Routine Chemical Examination of Urine Flashcards by Geno Alinsub

Routine Chemical Examination of Urine includes what observation of 3 components?

pH
Protein
Glucose

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Plastic strip that contains one or more chemical-impregnated absorbent pads

AKA dipstick

Reagent Strip

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Familiarize the Reagent Strip Testing Procedure

Mix the specimen
Insert reagent strip
Remove excess urine
Time according to manufacturer’s directions
Compare reaction colors with the manufacturer’s chart under a good light source
Perform backup tests when indicated
Be alert for the presence of interfering substances
Understand the principles and significance of the rest; read package inserts
Relate chemical findings to each other and to the physical and microscopic urinalysis results

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Reagent Strip Testing Procedure

refrigerated specimens to reach what temp prior to testing ?

Room temperature

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Reagent Strip Testing Procedure

For how many seconds should the reagent strip be dipped?

1 sec

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Reagent Strip Testing Procedure

How should the reagent strip be dipped?

complete but briefly

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Reagent Strip Testing Procedure

How to remove excess urine in reagent strip?

Run edge of strip along rim of tube
Blot edge on absorbent paper

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Reagent Strip Testing Procedure

For how many seconds should you wait to read glucose after dipping reagent strip into urine?

30 seconds

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Reagent Strip Testing Procedure

From what direction do you read the reagent strip?

Bottom to top

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Reagent Strip Testing Procedure

Do you read glucose or leukocytes first? why?

Glucose becasue it reacts rapidly

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T or F

Reading leukocytes first causes false positive results for glucose

F (false negative results)

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Reagent Strip Testing Procedure

After waiting for the reagents to react with the strip, what should you do?

Compare reaction colors with the manufacturer’s chart under a good light source

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Reagent Strip Testing Procedure

In comparing reaction color’s with manufacturer’s chart, in whwat direction should you hold the strip?

Horizontally close to the color chart (not touching)

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T or F

Holding the reagent strip close to the manufacturer’s bottle to the point of contact should not be done since it results to contamination

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Reagent Strip Testing Procedure

Where you will insert the strip then operate on for the machine to read it to you

Reagent strip reader

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T or F

the MT should always perform backup test when indicated

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Reagent Strip Testing Procedure

Backup test for glucose

Benedict’s test

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Reagent Strip Testing Procedure

Backup test for protein

heat and acetic acid or 3% Sulfosalicylic acid TEST (Exton’s)

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T or F

One should be alert for the presence of interfering substances

T duh

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Reagent Strip Testing Procedure

You understand the principle and significance of the test by?

reading package inserts

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Reagent Strip Testing Procedure

Relate ………. to each other and to the ………. ………….and ………… urinalysis results

pretend the period are blanks, di ko mapalce maayos yung blanks

Relate chemical findings to each other and to the** physical** and microscopic urinalysis results

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T or F

Relating physical and miscroscopic results means that once color of urine is red, microscopically there should be RBC present

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Care of Reagent Strips

How should reagent strips be stored?

Store with desiccant in opaque tightly capped containers
Store below 30 c
Keep strips in original container
Remove immediately prior to use

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# Care of Reagent Strips Presence of air in reagent strips cause?

discoloration

# Care of Reagent Strips Where should the reagent strips be stored? at what temperature?

* with desiccant in opaque tightly capped containers * below 30 c

# Care of Reagent Strips Do not expose the strips to?

volatile fumes

# Care of Reagent Strips Do not touch the ?

test areas

# Care of Reagent Strips Do not use if the chemical pads become?

discolored

# T or F One should remain to use if chemical pads become discolored

F (one should discard)

# Care of Reagent Strips The reagent in the strip that is usually the first one to be discolored

Urobilinogen

# T or F Do not use past the expiration date

# Care of Reagent Strips Do not transfer test strips to ?

another vial

# T or F Touch the test zones with your fingers

F (DO NOT touch test zones with your fingers; hold bottom without test)

What are the 4 sources of error

1. Unmixed specimen 2. Strip in urine for extended period 3. Excess urine in the strip 4. Refrigerated specimen

# Sources of error These 2 tests are usually affected by unmixed specimen

RBCs and WBCs

# T or F Unmixed specimen cause RBCs and WBCs to precipitate at bottom of container which causes false (+) results

F (cause false negative result)

# Sources of error reagents will leech (lalabas), goes into the urine → no reagent in test pad

Strip in urine for extended period

# Sources of Error What is the required component in a reagent strip which is a test fro protein that acts as a buffer

Citric acid

# Sources of Error No citric acid causes what result?

False positive result

# Sources of Error Run-over between chemicals producing distortion of colors

Excess urine in the strip

# Sources of Error What should be done to avoid excess urine in the strip ?

* Blot edge of the strip

# Sources of Error Refrigerated specimen cause what results?

False negative results | since enzymes do not react at cold temp.

