Urinalysis (Quiz 1) Flashcards
(140 cards)
1
Q
Excessive urine output
matching q
A
polyuria
2
Q
no urine output
matching q
A
anuria
3
Q
decreased urine output
matching q
A
oliguria
4
Q
excessive thirst/dehydration
matching q
A
polydipsia
5
Q
painful urination
matching q
A
dysuria
6
Q
urine containing leukocytes (neutrophils bc they kill bacteria) or pus
matching q
A
pyuria
7
Q
What is azotemia?
A
-biochemical abnormality, elevation, or buildup of nitrogenous products (BUN/ creatinine) in the blood, and other secondary waste products within the body
-raising the level of nitrogenous waste is attributed to the inability of the renal system to filter (decreased glomerular filtration rate (GFR)) such as waste products adequately
-because of azotemia, pt will develop uremia which is a clinical condition associated with worsening renal function
-uremia most commonly occurs in the setting of chronic and end stage renal disease but may also occur due to acute kidney injury
8
Q
uro=
A
urine
9
Q
Routine urinalysis (US) gives info about the….
A
kidneys and metabolic processes
10
Q
What does a routine urinalysis consist of?
test q
A
-macroscopic evaluation
-chemical evaluation (test strip)
-microscopic evaluation
11
Q
Urinalysis is commonly ordered for patients with what symptoms?
A
-abdominal pain
-back pain
-dysuria
-hematuria
-urinary frequency
12
Q
What is the best urine specimen?
test q
A
first morning clean catch or first morning catheterized specimen + mid stream
***first morning gives better overall impression of renal function
13
Q
What are the 24 hour UA test types we talked about?
A
24 UA for protein or creatinine
14
Q
What are the normal contents of urine?
A
-water
-electrolytes like Na, K, Cl, calcium, magnesium, urea, ammonia, phosphates, sulfates
15
Q
What is not normal in urine?
boards q
A
measurable protein or glucose
16
Q
Patients with diabetic ketoacidosis (DKA) have what urine odor?
A
strong, sweet smell of acetone
17
Q
Patients with infections would have what urine odor?
boards q
A
foul, fishy, strong ammonia smell
18
Q
Patients with maple syrup urine disease would have what urine odor?
A
maple syrup odor
19
Q
What is a normal urine color?
A
pale yellow/straw yellow
20
Q
Normal urine color is due to what pigment from bile metabolism?
A
urochrome
21
Q
Darker urine will have increased _________________ because of decreased hydration/dehydration
A
specific gravity (SG)
22
Q
Colorless urine may have decreased _________________ because of increased hydration
A
specific gravity (SG)
23
Q
Bright yellow urine is due to what vitamins?
A
B vitamins
24
Q
Red urine may indicate
A
bloody urine
25
What are the pathological causes of red urine?
test q
-tumors
-kidney stones or bladder stones
-cysts
-enlarged prostate
-myoglobin damage
-some hereditary disorders
26
What are some non-pathological causes of red urine?
-beets
-excessive exercise like marathon running
-menstrual contamination
27
What are the synonyms for brown urine?
-cola
-rusty
-amber
28
What are the pathological causes of brown urine?
-large amounts of RBCs (hematuria)
-glomerulonephritis
-alkaptonuria
-myoglobin
29
Hepatobiliary disorders would have brown urine due to an increase in...
bilirubin
30
Hemolytic anemia would have brown urine due to an increase in
urobilinogen from RBC breakdown
31
What are the non-pathological causes of brown urine?
-rhubarb
-licorice
-foods with dark dyes
-laxatives containing senna
32
What is a tell-tale sign of glomerulonephritis?
rusty urine
33
Why would a patient have brownish black urine?
test q
homogenistic acid caused by alkaptonuria
34
What is alkaptonuria?
-AA metabolism disorder
-also known as black urine disease
-rare inherited disorder that prevents the body from fully breaking down tyrosine and phenylalanine
-results in a build up of homogentisic acid in the body
35
Why would someone have purple-red urine/ wine colored urine?
test q
porphyria (rare disorder of RBC precursors)
36
T/F: it is normal to have clear or cloudy urine
false, clear is normal, cloudy is not
37
What causes cloudy urine?
solid particles (WBCs, bacteria, crystals, epithelial cells, and protein
more particles and proteins= more cloudiness
38
What are the synonyms for cloudy urine?
