Urinalysis Study Guide Flashcards by Alex Olsen

Under what magnification are urine cells enumerated?

400x

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How may, too numerous to count, rbc’s is dispersed so other sediment can be evaluated?

2% acetic acid

lyse rbc’s

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Casts and ? go hand in hand in a urine sediment

protein

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Possible causes of false negative dipstick test for blood

ascorbic acid
high SG
high nitrite

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Which crystals appear in acid urine

KNOW

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Which crystals appear in alkaline urine

KNOW

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Can indicate congenital cystinosis or cystinuria, tend to deposit in tubules as calculi resulting in renal damage

can be caused by pyelonephritis, diet high in animal fat and protein

Cystine crystals

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Indicates liver disease

formed when large amounts of bilirubin is present in urine

Bilirubin crystals

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Indicates aminoaciduria or severe liver disease

very water soluble so rarely seen

Leucine crystals

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Indicates aminoaciduria or severe liver damage

water soluble so rarely seen, but found more often than leucine

Tyrosine crystals

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Rare: aways accompanied by large protein and other fats

seen in nephrotic syndrome and conditions resulting in chyluria: rupture of lymphatic vessels in renal tubules

Cholesterol crystals

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Non pathologic, except in large amounts seen in gout and conditions of purine metabolism (cytotoxic drugs)

crystals form as body tries to rid itself of excess in the blood caused by overweight, rich diet, exposure to lead or genetic predispostition

Uric acid crystals

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Non pathologic; with ingestion of high oxalate foods but also seen in ingestion of antifreeze and severe renal disease

oxalic acid (metabolite of ascorbic acid) will combine with Ca2+ in urine to form. . .

Calcium oxalate crystals

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Rare

Indicates larege doses of the antibiotic

Ampicillin

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Not clinically significant

might be seen in ethylene glycol (antifreeze) intoxication, or exposure to toluene in atmosphere

Hippuric acid

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Extremely rare; indicates overdose if seen; salicylic acid

excess excreted in urine and may crystalize in acid urine

Aspirin

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Rare; renal damage uncommon

original drug was insoluble and formed cyrstals in renal tubules. Current drugs are soluble

Sulfonamide

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Not clinically significant; mistaken for cholesterol

form in acid urine as body excretes the dye

X-ray media

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No clinical significance but can be associated with UTI in alkaline urine

ammonium combines with magnesium and phosphate in alkaline urine to form “coffin lid” crystals

Triple phosphate

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Not clinically significant unless found in fresh urine (very rare). Can be mistaken for sulfanomide.

forms as urine ages. check collection time of specimen

ammonium biurate

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No clinical significance. Can be mistake for bacteria

seen after lare consumption of vegetables

Calcium carbonate

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Not clinically signficant. enhanced when urine has been refrigerated

Only distinguished by acetic acid or heating to 60C

Amorphous urate - dissolves when heated

Amorphous phosphate - does not dissolve when heated

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Increased indicates renal bleed, either glomerular or tubular. Associated with casts and proteinuria

Indicates glomerularnephritis, pyelonephritis, cystitis, calculi, tumors, or trauma. If no cast or proteinuria, bleed is below the kidney or may be contamination

RBCs

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Increased indicates inflammation of urinary tract

indicates bacterial/parasitic infections or renal diseases *ex; glomerularnephritis, chlamydia, mycoplasmosis, TB, trich, mycoses)

WBCs

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Hard to differentiate from other WBC Indicates acute interstitial nephritis (AIN) or chronic UTI

Eosinophils

Normally present in urine in small amounts. Not normally distinguished from WBCs but large amount is significant. Present in inflammatory conditions, such as acute pyelonephritis or in renal rejection transplant.

Lymphocytes

Increased viral conditions drawn to site of inflammation resulting from renal infection or immune reactions

Monocytes, Macrophages

Indicates inflammation or renal damage if found in large amounts. Can be UTI. Clusters/sheets seen after catheritization but if no instrumentation used, indicates pathological process

Transitional epithelial

Not clinically significant Indicates specimen contamination

Squamous epithelial

Increased in acute ischemic or toxic renal tubular disease indicates heavy metal or drug toxicity

Convoluted renal tubular epithelial

Very significant All types of renal disease, such as, mehpritis, acute tubular necrosis, kidney transplant rejection, salicylic acis poisoning

Collecting duct renal epithelial

Indicates glomerular dysfunction with renal tubular cell death and leakage or plasma into urine. Associated with casts and protein Renal tubular cells become engorged with fats from tubular lumen or own degenerating intracellular lipids

Oval fat bodies

Indicates viral infection affecting newborns with liver, spleen and blood disorders, and adults with Hodgkins, leukemia and aplastic anemia Viral inclusions found in nucleus of renal tubular epithelial cells

Cytomegalic Inclusion bodies CMV

Normal in low numbers. High numbers can indicate strenuous activity, dehydration, fever, stress, renal disease or congestive heart failure Composed of homogenous Tamm-Horsfall protein matrix and formed within tubules

Hyaline cast

Indicates urinary stasis Formed when granular cast degenerates as it sits in renal tubule

Waxy cast

Finely granular in low numbers can be normal. Coarse granular and broad granular indicates poor prognosis. Associated with renal tubular epithelial cells and proteinuria coarse granular results from degeneration of renal cells and other casts. Broad granular indicates renal damage

Granular cast

Renal failure, increase amount is poor prognosis Cast forms in dilated convoluted tubules or collecting ducts indicating severe urinary stasis

