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what insoluble materials are present in urine?
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Urinalysis
| Question | Answer |
|---|---|
| what insoluble materials are present in urine? | red and white blood cells, epithelial cells, casts, crystals, bacteria, yeast, and parasites, spermatozoa, mucus, artifacts |
| what must microscopic examination include? | identification and quantitation of the elements present (may or may not be considered normal) |
| what things are clinically significant? | renal urinary tract disorders and other systemic disorders |
| what is the least standardized and most time-consuming part of routine urinalysis | microscopic urinalysis |
| brightfield microscopy | most frequently used due to its availability |
| brightfield microscopy | unstained specimen |
| problems with brightfield microscopy | refractive index of some elements is similar to that of urine, causing false negative results |
| phase-contrast microscopy | enhances images of translucent / low refractile formed elements; provides better image reinforcement that brightfield |
| problem with phase-contrast microscopy | generally not available in most clinical labs |
| polarized light microscopy | confirms presence of choelsterol and crystals; aids in ID of some elements, synovial fluid is examined |
| interference-contrast microscopy | enhances images of formed elements by producing 3D images |
| what do sediment stains do? | aids in ID and icnreasing overall visibility of elements; most routine urinalysis is done on unstained specimens |
| sternheimer-malbin specimen stain | crystal violet + safranin (supravital stain); most frequently used stain |
| papanicolaou specimen stain | produces more standardized and uniform staining but is time consuming and requires special equipment |
| prussian blue specimen stain | identifies hemosiderin (free or in epithalial cells) |
| sudan III and Oil red O | fat stains used to stain neutral fat or triglycerides; stains fat orange or red |
| hansel stain specimen stain | enhances the ID of eosinophils |
| gram stain specimen stain | identifies bacteria as gram + or gram neg |
| what are the normal numerical values for RBC? | 0-2/hpf |
| what are the normal values for WBC? | 0-5/hpf |
| what are the normal values for hyaline casts? | 0-2/hpf |
| what are the normal values for epithelial cells? | few/hpf |
| what do you have to remember when checking sediment? | recent stress, strenuous exercise, menstrual contamination, presence of bacteria in combo with white blood cells |
| red blood cells appearance | colorless discs, may be crenated or may swell and lyse (ghost cells) |
| what are red cells frequently confused with, and how do you tell the difference? | yeast cells and oil droplets (yeast usually exhibit budding and oil droplets are highly refractile) |
| what test can you do to tell the difference between blood and yeast/oil? | acetic acid: lyses red cells but leaves others intact |
| what is the presence of red cells associated with? | glomerular membrane damage or vascular injury within the genitourinary tract; cannot be correlated with specimen color or a psoitive chemical test for blood |
| white blood cells appearance | spherical structures with cytoplasmic granules and lobed nuclei; in hypotonic urine, "glitter cells" - brownian movement of cytoplasmic granules produces sparkling appearance |
| pyuria | increase in WBC in urine |
| what does pyuria indicate? | presence of infection or inflammation in genitourinary system |
| what are WBCs seen in? | bacterial infections producing pyelonephritis, cystitis, and urethritis are most frequent causes |
| how can WBCs be seen? | enter urine through glomerular or capillary trauma, but may also enter through ameboid igration when infection and/or inflammation is present |
| what non-bacterial disorders are WBCs seen in? | glomerulonephritis, lupus, tumors may also be associated with increased numbers of WBCs |
| what are epithelial cells derived from? | linings of genitourinary system. represent normal sloughing unless present in large nubers or exhibit abnormal morphology |
| types of epithelial cells | squamous, transitional (urothelial), renal tubular |
| squamous appearance | large cells with abundant; irregular cytoplasm and a central nucleus |
| what is the most frequently seen epithelial cell? | squamous cells and least significant |
| what are squamous cells derived from? | vaginal lining and lower portion of male and female |
| what are increased numbers of squamous cells seen in? | improperly collected specimens from female patients (need a midstream clean-catch) |
| what do transitional (urothelial) cells look like? | depends on location in 3 layers of transitional epithelium, smaller than squamouse cells and are round or pear shaped with a central nucleus |
