Urinalysis
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| show | red and white blood cells,
epithelial cells,
casts,
crystals,
bacteria, yeast, and parasites,
spermatozoa,
mucus,
artifacts
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| what must microscopic examination include? | show 🗑
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| show | renal urinary tract disorders and other systemic disorders
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| show | microscopic urinalysis
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| brightfield microscopy | show 🗑
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| brightfield microscopy | show 🗑
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| problems with brightfield microscopy | show 🗑
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| phase-contrast microscopy | show 🗑
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| problem with phase-contrast microscopy | show 🗑
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| show | confirms presence of choelsterol and crystals; aids in ID of some elements, synovial fluid is examined
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| interference-contrast microscopy | show 🗑
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| what do sediment stains do? | show 🗑
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| sternheimer-malbin specimen stain | show 🗑
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| show | produces more standardized and uniform staining but is time consuming and requires special equipment
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| show | identifies hemosiderin (free or in epithalial cells)
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| show | fat stains used to stain neutral fat or triglycerides; stains fat orange or red
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| show | enhances the ID of eosinophils
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| gram stain specimen stain | show 🗑
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| what are the normal numerical values for RBC? | show 🗑
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| show | 0-5/hpf
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| what are the normal values for hyaline casts? | show 🗑
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| what are the normal values for epithelial cells? | show 🗑
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| what do you have to remember when checking sediment? | show 🗑
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| show | colorless discs, may be crenated or may swell and lyse (ghost cells)
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| show | yeast cells and oil droplets (yeast usually exhibit budding and oil droplets are highly refractile)
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| what test can you do to tell the difference between blood and yeast/oil? | show 🗑
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| what is the presence of red cells associated with? | show 🗑
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| show | spherical structures with cytoplasmic granules and lobed nuclei; in hypotonic urine, "glitter cells" - brownian movement of cytoplasmic granules produces sparkling appearance
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| show | increase in WBC in urine
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| what does pyuria indicate? | show 🗑
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| show | bacterial infections producing pyelonephritis, cystitis, and urethritis are most frequent causes
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| how can WBCs be seen? | show 🗑
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| what non-bacterial disorders are WBCs seen in? | show 🗑
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| show | linings of genitourinary system. represent normal sloughing unless present in large nubers or exhibit abnormal morphology
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| types of epithelial cells | show 🗑
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| show | large cells with abundant; irregular cytoplasm and a central nucleus
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| what is the most frequently seen epithelial cell? | show 🗑
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| show | vaginal lining and lower portion of male and female
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| what are increased numbers of squamous cells seen in? | show 🗑
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| show | depends on location in 3 layers of transitional epithelium, smaller than squamouse cells and are round or pear shaped with a central nucleus
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| where do transitional cells originate from? | show 🗑
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| show | seldom unless seen in clusters or sheets (exception: catheterization)
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| show | convuluted renal tubular cells and collecting duct cells
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| show | cytoplasm coarsely granular, making nucleus not visible; resembles a small granular cast; range from 15-60 um in size
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| show | contain smooth cytoplasm; cuboidal, polygonal or columnar shaped; rarely round or spherical; nucleus occupies 2/3 of cytoplasm; 12-20 um in size
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| show | originate from renal tubules
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| show | increased numbers indicate tubular damage or disease (pyelonephritis, viral infections, toxic reaction, graft rejection, etc)
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| show | lumen of tubules and collecting ducts
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| what are casts comprised of? | show 🗑
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| show | Tamm-Horsfall protein
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| show | glycoprotein secreted by renal tubular cells of the ascending limb of Henle's loop and distal convoluted tubules
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| is uromodulin detected by reagent strip? | show 🗑
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| show | have parallel sides and rounded ends; are the result of solidification of protein within the lumen of the kidney tubules (nephron)
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| show | material present within the tubule is trapped within the cast matrix and may visualized in the sediment.
