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75 Cards in this Set
- Front
- Back
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What may cause Myoglobinuria
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conditions resulting in significant muscle damage, crushing muscloskeletal injuries like Rhabdomyolysis and myocardial infarction
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How is bilirubin (conjugated) formed
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by the breakdown of Hgb in the spleen and RE cells
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give the steps in the break down of bilirubin
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Hgb is bound by haptoglobin and recycled; Hgb is transported by albumin to the liver and becomes unconjugated bilirubin (not soluble); bilirubin is conjugated with glucuronic acid in the liver and conjugated. now it is water soluble
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Where is the majority of urobilinogen excreted?
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The majority is excreted via the feces but some, a small amount is excreted in the urine.
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Intra or extra hepatic obstruction will result is an increase in what lab value?
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Bilirubin results, increased
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What type of diseases will one see when there is an intra or extra hepatic obstruction.
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carcinoma (within the liver or pancreas); Stone formation; fibrosis of the liver parenchyma
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If your patient has an intra or extra hepatic obstruction, you know that the formation of a stone is possible. Where might that stone form
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The stone will form in the gallbladder then obstructs the common bile duct
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Where is urobilinogen formed
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in the intestional tract by bacterial breakdown of conjugated bilirubin
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How much urobilinogen is reabsorbed into the portal circulation and excreted by the liver
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50%
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Is testing on a fresh sample required when looking at urobilinogen
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Yes and it must be done quickly
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Why is testing on a fresh sample important when testing urobilinogen?
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because any urobilinogen present will be rapidly oxidized to non detectable urobilin
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Why is it important to have the fresh same properly preserved when testing for urobilinogen
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because any urobilinogen present will be rapidly oxidized to non detectable urobilin
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Will decreased or absent levels of urobilinogen detected by urine chemstrip testing?
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NO, IT IS BETTER TO EVALUATE STOOL
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What color will the stool be when urobilinogen is present?
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light colored
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What will cause increased urobilinogen in the urine; prehepatic
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increased breakdown of Hgb causing increased level of conjugated bilirubin; hemolysis and ineffective erythropoiesis
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Prehepatic increased urobilinogen in urine is caused by what
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increased breakdown of Hgb, hemolysis(transfusion reactions), and ineffective erythropoiesis (thalassemias, pernicious and anemia)
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Increased urobilinogen in urine is caused by what?
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Hepatocellular disease, hepatitis, cirrhosis
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What causes a decreased to absent urobilinogen in urine?
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intra or extra hepatic obstruction, carcinoma, stone formation and fibrosis
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What can bilirubin and urobilinogen results be used to differentiate?
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liver disease, biliary obstruction and hemolysis
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is it normal to have urine urobilinogen and negative urine bilirubin with fecal urobilinogen
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yes this is a normal condition
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what is going on when a patient has increased urine urobilinogen, negative urine bilirubin and increased fecal urobilinogen
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pre hepatic
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variable urine urobilinogen, normal to increased, postitive urine bilirubine and decreased fecal urobilinogen
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hepatic disorders
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positive urine bilirubin, obstruction no urobilinogen, absent or decreased in the intestines
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post hepatic
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How is nitraite tested
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chemstrip
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What will happen to the chemstrip if common urinary tract pathogens like E coli are present on the chem stick
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they reduce urinary nitrate to nitrite resulting in a color change on the test pad
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When do you test nitrate
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the first morning urine specimen is preferred because more bacteria present and more contact time for conversion of nitrate to nitrite
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Why would a false negative test occur with nitrate
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UTI pathogen does not reduce nitrate and urine was not held in bladder long enough for adequate nitrate reduction to occur
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Why would a false positive test occur with nitrate
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an improperly preserved urine specimen gives a positive result due to growth of a bacterial contaminant like E coli
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How are positive nitrate results confirmed
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a microscopic examination of urine sediment and a bacterial culture of the specimen
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What is LE
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Leukocyte esterase
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What does LE test
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an enzymatic reaction that utilizes esterase produced by leukocytes resulting in a color change on the test pad
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You know that a positive LE result will often lead to a postive what
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nitrite test as well
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What does a positive LE test mean
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indicates a large number of white blood cells in the urine (pyuria)
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When will you most likely see a false positive results with LE test?
