Urinalysis

Question 1

Specimen Collection
•Specimen should be collected by a clean ——— catch or ———-.
•The urine should be freshly collected into a clean ,dry container with a tight-fitting cover.
•It must be analyzed within —hr of collection if held in at room temperature.
•Can be analyzed not more than —hr if refrigerated at —to— C.
•The urine container must be ——— if the urine is to be cultured.
•Specimen for routine urinalysis are usually ——-,or ——- collection.

Answer 1

Specimen Collection
•Specimen should be collected by a clean midstream catch or catheterization.
•The urine should be freshly collected into a clean ,dry container with a tight-fitting cover.
•It must be analyzed within 1hr of collection if held in at room temperature.
•Can be analyzed not more than 8hr if refrigerated at 20-80 C.
•The urine container must be sterile if the urine is to be cultured.
•Specimen for routine urinalysis are usually random,or spot collection.

Question 2

Color intensity of urine correlates with————.

Answer 2

Color intensity of urine correlates with concentration.

Question 3

Various colors observed in urine are as a result of different pigmentation.
•Yellow and amber-———-.
•Yellow-brown to green-———-
•Red and brown after standing –———.
•Reddish-brown in fresh specimen-——-.
•Brownish-black after standing –——-and ———-

Answer 3

Various colors observed in urine are as a result of different pigmentation.
•Yellow and amber-urochomes.
•Yellow-brown to green-bile pigment oxidation.
•Red and brown after standing –porphyrins.
•Reddish-brown in fresh specimen-heamoglobin or RBC.
•Brownish-black after standing –alkaptonuria and malignant melanoma.

Question 4

Odor
•Ordinarily has little significance.
•Characteristic pungent odor of fresh urine is due to ———- acids,in contrast to the typical ———- odor of urine that has been allowed to stand.
•UTI impart a noxious,——— smell to urine.
•Urine of diabetics often smells ——— as a result of ——-

Answer 4

Odor
•Ordinarily has little significance.
•Characteristic pungent odor of fresh urine is due to volatile aromatic acids,in contrast to the typical ammonia odor of urine that has been allowed to stand.
•UTI impart a noxious,fecal smell to urine.
•Urine of diabetics often smells fruity as a result of ketones.

Question 5

Turbidity
•The cloudiness of urine specimen depends on — and dissolved ——- composition.
•generally may be due to gross ——.
•Smoky appearance is seen in ——-.
•Threadlike cloudiness is observed when the specimen is full of ———.
•In alkaline urine-precipitate of ——— and ———.
•In acidic urine-———-

Answer 5

Turbidity
•The cloudiness of urine specimen depends on pH and dissolved solids composition.
•generally may be due to gross bacteriuria.
•Smoky appearance is seen in heamaturia.
•Threadlike cloudiness is observed when the specimen is full of mucus.
•In alkaline urine-precipitate of amorphous phosphates and carbonates.
•In acidic urine-amorphous urates.

Question 6

Volume
It indicates the balance between ——— and ——— from lungs,sweat and intestine.
•Most adults produce from — to—-ml every —hrs with average of ——L/person.
•Polyuria –caused by which diseases
•Anuria or Oliguria –caused by which diseases

Answer 6

It indicates the balance between fluid ingestion and water loss from lungs,sweat and intestine.
•Most adults produce from 750-2000ml every 24hrs with average of 1.5L/person.
•Polyuria –DM,DI,CRF,Acromegaly and Myxedema.
•Anuria or Oliguria –Nephritis,ESRD,Urinary tract obstruction and ARF.

Question 7

Specific gravity
•Normal range for urinary SG is ——— to -———.
•SG of urine is the weight of —ml of urine in grams divided by the ——— of 1ml of water.
•It varies with the ——- load to be excreted.
•It is used to assess the state of ———/——— of an individual or
•As an indicator of the ———- ability of the kidneys.

Answer 7

Specific gravity
•Normal range for urinary SG is 1.005-1.030.
•SG of urine is the weight of 1ml of urine in grams divided by the weight of 1ml of water.
•It varies with the solute load to be excreted.
•It is used to assess the state of hydration/dehydration of an individual or
•As an indicator of the concentrating ability of the kidneys.

