Urinalysis

chemical analysis of urine with use of ____ is described below:

• most common method

• plastic strip with reagent impregnated pads dipped in urine, resulting in a visual color change

  • qualitative results based on color change

• interfering substances such as ascorbic acid (vitamin C) need to be detected or eliminated

reagent strip

____ are used to confirm results obtained by reagent strip testing and as an alternative method for highly pigmented urine.

tablet and liquid tests

ictotest tablets are used for ____ testing (more sensitive than strip testing).

bilirubin

acetest is used to confirm ____.

ketones

reference interval for specific gravity.

1.002-1.035

what specific gravity value is fits the following scenario:

• physiologically impossible

• same as pure water; suspect adulteration of urine specimen

1.000

what specific gravity value is fits the following scenario:

• dilute urine

  • due to increased water intake

  • water diuresis (e.g., diuretics, diabetes insipidus)

1.001-1.009

what specific gravity value is fits the following scenario:

• indicates average solute and water intake and excretion

1.010-1.025

what specific gravity value is fits the following scenario:

• concentrated urine

  • dehydration, restriction, profuse sweating

1.025-1.040

what specific gravity value is fits the following scenario:

• physiologically impossible

• indicates presence of iatrogenic substance

  • e.g., radiographic contrast media, mannitol

>1.040

normally, the urine pH varies from ____.

4.5-8.0

pH values >8.0 and <4.5 physiologically impossible and require investigation. true or false?

true

the 3 common reason for a pH of ____:

• improper storage (urease+ bacteria)

• adulteration (adding alkali)

• administration of highly alkaline medications

>8.0

____ (blood) is associated with:

• glomerulonephritis

• pyelonephritis

• stones

hematuria

____ (blood) is associated with:

• IV hemolysis

  • PNH, HTR, HA

hemoglobinuria

____ (blood) is associated with:

• muscle trauma in crushing injuries

• contact sports

myoglobinuria

leukocyte esterase requires _____ WBCs/uL of urine.

10-25

the presence of ____ is the most common cause of UTI and can also be seen in inflammation in kidney.

leukocyte esterase

_____ is best for:

• UTI screening

  • if positive with leukocyte esterase should be cultured

• antibiotic therapy monitoring

nitrite

there are diverse causes for protein in urine. which category refers to:

• multiple myeloma

• hemolytic anemia

• muscle injury

prerenal or overflow proteinuria

there are diverse causes for protein in urine. which category refers to:

• glomerulonephritis

• infections

glomerular proteinuria

there are diverse causes for protein in urine. which category refers to:

• renal tubular acidosis

• acute pyelonephritis

tubular proteinuria

there are diverse causes for protein in urine. which category refers to:

• inflammation

• malignancy

• injury/trauma

• contamination during urination

postrenal proteinuria

tubular maximum reabsorptive capacity (Tm) is about 350 mg/min, if blood glucose level exceeds _____ glucosuria occurs.

180 mg/dL

____ glucose (glycosuria or glucosuria) is found in diabetes mellitus, stress, anxiety, cushing’s disease, and pregnancy.

prerenal

____ glucose (glycosuria or glucosuria) is found in fanconi’s syndrome, end stage renal disease, pregnancy, heavy metal poisoning.

renal

the presence of ____ in urine refers to the inability to utilize available carbohydrates (diabetes mellitus), insufficient carbohydrate consumption (starvation, alcoholism, severe exercise).

ketones

bilirubin and urobilinogen can be present in urine ____ for:

• increased heme degradation

  • hemolytic disorders

• bilirubin negative

• urobilinogen high

pre-hepatic

bilirubin and urobilinogen can be present in urine ____ for:

• hepatocellular disorders

  • hepatitis

  • cirrhosis

• bilirubin positive

• urobilinogen normal or high

hepatic

bilirubin and urobilinogen can be present in urine ____ for:

• obstruction

  • gallstones

  • tumors

• bilirubin positive

• urobilinogen low or absent

post-hepatic

what is the reference interval for RBCs in microscopic sediment analysis?

0-3/hpf

what is the reference interval for WBCs in microscopic sediment analysis?

0-8/hpf

ascorbic acid may interfere with ____ microscopic sediment analysis.

RBC

if ____ are present, leukocyte esterase should be positive as well as nitrite (suggests bacterial infection).

WBC

if WBCs are high and leukocyte esterase is negative, what can be considered?

inflammation

increased numbers in ____ epithelial cells are due to poor collection technique (not a “clean catch”).

squamous

increased numbers in ____ epithelial cells are associated with infection or inflammation of bladder, ureters, renal pelves, or male urethra.

transitional

increased numbers in ____ epithelial cells are increased in damage to renal tubules (e.g., ischemic events like shock, anoxia, sepsis, and heavy metals).

renal

unique to the kidney, urinary casts are formed in the distal and collecting tubules with a core matrix of _____.

uromodulin

____ was formerly known as Tamm-Horsfall protein.

uromodulin

urine casts do not need to be correlated with chemical exams. true or false?

false

which urine cast is most common (e.g., alone in strenuous exercise, stress, dehydration, fever)?

hyaline

which urine cast is (pr+, blood±) usually not associated with any specific pathology, alone in strenuous exercise, stress, dehydration, fever?

granular

the following are ____ casts:

• RBC

• WBC

• RTE

• waxy

• fatty

cellular

all ____ casts are pr+ and blood ±.

cellular

which cellular cast is associated with glomerular disease?

RBC

which cellular cast is associated with positive leukocyte esterase and infections (e.g., bacterial or viral pyelonephritis)?

WBC

which cellular cast is associated most with acute tubular necrosis but also all types of renal disease?

RTE

which cellular cast is associated with nephrotic syndrome and chronic renal disease (glomerulonephritis, pyelonephritis), transplant rejection, and malignant hypertension?

waxy

which cellular cast is associated with nephrotic syndrome and diabetic nephropathy and filled with fat droplets?

fatty