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32 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Routine Urinalysis consists of three parts, name them.
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1. Examination of physical characteristics
2. Chemical analysis with a urine dipstick 3. Microscopic examination of the urine sediment |
pg 7
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Urinalysis - Physical Characteristics (3)
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1. Color
2. Appearance 3. Specific Gravity |
pg 7
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Urinalysis - Specific Gravity
-definition -what does it mean if its low or high? |
Ratio of weight of a volume of urine to the weight of the same amount of distilled water. (1.003 - 1.035)
-High when: urine is concentrated or HMW substances are present in the urine (glucose, dyes) -Low when urine is dilute or in diabetes insipidus -Used to measure the concentrating and diluting power of the kidney |
pg 8
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Urinalysis - Urine Osmolality
-definition |
# of particles dissolved in a kilogram of H20 - only depends on the # of particles, not the weight.
-More accurate method of estimating the concentrating and diluting ability of the kidney but technically more demanding and not routine. |
pg 8
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Urinalysis - pH
-significance of high and low results |
Low: sign of excessive acid in the body --> more H+ is secreted in the urine. Common in people with Western diet (high in protein)
High: if pH is very high (>8) - could be a sign of UTI with Proteus, Pseudmonas and some E. Coli. **Dipstick pH is not sensitive enough to accurately diagnose renal tubular acidosis - need to use pH meter |
pg 8 (bottom)
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Urinalysis - protein
-normal values -when does dipstick become positive |
LMW proteins < 25,000 daltons (albumin is 69 kDa) are filtered and reabsorbed by the proximal tubule, <150mg/day are excreted normally
Dipstick is positive if >250mg/day excreted |
pg 9
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Urinalysis - protein
-sources for proteinuria and associated dipstick reading (4) -proteins dipstick is sensitive too |
1. Tubular disorders (reabsorption) -- dipstick reads 1+ or 2+
2. Glomerular diseases (filtration) -- dipstick reads 3+ or 4+ 3. Overflow states -- multiple myeloma -- dipstick may only read 1+ so negative dipstick doesnt rule this condition out 4. Contamination -- semen, vaginal discharge, pus, blood, heavy mucus --sensitive to albumin, less sensitive to gamma globulins or tubular proteins (Tamm-Horsfall) |
pg 9
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Urinalysis - glucose
-when does dipstick become positive -condition in which serum glucose is normal but glucose is positive in the urine |
Usually, glucose does not appear in the urine until blood glucose is >160-180mg/dL
If proximal convoluted tubule is not capable of reabsorbing as much glucose as normal, glucose can become positive in the urine with normal blood levels -- renal glycosuria (Fanconi's syndrome, pregnancy) |
pg 10
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Urinalysis - ketones
-which are detected by dipstick -detection is a sign of? (4) |
Acetoacetate and acetone are detected, beta-hydroxybutyrate is not.
1. Starvation 2. DKA 3. Preclampsia 4. Prolonged vomiting or diarrhea |
pg 10
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Urinalysis - blood
-what is detected (3) |
1. intact RBCs
2. free hemoglobin 3. myoglobin |
pg 10
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Rhabdomyolysis
-urinalysis and microscopic exam findings |
Positive in both due to myoglobin in the urine
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pg 10
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Intravascular hemolysis
-urinalysis and microscopic exam findings |
Positive in both due to free hemoglobin in the urine
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pg 10
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Urinalysis - bilirubin
-what condition leads to high bilirubin in the urine? |
When conjugated bilirubin is high as in obstructive jaundice
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pg 10
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Urinalysis - urobilinogen
-what condition leads to high urobilinogen in the urine? |
When there is excessive urobilinogen as in hemolytic anemia
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pg 10
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Urinalysis - nitrites
-Nitrites in the urine are a sign of? |
Bacteriuria
--E.Coli, Enterobacter, Klebsiella and Proteus have enzymes that reduce nitrate to nitrite. Can still have bacterial infection without elevation of nitrite however. |
pg 11
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Urinalysis - leukocyte esterase
-positive result is a sign of? |
When combined with a positive nitrite result, strong indication of a UTI.
