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Diagnostic Studies, Unit III > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

Urinalysis

(define, 2 advantages, 2 uses)

A

Def: fluid biopsy of the urinary tract that analyzes the physical, chemical, and microscopic** **components of urine

Advantages:

  1. Non-invasive
  2. Relatively low cost

Uses:

  1. Dx/monitor renal/urinary tract disease
  2. Detect metabolic/systemic diseases indrectly related to kidneys
    • (ex - diabetes is often dx c + GLU on urine dipstick)
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2
Q

Urine Composition

(4 parts, 4 variation factors)

A

Components:

  1. Water (main component)
  2. Oranic substances
    • Urea, creatine, uric acid, glucose, protein, hormones, vitamins, metabolized meds
  3. Inorganic substances
    • Primarily chloride, sodium, potassium
  4. Non-dissolved substances
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3
Q

Common Kidney/Urologic Conditions

(8)

A
  1. Glomerular Diseases
  2. Nephrotic Syndrome
  3. Hematuria/Hemoglobinuria
  4. Transfusion Reaction
  5. Azotemia (increased urea nitrogen)
  6. Diabetes
  7. Urinary Tract Infection (UTI)
  8. Liver Function
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4
Q

Urinalysis Process

(3 steps)

A
  1. Direct visual observation for the following
    • color
    • clarity
    • quantity
  2. Chemical testing via dipstick
  3. Microscopic analysis
    • ​automated
    • manual
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5
Q

Urine Color Analysis

(normal, 2 abnormals)

A

Normal - pale yellow to dark yellow or amber

Abnormal -

  • Red/Red-brown: food coloration, drugs, hemoglobin, myoglobin
  • Black/Brown: malignant melanoma, alkaptonuria
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6
Q

Urine Turbidity

(4 causes, concurrent observation)

A

Causes:

  1. Cellular material
  2. Protein
  3. Crystals
  4. Radiographic dye

Concurrent Observation: increased specific gravity

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7
Q

Specific Gravity

(testing method, what’s analyzed, normal plasma and urine values)

A

Method:

  1. Dipstick analysis
  2. Refractometer

Analyzed:

  1. Urine density (compared to water density)
  2. Ultimately, renal integrity
    • ex - if sp gravity <1.022 after 12 hour food/water fast, possible renal concentrating disability

Normals:

  • Urine = 1.002-1.035
    • >1.035 indicates contamination or high glucose
  • Plasma = 1.010
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8
Q

Factors Affecting Urine Volume

(4, evaluation)

A

Evaluation: via 24 hr urine test

Factors:

  1. Fluid intake
  2. Fluid loss from non-renal sources
  3. Variations in ADH secretion
  4. Excretion of inc dissolved solids (salts, glucose, etc)
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9
Q

Abnml Glucose Volume

(2 categories, 2/1 causes)

A

Polyuria: >2000 mL/day

  • Diabetes (mellitus or insipidus)
    • see picture
  • ADH suppressors
    • diuretics
    • caffeine
    • alcohol

Oliguria: <500 mL/day

  • Dehydration (hypovolemia, perspiration, severe burns)
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10
Q

Urine Dipstick Analytes

(10)

A

Vary in result time from 30 seconds to 2 minutes

  1. pH
  2. Protein
  3. Glucose
  4. Ketones
  5. Blood
  6. Bilirubin
  7. Urobilinogen
  8. Nitrite
  9. Leukocyte Esterase
  10. Specific gravity
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11
Q

Reagent Strip Preparation Considerations

(3)

A
  1. Sample must be thoroughly mixed
  2. Fresh sample (<1-2 hr old or refridgerated)
  3. Timing consideration on results (results appear b/w 30s and 2 min depending on test)
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12
Q

Dipstick Analysis Specimen Integrity

(major specimen change, results on values)

A

Major Specimen Change: bacterial multiplication

Value changes

  • Increased analytes (false positives)
    • ​color
    • turbidity
    • pH
    • nitrite
    • bacteria
    • odor
  • Decreased analytes (false negatives)
    • ​glucose
    • ketones
    • bilirubin
    • urobilinogen
    • RBC
    • WBC
    • casts
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13
Q

Dipstick Abnormal Results

(4 conditions, 4/2/2/2 results)

A

This may be the first indcation of disease

  • Renal function
    1. Specific gravity
    2. Protein
    3. pH
    4. Blood
  • UTI
    1. Nitrite
    2. Leukocyte esterase
  • Carbohydrate metabolism
    1. ​Glucose
    2. Ketones
  • Liver function
    1. ​Bilirubin
    2. Urobilinogen
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14
Q

