Urinalysis and Body Fluids MLS Review- | Quizlet

Urine Specimens- Random

use: routine urinalysis (UA)

collection: anytime

other: not ideal since urine may be dilute or contaminated

Urine Specimens- First am

use: Routine UA

collection: upon awakening

other: best for screening- most concentrated

Urine Specimens- 2 hr postprandial

use: Diabetes mellitus monitoring

collection: 2hr after eating

other: best for detecting glycosuria

Urine Specimens- 24-hr

use: Quantitative chemistry tests

collection: Discard 1st void on day 1 & note time.

Collect all urine for next 24 hr, including first void at same time on day 2

other: Improper collection is common source of error. Refrigerate or keep on ice. Preservatives required for some tests.

Urine Specimens- Clean Catch

use: routine, culture

collection: Cleanse external genitalia & collect midstream in sterile cup

other: less contamination. do culture before UA

Urine Specimens- Catheterized

use: culture

collection: catheter inserted into urethra

other: avoids contamination

Urine Specimens- Suprapubic aspiration

Use: culture

collection: needle inserted through abdomen into bladder

other: avoids contamination

Normal Daily Urine Volume

600ml - 2000ml (average 1,200-1,500mL)

Normal Day to Night ratio (urine)

2:1-3:1

exocrine function of kidney

elimination of metabolic waste products

Diuresis

increase urine production

Polyuria

excessive production of urine

Adult: >2,500mL daily

Children: 2.5-3mL/kg/day

Oliguria

Decreased urine output

Adult: <400mL/day

Children: <0.5mL/kg/hr

Infants: <1mL/kg/hr

Anuria

no urine production

Normal Urine color

yellow due to urochrome

Dilute urine color

colorless, pale yellow

Concentrated Urine color

Dark yellow, amber

Bilirubin urine color

Amber, orange, yellow-green; yellow foam on shaking

Urobilin Urine Color

Amber, orange; no yellow foam on shaking

Homogentisic acid

Normal on voiding; brown or black on standing

Myoglobin

Red; brown on standing

Blood/hemoglobin

pink or red when fresh; brown on standing

Porphyrin

port-wine stains

Drug medications, food

green, blue, red, orange

Pseudomonas infection (urine color)

green, blue-green

Changes in Unpreserved Urine at Room Temperature >2 hr: turbidity

increases due to multiplication of bacteria, precipitation of amorphous crystals

Changes in Unpreserved Urine at Room Temperature >2 hr: pH

increases due to the conversion of urea to ammonia by bacteria

Changes in Unpreserved Urine at Room Temperature >2 hr: Glucose

decreases due to the metabolism by bacteria

Changes in Unpreserved Urine at Room Temperature >2 hr: ketones

decreases due to volatilization of acetone, breakdown of acetoacetate by bacteria

Changes in Unpreserved Urine at Room Temperature >2 hr: Bilirubin

decreases due to the oxidation of biliverdin

Changes in Unpreserved Urine at Room Temperature >2 hr: Urobilinogen

decrease due to oxidation of urobilin

Changes in Unpreserved Urine at Room Temperature >2 hr: WBCs, RBCS, Casts

decreases due to lysis in dilute or alkaline urine

Chemical Urinalysis by Reagent Strip: pH

(normal, principle and significance)

normal range: 4.5-8

principle: double indicator system

Significance: acid-base balance, management of urinary tract infection (UTI)/renal calculi

protein/meat diet creates what type of pH

acidic pH

vegetarian diet create what type of pH

alkaline

pH 9 explains what

improperly preserved specimen

Chemical Urinalysis by Reagent Strip: Protein (normal, principal, significance)

normal range: negative-trace

principle: protein error of indicator

significance: possible renal disease (Kidney Disease); nephrotic syndrome

which protein is most sensitive to the reagent strip

albumin

Chemical Urinalysis by Reagent Strip: Glucose (normal, principle, significance)

normal range: negative

principle: Double sequential enzyme

significance: possible diabetes mellitus

Chemical Urinalysis by Reagent Strip: Ketones (normal, principle, significance)

normal: negative

principle: sodium nitroprusside rxn

significance: increase fat metabolism (uncontrolled diabetes mellitus, vomiting, starvation, low carb diet, strenuous exercise)