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| what does the cast represent? | show 🗑
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| what is a cylindroid? | show 🗑
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| show | portion of tubules where the lumen width differs;
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| significance of cylindroids | show 🗑
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| show | - acid pH urine
- increased salt concentration
- decreased urine flow
- increase amts of plasma proteins (esp albumin)
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| show | site of formation. if formed in collecting ducts, it's broader than those formed in tubules
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| what number is considered normal with casts? | show 🗑
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| show | status of the renal tubules; number reflects the extent of tubular involvement and the severity of disease
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| show | 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
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| show | patient history, including medication list
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| show | hyaline cast
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| show | uromodulin, colorless, must use low light, may occasionally have a trapped cell or granule
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| show | strenuous exercise, dehydration, heat exposure and stress, pathologically associated with acute glomerulonephritis, pyelonephritis, chronic renal disease and congestive heart failure
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| show | refractile, color ranges from yellow to brown
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| what does presence of red blood cell cast indicate? | show 🗑
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| show | glomerulonephritis, also see increased numbers following strenuous exercise
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| show | refractile cast containing white blood cells, sometimes difficult to distinguish from epithelial cell cast - may be necessary to use stain
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| when is white blood cell cast seen? | show 🗑
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| what is an epithelial cell cast? | show 🗑
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| when is epithelial cell cast seen? | show 🗑
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| what does granular cast represent? | show 🗑
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| are granular casts significant? | show 🗑
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| when are granular casts seen with hyaline casts and protein? | show 🗑
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| bacteria can also appear as what? | show 🗑
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| show | refractile structures with rigid texture - often appear cracked with blunt or broken ends; thought to be final stage in disintegration of cellular cast
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| show | prolonged stasis - associated with severe chronic renal disease
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| what does a fatty cast look like? | show 🗑
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| what is a fatty cast? | show 🗑
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| what can confirm presence of fatty cast? | show 🗑
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| show | much larger than other casts
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| show | collecting ducts
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| when is broad cast formed? | show 🗑
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| show | serious prognosis - sometimes referred to as "renal failure casts"
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| show | seldom
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| what is crystal formation dependent on? | show 🗑
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| why does crystal formation happen? | show 🗑
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| what is crystal ID based on? | show 🗑
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| show | - uric acid
- amorphous urates
- calcium oxalate
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| show | - cystine
- leucine
- tyrosine
- bilirubin
- cholesterol
- sulfonamides
- radiographic dyes
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| show | 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.
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| when should uric acid be investigated? | show 🗑
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| what do amorphous urates look like? | show 🗑
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| when do amorphous urates look pink | show 🗑
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| show | small envelope shaped crystals (dihydrate); dumbbells or spheres (monohydrate); may also be present in neutral urine
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| show | colorless, flat, hexagonal plates
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| show | congenital inability of renal tubules to reabsorb cystine
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| are cystine crystals clinically significant? | show 🗑
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| show | yellow-brown spheres that contain concentric circles with radial striations
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| show | severe liver disease and aminoaciduria
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| show | colorless to yellow, finy silky needles occurring in sheaths
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| show | severe liiver disease; tests for bilirubin should be positive
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| what does bilirubin look like? | show 🗑
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| what is bilirubin associated with? | show 🗑
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| what does cholesterol look like? | show 🗑
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| show | same conditions as oval fat bodies and fatty casts
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| what do sulfonamides look like? | show 🗑
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| when are sulfonamides seen? | show 🗑
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| what must you do if you see sulfonamides? | show 🗑
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| what do radiographic dyes look like? | show 🗑
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| show | extremely elevated SG when measured by refractometer or urinometer; dyes do not affect reagent strip measurement of SG
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| show | - calcium phosphate
- triple phosphate
- amorphous phosphate
- ammonium biurate
- calcium carbonate
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| show | - bacteria
- yeast
- parasites
- clue cells
- hemosiderin
- spermatozoa
- mucus
- starch granules
- oil droplets
- contaminants
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| show | colorless, long, thin prisms, plates or needles
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| what can calcium phosphate be confused with? | show 🗑
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| what does triple phosphate look like? | show 🗑
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| show | colorles, fine granular precipitate, appear grossly as a white precipitate
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| show | dark yellow to brown spheres with long, irregular spicules; found in "old" urine
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| show | 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
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| what forms of bacteria are seen? | show 🗑
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| show | large numbers of bacteria accompanied by leukocytes
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| show | contamination; most labs only report when seen in fresh specimen along with WBCs
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| yeast (usually Candida albicans) appearance | show 🗑
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| show | diabetes mellitus and vaginal yeast infections
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| show | trichomonas vaginalis (vaginal contaminant); flagellate is usually seen as it moves across the field
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| what other parasites are seen? | show 🗑
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| what do clue cells look like? | show 🗑
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| what are clue cells indicative of? | show 🗑
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| what do clue cells look like? | show 🗑
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| show | form of iron resulting from ferritin denaturation
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| what does hemosiderin look like? | show 🗑
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| show | 2-3 days following a severe hemolyti episode
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| show | Prussian blue stain
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| show | males and females can have it in urine; no clinical significance
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| show | long wavy threads; may be confused with hyaline casts
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| show | protein produced by glands and epithelial cells in genitourinary tract.