Leukocyte Esterase Dipstick Test

(function, normal result, timing)

A

Normal: negative (not a quantitiative test)

Timing: 2 minutes for results

Functions: detect WBCs in urine

  • Bacterial and non-bacterial UTI
    • ex - Trichomonas, Chlamiydia, yease, interstitial nephritis
  • Urinary tract inflammation
  • Urine cultre screening (in conjunction c nitrite, but a better predictor than nitrite)
  • Detects lysed cells
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15
Q

Nitrites

(normal result, function, false readings - 2 categories, 3/3 specifics)

A

Normal: negative (non-numerical value)

Function: detect nitrite reducing bacteria

False Readings:

  • False Negatives
    • nonreductase-containing bacteria
    • high [asorbic acid] (vitamin C supplimentation)
    • high specific gravity
  • False positives
    • old specimens (bacterial multiplication)
    • highly pigmented urine
    • contaminated collection
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16
Q

Urobilinogen

(normal, function, 2 clinically significant links)

A

Normal: 0.01-1.0

Function: quatify urobilinogen, the reabsorbed and converted intestinal bilirubin

Clinical significance:

  1. Early liver disease detection - hepatitis, cirrhosis, carcinoma
  2. Hemolytic disorder detection - excess bilirubin converted to urobilinogen, which reciruclates to liver
    • ​negative bilirubin c strong positive urobilinogen
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17
Q

Protein

(normal values, function)

A

Normal: <10 mg/dL or 100 mg/24 hr

Function: proteinuria is most indicative of renal disease

  • detect filtered low melecular weight serum proteins
  • proteins evaluated
    • albumin (smallest)
    • globulin
    • hemoglobin
    • fibrinogen
    • nucleoproteins
    • Bence Jones proteins
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18
Q

Clinical Significance, Proteinuria

A
  • Presence of protein in urine does not always indicate renal disease, BUT, additional testing is indicated to determine pathological condition
  • Clinical proteinuria = 30 mg/dL, 300 mg/24 hr
  • Variety of causes
    • Prerenal
    • Renal
    • Postrenal
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19
Q

Prerenal Proteinuria

(def, physiology, laboratory presentation)

A

Definition: Excess uremic protein due to plasma disease, not renal disease

Physiology: Transcient inc in low molecular wt plasma PRO, acute phase reactants, exceed reabsorptive capacity so they travel to urine

  • Ex - high Bence Jones pro in multiple myeloma

Presentation: Unless the proteinuria is concentrated to albumin, this will not appear on reagent strip. Protein-specific screening is indicated

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20
Q

Prerenal Tubular Disorders

(4)

A
  1. Intravascular hemolysis
  2. Muscle injury
  3. Acute phase reactants
  4. Multiple myeloma
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21
Q

Renal Proteinuria

(2 types, definitions, classification)

A
  1. Glomerular proteinuria
    • ​​def - damage to glomerular membrane, increasing pressure on filtration mechanism
    • classification - up to 4g uremic PRO/day
  2. Tubular proteinuria
    • ​​def - tubular damage that affects reabsorptive ability
    • classification - proteinuria significantly less dramatic than glomerular proteinuria
22
Q

Glomerular Proteinuria

(2 pathophysiological categories, 2/4 causative agents)

A
  • **Glomerular membrane damage, abnl substances deposit there **
    1. ​SLE
    2. Streptococcal glomerulonephritis
  • Increased pressure on filtration mechanism
    1. ​​HTN
    2. Strenuous exercise
    3. Dehydration
    4. Pregnancy, preeclampsia
23
Q

Glomerular Proteinuria Presentation

(2 categories)

A
  • Benign proteinuria (transcient)
    1. ​cold exposure
    2. exercise
    3. dehydration
    4. hyperthermia
  • Orthostatic proteinuria: benign (vertical) postural proteinuria from increased pressure on renal vn
    • frequently detected on random specimen
    • prevention
      • empty bladder before bed
      • collect specimien immediately on arising
24
Q

Tubular Proteinuria

(definition, 1 subtype c 7 causes, laboratory presentation)

A

Definition: tubular damage affecting rabsorptive ability

  • Acute tubular necrosis, caused by
    1. ​toxic substances
    2. shock
    3. trauma
    4. crushing injury
    5. heavy metal exposure
    6. viral infection
    7. Fanconi syndrome (generalized proximal confoluted tubule defect)

Presentation: proteinuria significantly milder than glomerular proteinuria

25
Q

Postrenal Proteinuria Causes

(6)

