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AUBF > UA 1: PHYSICAL EXAMINATION OF URINE PT. 2 > Flashcards

UA 1: PHYSICAL EXAMINATION OF URINE PT. 2 Flashcards

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1
Q

urine character/clarity

A

observing the turbidity/clarity of urine

- if particulate matter is present in unspun urine, it should be examined microscopically

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2
Q

urine turbidity may be due to the following…

A

a. precipitation of crystals/non-pathologic salts
b. WBCs
c. bacterial growth
d. high number of epithelial cells (usu. females)
d. RBCs (i.e. hematuria)
e. spermatozoa/prostatic fluid
f. mucus from urinary passages
g. fecal material (esp. in LBM)
h. contamination with powders/antiseptics
i. chyluria
j. lipiduria

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3
Q

Precipitation of Crystals:

amorphous phosphates vs. uric acid/urates

A

a. amorphous phosphates
- seen in alkaline urine
- occasionally carbonates
- redissolves when acetic acid (HAc) is added

b. uric acid/urates
- seen in acid urine
- redissolves on warming at 60 degrees Celsius (do not boil)

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4
Q

causes uniform opalescence, not removed by acidification or boiling

A 
Bacterial growth
- E. coli
- Proteus
- Enterococcus
- Yeast
 Staphylococcus
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5
Q

T/F:

turbidity due to hematuria is not cleared on warming

A

TRUE

- it should be examined microscopically

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6
Q

increases in inflammation of the lower UT

A

mucus from urinary passages

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7
Q

substance that becomes opaque with water

A

(diluted) phenol

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8
Q

chyluria

A

Urine contains lymphocytes associated with obstruction to lymph flow

  • rupture of lymphatic vessels into the renal pelvis, ureter, bladder & urethra
  • urine may be normal, opalescent, or milky
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9
Q

fat globules in urine

A

Lipiduria

  • caused by nephrotic syndrome & crush injury
      • crush injury = due to major skeletal trauma; 1 or more fractures to major long bones/pelvis
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10
Q

test to check for lipiduria/chyluria

A

Mix urine with ether

- chyluria & lipiduria are soluble in ether –> clear solution is exhibited

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11
Q

describing urine clarity

A

Place print at the back of the sample:

  1. no visible particulates present; transparent = “CLEAR”
  2. few particulates present; print can easily be seen through urine = “HAZY”
  3. many particulates present; print is blurred through urine = “CLOUDY”
  4. print cannot be seen through urine = “TURBID”
  5. urine may be precipitated or be clotted = “MILKY”
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12
Q

physical test not usually included in physical exams

A

Urine Odor

  • normal odor: slightly aromatic
  • contaminated/long-standing urine: ammoniacal
  • odor can be caused by certain diseases
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13
Q

urine odors associated with amino acid disorders

A
  1. SWEATY FEET odor
    - isovaleric acidemia, glutaric acidemia
  2. MAPLE SYRUP odor
    - maple syrup urine disease
  3. CABBAGE odor
    - methionine malabsorption
  4. MOUSY odor
    - phenylketonuria (PKU)
  5. ROTTING FISH odor
    - trimethylaminuria
  6. RANCID odor
    - tyrosinemia
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14
Q

not measured during routine UA, but is measured for timed specimens

A

Urine Volume

- the average daily volume of a normal adult: 1200-1500mL OR 600-2000mL

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15
Q

urinary occurrence & characteristics in normal pregnancy

A
  • nocturia (urine at night)
      • excretion of more than 500mL urine with an SG of less than 1.018 at night
  • urine excreted is dilute
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16
Q

a term referring to increased urine volume

A

Polyuria

- urine excreted is more than 2000mL in 24h

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17
Q

this refers to decreased urine output

A

Oliguria

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18
Q

anuria

A

The patient cannot void

  • “an” = lack or absent
  • “uria” = urine
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19
Q

reflects the ability of the kidneys to maintain normal H+ concentration in the plasma & ECF