-hazy
-frothy
-turbid
39
What is included in a urinalysis test strip?
1) protein
2) glucose
3) ketones
4) RBCs
5) leukocyte esterase (leukocytes)
6) nitrites (bacteria)
7) bilirubin
none of the above should be positive***
8) specific gravity (SG)
9) urobilinogen (trace amounts)
40
What is SG?
quiz 1 q
-stands for specific gravity
-measurement of concentration and excretory function of kidneys**
-measure of the conc. of solutes/stuff in urine
-compares the density of urine to the density of water
41
What abnormal substances contribute to high SG in urine?
test q
protein and glucose
42
Fixed SG indicates....
severe renal damage
43
What is fixed SG?
test q
SG remains 1.010 regardless of fluid intake= renal tubular dysfunction
44
What is the normal range for SG?
1.003-1.030
45
What are the pathological causes of increased SG?
-uncontrolled diabetes mellitus (glycosuria- glucose in urine)
-nephrotic syndrome or glomerulonephritis (proteinuria)
46
What is the non-pathological cause of increased SG?
dehydration
47
What is the non-pathological cause of decreased SG?
over hydration
48
What are the pathological causes of decreased SG?
-diabetes insipidus (not enough ADH or poor response to ADH)
-kidney failure
-renal tubular damage
49
Kidneys cannot concentrate urine over.....
hint: its a number larger than the normal SG
test q
1.035
50
define osmolality
measurement of the amount of particles/stuff/solute dissolved in a fluid
51
What is the confirmatory method for specific gravity?
test q
urine osmolality
52
What is the difference between SG and urine osmolality?
-SG is measuring concentration and excretory function of kidneys
-urine osmolality is confirmatory method to measure concentration and diluting ability of kidneys
-urine osmolality depends only on the number of particles, whereas SG depends on the number of particles and weight
-urine osmolality is more time consuming and expensive
53
Specific gravity is the ___________ test, whereas osmolality is the ________________ test
test q
screening, confirmatory
54
What is the normal pH range for urine?
5-8
note: first morning urine is usually 5-6, after that pH increases
55
Do UTIs make urine more acidic or alkaline?
test q
alkaline
56
Test trip is sensitive for which protein only?
albumin
57
Presence of protein in urine is often the first indicator of...
renal disease
58
When would a patient have foamy urine?
when they have protein in the urine
59
T/F: healthy glomerular membrane is too small to allow passage of protein molecules
true
60
What are the 2 major proteins found in blood?
albumin and globulin
61
What is the most common protein found in urine?
albumin
62
Albumin is the most common protein found in urine. Why?
because its smaller than globulin, so globulin wont be seen unless theres a LOT of damage to the glomerular membrane
63
loss of albumin in the blood=
test q
increase in albumin in the urine = edema
64
hypoalbuminemia (low albumin in blood) =
test q
albuminuria (albumin in urine)= edema
65
hypoproteinemia (low protein in blood)=
test q
proteinuria (protein in urine) = edema
66
What is the confirmatory test for protein in urine?
test q
SSA which detects albumin AND globulins
67
What do plasma cells secrete?
antibodies/Abs/Igs/immunoglobulins/gamma globulins (all mean same thing)
68
What is multiple myeloma?
cancer of plasma cells
69
Which protein is found in urine for multiple myeloma patients?
test q
globulin
70
Which syndrome has massive proteinuria?
nephrotic syndrome
71
Which syndrome has little proteinuria?
nephritic syndrome
72
What are the 7 causes of proteinuria?
test q
1) glomerular damage or nephritis (nephrotic syndrome, glomerulonephritis, or kidney damage pathology from HTN, SLE, DM)
2) diminished rubular rebasorbption (renal tubular disease, wilsons disease, fanconi syndrome)
3) fever
4) stress
5) strenuous exercise
6) pregnancy (eclampsia)
7) postural proteinuria (orthostatic)
73
What are the 3 issues that cause glomerular damage or nephritis?
