitter cells (WBC's undergoing phagocytosis) indicates\_\_\_\_\_\_\_\_\_\_
- Waxy, broad, and fatty casts indicate \_\_\_\_\_
- Yeast cells indicate \_\_\_\_\_\_\_\_\_\_\_
- Granular casts indicate \_\_\_\_\_\_
- Bacteria = UTI
- WBC = UTI
- Glitter cells = UTI
- Waxy = Chronic Renal Failure
- Yeast = Candida
- Granular = by product of metabolism, fine or course, increase with renal disease
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T/F Lower UTI will show up as casts, protein, cloudy, hazy urine possibly with blood, flank pain, and WBC's
FALSE
-These are all associated with Upper UTI (blood and protein = upper UTI)
Lower UTI = increase WBC's, mucous, blood, no casts, no protein, lower back/pubic pain (no casts and no protein = lower UTI)
