Urinalysis
Urinalysis aids in _________________________________
disease diagnosis and therapy
Urine is formed from ____________
plasma
Urine is _______% water and _______% solutes
95; 5
The main organic urine solutes are ____________________________
urea, creatinine, and uric acid
The main inorganic solids dissolved in urine is _______________________
chloride, sodium, and potassium
The normal urine output is _______________mL
1200-1500
For lab testing, ________________mL of urine is normal
600-2000
Oliguria:____________
< 400 mL/day urine output
Anuria: ____________
no urine output
Nocturia: ________________________________
increased urine excretion at night
Polyuria: _____________________
2.5 L/day
Polyuria is often associated with _______________________________________________ along with Polydipsia
diabetes mellitus/ insipidus
________________________ is an insulin defect causing increased glucose and high SG
Diabetes mellitus
______________________ is an ADH defect, causing low SG
Diabetes insipidus
_________ mL of urine is the recommended amount of urine to collect
50
Specimens should be delivered promptly and tested within ____________, if not tested immediately it should be refrigerated at 2-8℃ or have a chemical preservative added
2 hours
_____________________________ are the most commonly recieved and is used for routine screening
Random Specimen
The __________________________ is ideal due to it being the most concentrated
First morning void
_____________________________ interprets the patients ability to metabolize a measured amount of glucose
Glucose tolerance specimens
________________________ tests for infections in the bladder
Catherized Specimens
__________________________ is used for routine screening but is less contaminated than random specimens
Midstream clean-catch specimen
_______________________ stabs a needle through the abdomen into the bladder, keeping the sample completely free of extraneous contamination
Suprapubic Aspiration
_________________________ uses clear plastic bags that attach to the genital area
Pediatric Specimen
Normal urine color is a pale to ____________________ yellow color
darkish/ orangish
__________________ is what primarily gives urine its yellow color
Urochrome
Darkish/ orangish yellow urine can also be abnormal if _________________ is present
Bilirubin
Bilirubin will be detected during the chemical examination and will also produce a slowly dissipating ______________ when shook
yellow foam
______________________ (a medication) causes urine to turn orange
Pyridium
Red/pink/brown urine shows the presence of _________ in the urine
blood
Old, Acidic RBC specimens have a brown urine due to the oxidation of hemoglobin to __________________
methemoglobin
Intact _____________ make urine red and cloudy
RBCs
_____________________ makes urine red and clear
Hemoglobin or myoglobin
Brown/ Black urine (if not RBCs) is caused by the use of certain medications or the presence of __________________________________
melanin or homogentisic acid
Blue/ Green urine suggest ______________ or medication/ Cloret use
bacterial infections
Specimen that are allowed to stand or are refrigerated may develop tubididty from the precipitation of ____________________
amorphous phosphates and urates
Non pathologic turbidity could show the presence of _____________________________ or improper preservation
squamous epithelial cells and mucus
Pathologic turbidity is caused by the presence of _____________________________ from infections or organ disorders
RBCs, WBCs, and Bacteria
Reagent Strip QC should be done every _______ hrs, if you recevive questionable results, or the strips are questionable
24
The kidneys are the major regulators of the bodys ______________ content
acid-base
The pH of most random specimen samples range from _______, but never exceed _____
4.5-8.0; 8.5
Urinary pH is helpful in determining the existence of systemic acid base disorders as well as the ______________________ and if the specimen was stored properly
identification of crystals
Multistix and chemstrip brands use a double indicator system of _____________________ (4-6 pH) and ____________________ (6-9 pH)
methyl red and bromythol blue
___________ between reagent strip pads may affect pH
Run-over
testing for proteins in urine is the most indicative test for _______________
renal disease
_______________ is the major protein in urine
Albumin
Proteinuria is indicated at ⪰____ mg/dL or ⪰____ mg/day and can be from prerenal, renal, or postrenal origin
30; 300
_________________________________ is seen in the urine of Multiple myeloma patients
Bence Jones Protein
Protein reagent strip testing is sensitive to albumin and contains _________________________________________
tetrabromophenol blue
The strip appears yellow (pH 3) in the absence of proteins and trace values are considered less than ___mg/dL
30
Highly buffered alkaline urine, Highly pigmented urine, container contamination, and high specific gravity urine may cause a _____________ result for proteins
false positive
The ___________ test is a confirmatory test for proteins of all forms
SSA
The renal threshold for glucose is _________________ mg/dL and remaining is excreted in the urine
160-180
The _______________ test is the most frequently preformed chemical analysis on urine
glucose
Glycosuria is excess amounts of glucose in urine and usually seen in ______________________
diabetes mellitus
Hyperglycemia during pregnancy is called ___________________________