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Vaginal or urethral infections with trichomonas, yeast, chlamydia and mycoplasma. or viruses
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When will you get positive LE result without a postive nitrite result
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Viruses, mycoplasma, chlamydia, yeast and vaginalis
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How are positive LE result confirmed
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microscopic examination of the urine sediment for the presence of WBCs
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Define Specific gravity
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ratio of density of substance (urine) to water
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What does S.G. indicate?
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the relative proportions of dissolved solids to the total volume of the specimen and reflects the relative degree of concentration of the urine sample based on the specific gravity of water being 1.000
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1.002-1.040
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the physiological range of urine specific gravity
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1.005-1.030
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normal specific gravity with a norma urine output
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What measures the refractive index
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Refractometer
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ratio of the velocity of light in air to the velocity of light in a solution
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refractive index
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How do you test specific gravity
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Refractometetr
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When will you see high specific gravity results
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dehydration with oliguria, a solute diuresis
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the urine sample will have a positive glucose result and the patient will be experiencing increased frequent urination
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a solute iduresis
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the SG of fluid in Bowman's capsule is 1.010
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a significant low specific gravity
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Isosthenuria
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implies renal tubular damage and loss of tubular function. excretion of urine with a consistent SG of 1.010
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What is the most common cause of isothenuria
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chronic renal failure as a result of diabetic nephropathy, hypertensive renal disease or chronic glomerulonephritis
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Normal osmolaty results
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50-1400 mOsm/kg
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Why do we most frequently use osmolaity
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diagnosis of polyuria when diabetes mellitus has been ruled out
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What is the purpose of microscopic examination of urine sediment
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detect and identify insoluble materials present in the urine
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RBC & WBCs, Epithelial cells, casts, crystals, bacteria, yeast or parasites, mucus, spermatozoa, artifacts (junk)
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These are the insoluble materials in urine
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When is a microscopic examination preformed
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when there are any abnormal results detected on chemstrip and confirmatory test
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how much is an aliquot
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about 10ml
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RBC normal range
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0-2
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When will you see hematuria in the urine
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it is associated with UTI and pyuria
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When will you see nephronal hematuria
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proteinuria and RBC cast
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When will you see RBC in the urine
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urinary tract stones, benign or malignant urinary tract neoplasm, trauma, prostatitis
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Nephronal hematuria
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tubular disease due to infections, toxin, neoplasms, immune disorders or hereditary diseases, this will also cause RBC in urine
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Will very strenuous exercise within 12-24 hours cause RBCs in urine
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yes about 5-10
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What does pyuria in the urine indicate
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the presence of infection or inflammation of the genitourinary system
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What is the normal range of WBCs in the urine
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0-5
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What do moderate/heavy proteinuria, WBC cast and hematuria INDICATE
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a kidney infection
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what are the indication of a bladder infection
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hematuria, smaller amounts of protein and no casts
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When it comes to squamous epithelial cells most labs consider what a clean sample
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less than 5 cells/hpf
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The most frequently seen in the urine and the least clinically significant
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squamous epithelial cells
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When there are greater than 10 squamous epithelia cells present what does this indicate
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a poorly collected sample, contaminated and can not be forwarded to the microbiology lab for bacterial culture and antibiotic sensitivity testing
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Where do transitional epithelial cells originate from
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the lining of the renal pelvis, ureters and bladder and the upper urethra in males
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When will you see large numbers of transitional epithelial cells
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after instrument procedures, suspect a pathologic process if an instrument procedure has not been recently eperformed
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How do transitional epithelial cells look
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smaller than squamous and are round or pear shaped with a central nucleus
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What does an increased number of renal tubular epithelial cells indicate
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tubular necrosis or damage, severe kidney disease exists
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What do renal tubular epithelial cells do
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When lipids pss across the glomerular membrane, renal tubular cells absorb them
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RTE cells that contain lipids are described as
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Oval fat bodies and are commonly seen in nephrotic syndrome
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formed primarly in the lumen of the distal convoluted tubule and collecting duct
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Casts
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factors enhancing the formation of casts
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acid pH, high urine concentration, proteinuria, stasis
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