Broad cast

Indicates renal tubular disease. Associated with proteinuria and granular casts Become incorporated into the T-H matrix as it sits in tubule (urinary stasis)

Renal tubular epithelial cast

Diagnostic of intrinsic renal disease. Associated with proteinuria. Occasionally found in healthy people 24-48 hours after contact sports glomerular and tubular damage

RBC cast

Indicates renal inflammation or infection Glomerularnephritis will also have rbc casts, pyelomephritis with also have proteinuria and heamturia

WBC cast

Not often ID'ed because difficult to see, diagnostic of pyelonephritis Usually contains WBC so often reported as WBC cast

Bacterial cast

Significant in renal pathology: nephrotic syndrome or severe crush injury Usually contained with hyaline or granular matrix and associated with proteinuria

Fatty cast

Sulfonamide and Ca oxalate most common. associated with hematuria Any substance present in tubular lumen can be in casts

Hemosiderin

Pigments cast

Hgb, myoglobin: yellow to brown, with hematuria Bilirubin: yellow to brown in all urine & sediment Urobilinogen: yellow-golden urine but not sediment Phenazopyridine: urinary pain killer, brown to reddish brown

Hydrogen peroxide, H2O2, reacts with tetramethylbenzidine, chromogen, in presence of hemoglobin or myoglobin to produce oxidized chromogen and water

Occult blood

Oxidized dye, yellow, reacts with hydrogen ions to produce hydrogen and reduced dye, green-blue

An indicator dye added to protein in presence of pH 3.0 will produce a blue-green color as hydrogen ions are released from indicator dye

Protein

With acid pH, urine reacts with para-arsanilic acid to form a diazonium compound, which in turn couples with 1,2,3,4-tetrahydrobenzo(h)quinolin-3-ol to produce a pink color

Nitrite

Glucose oxidase catalyzes the oxidation of glucose in urine to forma hydrogen peroxide and gluconic acid. The hydrogen peroxide then oxidizes the chromogen on the pad in the presence of the peroxidase

Glucose

What is the reason for a negative dipstick on glucose and a positive clinitest?

reducing substance other than glucose present; galactose, sucrose

Acetoacetic acid in an alkaline medium reacts with sodium nitroprusside (nitroferricyanide) to produce a color change from beige to purple

Ketones

React with Ehrlich's reagent (para-dimethylaminobenzaldehyde) to form a red colored compound, light orange to dark pink

Urobilinogen

Reacts with a diazonium salt (diazotized 2,4-dichloroaniline) in acid medium to form an azodye, color change from light tan to beige

Bilirubin

Cleaves ester to form an aromatic compound which then combines with diazonium salt in acid pH to produce an azodye, color change from beige to violet

Leukocyte esterase

Ionic solutes in urine cause protons to release from a polyelectrolyte. As protons are released, the pH decreases and produces a color change of the bromthymol blue indicator from blue green to yellow green.

How may amorphous be dispersed so other sediment may be evaluated?

2% acetic acid to rid amorphous phosphate heat to 60C to get rid of amorphous urate

What organism may be found in the urine of diabetics?

yeast

What type of specimen provides an overall picture of the patients health?

Random specimen

can run routine analysis up to 24 hours

refrigeration

preserves urine for longer time at RT; routine analysis

Commercial transport tubes; boric acid

preserves sediment, inhibits bacteria and yeast

Thymol

cellular preservation, will cause false-negative in blood and uro tests; used in cytology

Formalin

cellular preservation; used in cytology

Saccomanno's fixative

Unacceptable preservatives for urine

Acids; HCl, glacial acetic acid Sodium carbonate

What is the clinical sign of BIL and URO in a urine specimen?

BIL: not normal, can indicate hep, cirrhosis or biliary obstruction, but neg in chronic disease URO: increased amount can indicate hep, cirrhosis or hemolytic states(PA). Decreased in chronic liver disease(cannot report negative URO) small amount is normal

What is the SG of normal urine?

1.002-1.030

What is the significance of ketones in the urine?

indicates fat metabolism resulting from starvation or deficiency in COH metabolism

How is urine osmolality determined?

measured by freezing point depression or vapor pressure osmometer. Unaffected heavy molecules, all solute contribute equally. Normal value is 275-900 mOsm/kg of water

What are the findings on the dipstick with a UTI?

protein: small

What are the findings on the dipstick with a HTR?

elevated URO but not bile

Count of # of WBC, RBC, and casts in a 12 hr overnight period when a pt is not eating or drinking: used to follow progress of renal disease, not commonly done

Addis count

Ability of a test to pick up the lowest level of pathological concentrations, but not normal urine levels

Sensitivity

Ability of test to react specifically to the substance being tested and no other

Specificity

Neutrophils in hypertonic solution swell causing Brownian movement in cytoplasmic granules

Glitter cells

What urinary crystals appear in more forms than any other crystal?

uric acid

How may RBC and yeast, plus WBC and renal epilthelial cells be differentiated?

acetic acid: lyses RBC but not yeast, WBC or RE and it will accentuate the nuclei of WBC Toluidine blue also accentuates the nuclei of WBC RE have lg dense nuclei and polygonal shape Yeast vary in size but are not concave and are usually budding

What sugar is a nonreducing sugar?

sucrose any sugar with an aldehyde group or can form one

How may myoglobin and hemoglobin be differentiated?

80% ammonium sulfate precipitation: Hgb precipitates out of solution but myoglobin remains soluble

What is the best way to find urinary casts in a microscopic field?

low power, dim light

What is the most common constituent of renal calculi?

Calcium oxalate

Urinalysis Study Guide Flashcards

(80 cards)