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75 Cards in this Set
- Front
- Back
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urine with a specific gravity greater than the 1.010 specific gravity of the plasma filtrate
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hypersthenuria
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urine with a specific gravity less than the 1.010 specific gravity of the plasma filtrate
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hyposthenuria
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This is the most common. It is a voided sample done at any time
of the day. This is most useful for routine screening. |
random specimen
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This is
particularly useful to evaluate for casts, orthostatic proteinuria, and can help prevent false negative pregnancy tests. |
first morning specimen
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This method decreases contamination and is the
easiest way to obtain a specimen for bacterial culture. Patients must be instructed on how to clean their genitalia prior to the collection. Sterile containers must also be used if it is to be sent for culture. |
midstream clean catch
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This requires the bladder to be catheterized with a hollow tube
called a Foley catheter or straight catheter. This is done under sterile conditions and is more traumatic than the midstream clean-catch but may be necessary in some patients who can not adequately clean their genitalia prior to a collection. |
catheterized specimen
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This is done by placing a sterile needle into the bladder to
obtain the specimen. This provides a sterile specimen. It is rarely done and is done primarily in patients who are felt to be at risk for bacteremia or contamination of the urinary system by catheterization. |
suprapubic aspiration
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3 steps in a urinalysis
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1) Inspection
2) Chemical Testing 3) Microscopic evaluation |
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What disorders will show yellow color, Elevated specific gravity and positive dip test for glucose in urine?
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Polyuria or
Diabetes insipidus or diabetes mellitus |
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What changes do the following factors cause to the urine?
Concentrated specimen Dehydration Bilirubin Carrots or vitamin A Pyridium Nitrofurantoin |
1) Cause color to become dark yellow/orange
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Yellow foam when shaken and positive test is indicative of what in urine?
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bilirubin
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Bilirubin oxidized to
biliverdin will what color? |
yellow-green
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What color does rhubarb turn urine?
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Yellow-brown
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Pseudomonas infection : color of urine
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Green/Blue Green
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In addition to a pseudomonas infection, what other things turn urine greenish?
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Amitriptyline
Clorets Methylene Blue |
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Red Blood Cells
Hemoglobin Myoglobin Beets Rhubarb Turn urine what color? |
Pink/red
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What will be the difference in urinalysis for the following:
A) RBCs B) Hemoglobin C) Myoglobin |
A) Cloudy urine, POSITIVE for blood. Will see the RBCs microscopically
B) Clear urine with + result for blood. Will NOT see RBCs. C) Same as Hb |
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Red Blood cells oxidized to
methemoglobin Myoglobin Methyldopa Metronidazole Turn urine what color? |
brown
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four most common substances that cause turbidity in urine
are _____ |
white blood cells, red blood cells , epithelial cells, and bacteria.
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Specific gravity: definition
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the density of a substance compared with the
density of a similar volume of distilled water at a similar temperature |
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What does the specific gravity of urine measure?
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measure of the density of the
dissolved chemicals in the specimen. Because it is a measure of density it is affected by both the size and number of the particles. |
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With concentrated urine,
such as in volume depletion, the specific gravity will (increase,decrease) and in dilute urine it will (increase,decrease.) Specific gravity will also be affected by the presence of glucose, drugs, contrast, or ketones in the urine. |
increase;decrease
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How are the following detected in urine?
pH Protein Glucose Ketones Blood- Red blood cells, myoglobin and hemoglobin Bilirubin (Conjugated) Urobilinogen Nitrite Specific Gravity Leukocytes |
Chemical testing - reagent strips
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What aspects of UA require microscopic analysis?
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Looking for cells and casts.
Epithelial Cells Squamous Cells-lining of the vaginal and lower portion of the male and female urethras Transitional cells- lining of the bladder, renal pelvis, and upper urethra Renal Tubular Cells Red Blood Cells White Blood Cells Crystals Bacteria, Fungus and Protozoa Casts |
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What does a very high urine pH (8) usually indicate?
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usually indicates the presence of a urea splitting organism.
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A urine pH of 9
usually indicate? |
that the specimen has been sitting for a while and a fresh specimen should be
obtained. |
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T/F All proteinuria should be further evaluated.
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T
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What do the following have in common:
fever, exposure to cold, strenuous exercise, dehydration, and orthostatic proteinuria |
All are non-pathologic causes of proteinuria
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What are some pathologic conditions associated with proteinuria?
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glomerular membrane damage, impaired tubular reabsorption, multiple
myeloma, preeclampsia, and diabetic nephropathy. |
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3 ketones that are intermediate products of fat metabolism.
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acetone,
acetoacetate, and beta-hydroxybutyrate. |
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What does the blood component of the urine reagent dipstick test for?
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Intact red cells, myoglobin, free hemoglobin
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T/F Conjugated bilirubin is excreted in the urine
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T. It's water soluble and not protein bound.
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In what conditions will Conjugated bilirubin be seen in urine?
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hepatitis, cirrhosis, gallbladder disease, cancer
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What does the nitrite component of the urine reagent dipstick screen for?
