Quiz 2 Flashcards

(62 cards)

0
Q

About how much urine is produced/voided a day (on average)?

A

1.4L

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1
Q

What is urine an ultra-filtrate from?

A

Plasma

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2
Q

What do the PCTs do?

A

Contribute secretions for filtration

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3
Q

Where does concentration occur?

A

Loop of Henle, DCTs, and collecting ducts

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4
Q

What compound makes up the majority of urine?

A

Urea

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5
Q

What might a urinalysis reveal information about?

A

Kidney/liver function, metabolic processes, infectious disease, nutritional status, or other occult disease

Glomerulonephritis, hypertensive nephritis, renal failure, DM, neoplasms, UTI

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6
Q

We routinely monitor urine in patients with _____ (4).

A

High blood pressure, DM, liver disease, chronic renal disease

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7
Q

What populations do we like to routinely analyze urine for?

A

Prenatal, childhood, those at risk (lifestyle), and those with a family history

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8
Q

What is the main cause of end-stage renal disease?

A

Diabetes…. then HTN

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9
Q

How soon do we analyze the urine?

A

Within one hour, post-void; if refrigerated, four hours

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10
Q

What does CCMS mean?

A

Clean-catch, Mid-stream

Decreases potential contamination by cleansing external genitalia prior to void

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11
Q

What are alternate collection methods?

A

Bagged, needle aspiration, catheter

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12
Q

When is the urine the most concentrated? What does it screen for best?

A

Morning: proteins, bilirubin, nitrites, and functional concentration

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13
Q

What are physical properties observed upon urinalysis?

A

Color, clarity, specific gravity

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14
Q

What chemical components are measured upon urinalysis?

A

pH, protein, bilirubin, ketones, glucose, blood, urobilinogen, leukocyte esterase, nitrites

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15
Q

What microscopic findings are useful upon urinalysis?

A

Cells, microorganisms, casts, crystals, debris

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16
Q

REVIEW UA RESULTS FOR COLOR, CLARITY, AND ODOR

A

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17
Q

How many tests are on the dipstick?

A

10; 11 if they include ascorbic acid

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18
Q

Why do we look at specific gravity? What’s normal?

A

Monitors dehydration and ability to concentrate urine

1.010-1.025 (lower in <2y.o.)

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19
Q

What are hyper- and hyposthenuria? What do each indicate?

A

Continually high or low specific gravity
Hypersthenuria: DM (glycosuria), nephrotic syndrome (proteinuria), drugs, dehydration
Hyposthenuria: DI (ADH insufficiency), diuretics, glomerulonephritis, chronic renal disease (always 1.010 –> isosthenuria throughout the day)

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20
Q

What can give you a high false-positive upon SG analysis?

A

Proteinuria

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21
Q

Where is glucose suppose to be reabsorbed? When is the plasma concentration threshold for blood glucose to affect glucosuria?

A

PCTs

160-180 mg/dl

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22
Q

What are causes of glucosuria?

A

DM, Cushing’s Syndrome, pheochromocytoma, acromegaly, chronic pancreatitis, DRUGS

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23
Q

What can cause a false negative in glucose analysis?