Question 8

Laboratory methods
•Most commonly encountered analytic method consists of a ———,or ———meter.
•This operates on the principle that the refractive index of a urine specimen will vary directly with the total amount of ——— in the sample.
•It measures the ——- of urine as compared with —— on a scale calibrated directly into the ocular and viewed while held up to a light source.
•Correct calibration is vital for ———.
•Unlike the refractometer,dipsticks measure only ——— and do not take into account of ——- and ———

Answer 8

Laboratory methods
•Most commonly encountered analytic method consists of a refractometer,or total solid meter.
•This operates on the principle that the refractive index of a urine specimen will vary directly with the total amount of dissolved solids in the sample.
•It measures the refractive index of urine as compared with water on a scale calibrated directly into the ocular and viewed while held up to a light source.
•Correct calibration is vital for accuracy.
•Unlike the refractometer,dipsticks measure only ionic solutes and do not take into account of glucose and protein

Question 9

Disease correlation
•Normal SG-——- to ———.
•Dilutespecimen-—— to ——-
,Concentrated samples-——- to -——-.
•SG varies in pathologic states.
•Low SG-DI(—- to -——-),other diseases seen are:
•High SG –diseases seen are:
•SG will increase about —- unit for every —% change in glucose concentration and about —— units for every —% change in protein.
Fixed SG(isosthenuria) around ——- is observed in severe renal damage in which the kidneys excrete urine that is ———with the plasma.

Answer 9

Disease correlation
•Normal SG-1.005-1.030.
•Dilute specimen-1.000-1.010,Concentrated samples-1.025-1.030.
•SG varies in pathologic states.
•Low SG-DI(1.001-1.003),Pyelonephritis and Glomerulonephritis.
•High SG –DM,CHF,Dehydration,Adrenal insufficiency,liver Dx and Nephrosis.
•SG will increase about 0.004 unit for every 1% change in glucose concentration and about 0.003 units for every 1% change in protein.
Fixed SG(isosthenuria) around 1.010 is observed in severe renal damage in which the kidneys excrete urine that is iso-osmotic with the plasma.

Question 10

pH
•Normal urine pH falls within the range of — to —.
•Determination of urinary pH must be performed on fresh specimens because of the significant tendency of urine to ——— on standing.
•Acidic urine <— is primarily caused by ——- which are excreted as salts conjugated —,— and —.
•Acidity also reflects the excretion of the ———acids pyruvate,lactate and citrate.
•Pathologic states with increased acidity include:———-&———-

Answer 10

pH
•Normal urine pH falls within the range of 4.5-8.0.
•Determination of urinary pH must be performed on fresh specimens because of the significant tendency of urine to alkalinize on standing.
•Acidic urine <7.0 is primarily caused by phosphates which are excreted as salts conjugated Na,K and Ca.
•Acidity also reflects the excretion of the nonvolatile metabolic acids pyruvate,lactate and citrate.
•Pathologic states with increased acidity include:Systemic acidosis-DM and Renal tubular acidosis.

Question 11

Ph contd
•Alkaline urine >— is observed postprandially.
•Normal reaction to the acidity of ——— dumped into the duodenum and then into the circulation.
•May follow the ingestion of ——or——
•also be due to ——— infections and ——— contamination.
•Alkaline urine is also found in ———

Answer 11

PH CONTD
􏰀 Alkaline urine >7.0 is observed postprandially.
􏰀 Normal reaction to the acidity of gastric HCL dumped
into the duodenum and then into the circulation.
􏰀 May follow the ingestion of alkaline food or medication.
􏰀 Urinary tract infections and bacterial contamination.
􏰀 Alkaline urine is also found in Fanconi’s syndrome.

Question 12

CHEMICAL ANALYSES
Routine urine analysis is rapid and easily performed with commercially available ——— or ———.
These strips are plastics coated with different ——— directed toward different ———.
Abnormal results are followed up by specific ——— or ——— urine assays.
The analytes routinely tested are:

Answer 12

CHEMICAL ANALYSES
Routine urine analysis is rapid and easily performed with commercially available reagent strips or dipsticks.
These strips are plastics coated with different reagent bands directed toward different analyses.
Abnormal results are followed up by specific quantitative or confirmatory urine assays.
The analytes routinely tested are: Glucose
Protein
Ketones
Nitrite
Leukocyte Esterase
Hemoglobin/Blood and Bilirubin/Urobilinogen.