| where do transitional cells originate from? | lining of renal pelvis, bladder, and upper urethra |
| are transitional (urothelial cells) pathologic? | seldom unless seen in clusters or sheets (exception: catheterization) |
| two types of renal tubular cells typically observed | convuluted renal tubular cells and collecting duct cells |
| what are convuluted renal tubular cells | cytoplasm coarsely granular, making nucleus not visible; resembles a small granular cast; range from 15-60 um in size |
| what are collecting duct cells | contain smooth cytoplasm; cuboidal, polygonal or columnar shaped; rarely round or spherical; nucleus occupies 2/3 of cytoplasm; 12-20 um in size |
| where do renal tubular cells originate from? | originate from renal tubules |
| why are renal tubular cells most significant? | increased numbers indicate tubular damage or disease (pyelonephritis, viral infections, toxic reaction, graft rejection, etc) |
| where are casts formed and molded? | lumen of tubules and collecting ducts |
| what are casts comprised of? | uromodulin |
| what is uromodulin formerly known as? | Tamm-Horsfall protein |
| what is uromodulin? | glycoprotein secreted by renal tubular cells of the ascending limb of Henle's loop and distal convoluted tubules |
| is uromodulin detected by reagent strip? | NO! |
| shape of casts | have parallel sides and rounded ends; are the result of solidification of protein within the lumen of the kidney tubules (nephron) |
| what happens at the time of cast formation? | material present within the tubule is trapped within the cast matrix and may visualized in the sediment. |
| what does the cast represent? | the condition within the nephron at the time the cast was formed. |
| what is a cylindroid? | cast with a tapered end |
| where is cylindroid formed? | portion of tubules where the lumen width differs; |
| significance of cylindroids | same as casts |
| factors which contribute to formation of casts | - acid pH urine - increased salt concentration - decreased urine flow - increase amts of plasma proteins (esp albumin) |
| what does the size and shape of casts depend on? | site of formation. if formed in collecting ducts, it's broader than those formed in tubules |
| what number is considered normal with casts? | few hyaline or finely granular |
| what do casts reflect? | status of the renal tubules; number reflects the extent of tubular involvement and the severity of disease |
| what are 2 cast exceptions? | strenuous exercise - athletic pseudonephritis due to glomerular permebility changes; may see up to 50 hyaline or granular casts / lpf; returns to normal within 24-48 hours. some diuretic therapies also an exception |
| what can prevent misdiagnosis or overdiagnosis of renal dysfunction? | patient history, including medication list |
| which is the most frequently seen cast? | hyaline cast |
| hyaline cast appearance | uromodulin, colorless, must use low light, may occasionally have a trapped cell or granule |
| when can you see increased hyaline casts? | strenuous exercise, dehydration, heat exposure and stress, pathologically associated with acute glomerulonephritis, pyelonephritis, chronic renal disease and congestive heart failure |
| red blood cell cast appearance | refractile, color ranges from yellow to brown |
| what does presence of red blood cell cast indicate? | bleeding from within the nephron |
| what is red blood cell cast primarily associated with | glomerulonephritis, also see increased numbers following strenuous exercise |
| what does white blood cell cast look like? | refractile cast containing white blood cells, sometimes difficult to distinguish from epithelial cell cast - may be necessary to use stain |
| when is white blood cell cast seen? | pyelonephritis |
| what is an epithelial cell cast? | cast containing renal tubular epithelial cells |
| when is epithelial cell cast seen? | conjunction with red cell and white cell casts - glomerulonephritis and pyelonephritis both produce tubular damage |
| what does granular cast represent? | disintegration of cellular casts - have same significance of cellular casts |
| are granular casts significant? | not necessarily |
| when are granular casts seen with hyaline casts and protein? | following periods of stress or strenuous exercise |
| bacteria can also appear as what? | granules |
| what does waxy cast look like? | refractile structures with rigid texture - often appear cracked with blunt or broken ends; thought to be final stage in disintegration of cellular cast |
| what does waxy cast indicate? | prolonged stasis - associated with severe chronic renal disease |
| what does a fatty cast look like? | highly refractile structures containing yellow-brown fat droplets |
| what is a fatty cast? | degenerative product of epithelial cell cast which contain "oval fat bodies" |