Do enzymes thrive in cold or hot environment?

hot environment; do not react in cold temperature

# T or F Glucose gives false negative results once strip is subjected to cold temperature

Familiarize Quality Control for Routine Chemistry

1. Test open bottles of reagent strips with known positive and negative controls every 24 hours 2. Resolve control results that are out of range by further testing 3. Test reagents used in backup tests with positive and negative controls 4. Perform positive and negative controls on new reagents and newly opened bottles of reagent strips 5. Record all control results and reagent lot numbers

# Quality control Test open bottles of reagent strips using what method?

positive and negative controls

# Quality Control How often should one test open bottles of reagent strips with known positive and negative controls?

every 24 hours (once daily)

# Quality control What should one do when control results are out of range ?

Resolve by further testing or repeating it

# Quality control What are the following that should be tested for positive and negative control?

* Open bottle of reagent strip * Test reagents in backup test * New and newly opened bottles of reagent strips

# Quality Control; T or F one should record only the control results of the newly opened bottles

F (all control results and their reagent lot numbers)

# Quality Control What 2 things should be recorded?

All control results and reagent lot numbers

If you see this card, study the procedure for quality control of reagent strips

Test using different reagents or methodologies to detect the same substances as detected by the reagent strips

Confirmatory Test

# Confirmatory Test To what products are confirmatory tests done?

Tablets and liquid chemicals

# Confirmatory Test reflects the ability of the kidney to maintain normal hydrogen ion concentration in plasma and extracellular fluid

# pH; T or F Secretion of H+ ions in urine hekp maintain acid-base balance in the body

# pH must buffer and eliminate excess acids

Blood

Buffering capacity of blood depends on?

bicarbonate ions (HCO3)

Secretion of hydrogen ions causes reabsorption of?

bicarbonates

# acidosis, normal, alkalosis? pH of 7.40

Normal

# acidosis, normal, alkalosis pH of 7.00

acidosis

# acidosis, normal, alkalosis 8.75

alkalosis

pH range of a first morning specimen

5.0 – 6.0

pH range of a random specimen

4.5 – 8.0

pH of an after meal specimen

Alkaline

Familiarize the factors which could affect urine pH

* Acid base content of the blood * Patient’s renal function * UTI * Patient’s dietary intake * Age of the specimen

# factors which could affect urine pH What is the effect of UTI in urine?

increases alkalinity

# factors which could affect urine pH What is the effect of old age of specimen?

specimen becomes alkaline

Familiarize the Clinical Significance of urine pH

1. Respiratory or metabolic acidosis 2. Respiratory or metabolic alkalosis 3. Defects in renal tubular secretion and reabsorption of acids and bases (renal tubular acidosis) 4. Precipitation of crystals and calculi formation 5. Treatment of UTI 6. Determination of unsatisfactory specimen

# Clinical Significance of urine pH happens when lungs are unable remove enough CO2, leads to too much CO2 in body

metabolic acidosis

# Clinical Significance of urine pH Too much CO2 causes pH to become?

acidic

# Clinical Significance of urine pH Low CO2

metabolic alkalosis

# Clinical Significance of urine pH Tubules unable to reabsorb bicarbonates

Defects in renal tubular secretion and reabsorption of acids and bases (renal tubular acidosis)

# Clinical Significance of urine pH What happens if tubules cannot reabsorb bicarbonates?

goes into urine and will not secrete H+

# Clinical Significance of urine pH Precipitation of crystals and calculi formation depends on?

# Clinical Significance of urine pH Crystals come from precipitation of what?

precipitation of inorganic chemicals

# Clinical Significance of urine pH What happens if crystals are not flushed out

it turns into stones

# Clinical Significance of urine pH most frequent constituent of renal calculi

Calcium oxalate

# Clinical Significance of urine pH In what pH of urine does the calcium oxalate precipitate?

acidic urine

# Clinical Significance of urine pH Since calcium oxalate precipitate in acidic urine, what do the physicians do in order to idscourage formation of calculi?

they alkalinize it

# Clinical Significance of urine pH pH which indicates specimen is already stale?

9.0

# Clinical Significance of urine pH; T or F Specimen should be recollected if it has pH of 9.0

T (stale already)

# Acid or Alkaline Urine? Increased protein and meat diet

Acid Urine

# Acid or Alkaline Urine? Cranberries

Acid Urine

# Acid or Alkaline Urine? Acid producing bacteria

Acid Urine

# Acid or Alkaline Urine? Starvation

Acid Urine

# Acid or Alkaline Urine? Dehydration

Acid Urine

# Acid or Alkaline Urine? Diarrhea

Acid Urine

# Acid or Alkaline Urine? Diabetes mellitus

Acid Urine

# Acid or Alkaline Urine? Increased fruits and vegetables

Alkaline Urine

# Acid or Alkaline Urine? Citrus

Alkaline Urine

# Acid or Alkaline Urine? after meal

Alkaline Urine

# Acid or Alkaline Urine? Renal tubular acidosis

Alkaline Urine

# Acid or Alkaline Urine? Urease producing bacteria

Alkaline Urine

# Acid or Alkaline Urine? Hyperventilation

Alkaline Urine | rabid release of carbon dioxide

# Acid or Alkaline Urine? Old specimen

Alkaline Urine

used as home remedy for urine

Cranberries

the common of these 4 are the formation of ketone bodies (presence of acid substances)

* Starvation * Dehydration * Diarrhea * Diabetes mellitus

# T or F Hyperventilation causes rabid reabsorption of carbon dioxide hence produces acid urine | CONGRATS YOU'RE ON THE 100TH CARD ## Footnote CELEBRATORY TWERK PLS SEND TO ME VID

F (opposite, hyperventilation is rabid release of CO2 hence alkaline urine)

What are the methods used to measure pH?

