UA and other body fluids

polyuria

Increased urine output

oliguria

decreased urine output (like from a blockage)

anuria

No urine output

nocturia

frequent urination at night

Random

What type of urine specimen is collected at any time, the most common, and is used for routine screening and chemical testing?

morning void

What type of urine specimen is the 1st sample in the morning, the most concentrated, and is best for pregnancy and microscopic analysis?

24 hours

What type of urine specimen is all the urine collected during the day and night and is used for quantitative and qualitative analysis of chemical analytes; total volume required?

midstream clean catch

What type of urine specimen am I describing? Cleanse the urethral area discard first few mLs and collect the rest, used for culture and sensitivity.

dirty

What type of urine specimen am I describing? No cleansing at site prior and is not the preferred specimen - bare minimum.

foley catheter

What type of urine specimen am I describing? Assisted sterile technique, urine goes from bladder through a drainage tube into a collection bag - sterile specimen.

suprapubic aspiration

What type of urine specimen am I describing? Sterile technique in which urine is collected by inserting a need through the abdominal wall into the bladder - sterile specimen.

transparency, odor, foam, color, pH, specific gravity, protein, blood, nitrite, leukocyte esterase, glucose, ketones, bilirubin, urobilinogen

What test are included in the macroscopic analysis?

yellow (straw to amber), clear, smells slightly aromatic, small amounts of foam

What does healthy urine look like

2 hours (refrigerate to avoid ammonia build up)

Macroscopic urine analysis has to be done in ______________.

DM, pseudomonas

Sweet/fruity smelling urine is a red flag for

clear, hazy, cloudy, turbid

How can the lab report transparency of urine?

slightly aromatic, ammonia, putrid, sweet/fruity

How can the lab report the odor of urine?

small, large amount of yellow foam, large amount of white foam

How can the lab report foam in the urine?

proteins, WBCs, speed of urination

What causes foam in urine?

Urochrome, uroethrine, urobillin

What proteins give urine its color?

concentration, dehydration

What causes dark yellow urine?

concentration, bilirubin

What causes amber urine?

hemoglobin, RBC

What causes bright red urine?

myoglobin, beats

What causes dark red urine?

polyphorins

What causes red/purple urine?

melanin, homogentisic acid (alkaptonuria)

What causes dark brown/black urine?

pseudomonas, medication

What can cause green/blue urine?

phenazopyridine

What causes orange urine?

dipstick (manual), photoelectric colorimetry (automated)

What methods are used for the chemical analysis of urine?

possible UTI, renal disease, vegetarianism

Alkaline urine could be a sign of?

possible starvation, diarrhea, DM, dehydration

Acidic urine can be a sign of

specific gravity

What macro-analysis of the urine is a measure to determine the state of the kidneys or the state of hydration and is inversely proportional to urine output - tests osmolality?

Protein

What macro-analysis of the urine is measured to determine kidney/tuble function and reabsorption?

glomerulonephritis, nephrotic syndrome, hypertension, pyelonephritis, cystitis, urethritis, Fanconi’s syndrome, toxin induced, pregnancy

What are some causes of proteinuria?

salicylate acid test

How do you confirm proteinuria?

blood

What macro-analysis of the urine test for conditions of urinary tract and renal function?

glomerular damage, interstitial nephritis, kidney infections/disease, bladder infections/disease, upper/lower UTI

Hematuria could be indicative of

intravascular hemolysis

Hemogloburia could be indicative of

rhabdo

Myoglobinuria could be indicative of

Bacterial infection (think gram negs - E.coli, Kleb, proteus, enterococcus)

A urine with a positive nitrite is a red flag for

non-nitrate reducing bacteria, gram positive

What are some false negatives for nitrite?

Leukocyte esterase

What urine macro-analysis is used to detect WBCs being excreted in the urine?

Bacterial

If you have a positive nitrite and a positive LE, what are we thinking?

trich, yeast, viruses

If you have a negative nitrite and a positive LE, what are we thinking?

180 mg/dl

What is the renal threshold for glucose - on a dipstick?

pregnancy, Fanconi’s

If you see glucosuria without hyperglycemia…

DM, hyperthyroidism, strokes, tumors

If you see glucosuria with hyperglycemia…

DM, diet, starvation, high protein, keto diet, alcoholism, strenuous exercise, pregnancy, Fanconi’s syndrome

What causes ketonuria?

acid (purple/pink)

What test can you use to confirm ketones?

bilirubin

What urine marco-analysis is a indication of liver function?

cirrhosis, hepatitis, liver congestion, obstructive jaundice, carcinomas, fibrosis

If you see bilirubinuria, that is a red flag…

pre-hepatic, hepatic, post-hepatic diseases

If you see urobilinogen in the urine

abnormal color/appearance, positive protein/blood/leukocyte esterase/nitrite

What are the clinical indications for a microscopic analysis of the urine?