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| show | no; usually due to vaginal contamination
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| show | powdered gloves or body powders
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| what do starch granules look like? | show 🗑
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| show | free-floating globules
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| why would you have oil droplets? | show 🗑
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| what are urine contaminants? | show 🗑
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| show | 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
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| show | red blood cells; exception: number, hemolysis
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| show | red cells, white cell, epi cells, crystals, bacteria
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| show | positive protein, nitrite, leukocytes
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| show | positive protein
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| how do you report crystals? | show 🗑
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| show | pH, positive nitrite and leukocytes
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| show | WBC
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| show | crystals and bacteria
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| what are the renal diseases? | show 🗑
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| what are the metabolic diseases? | show 🗑
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| what are the mucopolysaccharide disorders? | show 🗑
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| cause and/or defect of AGN | show 🗑
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| show | fever, nausea, edema, hypertension, electrolyte balance; certain strains of group A strep
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| show | - oliguria
- marked hematuria
- red blood cell casts
- hyaline and granular casts
- increased protein
- white blood cells
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| treatment of AGN | show 🗑
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| show | variety of disorders that produce continual and/or permanent damage to the glomerulus. slow development
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| show | recurring hematuria and/or hypertension
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| lab findings of CGN | show 🗑
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| treatment of CGN | show 🗑
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| cause and/or defect of nephrotic syndrome | show 🗑
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| show | none
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| show | - 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
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| show | corticosteroids, diuretics
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| cause and/or defect of acute pyelonephritis | show 🗑
|
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| show | - lower back pain
- nocturia
- urgency to urinary
- fever
- nausea
- headache
- generalized malaise
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| lab findings of acute pyelonephritis | show 🗑
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| show | antibiotics
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| show | allergic reaction to various drugs and toxins
- also, acute pyelonephritis, septicemia, graft rejection, immune disorders
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| show | - oliguria
- edema
- decreased renal concentrating ability
- decreased GFR
- fever
- skin rash (usually 2 weeks after taking medication)
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| show | - hematuria
- WBCs (without bacteria)
- WBC casts
- mild to moderate proteinuria
- eosinophils in urine sediment
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| show | discontinue the offending drug
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| cause and/or defect of minimal change glomerular disease | show 🗑
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| show | - edema
- heavy proteinuria
- transient hematuria
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| lab findings of minimal change glomerular disease | show 🗑
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| show | corticosteroid therapy
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| cause and/or defect of renal calculi | show 🗑
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| show | - intense pain
- nausea
- vomiting
- sweating
- frequent urge to urinate
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| show | hematuria
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| treatment of renal calculi | show 🗑
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| cause and/or defect in PKU | show 🗑
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| show | severe mental retardation, delayed development, feeding difficulties
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| show | mousty or musty odor
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| show | maintain a low phenylalanine diet
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| cause and/or defect of alkaptonuria | show 🗑
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| symptoms of alkaptonuria | show 🗑
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| show | brown urine
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| show | dietary restrictions
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| show | AR trait
- accumulation of leucine, isoleucine, valine
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| symptoms of maple syrup urine disease | show 🗑
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| show | smells like maple syrup or caramelized sugar
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| show | dietary regulation and careful monitoring of urinary keto acid concentrations
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| show | deficiency in the production of pancreatic insulin or the production of dysfunctional insulin
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| show | polyuria, polydipsia, yeast
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| show | increased SG (bc of glucose)
glycosuria (renal threshold is exceeded)
ketonuria (fat is metabolized)
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| treatment of diabetes mellitus | show 🗑
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| cause and/or defect of diabetes insipidus | show 🗑
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| show | polyuria, polydipsia, decreased SG
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| show | polyuria, polydipsia, decreased SG
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| show | replacement of large amts of water being excreted
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| show | mucopolysaccharides accumulate in cornea.