1. pH strip 2. pH electrode 3. Titratable acidity

# Methods of Measuring pH * Double indicator system

pH reagent strip

# Methods of Measuring pH Indicators used in pH reagent strip

Methyl red & Bromothymol blue

# Methods of Measuring pH Principle of pH Reagent strip

Double indicator system

# Methods of Measuring pH Methyl red changes color from? also what pH range

red to yellow pH 4-6

# Methods of Measuring pH Bromothymol blue changes from what color? also what pH

yellow to blue pH 6-9

# Methods of Measuring pH In reagent strips, what pH does correspond to color orange?

5.0

# Methods of Measuring pH In reagent strips, what pH does correspond to color blue

8.5

# Methods of Measuring pH What is the color transition in reagent strip?

5.0 orange → green → blue (8.5) as pH ↑

# Methods of Measuring pH Reagent strips should be read after?

after 60 seconds

# Methods of Measuring pH * pH meter w/ glass electrode * Measures the voltage caused by the H+ ions in the urine * An electrode is dipped into the solutions

pH electrode

# Methods of Measuring pH Measured by titrating an aliquot of 24 hour urine with 0.1 N NaOH with pH 7.4 as an end point

Titratable Acidity

# Methods of Measuring pH What urine specimen is used in titratable acidity?

24 hour urine specimen

# Methods of Measuring pH In titratable acidity, what other substance are used with 24 hour urine?

0.1 N NaOH

# Methods of Measuring pH In titratable acidity, what is the pH end point?

pH 7.4

Important renal marker

Protein

Volume of clinical proteinuria?

>30 mg/dl

# T or F Most of the albumin is not filtered

Filtered albumin is reabsorbed or excreted?

reabsorbed by tubule

Normal amount of protein in the body per day?

less than 100 mg of protein / 24 hours (*150 from henry*) or less than 10 mg/dl average random

According to henry's and bishop, what is the molecular weight of protein allowed by glomerulus to filter?

Henry: < 70,000 mw Bishop: < 66,000 mw

What are the other proteins in urine?

* Microglobulin * Uromoduli

# Other proteins in urine What is the other name of uromodulin?

Tamm-Horsfall glycoprotein

# Other proteins in urine * Tamm-Horsfall glycoprotein * lines matrix of all casts

Uromodulin

How many g/day is the protein content for functional proteinuria?

0.5 g/day

* 0.5 g/day * This is usually resolved with rest for 2-3 days

Functional Proteinuria

How many days should one rest to resolved functional proteinuria

2-3 days | repeat collection after

Familiarize the causes of functional proteinuria

1. Dehydration 2. Exercise 3. Congestive Heart Failure 4. Cold exposure (prolonged cold baths) 5. Fever 6. Late pregnancy 7. Emotional stress

* Exaggerated Lordotic posture * (Exaggerated lumbar curve)* * Happens when patient is standing

Postural/Orthostatic

# Positive or negative in urine protein? Day

positive

# Positive or negative in urine protein? Night

negative

# Positive or negative in urine protein? Vertical positioning of the body

positive

# Positive or negative in urine protein? Horizontal positioning of the body

negative

# Positive or negative in urine protein? First voided urine

negative

# Positive or negative in urine protein? 2 hrs standing or walking

positive

Familiarize the procedure in collecting sample postural/orthostatic

1. Let patient urinate before bedtime and get sample 2. Patient sleeps horizontally 3. Upon waking up, patient will be asked to urinate and test 4. Ask patient to stand up and walk, after 2 hours collect urine sample and test again 5. Comapre samples

Urine is contaminated directly or indirectly with **albuminous fluids, pus cells, blood, vaginal discharge**

Accidental or False or Pseudo

In Accidental or False or Pseudo, what are the constituents which directly or indirectly contaminate urine?

albuminous fluids, pus cells, blood, vaginal discharge

Example of Accidental or False or Pseudo

vaginitis, cystitis

# T or F Pathologic proteinuria are renal diseases and indicated decreased permeability of the glomerular filter

F (indicated increased permeability of the glomerular filter)

# Quantification proteinuria How many g/day is the amount of protein in heavy proteinuria?

> 4g per day

# Quantification proteinuria How many g/day is the amount of protein in moderate proteinuria?

1 to 4 g/day

# Quantification proteinuria How many g/day is the amount of protein in minimal proteinuria?

<1 g/day

# Quantification proteinuria Syndrome associated with heavy proteinuria

Nephrotic syndrome

# Yes or No Is this correlated with nephrotic syndrome? ↑ serum albumin

No, should be ↓ serum albumin

# Yes or No Is this correlated with nephrotic syndrome? ↑ Lipid in blood & urine

Yes

# Yes or No Is this correlated with nephrotic syndrome? Granular cast

Yes

# Yes or No Is this correlated with nephrotic syndrome? Glycogen cast

No, should be Fatty cast

# Yes or No Is this correlated with nephrotic syndrome? Oval fat body

Yes

# Quantification proteinuria What are the conditions correlated with nephrotic syndrome?

* ↓ serum albumin * ↑ Lipid in blood & urine * Granular cast * Fatty cast * Oval fat body

# T or F Heavy proteinuria means there is high amount of protein in urine and low in blood

# Quantification proteinuria Low protein blood is compensated by body through producing of?

lipids (which increase cast)

