Urinalysis

Question 1

Calcium Oxalate

Answer 1

Octahedral “envelope” crystal (dihydrate, most common); Spherical monohydrate esp. with Ethylene Glycol Poisoning; Normal Acidic/Neutral

Question 2

Triple Phosphate

Answer 2

“Coffin-lid” crystal; Normal Alkaline

Question 3

Ammonium biurate

Answer 3

“Thorny apple”; Normal Alkaline

Question 4

Amorphous urates

Answer 4

irregular granules; normal acidic

Question 5

Amorphous phosphates

Answer 5

irregular granules; normal alkaline

Question 6

Uric acid

Answer 6

Pleomorphic. 4-sided, 6-sided, star shaped, rosettes, spears, plates; normal acidic

Question 7

Calcium phosphate

Answer 7

needles, rosettes, “pointing finger”; Normal alkaline

Question 8

Calcium carbonate

Answer 8

“Dumbbells” or aggregates; normal alkaline

Question 9

Leucine

Answer 9

Oily spheres, concentric circles; abnormal acid/neutral (Severe liver disease)

Question 10

Tyrosine

Answer 10

Needles in sheaves or rosettes; abnormal acid/neutral (Severe liver disease)

Question 11

Cystine

Answer 11

Hexagonal (6-sides); abnormal acid (Cystinuria, metabolic disease)

Question 12

Cholesterol

Answer 12

Flat plates, notched out corners “stair-steps”; abnormal acid (Nephrotic syndrome)

Question 13

Bilirubin

Answer 13

Yellowish brown needles, plates, granules; abnormal acid (Liver disease)

Question 14

Acute glomerulonephritis

Answer 14

Cause: Inflammation and damage to glomeruli
Macro: protein, blood
Micro: RBCs, WBCs, red cell casts
Notes: Frequently follows untreated group A strep

Question 15

Nephrotic syndrome

Answer 15

Cause: Increased glomerular permeability
Macro: protein (4+)
Micro: Casts (all kinds), free fat, oval fat bodies

Question 16

Pyelonephritis

Answer 16

Cause: Kidney infection (upper UTI)
Macro: Protein, LE, nitrite
Micro: WBCs, WBC casts, bacteria

Question 17

Cystitis

Answer 17

Cause: bladder infection (lower UTI)
Macro: LE, nitrite
Micro: WBCs, bacteria, possible RBCs, no casts

Question 18

Renal Calculi

Answer 18

AKA: Kidney Stones
Macro: Blood (4+)
Micro: RBCs, crystals (usually Ca Oxalate)

Question 19

Major protein component of casts

Answer 19

Tamm-Horsfall protein

Question 20

Fat in urine can be identified by

Answer 20

stain (Sudan III or IV); polarized light

Question 21

Glucose reflex test. Condition?

Answer 21

Clinitest. Patient <2 yrs old.

Question 22

Bilirubin reflex test. Condition?

Answer 22

Ictotest. Positive bilirubin.

Question 23

Protein reflex test. Condition?

Answer 23

SSA. Trace protein result.

Question 24

Renal threshold for Glucose

Answer 24

160-180 mg/dL

Question 25

Yeast Infection

Answer 25

Macro: (+/-) protein, LE, Blood Micro: WBC, RBC, Yeast

Question 26

High Uro, +/- Bili

Answer 26

Liver disease

Question 27

Normal Uro, + Bili

Answer 27

Biliary Obstruction

Question 28

High Uro, - Bili

Answer 28

Hemolytic disorder

Question 29

End-stage Renal Disease

Answer 29

Cause: any renal condition can lead to this Macro: protein, +/- blood Micro: Renal Epithelial cells, granular casts, broad waxy casts

Question 30

If >2 hrs unpreserved before testing

Answer 30

Macro: pH up, protein slightly up, glucose down, ketones down, bili down, nitrite up Micro: Casts down, RBCs down, Bacteria up, WBCs down

Question 31

Creatinine clearance reference range

Answer 31

80-130 mL/min

Question 32

Angiotensin

Answer 32

Produced when low plasma Na+, promotes Na+ reabsorption in PCT

Question 33

Aldosterone

Answer 33

Produced when low plasma Na+, promotes Na+ reabsorption in DCT

Question 34

ADH

Answer 34

opens door for passive transport of H2O in DCT (more ADH, more H2O reabsorbed)

Question 35

GFR vs. Kidney disease

Answer 35

Stage 1: >= 90 mL/min Stage 2: 60-89 mL/min Stage 3: 45-59 mL/min Stage 4: 15-29 mL/min Stage 5: <15 mL/min

Question 36

Nephritic

Answer 36

sterile, RBC casts

Question 37

Nephrotic

Answer 37

fatty and waxy casts, protein +++

Question 38

Broad casts

Answer 38

tubular dilation and stasis (chronic renal failure)

Question 39

PKU (phenylketonuria)

Answer 39

Symptoms: Mousy-smelling urine, developmental delays Pathology: Missing enzyme phenylalanine hydroxylase Testing: Guthrie (B. subtilis on blood) or Ferric Chloride (urine)

Question 40

MSUD (maple syrup urine disease)

Answer 40

Symptoms: very sweet smelling urine (keto acid buildup) Pathology: buildup of leucine, isoleucine, and valine Testing: 2,4-DNPH

Question 41

Alkaptonuria

Answer 41

Symptoms: urine darkens as it turns alkaline at room temp Pathology: buildup of homogentisic acid due to missing oxidase Testing: Silver nitrate test

Question 42

Melanuria

Answer 42

Symptoms: dark brown or black urine Pathology: malignancy of melanocytes (melanoma)

Question 43

Indicanuria

Answer 43

Symptoms: urine turns blue when exposed to air ("blue diaper syndrome" Pathology: Deficient intestinal reabsorption of tryptophan (sometimes general aminoaciduria a.k.a. Fanconi syndrome)

Question 44

Porphyria/Porphyrinuria

Answer 44

Symptoms: red/port wine colored urine Pathology: Errors in heme synthesis (porphyrin metabolism) Causes: inherited (rare), lead poisoning, iron deficiency, +++ alcohol Testing: Watson-Schwartz test

Question 45

Cystinuria

Answer 45

Symptoms: calculi of cystine crystals Pathology: poor reabsorption of cystine and lysine (and sometimes arginine and ornithine) in renal tubules Testing: Cyanide Nitroprusside (+), Silver Nitroprusside (-)

Question 46

Homocystinuria

Answer 46

Symptoms: cataracts, FTT, intellectual disability, stroke, death Pathology: buildup of homocystine (defects in methionine metabolism) Testing: Cyanide Nitroprusside (+), Silver Nitroprusside (+)

Question 47

Watson-Schwartz Test

Answer 47

Urine/Chloroform; Butanol/Urine Y/R; R/Y = Urobilinogen R/Y; Y/R = Porphobilinogen R/Y; R/Y = Ehrlich-reactive R/R; R/R = Urobilinogen/porphobilinogen