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UTI
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T/F A negative nitrite test rules out UTI
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F. Not all bacteria that can cause UTI can convert nitrate to nitrite.
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What is use of the leukocytes component of the urine reagent dipstick?
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Detects both whole and lysed RBCs. Useful in screening for UTIs.
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How to prep for microscopic exam?
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Fresh urine should be centrifuged and effluent removed.
Place sediment of clean microscope slide for evaluation. Too many squamous cells indicates inadequate collections. |
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What are urinary casts?
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cylindrical structures produced by the kidney and present in the urine in certain disease states.They form in the distal convoluted tubule and collecting ducts of nephrons, then dislodge and pass into the urine, where they can be detected by microscopy.
<b>They indicate the substance has arisen from the KIDNEY ITSELF, not somewhere else along the urinary tract. </b> |
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What does the presence of urinary casts indicate?
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That the cast originated in the KIDNEY, not somewhere else along the urinary tract.
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What are the types of epithelial cells that may be seen on microscopic exam?
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Squamous cells, transitional cells, renal tubular cells
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Clinical significance of the following type of urine cast:
Hyaline |
Glomerulonephritis, pyelonephritis, chronic renal disease, CHF, Stress and exercise
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Clinical significance of the following type of urine cast:
Red Blood Cell |
Glomerulonephritis
Strenuous exercise |
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Clinical significance of the following type of urine cast:
White Blood Cell |
Pyelonephritis
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Clinical significance of the following type of urine cast:
Epithelial cell |
Renal tubular nephritis
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Clinical significance of the following type of urine cast:
Granular |
Stasis of urine flow
UTI Stress and Exercise |
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Clinical significance of the following type of urine cast:
Waxy |
From hyaline cases.
Stasis of urine flow |
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Clinical significance of the following type of urine cast:
Fatty |
Nephrotic syndrome
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Clinical significance of the following type of urine cast:
Broad casts |
Formation in collecting ducts
Extreme stasis of urine flow |
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What casts are formed in statis of urine flow?
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Broad cases (collecting ducts); Waxy (hyaline casts); Granular (due to disintegration of white cell casts, bacteria, urates)
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When are fat droplets/lipid globules seen in urine?
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nephrotic syndrome
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acute non-complicated cystitis: defn
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infection of bladder in otherwise healthy, nonpregnant adult woman
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Causative agent in 70-95% of infections
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E. Coli
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Acute non-complicated cystitis: sx
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dysuria, frequency, urgency, suprapubic pain, hematuria
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Presence of ______ make likelihood of cystitis higher than vaginitis or urethritis
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hematuria
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pyelonephritis: defn
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Urinary infection involving upper urinary tract (kidneys, ureters)
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Most infections are _____, that is the lower urinary tract is colonized or infected and the infections ascend up the urinary tract to involve the kidneys
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ascending
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What plays a role in determining which bacteria will affect the kidneys?
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What virulence factors they have.
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Acute pyelonephritis: sx
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Fever >101
Flank pain, CVA tenderness nausea/vomiting dysuria suprapubic pain frequency |
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DDX for Acute pyelonephritis
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Acute cystitis; urethritis; PID, ectopic pregnancy
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When should a pelvic exam be done with acute pyelonephritis is suspected?
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When the patient is a sexually active woman who does not have unilateral flank pain and tenderness
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What is diagnostic of pyelonephritis but not a very sensitive test?
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WBC casts on microscopic exam
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Who should be hospitalized for pyelonephritis?
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Can't maintain hydration due to vomiting, Concerns about compliance, Uncertainty about dx, severe illness with hypotension
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Antibiotics for pyelonephritis
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Fluoroquinolones
TMP-SMX can be used if resistance is low. |
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When is a UTI considered complicated?
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1) Pregnancy
2) pt is over 70 yo 3) Diabetics 4) Immunocompromised 5) Failed a prior course of therapy/bacterial resistance 6) hospital acquired infection 7) Pts with suspected fungal infections 8) Anatomic abnormalities of the urinary tract |
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Neurogenic bladder, cystic kidney disease, and nephrolithiasis are all examples of what?
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Anatomic or functional abnormalities of the urinary tract
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Tx of complicated UTIs
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begin tx with broad empiric antibx - flouroquinolones (NOT in pregnancy)
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Risk factors for cystitis in men
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homosexuality; Intercourse with infected woman; uncircumsized
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When is the ONLY time asymptomatic bacteriuria should be treated?
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pregnancy. should always tx
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Drug of choice for UTI in pregnant woman
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Nitrofurantoin
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Glomerular disease shows ____c asts
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RBC
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Allergic interstitial nephritis, pyelonephritis shows ____ casts
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WBC
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Acute tubular necrosis shows ____ casts
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muddy brown granular
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calcium oxalate has a _____ shape in urine
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envelope
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triple ammonium phosphate has a ____ shape in urine
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coffin
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T/F dipsticks check for albumin only -Bence Jones proteins (immunoglobulin light chains produced in the plasma cell tumor multiple myeloma) are not detected
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T
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