What are the patterns under Qualitative Proteinuria

Glomerular and Tubular pattern

# Qualitative Proteinuria Glomerular or Tubular Pattern? more than 3 - 4 g/day

Glomerular Pattern

# Qualitative Proteinuria Glomerular or Tubular Pattern? (-) charge on GBM

Glomerular Pattern

# Qualitative Proteinuria Glomerular or Tubular Pattern? Urine (+) large protein * a2 macroglobulin * B-lipoprotein

Glomerular Pattern

# Qualitative Proteinuria Glomerular or Tubular Pattern? Glomerulonephritis

Glomerular Pattern

# Qualitative Proteinuria Glomerular or Tubular Pattern? 1 - 2 g/day

Tubular Pattern

# Qualitative Proteinuria Glomerular or Tubular Pattern? Urine (+) small proteins * a1 microglobulin * b2 microglobulin

Tubular Pattern

# Qualitative Proteinuria Glomerular or Tubular Pattern? Fanconi, Cystinosis

Tubular Pattern

# Qualitative Proteinuria What are the urine (+) large protein in glomerular pattern?

* a2 macroglobulin * B-lipoprotein

# Qualitative Proteinuria What are the urine (+) small protein in tubular pattern?

* a1 microglobulin * b2 microglobulin

# Qualitative Proteinuria; T or F In Glomerular Pattern, the problem is Glomerular basement membrane since it lets even big proteins pass through

True the fire

# Qualitative Proteinuria; T or F In tubular pattern, Glomerular basement membrane is also damaged

F (GBM is intact, tubular is problem)

* due to the overflow of excess level of protein in the circulation * can be seen with hemoglobin, myoglobin or immunoglobulin loss into the urine

Overflow Proteinuria

# Overflow Proteinuria What is loss into urine which can indicate overflow proteinuria?

hemoglobin, myoglobin or immunoglobulin loss | globin losses heheheh

# Causes of Proteinuria * before plasma reaches the tubules * Multiple myeloma (Bence Jones Protein) intravascular hemolysis (hemoglobin) * acute phase reactants

Prerenal

# Causes of Proteinuria * associated with tubes; protein is added as it passes urinary tract * Glomerular Disorders * Tubular proteinuria * Orthostatic proteinuria * Microalbuminuria

Renal

# Causes of Proteinuria * Lower UTI * Menstrual contamination * Vaginal secretions

Post renal

2 common methods in measurement of protein?

1. Reagent strip method 2. Acid precipitation techniques

# 2 common methods in measurement of protein Principle: Protein error of pH indicators *More sensitive to albumin *Indicators change in color in the presence of protein

Reagent Strip Method

# Measurement of Protein: Reagent Strip Method pH is at constant at ?

# Measurement of Protein: Reagent Strip Method Reagent strip is constant due to what substance which acts as a buffer

Citric acid

# Measurement of Protein: Reagent Strip Method accepts ions from the indicator

Protein (anion)

# T or F Reagent Strip Method is more sensitive to albumin

# Measurement of Protein: Reagent Strip Method * contains more amino groups to accept H+ than other proteins * ideal to observe since this indicates damage in GBR

Albumin

# Measurement of Protein: Reagent Strip Method Indicator used in reagent strip in measurement of protein

tetrabromophenol blue

# Measurement of Protein: Reagent Strip Method Other indicators used in reagent strip in measurement of protein

* Tetrachlorophenol Tetrabromosulfonaphthalein

# Measurement of Protein: Reagent Strip Method Results: Negative and Trace value in reagent strip-protein

N/A

# Measurement of Protein: Reagent Strip Method Results: +

30 mg/dl

# Measurement of Protein: Reagent Strip Method ++

100 mg/dl

# Measurement of Protein: Reagent Strip Method +++

300 mg/dl

# Measurement of Protein: Reagent Strip Method ++++

2,000 mg/dl

# Measurement of Protein: Reagent Strip Method False positive or False negative? highly buffered alkaline urine | Sources of error

False positive | acidic strip is override

# Measurement of Protein: Reagent Strip Method False positive or False negative? high specific gravity

False positive | because specimen is concentrated

# Measurement of Protein: Reagent Strip Method False positive or False negative? quaternary ammonium compounds | also accepts H ions

False positive

# Measurement of Protein: Reagent Strip Method False positive or False negative? microalbuminuria

False negative

# Measurement of Protein: Reagent Strip Method False positive or False negative? proteins other than albumin

False negative

# Measurement of Protein: Heat & Acetic acid Where do you add drops of acid and where do you heat it?

Upper portion

# Measurement of Protein: Acid Precipitation Techniques Principle: precipitation of protein because of heat and acetic acid * one of the methods under acid precipitation technqiues where you put acid and heat protein

Heat & acetic acid

# Measurement of Protein: Heat & Acetic acid Results: (-)

no cloudiness or haziness

# Measurement of Protein: Heat & Acetic acid (+1)

diffuse cloud

# Measurement of Protein: Heat & Acetic acid (+2)

granular cloud

# Measurement of Protein: Heat & Acetic acid (+3)

distinct flocculation

# Measurement of Protein: Heat & Acetic acid (+4)

large flocculation dense, sometimes solid

# Measurement of Protein What are the techniques under Acid Precipitation?

1. Heat and acetic acid 2. 3% Sulfosalicylic acid TEST (Exton’s) *Other mentioned:* * *Heller’s Ring or Heller’s Heat or Nitric acid test* * *Picric Acid Test* * *Robert’s Ring Test*

# Measurement of Protein: Acid Precipitation Techniques Also known as Exton's test

3% Sulfosalicylic acid TEST

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) Positive result is?