A
  1. Protein added in the lower urinary and genitourinary tract
  2. Microbial infections causing inflammations and release of interstitial fluid protein
  3. Menstrual contamination
  4. Semen / Prostatic fluid
  5. Vaginal secretions
  6. Traumatic injury
26
Q

Urine pH

(normal/abnormal values, phys signiciance)

A

Signif: kidneys are major regulators of acid-base balance

Numbers: overall 4.6-8.0, avg 6.0 [no absolute values are assigned]

  • first morning specimen = 5-6
  • postprandial (post-meal) specimen = more alkaline
  • normal fresh urine cannot reach 9, this indicates bacteria-contaminated urine
27
Q

Dietary Urine pH Changes

(3)

A

Meat = acid pH

Vegetables = alkaline pH

  • Exception = cranberry juice

Medications for urinary tract infection

  • Maintain an acid pH
28
Q

Urine pH Clinical Significance

(7)

A
  1. Respiratory/metabolic acidosis or ketosis
  2. Respiratory or metabolic alkalosis
  3. Defects in renal tubular acid/base secretion and reabsoption - renal tubular acidosis
  4. Renal calculi formation
  5. UTI tx
  6. Crystal precipitation/identification
  7. Specimen integrity determination
29
Q

Urine Blood analysis

(function, normal, false results, indication of results)

A

Function: assess kidney or urinarty tract damage better than microscopic exam

Normal: negative

False Results:

  • Negative: high asorbic acid (Vitman C), crenated RBC’s
  • Positive: menstrual contam, oxidizing detergents (improper container cleaning)

Result Interpretetation:

  1. Hematuria
    • ​intact RBC’s
    • cloudy red urine
    • sources
      • infectious disease
      • renal disorders
      • renal system trauma
  2. Hemoglobinuria
    • ​broken RBC, hemoglobin exposed
    • clear red urine
    • sources
      • transfusion rxn
      • severe burns
      • hemolytic anemia
      • paradoxical hemoglobinuria
  3. Myoglobinuria
    • ​heme-containing protein in muscle tissue
    • clear red/brown urine
    • sources
      • tissue wasting disease
      • severe trauma
30
Q

Crenated RBC

A

RBC that lost its fluid

31
Q

Hemoglobinuria vs Myoglobinuria

(5 comparisons)

A
  1. Both produce clear, red urine
  2. Both are toxic to renal tubules
  3. Hemoglobin causes red plasma; with myoglobin plasma is clear
  4. Increased CK enzymes with myoglobin
  5. Both will produce positive dipstick results
32
Q

Specific Gravity from Dipstick

(differentiation from refractometer)

A
  1. No interference (large molecules, glucose, urea, radiographic dye, plasma expanders), therefore preferred method of SG evaluation
  2. Slight elevation from PRO that can be calculated out
  3. Decreased readings c urine >6.5
    • ​interferes c indicator
    • correction - lab adds 0.005 to reading
33
Q

Ketones

(function, normal values, deviations from normal)

A

Function: indicate level of fat metabolism

Normal: negative

Positive Results - Ketonuria: appear in urine when fat is broken down to glucose for energy

  • DM (may indicate acidosis)
  • Vomiting (loss of CHO)
  • Starvation/malabsorption/low CHO diet
34
Q

Bilirubin

(function, normal value)

A

Function: early indicator of liver disaese or biliary obstruction, shows amount of RBC breakdown

Normal: negative

35
Q

Clinical Significance, Positive Bilirubin

(general, 3 specific)

A

Bilirubin appears in urine c bile duct obstruction and liver disease

  • Obstruction: bilirubin backup into circulation (no urobilinogen formation)
  • Liver Disease: conjugated bilirubin leaks back into circulation from damaged liver; some bilirubin passes to intestine
  • Hemolytic disease: increased unconjugated bilirubin indicates jaundice.
    • bilirubin = negative
    • *urobilinogen = positive *
36
Q

Glucose

(normal, false results, clinical significance)

A

Normal: <0.5 g/day in a 24 hr specimen

False Results:

  • Negative - high ascorbic acid (vitamin C)
  • Positive - oxidizing detergents (improper container cleaning)

Clinical Significance:

  • Major DM screening test
    • Gestational diabetes
  • Renal threshold = 160-180 mg/dL
  • Excess urine blood sugar = glycosuria
37
Q

Gestational Diabetes

(pathophys, results)

A

Pathophys

  • Placental hormones block insulin action
  • High fetal GLU stresses fetal pancreas

Results

  • fat baby
  • mother is prone to type II DM later
38
Q

Nondiabetic glycosuria

(5 causes)

