Urinalysis

Question 1

What is dysuria?

Answer 1

Burning pain when urinating

Question 2

What is nocturia?

Answer 2

Need to constantly urinate throughout night

Question 3

What are the 3 most common key signs of UTIs in women?

Answer 3

Dysuria
Nocturia
Cloudy urine

Question 4

When you skip urinalysis and instead obtain an urine culture for a female patient?

Answer 4

They have at least 2 out of 3 of the most common UTI key signs

Question 5

When a female patient has 2 out of 3 of the most common UTI key signs, what 2 actions must you take?

Answer 5

Skin urinalysis, instead send urine culture to lab

Start patient on antibiotics

Question 6

What are the 2 first-line antibiotics used to treat UTIs in men and women?

Answer 6

Oral trimethoprim

Oral nitrofurantoin

Question 7

If a patient with a UTI has pain, what 2 analgesics can be recommended?

Answer 7

Ibuprofen

Paracetamol

Question 8

Give 3 examples of non-pharmacological treatment recommendations for UTIs?

Answer 8

Drink plenty of fluids to avoid dehydration

Wipe front to back after defecation

Don’t delay urination

Question 9

If a female patient has 1 out of 3 of the most common UTI key signs, what test do you perform?

Answer 9

Urine dipstick

Question 10

Apart from the 3 most common UTI key signs, list 4 other symptoms of a UTI in women?

Answer 10

Suprapubic tenderness/lower abdominal pain

Increased urgency and frequency of urination

Haematuria (blood in urine)

Urine has strong unpleasant smell

Question 11

Is urinalysis or urine dipstick necessary to confirm an UTI diagnosis?

Answer 11

No, but can provide additional info about underlying conditions

Question 12

Is urine dipstick equally reliable in men and women?

Answer 12

Much more reliable in women than men

Question 13

What is the precursor of urobilinogen?

Answer 13

Bilirubin

Question 14

Where does bilirubin originate from, and how is it converted into urobilinogen?

Answer 14

Bilirubin is a byproduct of RBC death

Bilirubin is transported to liver and becomes bile, bile transported to intestines and changed into urobilinogen by gut bacteria

Question 15

Is the total amount of urobilinogen produced excreted?

Answer 15

Some is stored in liver and rest is excreted in stool and urine

Question 16

How does presence of urobilinogen change the visible features of stool and urine?

Answer 16

Urine looks yellow

Stool looks more brown

Question 17

What proportion of urobilinogen in urine is considered normal?

Answer 17

Normal to have small amount of urobilinogen in urine

Large amount suggests that urobilinogen production has significantly increased

Question 18

Give 2 examples of underlying conditions that are indicated when there is a large amount of urobilinogen in urine?

Answer 18

Haemolytic disease such as anaemia which is causing more RBCs to die

Hepatitis or cirrhosis, which damages liver so that less urobilinogen is reabsorbed

Question 19

Give 2 examples of underlying conditions that are indicated where there is very little/no urobilinogen in urine?

Answer 19

Blockage in bile ducts between liver and gallbladder

Blockage between gallbladder and intestines

Question 20

When are ketones produced in the body?

Answer 20

Produced when fat is used as energy source instead of carbohydrates

Question 21

What is ketoacidosis?

Answer 21

Metabolic state of excessive ketone levels in blood, which makes it more acidic

Question 22

How does starvation ketoacidosis occur, and why does this lead to ketonuria?

Answer 22

Body hasn’t received glucose as its primary source of energy for a prolonged period, so uses fat instead

Excess ketones are excreted in urine

Question 23

How does diabetes ketoacidosis cause ketonuria?

Answer 23

Body doesn’t produce enough insulin to break down glucose, so hormones are released to break down fats instead for energy

Excess ketones excreted in urine

Question 24

Does diabetic ketoacidosis tend to affect type 1 or type 2 diabetes more?

Answer 24

Type 1, as pancreas makes no insulin but in type 2 the pancreas still makes little insulin until resistance develops

Question 25

How does ketoacidosis occur in pregnancy, and cause ketonuria?

Answer 25

Increased insulin resistance and lipolysis, so overall more fats are broken down which causes excessive ketone levels

Question 26

What is the glucose level in normal urine?

Answer 26

Little to no (undetectable) glucose in urine

Question 27

Give 3 possible causes of glucosuria?

Answer 27

Kidney damage Pregnancy Diabetes

Question 28

Why does diabetes cause glucosuria?

Answer 28

Not enough insulin to convert glucose into glycogen, so blood glucose levels become too high and kidney filters excess out into urine

Question 29

Why does pregnancy cause glucosuria?

