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Urinalysis Chapter 3

Physical Examination of the Urine

What determines the physical examination of urine? Color, clarity, specific gravity, Osmolarity, and volume if timed.
What are the common colors of urine? Pale yellow, yellow, dark yellow, and amber.
What is the yellow color of urine caused by? the presence of a pigment, named urochrome.
What is urochrome? is a product of endogenous metabolism, and under normal conditions the body produces it at a constant rate.
What is uroerythrin? A pink pigment present in urine in smaller amounts, and it is most evident in specimens that have been refrigerated, resulting in the precipitation of amorphous urates.
What is urobilin? is an oxidation product of the normal urinary constituent urobilinogen, imparts an orange-brown color to urine that is not fresh.
What does Dark yellow/Amber/Orange urine mean? It can be caused by the presence of the abnormal pigment bilirubin.
What do techs do if it is suspected that specimen contains bilirubin? It is shaken and a yellow foam appears.
What does yellow-orange specimen mean? it is caused by the administration of phenazopyridine(Pyridium) or azo-gantrisin compounds to persons with urinary tract infections.
What does Red/Pink/Brown urine mean? blood in urine.
What color is produced when the oxidation of hemoglobin to methemoglobin has occured from urine remaining in an acidic conditions for several hours? brown
What does a fresh brown color mean when the urine contains blood indicate? It could indicate glomerular bleeding resulting from the conversion of hemoglobin to methemoglobin.
If RBC are present what does the urine look like and if it's myoglobin? it's red and cloudy and if myoglogin is present it's red and clear.
What does hemoglobinuria mean? it's resulting from the in vivo breakdown of RBC and is accompanied by red plasma.
What does the breakdown of skeletal muscle produce? myoglobin
How does urine specimens appear of they contain porphyrins and why? appear red from the oxiation of porphobilinogen to porphyrins, they are referred to as port wine.
What does brown/black urine mean? if negative chemical results for blood, they many contain melanin or homogentisic acid.
What is melanin? an oxidation product of the colorless pigment, melanogen, produced in excess when an malignant melanoma is present.
What does homogentisic acid mean? a metabolite of phenylalanine, imparts a black color to alkaline urine from persons with the inborn-error of metabolism called alkaptonuria.
What are some of the medications that produce black/brn urine? levodopa, methyldopa, phenol derivatives, and metronidazole.
What does it mean to have blue/green urine? a pseudomonas infection and intestinal tract infections.
What does clarity refer to? is a general term that refers to the transparency/turbidity of a urine specimen.
Clarity if determined by? visually examining the mixed specimen while holding it in front of a light source.
What is some of the common terminology when reporting clarity? clear, hazy, cloudy, turbid, and milky.
What do precipitation of amorphous phosphates and carbonates cause? a white cloudiness.
What are the causes of cloudy urine? Temperature(cold,refrigerator storage), pink turbidity(acid pH) - urates.
What does hazy clarity mean? Few particulates, print easily seen through urine.
What does cloudy clarity mean? Many particulates, print blurred through urine.
What does turbid mean? Print cannot be seen through urine.
What does milky clarity mean? May precipitate or be clotted.
What are some of the nonpathologic causes of urine turbidity? Squamous epithelial cells, mucus, amorphous phosphates, carbonates, urates, semen, spermatozoa, fecal contamination, radiographic contrast media, talcum powder, and vaginal creams.
What are some of the pathologic causes of turbidity? RBC, WBC, and bacteria caused by infection or a systemic organ disorder, yeast, nonsquamous epithelial cells, abnormal crystals, lymph fluid and lipids.
What is the current criteria used to determine the necessity of performing a microscopic examination on urine specimen? both clarity and chemical test for RBC, WBC, bacteria and protein.
The ability of the kidneys to selectively reabsorb essential chemicals and water from the glomerular filtrate is one of the body's most important functions. True or False True
What is specific gravity defined as? the density of a solution compared with the density of a similar volume of distilled water at a similar temperature.
What is specific gravity of urine defined as? is a measure of the density of the dissolved chemicals in the specimen.
What is the normal range for SG? 1.005-1.030
What is the measure of SG influenced by? number of particles and size of particles.
What are some of the methods for measuring SG? direct methods: using a urinometer, harmonic oscillation densitometry(HOD) and indirectly by usina a refractometer or the chemical reagent strip.
Explain the urinometer? consists of a weighted float attached to a scale that has been calibrated in terms of urine specific gravity. the level to which the urinometer sinks represents the specimen's mass or specific gravity.
Name the disadvantage of using the urinometer? requires a large volume of 10 to 15mL, must be corrected for temperature(0.001 for every 3 degrees C) must be correcte for high levels of protein(subtract .003 for every gram of protein) glucose(subtract .004 for every gram of glucose)
