Urinalysis

Question 1

What are the 2 ways to measure concentration of urine?

Answer 1

specific gravity and osmolality

Question 2

How does specific gravity measure the concentration of urine?

Answer 2

both number and weight of solutes

Question 3

When is specific gravity not a good way to measure urine concentration?

Answer 3

increased concentration of heavy solutes like in glycosuria and contrast media

Question 4

how does osmolality measure urine concentration?

Answer 4

number of solutes only

Question 5

What specific gravity represents isotonic urine? What osmolality?

Answer 5

1.010; 300 mosm

Question 6

What is the max dilution of urine in specific gravity and osmolality?

Answer 6

1.002; 50-100

Question 7

What is the max concentration of urine?

Answer 7

1.030; 1200mOsm

Question 8

Urine pH is a reflection of what 2 things?

Answer 8

systemic acid-base and intake

Question 9

What is normal urine pH?

Answer 9

5-6.5

Question 10

What urine pH represents metabolic acidosis?

Answer 10

<5.3

Question 11

What urine pH represents urea splitting gram negative bacteria like in a UTI?

Answer 11

7.5-8

Question 12

What does glucosuria with elevated blood glucose indicate?

Answer 12

diabetes uncontrolled

Question 13

What does glucosuria without elevated blood glucose represent?

Answer 13

PT dysfunction

Question 14

When are ketones present in the urine?

Answer 14

fasting, diabetes and alcoholic ketoacidosis

Question 15

When is bilirubin present in the urine?

Answer 15

liver disease, hyperbilirubinemia

Question 16

When is nitrite present in the urine?

Answer 16

Infection by G (-); convert nitrate–> nitrite in UTIs

Question 17

When is leukocyte esterase in the urine?

Answer 17

Specific for WBC, so + in infection, like but not limited to UTI, and inflammation, like lupus

Question 18

How do you quantitate proteinuria?

Answer 18

1. measure over 24 hours 2. ration of urine protein/creatinine

Question 19

What is normal excretion of protein in urine?

Answer 19

<150 mg/day

Question 20

In proteinuria, what protein changes are seen in urine?

Answer 20

Mostly Tamm-Horsfall protein, which is a small protein, and micro-amounts of albumin

Question 21

The heaviest proteinuria is ____.

Answer 21

Glomerular proteinuria

Question 22

Describe glomerular proteinuria.

Answer 22

permeability problem, lots of albumin in urine (3+, 4+), dipstick positive,

Question 23

What are the 2 tests for proteins in urine?

Answer 23

Dipstick: albumin

Sulfasalicylic acid: ID different proteins

Question 24

What is tubular proteinuria?

Answer 24

small amounts of low mw protein means the tubules have a reabsorption problem

Question 25

Excess production of low mw proteins is ____ proteinuria.

Answer 25

overflow

Question 26

Describe overflow proteinuria

Answer 26

more small proteins are made, like light chains in multiple myeloma. These have a negative dipstick test

Question 27

What kind of proteinuria will have a negative dipstick test?

Answer 27

overflow

Question 28

What electrolytes are measured from urine?

Answer 28

Na, K, Cl

Question 29

How is the etiology of hyperchloremic metabolic acidosis determined?

Answer 29

Anion gap: If Na+K-Cl= negative number:GI loss like diarrhea | positive number: renal tubular acidosis

Question 30

What is the usefulness of creatinine and nitrogen measurements from urine?

Answer 30

nutritional assessment and protein intake

Question 31

What is the usefulness of measuring calcium phosphate and uric acid from urine?

Answer 31

determine cause of kidney stones

Question 32

Normal urine has ____ rbc/hpf and a ___ dipstick test.

Answer 32

0-2; negative

Question 33

How can you tell if RBC in urine are of renal origin?

Answer 33

cells are pleomorcphic, casts, no clots, proteinuria associated with it.Cells are crenated with decreased volume

Question 34

How can you tell if RBC are of extra-renal origin?

Answer 34

cells are normal, no casts, clots

Question 35

When are WBC seen in urine?

Answer 35

UTI, pyelonephritis, nephritis

Question 36

What do renal tubular epithelial cells look like?

Answer 36

big cells that look like an egg cut in .5

Question 37

What is the significance of squamous epithelial cells in urine?

Answer 37

These are large, plate-like cells from the lower tract with a small nucleus. Doesn't mean anything about renal function

Question 38

When are renal tubular epithelial cells seen in clumps?

Answer 38

when there is acute tubular injury like necrosis

Question 39

What cells secrete Tamm-Horsfall protein?

Answer 39

renal tubular epithelial cells

Question 40

What type of cast is normal?

Answer 40

Hyaline cast

Question 41

What makes up the matrix of hyaline cast?

Answer 41

Tamm-horsfall

Question 42

What is the significance of waxy casts?

Answer 42

These are large and pathogenic. They are dense with a white border and sometimes cracks. They mean there is a chronic renal problem.

Question 43

The most common kidney stone is formed by _____ and looks like ____.

Answer 43

calcium oxalate; envelopes

Question 44

What do triple phosphate crystals look like and what do they mean?

Answer 44

coffins; infection

Question 45

What do cystine crystals look like and what do they mean?

Answer 45

Hexagon, cystinuria--> bad

Question 46

Lipiduria means the pt has ____.

Answer 46

nephrotic syndrome

Question 47

What does lipiduria look like?

Answer 47

maltese croses, oval fat bodies, polarized

Question 48

What are granular casts?

Answer 48

abnormal, cellular debris, starch

Question 49

What does a RBC cast mean?

Answer 49

glomerulonephritis