Urinalysis

Front 1

What does urinalysis test for

Back 1

routinely includes remarks about color, appearance, and odor of the urine

the pH is determined

The urine is tested for the presence of proteins, glucose, ketones, blood, and leukocyte esterase.

The urine is examined microscopically for RBCs, WBCs, casts, crystals, and bacteria

Examination of the urine sediment provides a significant amount of information about the urinary system

Front 2

Urine appearance and color

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Normal urine should be clear

Cloudy urine may be caused by the presence of pus, RBCs, or bacteria; however, normal urine may be cloudy because of ingestion of certain foods (e.g. large amounts of fat, ureates, or phosphates)

Front 3

What causes urine color

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the color of urine ranges from pale yellow to amber because of the pigment urochrome

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What does the color of urine indicate

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the concentration of the urine and varies with specific gravity.

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Urine Odor

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the aromatic odor of fresh, normal urine is caused b the presence of volatile acids

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Urine Ph

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pH is affected by diet, medications, systemic acid base disturbances, and renal tubular function.

Front 7

What can cause a high urine PH

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bacteria, urinary tract infection, or a diet high in citrus fruits or vegetables may cause an increased pH.

Front 8

What medications are effective in treating urinary tract infections when the urine is alkaline

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streptomycin, neomycin, kanamycin.

Front 9

what is the normal pH for urine

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7.0

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what causes acidic urine

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metabolic or respiratory acidosis, starvation, dehydration, or a diet high in meat products or cranberries.

Front 11

The urine pH is useful in identify...

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crystals in the urine and determining the predisposition to form a given type of stone.

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Urine protein is a sensitive indicator of

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glomerular and tubular renal function

Front 13

Is protein normally detected on a routine urinanalysis

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Normally less than 30 mg of protein per day is in urine.

This is not detectable in the routine protein analysis.

Front 14

What would cause protein to be in the urine

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If the glomerular filtration membrane is injured, as in glomerulonephritis, the spaces become much large, and protein seeps out into the filtrate and then into the urine.

Renal tubules are the site of protein resorption.

if tubular disease exist, protein is in the urine.

Front 15

What is the most common indicator of renal disease

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proteinuria (usually albumin)

Front 16

Measuring glucose in the urine

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Glucose is filtered from the blood by the glomeruli of the kidney

Normally, all the glucose is reabsorbed in the proximal renal tubules.

When the blood glucose level exceeds the capability of the renal threshold to reabsorb the glucose (normally around 180 mg/dL), it begins to spill into the urine (glycosuria)

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Urine specific gravity

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The specific gravity is a measure of the concentration of particles, including wastes and electrolytes, in the urine.

A high specific gravity indicates concentrated urine; a low specific gravity indicates diluted urine.

Specific gravity refers to the weight of the urine compared with that of distilled water (which has a specific gravity of 1.000)

Front 18

What is urine specific gravity used to evaluate

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the concentrating and excretory power of the kidney.

renal disease tends to diminish the concentrating capability of the kidney

Front 19

Leukocyte esterase

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screening test used to detect leukocytes in the urine

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Positive leukocyte esterase

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indicates a urinary tract infection

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Nitrites

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like leukocyte esterase, the nitrite test is a screening test for the identification of urinary tract infections.

this test is based on the principle that many, but not all, bacteria produce an enzyme called reductase, which can reduce urinary nitrates to nitrites.

Front 22

Positive nitrites

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indicating the presence of bacteria

a positive results would indicate the need for urine culture

nitrite screening enhances the sensitivity of the leukocyte esterase test to detect urinary tract infections

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Ketones

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normally no ketones are present in the urine; however, a patient with poorly controlled diabetes who is hyperglycemic may have massive fatty acid catabolism.

Ketones are the end product of of fatty acid breakdown.

As with glucose, ketones spill over into the urine when the blood levels of patients with diabetes are elevated.

the excess production of ketones in the urine is usually associated with poorly controlled diabetes.

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Bilirubin

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Bilirubin is a major constituent of bile.

If bilirubin excretion is inhibited, conjugated (direct) hyperbilirubinema will result

unlike the unconjugated form, conjugated bilirubin is water soluble and can be excreted into the urine.

therefore, bilirubin in urine suggests disease affecting bilirubin metabolism after conjugation or the defects of excretion (e.g. gallstones)

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Urobilinogen

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Bilirubin is excreted by way of the bile ducts into the bowel.

There, some of the bilirubin is transformed into urobilinogen by the action of bacteria in the bowel.

Most of the urobilinogen is excreted from the liver back into the bowel, but some is excreted by the kidenys.

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Crystals

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crystals found in urinary sediment on microscopic examination indicate renal stone formation is imminent, if not already present.

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urea crystals

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occur in patients with high serum uric acid levels (gout)

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Phosphate and calcium oxalate crystals

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occur in the urine of patients with parathyroid abnormalities or malabsorption states

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Casts

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casts are rectangular clumps of materials or cells are formed in the renal distal and collecting tubules, where the material is maximally concentrated.

these clumps of materials and cells take the shape of a tubule, thus the term cast

casts are usually associated with some degree of proteinuria and stasis in the renal tubules.

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what are the two types of casts

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hyaline casts

cellular casts

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hyaline casts

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conglomerations of protein and indicate proteinuria

a few hyaline casts are normally found, especially after strenuous exercise or dehydration

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cellular casts

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conglomerations of degenerated cells.

Front 33

the presence of _________ wbc's in the urine indicate a urinary tract infection involving the bladder, kidney, or both

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5 or more

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when are WBC casts normally found

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commonly found in infections of the kidney, such as acute pyelonephritis or interstitial nephritis.

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microhematuria

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patients with more than three RBCs per high power field in 2 out of 3 properly collected urine specimans should be considered to have microhematuria, and hence be evaluated for possible pathologic causes

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RBC casts

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suggests glomerulonephritis

seen in patients with active tubular necrosis, pyelonephritis, renal trauma, or renal tumor.