Urine Flashcards
(174 cards)
1
Q
What type of lab should you make sure you use in practice?
A
CLIA approved lab
2
Q
What does CLIA stand for?
A
Clinical laboratory improvement amendments
3
Q
How do chiropractors use lab tests?
A
- Establish baseline data
- Screening
- Determine diagnosis or prognosis
- Monitor progress
- Make decision regarding second opinion
4
Q
What are the signs and symptoms to order a UA?
A
- Low back pain
- Painful urination
- Hematuria
- Suprapubic pain
- Urethral or vaginal discharge
- Frequent urination
- Inability to urinate
- Polydipsia
- Polyphagia
- Physical and wellness screening
5
Q
What percent of cardiac output per fuse threw the kidneys every minute?
A
25%
6
Q
What do kidneys play a role in regarding balance in the body?
A
- Water balance
- Acid-base balance
- Electrolyte balance
7
Q
What hormones/enzymes do the kidneys play a role in the production of?
A
- Erythropoietin
2. Renin
8
Q
What is the purpose of erythropoietin?
A
Stimulate RBC production
9
Q
What is the purpose of renin?
A
Controlling blood pressure
10
Q
What three parts does a routine UA consist of?
A
- Physical properties
- Chemical properties
- Microscopic properties
11
Q
What is the functional unit of the kidney?
A
Nephron
12
Q
What is the oldest clinical lab procedure?
A
UA
13
Q
What are some of the old names for people who examined urine?
A
Urine gazers
Pisse-prophets
Urinomancers
14
Q
At what point does the glomerular filtrate become urine?
A
After it leaves the distal convoluted tubule
15
Q
What are the principle solutes of urine?
A
Urea, sodium, chloride, potassium, creatinine, uric acid, ammonia
16
Q
How much does the body excrete daily?
A
60 grams of dissolved material/24 hours
17
Q
What percent of the amount excreted daily is urea?
A
One half
18
Q
What percent of urine is water?
A
95%
19
Q
What percent of urine is dissolved solids?
A
5%
20
Q
What is polyuria?
A
Excessive urine output - >2000 ml/24 hours
21
Q
What is oliguria?
A
Below normal urine output - <500ml/25 hours
22
Q
What are some of the causes of oliguria?
A
Renal tubule dysfunction, end stage renal disease, obstruction, edema, dehydration, diarrhea, vomiting, shock
23
Q
What is anuria?
A
Absence of urine
24
Q
What are some of the causes of anuria?
A
Renal failure, obstruction, heart attack
25
What is polydipsia?
Excessive water intake
26
What is the best practice for collecting a urine specimen?
Early morning, midstream clean catch
27
When is the urine most concentrated?
Morning
28
Why is the morning the best time for a urine specimen?
Most concentrated
29
How soon after a urine sample is given does decomposition begin?
Within 30 minutes at room temperature or 4 hours if refrigerated
30
What is the most common and convenient sample?
Random sample
31
How soon after collection should testing begin?
Immediately or within 2 hours if at room temperature
32
How long is the sample good for testing with a preservative?
24 hours
33
What changes occur in unpreserved urine over time?
Color becomes darker, turbidity increases, odor is more foul smelling, pH increases, glucose, ketones, bilirubin and urobilinogen decrease, nitrites and bacteria increase, RBCs lyse, WBCs and casts disintegrate.
34
What does color roughly indicate in urine?
Degree of hydration and concentration
35
What color range is considered normal in urine?
Straw to amber or light yellow to dark yellow
36
What is red, dark brown urine found with?
Excessive hemoglobin, RBC, myoglobin
37
What is red or dark brown urine associated with?
Menses, UTI, malignancy, prostate, etc.
38
What is the smoky urine associated with?
Blood, hemoglobin, myoglobin
39
What in a diet can affect urine?
Beets, drugs, rhubarb, Vit C, carrots
40
What conditions are found with orange colored urine?
Dehydration from fever, vomiting, certain foods (rhubarb, Vit C, carrots), medications.
41
What conditions are found with bright yellow urine?