If both tests are negative, chances of a UTI are very small |
pg 11
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Urinalysis -- cells
--normal values and orgin of these cells: 1. RBC 2. WBC 3. Epithelial (subtypes) |
1. RBC -- 1-2 are normal; 3-5 is dividing line. May origninate in any part of the urinary tract from glomerulus to urethra
2. WBC -- 3-5 are normal; >5 is positive on dipstick. Predominant cell is neutrophil, can enter urine anywhere from glomerulus to the urethra 3. Epithelial -- 0-2 are normal; >5 is abnormal. --tubular epithelial cells --transitional epithelial cells --squamous epithelial cells |
pg 11
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Urinalysis -- tubular epithelial cell
-description -conditions in which their # will increase |
A bit larger than a WBC; large, round nucleus
Increased in renal tubular injury |
pg 11
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Urinalysis -- transitional epithelial cell
-description -conditions in which their # will increase |
2-4 times larger than WBC; may be round or pear shaped
Increased in inflammatory conditions involving the ureters or bladder |
pg 11
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Urinalysis -- squamous epithelial cell
-description -conditions in which their # will increase |
Large cytoplasm sheets with small central nuclei
Vaginal contamination is the most common cause of increased # |
pg 11
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Urinalysis -- casts
-definition of a cast; protein, location of formation, significance |
Formed in the lumen of the renal tubules when Tamm-Horsfall protein gels. Different material may become trapped with the cast in the tubules -- this leads to the various kinds of casts.
Depending of the type of cast, can be be normal (hyaline or granular) or pathological (RBC, WBC, Epithelial...) |
pg 12
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Urinalysis -- Hyaline cast
-associated conditions -# needed to be significant |
--seen during dehydration or after exercise
--normal finding in small numbers |
pg 12
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Urinalysis -- RBC cast
-associated conditions -# needed to be significant |
--hallmark of glomerulonephritis; rarely present in pyelonephritis or renal infarction
--presence of even ONE is significant |
pg 12
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Urinalysis -- WBC cast
-associated conditions/source |
--usually from inflamed interstitium around the tubules, seen in interstitial nephritis or pyelonephritis (acute inflammatory processes)
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pg 12
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Urinalysis -- Epithelial cell cast
-associated conditions |
--imply tubular damage; acute tubular necrosis (diagnostic if found w/coarse granular casts)
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pg 12
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Urinalysis -- Granular cast
-two types -associated conditions |
--finely granular casts are more likely the aggregation of proteins and cellular debris; may be normal
--coarsely granular casts are usually the result of cellular death and injury; acute tubular necrosis (diagnostic if found w/epithelial cell casts) |
pg 12
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Urinalysis -- Waxy cast
-associated conditions/source |
--highly refractile w/sharp edges; occasional granules or cells
--end result of degeneration of granular casts; usually represent particularly severe and long standing renal disease |
pg 12
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Urinalysis -- Fatty cast
-associated conditions/source |
--casts embedded with lipid
--along with oval fat bodies and free fat droplets are characteristic of nephrotic syndrome --polarizing light shows "Maltese cross" pattern of cholesterol and cholesterol esters |
pg 12
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Urinalysis -- crystals
-signifcance |
--common, especially if the urine has been standing
--limited clinical importance, however presence of some crystals in urine is always abnormal |
pg 12
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Urinalysis -- crystals
-presence of cystine crystals |
--always abnormal, signifies presence of cystinuria
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pg 12
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Urinalysis -- crystals
-effect of pH (acidic vs alkaline) -what crystals are found in each condition |
--type of crystal in part reflects the pH of the urine
--acidic: uric acid, calcium oxalate and amorphous urate --alkaline: amorphous phosphate, triple phosphate (coffin-lid), ammonium biurate or calcium carbonate. |
pg 12
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Urinalysis -- crystals
-siginficane of oxalate crystals |
-seen in ethylene glycol ingestion (anti-freeze)
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pg 12
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