Formation of precipitation

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) Identify what result **Turbidity:** No increase in turbidity **Protein range:** < 6

Negative

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) Identify what result **Turbidity:** Noticeable turbidity **Protein range:** 6-30 | CONGRATS YOU'RE ON THE 200TH CARD

Trace

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) Identify what result **Turbidity:** Distinct turbidity w/ no granulation **Protein range:** 30-100

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) Identify what result **Turbidity:** Turbidity with granulation; no flocculation **Protein range:** 100-200

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) Identify what result **Turbidity:** Turbidity with granulation & flocculation **Protein range:** 200-400

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) Identify what result **Turbidity:** Clumps of protein **Protein range:** > 400

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) False positive or False negative? highly alkaline urine

False negative | it neutralizes since acid is used here

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) False positive or False negative? Iodinated dyes (x-ray contrast media)

False positive | turbid specimen

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) False positive or False negative? Penicillin

False positive

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) False positive or False negative? Salicylate

False positive

# Measurement of Protein: 3% Sulfosalicylic acid TEST (Exton’s) False positive or False negative? Tolbutamide

False positive

# Acid Precipitation Technique: OTHER ACID PRECIPITATION METHODS Positive result: White opaque ring at the zone of contact

Heller’s Ring or Heller’s Heat or Nitric acid test

# Acid Precipitation Technique: OTHER ACID PRECIPITATION METHODS Positive result: Light cloudiness to a heavy flocculation

Picric Acid Test

# Acid Precipitation Technique: OTHER ACID PRECIPITATION METHODS Positive result: White ring at the point of contact

Robert’s Ring Test

# Measurement of Protein Drug metabolites can cause what result in Reagent strip and Acid precipitation?

**Reagent strip:** No effect **Acid precipitation:** May cause False positive

# Measurement of Protein False positive, False negative, or No effect? Highly alkaline urine in reagent strip test

False positive

# Measurement of Protein False positive, False negative, or No effect? Quaternary ammonium compounds in reagent strip

False positive

# Measurement of Protein False positive, False negative, or No effect? Radiographic contrast media heat and acetic acid tes

False positive

# Measurement of Protein False positive, False negative, or No effect? High alkaline urine in acid precipitation test

False negative

# Measurement of Protein False positive, False negative, or No effect? Radiographic contrast media in reagent strip

No effect

What are the methods in quantitative protein?

1. Precipitation 2. Colorimetric 3. Dye binding

# Quantitative Protein * Salicylic acid + Trichloroacetic acid * Measured by nephelometer or photometer

Precipitation

# Quantitative Protein What reagents does Precipitation use?

Salicylic acid + Trichloroacetic acid

# Quantitative Protein How is Precipitation measured?

nephelometer or photometer

# Quantitative Protein * Trichloroacetic acid + Biuret * Mixed; solution will be gray * measured by spectrophotomete

Colorimetric

# Quantitative Protein What reagents does Colorimetric use?

Trichloroacetic acid + Biuret

# Quantitative Protein How is Colorimetric method measured?

spectrophotometer

# Quantitative Protein * Coomassie brilliant blue + Ponceau S * measured by spectrophotometer

Dye binding

# Quantitative Protein What reagents does dye binding use?

Coomassie brilliant blue + Ponceau S

# Quantitative Protein How is dye binding measured?

spectrophotometer

* Gamma globulin/Light chain immunoglobulin * Coagulates: between 40 c and 60 c * Dissolves: 100 c Associated with: * Multiple myeloma * Waldenstrome’s macroglobulinemia * Malignant lymphomas

Bence Jones Proteinuria

What are the conditions associated with Bence Jones Proteinuria?

1. Multiple myeloma 2. Waldenstrome’s macroglobulinemia 3. Malignant lymphomas

# Bence Jones Proteinuria malignant disorder that results in infiltration of bone marrow by plasma cells

Multiple myeloma

# Bence Jones Proteinuria Bence Jones Proteinuria coagulates at what temp?

between 40 c and 60 c

# Bence Jones Proteinuria Bence Jones Proteinuria dissolves at what temp?

100 c

# Bence Jones Proteinuria What are the methods for Bence Jones Proteinuria

1. Heat and HAc Acid test 2. Bradshaw 3. Toluene Sulfonic Acid (TSA) test 4. Electrophoresis 5. Immunoglobulin electrophoresis (IFE)

# Bence Jones Proteinuria * indicated by single sharp peak in gamma globulin region * best method in Bence jones proteinuria

Electrophoresis

* Predictor of clinical nephropathy in insulin dependent diabetes mellitus (diabetic nephropathy) * Hypertension and cardiovascular risk * Beginning stages

Microalbuminuria

Presence of microalbuminuria helps detect risk in what diseases?

Hypertension and cardiovascular risk

# Microalbuminuria Specimen for microalbuminuria?

random or first morning urine

Preservation of Microalbuminuria using 24 hour urine specimen?

Refrigeration

# T or F Less than 30 mg is normal in Microalbuminuria using 24 hour urine specimen

Amount of albumin present for early kidney disease or Microalbuminuria?

30 to 300 mg

Amount of albumin present for more advanced kidney disease or Macroalbuminuria?

>300 mg

Albumin Excretion Rate (AER)?

20 to 200 ug/min

What are the methods in Microalbuminuria?

