Urine Analysis

Question 1

What is urine and describe the path it takes to be excreted

Answer 1

Waste products ( urea, ammonia , creatinine, etc electrolytes) which are filtered out of the blood by the kidneys. The urine then travels through the ureter and is stored in the bladder to be then excreted via the urethra.

Question 2

What is a urine dipstick

Answer 2

A strip which is dipped into a urine sample( all squares need to be submerged) and then laid flat for 30-60 seconds. The reagents on the dipstick can react with substances from the urine to cause colour changes

Question 3

What does dark urine indicate?

Answer 3

Dark urine may indicate dehydration, while red or brown urine may suggest blood

Question 4

What does cloudy urine suggest ?

Answer 4

Cloudy urine may suggest infections or the presence of crystals

Question 5

What might unusual odours in urine suggest?

Answer 5

Unusual odours can indicate infection or metabolic disorders

Question 6

What is the normal specific gravity range for urine?

Answer 6

1.002 - 1.035

Question 7

What does a specific gravity greater than 1.035 suggest ?

Answer 7

Overhydration, kidney disease or diabetes

Question 8

What does a low specific gravity (less than 1.002) suggest?

Answer 8

Dehydration or highly concentrated urine

Question 9

What is the normal pH range of urine?

Answer 9

4.5- 8.0

Question 10

What does acidic urine indicate?

Answer 10

Acidic urine can indicate metabolic acidosis ( too much acid in blood)

Question 11

What does alkaline urine suggest?

Answer 11

Alkaline urine can suggest a urinary tract infection (UTI)

Question 12

What does the presence of proteins in urine indicate?

Answer 12

It can indicate kidney disease, strenuous exercise, or diet influence

Question 13

What does glucose in the urine signify

Answer 13

It can indicate diabetes

Question 14

What can ketones in urine indicate

Answer 14

When glucose levels are low, the liver breaks down fats to release ketones as a source of energy. High levels of ketones ( ketonuria) may signal uncontrolled diabetes (not enough insulin so build up of ketones in the blood) , diabetic ketoacidosis and alcohol abuse.

Question 15

What do nitrites in urine suggest

Answer 15

A bacterial infection

Question 16

What does leukocyte esterase in urine indicate ?

Answer 16

A urinary tract infection (UTI) or inflammation as nitrites and leukocytes are produced in the body when fighting an infection.

Question 17

What does the presence of blood in urine indicate

Answer 17

It can indicate kidney stones (as large kidney stones get trapped in your ureter meaning that less pee can travel down= impacts kidneys ability to filter blood )
Can also indicate infection , trauma or cancer

Question 18

What might cells found in the urine suggest in a microscopic examination?

Answer 18

The presence of red blood cells, white blood cells, and epithelial cells

Question 19

What do casts in urine indicate in microscopic examination?

Answer 19

Cylindrical structures formed in the renal tubules, indicating kidney disease

Question 20

What does the presence of crystals in urine indicate in microscopic examination?

Answer 20

Kidney stones or metabolic disorders

Question 21

What does the presence of microorganisms in urine suggest in microscopic examination?

Answer 21

Bacterial infection, yeast infection, or parasites

Question 22

What are symptoms that indicate a lower urinary tract infection (LUTS) (7)

Answer 22

. Hesitancy
. Frequent urination
. Dysuria ( burning sensation/ pain when passing urine )
. Haematuria ( blood in urine )
. Lower abdominal pain
. Flank pain ( right and left sides of the mid back )
. Cloudy urine

Question 23

What are the key vital signs to check during clinical examination for a patient with a lower urinary tract infection? (4)

Answer 23

. Heart rate
. Respiratory rate
. Blood pressure
. Temperature

Question 24

What are the main areas checked in abdominal examination?

