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GU Exam 1 > Renal function test and urinalysis > Flashcards

Renal function test and urinalysis Flashcards

1
Q

Symptoms of urinary tract infections

A

– burning, frequency, urgency
– should undergo urinalysis
– macroscopic UA (dip-strip) is normal,
microscopic analysis is not necessary

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2
Q

➔ Signs and symptoms suggestive of
urologic disease or if UA is (+) for _____

A

protein, heme, leukocyte esterase, or nitrite

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3
Q

TIMING for urine specimens

A
  • First-voided morning specimens
    are helpful for qualitative protein testing in pts with possible proteinuria or for specific gravity assessment.
  • Freshly voided specimen obtained a few hours after the patient has eaten and examined
    within 1 hour of voiding is most reliable
    Urine may be refrigerated, however, this increases crystal
    formation
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4
Q

T/F The urine specimen should be collected after a genital or rectal exam

A

F - it should be collected before

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5
Q

HOW DO YOU GET A URINE SPECIMEN from children?

A
  • UA can be obtained from males and females by covering the cleansed urethral meatus
    with a plastic “U” bag
  • If bacterial culture is needed catheterization or suprapubic needle aspiration is recommended
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6
Q

Factors of macroscopic urine examination

A

Color and appearance
Specific gravity
pH
Protein
Glucose
Hemoglobin
Nitrite (bacteria)
Leukocyte esterase
Culture and sensativity

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7
Q

Urine is often colored secondary to drugs:

A

– Phenazopyridine (pyridium) will turn urine orange
– Nitrofurantoin (macrobid) will turn urine brown
– Metronidazole will turn urine reddish brown

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8
Q

causes of discolored urine

A
  • Drugs
    – Beet ingestion
    – Vegetable dyes
    – Concentrated urine
    – Muscle trauma
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9
Q

T/F Odor of urine is rarely clinically significant

A

T

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10
Q

SPECIFIC GRAVITY of Urine

A
  • A measure of urine concentration
  • Used to determine hydration status and renal
    function.
  • The specific gravity of urine (normal
    1.003-1.030)
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11
Q

What should you consider of the urine specific gravity is low?

A

– Chronic renal failure
– Diabetes insipidus
– Intracranial trauma evaluating for lack of
antidiuretic hormone (vasopressin)

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12
Q

What should you consider of the urine specific gravity is high?

A

– Dehydration
– Preeclampsia
– CHF

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13
Q

What should you consider of the urine pH is low?

A

– acidosis
– dehydration
– diabetic ketoacidosis
– diarrhea
– starvation
– Uric acid kidney stones develop in acidic urine

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14
Q

pH of the Urine

A
  • A measure of free hydrogen ions (H+) concentration in the urine
  • Normal range 4.6-8.0
  • Diet can impact pH, ie high protein usually acidotic
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15
Q

What should you consider of the urine pH is high?

A

– gastric suctioning that takes away stomach acids
– kidney failure
– kidney tubular acidosis
– pyloric obstruction
– respiratory alkalosis
– urinary tract infection
– vomiting

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16
Q

PROTEIN in the urine

A
  • A measure of urinary albumin, the main protein
    found in urine.
  • Normal range: negative
  • Concentrated urine will give false positive
  • Prolonged fever and excessive physical exertion
    will cause transient proteinuria
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17
Q

What should you consider if the urine is positive for protein?

A

– Glomerular damage
– Hypertension
– Preeclampsia

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18
Q

GLUCOSE in the urine

A
  • Glucose is present in glomerular filtrate, is reabsorbed in the proximal tubule by active
    transport (requires carrier protein and ATP.)
  • Normal range: negative
  • Most patients with positive reading
    have diabetes mellitus
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19
Q

Glucosuria seen with serum glucose
_____ mg/dL

A

> 180

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20
Q

HEMOGLOBIN in the urine

A
  • A measure of free hemoglobin in urine
    (product of lysed red blood cells).
  • Normal range: negative
  • Microscopic analysis of urinary sediment for
    RBCs used for confirmation.
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21
Q

What should you consider if the urine is positive for hemoglobin?