Excessive B vitamins
42
What conditions are found with black urine?
Alkaptonuria and melanin problems like malignant melanoma.
43
What conditions are found with colorless urine?
Diabetes insipidus associated with decrease pituitary ADH, over hydration associated with low SpG.
44
What conditions are brownish yellow/green urine found with?
Liver problems, check bilirubin and urobilinogen
45
What other signs/symptoms can possibly be seen with liver problems?
Jaundice of skin and sclera
46
What conditions are associated with milky urine?
Hyperlipidemia
47
What is normal turbidity?
Clear
48
What if the urine is slightly hazy? What should be done?
Usually normal but check sediment
49
What is cloudy urine associated with?
Crystals usually insignificant but could be pus, bacteria, RBCs, spermatozoa
50
What issue could be associated with hazy/cloudy urine
Infection
51
What issue is associated with white frothy urine?
Proteins
52
What issue is associated with yellow frothy urine?
Bilirubin/bile
53
What would the lab need to do if the urine is hazy/cloudy/frothy?
Look at the urinary sediment
54
What does the specific gravity measure?
Ability of the kidneys to concentrate the urine
55
What is the inability to concentrate urine an early sign of?
Renal disease
56
What is the normal range for specific gravity?
1.015 - 1.035
57
What is hyposthenuria?
Low specific gravity
58
What is hypersthenuria?
High specific gravity
59
What is isoshenuria?
1.010 SpG - same as protein free plasma and signifies the end of renal failure
60
What is increased specific gravity an indicator of?
Concentrated urine, dehydration, decreased renal blood flow (heart failure, renal artery stenosis)
61
What is decrease specific gravity an indicator of?
dilute urine, decreased concentration, over hydration, glomerulonephritis, pyelonephritis, diabetes insipidus, renal failure
62
What is consider an abnormal urine smell?
Foul, fishy, fruity, sweet, feces
63
What is a foul/fishy odor an indicator of?
UTI
64
What is a fruity/sweet odor an indicator of?
Diabetes mellitus/ketosis
65
What is feces odor an indicator of?
Asparagus, enterobladder fistula
66
What is the pH an indicator of?
Renal or lung disease
67
What is consider normal range for pH for urine?
4.5 - 7.5
68
What is considered acidic urine?
pH <7
69
What is considered neutral urine?
pH 7
70
What is considered alkaline urine?
pH > 7
71
What happens to urine's pH as it stands?
Becomes more alkaline as it stands due to bacterial growth and breakdown of urea
72
If a diet is high in animal protein, is the urine more acidic or alkaline?
Acidic
73
If a diet is high in citrus fruits and vegetables, is the urine more acidic or alkaline?
Alkaline
74
What is acidic pH an indicator of physiologically?
Emphysema, metabolic acidosis, diabetes mellitus, large amounts of cranberries and meats in diets.
75
What is alkaline pH an indicator physiologically?
Hyperventilation, metabolic alkaline, UTI, large amounts of vegetables and citrus fruits in diet.
76
What term is used synonymously with proteinuria?
Albuminuria
77
How is protein/albumin reported as in urine?
Negative, trace, 1+, 2+ 3+, 4+
78
What is normal of proteins in the urine?
Negative
79
What normally prevents protein from entering the urine?
Glomerulus
80
What is proteinuria a primary indicator of?
Renal disease
81
If the screen test is found to be positive with protein, what is the test to confirm this?
SSA
82
What does proteinuria because of kidney disease usually indicate?
Upper UTI
83
What are some reasons there may be protein in the urine?
Diabetes, glomerulonephritis, nephrotic syndrome, preeclampsia, trauma, strenuous exercise, exposure to cold, dehydration, febrile illness, large abdomen, pregnancy increase abdominal pressure
84
What is orthostatic proteinuria?
Patient displays normal urine when supine and displays proteinuria when standing
85
How should one handle a patient presenting with orthostatic proteinuria?
Have the patient lie down for one hour and recheck urine
86
What population is orthostatic proteinuria more commonly seen in?