| what can confirm presence of fatty cast? | polarized light or staining with Sudan III |
| what does broad cast look like? | much larger than other casts |
| where do broad casts form? | collecting ducts |
| when is broad cast formed? | when flow of urine from tubules to collecting duct becomes severely compromised; all types of casts can occur in this form |
| what does broad cast mean? | serious prognosis - sometimes referred to as "renal failure casts" |
| do crystals have any clinical significance? | seldom |
| what is crystal formation dependent on? | pH. all crystals associated with diseas tates are seen in acid or neutral urine. the acid crystals most commonly seen are NOT associated with disease |
| why does crystal formation happen? | urine has been allowed to remain at room temp or refrigerated |
| what is crystal ID based on? | - appearance - solubility characteristics - pH |
| what are the normal acid urine crystals? | - uric acid - amorphous urates - calcium oxalate |
| what are the abnormal acid urine crystals? | - cystine - leucine - tyrosine - bilirubin - cholesterol - sulfonamides - radiographic dyes |
| what is uric acid crystal? | most typical form is yellow, four-sided, and flat. may also appear as rhombic plates or prisms, as colorless hexagonal paltes, or as oval forms with pointed ends. exhibit a kaleidoscopic appearance under polarized light. |
| when should uric acid be investigated? | when persistent excretion of large amounts |
| what do amorphous urates look like? | clumps of yellow to reddish-brown granules |
| when do amorphous urates look pink | when present in large amts (sediment looks like brick dust) |
| what does calcium oxalate look like? | small envelope shaped crystals (dihydrate); dumbbells or spheres (monohydrate); may also be present in neutral urine |
| what does cystine look like? | colorless, flat, hexagonal plates |
| when are cystine crystals seen? | congenital inability of renal tubules to reabsorb cystine |
| are cystine crystals clinically significant? | yes; use confirmatory tet before reporting - colorless with polarized light, cyanide-nitroprusside test, chromatography, mino acid analysis |
| what do leucine crystals look like? | yellow-brown spheres that contain concentric circles with radial striations |
| what are leucine crystals associated with? | severe liver disease and aminoaciduria |
| what does tyrosine look like? | colorless to yellow, finy silky needles occurring in sheaths |
| what is tyrosine associated with? | severe liiver disease; tests for bilirubin should be positive |
| what does bilirubin look like? | red-orange or red-brown needles wich appear singly or in clusters |
| what is bilirubin associated with? | severe liver disease; tests for bilirubin should be positive |
| what does cholesterol look like? | colorless, notched plates; colorless with polarized light |
| what is cholesterol associated with? | same conditions as oval fat bodies and fatty casts |
| what do sulfonamides look like? | yellow sheaves of wheat with eccentric binding, brown dense sphere, or needles |
| when are sulfonamides seen? | rarely due to development of more soluble sulfa drugs |
| what must you do if you see sulfonamides? | verify that the patient is on sulfa drugs and/or confirm with diazo test |
| what do radiographic dyes look like? | colorless long pointed needles or flat thin rectangles - shows a kaleidoscope of light when polarized |
| what are radiographic dyes accompanied with? | extremely elevated SG when measured by refractometer or urinometer; dyes do not affect reagent strip measurement of SG |
| what are normal alkaline urine crystals? | - calcium phosphate - triple phosphate - amorphous phosphate - ammonium biurate - calcium carbonate |
| what are considered miscellaneous? | - bacteria - yeast - parasites - clue cells - hemosiderin - spermatozoa - mucus - starch granules - oil droplets - contaminants |
| what does calcium phosphate look like? | colorless, long, thin prisms, plates or needles |
| what can calcium phosphate be confused with? | sulfonamides; however cp dissolves in acetic acid |
| what does triple phosphate look like? | three to six-sided colorless prisms "coffin lids"; may also be seen in neutral urines |
| what do amorphous phosphates look like? | colorles, fine granular precipitate, appear grossly as a white precipitate |
| what does ammonium biurate look like? | dark yellow to brown spheres with long, irregular spicules; found in "old" urine |
| what does calcium carbonate look like? | small colorless crystals which resemble a "bow-tie" or "dumbbell" and usually appear in pairs; also as spheres and rarely as needles. usually need high dry for ID because they are very small |
| what forms of bacteria are seen? | rods, then cocci, singly or in chains |
| what is indicative of UTI? | large numbers of bacteria accompanied by leukocytes |
