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Clin med A 2 > urinalysis and hematuria > Flashcards

urinalysis and hematuria Flashcards

1
Q

what is a urine reagent strip also known as

A

urine dipstick or urine dip

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2
Q

what is a urine reagent strip used for

A

Rapid semiquantative analysis for several urine parameters such as:
RBC (heme), leukocyte esterase, nitrite, albumin, pH, specific gravity, glucose, bilirubin, urobilinogen

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3
Q

what is the ideal sample for a urine reagent strip

A

“clean catch” urine

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4
Q

what is normal color for urine

A

usually translucent “straw yellow”

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5
Q

what could cloudy urine indicate

A
  • pyuria
  • bacteriuria
  • diet
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6
Q

what pathologies are reflected by the following colors?
red
red-orange
orange
intense yellow
green
brown
purple

A

Red - blood, beets, phenazopyridine
Red-orange - phenazopyridine, rifampin
Orange - phenazopyridine
Intense yellow - vitamin B
Green - pseudomonas, amitriptyline
Brown - Rhubarb
Purple - UTI

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7
Q

what is the description of normal smell of urine

A

urinous odor

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8
Q

what pathological origin could the following smells indicate:
ammonia odor
fishy/pungent
strong urine odor
fecal odor
sweet/fruity/acetone
maple syrup
musty odor

A
  • “Ammonia” odor - Bladder retention, long-standing urine
  • “Fishy” or “pungent” odor - UTI
  • “Strong” urine odor - concentrated urine
  • “Fecal” odor - bladder-intestinal fistula
  • “Sweet” or “fruity” odor, “acetone” odor - DKA
  • “Maple Syrup” odor - Maple Syrup Urine Disease
  • “Musty” odor - PKU
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9
Q

what two things may cause abnormal urine odor(this was so oddly specific)

A
  • asparagus
  • vitamin B6
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10
Q

what is normal pH range for urine?

A

4.5-8 (usually about 5-6)

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11
Q

what can caused alkaline urine

A
  • bacteria such as proteus
  • vegetarian diet
  • low carb diet
  • citrus
  • metabolic disorders/errors
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12
Q

what can cause acidic urine

A
  • high protein diet
  • cranberries
  • metabolic disoders/errors
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13
Q

what would a + “heme” dipstick test suggest

A

urine containing one or more of the following
- RBCs
- hemoglobin
- myoglobin

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14
Q

what are possible pathological causes for + heme dipstick test

A
  • kidney injury/disease
  • GU tumor
  • GU tract trauma/inflammation
  • nephrolithiasis
  • UTIs
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15
Q

what could cause false positives in heme dipstick tests

A
  • menstrual blood contamination
  • semen in urine
  • vigorous exercise
  • concentrated urine
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16
Q

what could cause false negatives in heme dipstick tests

A

high ascorbic acid levels in urine

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17
Q

what must be used to diagnose true hematuria

A

microscopy with confirmation of presence of RBCs

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18
Q

what is leukocyte esterase

A

enzyme produced by WBCs
this test indicates presence of WBCs

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19
Q

what pathology is a + leukocyte esterase suggestive of

A

suggestive but NOT diagnostic of UTI

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20
Q

aside from UTI, what are other common causes of + leukocyte esterase

A
  • renal disease
  • asymptomatic bacteriuria
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21
Q

what could cause a false + leukocyte esterase

A
  • contamination
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22
Q

what could cause false negatives in leukocyte esterase

A
  • high specific gravity
  • glycosuria
  • urobilinogen
  • medications (rifampin, phenazopyridine)
  • ascorbic acid
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23
Q

what is the nitrite level in normal urine

A

0

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24
Q

what produces nitries

A

gram negative bacteria

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24
Q

what could cause false positive nitrites in urne

A
  • contamination (bacteria in sample but not in urinary tract)
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25
Q

what causes false negatives for nitrites in the urine

A
  • non-nitrite producing organisms
  • frequent urination
  • dilute/acidic urine
  • urobilinogen
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26
Q

what is urobilinogen

A

bilirubin metabolism by gut bacteria

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27
Q

What could increase urobilinogen

A
  • hemolysis
  • hepatocellular disease
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28
Q

what could decrease urobilinogen

A
  • biliary obstruction
  • altered gut flora
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29
Q