A

– UTI
– Renal calculi
– Renal trauma
– Glomerulonephritis
– Rhabdomyolysis (strenuous exercise)
– Hemoglobinuria Nephritis
– Bladder or kidney cancer

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22
Q

NITRITE (BACTERIA)

A
  • A urine dipstick test used for evaluation of
    UTI.
  • Enterobacteriaceae (E.coli, most common
    UTI causing bacteria) converts nitrate to
    nitrite which gives a positive test.
  • Result may be negative as not all bacteria
    are capable of converting nitrate.
  • Normal range: negative (does not R/O UTI)
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23
Q

What should you consider if the urine tests positive for nitrite?

A

– UTI
– False positive - dyes

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24
Q

LEUKOCYTE ESTERASE

A
  • Detects esterase released by the leukocytes in
    the urine and indicates the presence of WBCs.
  • A positive indicates pyuria and warrants
    subsequent microscopy. .
  • Normal range: negative
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25
Q

What should you consider if the urine is positive for leukocyte esterase?

A

– UTI
– Pyleonephritis
– Nephrolithiasis
– Interstitial nephritis
– Vaginal contamination (yeast infection, STI,
bacteria vaginosis)

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26
Q

HOW TO PREPARE A URINE SPECIMEN FOR MICROSCOPIC EXAM

A
  • Centrifuge a 10-mL specimen at 2000 rpm for 5
    minutes
  • Decant the supernatant
  • Resuspend the sediment in the remaining 1 mL of urine by tapping the tube gently against
    countertop
  • Place 1 drop of the mixture on a microscope slide, cover with a coverslip, and examine first under a low power (10x) lens then under a high-power (40x) lens.
  • Significant elements (particularly bacteria) are
    more easily seen if the slide is stained with
    methylene blue
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27
Q

Microscopic examination factors of urine

A

SQUAMOUS EPITHELIAL CELLS
RED BLOOD CELLS
WHITE BLOOD CELLS
CASTS
RED BLOOD CELL CASTS
WHITE BLOOD CELL CASTS
GRANULAR CASTS
BACTERIA
YEAST
Trichomoniasis
CRYSTALS

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28
Q

SQUAMOUS EPITHELIAL CELLS significance in the urine

A
  • Squamous epithelial cells from the
    skin surface or from the outer urethra
    can appear in urine.
  • Their significance is that they
    represent contamination of the
    specimen with skin flora
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29
Q

RED BLOOD CELLS significance in the urine

A
  • RBCs may appear normally shaped,
    swollen by dilute urine, or crenated
    by concentrated urine.
    0-2 RBCs/HPF Normal
  • Much smaller, more round, than
    WBCs, and don’t have a nucleus.
  • Red cells may simulate yeast
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30
Q

Significance of WHITE BLOOD CELLS in the urine

A
  • Normal Range 0 - 5/HPF
  • > 5 WBC/HPF; specimen is probably
    abnormal.
  • Leukocytes have lobed nuclei and
    granular cytoplasm
31
Q

Significance of CASTS in the urine

A
  • Urinary casts are formed only in the
    distal convoluted tubule (DCT) or the
    collecting duct (distal nephron).
  • Hyaline casts are composed primarily of
    a mucoprotein secreted by tubule cells.
    ● Hyaline casts can be seen even in
    healthy patients.
32
Q

Significance of RED BLOOD CELL CASTS in the urine

A
  • Red blood cells may stick together and
    form red blood cell casts.
  • Such casts are indicative of
    glomerulonephritis, with leakage of RBC’s
    from glomeruli, or severe tubular
    damage
33
Q

Significance of white blood cell casts in the urine

A
  • White blood cell casts are typical for
    acute pyelonephritis, but they may also
    be present with glomerulonephritis.
  • Their presence indicates inflammation of
    the kidney, such casts will not form
    except in the kidney (Distal convoluted
    tubule or collecting duct)
34
Q

Significance of GRANULAR CASTS in the urine

A
  • When cellular casts remain in the nephron for
    some time before they are flushed into the
    bladder urine,
  • Cells degenerate to become 1st coarsely granular
    cast,
  • Later a finely granular cast
35
Q

Significance of Waxy casts in the urine?