Explain the refractometry? determines the concentration of dissolved particles in a specimen, does this by measuring the refractive index.
What is a refractive index? a comparison of the velocity of light in air with the velocity of light in a solution.
What does the concentration of dissolve particles present in solution determine? the velocity and angle at which light passes through a solution.
What are the advantages of the refractometer? requires only 2 drops of urine, temperature corrections are not necessary, reads refractive index.
How do you calibrate the refractometer? Using distilled water that should read 1.000, 9% sucrose solution should read 1.033-1.035, 5% NaCl solution should read 1.021-1.023, use a zero set screw to adjust reading.
What do the 3 scales in the refractometer mean? urine specific gravity (far left) starts with 1.000; serum protein (center scale gm%); and refractive index (far right) starts with 0.000
If the specific gravity is >1.035 what must you do? dilute the specimen
If you make a 1:2 dilution of a urine specimen and the result now reads 1.018 on the diluted specimen on the refractometer, what is the reported result? 1.036
Explain urine odor? It's not routinely reported, an ammomnia smell usually indicates presence of bacteria versus sample integrity(older than 1 hour)
What does a fruity odor indicate? acetone found in patients in diabetic ketoacidosis.
What does an maple syrup odor indicate? branched chain amino acids a serious metabolic defect, it includes amino acids leucine, isoleucine, and valine.
What are the disadvantages and advantages uring a dip stick for measuring SG? Disadvantages: measures only in 0.005 increments, and cost. Advantages are it's faster.
What does Osmolarity mean? weight per volume
What does Osmolality mean? Weight per weight
What is the formula for Osmolarity? MW/#ions=osmolarity (gm/osmole)
What is the osmolarity of NaCl? NaCl->Na+Cl-MW=58.5/2=29.25 gm/osmole
What is the osmolarity of glucose? Glucose does NOT dissociateMW=180/1=180 gm/osmole
Osmolality ranges and unit conversions 1 osmole= 1000 milliosmolesNormal ranges:-serum: 275-300 milliosmoles-urine: 50-1400 milliosmoles
If one mole of NaCl is dissolved in 1 kg of water depresses the Freezing point -3.49C, calculate the osmolarity: 1000mOsm/-1.86 = XmOsm/-3.46 X=1860 mOsm.
The concentration of a normal urine specimen can be estimated by which of the following? Color
The normal yellow color of urine is produced by: Urochrome
A yellow-brown specimen that produces a yellow foam when shaken can be suspected of containing: bilirubin
A urine that turns black after standing may contain: Homogentisic acid, Melanin, and Methemoglobin.
Specimens that contain intact RBCs can be visually distinguihed by those that contain hemoglobin because: RBC produce a cloudy specimen
After eating beets purchased at the local farmers' market, Mrs. Williams notices that her urine is red, but Mr. William's urine is remains yellow. The williamses should: Not be concerned because only Mrs. Williams is genetically susceptible to producing red urine from beets.
Specimens from patients receiving treatment for urinary tract infections frequently appear: Viscous and Orange
Freshly voided normal urine is usually clear; however, if it is alkaline, a white turbidity may be present due to: Amorphous phosphates and carbonates
Microscopic examination of a clear urine that produces a pink precipitate after refrigeration will show: Amorphous urates
Under what conditions will a port-wine urine color be observe in a urine specimen? urine contains porphyrins
Which of the following specific gravities would be most likely to correlate with a dark yellow urine? 1.030
True or False: Urine specific gravity is equally influenced by the presence of glucose and sodium. False
In what circumstance might a sediment be slightly warmed prior to microscopic examination? To dissolve amorphous urates
A urine specific gravity measured by refractometer is 1.029, and the temperature of the urine is 14 degrees C. The specific gravity should be reported as: 1.027
Refractive index compares: Light velocity in air with light velocity in solutions.
Refractometers are calibrated using: Distilled water and sodium chloride
A correlation exist between a specific gravity of 1.050 and a: Radiographic dye infusion
An alkaline urine turns black upon standing, develops a cloudy white precipitate, and has a SG of 1.012. The major concern about this specimen would be: Color
The reading of distilled water by the refractometer is 1.003. You should: Adjust the set screw
A urine specimen with a specific gravity of 1.008 has been diluted 1:5, the actual specific gravity is: 1.040
The method for determining a urine specific gravity that is based on the principle that the frequency of a sound wave entering a solution changes in proportion to the density of the solution is: Harmonic Oscillation Densitometry
A specimen with a specific gravity of 1.005 would be considered: Hyposthenuric
True or False: Specific gravity is of more diagnostic value than osmolarity in evaluating renal concentration ability. False
A strong odor of ammonia in a urine specimen coul indicate: Urinary tract infection
The microscopic of a cloudy amber urine is reported as rare WBCs and epithelial cells. What does this suggest? A possible mix up of specimen and sediment
A specimen with a strong ammonia odor and a heavy white precipitate when it arrives in the laboratory may require: collection of a fresh specimen.
Created by: Twixy565

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