Im not really sure what this means

A

okay. thanks

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30
Q

what could cause false negatives and positives in bilirubin

A

false +: phenazopyridine
false -: ascorbic acid

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31
Q

how much glucose detected on a urine dip is suspicious for DM

A

any positive glucose at all.

the urine should contain such small amounts of glucose that the urine dip is negative

32
Q

what could cause a false negative for urine glucose

A
  • ketones
  • ascorbic acid
33
Q

what are causes of ketones in the urine

A
  • post-exercise
  • fasting
  • pregnancy
  • may see elevated in DM patients prior to serum ketosis occurring
34
Q

what could cause false positives of ketones in the urine

A
  • dehydration
  • levodopa metabolites
35
Q

what type of protein is urine protein sensitive to?

A

albumin only

36
Q

what could cause false positives in urine protein? false negatives?

A
  • False positive - WBCs, epithelial cells, bacteria
  • False negative - dilute urine, lower proteinuria levels
37
Q

what is specific urine gravity

A

Weight of urine compared with weight of water

gives estimate of urine concentration and osmolality

38
Q

what is urine osmolality

A

measures the number of particles in the urine

39
Q

when may urine osmolality and urine specific gravity not match up

A

if there are very large particles in the urine such as protein or contrast

40
Q

what occurs during urine microscopy

A
  • urine is centrifuged to cause sediment to precipitate
  • This sediment is then resuspended in a small volume of urine and put onto a glass slide for analysis
41
Q

what is considered positive result for red blood cells in urine microscopy

A

> 5 RBC per HPF on a single occasion OR >3 RBC per HPF on multiple occasions

42
Q

what are the causes of RBC in urine microscopy

A

glomerular damage, tumors, trauma, nephrolithiasis, infection, inflammation, nephrotoxins, AKI

If dysmorphic - likely d/t glomerular disease
if round (normal) - likely d/t urinary tract epithelial disease/damage

43
Q

what are RBC casts

A

Mucoprotein with RBCs inside or stuck together

44
Q

what are causes of RBC casts

A
  • glomerulonephritis
  • vasculitis
  • low urine flow can promote formation
45
Q

what is considered significant WBCs on urine microscopy

A

> 5 WBCs per HPF

46
Q

what does WBCs on urine microscopy indicate? what can cause this?

A

injury to the urinary tract.

  • infection
  • stones
  • strictures
  • cancer
  • glomerulonephritis
  • interstitial cystitis
  • AKI
47
Q

what are WBC casts

A

WBCs inside or stuck together by mucoprotein

48
Q

what do WBC casts indicate? what could cause this?

A

indicates inflammation of the kidney.

caused by:
- acute pyelonephritis
- interstitial nephritis
- low urine output promotes formation

49
Q

is bacteria in the urine common? why or why not?

A

Common in urine due to microbial flora of vagina, external genitalia

50
Q

what urine bacteria pattern would be suspicious of infection

A
  • Single organism = more likely to be infection
  • Multiple organisms = more likely to be contamination
51
Q

what bacterial count is suspicious of a UTI or bacteriuria

A
  • > 100,000 colony count/mL - UTI or bacteriuria
  • Treat if symptomatic or high-risk for infection
52
Q

if you see any bacteria in this type of urine catch, it is significant and indicative of UTI/bacteriuria

A

Catheterized or suprapubic tap - any bacteria = significant

53
Q

what could yeast in the urine microscopy indicate. what is the MC species of yeast?

A
  • indicates Contaminant or true infection
  • MC species - Candida albicans
54
Q

when are tubular epithelial cells normal vs increased?

A
  • Normally slough in small numbers
  • Nephrotic syndrome or any tubular degeneration → increased shedding
55
Q

if lipiduria occurs, what happens to the tubular epithelial cells

A

endogenous fat droplets fill these cells, creating:
“oval fat bodies,” “Maltese crosses,” or “grape clusters”

56
Q

what are squamous epithelial cells? what do they indicate on a urine microscopy?