A

suggest very low urine
flow associated with severe,
longstanding kidney disease such
as renal failure.
● Due to urine stasis and their
formation in diseased, dilated ducts,
these casts are significantly larger
than hyaline casts

36
Q

Significance of BACTERIA in the urine

A
  • Bacteria are common in urine
    specimens because of the abundant
    normal microbial flora.
  • If bacteria found, interpret in view of
    clinical symptoms.
  • Get a urine culture and sensitivity
    More than 100,000/ml colonies of
    one organism reflects significant
    bacteriuria. ***
37
Q

Significance of YEAST in the urine

A
  • Yeast cells may be contaminants or
    represent a true yeast infection.
  • They are often difficult to distinguish
    from red cells and amorphous crystals
    but are distinguished by their tendency
    to bud.
  • Most often they are Candida, which may
    colonize bladder, urethra, or vagina
38
Q

Significance of Trichomoniasis in the urine?

A
  • “Trich” STI very common
  • Flagelatted parasite
  • Incidental finding in microscopic
    exam as most people are
    asymptomatic
  • Foul smelling urine
  • Vaginal itching pain with urination
  • Frothy discharge
39
Q

Significance of crystals in the urine

A
  • Common crystals seen even in healthy
    patients include calcium oxalate, triple
    phosphate crystals and amorphous
    phosphates.
  • Very uncommon crystals include:
  • Cystine crystals in urine of neonates with
    congenital cystinuria or severe liver
    disease
40
Q

_____ may be detected in the urine even in the early stages of kidney disease.

A

Albumin

41
Q

How often should patients with T1D and T2D undergo urinalysis?

A

Type 1 diabetes: tested annually, starting 5 years after onset of disease.
Type 2 diabetes: tested annually starting at time of diagnosis

42
Q

According to the National Institutes of Health (NIH), a normal 24 hour urine protein test result shows less than____of protein per day

A

80 milligrams

43
Q

Renal function tests include:

A

Blood Urea Nitrogen
Serum Creatinine
Endogenous Creatinine Clearance
GFR
Serum Albumin
Anion Gap
Calcium
Chloride
Glucose
Phosphorus
Potassium
Sodium

44
Q

Blood Urea Nitrogen

A
  • Measurement of blood urea nitrogen (BUN). BUN is a waste
    product of protein breakdown. Helpful in assessing kidney
    function.
  • Normal range: 7-10 mg/dL
  • Unlike creatinine, BUN is influenced by dietary protein intake, hydration status, and gastrointestinal bleeding.
45
Q

What should you consider if BUN is low?

A

nephrotic syndrome, acromegaly, celiac sprue,
malnutrition, pregnancy

46
Q

What should you consider if BUN is low?

A

GI bleed, renal disease, post renal azotemia,
prerenal azotemia.

47
Q

Approximately _____ of renal function must be lost before a significant
rise in BUN level becomes evident

A

two-thirds

48
Q

T/F BUN level is less specific for renal insufficiency than an elevated serum creatinine level.

A

T

49
Q

Serum Creatinine

A
  • Creatinine, the end product of the metabolism of creatine in skeletal muscle, is
    normally excreted by the kidneys.
  • Because individual daily creatinine production is constant, the serum level is a direct reflection of renal function.
  • Serum creatinine levels remain within the normal range (0.8–1.2 mg/dL in adults; 0.4–0.8 mg/dL in young children) until approximately 50% of renal function has been lost.
  • Unlike most other excretory products, the serum creatinine level generally is not influenced by normal dietary intake or hydration status. It is however elevated with long term use of supplemental creatine products.
50
Q

Because creatinine production is stable and creatinine is filtered through the glomerulus, its
renal clearance is essentially equal to the _____

A

glomerular filtration rate.

51
Q

the most accurate and reliable
measure of renal function

A

endogenous creatinine clearance

52
Q

GFR

A
  • GFR - glomerular filtration rate is one of the best
    test to measure the level of kidney function and
    determine the stage of kidney disease.
  • To obtain a GFR a serum creatinine test should be
    obtained. That number is then calculated in a
    formula with additional information such as
    – Age
    – Ethnicity
    – Gender
    – Height
    – Weight
  • Normal range 90-120 mL/min
53
Q

When does GFR become too low?

