Clinical Lab Test 3 Up To Proteins

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Diabetes mellitus in polyuria

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excess glucose in blood leads to high concentration of glucose in filtrate exceeding the renal threshold. urine looks dilute but has a high osmolality

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Average adult daily output volume

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1200-1500 mL

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commonly see in states of dehydration resulting from water loss due to excessive vomiting, diarrhea, perspiration, or from severe burns

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Oliguria, this may lead to anuria a complete cessation of urine flow.

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What causes auria

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any serious damage to the kidneys or a decrease in blood flow to the kidneys

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Decreased production or function of ADH affecting the nephron's ability to concentrate urine through water reabsorption

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Diabetes insipidus: urine is dilute with a low osmolality

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Why would the urine be an amber beer brown

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due to the presence of conjugated bilirubin

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Why would the urine be red or pink and clear

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hemoglobin or myoglobin or porphyrins

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Your patients urine is cloudy in appearance, what is the problem?

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Intact red blood cells

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Your patients urine is pink and clear what is the problem

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it has hemoglobin, myoglobin or porphyrins present in the urine

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What color does methemoglobin turn urine to?

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Brown, black. Upon standing, hemoglobin iron in acidic urine will be oxidized to methemoglobin, which turns the urine brown

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What color does homogentisic acid turn the urine

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brown/black upon standing alkaline urine will turn brown if homogentisic acid is present in the urine sample

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Alkaptonuria

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a metabolic defect. increased excretion in occurs in the disease

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What color does melanin turn the urine

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Upon standing, neutral pH urine will turn black if melanin is present in the urine sample

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Why will melanin appear in the urine

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the patient has metastatic malignant melanoma (an aggressive form of skin cancer)

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What color does Pyridium (phenazopyriding) turn the urine?

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dark orange. antibiotic rifampicin

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How does normal urine look

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clear or hazy

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How does amorphous crystal make the urine look

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a normal clear or hazy

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How does squamous epithelial cells make the urine look?

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a normal clear or hazy

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How does seminal fluid make the urine look

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a normal clear or hazy

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how does fecal contamination make the urine look

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a normal clear or hazy

Front 21

What color does homogentisic acid turn the urine

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brown/black upon standing alkaline urine will turn brown if homogentisic acid is present in the urine sample

Front 22

Alkaptonuria

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a metabolic defect. increased excretion in occurs in the disease

Front 23

What color does melanin turn the urine

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Upon standing, neutral pH urine will turn black if melanin is present in the urine sample

Front 24

Why will melanin appear in the urine

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the patient has metastatic malignant melanoma (an aggressive form of skin cancer)

Front 25

What color does Pyridium (phenazopyriding) turn the urine?

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dark orange. antibiotic rifampicin

Front 26

How does normal urine look

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clear or hazy

Front 27

How does amorphous crystal make the urine look

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a normal clear or hazy

Front 28

How does squamous epithelial cells make the urine look?

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a normal clear or hazy

Front 29

How does seminal fluid make the urine look

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a normal clear or hazy

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how does fecal contamination make the urine look

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a normal clear or hazy

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how does mucus make the urine look

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a normal clear or hazy

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What causes the urine to have WBC, RBC, and bacteria

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Pathologic etiologies

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When the urine is cloudy or turbid, is this normal

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No, this is caused by a pathologic etiologies

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How does normal freshly voided urine smell

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pungent odor of volatile aromatic acids

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What does bacterial infections, elevated ketones, maple syrup urine disease, and asparagus have in common?

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They all make unusual odors in the urine

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How is the chemical analysis of urine accomplished?

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Utilization of a urine chemstrip or dipstick

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What is the normal value of protein in the urine

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Negative, Trace or trace dipstick reading (<= 150mg/day)

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What is the significance of urine pH?

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Aids in identifying acid base disorders

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When is acidic urine produced

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Respiratory or metabolic acidosis - not related to renal function disorders

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When is alkaline urine produced

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Respiratory or metabolic alkalosis

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How are abnormally high protein values reported

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3+, 4+

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How much proteins are reabsorbed by the tubules?

