Urinalysis

What effect will prolonged standing at room temp have on urine

nitrite, ph, and turbidity will increase
glucose, ketones, bilibrubin, urobilinogen, cells and cast will decrease

Ketone bodies are in the urine as a result of what process taking place in the body

Fat Catabolism

What would be indicated if you have a pos glucose oxidase (dipstick) and a neg copper reduction (clinitest) test for urine glucose?

small quantity of glucose. Remember that glucose oxidase is specific for glucose and the clinitest is not specific but will detect glucose and other NGRS.

What effect will the consumption of a meal have on a patients urine pH?

It will become more alkaline

Which cast found in the urine is indicative of bleeding from nephron and is diagnostic for glomerulonephritis?

RBC cast

An increased urine urobilinogen is suggestive of what two diseases?

Liver damage (hepatitis, cirrhosis) and hemolytic disease

Give the color produced by the following substances:
Porphyrin-
melanin-
homogentisic-
biliverdin-

red/ port wine
brown or black
black
yellow-green

Name the clinically significant crystals found in urine

Bilirubin, leucine, tyrosine, cystine, and cholesterol

What stains are used to confirm the presence of fat or triglyceride?

Sudan III or Oil Red O

Using the descriptive terms, give the name of the following crystals found in the urine.
Coffin Lid-
Envelope-
Dumb Bell-

triple phosphate
calcium oxalate
calcium carbonate

What is the significance of the waxy cast in the urine sediment?

indicates prolonged urinary stasis and if broad, is considered a renal faillure cast

Which findings are suggestive if the clinitest is pos and the dipstick for glucose is negative?

sugars other than glucose such as glactose and lactose

Name three conditions in which polyuria occurs

Diabetes mellitis, Diabetes insipidus, excess fluid intake

Give three microscopic indicators of a UTI?

Bacteria, WBC and cast

Erythropoietin is produced by what organ

Kidney

Patient has increased intake of vit C. This may give a false neg for what substances in the urine?

glucose, ketones, blood, bilirubin, nitrite

What crystal does a pink and cloudy urine indicate?

amorphous urates

RBC might be confused with what other sediment in the microscopic urine? What may be used to aid in differentiation?

yeast; drop of acetic acid will dissolve RBC

Cast are mostly composed of what?

Protein

If you have a pos urine glucose, what else should you test for?

ketones

What test is specific for glucose

Glucose oxidase on dipstick

What are glitter cells

Polymorphonuclear (neutrophil) cells with browian movement of the granules

What is the principle of protein on the dipstick?

Protein error of indicators

Where is glucose reabsorbed in the kidney?

in the proximal convoluted tubules

What could cause the urine dipstick to be inactivated?

leaving the lid off the dipstick can and removing the desiccant

Where are casts formed?

in the distal concoluted tubules

What is the most probable cause of jaundice if the patients lab results were as followed:
urine: bili neg
blood: increased unconjugated bili
feces: increased urobilinogen

Hemolytic Jaundice

How would you get rid of amorphous urates?

By heating

How would you get rid of amorphous phosphates

by adding acid

What is the average 24 hour urine excretion from a normal- adult?

1200-1500 ml

What would it mean if you had a pos occult blood on a dipstick, but no RBC were seen microscopically?

Presence of myoglobin and/or hemoglobin in urine

What has a maltest cross appearance when viewed with polarized microscopy?

oval fat bodies (cholesterol), starch, cholesterol crystals

In what condition are oval fat bodies seen in?

Nephrotic syndrome

What could cause urine to turn black upon standing?

homogenistic acid or melanin

What gives urine its natural color?

urochrome

What happens to the volume and specific gravity of urine in a patient that has diabetes insipidus?

specific gravity is decreased and volume is increased

To do quantitative tests on urine what kind of specimen is preferred?

24 hour

Do you have a increased or decreased urine output in diabetes mellitus?

increased (polyuria)

Urinary cast are best found under what microscopic condition?

low power with dim illumination

What may be confused with leukocytes in a urine microscopic?

Renal epithelial cells

Name 8 acid and 5 alkaline crystals

Acid- uric acid, calcium oxalate, amorphous urates, calcium sulfate, hippuric acid, sodium urates, cystine, leucine

Alkaline- triple phosphate, calcium carbonate, ammonium birurate, amorphous phosphates, calcium phosphate

What is the functional unit of the kidney?

Nephron

What is the glucose renal threshold?

glucose will be spilled over into the urine when the blood glucose exceeds 160 to 180 mg/dl

What is the preferred specimen for routine UA?