A
  • GFR below 60 mL/min for 3 or more months is a
    sign of chronic kidney disease
  • GFR lower than 15 mL/min is a sign of kidney
    failure and requires immediate medical attention
54
Q

Serum Albumin

A
  • Measure of albumin a plasma binding protein synthesized by the liver. Albumin helps
    to maintain osmotic pressure in the vascular space and also reflects overall nutritional
    status. Generally decreased levels after age 40; edema seen with levels <2.5;
  • Reference range: 3.4-5.4 g/dL
55
Q

What should you consider if Serum albumin is low?

A

– acute infection
– CHF
– Malnutrition
– Nephropathy

56
Q

What should you consider if Serum albumin is high?

A

– dehydration
– Blood loss

57
Q

Anion Gap

A

Anion Gap (AG) is the difference between the measured cations and measured
anions in the blood. Na is the primary measured cation and Cl and HCO3 are the
primary measured anions. Used to classify metabolic acidosis.

58
Q

What should you consider if the anion gap is low?

A

– Hypocalcemia
– Hypoalbuminemia
– Hyponatremia

59
Q

What should you consider if the anion gap is high?

A

– Ketoacidosis
– Lactic Acidosis
– Renal failure
– Toxic ingestion

60
Q

Calcium

A
  • Element. Sum of ionized calcium plus protein bound calcium. Important in cellular transport
    mechanisms.
  • Normal range: 8.5-10.2 mg/dL
61
Q

What should you consider is the urine calcium is low?

A

– Hypoalbuminemia (most common cause)
– Hypoparathyroidism
– Renal failure
– Vitamin D deficiency

62
Q

What should you consider if urine calcium is high?

A

– Hyperparathyroidism
– Familial hypocalciuria
– Hyperthyroidism
– Immobilization
– Malignancy

63
Q

Chloride

A
  • Extracellular electrolyte. Levels usually increase or decrease in concert with sodium.
  • Normal range: 96-106 mg/L
64
Q

What should you consider if urine calcium is low?

A

– Addison’s disease
– Burns
– CHF
– GI loss
– Metabolic alkalosis
– Renal disease
– Respiratory acidosis

65
Q

What should you consider if urine calcium is high?

A

Diabetes insipidus
Hyperparathyroid,
prolonged diarrhea,
renal tubular acidosis,
Respiratory alkalosis,
Severe dehydration

66
Q

Phosphorus

A
  • An inorganic anion, important calcium homeostasis. Assess along with calcium
  • Normal range: 2.4 -4.1 mg/dl
67
Q

What should you consider if phosphorus is low?

A

– Hungry bone syndrome
– Hypercalcemia
– Hyperparathyroidism
– Malabsorption
– Renal disease
– Vitamin D deficiency

68
Q

What should you consider if phosphorus is high?

A

– Acromegaly
– Hypoparathyroidism
– Renal failure
– Sickle cell anemia

69
Q

Potassium

A
  • Intracellular cation, functions as an electrolyte. Important at maintaining acid/base balance.
  • Normal range: 3.5-5.2meq/L
70
Q

What should you consider if potassium is low?

A

– Bartter syndrome
– Excessive sweating
– GI Loss
– Increased urine secretion

71
Q

What should you consider if potassium is high?

A

– Acidosis
– Diabetes mellitus
– Excessive intake
– Hypoaldosteronism
– Renal failure
– Tissue necrosis

72
Q

Sodium

A
  • Cation found mainly in the extracellular fluid. Used in the evaluation of hydration states.
  • Normal range: 135-145 mEq/L
73
Q

What should you consider if sodium is low?

A

– Addison’s disease
– CHF
– GI loss
– Hyperglycemia
– Hypothyroidism
– Nephrotic syndrome
– Renal failure
– Renal tubular acidosis

74
Q

What should you consider if sodium is high?

A

– Glucosuria

GU Exam 1 (5 decks)

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