| when does bacteria occur? | contamination; most labs only report when seen in fresh specimen along with WBCs |
| yeast (usually Candida albicans) appearance | smooth oval cells which may be confused with RBCs - look for budding forms |
| what is yeast associated with? | diabetes mellitus and vaginal yeast infections |
| what is the most frequently encourntered parasite in urine? | trichomonas vaginalis (vaginal contaminant); flagellate is usually seen as it moves across the field |
| what other parasites are seen? | ova from pinworms and other parasites (fecal contamination) |
| what do clue cells look like? | squamous epithelial cells from the vaginal mucosa with large numbers of bacteria adhering to them |
| what are clue cells indicative of? | bacterial vaginosis, an infection usually involving Gardnerella vaginalis |
| what do clue cells look like? | "shaggy edges" and the nucleus may not be visible |
| what is hemosiderin? | form of iron resulting from ferritin denaturation |
| what does hemosiderin look like? | coarse yellow-brown granules; difficult to distinguish from amorphous crystals |
| when is hemosiderin found? | 2-3 days following a severe hemolyti episode |
| how do you ID hemosiderin? | Prussian blue stain |
| spermatozoa | males and females can have it in urine; no clinical significance |
| what does mucus look like? | long wavy threads; may be confused with hyaline casts |
| what is mucus? | protein produced by glands and epithelial cells in genitourinary tract. |
| is mucus clinically significant? | no; usually due to vaginal contamination |
| why would starch granules be present? | powdered gloves or body powders |
| what do starch granules look like? | centrally located dimple; maltese cross pattern under polarized microscopy |
| what do oil droplets look like? | free-floating globules |
| why would you have oil droplets? | catheter lubricants, ointments, creams, or immersion oil |
| what are urine contaminants? | muscle fibers, cotton (diaper) fibers, hair, pollen grains |
| rule of thumb regarding microscopic exam | results must correlate. if not, check for technical and clerical error. take into account the amt of formed elements or chemicals as well as possibility of interference with chemical tests and age of specimen |
| what causes urine to be red? | red blood cells; exception: number, hemolysis |
| what causes urine to be turbid? | red cells, white cell, epi cells, crystals, bacteria |
| how do you report white cells? | positive protein, nitrite, leukocytes |
| how do you report casts? | positive protein |
| how do you report crystals? | pH |
| how do you report bacteria? | pH, positive nitrite and leukocytes |
| when is lysis an exception? | WBC |
| when is type an exception? | crystals and bacteria |
| what are the renal diseases? | - AGN - CGN - nephrotic syndrome - acute pyelonephritis - acute interstitial nephritis - minimal change glomerular disease - renal calculi |
| what are the metabolic diseases? | - PKU - alkaptonuria - maple syrup urine disease - diabetes mellitus - diabetes insipidus |
| what are the mucopolysaccharide disorders? | - Hurler's and Hunter's syndrome - Sanfilippo's syndrome |
| cause and/or defect of AGN | damage to glomerular membrane |
| symptoms of AGN | fever, nausea, edema, hypertension, electrolyte balance; certain strains of group A strep |
| lab findings of AGN | - oliguria - marked hematuria - red blood cell casts - hyaline and granular casts - increased protein - white blood cells |
| treatment of AGN | treat the underlying infection |
| cause and/or defect of CGN | variety of disorders that produce continual and/or permanent damage to the glomerulus. slow development |
| symptoms of CGN | recurring hematuria and/or hypertension |
| lab findings of CGN | - hematuria - proteinuria - azotemia - many varieties of casts - SG 1.010 - decreased GFR |
| treatment of CGN | dialysis or renal transplant; death if not treated |
| cause and/or defect of nephrotic syndrome | - passage of HMW proteins and lipids into glomerular filtrate (circulatory disorders) - tubular damage, as well as glomerular damage and condition may progress to chronic renal failure |
| symptoms of nephrotic syndrome | none |
| lab findings of nephrotic syndrome | - marked proteinuria - urinary fat droplets - oval fat bodies - renal tubular epi cells - epi, waxy, and fatty casts - microscopic hematuria - increased serum lipids - decreased serum albumin |
| treatment of nephrotic syndrome | corticosteroids, diuretics |
| cause and/or defect of acute pyelonephritis | untreated cystitis or lower UTI; structural abnormalities or obstructions of urinary tract |
| symptoms of acute pyelonephritis | - lower back pain - nocturia - urgency to urinary - fever - nausea - headache - generalized malaise |