A

Hydrogen ion concentration

  • “Urine pH”
  • urine pH of healthy individuals:
      • first morning urine = pH 5-6
      • after meals = alkaline “tide”
      • random specimens = pH4.5-8.0
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20
Q

clinical significance/s of measuring urine pH

A
  • respiratory or metabolic acidosis/ketosis
  • respiratory or metabolic alkalosis
  • defects in renal tubular secretion & reabsorption of acids/bases
      • i.e. in renal tubular acidosis
  • renal calculi formation
  • treatment of UTI
  • precipitation & identification of crystals
  • determination of unsatisfactory specimens
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21
Q

possible causes of acidic urine

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A
  • emphysema
  • DM
  • starvation
  • dehydration
  • diarrhea
  • high protein diet
  • intake of cranberry juice
  • taking medications for UTI (eg. Mandelamine)
  • presence of acid-producing bacteria (ex. E. coli)
22
Q

possible causes of alkaline urine

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A
  • hyperventilation
  • vomiting
  • renal tubular acidosis
  • old specimens
  • presence of urease-producing bacteria
  • vegetarian diet
23
Q

basic methods of H+ determination

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A
  1. potentiometric determination

2. indicator paper strips

24
Q

unsuitable for routine measurement

Study These Flashcards
A

Potentiometric determination

  • “pH meter”
  • should be used for QC
25
test for pH that uses indicator systems to determine urine pH
Indicator paper strips - rapid & inexpensive - some brands use double-indicator systems: - - Multistix - - Chemstrip - pH range: 5.0-8.5 (in half units)
26
T/F: | indicator paper strips should be dipped in urine for a long time to obtain accurate results
FALSE - strips should NOT BE DIPPED FOR A LONG TIME because reagents will be washed out in the urine - results should be read 60 SECONDS AFTER DIPPING
27
indicator/s used in pH strips
1. METHYL RED = ACID indicator - range: pH 4-6 (high H+ concentration) - strip color: from RED TO YELLOW 2. BROMTHYMOL BLUE = ALKALINE indicator - range: pH 6-9 (low H+ concentration) - strip color: from YELLOW TO BLUE
28
this measures the concentrating & diluting power of the kidneys
Specific Gravity & Osmolality - both tests should give an indication of urinary total solute concentration - - the inability of the kidneys to concentrate & dilute urine indicates renal disease or hormonal deficiency
29
dependent on the number of particles present & their density
``` Specific Gravity (SG) - influenced by the size of molecules that are not significant in renal concentration (eg. urea, glucose, proteins) ```
30
the specific gravity of a protein-free glomerular filtrate
1.010
31
dependent on the number of solutes in a unit of solution
Osmolality - a more exact measurement of urine concentration than SG - commonly employed method: freezing point determination
32
hyposthenuric urine
urine constantly has low SG (less than 1.007)
33
isosthenuric urine
urine constantly has fixed SG
34
methods of specific gravity measurement
1. refractometer 2. urinometer 3. reagent strip 4. harmonic oscillation densitometry 5. falling drop
35
measures the refractive index of a solution
Refractometer - "TS meter" - PROS: - - the temperature is compensated between 60-100F - - small sample required (1 drop)
36
calibrators that can be used in a refractometer
1. distilled water - SG: 1.000 2. 5% NaCl - SG: 1.022 +/- 0.001 3. 9% Sucrose - SG: 1.034 +/- 0.001
37
a hydrometer adapted to measure SG at room temperature
Urinometer
38
parts of the urinometer
1. urinometer cylinder 2. urinometer float - a weighted float with a calibrated stem where calibrations are read
39
T/F: | the urinometer float displaces a volume of liquid equal to its weight