Answer 29

Increased insulin resistance causes blood glucose levels to become too high, so excess is excreted in urine

Question 30

Why does kidney damage cause renal glucosuria?

Answer 30

Often when proximal tubule dysfunction occurs, causes impaired reabsorption of glucose, so it is excreted in urine when it shouldn't be

Question 31

How can high vitamin C/ascorbic acid levels in urine produce false negative results of urinalysis, and in particular what 4 substances are affected?

Answer 31

Ascorbic acid interferes with redox reactions of dye indicators for haemoglobin in blood cells, glucose, nitrite, bilirubin presence Produces false negative results and these 4 clinical findings are overlooked

Question 32

Give one common reason for high ascorbic level in urine, and does this cause a visible change to urine?

Answer 32

High vitamin C level in urine due to consuming high amount of food containing vitamin C Urine is dark orange

Question 33

What substance is the precursor of nitrites, and how are nitrites formed?

Answer 33

Nitrates are converted to nitrites by certain nitrate-reducing bacteria such as gram-negative bacteria

Question 34

If there is a high nitrite level in urine, can you confirm that there is an UTI?

Answer 34

Nitrituria is usually a sign of UTI presence, but can also cause false negative test

Question 35

How can urinalysis produce a false negative result for nitrituria?

Answer 35

Some bacteria cause UTI but don't convert nitrate into nitrite, so this will have negative result Even if there isn't nitrituria the patient can still have an UTI

Question 36

What substance is detected in urine that are produced by white blood cells?

Answer 36

Leukocyte esterase

Question 37

Is high leukocyte esterase level in urine always caused by an UTI?

Answer 37

No, elevated leukocyte esterase can also be due to kidney stones, inflammatory conditions such as SLE, tumour

Question 38

Do all UTIs cause elevated leukocyte esterase in urine?

Answer 38

No, 20% of UTI cases have negative result for leukocyte esterase

Question 39

Give 4 examples of medications that can cause high leukocyte esterase level in urine, even if there is no UTI?

Answer 39

PPIs NSAIDs Some antibiotics Steroids

Question 40

What is specific gravity of urine?

Answer 40

Measure of urine concentration and density compared to water

Question 41

What is the correlation between urine concentration and specific gravity?

Answer 41

The higher the urine (solute) concentration, the higher the specific gravity

Question 42

Explain 3 causes of high specific gravity?

Answer 42

Diabetes, due to glucosuria which increases urine concentration Dehydration, as lower water concentration causes higher urine concentration Heart failure, increased urine albumin excretion (UAE) caused by cardiovascular events increases urine concentration

Question 43

What is diabetes insipidus?

Answer 43

Rare condition that causes fluid imbalance, causes frequent urination and constant thirst Not related to type 1 and 2 diabetes

Question 44

Explain 3 causes of low urine specific gravity?

Answer 44

Diabetes insipidus, absence/decrease of anti-diuretic hormone causes water to not be reabsorbed and it is excreted in urine, producing low urine concentration Excessive fluid intake causes dilute urine due to high water concentration Acute tubular necrosis

Question 45

What is the complete pH range of urine, and what is the normal pH found in most individuals?

Answer 45

Urine pH range 4.5-8 normal urine is slightly acidic (5.5-6.5)

Question 46

What substance does urine pH tend to reflect the pH of?

Answer 46

Blood pH

Question 47

Give 2 underlying conditions that can cause acidic urine?

Answer 47

Septic acidosis Diabetes acidosis

Question 48

What common underlying condition can cause alkaline urine?

Answer 48

Systemic alkalosis

Question 49

What is the proportion of protein in normal urine?

Answer 49

Very little/trace amount of protein

Question 50

Give 4 examples of underlying conditions that can cause proteinuria?

Answer 50

CKD SLE Hypertension RA

Question 51

What is microscopic haematuria?

Answer 51

Blood is not visible in urine but is detected by urine dipstick

Question 52

Give 4 examples of causes that can cause haematuria?

Answer 52

UTI Kidney stones Clotting disorders Tumours

Question 53

What is a visible change in urine that indicates proteinuria?

Answer 53

Frothy urine

Question 54

Is you suspect that a patient has sepsis, should you still do a urine dipstick?

Answer 54

No, take urine cultures and immediately start patient on antibiotics then send patient to hospital

Question 55

What is the age cutoff for doing an urine dipstick, and why is it at this age?

Answer 55

Aged 65, as half of patients 65 or over/with catheter have asymptomatic bacteriuria (bacteria in stomach that doesn’t cause infection)