gestational diabetes
The reagent strips use ______________________ to measure urine glucose with a double sequential enzyme reaction
glucose oxidase
Urine glucose is measured in ranges of _____ mg/dL (0.1%) to ____ g/dL (2%)
100; 2
Ascorbic acid, ketones, high SG, and bacterial growth may cause ___________________ for glucose
false negatives
peroxide or oxidizing detergents may cause a _______________ for glucose
false positive
The _______________ reduces copper sulfate to cuprous oxide and tests for glucose and galactosemia in newborns
Clinitest
Ketones consist of ______________________________
Acetone, Acetoiacetic acid, and Beta-hydroxybutyrate
Ketones appear in urine when body fat must be metabolized in cases of vomiting, starvation, and inability to metabolize carbs (such as in ______________________)
diabetes mellitus
Reagent strips for ketones primarily measures __________________ which reacts with sodium nitroprusside to produce a purple color
acetoacetic acid
__________________________________ may cause atypical colors for ketones
Levodopa and sulfer-based medications
Bacteria and the volatilization of acetone may produce a ________________ for ketones
false negative
__________________ are a non-confirmatory test for ketones and gives better color differentiation due to the addition of lactose
Acetest tablets
___________________ can be from nonpathological or pathological causes (such as kidney stones)
Hematuria
____________________ may result from RBC lysis caused by brown recluse spider bites and the presence of Hemosiderin
Hemoglobinuria
_________________ may be present in rhabdomyolysis patients
Myoglobinuria
Reagent strips use the pseudoperoxidase activity of hemoglobin and uses the chromagen ___________________________
tetramethylbenzidine
Free hemoglobin/ myoglobin will range from yellow-green-blue and ______________ result in a speckled pattern on the pad
intact RBCs
Reagent strip tests can detect concentrations as low as ____ RBCs/microL
5
Oxidizing detergents, vegetable peroxidase, Bacterial Enzymes, and menstrual contamination may cause ____________________ for blood
false positives
Failure to mix and Ascorbic Acid may cause _____________________ for blood
false negatives
10-15 mL of fresh or adequately preserved urine is gently mixed and centrifuged at _________________ minutes, leaving a small amount of urine and sediment ready for microscopic examination
400 RCF for 5
When examining sediment under a microscope, you first look under low power to detect casts and the general composition of the sediment, then high power for ____________________
identification
_____________________________ is the most frequently used and shows WBCs, epithelial cells, and casts
Sternheimer-Malbin Stain
_________________________________ enhances nuclear details
Toluidine Blue
___________________ enhances nuclear detail however it lyses all RBCs, so should be done after initial analysis
2% Acetic Acid
______________________ stains triglycerides and fats
Lipid Stain
__________________ is preferred for detecting urinary eosinophils
Hansel Stain
Prussian blue stain is to detect the iron from ____________________
hemoglobin breakdown
______________ suggest the presence of urinary RBCs
Ghost cells
Urinary RBCs suggest _________________________________ in the genitourinary tract
glomerular damage or vascular injury
______________ suggest the presence of urinary WBCs
Glitter Cells
______________ in the urine suggest drug induced nephritis or a UTI
Eosinophils
Mononuclear cells along with eosinophils suggest _______________________
renal transplant rejection
Urinary WBCs suggest glomerular or capillary trauma and ________________________ of the genitourinary system
infection or inflammation
___________ is an increase in the number of urinary WBCs
Pyuria
_____________________ are classified as squamous, transitional, or as RTEs according to their site of origin
Epithelial cells
_________________ are the largest found and has a prominent nucleus
Squamos EC
Clue Cells are a variation of Squamos EC and suggest vaginal infection by the bacterium ___________________
Gardnerella Vaginalis
_________________ have bacteria covering most of the cell and extending beyomg the edges
Clue cells
______________________ can be Spherical, Polyhedral, or have "Tails", but all forms have a centrally located nucleus
Transitional EC
RTEs can be columnar, round, oval, or cuboidal and have an ________________________
eccentrically placed nucleus
The presence of large amounts of __________ indicates tubular necrosis
RTEs
____________________ are RTEs that absorbed lipids and are usually present with free floating fat droplets
Oval Fat Bodies
Oval Fat bodies and Lipiduria suggest ______________________ from nephrotic syndrome
glomerular damage
Bacteria along with WBCs suggest a ___________
UTI
A true yeast infection is accompanied by ___________
WBCs
The most frequently encountered parasite in urine is _____________________
trichimonas vaginalis
____________________ are present in the urine in cases of male infertility
Spermatozoa
__________ in urine appears as irregular threads
Mucus
_____________________(Tamm-Horsfall protein) primarily makes up casts
uromodulin
The aggregation of uromodulin protein into individual fibrils, which interweave and traps urinary elements forming a solid structure, and eventually a __________ after the fibrils dissolve
cast
Hyaline casts are the most frequently seen and consists of ________________; colorless but pink when stained