Adolescents
87
What is orthostatic proteinuria often associated with?
Exaggerated lumbar lordosis, renal congestion
88
What is preeclampsia?
Toxemia associated with pregnancy especially 3rd trimester
89
What signs/symptoms are associated with preeclampsia?
Proteinuria and increased blood pressure, if severe with headache, visual changes, liver enlargement, severe proteinuria, intrauterine growth retardation, convulsions, coma, etc.
90
What pathologies are associated with proteinuria?
Heart conditions, CNS lesions, blood disorders, drug therapy, systemic disorders (diabetes), collagen disease (SLE, scleroderma), septicemia
91
What is commonly associated with massive proteinuria?
Nephrotic syndrome
92
What rating does nephrotic syndrome show up as?
4+ proteins
93
What appearance does urine with nephrotic syndrome have?
Frothy white
94
What signs/symptoms would someone with nephrotic syndrome have?
severe edema, especially around the eyes
95
What test should be run on all patients with 4+ proteins?
Bence Jones test
96
What does the Bence Jones test test for?
Multiple myeloma
97
What would you suspect if a patient had back pain, lytic changes, punched out lesions of the skull, rain drop skull, and pathological fractures?
Multiple myeloma
98
What is multiple myeloma?
Malignant proliferation of plasma cells
99
What is the most common malignancy of bone?
Mets
100
What is the most common primary malignancy of bone?
Multiple myeloma
101
What is the most common pediatric malignancy of bone?
Osteosarcoma
102
What test is used to look for Bence Jones proteins?
Urine protein electrophoresis
103
What are some signs/symptoms of Multiple Myeloma?
nausea, confusion, polyuria, hypercalcemia, renal insufficiency, fatigue, anemia, bone lysis, pathological fractures, thrombocytopenia, immune deficiency, dizzy, blurred vision, hyper viscosity
104
What population is multiple myeloma more commonly found in?
Older adults
105
If multiple myeloma is suspected and the dipstick is negative for Bence Jones proteins, what confirmatory test should be done?
Protein electrophoresis
106
What does CRAB stand from in relation to multiple myeloma?
```
C = calcium (elevated)
R = renal failure
A = anemia
B = bone lesions
```
107
What is the labs pathway for lytic mets?
X-ray --> Bone Scan --> MRI --> Biopsy
108
What is the labs pathway for multiple myeloma?
X-ray --> PEP --> Skeletal Survey (x-ray all axial skeleton) --> MRI --> Biopsy
109
IS a bone scan useful in multiple myeloma?
No, it is not indicated for patients with multiple myeloma as it is purely lytic
110
What are the different classifications of possible to definite multiple myeloma?
MGUS (could turn to MM)
Smoldering MM
MM
111
What is the normal level for glucose in urine?
Negative
112
What is the confirmation test for glucose in the urine?
Clinitest
113
What is the renal threshold value for glucose in the urine?
140-180 mg/dl
114
What are hyperglycemia and glucosuria commonly due to?
Diabetes mellitus, endocrine disorders (acromegaly), pancreatic problems (tumor, pancreatitis), adrenal disorders (Cushing's), hyperthyroidism, pregnancy, stress, CNS disorders, tumor hemorrhage, stroke, obesity, liver disease, exercise, certain drugs
115
What are ketones a result of?
Lack of available sugar getting to the cells due to lack of insulin
116
What is a byproduct of fat metabolism?
Ketones
117
How are ketones reported?
Negative, trace, small, moderate, large (1+, 2+, 3+, 4+)
118
What is the normal level of ketones in urine?
Negative
119
What are the different ketones?
acetone, betahydroxybutric acid, acetoacetic acid
120
What are ketones in the urine usually due associated with?
Poorly controlled diabetes mellitus and may warn of impending diabetic coma
121
Under what conditions would you possibly see ketones in urine?
Diabetes mellitus, fasting/starvation, low carb/high protein diet, dehydration, electrolyte imbalance, alcoholism, babies and kids with fever
122
What level of bilirubin in urine is normal?
Negative
123
Where is most bilirubin formed in?