1. Micral II Test strip 2. Immunodip 3. Clinitek microalbumin 4. Multistix pro

# methods in Microalbuminuria * Immunologic Test * Enzyme Immunoassay * Strip contains gold labeled anti human albumin antibody – enzyme conjugate * Albumin binds with antibody and move up the strip * Reacts with the enzyme substrate

Micral Test

# methods in Microalbuminuria: Micral Test What does the strip in micral test contain?

gold labeled anti human albumin antibody (enzyme conjugate)

# methods in Microalbuminuria: Micral Test Antigen: Antibody:

Antigen: Albumin in urine Antibody: Reagent

# methods in Microalbuminuria: Micral Test Albumin binds with ........ and move ...... the strip

Albumin binds with **antibody** and move **up** the strip

# methods in Microalbuminuria: Micral Test The principle used in micral test is reaction with?

reaction with enzyme substrate

# methods in Microalbuminuria: Micral Test sensitivity?

0-10 mg/dl

# methods in Microalbuminuria: Micral Test reagents?

gold-labeled antibody

# methods in Microalbuminuria: Micral Test Enzyme? | 2

* B galactosidase * Chlorophenol red galactoside

# methods in Microalbuminuria: Micral Test; T or F Possible interference in micral test could be due to concentrated urine which results in false positive

F (dilute urine: false positive)

# methods in Microalbuminuria: Micral Test For how long should the strip be allowed to stand

1 min

# methods in Microalbuminuria: Micral Test Positive result?

pink-red

# methods in Microalbuminuria: Micral Test Negative result?

white

# methods in Microalbuminuria: Micral Test This is where the free antibodies reside | part of the micral strip

Zone 1: Conjugate matrix fleece

# methods in Microalbuminuria: Micral Test controls that are fixed | part of the micral strip

Zone 2: Capture Matrix Fleece

# methods in Microalbuminuria * Immunochromatography * Principle: Immunology * Albumin in urine binds with blue latex particles coated with anti human albumin antibody

Immunodip

# methods in Microalbuminuria: Immunodip For how long should the strip be left in the urine?

3 mins

# methods in Microalbuminuria: Immunodip Albumin in urine binds with ........ coated with ............

Albumin in urine binds with **blue latex particles** coated with **anti human albumin antibody**

# methods in Microalbuminuria: Immunodip migration direction of bound and unbound particle?

migrate up the strip

# methods in Microalbuminuria: Immunodip These particles do not migrate as far as the bound particles

Unbound particles

# methods in Microalbuminuria: Immunodip Positive result?

Darker top band

# methods in Microalbuminuria: Immunodip Negative result?

Darker bottom band

# methods in Microalbuminuria: Immunodip Reagent?

blue latex coated with anti human albumin antibody

# methods in Microalbuminuria: Immunodip Interference in Immunodip happens when urine is dilute which causes false positive results

F (Dilute urine: false negative)

# methods in Microalbuminuria * Albumin:Creatinine ratio * Principle:Albumin dye binding principle * More specific & sensitive to albumin * estimates 24 hr microalbumin excretion * corrects for overhydration or dehydration in a random specimen

Clinitek Microalbumin

# methods in Microalbuminuria: Clinitek Microalbumin Dye used in Clinitek Microalbumin

diodo dihydoxy dinitrophenyl tetrabrosulphonaphthalein (DIDNTB)

# methods in Microalbuminuria: Clinitek Microalbumin Sensitivity?

8 to 15 mg/dl (80 to 150 mg/dl)

# methods in Microalbuminuria: Clinitek Microalbumin Clinitek microalbumin estimates?

24 hr microalbumin excretion

# methods in Microalbuminuria: Clinitek Microalbumin; T or F Clinitek microalbumin corrects for overhydration or dehydration in a 24 hour specimen

F (corrects for overhydration or dehydration in a **random specimen**)

# methods in Microalbuminuria: Clinitek Microalbumin produced & excreted at a constant rate

Creatinine

# methods in Microalbuminuria: Clinitek Microalbumin Detection of creatinine in clinitek microalbumin uses what priciple?

Pseudo-peroxide activity of copper-creatinine complexes

# methods in Microalbuminuria: Clinitek Microalbumin These are the involved reactants in clinitek microalbumin

diisopropylbenzene dihydroperoxide (DBDH) and tetramethylbenzidine (TMB)

# methods in Microalbuminuria Multistix pro What does this indicate: Protein error of indicators

Protein high

# methods in Microalbuminuria Multistix pro What does this indicate: Dye binding method (sulphonapthalein dye)

Protein low

# methods in Microalbuminuria Multistix pro This substance is based on the Pseudoperoxidase of CuCrea

Creatinine

# methods in Microalbuminuria Multistix or Multistix Pro? Leukocytes

Multistix and Multistix Pro

# methods in Microalbuminuria Multistix pro Urobilinogen and bilirubin

Not measured

# methods in Microalbuminuria Multistix or Multistix Pro? Nitrite

Multistix and Multistix Pro

# methods in Microalbuminuria Multistix or Multistix Pro? Urobilinogen

Multistix

# methods in Microalbuminuria Multistix or Multistix Pro? Protein

Multistix and Multistix Pro

# methods in Microalbuminuria Multistix or Multistix Pro? pH

Multistix and Multistix Pro

# methods in Microalbuminuria Multistix or Multistix Pro? Blood

Multistix and Multistix Pro

# methods in Microalbuminuria Multistix or Multistix Pro? Specific Gravity

Multistix and Multistix Pro

# methods in Microalbuminuria Multistix or Multistix Pro? Ketone

Multistix and Multistix Pro

# methods in Microalbuminuria Multistix or Multistix Pro? Bilirubin

Multistix

# methods in Microalbuminuria Multistix or Multistix Pro? Glucose

Multistix and Multistix Pro

# methods in Microalbuminuria Multistix or Multistix Pro? Protein high

Multistix Pro

# methods in Microalbuminuria Multistix or Multistix Pro? Protein low

Multistix Pro

# methods in Microalbuminuria Multistix or Multistix Pro? Creatinine

Multistix Pro

Detectable amount of glucose

Glucosuria (glucose in urine)

Renal threshold of glucose?