A
  • Cells of skin surface or outer urethra
  • Suggest urine contamination
57
Q

what are transitional epithelial cells indicative of?

A

If present in high numbers, concerning for neoplasm

58
Q

what type of casts are common and can be a normal finding

A

hyaline casts

59
Q

what are granular casts? what are they a sign of?

A
  • Cellular casts which remain in urine long enough to degenerate
  • sign of renal damage
60
Q

what are waxy casts? what do they indicate?

A
  • Wide, bland-looking casts
  • Shaped like wide, dilated nephrons - CKD
61
Q

this is a good pic to differentiate gross vs microscopic hematuria

A
62
Q

should gross hematuria or microscopic hematuria be evaluated?

A

Both gross and microscopic hematuria require evaluation. The upper urinary tract should be imaged, and cystoscopy should be performed if there is persistent hematuria in the absence of infection.

(i just felt like this blurb was important but didnt know how to ask about it lol)

63
Q

what should be the initial test when evaluating for hematuria

A

UA

A fresh, midstream, clean-catch or catheterized urine specimen should be collected.

64
Q

If you see positive WBC, leukocyte esterase, or nitrites what could it indicate and how would you further evaluate this patient?

A

indicates possible infection and may be confirmed by urine culture (if indicated) and treated appropriately

65
Q

if you see proteinuria and RBC casts what does this indicate and what further evaluation is indicated in this patient?

A

indicate renal origin – labs and renal imaging along with a nephrology consult are indicated

66
Q

what can assist in the diagnosis of a bladder neoplasm

A

urinary cytology and/or cystoscopy with biopsy.

67
Q

what other tests could be used in the work up of hematuria

A
  • serum BUN/Cr and GFR - to assess renal fxn and suitability for radiographic studies w contrast
  • CBC - to evaluate for anemia and infection
  • Coags if coagulopathy is suspected
68
Q

what is the imaging modality of choice when evaluating the upper tracts for sources of hematuria?

A
  • CT urography (choice)
  • MRI is also used but is not first choice
69
Q

what is the use of CT abdomen/pelvis with and w/o contrast in the evaluation of hematuria

A

may identify neoplasms of the kidney or ureter as well as benign conditions such as urolithiasis, obstructive uropathy, papillary necrosis, medullary sponge kidney, or polycystic kidney disease.

70
Q

what is the role of US in urinary tract for hematuria

A

The role of US of the urinary tract for hematuria is unclear. Although it may provide adequate information for the kidney, its sensitivity in detecting ureteral disease is lower. In addition, its higher degree of operator dependence may further confound its utility.

so basically dont choose it.

71
Q

what is IV pyelogram and when is it used

A

An x ray of the urinary tract using contrast medium to visualize urine and possible blockage in the urinary tract.

72
Q

what is used to rule out pathology of the lower urinary tract?

A

cystoscopy

ideally performed whil patient is actively bleeding to allow better localization

(ie, lateralize to one side of the upper tracts, bladder, or urethra).

73
Q

heres just some images of cystoscopy!

A
74
Q

when should biopsy be cautioned

A

in patients with known coagulopathy

75
Q

what is the treatment for hematuria

A
  • Treatment of underlying cause
  • Rule out possibility of cancer or serious underlying disease with potential for harmful long-term sequelae
76
Q

what is the follow up protocol for hematuria

A

since the cause may never be found, negative evaluations (repeat evals) should be done to avoid missing malignancy.
- No set frequency for repeat evaluations
- Urinary cytology can be repeated in 3–6 months
- Cystoscopy and upper tract imaging can be repeated after a year

77
Q

when is referral indicated in hematuria

A

If no infection is present, persistent/recurrent hematuria requires evaluation with urology or nephrology as appropriate

78
Q

yay! done with another one! flip for a flashback to rhys’ first christmas

A

Clin med A 2 (30 decks)

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