MLT FINAL EXAM STUDY NOTES Urinalysis/ Body Fluids (CH 4-15)

What is the urine daily output?

The average urine daily output is 1200mL

What is urine composition?

95% water, urea, uric acid, creatinine, chloride, sodium and potassium.

What is urine volume?

Oliguria, Anuria, Polyuria

What is oliguria?

500mL/ day

What is oliguria associated with?

dehydration, vomiting, diarrhea, burns, perspiration

What is anuria?

Complete cessation

What is anuria associated with?

Kidney damage, decrease blood flow to kidneys

What is polyuria?

2500 mL/day

What is polyuria associated with?

diabetes mellitus and diabetes insipidus, diuretics, caffeine, alcohol, excessive fluid intake

What is nocturia?

Increase volume at night

What is nocturia associated with?

renal disease, pregnancy, enlarged prostate, increased fluids at night.

What are physical exam components in urine?

Color, Clarity, Specific Gravity, Odor

What is the colors in urine?

Pale yellow, dark yellow, orange-yellow, yellow-green, green, blue-green, amber, clear, red.

What is clarity in urine?

Clear, Hazy, Cloudy, Turbid, Milky

What is the specific gravity of urine?

Refractometry, Osmolality, Reagent strip

What is refractometry?

Refractive index

What is the osmolarity of urine?

Changes in colligative properties by particle number

What is the reagent strips?

Pk changes of a polyelectrolyte by ions present

What is odor in urine?

Aromatic, foul, ammonia-like, fruity, sweet, maple syrup, mousy, rancid, sweaty feet, cabbage, bleach

What is abnormal urine colors?

Clear, Dark brown, Dark yellow, Orange, Pink, Red, Lighter Brown

What are the chemical exam components in urine?

pH, Protein, Glucose, Ketones, Blood, Bilirubin, Urobilinogen, Nitrite, Leukocytes, Specific Gravity

What is the pH clinical significance of urine

Alkaline - may indicate " old urine; seen after eating ( response to HCI secretion)

What is protein clinical significance in urine?

• Proteinuria=Best single indicator of early disease

-Glomerular involvement

• Can be increased after strenuous exercise

What is glucose clinical significance in urine?

Diabetes Mellitus

What is ketones clinical significance in urine?

• Uncontrolled diabetes Mellitus

• High protein diet (restricted carbohydrates)

• Dehydration (excess vomiting and diarrhea)

What is blood clinical significance in urine?

-Hematuria - Systemic bleeding disorders, renal disease, cystitis, calculi, strenuous exercise, menstrual contamination

-Hemoglobinuria-Incompatible blood transfusion, malaria, strenuous exercise, hemolytic anemias

-Myoglobin- muscle destruction

What is bilirubin clinical significance in urine?

• bile duct obstruction

• liver damage(hepatitis and cirrhosis)

What is urobilinogen clinical significance in urine?

·-Liver damage (Hepatitis and cirrhosis)

-Hemolytic anemias

What is nitrite clinical significance in urine?

Bacteria (UTI)

What is leukocytes clinical significance in urine?

-WBC in urine which most likely indicated the presence of bacteria

-Reacts with granulocytes not lymphocytes

What is specific gravity clinical significance in urine?

-decreased diabetes insipidus ( consistently low)

• Radiopaque dye

What is storage requirements for urine strips?

Container, Temperature, environment, desiccant

What is container storage requirements for urine strips?

Always keep strips in their original opaque bottle with a tightly fitting cap. This protects them from light and moisture.

What is temperature storage requirements for urine strips?

store at room temperature, typically between 15-30 C degrees ( 59-86 F). Extreme temperatures ( too hot or too cold) can denature reagnents.

What is environment storage requirements for urine strips?

Keep away from direct sunlight, high humidity, and areas with volatile chemicals (e.g., disinfectants, strong acids/bases) that could interfere with the reagents.

What is desiccant storage requirements for urine strips?

the bottle usually contains a desiccant packet to absorb moisture; do not remove it.

What is Indications of negative urine dipstick for glucose but positive clinitest

-urine sitting at Room Temp too long

-ascorbic acid

-ketones

-High S G

-Low Temp

What is a macroscopic screening in urine exam techniques?

Increase cost-effectiveness of urinalysis

What is a microscopic screening in urine exam techniques?

identification of formed elements

What is Urine sediment constituents and their clinical significance

Normal urine, abnormal urine constituent

What is normal urine sediment?

• 0-2 rbc/hpf

• 0-5 wbc/hpf

• 0-2 hyaline or fine granular cast/Ipf

• Few epithelial cells

Slight mucus

What is abnormal Urine constituent?

Red cells

• May indicate glomerular damage or menstrual contamination

• May be altered by pH and osmotic pressure to form "ghost", crenated or swollen cells

• May be confused with yeast cells and oil droplets; add 2% acetic acid to lyse RBC

What abnormal urine sediment constituents?

White Cells

-May indicate inflammation or infection (pyuria)

-Cylindrical form having parallel sides

-Formed in the lumen of the distal convoluted tubule and collecting duct

Major constituent of casts is uromodulin(formerly knowns as Tamm Horsfall protein), a glycoprotein secreted by renal tubular epithelial cells

What is factors that influence cast formation?

• Decrease pH

-Decrease output

• Increase solute concentration (increased S.G.)

• Increase protein

What are clue cells?

Squamous epithelial cells with ragged borders and stippling caused by colonization with bacteria

What are urine crystals (pictures, alkaline vs. acidic)?

Amorphous urates, uric acid, calcium oxalate, amorphous phosphates, triple phosphate, Ammonium biurate, Calcium phosphate, Calcium carbonate

Amorphous urates

-Normal crystal found in acid or neutral urine

• Irregular granules

-form pink precipitate at bottom of tube, dissolve by warming to 60 degrees C.

Uric acid

-Normal crystal found in acid or neutral urine

-Pleomorphic. 4-sided, 6-sided, star-shaped, rosettes, spears, plates. Colorless, red-brown, or yellow.

• Birefringent, polarizes light

Calcium oxalate

• Normal crystal found in neutral or acid urine

• Octahedral envelope form is most common. Also dumbbell and ovoid forms.

-Most common constituent of renal calculi.

Amorphous phosphates

-Normal crystal found in alkaline urine

-Irregular granules

-Form white precipitate at bottom of tube, dissolve with 2% acetic acid

Triple Phosphate

• Normal crystal found in alkaline urine

-"Coffin-lid" crystal

Ammonium biurate

• Normal crystal found in alkaline urine

-Yellow-brown "thorn apples" and spheres

• seen in old specimens

Calcium Phosphate

-Normal crystal found in alkaline urine

-needles, rosettes, "pointing finger"

• only needle form seen in alkaline urine

Calcium Carbonate

-Normal crystal found in alkaline urine

• colorless dumbbells or aggregates

What is Indications of cloudy unpreserved urine?

Bacterial growth and the precipitation of crystals and amorphous materials.

What is Glomerular Disorders?

Result from immunologic disorders throughout the body, including the kidney

Complement, neutrophils, lymphocytes, monocytes and cytokines are then attracted to the area, producing changes and damage to the membranes Changes to the glomerulus:

· Cellular proliferation

· Leukocyte infiltration- neutrophils or monocytes