| lab findings of acute pyelonephritis | - clumped WBCs - WBC casts - bacteria - positive nitrite - possible proteinuria and hematuria - low SG |
| tretment of acute pyelonephritis | antibiotics |
| cause and/or defect of acute interstitial nephritis | allergic reaction to various drugs and toxins - also, acute pyelonephritis, septicemia, graft rejection, immune disorders |
| symptoms of acute interstitial nephritis | - oliguria - edema - decreased renal concentrating ability - decreased GFR - fever - skin rash (usually 2 weeks after taking medication) |
| lab findings of acute interstitial nephritis | - hematuria - WBCs (without bacteria) - WBC casts - mild to moderate proteinuria - eosinophils in urine sediment |
| treatment of acute interstitial nephritis | discontinue the offending drug |
| cause and/or defect of minimal change glomerular disease | cells within glomerulus are less tightly fitted, allowing for increased filtration of protein; immunologically based, T-cell immunity problem; allergic reactions and recent immunizations |
| symptoms of minimal change glomerular disease | - edema - heavy proteinuria - transient hematuria |
| lab findings of minimal change glomerular disease | - edema - heavy proteinuria - transient hematuria |
| treatment of minimal change glomerular disease | corticosteroid therapy |
| cause and/or defect of renal calculi | obstructed urinary tract or stones produce ulceration and bleeding |
| symptoms of renal calculi | - intense pain - nausea - vomiting - sweating - frequent urge to urinate |
| lab findings of renal calculi | hematuria |
| treatment of renal calculi | - lithotripsy (breaks up) - cytoscopy (crush and remove) |
| cause and/or defect in PKU | AR disease - can't produce phenylalanine hydroxylase |
| symptoms of PKU | severe mental retardation, delayed development, feeding difficulties |
| lab findings in PKU | mousty or musty odor |
| treatment of PKU | maintain a low phenylalanine diet |
| cause and/or defect of alkaptonuria | recessive, deficiency or absence of homogentisic acid oxidase - accumulation of homogentisic acid in cells and body fluids |
| symptoms of alkaptonuria | urine darkens at room temp, brown pigment deposits in body tissues / cartilage, arthritis |
| lab findings of alkaptonuria | brown urine |
| treatment of alkaptonuria | dietary restrictions |
| cause and/or defect of maple syrup urine disease | AR trait - accumulation of leucine, isoleucine, valine |
| symptoms of maple syrup urine disease | - failure to thrive - lethargy - vomiting |
| lab findings of maple syrup urine disease | smells like maple syrup or caramelized sugar |
| treatment of maple syrup urine disease | dietary regulation and careful monitoring of urinary keto acid concentrations |
| cause and/or defect of diabetes mellitus | deficiency in the production of pancreatic insulin or the production of dysfunctional insulin |
| symptoms of diabetes mellitus | polyuria, polydipsia, yeast |
| lab findings of diabetes mellitus | increased SG (bc of glucose) glycosuria (renal threshold is exceeded) ketonuria (fat is metabolized) |
| treatment of diabetes mellitus | type I requires insulin injections |
| cause and/or defect of diabetes insipidus | decrerased production of AVP or lack of renal tubular response to AVP |
| symptoms of diabetes insipidus | polyuria, polydipsia, decreased SG |
| lab findings of diabetes insipidus | polyuria, polydipsia, decreased SG |
| treatment of diabetes insipidus | replacement of large amts of water being excreted |
| cause and/or defect of hurler's and hunter's syndrome | mucopolysaccharides accumulate in cornea. |
| symptoms of hurler's and hunter's syndrome | abnormal skeletal structure and severe mental retardation |
| lab findings of hurler's and hunter's syndrome | increased polysaccharides in urine |
| treatment of hurler's and hunter's syndrome | bone marrow transplant, gene replacement therapy |
| cause and/or defect of sanfilippo's syndrome | mucopolysaccharides |
| symptoms of sanfilippo's syndrome | mental retardation |
| lab findings of sanfilippo's syndrome | none |
| treatment of sanfilippo's syndrome | bone marrow transplants and gene replacement therapy |
| functions of dialysis | removes waste, salt, water, keeps safe level of chemicals in blood, controls blood pressure |
| factors influencing formation of kidney stones | - increase in concentration of chemical salts - constant urinary pH - urinary stasis - presence of a foreign body seed |
| increase in concentration of chemical salts | - dehydration, dietary excess, medications - hyperparathyroidism - gout |
| constant urinary pH | losing the normal "acid-base tide" |
| urinary stasis | increases the chances of supersaturation and precipitation |
| presence of a foreign body seed | provides a nucleus that stimulates crystalline deposition; may be a clump of bacteria, fibrin clot, epithelial cell, or bit of debris |