First morning void

What hormone regulates the absorption of water in the distal portion of the nephron

ADH antidiuretic hormone

What is the best chemical preservative for urinary sediment?

formalin

Odors of urines are important- identify the following;
Sweet or fruity smell-
ammonia-
musty or mousy odor-
maple syrup-

ketones
bacteria
phenylketonuria
maple syrup disease

Name three functions of the kidney

maintain acid base balance
excretion of nitrogenous waste products
maintain electrolyte balance

Name the chemical tests performed in routine urinalysis

pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leukocytes, and specific gravity

Name the single most important test that may indicate renal diease.

Protein

Give a list of contaminants which may be found in urines

sperm, pinworms, trichomonas, yeast

Define hematuria

intact red cells in urine

why do you need to screen infants for nonglucose reducing substances? What test is performed

Because the presence of non glucose sugar may be indicative of a carbohydrate disorder such as galactosemia. Do the clinitest

What percent of plasma glucose is CSF glucose?

60 to 70%

Nitrite in a urine specimen suggests the presence of?

Gram negative bacteria

The final phase of degeneration that granular casts undergo is represented by which of casts?

waxy cast which implicates there is urinary stasis

What is the titer in tube 8 if tube 1 is undiluted and dilutions are doubled?

128 titer

What test measures IgE levels against a specific allergen?

RAST (Radioallergosorbent)

What type of immunity do you get when you are given an immunization shot? Ex: Rubella vaccine

Active

What disease is indicated by a high titer of anti-Sm (anti smith) antibody?

Systemic Lupus Erythematosus (SLE)

What type of test are performed to detect lyme disease and what is the causative agent?

Serologic testing is done to detect antibodies. Borrelia burgdorferi, a spirochete, is transmitted to humans by the bite of the deer tick

What is an immediate hypersensitivity reaction and give some examples.

Type one anaphylatic is IgE mediated. Antigen binds to IgE sensitized mast cell which releases histamine. Examples are bee sting, hay fever, and asthma

Define titer

The reciprocal of the highest dilution in which a pos reaction occurs

What can activate the alternate pathway of complement?

non antibody initiated pathway. Polysaccharide complexes from yeast cells, bacterial and endotoxins

What is the lineage and function of a plasma cell?

Activated B lymphocytes; produce antibodies

Which antibody is associated with speckled nuclear pattern on the ANA test?

ENA antibody

What can cause a false pos glucose on a dipstick

bleach

A urine specimen has a occult blood of 2+ and 0 RBC microscopically, what is the probable cause?

Hemoglobinuria

What structure connects the bladder to the exterior of the body?

urethra

Name the flat colorless plate, notched on one corner, and what is it soluble in?

Cholesterol, soluble in chloroform

What are oval fat bodies?

Renal tubule epi cells with fat or lipids

Name this casts- homogenous, opaque, notched edges, broken ends

waxy casts

Name crystal that is colorless dumbbell or sphere shaped and soluble in acetic acid?

calcium carbonate

A 17 year old girl has been on a starvation diet for a week. What substance would you expect to see in the urine?

Ketones from fat catabolism

Name two primary functions of the complement system.

Cell lysis and promote inflammation

What test would be pos on the reagent strip when a patient is suffering from dehydration due to diarrhea or vomiting?

Ketones

The serum hemolytic complement level is

A measure of total complement activity

Urine sediment that contains RBC, RBC cast, and protein is characteristic of

Acute glomerulonephritis

The finding of WBC cast in urine sediment has been linked with what condition?

Pyleonephritis

What type of urine specimen is used to evaluate whether a patient has a UTI?

Midstream clean catch

What routine urine test may be used to assess the kidney ability to concentrate urine

Specific gravity

Which specimens are usually not infectious unless visibly bloody?

Urine, feces, sputum, nasal secrection, sweat, tears, and vomitus

Explain the concept of Universal/ Standard Precautions

All specimens should be handled as if they are infectious

Name four categories of chemicals that pose health hazards

irritants, corrosives, toxic agents, and carcinogens

What are proficiency test

Samples sent from an outside agency that are tested as unknown by the lab. Results obtained are compared to those of other participating labs reference labs.

Which federal agency issues regulations to ensure employee safety.

The Occupational Safety and Health Administration (OSHA)

Which federal agency regualtes blood banks

The food and drug administration (FDA)

What is the federal legislation that regualtes almost all clinical lab in the US

The clinical lab improvement amendments of 1988 (CLIA '88)

What is the role of the centers for disease control and prevention (CDC)

It issues standards and guidelines for hospitals and lab, primarily related to infection control and safe work practices. Its role is advisory; it is not a regulatory agency and does not have enforcement authority