Answer 24

• tenderness in the suprapubic region (just below belly button ) and tenderness in the flank regions

Question 25

What symptoms are associated with upper urinary tract infections? (6)

Answer 25

. Fever/chills . Flank pain . Nausea . Vomiting . Dysuria . Frequent urination

Question 26

What are the symptoms of kidneys stones? (5)

Answer 26

. Severe flank pain . Haematuria . Nausea . Vomiting . Dysuria

Question 27

What symptoms are associated with vaginitis? (3)

Answer 27

. Vaginal discharge . Itching/ irritation . Dysuria

Question 28

What are common symptoms of pelvic inflammatory disease PID (5)

Answer 28

. Lower abdominal pain . Fever . Abnormal vaginal discharge . Dysuria . Pain during intercourse

Question 29

What symptoms are seen in acute prostatitis? (5)

Answer 29

. Fever/chills . Perineal pain . Dysuria . Urinary urgency . Painful ejaculation

Question 30

What are symptoms of sexually transmitted infections STIs (5)

Answer 30

. Dysuria . Foul smelling Urethral discharge . Genital sores . Pelvic pain . Fever

Question 31

What symptoms indicate benign prostatic cancer? (3)

Answer 31

. Haematuria (blood in urine ) . Dysuria ( painful urination ) . Pelvic/ back pain

Question 32

What symptoms indicate bladder cancer (2)

Answer 32

. Dysuria . Haematuria

Question 33

What is the purpose of a urine dipstick in UTI diagnosis

Answer 33

It’s quick, inexpensive, and used as an initial screening, especially in women under 65 with lower urinary tract symptoms

Question 34

In which cases is a urine dipstick generally not needed according to NICE guidelines?

Answer 34

In uncomplicated ( low risk of treatment rejection ) UTIs in females under 65 with one symptom of a UTI.

Question 35

What is considered the gold standard for UTI diagnosis?

Answer 35

Urine microscopy, culture and sensitivity MC&S

Question 36

When should a urine sample be obtained in the context of antibiotic treatment?

Answer 36

Before starting antibiotics

Question 37

What does a positive dipstick result for nitrite or leukocyte and red blood cells indicate?

Answer 37

It likely indicates a urinary tract infection (UTI)

Question 38

If a urine dipstick is negative for nitrite but positive for leukocyte, what does this suggest ?

Answer 38

A UTI is equally as likely as an alternative cause for symptoms

Question 39

What does a negative result for all nitrite, leukocyte and RBCs on a dipstick test suggest?

Answer 39

A UTI less likely, and an alternative cause for symptoms should be considered

Question 40

What is a normal glucose concentration in urine ?

Answer 40

In normal urine, glucose level should be low, 0-0.8mmol/L High urine glucose levels (glucosuria) >1.39 mmol/L may signal endocrine abnormality e.g. diabetes mellitus (type 1/2) , or pregnancy

Question 41

What do high levels of bilirubin indicate?

Answer 41

The liver breaks down red blood cells and releases bilirubin into bile. If bilirubin levels are elevated ( bilirubinuria) this may indicate a sign of liver disease or that the bile is not draining properly into the small intestine

Question 42

What do high levels of urobilinogen indicate?

Answer 42

Bacteria in the intestines make urobilinogen from bilirubin (a component of bile ). Elevated levels of urine urobilinogen suggests that it has entered the urinary tract from the bloodstream which suggests there could be liver disease.

Question 43

What is non visible Haematuria?

Answer 43

Positive blood in the absence of nitrites or leukocytes(microscopic )

Question 44

When does non visible Haematuria need further investigation? (3)

Answer 44

. Age 60 or above with unexplained non-visible Haematuria and either Dysuria or raised white blood cell count on a blood test, you should be referred for further investigation to rule out bladder cancer. . Persistent or recurrent Haematuria even after UTI treatment- further investigation warranted . Risk factors for malignancy- if there are risk factors such as a history of smoking, exposure to certain chemicals, or family history of urothelial cancer, further investigation is needed

Question 45

Nephrotic syndrome 1. What is nephrotic syndrome 2. What are the symptoms 3. What will be present in urine dipstick test

Answer 45

1. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood 2. Symptoms include: fatigue, swelling in legs, frothy (bubbly) urine 3. Presence of protein indicates nephrotic syndrome

Question 46

Renal stones 1. What are symptoms of of renal stones 2. What may be present in blood

Answer 46

1. Symptoms include: severe flank pain 2. Blood- as renal stones sit inside your kidneys, decreasing reabsorption of blood.

Question 47

Hepatitis 1. What is hepatitis 2. What are the symptoms 3. What would be present in urine

Answer 47

1. Hepatitis is the term used to describe inflammation of the liver. It's usually the result of a viral infection or liver damage caused by drinking alcohol. 2. Symptoms include: Right upper quadrant abdominal pain, fatigue , yellowing of skin and eyes (as liver cannot get rid of bilirubin- gives yellow pigment) 3. Blood in urine