| types of dialysis | - hemodialysis - peritoneal dialysis - nocturnal dialysis |
| hemodialysis advantages | - requires no special training - monitored regularly bytrained personnel |
| hemodialysis disadvantages | lasts about 4 hours and is performed 3 times/week |
| peritoneal dialysis advantages | - treatments can be performed at home - patient has control of therapy - no needles required - facilitates employment; easy travel |
| peritoneal dialysis disadvantages | - ifnections can easily occur - membrane function may decrease over time |
| nocturnal dialysis advantages | - blood is cleaner - patient use less medicine and can have a more liberal diet - improved quality of life |
| nocturnal dialysis disadvantages | none |
| hemodialysis | - 90% of patients choose this - removes waste, chemicals, and fluid from the blood minor surgery required, artery and vein joined under skin to make large vessel |
| peritoneal dialysis | blood is cleaned inside patient's body surgery required to place a plastic catheter into abdomen |
| nocturnal dialysis | at night while patient sleeps usually on children blood filtered continuously by machine for 8-10 hours provides a greater amt of toxin removal (24-30 hours / week instaed of 10-12 hours/week) |
| what are the major functions of CSF? | - provides physiological system to supply nutrients to nervous tissue - removes metabolic wastes - produces a mechanical barrier to cushion brain and spinal cord against trauma |
| how is CSF obtained? | lumbar puncture (spinal tap) - fluid is withdrawn from sub-arachnoid space |
| what are tubes 1,2,3 used for in CSF testing? | 1 - chemical and serological testing 2 - gram stain and culture 3 - cell count and diff |
| indications for a lumbar puncture | - meningitis - encephalitis - syphilis - brain abscess - intracranial or subarachnoid hemorrhage - spinal cord and brain tumors - leukemia or lymphoma with CNS involvement |
| appearance of normal CSF | clear and colorless |
| appearance of abnormal CSF | hazy / cloudy and red/pink |
| traumatic spinal tap | subsequent clearing of red color, supernatant is clear, clots due to fibrinogen |
| true hemorrhagic spinal tap | all tubes are equally red, supernatant is xanthochromic, no clots present |
| xanthochromia and its significance | yellowish tinge cause by the releas of hemoglobin from hemolyzed red blood cells; tells hemorrhage from traumatic puncture |
| diagnostic value of CSF protein | any increase |
| diagnostic value of CSF glucose | anything below 60% of plasma is bacterial meningitis |
| diagnostic value for CSF lactate | increased levels |
| diagnostic value for CSF glutamine | |
| diagnostic value for CSF lactic dehydrogenase | |
| what microbe is associated with positive india ink prep | Cryptococcus neoformans |
| CSF white and red cell counts calculation | (# cells counter * dilution factor) / (# squares counted * volume of 1 square) = cells / ul |
| tell if meningitis is bacterial | neutrophils, marked protein, decreased glucose, elevated lactate |
| 3 primary reaosns to analyze seminal fluid | - evaluate infertility cases - evaluate post-vasectomy cases - ID of a fluid as semenin forensic medicine (alleged rape cases) |
| normal values for semen analysis | volume = 2-5 mL viscosity = pours in droplets pH = 7.3-8.3 count = 20-250 million/mL motility = >50-60^ within 3 hours morphology = <30% abnormal forms viability = >75% live forms |
| viral meningitis | lymphocytes, moderate protein, normal glucose, normal lactate |
| fungal meningitis | lymphs and monos, mod to marked protein, normal to decreased glucose, elevated lactate |
| tubercular meningitis | lymphs and monocytes present, mod to marked protein, decreased glucose, elevated lactate |
| discuss the steps which must be followed to insure the quality of a specimen | clean, dry container; labeled properly; tested prompty or properly preserved |
| what is the most common method to preserve urine specimens? | refrigeration (4 to 6 C) |
| what problems may occur if a urine specimen is left unpreserved for more than 2 hours? | physical: changes in color, increased turbidity, increased odor; chemical: increased pH and nitrite, decreased glucose, ketones, bilirubin, urobilinogen; microscopic: increased bacteria and disint. of red and white cells and casts |
| random specimen | most common; very easy to collect; routing screening tests |
| first morning specimen | ideal screening specimen; concentrated; essential for preventing false-neg preg tests and evaluating orthostatic proteinuria |
| 2 hour postprandial specimen | voids shortly before meal and 2 hours after eating; tested for glucose, results are used for monitoring insulin therapy in diabetes mellitus |
| GTT specimen | corresponds with blood samples during GTT; fasting, 1/2 hour, 1,2,3 hour; tested for glucose and ketones. aid to interpret pt's ability to metabolize glucose; correlated with renal threshold for glucose |