Question 13

SEDIMENT EXAMINATION
􏰀 Centrifuged, decanted urine ——-, leaves behind a sediment of formed elements that is used for microscopic examination. They are:

Answer 13

SEDIMENT EXAMINATION
􏰀 Centrifuged, decanted urine aliquot, leaves behind a sediment of formed elements that is used for microscopic examination. They are:
􏰀 Cells
􏰀 Red Blood Cells
􏰀 White Blood Cells
􏰀 Epithelial cells
􏰀 Miscellaneous elements
􏰀 Bacteria
􏰀 Cast
􏰀 Hyaline
􏰀 Granular
􏰀 Cellular
􏰀 crystals

Question 14

CELLS
􏰀 Evaluation is best accomplished by ——— and then taking the average of at least —- microscopic fields for cellular elements.

Answer 14

counting
10.

Question 15

RED BLOOD CELLS
􏰀 Erythrocytes >—to—/HPF are considered abnormal.
􏰀 May result from simple severe ———/———contamination.
􏰀 May be indicative of ——— esply from vascular injury,renal/urinary calculi obstruction,pyelonephritis or cystitis.
􏰀 Heamaturia +leukocytes=———.

Answer 15

RED BLOOD CELLS
􏰀 Erythrocytes >0-2/HPF are considered abnormal.
􏰀 May result from simple severe exercise /menstrual bld contamination.
􏰀 May be indicative of Trauma esply from vascular injury,renal/urinary calculi obstruction,pyelonephritis or cystitis.
􏰀 Heamaturia +leukocytes-Infection.

Question 16

WHITE BLOOD CELLS
􏰀 Leukocytes >—to—/HPF are considered abnormal.
􏰀 They are usually ———- phagocytes-segmented ——-.
􏰀 They are observed when there is ————,—— or inflammation of any type.

Answer 16

WHITE BLOOD CELLS
􏰀 Leukocytes >0-1/HPF are considered abnormal.
􏰀 They are usually polymorphonuclear phagocytes-segmented neutrophils.
􏰀 They are observed when there is Acute glomerulonephritis,UTI or inflammation of any type.

Question 17

EPITHELIAL CELLS
􏰀 Several types are frequently encountered in normal urine.
􏰀 Due to continuously sloughed off the lining of ——- and ——-.
􏰀 Large,flat,squamous vaginal epithelia-——— specimen.
􏰀 Renal epith cells are round,—-nucleated cells ,if>—/HPF-Active tubular injury.
􏰀 ——— bladder epith may be flat,cuboidal,or columnar-occassionally.
􏰀 Large numbers will be seen only in cases of ———-,———— or ———-.

Answer 17

EPITHELIAL CELLS
􏰀 Several types are frequently encountered in normal urine.
􏰀 Due to continuously sloughed off the lining of nephrons and urinary tract.
􏰀 Large,flat,squamous vaginal epithelia-female specimen.
􏰀 Renal epith cells are round,uninucleated cells ,if>2/HPF-Active tubular injury.
􏰀 Transitional bladder epith may be flat,cuboidal,or columnar-occassionally.
􏰀 Large numbers will be seen only in cases of urinary catheterization,bladder inflammation or neoplasm.

Question 18

MISCELLANEOUS
􏰀 Usually not reported because they are of no pathologic significance.
􏰀 Spermatozoan-M and F,in Male-———abnormalities.
􏰀 Yeast can also be seen T or F
􏰀 Parasites-fecal(——- organism) and vaginal(——— organism )
􏰀 True urinary parasite –ova of the trematode of ———— organism .
􏰀 Usually occur with significant ———-.

Answer 18

MISCELLANEOUS
􏰀 Usually not reported because they are of no pathologic significance.
􏰀 Spermatozoan-M and F,in Male-prostate abnormalities.
􏰀 Yeast
􏰀 Parasites-fecal(Enterobium vermicularis) and vaginal(T.vaginalis)
􏰀 True urinary parasite –ova of the trematode S.heamatobium.
􏰀 Usually occur with significant heamaturia.

