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Flashcards in urinalysis Deck (48):
1

What is a clean catch urine ssample

collected midstream

2

Methods of urine collection

random collection is taken at any time of day with no precautions (urine may be dilute, isotonic or hypertonic), eraly morning sample before ingestion of fluids (hypertonic), catheterization of bladder or suprapubic needle aspiration of bladder

3

What causes foul, sweet, fruity or maple-syrup like smelling urine

Foul, offensive: Old specimen, pus or inflammation. Sweet: Glucose. Fruity: Ketones. Maple syrup-like: (Maple Syrup Urine Disease)

4

What causes deep yeelo, yello-green, red, brownish-red and brownish-black colored urine?

Deep Yellow: Concentrated Urine, Riboflavin. Yellow-Green: Bilirubin / Biliverdin. Red: Blood / Hemoglobin. Brownish-red : Acidified Blood (Acute GN). Brownish-black: Homogentisic acid (Melanin)

5

How is glucose detected by urine dipstick?

Glucose oxidase converts glucose + water and O2 to gluconic acid and peroxide. Then, Horseradish peroxidase converts peroxide + KI (also on the strip) to KIO3 and water, then the oxygen liberated binds with dye forming a colored substrate

6

False negative glucose urine dipstick

As ascorbic acid is an oxygen acceptor and most likely to be present in large amounts in the urine of pregnant women, this will cause a false-negative result. Also, this can not detect sugars other than glucose, so not beneficial in newborn screens

7

Another method used to detect sugars

CuSO4 can detect reducing sugars: Galactose (galactosemias), fructose (fructose intolerance), lactose (lactase deficiency), pentoses (essential pentosuria), maltose (non-pathogenic). NOT sucrose b/c it is not reducing

8

How is bilirubin detected by urine dipstick?

Bilirubin combines with a diazo salt in an acidic medium to form azobilirubin which forms a light-dark tan color.

9

False negative and positive bilirubin are caused by…

Indican (indoxyl sulfate) will cause a false-positive result, while ascorbate will cause a false-negative result

10

Limitations of urine bilirubin dipstick

Only measure direct bilirubin (which correlates with urobilinogen and serum bilirubin), not indirect. Interference can occur with prolonged exposure of sample to light.

11

Other methods for measuring bilirubin

Ictotest (more sensitive tablet version of same assay) and serum test for total and direct bilirubin

12

How are ketones detected by urine dipstick?

The ketones (acetoacetate) reacts with nitroprusside to form a purple color Also detects acetone but not beta-hydroxybutyrate

13

What causes ketones in urine

Diabetic ketosis or other form of calorie deprivation

14

Limitations of urine ketone detection

Interference can occur with expired reagents(due to degradation with exposure to moisture in air) and it only measures acetoacetate, not other ketone bodies.

15

Other methods for urine keytone detection

Ketostix (more sensitive tablet version of same assay) and serum glucose measurement to confirm Diabetic ketoacidosis.

16

How is specific gravity measured by urine dipstick?

by measuring the change in pKa of polyelectrolytes in relation to ionic concentration

17

What is the normal range for urine specific gravity

1.003-1.035

18

Uses and limitations of urine specific gravity

Useful for diabetes insipidus. Limitations: alkaline urine interferes with test and does not measure non-ionized solutes such as glucose.

19

Other methods for urine specific gravity detection

refractometry, hydrometer, osmolality measurement

20

What will show up as a positive in the urine blood dipstick

RBCs, free hemoglobin or free myoglobin. While hemoglobin and RBCs are normally too large to pass through glomerulus, myoglobin passes freely through glomerulus.

21

How is blood detected by urine dipstick

pseudoperoxidase reaction, which is more sensitive to hemoglobin and myoglobin than intact RBCs.

22

Describe urine in hematuria vs hemoglobinuria

In cases of hematuria, the urine is red and cloudy, but will clear if centrifuged.Hemoglobinuria will have reddish brown urine that does not become clear after centrifugation

23

Normal range of urine pH, and causes of high/low pH

Normal is 4.5-8.0. Acidic urine 8.0 occurs in renal tubular acidosis.

24

Interference of urine pH test

bacterial overgrowth (alkaline or acidic), or “run over effect” effect of protein pad on pH indicator pad where buffers from protein area of strip spill over to pH area and make pH appear more acidic than it really is.

25

Other methods for urine pH

Acidity titer and blood gases

26

define proteinuria

>150mg/ day protein in urine.

27

How are proteins measured by urine dipstick and its limitations

Bromophenol blue is used as an indicator dye. It is most sensitive to albumin and interference occurs with highly alkaline urine.