160 to 180 mg/dl

2 Types of Glucosuria

1. Glucosuria Hyperglycemia associated 2. Glucose Renal associated

# 2 Types of Glucosuria * Glucose high in blood * More than 180 mg/dl * Hormones that cause breakdown of glycogen to glucose

Glucosuria Hyperglycemia associated

# 2 Types of Glucosuria What are the conditions associated with Glucosuria Hyperglycemia

1. Diabetes mellitus 2. Pancreatitis 3. Pancreatic Ca 4. Acromegaly 5. Cushing’s syndrome 6. Hyperthyroidism 7. Pheochromocytoma 8. CNS damage 9. Stress 10. Gestational diabetes

# 2 Types of Glucosuria * Glucose in the blood is normal * Tubules cannot reabsorb glucose

Glucose Renal associated

# 2 Types of Glucosuria What is the main tubule affected in Glucose Renal associated type of glucosuria? | CONGRATS YOU'RE ON THE 200TH CARD ## Footnote TWERK KA MUNA

Proximal Convoluted Tubule

# 2 Types of Glucosuria What are the conditions associated with Glucose Renal

1. Fanconi’s syndrome 2. Advanced Renal Disease 3. Osteomalacia 4. Pregnancy

What are the 2 methods used in measuring glucose for glucose renal associated?

Reagent Strip Methods, Copper Reduction Methods

# 2 methods used in measuring glucose for glucose renal associated * Specific for glucose only * Principle: Double sequential enzyme * Glucose & Peroxidase

Reagent Strip Methods

# 2 methods used in measuring glucose for glucose renal associated Principle of reagent strip method?

Double sequential enzyme

# 2 methods used in measuring glucose for glucose renal associated ENzymes involved for reagent strip method?

Glucose & Peroxidase

# 2 methods used in measuring glucose for glucose renal associated End products of reagent strips?

Oxidized chromogen + Water

# 2 methods used in measuring glucose for glucose renal associated Causes of error: Reagent strips False positive or False negative? oxidizing cleaning agent (peroxide)

False positive

# 2 methods used in measuring glucose for glucose renal associated Causes of error: Reagent strips False positive or False negative? Vit C

False negative

# 2 methods used in measuring glucose for glucose renal associated False positive or False negative? Improperly preserved specimen

False negative

# 2 methods used in measuring glucose for glucose renal associated False positive or False negative? High specific gravity

False negative

# 2 methods used in measuring glucose for glucose renal associated False positive or False negative? High ketones

False negative

# 2 methods used in measuring glucose for glucose renal associated False positive or False negative? Low temperatures

False negative

# 2 methods used in measuring glucose for glucose renal associated What is the chromogen used for multistix reagent strips?

Potassium Iodide chromogen

# 2 methods used in measuring glucose for glucose renal associated What is the negative result in multistix using potasssium iodide chromagen?

Blue

# 2 methods used in measuring glucose for glucose renal associated What is the positive result in multistix using potasssium iodide chromagen?

Green-brown in 30 seconds

# 2 methods used in measuring glucose for glucose renal associated Chromogen used in chemstrip?

Aminopropyl-carbazole

# 2 methods used in measuring glucose for glucose renal associated What is the color transition of chemstrip?

yellow to orange brown

# 2 methods used in measuring glucose for glucose renal associated What is the chromogen used in Clinistix?

O toluidine chromogen

# 2 methods used in measuring glucose for glucose renal associated What is the color transition of Clinistix?

pink to purple

# 2 methods used in measuring glucose for glucose renal associated Reporting for Reagent Strips Amount present for Negative ?

N/A

# 2 methods used in measuring glucose for glucose renal associated Reporting for Reagent Strips Amount present for Trace ?

100 mg/dl

# 2 methods used in measuring glucose for glucose renal associated Reporting for Reagent Strips Amount present for 1+ ?

250 mg/dl

# 2 methods used in measuring glucose for glucose renal associated Reporting for Reagent Strips Amount present for +2 ?

500 mg/dl

# 2 methods used in measuring glucose for glucose renal associated Reporting for Reagent Strips Amount present for 3+?

1,000 mg/dl

# 2 methods used in measuring glucose for glucose renal associated Reporting for Reagent Strips Amount present for 4+

> 2,000 mg/dl

# 2 methods used in measuring glucose for glucose renal associated * Principle: Copper reduction * Ability of glucose to reduce copper sulfate to cuprous oxide in the presence of alkali & heat

Benedict’s & Clinitest

# 2 methods used in measuring glucose for glucose renal associated What are the reagents used in Benedict's test

* Copper Sulfate * Na carbonate * Citric acid

# 2 methods used in measuring glucose for glucose renal associated Results for coppper reduction test: Benedict’s & Clinitest Neg

Blue

# 2 methods used in measuring glucose for glucose renal associated Results for coppper reduction test: Benedict’s & Clinitest Trace

Green w/o precipitate

# 2 methods used in measuring glucose for glucose renal associated Results for coppper reduction test: Benedict’s & Clinitest 1+

Yellow w/o precipitate

# 2 methods used in measuring glucose for glucose renal associated Results for coppper reduction test: Benedict’s & Clinitest 2+

Yellow green w/ yellow precipitate

# 2 methods used in measuring glucose for glucose renal associated Results for coppper reduction test: Benedict’s & Clinitest 3+

Muddy orange w/ yellow precipitate

# 2 methods used in measuring glucose for glucose renal associated Results for coppper reduction test: Benedict’s & Clinitest 4+

Orange to red precipitate

# T or f Sucrose tests negative for benedict's and clinitest

# 2 methods used in measuring glucose for glucose renal associated * Principle: Copper reduction * Reagents of benedict’s are in tablet form