Recticuloendothelial system (spleen, liver, marrow)
124
Which type of bilirubin cannot pass the glomerular filter (not water soluble)?
Unconjugated
125
When bilirubin is acted on by bacteria it becomes what?
Urobilinogen
126
What gives feces its brown color?
Stercobilinogen
127
What does conjugated bilirubin in urine indicate?
Obstruction of bile from liver (gall stones, tumor, liver inflammation) or liver dysfunction
128
What is the appearance of urine that contains bilirubin?
Dark yellow, yellow foam
129
What color are feces if there is a biliary obstruction?
Pale
130
What is the normal range for urobilinogen?
0.1 - 1.0 mg/dl
131
What do abnormal urobilinogen suggest?
liver problems
132
What type of bilirubin is prehepatic?
Unconjugated
133
What is the main cause of biliary obstruction?
Gallstones
134
What is expectant management regarding gallstones?
"Wait and see" since the patient has no symptoms, the risks of surgical and non surgical treatments outweigh the benefits.
135
What is the normal level of occult blood in urine?
Negative
136
What may be the cause of hematuria?
Kidney or bladder calculi, damage to kidney or urinary tract, malignancy, menses, trauma, exercise
137
What may be the cause of hemoglobinuria?
Breakdown of RBCs
138
What may be the cause of myoglobinuria?
Myocardial infarct or muscle damage
139
What are some external causes of hemolysis?
Drugs, crushing injuries, transfusion reactions, burns
140
What are some internal causes of hemolysis?
Hemolytic anemia
141
What is yellow colored urine with increased RBC?
Microhematuria
142
What is yellow colored urine with normal RBC?
Microhemoglobinuria or micromyoglobinuria
143
What is red, pink, smoky colored urine with increased RBC?
Hematuria
144
What is red, pink, smoky colored urine with normal RBC?
Hemoglobinuria or myoglobinuria
145
What does leukocyte esterase test for?
WBCs in urine
146
What does positive leukocyte esterase indicate?
UTI
147
What is the normal level for nitrites in urine?
Negative
148
What do positive nitrites in urine indicate?
Bacteria, screening for UTI
149
What is the normal for RBCs in urine?
0-3
150
What is the normal for WBCs in urine?
0-3
151
What does increase WBCs imply?
Infection
152
How are levels of urinary sediment/crystals reported as?
Few, moderate, or many
153
What appearance do crystals/sediment give to the urine?
Sandy, cloudy
154
What do crystals in the urine indicate a possibility of?
Stone formation
155
What population is more likely to develop renal calculi?
Males, 23-30 years old
156
What element do most renal calculi contain?
Calcium
157
What are the reported levels of epithelial cells?
Rare, occasional, few, moderate, many or 1+, 2+, 3+, etc.
158
What type of cells should you assume are the type unless reported differently?
Squamous cells
159
What part of the urinary tract are squamous cells found in?
Lower half of bladder and urethra
160
What type of epithelial cells are found in the upper half of the bladder?
Transitional
161
What would epithelial cells with no other findings indicate?
contamination particularly vaginal
162
What does renal cell epithelium imply if found in urine?
Kidney disease
163
What is the normal for urinary sediment/mucous?
Negative
164
How is mucous reported as?
Scant, moderate, heavy, few, frequent, many
165
What is mucous usually associated with?
Infection
166
What anatomy do casts give a picture of?
Nephron
167
What is a cast?
congealed protein that acts as a mold of its origin, kidney specific protein
168
What do casts indicate?
Upper UTI
169
What type of casts can normally found?
granular and hyaline, 0-2/LPF, with no other findings
170
What is an indicator of glomerulonephritis?
RBC casts
171
If a patient has RBC casts in urine and recently had a sore throat, what would likely be the cause and the diagnosis?
Strep throat and glomerulonephritis
172
What would be an indicator of pyelonephritis?
WBC casts
173
What type of infection is pyelonephritis or glomerulonephritis?
Upper UTI
174
What type of infection is cystitis and urethritis?
Lower UTI
