Clinical Chem Urinalysis

volume, colour, odour, clarity, specific gravity

name all physical test done for urinalysis

Mousy smell

________: associated with phenylketonuria.

Stool samples

________ are obtained after bowel movement or during rectal examination.

Colour intensity

________ indirectly indicates urine concentration & state of hydration.

Prompt testing

________ is mandatory (as it is dissolved in acidic urine within 30min or 10min in alkaline urine)

Urine osmolality

________ → more reliable & accurate to evaluate kidney function, particularly the concentrating ability.

leucine

Tyrosine & ________ crystals: abnormal; suggestive of severe liver diseases.

squamous epithelial cells

Increased ________: originate from vagina, suggestive of contamination.

Cystine crystals

________: abnormal; in those who have cystinuria & kidney stones.

white blood cells, red blood cells, bacteria, fats

substances that can cause cloudy urine

low USG

overhydration, diabetes insipidus, acute tubular necrosis, pyelonephritis

high USG

dehydration, uncontrolled diabetes mellitus, acute glomerulonepritis, heart & liver failure

acidic urine

calcium oxalate, uric acid & amorphous urate crystals indicates a what urine? (acidic/alkaline)

alkaline urine

calcium phosphate, amorphous phosphate & ammonium magnesium phosphate crystals indicates a what urine? (acidic/alkaline)

kidneys

volume of urine is closely regulated by ______

2000

Polyuria is where urine volume exceeds _____ml/day

antidiuretic hormone, aldosterone

Polyuria occurs due to:
osmotic diuresis in diabetes mellitus, hyperthyroidism & infections

insufficient secretion of / inability to respond to ______ (ADH)

lack of hormone a______

500

Oliguria is where urine volume

plasma, dehydration

Oliguria usually occurs as a consequence of conditions that decrease _____ volume, lead to d______, have impaired renal functions

urochrome

Pigment in urine (yellow) is u_____

ketonuria resulting from uncontrolled diabetes mellitus

Odour of urine (not routinely reported):
what does a fruity odour indicate?

presence of proteins

Clarity of urine:
what does a foamy urine indicate?

white blood cells, red blood cells, bacteria, fats

Clarity of urine:
what does a cloudy urine indicate?

reabsorb, filtrate

specific gravity indicates the kidney’s ability to ____ water & chemical substances from the glomerular _____

pH, RBC, WBC, proteins, glucose, ketones, bilirubin, urobilinogen, leukocyte esterase, nitrites

Name all chemical tests done for urinalysis

respiratory/metabolic alkalosis, presence of urease-producing bacteria, renal tubular acidosis, urinary tract infection

Alkaline urine may be due to:

alkaline

vegetarian diet, diets high in citrate may cause an (acidic/alkaline) urine?

acidic

high-protein diet, intake of acidic fruits may cause an (acidic/alkaline) urine?

regulate acid-base, diet, medications

pH reflects the kidneys’ ability to ___________ balance
pH can be influenced by ____ & _________

diabetes mellitus, diabetes ketoacidosis, diarrhea, emphysema

Acidic urine may be due to:

genitourinary, hemorrhagic, strenuous

Red blood cells in urine indicates tumours/trauma/infections/inflammation in _______ tract
non-renal: h______ disorder, exposure to toxic chemicals, s_____ exercise

bacterial, tumours

White blood cells in urine indicates:
b_____ infection in renal/genitourinary system
presence of ______ and renal calculi

strenuous, dehydration, renal, proteins

Proteins in urine indicates:
s______ exercise, d_____
_____ diseases/failure (e.g. nephrosis, glomerulonephritis)
systemic disorders leading to increased level of serum _____ (e.g., multiple myeloma)

diabetes mellitus

Glucose in urine indicates:
d______ m_____, Cushing's syndrome, Fanconi’s syndrome, liver & pancreatic diseases

rare hereditary metabolic disorders

gestational diabetes

pregnancy, nutritional

Ketones in urine indicate:
p_______, ketogenic diets, compromised n______ intake

uncontrolled diabetes mellitus (diabetic ketoacidosis), liver disease, certain forms of glycogen storage disease

dysfunction, obstruction

Bilirubin in urine indicates:
liver d______ (due to obstructive jaundice, cirrhosis, viral- or drug-induced hepatitis, hepatotoxic drugs, toxins)

biliary o______

hemolysis, severe, obstruction

Urobilinogen in urine indicates:
↑in _______, hepatocellular disease (e.g., cirrhosis, hepatitis), s______ infection

↓in bile duct o______, renal insufficiency, with antibiotic use

neutrophils, infection

Leukocyte esterase in urine indicates:
presence of n______, either due to i______ or other inflammatory processes, in urinary tract or kidneys

bacteria, nitrate reductase positive

nitrites in urine indicates:
presence of a significant number of ______, and a urine culture should be performed

UTI caused by n_____ r_____ p______ bacteria

cells, casts, crystal, bacteria

Name all microscopial tests done for urinalysis

it should be performed among those with persistent hematuria or proteinuria

When should microscopial tests be done?

glomerular diseases

presence of dysmorphic red blood cells is suggestive of g_____ d_____

UTI

presence of wbc is indicative of _____, but culture is still needed for confirmation

transitional epithelial cells

What type of epithelial cells are normal if present in urine?

renal tubule cells

What type of epithelial cells are abnormal if present in urine?

acute tubular necrosis & renal pathology associated to nephrotoxic agents

what does the presence of renal tubule cells in urine indicate?

the lumen of distal convoluted tubules & collecting ducts

Casts in urine may be formed in:

hyaline and erythrocytes (only in people who play contact sports)

What type of casts may be a normal finding in urine?

yes

Crystals are considered normal finding in urine, yes or no?

calcium oxalate, uric acid & amorphous urate crystals

Types of crystals found in acidic urine

calcium phosphate, amorphous phosphate & ammonium magnesium phosphate crystals

Types of crystals found in alkaline urine

cystine, tyrosine & leucine crystals

Abnormal crystals in urine

the patient may have cystinuria & kidney stones

what do cystine crystals in urine indicate?

suggestive of severe liver diseases

what do tyrosine & leucine crystals in urine suggest?

false

Bacteria in urine is normal, true or false?

diarrhea of unknown cause

Presence of leukocyte in faeces might indicate

an irritated intestinal mucosa

large amount of epithelial cells in faeces might indicate

malabsorption, pancreatic, intestines, fats

Fats in faeces might be due to
m______ syndromes or deficiency in p______ enzymes
However, it can also be due to
surgical resection of i_______ & recent intake of excessive amounts of dietary f____

triglycerides, fatty acids & fatty acid salts

fats in stool are usually in the forms of:

fats

Meat fibers in stool usually correlates with ____ in the stool

carcinoma, peptic ulcer, gastritis, inflammatory bowel diseases, diverticular diseases, hemmorrhoids, anorectal fissure

Occult blood test is the most frequently done in the lab. Presence of blood in stool is indicative of:

malabsorption

elevated level of quantitative fats indicates intestinal m_____ or pancreatic insufficiency

pancreatic deficiency

Trypsin absence in children

diarrhea

Presence of bile in stool is abnormal
occurs with d____ & hemolytic anemias