retractile green biconcave disc

What do RBCs look like in the urine

concentrated

If the RBCs are crenated (fluffy) the urine is

granular cells containing nuclei

What do WBCs look like in the urine?

interstitial nephiritis

WBCs (especially eosinophils) in the urine is a red flag for?

large, flat, single nuclei (fried egg)

What do normal squamous epithelial cells look like in the urine?

dirty catch, vaginal fluid contamination

A positive result of squamous epithelial cells could mean

furry looking squamous epithelial (Bacteria vaginalis)

What are clue cells?

damage to urinary tract

Transitional epithelial cells (cytoplasmic ration 3:1) in the urine is a sign of

renal disease, tubular necrosis/damage

Renal tubular epithelial cells (cytoplasmic ratio 1:1) are a sign of

Nephrotic syndrome

Oval fat bodies in the urine is a significant finding for (usually with proteinuria)

sudan stain, red oil, polarizing microscopy

How do you confirm oval fat bodies

motile/nonmotile green refractile small rods

Bacteria in the urine look like (GET A CULTURE)

green, refractile, small, ovoid, snowmen

What do budding yeast look like

long branching with buds

What does pseudohyphae look like

vaginal contamination, fungal kidney infection, diabetic patient with flucosuria

Yeast in the urine is a sign of (GET A CULTURE)

TRICH

If you see a flaggellated motile protozoa moving in a rapid jerky movement →

schistosoma haematobium

What parasite infects the bladder leading to cancer and have eggs that are present in the urine

enterobius vermicularis

What parasitic infection can show up in the urine as pinworm eggs usually due to a perianal infection?

No (unless its a child or SANE)

If we see motile/non-motile bodies with a long tail in the urine, do we really care?

Cast

What are microscopic clusters of particles wrapped in Tamm-Horsefall protein matrices found in the urine?

hyaline

What type of cast is transparent, colorless, and cylindrical - normal in exercise and dehydration?

granular (coarse or fine)

What type of cast is granulated could be a sign of renal disease (not signficant) and is found in concentrated urine with WBCs?

RBC

What type of cast is indicative of acute glomerulonephritis?

WBC

What type of cast is indicative of pylonephritis and a HIGH UTI (kidney infection)

fatty

What type of cast is normally seen with fat oval bodies and indicative of nephrotic syndrome as well as extremely high protein content?

Waxy

What type of cast is broad with blunt ends, fissures, cracks and is indicative of end-stage renal disease, renal failure, and urine stasis?

crystals

What is formed in response to precipitated urine salts and can be found in both acidic and basic urine

amorphous urates

What type of urinary crystal is granular black dust and the urine appears pink?

calcium oxalate

What type of urinary crystal is octahedral/oval shapes a sign of ethylene glycol poisoning, contamination, and UTI?

uric acid

What type of urinary crystal is yellow-brown irregular shapes and supports the diagnosis for gout?

amorphous phosphate

What type of urinary crystal is is white granular masses and indicated basic urine?

triple phosphate

What type of urinary crystal is known as “coffin lids” and is a sign of UTI?

ammonium biurate

What type of urinary crystal is yellow brown spicules “thorny apples” and is not typically clinically significant?

cysteine

What type of urinary crystal are colorless hexagonal plates and present with cystinuria, amino acid disorder, and increased renal calculi formation?

cholesterol

What type of urinary crystal is colorless, flat, rectangular plates with notches and nephrotic syndrome?

tyrosine

What type of urinary crystal are fine, colorless, needles in clusters and indicate severe liver disease?

Leucine

What type of urinary crystal are yellow spheres with radial striations and indicate severe liver disease?

Bilirubin

What type of urinary crystal are yellow-brown clumped needles/granules, seen in liver disease, and correlate with the chemical bilirubin test and color of urine?

transudate

What type of serous membrane fluid has protein less than 25, cell count less than 5000, colorless/yellow, clear/moderately cloudy, specific gravity is 1.015-1.020?

exudate

What type of serous membrane fluid has protein above 30, specific gravity more than 1.018, cell count more than 10,000, moderately cloudy/opaque, and variable color?

CSF

What type of fluid is collected via lumbar puncture and is collected in a 4 tube system (1 for chem, micro, heme, good measure)?

bacterial meningitis

CSF fluid that is turbid, with lots of WBC and protein, with low glucose is a red flag for

viral meningitis

CSF fluid that is clear, with low WBCs (predominately lymphocytes though), low protein and normal glucose is a red flag for?

Fungal meningitis

CSF fluid that is clear, with lowish WBCs, high proteins, and normal-low glucose is a red flag for

synovial

What type of fluid is collected from the joints and is used in the diagnostics for arthritic pain?

gout

If you see monosodium urate crystals in synovial fluids, what are we thinking team

pseudogout

If you see CPPD crystals in synovial fluids, what are we thinking team