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95-99%. Only the smallest proteins are filtered from the plasma into the urine

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What are Tamm-Horsfall protein

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muco protein synthesized by the distal tubular cells and involved in cast formation

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What is the chemstrip most sensitive to

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the presence of albumin-although globulin are the major protein fraction found in urine

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What is sulfosalicylic Acid (SSA)

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Confirmatory test, used to retest all specimens with positive chemstrip results (1+ to 4+)

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When the SSA test confirms the presence of protein what should you order

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24 hour urine protein

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What does the 24hr urine provide

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quantify the amount of protein that is being secreted per day. It averages out normal variations in urine concentration

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What do you order if the 24hr urine is > 150 mg/day

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a urine protein electrophoresis procedure is performed to identify proportions of albumin and other proteins

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Why would a 24hr urine protein be ordered for patients with diabetes melitus and hypertension

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to screen for nephropathy

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What is most commonly performed on a spot urine specimen from a diabetic patient

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albumin to creatinine ratio

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What is the most common screening test for the presence of microalbumin in the urine

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Spot Method

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What test is used to diagnose diabetic nephropathy and to follow the disease

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Spot Method

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Can you find the presence of microalbumin in a routine chemstrip testing

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no, you must use the spot method

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Why is a random urine sample done in the spot method

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Tested for the amount of albumin and cratinine present. The amount of albumin present (abnormal) is compared to the amount of creatinine (assumed normal)

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What items are checked in a "spot Method"

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1. an albumin to creatinine ration
2. presence of microalbumin
3. a random urine sample is tested for the amount of albumin and creatinine present
4. the amount of albumin present is compared to the amount of creatine present

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Significance of abnormal protein results

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1. increased is pathologic when the level exceeds 150mg/day
2. a level of over 3.5 g/day is defined as massive proteinuria

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What are the functional causes proteinuria

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1. r/t changes in glomerular blood flow
2. enhanced glomerular permeability
3. no discernible systemic or renal disease or damage
4. severe muscular exertion within 24hrs
5. pregnancy
6. orthostatic proteinuria

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These causes of protein urina are usually transient and resolve with time

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proteinuria r/t changes in glomerular blood flow or enhanced glomerular permeability

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Is the proteinuria with pregnancy usually benign

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yes

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when is protein uria with pregnancy significant?

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with it is in conjunction with hypertension and edema. could be pre-eclampsia

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What is orthostatic proteinuria

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a benign proteinuria associated with the upright position

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What are the organic causes for proteinura

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1. prerenal proteinuria: associated with non-renal diseases
2. kidney diseases

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name some diseases associated with prerenal proteinuria with non renal diseases

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1. multiple myeloma
2. bence jones proteins of low molecular weight
3. CHF
4. Renal hypoxia due to renal artery stenosis
5. hypertension
6. fever

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Define multiple myeloma

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malignancy of plasma cells causing production of excess immunoglobulin (Ig) light chains

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Causes of renal protein uria

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caused by kidney diseases, primary or induced glomerular proteinuria: protein leaks through gomerulus

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Renal proteinuria: primary

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Glomerulonephritis, nephrotic syndrome

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Renal proteinuria: induced

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Drugs or toxins, systemic disease, diabetes mellitus or pre-eclampsia

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Defective tubular reabsorption characterized by increased levels of low molecular weight proteins

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Tubular proteinuria

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Examples of tubular proteinuria

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1. acute or chronic pylelonephritis
2. Drugs or toxins

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Postrenal Proteinuria

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Protein from the urinary tract below the level of the kidney parenchyma

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Examples of postrenal proteinuria

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1. inflammation within the urinary tract
2. contamination with vaginal secretions

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Example of Inflammation within the urinary tract

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1. renal pelvis-pyelonephritis
2. bladder-cystitis
3. urethral-urethritis
4. prostate gland-prostatitis