urinalysis can be used to diagnose
renal or urinary tract disease
monitor renal or urinary tract disease
detect metabolic or systemic disease (DM)
cystocentesis
remove fluid from the bladder using a suprapubic catheter
first morning specimen
pt. gets specimen first thing in the morning
must use a preservative
random urine specimen
obtained during the day w/o pt prior notice
- drug testing
- most common
timed urine collection
pt collects all urine over a period of 24 hours
- does not include the first morning void (would include urine produced during the night)
- proteinuria
urine for culture and sensitivity
examines bacteria, sterile, midstream collection, cultured w/in one hour of collection (doesn’t usually happen)
-avoids contamination and cell lysis
cloudy urine indicates
presence of WBC, RBC, bacteria
pale yellow to amber urine indicates
urochrome (a pigment which is a product of bilirubin metabolism)
red urine indicates
pt is bleeding, dark red (from the kidneys) bright red (from bladder)
dark yellow urine indicates
bilirubin
specific gravity
measures kidney’s ability to conc the urine
- weight is compared to weight of distilled water
- value is affected by amt of solutes, volume, hydration
low specific gravity indicates
diabetes insipidus
chronic renal diseases (diminished conc ability)
renal threshold
180mg/dl
point at which kidneys start allowing sugar through
anti-diuretic hormone
in posterior pituitary, keeps your body from diuresing (urinating)
high specific gravity indicates
DM
excessive water loss (dehydration)
increased secrection of ADH (urine is concentrated)
lots of solute in the urine
urine osmolality
number of particles in a unit of solution-correlates w/specific gravity but not the same thing
normal is 50-1200 mOsm/kg
pH
normal is 4.6-8.0 (avg is 6.0)
low pH (acidic)
acidosis, diet high in cranberries
high pH (basic)
some bacteria, UTI
protein
no protein should be in the urine
measured negative (-) to 4+
qualitative check
proteinuria indicates
glomerular injury (allows proteins, albumin, to seep into filtrate) if pos for protein, should f/u with 24 hr specimen
proteinuria indicates also
preeclampsia-HTN, edema, proteinuria
eclampsia
diabetes -decreased renal flow
glomerulonephritis
blood
measured negative (-) to 4+
hematuria
bleeding w/i the urinary tract may be gross or microscopic
positive microscopy needs to have
3-5 RBC per high power field
hematuria indicates
cystitis (most common cause of hematuria)
glomerulonephritis
cancer
false positive on a heme test could be caused by
beets
microscopy
looking at urine under the microscope
glucose
normally negative
positive is 100-2000 mg/dl
glucose in urine indicates
possible diabetes (unless pregnant)
ketones in urine
normally negative
positive reported as 1+ to 4+
ketone (definition)
byproduct of fatty acid catabolism
used as energy source when glucose cannot be used
breakdown of muscle
ketonuria indicates
poorly controlled DM (insulin resistance) hyperglycemia diabetic ketoacidosis alcoholic ketoacidosis starvation high protein diets
bilirubin
breakdown product of hemoglobin
urobilinogen
bilirubin that has been transformed by the kidney
-water soluble
urobilinogen increase indicates
hemolysis
leukocyte esterase
screens for WBC
positive leuk esterase indicates
UTI
-may be contaminated by vaginal discharge
nitrites
gram negative bacteria takes nitrates and turns them into nitrites
positive nitrites indicates
UTI with a gram negative bacteria
microscopic examination can note
RBC, WBC, epithelial cells (squamous, renal tubular)
crystals (indicates stone formation) varies w/ dz and pH
most common cause of a urinary stone
calcium oxalate
uric acid crystals
crystals in acidic urine indicates gout
calcium oxalate
crystals in acidic urine composes kidney stones (envelopes)
calcium phosphate
crystals in alkaline urine
lots of epithelial cells indicate
contamination from vagina or penis
triple phosphate
coffin lids a/w stones, chronic cystitis
casts
formed in DCT
form when overproduction of cells, and conc of Na+, decreased urine flow
cells in the form of whatever area it came out of
hyaline cast
protein cast
strenuous excercise or dehydration
cellular cast
abundance of red or white blood cells
granular cast
cellular or protein material that has been broken down
- renal disease
- strenuous excersize
fatty cast
overproduction of lipids
oval fat bodies
within cellular cast
-nephrotic sydrome
waxy cast
cell or hyaline cast that has been present for a long time and has broken down diminished flow -long term kidney disease -diabetic nephropathy -malignant HTN
epithelial cast
may be squamous cell or renal tubule
- renal tubular indicates glomerulonephritis
- from bladder indicates tumor, infection or polyps
WBC cast
found in infections
- pyelonephritis
- inflammatory nephritis (lupus)
RBC cast
found in disruption of blood/urine barrier
indicates membrane damage (glomerulonephritis)
conjugated bilirubin
bilirubin that has passed through the liver and is now water soluble
unconjugated bilirubin
bilirubin that has not passed through the liver and is fat soluble
Tamm-Horsfall protein
most common protein that makes up hyaline casts