Clinitest

# 2 methods used in measuring glucose for glucose renal associated CuSO4, NaOH, Sodium carbonate, Sodium citrate | Clinitest

Reagents in clinitest

# 2 methods used in measuring glucose for glucose renal associated Citric acid + Na carbonate | Clinitest

Bubbles

# 2 methods used in measuring glucose for glucose renal associated NaOH + water | Clinitest

Heat

# 2 methods used in measuring glucose for glucose renal associated Negative results for clinitest?

Blue

# 2 methods used in measuring glucose for glucose renal associated Positive results for clinitest?

Green to orange/red

# 2 methods used in measuring glucose for glucose renal associated If glucose is too high, pass through phenomenon has how much amount of glucose? | Copper reduction test: glucose

>2g/dl sugar

# 2 methods used in measuring glucose for glucose renal associated If glucose is too high, pass through phenomenon goes through what color transition? | Copper reduction test: glucose

Passes through **orange to a dark shade of greenish brown**

# 2 methods used in measuring glucose for glucose renal associated When glucose is high, results pass through orange to a dark shade of greenish brown becasue of what phenomenon? | Copper reduction test: glucose ## Footnote what specific rection

Re-oxidation of cuprous oxide to cupric oxide

# 2 methods used in measuring glucose for glucose renal associated Result: Spotted bluish white tablet | Clinitest

Normal

# 2 methods used in measuring glucose for glucose renal associated Result: Dark blue to brown table | Clinitest

Discard specimen

# 2 methods used in measuring glucose for glucose renal associated what do you do to the specimen when glucose is too high? | Clinitest

Dilute using two-drop method

# 2 methods used in measuring glucose for glucose renal associated Identify what method: 5 drops of urine; 10 drops of water | Clinitest

Five-drop method

# 2 methods used in measuring glucose for glucose renal associated Identify what method: 2 drops of urine; 10 drops of water | Clinitest

Two-drop method

# 2 methods used in measuring glucose for glucose renal associated Five-drop method results: Negative? | Clinitest

N/A

Five-drop method results: Trace | Clinitest

0.25 g/dl

# 2 methods used in measuring glucose for glucose renal associated Five-drop method results: + | Clinitest

0.5 g/dl

# 2 methods used in measuring glucose for glucose renal associated Five-drop method results: ++ | Clinitest

0.75 g/dl

# 2 methods used in measuring glucose for glucose renal associated Five-drop method results: +++ | Clinitest

1.0 g/dl

# 2 methods used in measuring glucose for glucose renal associated Five-drop method results: ++++ | Clinitest

2.0 g.dl

# 2 methods used in measuring glucose for glucose renal associated Two-drop method results: Negative | Clinitest

N/A

# 2 methods used in measuring glucose for glucose renal associated Two-drop method results: + | Clinitest

1 g/dl

# 2 methods used in measuring glucose for glucose renal associated Two-drop method results: ++ | Clinitest

2 g/dl

# 2 methods used in measuring glucose for glucose renal associated Two-drop method results: +++ | Clinitest

3 g/dl

# 2 methods used in measuring glucose for glucose renal associated Two-drop method results: ++++ | Clinitest

5 g/dl

Method: Benedict What is the principle, positive result, and sugar measured?

Principle: copper reduction Positive result: green, yellow, orange, red Sugar measured: Glucose and other reducing sugars

Method: Clinitest tablet What is the principle, positive result, and sugar measured?

Principle: copper reduction Positive result: green, yellow, orange, red Sugar measured: Glucose and other reducing sugars

Method: Reagent Strip What is the principle, positive result, and sugar measured?

Principle: Double sequential enzyme reaction (glucose oxidase) Positive result: Green to brown Sugar measured: Glucose only

Method: Reagent Strip What is the negative result?

blue

Results Reagent strip: 1+ Benedict's: - What is the interpretation?

Glucose (small amount)

Results Reagent strip: + Benedict's: + What is the interpretation?

glucose & reducing sugars

Results Reagent strip: - Benedict's: +3 What is the interpretation?

non-glucose reducing sugars

Results Reagent strip: 3+ Benedict's: + What is the interpretation?

?????? | (strips may not oxidizing agent; benedict reagent is not effective)

# Correlation of Reagent Strip and Heat and Acetic acid results: Reagent strip: +1 Heat &HAc: -

Albumin present

# Correlation of Reagent Strip and Heat and Acetic acid results: Reagent strip: + Heat &HAc: +

Proteinuria

# Correlation of Reagent Strip and Heat and Acetic acid results: Reagent strip: - Heat &HAc: +

BJP, Globulins, etc.

Glucose What is the results on reagent strip and copper reduction?

Reagent strip: + Copper reduction: +

Reducing sugars What is the results on reagent strip and copper reduction?

Reagent strip: NE Copper reduction: +

Homogentisic acid What is the results on reagent strip and copper reduction?

Reagent strip: NE Copper reduction: +

Xray dye What is the results on reagent strip and copper reduction?

Reagent strip: NE Copper reduction: black

H202 & hypochlorite What is the results on reagent strip and copper reduction?

Reagent strip: False (-) Copper reduction: -

# Glucose Results False positive or False Negative? Ascorbic acid in Clinitest

False positive

# Glucose Results False positive or False Negative? Oxidizing agents in Reagent strip testing

False positive

# Glucose Results False positive or False Negative? Ascorbic acid in Reagent strip

False negative

Routine Chemical Examination of Urine Flashcards

(378 cards)