A

Ascorbic acid

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24
What can cause false positives in urine glucose analysis?
Oxidizing agents
25
What ketones are being tested in urinalysis dipstick tests? What is the problem with this?
Acetoacetic acid | Problem: DKA shows an increased B-hydroxybutyrate, therefore not providing a perfect correlation with acidosis severity
26
When is ketonuria seen?
DM, increased metabolic states (hyperthyroidism, fever, pregnancy)
27
What can give a false negative for ketonuria upon urinalysis?
Prolonged air exposure due to the volatile nature of ketones
28
Is it normal or abnormal to have blood in the urine? What components of blood are detected in dipstick tests?
Abnormal Free Hb, Hb, Mb *Determine the SOURCE of the blood
29
What can give you a false positive for hemoglobinuria upon urinalysis? False negative?
Myoglobinuria, menstruation | Ascorbic acid
30
What is the normal pH range of urine?
4.5-8.0 (6.0 average)
31
What is the pH run over effect?
The buffers in the protein analysis square above the pH square on the dipstick may run over into the pH square, affecting the results and coloring
32
What microbes want to be in alkaline urine? Acidic urine?
Pseudomonas - UTI | E. coli - UTI
33
What are DDxs for alkaline and acidic urine?
Alkaline: metabolic/respiratory alkalosis, UTI, diet, vomiting Acidic: metabolic/respiratory acidosis, DM, starvation, COPD
34
Is it normal for protein to be present in the urine? What could be a contaminant for a false positive?
NO - this is a test of kidney function | Vaginal secretion and pyridium
35
What are the four categories underlying positive urine protein?
Functional, renal, pre-renal, post-renal
36
What can cause transient proteinuria (continuous/consistent proteinuria)?
Fever, stress, exercise, CHF
37
Which protein is urine protein analysis most sensitive to?
Albumin
38
Is it normal for bilirubin to be positive or negative on the dipstick test? Is the bilirubin we find upon testing conjugated or unconjugated?
Negative | Conjugated
39
When do we see bilirubinuria?
Bile duct obstruction, acute hepatitis, congenital defects, gall stones, and cholestasis (Obstruction: not able to get into intestines; Inflammation: back-up and reabsorbed by blood)
40
What can give us false negatives for bilirubinuria?
Ascorbic acid, nitrites, light
41
Why do we see urobilinigenuria?
Because it is supposed to be excreted in the stool, you either have a type of bowel obstruction or intravascular hemolysis A small amount of urobilinogen is normal
42
What would give a false negative for urobilinogenuria upon UA? False positive?
Antibiotics (affecting digestion) | Fecal contamination
43
Is it normal to have nitrites in the urine? What is indicated upon UA?
NO; positive indicates bacterial UTI
44
What bacteria produce nitrites? How?
Not ALL bacteria produce nitrites --> conversion from nitrate -> nitrite
45
What gives a false positive for nitrites? False negative?
Pyridium | Ascorbic Acid
46
If you are negative for nitrites, can you have a UTI?
YES YOU CAN! You must have a certain type of bacterial infection, nitrates in your diet (consumed within the last four hours)
47
Is it normal to find LE (leukocyte esteracte) upon UA?
No
48
What would a positive LE result indicate? What could give you a false negative?
POSSIBLE UTI; not definitive | Glucose, protein, increased SG
49
REVIEW SLIDE FOR ABNORMAL FINDINGS UPON MICROSCOPIC EXAMINATION
...
50
Is bacteria normal upon microscopic analysis? What would be the most commonly found bacteria?
Normally sterile, no bacteria | Gm(-) rods most common - contamination
51
Is finding yeast upon microscopic evaluation normal during UA? What populations shows abnormal findings most commonly?
No; those with compromised immune systems and those with glucosuria more commonly present
52
Where do squamous epithelial cells come from? Transitional? Renal?
SECs: lower GU contaminant TECs: proximal 2/3 urethra -- BIG cells upon finding RECs: a few are normal, but many can indicate renal diseases
53
REVIEW MICROSCOPIC CELL FINDINGS (pictures)
...
54
Where are casts formed? Finding casts in the UA would indicate what?
Formed in tubules (distal and collecting) --> these are in the kidneys Finding casts would indicate renal pathology; pH must be acidic with concentrated urine
55
What protein do casts lead to production of? Is this protein detected on the dipstick? What pathology would this indicate?
Tamm-Horsfall protein NO, it is not Stasis/dehydration
56
What are hyaline casts associated with?
Glomerulonephritis, pyelonephritis, CHF, CRF
57
What do RBC casts indicate?
Glomerulonephritis (PSGN) - almost pathognomonic | *We know that there are RBCs in the kidneys because casts are formed in the kidneys*
58
What do WBC casts indicate?
Infectious/inflammatory Dz affecting the kidney: | pyelonephritis, glomerulonephritis, Lupus nephritis
59
What do renal tubular epithelial (RTE) cell casts indicate?
"Sloughing off" of these epithelial cells, indicating toxicity - heavy metal poisoning, nephrosis, etc
60
What are granular cell casts? What are waxy casts? What are fatty cell casts?
Granular: Degenerated cellular casts that have been stuck and not voided Waxy: As granular cell casts are still not voided, the granules disappear... indicates renal failure Fatty: seen in chronic renal dz
61
What can cause crystal formation?
pH-dependent | UTIs caused by Proteus - triple phosphate crystals