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| symptoms of hurler's and hunter's syndrome | show 🗑
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| lab findings of hurler's and hunter's syndrome | show 🗑
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| show | bone marrow transplant, gene replacement therapy
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| cause and/or defect of sanfilippo's syndrome | show 🗑
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| symptoms of sanfilippo's syndrome | show 🗑
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| show | none
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| treatment of sanfilippo's syndrome | show 🗑
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| functions of dialysis | show 🗑
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| show | - increase in concentration of chemical salts
- constant urinary pH
- urinary stasis
- presence of a foreign body seed
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| increase in concentration of chemical salts | show 🗑
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| show | losing the normal "acid-base tide"
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| show | increases the chances of supersaturation and precipitation
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| presence of a foreign body seed | show 🗑
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| show | - hemodialysis
- peritoneal dialysis
- nocturnal dialysis
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| show | - requires no special training
- monitored regularly bytrained personnel
🗑
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| hemodialysis disadvantages | show 🗑
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| peritoneal dialysis advantages | show 🗑
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| peritoneal dialysis disadvantages | show 🗑
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| nocturnal dialysis advantages | show 🗑
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| show | none
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| hemodialysis | show 🗑
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| show | blood is cleaned inside patient's body
surgery required to place a plastic catheter into abdomen
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| show | 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)
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| show | - provides physiological system to supply nutrients to nervous tissue
- removes metabolic wastes
- produces a mechanical barrier to cushion brain and spinal cord against trauma
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|
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| how is CSF obtained? | show 🗑
|
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| show | 1 - chemical and serological testing
2 - gram stain and culture
3 - cell count and diff
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|
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| indications for a lumbar puncture | show 🗑
|
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| appearance of normal CSF | show 🗑
|
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| appearance of abnormal CSF | show 🗑
|
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| traumatic spinal tap | show 🗑
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| true hemorrhagic spinal tap | show 🗑
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| show | yellowish tinge cause by the releas of hemoglobin from hemolyzed red blood cells; tells hemorrhage from traumatic puncture
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| diagnostic value of CSF protein | show 🗑
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| diagnostic value of CSF glucose | show 🗑
|
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| show | increased levels
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|
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| diagnostic value for CSF glutamine | show 🗑
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| show |
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|
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| what microbe is associated with positive india ink prep | show 🗑
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| CSF white and red cell counts calculation | show 🗑
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| show | neutrophils, marked protein, decreased glucose, elevated lactate
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|
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| 3 primary reaosns to analyze seminal fluid | show 🗑
|
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| normal values for semen analysis | show 🗑
|
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| viral meningitis | show 🗑
|
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| fungal meningitis | show 🗑
|
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| show | lymphs and monocytes present, mod to marked protein, decreased glucose, elevated lactate
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|
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| discuss the steps which must be followed to insure the quality of a specimen | show 🗑
|
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| what is the most common method to preserve urine specimens? | show 🗑
|
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| show | 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
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| random specimen | show 🗑
|
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| first morning specimen | show 🗑
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| 2 hour postprandial specimen | show 🗑
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| GTT specimen | show 🗑
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| show | measures exact amt of urine rather than report qualitatively; timing is important; first specimen is discarded, must be well mixed
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|
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| catheterized specimen | show 🗑
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| show | safer, less traumatic method than catheterized specimen; more representative and less contaminated for microscopy than random; must cleanse properly and collect properly
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| suprapubic aspiration | show 🗑
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| show | placed over genital area, checked every 15 minutes, many sources of contamination
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|
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| show |
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|
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| show | pale yellow - dark yellow; clear; 600-1800 ml/24 hour; faintly aromatic; small amt of white foam when shaken
🗑
|
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| urinometer | show 🗑
|
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| refractometer | show 🗑
|
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| show | glucose: subtract 0.004 for each g/dL; protein: subtract .003 for each g/dL
🗑
|
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| show | measure on reagent strip; if greater than refractometer, should be dilulted and retested
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|
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| anuria | show 🗑
|
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| oliguria | show 🗑
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| show | excessive urine; diabetes insipidus, diabetes mellitus, chronic nephritis, edematous states, hyperthyroidism, excessive intake of fluids
🗑
|
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| nocturia | show 🗑
|
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| isosthenuria | show 🗑
|
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| hyposthenuria | show 🗑
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| show | specific gravity above 1.010
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|
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| ammonia smell of urine | show 🗑
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| show | increased ketone bodies (diabetic pt at risk of diabetic coma)
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|
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| show | maple syrup urine disease
🗑
|
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| show | phenylketonuria
🗑
|
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| show | contains bilirubin
🗑
|
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| show | protein
🗑
|
||||
| show | double sequential enzyme reaction (glucose oxidase and peroxidase)
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|
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| specificity of glucose | show 🗑
|
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| show | 75-125 mg/dL
🗑
|
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| clinical significance of glucose | show 🗑
|
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| principle of bilirubin | show 🗑
|
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| show | specific for bilirubin
🗑
|
||||
| show | 0.4-0.8 mg/dL conjugated bili; more sensitive method needed to detect early liver disease
🗑
|
||||
| show | any detectable amt is significant; hepatitis, liver diseases, biliary tract obstruction
🗑
|
||||
| show | sodium nitroprusside
🗑
|
||||
| show | does not detect beta-hydroxybutyric acid; strip detects acetoacete only.