28

Other tests for urine protein detection

sulfosalicylic acid can detect albumins, globulins, and Bence Jones protein. Urine protein electrophoresis

29

Which proteins can be found in normal urine

albumin, Tamm-Horsfall, immunoglobulins, secretory IgA all at small amounts

30

What is urobilinogen

Urobilinogen is formed by intestinal bacteria from the breakdown of conjugated bilirubin, and it is usually excreted in feces. However a small amount may be reabsorbed and excreted in urine

31

How is urobilinogen detected on urine dipstick

based on a modified Ehrlich reaction, in which p-dimethyl amino benzaldehyde in conjunction with a color enhancer reacts with urobilinogen in a strongly acid medium to produce a pink-red color. A positive test response indicates normal enterohepatic circulation of biliary pigments. High concentrations of biliary pigments may occur in hemolytic crisis, or cases of hepatic or intestinal dysfunction. Low indicaties bile obstruction

32

Causes of a false positive and false negative urobilinogen urine test

A false positive test result may occur if the temperature of the reagent strip is elevated. A false negative test result may occur if there is formalin residue in the collection container, or if the sample is old, because urobilinogen is very unstable when exposed to light and air.

33

What causes nitrites in the urine

A positive nitrite test indicates that bacteria may be present in significant numbers in urine. Gram negative rods such as E. coli are more likely to give a positive test.

34

What causes positive leukocyte esteraste in urine

A positive leukocyte esterase test results from the presence of white blood cells either as whole cells or as lysed cells. If negative, there is no need t loo for further signs of infection

35

Causes of false positive and false negative leukocyte esterase in urine

False positive test results also may occur in the event of vaginal contamination. False negative test results may develop if the patient has been treated with high doses of antibiotics. Glucosuria or increased urine specific gravity may cause false negative test results

36

Preservation of cells/casts for microscopic analysis

Cells and casts begin to disintegrate in 1 - 3 hrs. at room temp. Refrigeration for up to 48 hours (little loss of cells).

37

For a high power field, what is the definition of abnormal: erythrocytes, leukocytes, renal tubular cells , bacteria, neutrophils

Per high power field (400x): > 3 erythrocytes, >5 leukocytes, >2 renal tubular cells, >10 bacteria, >1 neutrophil per 3 HPF

38

For low power field, what is the definition of abnormal: hyaline/granular casts, squamous cells, RBC/WBC casts

per low power field (200x): >3 hyaline casts or >1 granular cast, >10 squamous cells (contamination), any number of RBC/WBC casts

39

Causes of hematuria and dysmorphic RBCs

glomerular damage, tumors which erode the urinary tract anywhere along its length, kidney trauma, urinary tract stones, renal infarcts, acute tubular necrosis, upper and lower urinary tract infections, nephrotoxins, and physical stress and contamination. dysmorphic RBCs are found in glomerular disease where passage through abnormal glomerulus distorts the RBC shape

40

Oval fat bodies

renal tubular epithelial cells that contain numerous fat droplets and exhibit a Maltese cross configuration by polarized light microscopy

41

Where are casts formed

distal convoluted tubule or the collecting duct

42

What are hyaline casts

composed primarily of a mucoprotein (Tamm-Horsfall protein) secreted by tubule cells. The Tamm-Horsfall protein secretion, forms hyaline casts in the distal collecting duct. Most casts are made of Tamm-Horsfall mucoprotein

43

Factors favoring protein cast formation

low flow rate, high salt concentration, and low pH, all of which favor protein denaturation and precipitation, particularly that of the Tamm-Horsfall protein.

44

Cylindroids

Protein casts with long, thin tails formed at the junction of Henle's loop and the distal convoluted tubule

45

What are granular and waxy casts? Broad casts?

When cellular casts remain in the nephron for some time before they are flushed into the bladder urine, the cells may degenerate to become a coarsely granular cast, later a finely granular cast, and ultimately, a waxy cast They are derived from renal tubular cells and are seen in end stage chronic renal disease

46

Telescoped urinary sediment and what cuases is

red cells, white cells, oval fat bodies, and all types of casts are found in more or less equal profusion. 1) lupus nephritis 2) malignant hypertension 3) diabetic glomerulosclerosis, and 4) rapidly progressive glomerulonephritis

47

Causes of fatty casts

nephrotic syndrome

48

Normal crystals and abnormal crystals

Normal: calcium oxalate, triple phosphate crystals and amorphous phosphates. Uncommon/abnormal: cystine crystals in urine of neonates with congenital cystinuria or severe liver disease, tyrosine crystals with congenital tyrosinosis or marked liver impairment, or leucine crystals in patients with severe liver disease or with maple syrup urine disease.