| 24 hour specimen | measures exact amt of urine rather than report qualitatively; timing is important; first specimen is discarded, must be well mixed |
| catheterized specimen | sterile conditions (hollow tube through urethra into bladder - for hospital pts); requested for bacterial cultures |
| midstream clean-catch specimen | safer, less traumatic method than catheterized specimen; more representative and less contaminated for microscopy than random; must cleanse properly and collect properly |
| suprapubic aspiration | external needle into bladder. best sample for bacterial cultures (anaerobes and infants) |
| pediatric specimen | placed over genital area, checked every 15 minutes, many sources of contamination |
| normal color, clarity, volume, odor, and foam of urine | pale yellow - dark yellow; clear; 600-1800 ml/24 hour; faintly aromatic; small amt of white foam when shaken |
| urinometer | direct method for measuring dissolved solids in solution. requires large volume, must be calibrated daily, corrections made for temp |
| refractometer | indirect method for SG; determines refractive index of urine by comparing velocity of light in air with velocity of light in urine |
| calculate the corrected SG measurements | glucose: subtract 0.004 for each g/dL; protein: subtract .003 for each g/dL |
| what do you do if you have an abnormally high SG reading | measure on reagent strip; if greater than refractometer, should be dilulted and retested |
| anuria | absence of urine formation; hypotension, hemorrhage, shock, heart failure |
| oliguria | diminished amt of urine; profuse perspiration, vomiting, diarrhea, renal failure |
| polyuria | excessive urine; diabetes insipidus, diabetes mellitus, chronic nephritis, edematous states, hyperthyroidism, excessive intake of fluids |
| nocturia | excessive urination during the night, chronic renal failure |
| isosthenuria | urine with SG 1.010 |
| hyposthenuria | specific gravity below 1.010 |
| hypersthenuria | specific gravity above 1.010 |
| ammonia smell of urine | as specimen remains at room temp (due to breakdown of urea by bacteria) |
| fruity or sweet smell of urine | increased ketone bodies (diabetic pt at risk of diabetic coma) |
| maple syrup urine | maple syrup urine disease |
| mousy smell urine | phenylketonuria |
| yellow foam urine | contains bilirubin |
| abundant white foam urine | protein |
| principle of glucose | double sequential enzyme reaction (glucose oxidase and peroxidase) |
| specificity of glucose | specific for glucose, dont detect other sugars |
| sensitivity of glucose | 75-125 mg/dL |
| clinical significance of glucose | glycosuria associated with hyperglycemia or renal conditions |
| principle of bilirubin | diazo reaction |
| specificity of bilirubin | specific for bilirubin |
| sensitivity of bilirubin | 0.4-0.8 mg/dL conjugated bili; more sensitive method needed to detect early liver disease |
| clinical sign of bilirubin | any detectable amt is significant; hepatitis, liver diseases, biliary tract obstruction |
| principle of ketone | sodium nitroprusside |
| specificity of ketone | does not detect beta-hydroxybutyric acid; strip detects acetoacete only. |
| sensitivity of ketone | |
| clinical sign of ketone | inability to utilize carbs (diabetes mellitus); insufficient carb consumption (starvation, diet or exercise); loss of carbs (vomiting, defective renal reabs, digestive disturbances) |
| principle of SG | bromthymol blue changes to yellow-green |
| specificity of SG | correlates within 0.005 of refractometer |
| sensitivity of SG | |
| clinical sign of SG | normal: 1.003-1.035 random; 1.016-1.022 24 hr; diabetes mellitus: inc volume and increased SG; diabetes insipidus: inc volu and dec SG |
| principle of blood | peroxidase |
| specificity of blood | detects intact red cells, hemoglobin, and myoglobin |
| sensitivity of blood | .02-.06 mg/dL hemoglobin |
| clinical sign of blood | bleeding or lack of red cells |
| principle of pH | double indicator system |
| specificity of pH | alkaline is old specimen; acid is improper procedure |
| sensitivity of pH | |
| clinical sign of pH | ranges from 4.5-8.0; diet is major factor |
| principle of protein | "protein-error of indicaotrs" |
| specificity of protein | strips detect albumin and not abnormal proteins |
| sensitivity of protein | 15-30 mg/dL |
| clinical sign of protein | more than trace amts of protein: renal disease, strenuous exercise, emotional stress, pregnancy, infections, newborns, postural or orthostatic proteinuria |
| principle of urobilinogen | Erlich's reaction |
| specificity of urobilinogen | cannot be used for PBG |
| sensitivity of urobilinogen | cannot be used to determine the absence of urobilinogen |