A
  1. Hormonal disorders: pancreatitis, pancreatic cancer, acromegaly, Cushing’s syndrome, hyperthyroidism, pheochromocytoma
  2. Hormones: glucagon, epinephrine, cortisol, thyroxine, growth hormone oppose glucose
  3. Insulin: converts glucose to storage glycogen
  4. Hormones: glycogen back to glucose
  5. Epinephrine: inhibits insulin; seen with stress, cerebral trauma, and myocardial infarction

<!--EndFragment-->

39
Q

Renal Glycosuria

(4 causes)

A

<!--StartFragment-->

  1. Tubular reabsorption disorder
  2. End-stage renal disease
  3. Fanconi syndrome
  4. Temporary lowering of renal threshold in pregnancy

<!--EndFragment-->

40
Q

Clinical Significance, Urine Glucose

(11)

A
  1. Hyperglycemia-Associated
  2. Diabetes mellitus
  3. Pancreatitis
  4. Pancreatic cancer
  5. Acromegaly
  6. Cushing syndrome
  7. Hyperthyroidism
  8. Pheochromocytoma
  9. Central nervous system damage
  10. Stress
  11. Gestational diabetes
41
Q

Microscopic Urinalysis

(1 goal c 10 specifics, procedural notes)

A

Goal: Identify insoluble substances (formed elements)

  1. RBC
  2. WBC
  3. Epithelial cells
  4. Casts
  5. Bacteria
  6. Yeast; parasites
  7. Mucus
  8. Spermatozoa
  9. Crystals
  10. Artifacts

Procedural notes:

  • Some labs automate this but others do not
  • Less standardized than dipstick
  • Time consuming, esp when done manually
42
Q

Microscopic Screening Correlations

(7 screenings)

A

See picture

43
Q

Microscopic Urinalysis Reporting

A
  • Consistent within laboratory
    • Rare, few, moderate, many, or full field or 1+, etc. – semiquantitative
  • Casts: average per lpf
  • RBCs, WBCs: average per hpf
  • Epithelial cells, crystals, etc., in semiquantitative terms
44
Q

Microscopic Eval RBC’s

(normal value, pathology indications)

A

Normal: 0-3 or 5/hpf

Indications:

  • Damage to glomerular membrane or vascular injury to GU tract
  • More cells = more damage
45
Q

Macroscopic vs Microscopic Hematuria

A

<!--StartFragment-->

**Macroscopic - **Cloudy, red urine, advanced disease, trauma, acute infection, coagulation disorders

**Microscopic - **Clear urine, early glomerular disease, malignancy, strenuous exercise, RENAL CALCULI confirmation

<!--EndFragment-->

46
Q

Microscopic Eval, WBC’s

(normal values, pathology indicatons)

A

Normal: <5/hpf* (more in females)

Pathology: Inc urine WBC = pyuria

  • May enter thru glomerulus, trauma, amoeboid migration
  • **Report presence of bacteria **
  • Infections
    • cystitis
    • pyelonephritis
    • prostatitis
    • urethritis
  • Glomerulonephritis
  • Lupus erythematosus
  • Interstitial nephritis
  • Tumors

*high power field

47
Q

Epithelial Cells

(3 types, clinical significance)

A
  1. Squamous
  2. Urothelial (transitional)
  3. RTE - most clinically significant
    • ​indicate tubular necrosis
    • fragments indicate severe destruction
    • some causes
      • heavy metals
      • drug toxicity
      • heomglobin
      • myoglobin
      • viral infections
      • pyelonephritis
      • transplant rejection
      • salicylate poisoning
48
Q

Microscopic Urinalysis, Casts

A
  • Incresed concentration of solutes, diminished urinary flow, acid pH
  • Hyaline
    • Protein in nature; common in athletes (1-2 nl), fever, glomerulo/pyelonephritis
  • Granular
    • Renal disease
  • Waxy
    • Renal failure
49
Q

Microscopic Urinalysis, Crystals

(formation, three types c significance)

A

Formation: temperature/solute concentration/pH dependent precipitation of urine solutes

  • salts
  • organic compounds
  • medications

Crystal types:

  • Calcium oxalate
    • most common component of renal calculi
    • normal finding in lithiases
  • Liver disease crystals
    • leucine
    • tyrosine
    • bilirubin
  • Cystine
    • metabolic disorder
50
Q

Microscopic Urinalysis, Microorganisms

(3)

A
  1. Bacteria
  2. Yeast
  3. Trichomonas (parasite)

Diagnostic Studies, Unit III (6 decks)

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