Question 19

BACTERIA
􏰀 Normal urine is sterile with no bacteria.
􏰀 Large no of orgs/small nos+WBCs and UTI symptoms =——-
􏰀 Clinical significant bacteriuria->—orgs/HPF or—or > registered on a microbiologic ——- count.
􏰀 Most seen pathogen are gram—coliforms e.g —— and ——-.
􏰀 Asymptomatic bacteriuria seen in ——-/,———- and Pt with ——.

Answer 19

BACTERIA
􏰀 Normal urine is sterile with no bacteria.
􏰀 Large no of orgs/small nos+WBCs and UTI symptoms -True infection.
􏰀 Clinical significant bacteriuria->20orgs/HPF or10^5 or > registered on a microbiologic colony count.
􏰀 Most seen pathogen are gram –ve coliforms e.g E.coli and Proteus.
􏰀 Asymptomatic bacteriuria-young girls,pregnant woman and Pt with DM.

Question 20

CASTS
􏰀 They are precipitated,———— impressions of the nephrons.
􏰀 They comprise ——— mucoprotein from the tubular epithelia in the ascending ————.
􏰀 Casts form whenever there is sufficient renal ——-, increased urine —— or ——- concentration and decreased urine ——.
􏰀 Casts should be examined under (low/high?) power and are most often located around the ——— of the ——-.

Answer 20

CASTS
􏰀 They are precipitated,cylindrical impressions of the nephrons.
􏰀 They comprise Tamm-Horsfall mucoprotein from the tubular epithelia in the ascending loop of Henle.
􏰀 Casts form whenever there is sufficient renal stasis, increased urine salt or protein concentration and decreased urine pH.
􏰀 Casts should be examined under low power and are most often located around the edges of the coverslip.

Question 21

HYALINE
􏰀 The matrix of these casts is —— and ——,without embedded ——- or ——- matter.
􏰀 May be difficult to visualize unless a ———- lamp is used.
􏰀 Presence indicates ———
􏰀 Leakage may be temporary( as a result of: ) or may be permanent.
􏰀 Their occassional presence is considered pathologic.T or F

Answer 21

HYALINE
􏰀 The matrix of these casts is clear and gelatinuos,without embedded cellular or particulate matter.
􏰀 May be difficult to visualize unless a high-intensity lamp is used.
􏰀 Presence indicates glomerular leakage of protein.
􏰀 Leakage may be temporary( fever, upright posture, dehydration, or emotional stress) or may be permanent.
􏰀 Their occassional presence is not considered pathologic.

Question 22

GRANULAR
􏰀 Casts are descriptively classified as either —— or finely ———.
􏰀 Is simply a matter of the amount of degeneration that the ———- have undergone.
􏰀 Occasional presence is pathologic.T or F
􏰀 Large nos may be found in chronic —— toxicity and ——-

Answer 22

GRANULAR
􏰀 Casts are descriptively classified as either coarse or finely granular.
􏰀 Is simply a matter of the amount of degeneration that the epithelial cell inclusions have undergone.
􏰀 Occasional presence is not pathologic.
􏰀 Large nos may be found in chronic lead toxicity and pyelonephritis

Question 23

CELLULAR
􏰀 Several different types of casts are included in this category.
􏰀 RBC Casts-(not always/always?) pathologic, diagnostic for glomerular ———that results in renal ———,seen in ——,———-,———- and acute ———-.
􏰀 WBC Casts-(not always/always?) pathologic, diagnostic for inflammation of the nephrons.observed in ——-, ——, and acute ———-.

Answer 23

CELLULAR
􏰀 Several different types of casts are included in this category.
􏰀 RBC Casts-always pathologic, diagnostic for glomerular inflammation that results in renal heamaturia,seen in SBE,kidnry infarcts,collagen dxs and acute glomerulonephritis.
􏰀 WBC Casts-always pathologic, diagnostic for inflammationof the nephrons.observed in pyelonephritis, nephrotic syn, and acute glomerulonephritis.