uromodulin
____________________ are increased in acute glomerulonephritis, pyelonephritis, chronic renal disease, and heart failure
Hyaline casts
_____________ are orange-red and may be fragmented, suggest damage to the glomerulus
RBC casts
_______________ signifies nephron inflammation or a UTI
WBC Casts
WBC casts have _____________________________________
irregular borders and a multilobed nucleus
With ______________________________, the uromodulin fibrils remain attached to the RTE cells
Epithelial Cell casts
Casts containing ___________ represent tubular destruction and exposure to toxic substances and heavy metals
RTE
__________________ are seen with Oval Fat Bodies and free fat droplets; seen with nephrotic syndrome, tubular necrosis, diabetes mellitus, and crush injuries
Fatty Casts
_____________________ suggest urinary stasis
Granular Casts
Bacterial Casts are seen in __________________
pyelonephritis
______________________ are jagged and suggest chronic renal failure; fatal
Waxy Casts
____________________ suggest extreme urine stasis and widening of the distal convoluted tubules walls
Broad casts
____________ are formed by the precipitation of urine solutes
Crystals
All abnormal crystals are found in __________________
acidic urine
Normal Acidic Urine crystals are the most common and consist of ________________________
Amorphous Urates, Uric Acid Crystals, and Calcium Oxalate Crystals
_____________________ may appear pink due to the accumulation of uroerythrin on the surface
Amorphous Urates
The most common form of calcium oxalate crystal is the ___________________ and are diamond shaped
dihydrate
For QC, + results should be within ∓ __ color block
1
For QC, negative results must be _____________
negative
____________________ calcium oxalate crystals are oval/ dumbell shaped
Monohydrate
Normal Alkaline crystals consist of _______________________________
Amorphous phosphates, triple phosphates, and Ammonium biurate
____________________________ create a non dissolving white precipitate when warmed
Amorphous Phosphates
__________________________ resemble a coffin lid
Triple Phosphates
____________________________ are the only urates seen in Alkaline Urine
Ammonium biurate crystals
Abnormal urine crystals consist of ____________________________________ (Tyrosine, Leucine, and bilirubin)
Cystine Crystals, Cholesterol Crystals, and liver disorder crystal
_____________________________ are associated with nephrotic syndrome and only seen in refrigerated specimen
Cholesterol Crystals
_________________________ are fine yellow needles usually seen with Leucine crystals
Tyrosine crystals
__________________________ are yellow-brown spheres demonstrating concentric circles and radial striations
Leucine Crystals
____________________ are yellow clumped needles or granules
Bilirubin Crystals
Artifacts are just contaminants and usually consist of ____________________________________________________________________
Starch, Oil droplets, Air bubbles, Pollen, and Fibers
The main way to tell fibers and casts apart is that fibers ______________ and casts do not
polarize
Casts tend to be located _________________________ of cover slip
near the edges
The most seen dysmorphic RBCs in urine are _____________________
Acanthocytes and Schistocytes
Urobilinogen and bilirubin in the urine can provide an early indication of _______________ or bile duct obstruction
Liver Disease
Reagent Strips test for bilirubin using the _______________ to make the pad pink-violet
Diazo reaction
Urine pigments and certain medication can cause a ____________ for bilirubin
false positive
High concentrations of ascorbic acid and nitrite as well as old specimens can cause a ___________________ for bilirubin
false negative
__________________ are a confirmatory test for bilirubin and can detect as low as 0.05 mg/dL of bilirubin
Ictotest Tablets
Negative bilirubin and strong positive urobilinogen are seen in ______________________________
hemolytic disorders
Reagent Strips use the __________________________ to make urobilinogen pink
Ehrlich Aldehyde reaction
Highly pigmented urines and Ehrlich Aldehyde compounds cause a _________________________ for urobilinogen
false positive
Improper preservation may cause a ________________________ for urobilinogen
false negative
Nitrite testing helps monitor ______________
UTI
Reagent strips use the __________________ to make nitrite a pink color
greiss reaction
A high SG, ascorbic acid, antibiotics, nitrogen, and bacteria "malfunction" can cause ____________________ reactions for nitrite
false negative
The multiplication of bacteria and highly pigmented samples can cause a ___________________ for nitrite
false positive
_________________________________________ detects the presence of (even lysed) WBCs and indicates UTI and UT inflammation
Leukocyte Esterase
The Reagent Strip relies on the Acid Ester embedded on the pad to produce an aromatic compound that produces a purple color for the presence of _________________
WBCs
Antibiotics, Strong oxidizing agents, and highly pigmented urine cause a __________________________ result on LE
false positive
Antibiotics and high concentrations of proteins, glucose, and acids cause ____________________________ on LE
false negatives
The term ____________________________ is used to describe urine with a SG of 1.010
isothenuric
Hyposthenuric: <______________
1.010
Hypersthenuric: >___________________
1.010
A ________________________ is used to measure SG
refractometer