TRUE - "weight" = the amount of dissolved solutes in the sample - - the additional mass provided by the solutes causes the float to displace a volume of urine smaller than the volume of distilled H2O - - the float is designed to sink to a level of 1.000 (SG of dist. H2O)
40
source/s of error in using the urinometer
1. urine volume - urinometer cylinder needs to be filled approx. 3/4 full 2. temperature differences - a difference of 3C between the urine & calibration temps. requires correction of 0.001 - urinometer is mostly calibrated at 20C 3. proteinuria - correction: subtract 0.003 for every 1g/100mL CHON 4. glycosuria - correction: subtract 0.004 for every 1g/100mL glucose 5. presence of x-ray contrast media - used in the examination of patients to follow the course of a dye - - dye is injected into the patient & its course is followed using x-ray; dye is excreted later through the urine 6. presence of urinary preservative - SG is increased
41
urine passed out after injecting the dye will have (high, low) SG
High SG - sometimes it cannot be read; may be > 1.050 - correction: dilute urine with dist. H2O & multiply the SG by the dilution
42
this method is based on the pKa of a polyelectrolyte in an alkaline medium
Reagent strip method - "pKa" = dissociation constant - polyelectrolyte ionizes releasing H+ in proportion to the number of ions in the solution - - higher urine concentration = more H+ released = lower pH - indicator: Bromthymol blue
43
Principle: | the frequency of a soundwave entering a solution will change in proportion to the density of the solution
Harmonic oscillation densitometry - used by the Yellow IRIS (International Remote Imaging System) 1. a portion of urine enters a U-shaped tube 2. a soundwave of a specific frequency is generated at 1 end of the tube 3. the soundwave passes through the urine 4. the frequency is altered by the density of the solution
44
a direct method of measuring the specific gravity
Falling drop method - by M. Winstead; more historical method 1. a specially designed column is filled with water-immiscible oil 2. a measured drop of urine is introduced into the column 3. as the drop falls, it encounters 2 light beams - - 1st light beam = timer starts - - 2nd light beam = timer ends 4. the time that the drop of urine passes through the 2 beams is measured
45
Sample scenario: ``` urine temperature = 30C calibration temperature (urinometer) = 20C ``` how to correct SG?
1. determine the difference between urine & calibration temps. - 30-20 = 10C difference 2. divide the difference by 3C - 10 / 3 = 3.33 3. multiply quotient by 0.001 - 3.33 x 0.001 = 0.003 4. ADD the product to the SG reading - 0.003 + SG reading
46
Sample scenario: ``` urine temperature = 17C calibration temperature (urinometer) = 20C ``` how to correct SG?
1. determine the difference between urine & calibration temps. - 20-17 = 3C difference 2. divide the difference by 3C - 3 / 3 = 1 3. multiply quotient by 0.001 - 1 x 0.001 = 0.001 4. SUBTRACT the product to the SG reading - 0.001 - SG reading
47
Sample scenario: ``` patient name - Maria Cruz urine temperature = 36C calibration temperature (urinometer) = 21C SG reading = 1.015 ``` Determine urine true SG
1. 36-21 = 15C difference 2. 15 / 3 = 5 3. 5 x 0.001 = 0.005 4. 0.005 + 1.015 = 1.020 True SG = 1.020
48
Sample scenario: patient Maria Cruz has proteinuria. Her urine contains 2g CHON/100mL. What is the final SG?
CORRECTION: SUBTRACT 0.003 FOR EVERY 1g/100mL CHON Final SG = True SG - (0.003 x 2g) Final SG = 1.020 - (0.006) Final SG = 1.014
49
Sample scenario: patient Maria Cruz had a very high SG. So, 5mL of the urine was diluted with 15mL distilled H2O. What is the final SG?
True SG x DILUTION - dilution = 5mL urine / 15mL dist. H2O = 1 part urine to 3 parts H2O Final SG = 1.020 x 3 = 1.060
50
why is the final SG 1.060 and not 3.060 (1.020 x 3)?
There is no SG that begins with any number except 1. ALL SG STARTS WITH 1. Therefore, 1.020 x 3 = .020 x 3 = 1.060

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