🗑
|
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| show |
🗑
|
||||
| show | inability to utilize carbs (diabetes mellitus); insufficient carb consumption (starvation, diet or exercise); loss of carbs (vomiting, defective renal reabs, digestive disturbances)
🗑
|
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| show | bromthymol blue changes to yellow-green
🗑
|
||||
| specificity of SG | show 🗑
|
||||
| show |
🗑
|
||||
| show | 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
🗑
|
||||
| show | peroxidase
🗑
|
||||
| show | detects intact red cells, hemoglobin, and myoglobin
🗑
|
||||
| show | .02-.06 mg/dL hemoglobin
🗑
|
||||
| show | bleeding or lack of red cells
🗑
|
||||
| principle of pH | show 🗑
|
||||
| specificity of pH | show 🗑
|
||||
| show |
🗑
|
||||
| show | ranges from 4.5-8.0; diet is major factor
🗑
|
||||
| principle of protein | show 🗑
|
||||
| show | strips detect albumin and not abnormal proteins
🗑
|
||||
| show | 15-30 mg/dL
🗑
|
||||
| clinical sign of protein | show 🗑
|
||||
| principle of urobilinogen | show 🗑
|
||||
| specificity of urobilinogen | show 🗑
|
||||
| sensitivity of urobilinogen | show 🗑
|
||||
| clinical significance of urobilinogen | show 🗑
|
||||
| show | diazo reaction
🗑
|
||||
| show | specific for nitrite
🗑
|
||||
| show | qualitative test only
🗑
|
||||
| show | urinary tract infection
🗑
|
||||
| principle of leukocytes | show 🗑
|
||||
| show | speific for esterase that is present in WBCs
🗑
|
||||
| sensitivity of leukocytes | show 🗑
|
||||
| clinical sign of leukocytes | show 🗑
|
||||
| show | increased ketones in uria results when body mobilizes fatty acids from triglyceride stores because of inadequate intake or availability of carbs
🗑
|
||||
| ketonuria | show 🗑
|
||||
| ketonemia | show 🗑
|
||||
| hematuria | show 🗑
|
||||
| hemoglobinuria | show 🗑
|
||||
| myoglobinuria | show 🗑
|
||||
| show | protein in urine; often first indicator of renal disease
🗑
|
||||
| show | 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 | show 🗑
|
||||
| show | ketone bodies affects low glucose concentration; ascorbic acid also affects low glucose concentration
🗑
|
||||
| show | chlorpromazine, drug-induced color changes
🗑
|
||||
| show | ascorbic acid, high nitrite concentrations, exposure to light
🗑
|
||||
| ketone false positive | show 🗑
|
||||
| show | improperly stores specimens
🗑
|
||||
| SG false decreased | show 🗑
|
||||
| blood false positive | show 🗑
|
||||
| blood false negative | show 🗑
|
||||
| causes of hematuria | show 🗑
|
||||
| causes of hemoglobinuria | show 🗑
|
||||
| show | - skeletal or cardiac muscle injury
- seizsures
- toxins
- severe exercise
🗑
|
||||
| show | old specimen
🗑
|
||||
| show | improper procedure (too long, run over)
🗑
|
||||
| show | metabolic acidosis, respiratory acidosis, UTI with acid-producing bacteria
🗑
|
||||
| what is alkaline urine seen in? | show 🗑
|
||||
| show | - highly buffered or alkaline urines
- contamination with some antiseptics, detergents, or skin cleansers
🗑
|
||||
| falsely negative protein cause | show 🗑
|
||||
| cause of false positive urobilinogen | show 🗑
|
||||
| show | formalin, specimens left at room temp for more than 1-2 hours
🗑
|
||||
| cause of false positive nitrite | show 🗑
|
||||
| show | ascorbic acid, facotrs that inhibit or prevent nitrite formation despite bacteriuria
🗑
|
||||
| show | - 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 | show 🗑
|
||||
| cause of false negative leukocyte | show 🗑
|
||||
| what does clinitest confirm? | show 🗑
|
||||
| what does ictotest confirm? | show 🗑
|
||||
| show | ketones; just as good as the strip
🗑
|
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