Question 24

CELLULAR CONTD
􏰀 Epithelial cell casts-sometimes formed by fusion of renal tubular ——- after ———.
􏰀 Many are observed in severe desquamative processes and renal stases that occur in heavy —— poisoning, ——-toxicity, ——-,——- syn and ———.
􏰀 Waxy casts-uniformly ——ish, refractile, and ——- appearing, with sharply defined , often broken ——.
􏰀 Almost always pathologic.T or F
􏰀 Indicate tubular ———.
􏰀 Formed by renal —— in the collecting ducts –—— disease .

Answer 24

CELLULAR CONTD
􏰀 Epithelial cell casts-sometimes formed by fusion of renal tubular epithelia after desquamation.
􏰀 Many are observed in severe desquamative processes and renal stases that occur in heavy mrtal poisoning, renal toxicity, eclampsia,nephrotic syn and amyloidosis.
􏰀 Waxy casts-uniformly yellowish, refractile, and brittle appearing, with sharply defined , often broken edges.
􏰀 Almost always pathologic.
􏰀 Indicate tubular inflammation.
􏰀 Formed by renal stasis in the collecting ducts –CRF.

Question 25

CELLULAR CONT
􏰀 Fatty casts-abnormal, ——, —— casts with ——- inclusions that appear as ——- globules of different sizes.

Answer 25

CELLULAR CONT
􏰀 Fatty casts-abnormal, coarse, granular casts with lipid inclusions that appear as refractile globules of different sizes.

Question 26

CRYSTALS
􏰀 Acid environment:
Include:

􏰀Alkaline environment:
Include:

Answer 26

CRYSTALS
􏰀 Acid environment:
􏰀 Ca oxalate
􏰀 Amorphous urates
􏰀 Uric acid.
􏰀 Cholesterol
􏰀 Cystine

􏰀 Alkaline environment:
􏰀 Amorphous phosphates
􏰀 Calcium carbonate
􏰀 Triple phosphate
􏰀 Ammonium biurates

Question 27

CRYSTALS
􏰀 Acid environment:
􏰀 Ca oxalate-normal ——-,may have almost like ——- appearance.
􏰀 Amorphous urates-normal ——— colour masses with a grain of ——- appearance.
􏰀 Uric acid –normal ——- to ——- colour that appear in extremely irregular shapes,such as ——, ——-, or ——-.
􏰀 Cholesterol –clear, flat, ——— plates with ——— corners may be seen in ——- syn.
􏰀 Cystine –highly pathologic.appear colorless, refractile, nearly flat ———, somehow similar to —— seen in ——- and ———-.

Answer 27

CRYSTALS
􏰀 Acid environment:
􏰀 Ca oxalate-normal octahedrons,may have almost like starlike appearance.
􏰀 Amorphous urates-normal yellow-red masses with a grain of sand appearance.
􏰀 Uric acid –normal yellow to red-brown that appear in extremely irregular shapes,such as rosettes, prisms, or rhomboid.
􏰀 Cholesterol –clear, flat, rectangular plates with notched corners.may be seen in neprotic syn.
􏰀 Cystine –highly pathologic.appear colorless, refractile, nearly flat hexagons, somehow similar to uric acid.seen in homocystinuria and cystinuria.

Question 28

CRYSTALS CONTD
􏰀 Alkaline environment:
􏰀 Amorphous phosphates-fine,
colorless masses, resembling ——.
􏰀 Calcium carbonate-small, colorless —— os ——— shape.
􏰀 Triple phosphate-colorless —- of — to — sides, resembling a “———”.
􏰀 Ammonium biurates-——-,——— shape or “———”.

Answer 28

CRYSTALS CONTD
􏰀 Alkaline environment:
􏰀 Amorphous phosphates-fine,
colorless masses, resembling sand.
􏰀 Calcium carbonate-small, colorless dumbbells os spheres.
􏰀 Triple phosphate-colorless prisms of 3-6 sides, resembling a “coffin lids”.
􏰀 Ammonium biurates-spiny,yellow-brown spheres or “thorn apples”.

Question 29

INDICATIONS FOR URINALYSIS
􏰀
􏰀
􏰀

Answer 29

INDICATIONS FOR URINALYSIS
􏰀 Assessment of renal status
􏰀 Quick indicator of an individual’s glucose status.
􏰀 Hepatic: biliary function