test q
1) nephrotic syndrome
2) glomerulonephritis
3) kidney damaging pathologies (HTN, DM, SLE)
74
What typically moves solutes back into plasma?
tubules
75
What are the 3 diseases/syndromes that cause diminished tubular reabsorption?
test q
1) renal tubular disease
2) wilsons disease
3) fanconi syndrome
76
What are the non-pathological causes of proteinuria?
test q
stress or strenuous exercise
77
A change in renal hemodynamics, which in some otherwise normal individuals causes protein (mostly albumin) to appear in urine when they in the....
standing position
(elevated protein excretion while in upright position, normal protein excretion while recumbent)
78
Renal tubules produce this unique protein to the kidneys, it is not measured in the urinalysis because its a normal protein
uromodulin (tamm horsfall protein)
79
uromodulin is a ____________ secreted by renal tubules
mucoprotein
80
What is the matrix or major constituent of casts?
test q
uromodulin (tamm horsfall protein)
81
increased glucose in blood=
increased glucose in urine
82
UA test strip assesses which sugars?
glucose only!!!
83
What UA test is performed to screen for diabetes mellitus aka hyperglycemia?
glucose
84
Almost all glucose filtered by the glomerulus is reabsorbed in the...
PCT
85
What is normal fasting glucose?
70-100 mg/dL
86
If blood glucose is >160-180 mg/dL then the body cannot reabsorb it and glucose appears in the....
test q
urine
87
What is the renal threshold for glucose?
test q!!!!!!!!!!!!!!!
160-180 mg/dL
when glucose reaches this level in blood, proximal tubule begins to excrete glucose in the urine
88
What is primary hyperglycemia?
test q
-diabetes mellitus
-glycosuria with hyperglycemia
89
What is secondary hyperglycemia?
test q
-result from cushings disease or hyperthyroidism
-glycosuria with hyperglycemia
90
glycosuria without hyperglycemia is....
fanconi syndrome (blood glucose is normal or low due to tubule reabsorption problem)
91
What is this called?
-glycosuria after a meal high in carbs
alimentary glycosuria
92
T/F: normally, the body does not get enough energy from carbs in diet
false, we do get enough energy from carbs in diet
93
When the body breaks down fat for energy (instead of carbs), there are 3 intermediate products referred to as ketones. What are the 3 ketones?
1) acetone
2) acetoacetic acid
3) betahydroxybutyric acid
94
Ketones are produced and appear in the blood and urine if....
1) the diet does not contain enough carbs to supply the body with glucose for energy (starvation, prolonged vomiting, alcoholism)***
2) the body cannot use glucose properly (diabetic ketoacidosis) stored fat is broken down (in DM, little or no insulin is produced, glucose cannot be absorbed by cells to be used a fuel and without enough insulin the body breaks down fat as fuel producing ketones) so this is due to new onset of DM or improper use of insulin
95
_____________ in DM is an indication that the insulin dose needs to be increased
Ketonuria
96
What helps glucose enter cells?
insulin
97
Low presence of ketones due to fasting, rapid weight loss, frequent strenuous exercise, or prolonged vomiting is due to....
test q
inadequate intake of carbs or increased loss of carbs
98
Ketones, predominantly _______________, spill over into urine when blood levels are elevated
test q
acetoacetic acid
99
What are the 6 causes of ketonuria?
1) diabetic ketoacidosis (DKA, with type 1 DM, impaired glucose metabolism due to insulin insufficiency)
2) alcoholism
3) starvation
4) prolonged vomiting
5) fasting
6) high protein diet (catabolism of fat for production of energy, ketones are formed and pill into urine from the blood)
100
Orange yellow pigment occurs when RBCs break down
bilirubin
101
What is a product of heme catabolism?
bilirubin
102
Is bilirubin a waste product?
yes
103
How is bilirubin normally excreted?
in bile and feces as urobilinogen and stercobilinogen
104
Normally we should not have bilirubin in the urine, but if we do, then is it conjugated or unconjugated?
conjugated
105
Bilirubin is a major constituent of....
bile
106
define bilirubinuria
bilirubin in urine
107
What color is urine if bilirubin is in it?
dark yellow to orange
108
UA dipstick detects conjugated, unconjugated bilirubin, or both?
test q
conjugated only bc its water soluble
109
What is light sensitive and breaks down with exposure to light?
boards q
bilirubin
110
What is the confirmatory test for bilirubin in urine?
test q
ICTO test!!