| clinical significance of urobilinogen | hemolytic anemias and megaloblastic anemia, fever and dehydration, liver disease and dysfunction |
| principle of nitrite | diazo reaction |
| specificity of nitrite | specific for nitrite |
| sensitivity of nitrite | qualitative test only |
| clinical sign of nitrite | urinary tract infection |
| principle of leukocytes | diazo reaction |
| specificity of leukocytes | speific for esterase that is present in WBCs |
| sensitivity of leukocytes | 5-15 white cells/hpf; sensitive to both intact and lysed granulocytes |
| clinical sign of leukocytes | significant amt: inflammation. can occur with or without bacteriuria. most common cause is UTI. |
| ketosis | increased ketones in uria results when body mobilizes fatty acids from triglyceride stores because of inadequate intake or availability of carbs |
| ketonuria | increased ketones in urine |
| ketonemia | increased ketones in blood |
| hematuria | the presence of blood in urine (may indicate bleeding at any point in the urinary system from glomerulus to urethra). can be associated with benign conditions |
| hemoglobinuria | hemoglobin in urine. absence of red cells in urine sediment doesn't mean anything definitive for hemoglobinuria |
| myoglobinuria | myoglobin in urine; skeletal or cardiac muscle injury, seizsures, tocins, severe exercise |
| proteinuria | protein in urine; often first indicator of renal disease |
| postural or orthostatic proteinuria | occurs in 3-5% of healthy young adults. excretion of protein by patients in upright position. must collect sample immediately after awakening and then another sample after at elast 2 hours of being upright or walking |
| glucose false positive | contamination with bleach or peroxide |
| glucose false negative | ketone bodies affects low glucose concentration; ascorbic acid also affects low glucose concentration |
| bilirubin false positive | chlorpromazine, drug-induced color changes |
| bilirubin false negative | ascorbic acid, high nitrite concentrations, exposure to light |
| ketone false positive | levodopa, highly pigmented urine |
| ketone false negative | improperly stores specimens |
| SG false decreased | pH greater than or equal to 6.5, add 0.005 (manual); presence of non-ionizable substsances such as glucose and radio dyes does not affect reagent strip values |
| blood false positive | menstrual contamination, microbial peroxidases, strong oxidizing agents |
| blood false negative | ascorbic acid, elevated SG, specimen not properly mixed |
| causes of hematuria | - renal disease / dysfunction - kidney stones - glomerular nephritis - auto accident - marathon running - drugs |
| causes of hemoglobinuria | - intravascular hemolysis - severe burns and various poisonings - infections - strenuous exercise - hemolysis within kidney or lower urinary tract |
| cause for myoglobinuria | - skeletal or cardiac muscle injury - seizsures - toxins - severe exercise |
| falsely increased pH cause | old specimen |
| falsely decreased pH cause | improper procedure (too long, run over) |
| what is acid urine seen in? | metabolic acidosis, respiratory acidosis, UTI with acid-producing bacteria |
| what is alkaline urine seen in? | - metabolic alkalosis - resp alkalosis - excessive loss of gastric contents by vomiting - UTI with urease-producing bacteria - renal tubular acidosis |
| falsely positive protein cause | - highly buffered or alkaline urines - contamination with some antiseptics, detergents, or skin cleansers |
| falsely negative protein cause | does not rule out presence of globulins, hemoglobin, mucoprotein, and Bence-Jones protein. sulfosalicyclic acid should be used if these are suspected |
| cause of false positive urobilinogen | Ehrlich-reactive substances, strip reactivity increases with temperature |
| cause of false negative urobilinogen | formalin, specimens left at room temp for more than 1-2 hours |
| cause of false positive nitrite | contaminated sample, certain medications that colur urine |
| cause of false negative nitrite | ascorbic acid, facotrs that inhibit or prevent nitrite formation despite bacteriuria |
| what can negative nitrite findings indicate? | - inadequate retention of urine in bladder - can be already converted to nitrogen, antibiotic therapy can inhibit conversion to nitrite - insufficient dietary nitrate in urine for bacteria to use - organisms present may not produce enzymes necessary |
| cause of false positive leukocyte | vaginal contamination |
| cause of false negative leukocyte | increased glucose increased SG high levels of protein strong oxidizing agents certain drugs |
| what does clinitest confirm? | any reducing sugar, including glucose (NOT SUCROSE); less sensitive than the strip |
| what does ictotest confirm? | bilirubin; more sensitive than the strip |
| what does acetest confirm? | ketones; just as good as the strip |
Created by:
turnip1185