111
what is another word for jaundice?
icterus
112
What are the causes of bilirubinuria?
1) hepatic jaundice
2) post hepatic jaundice
3) disease affecting bilirubin metabolism after conjugation or defect in excretion***
-gallstones
-liver pathologies
-extrahepatic duct obstruction (scarring, tumors, inflammation)
-carcinoma
-pancreatitis**
-obstruction of ampulla of vater (union of pancreatic duct and bile duct)
-drug toxicity
113
Urobilinogen is formed in the intestines _____% of urobilinogen is excreted in the stool. Some will filter through kidneys and be excreted in urine. It is normal to have a small amount of urobilinogen in the urine
90
114
What causes increased urobilinogen in urine?
1) hemolytic processes like prehepatic jaundice
2) hemolytic anemias like sickle cell anemia, G6PD, pernicious anemia
115
T/F: blood in urine should always be investigated
true
116
What are the 3 forms of blood in urine?
test q
1) hematuria
2) hemoglobinuria
3) myoglobinuria
117
What is hematuria?
-intact RBCs in urine
-not hemolyzed
118
What is hemoglobinuria?
-hemoglobin present in urine
-lysed RBCs
119
What is myoglobinuria?
myoglobin in urine resulting from rhabdomyolysis or traumatic muscle pathologies like crush injuries, car accidents, muscle degeneration causes myoglobin to be released
120
Is the UA test strip positive for all types of blood?
yes
121
What are the causes of hematuria?
1) tumors/cancer of kidney or bladder
2) renal calculi/stones
3) primary renal diseases like glomerulonephritis, acute tubular necrosis, or prostatitis
122
What is the most common cause of hematuria?
kidney stones
123
What causes hemoglobinuria?
1) hemolytic anemias
2) transfusion reactions
3) snake or spider bites
4) bacterial toxins
5) strenuous exercise
6) increased or decreased pH
124
What causes myoglobinuria?
1) muscle trauma/ crush syndrome (rhabdomyolysis)
2) prolonged coma (muscle deterioration)
3) excess myoglobin from tubular necrosis of kidney**
125
Why is the UA test strip positive for myoglobinuria?
because it contains heme like hemoglobin
126
Is myoglobin or hemoglobin toxic to kidneys?
test q
myoglobin
127
Myoglobin from muscle -> blood-> kidney tubules =
toxic= acute tubular necrosis
128
Serum and urine myoglobin testing (specific fro myoglobin) will tell if the dipstick is positive due to
hemoglobin or myoglobin
129
Leukocyte esterase is an enzyme produced by what white blood cell?
neutrophils
130
What is the screening test to detect neutrophils in urine?
test q
leukocyte esterase
131
What does it mean if there are neutrophils in the urine?
bacteria because neutrophils kill bacteria
132
Positive results of leukocyte esterase indicate what?
pyuria (WBCs in urine)
133
What is the most common cause of positive leukocyte esterase?
UTI
134
Does leukocyte esterase test for bacteria?
NO just for leukocyte esterase which is made by neutrophils so it can be assumed theres bacteria
135
What is the most common cause of UTIs?
e coli which is a gram neg bacili or rod
136
Can all bacteria reduce nitrites?
no!!!!
137
What does a positive nitrite result in UA usually indicate?
UTI
138
Some bacterias produce an enzyme that reduces urinary nitrates to nitrites. What is this enzyme called?
test q
reductase
139
What bacteria usually produces reductase?
gram neg
140
Is it possible to have a bacterial infection with the nitrite being negative?
yes especially with staphs and strep