Ketones reagent strip is most sensitive to

acetoacetic acid

Ketones reagent strip is less sensitive to

acetone

ketones reagent strip doesn't react with

beta-hydoxybutyric acid

Chemical Urinalysis by Reagent Strip: Blood (normal, principle, significance)

normal: negative

principle: Pseudoperoxidase activity of hgb

significance: Hematuria, hemoglobinuria, myoglobinuria

Chemical Urinalysis by Reagent Strip: Bilirubin (normal, principle, significance)

normal: negative

principle: Diazo reaction

significance: Liver disease, biliary obstruction

what is the only type of bilirubin excreted in the urine

only conjugated bilirubin

Chemical Urinalysis by Reagent Strip: Urobilinogen (normal, principle, significance)

normal: 0.2-1

principle: Ehrlich's aldehyde rxn or diazo rxn

significance: Liver disease, hemolytic disorders

Chemical Urinalysis by Reagent Strip: Nitrite (normal, principle, significance)

normal: negative

principle: Greiss reaction

significance: UTI

some bacteria reduce nitrates to

nitrites (1st am specimen best)

Chemical Urinalysis by Reagent Strip: Leukocyte estrase (normal, principle, significance)

normal: negtaive

principle: Leukocyte esterase rxn

significance: UTI

Chemical Urinalysis by Reagent Strip: Specific Gravity (normal, principle, significance)

normal: Random specimen: 1.003-1.030

principle: pKa change of polyelectrolyte

significance: Indication of kidney's concentrating ability & state of hydration. increase in diabetes mellitus due to glucose. decrease in diabetes insipidus due to decrease ADH

Increase/False Positive w/ pH

improperly preserved specimen

Decrease/false negative w/ pH

acid runover from protein square

increase/false positive w/ protein

highly buffered alkaline urine, prolonged dippin, contaminated container, increased SG

decrease/false negative w/ protein

proteins other than albumin

increase/false positives w/ glucose

contrition w/ peroxide or bleach

decrease/false negative w/ glucose

unpreserved specimen

increase/false positive w/ ketones

red pigments, dyes and some meds

decrease/false negative w/ ketones

improper storage. Acetone is volatile. Bacteria break down acetoacetic acid

What will cause an increased/false positive w/ blood?

Menstruation, oxidizing agens, bacterial peroxidase, ascorbic acid

decreased/false negative w/ blood

unmixed specimen

what will cause an increased/false positive with Bilirubin?

highly pigmented urine

decreased/false negative w/ bilirubin

exposure to light.

increased/false positive w/ urobilinogen

highly pigmented urine

decreased/false negative w/ urobilinogen

improperly preserved specimen

what will casue increased/false positive with nitrite?

Highly pigmented urine, improperly preserved specimen (contaminating bacteria produce nitrites)

decreased/false negative w/ nitrite

non-nitrate reducing bacteria

what will cause an increased/false positive with leukocyte esterase?

Highly pigmented urine, vaginal discharge

decreased/false negative w/ leukocyte esterase

increase glucose, protein, ascorbic acid and SG; antibiotics; reading too soon

increased/false positive w/ SG

increased SG

decreased/false negative w/ SG

Alkaline urine

Microalbumin test

detects albumin in low concentrations (not detected by most urine dipsticks- which is why its done on chemistry instrument)

Sulfosalicylic acid (SSA) test

detects all proteins, including Bence Jones proteins

Bence Jone Proteins

are rarely found in urine. If they are, it is usually associated with multiple myeloma. An abnormal result may also be due to: An abnormal buildup of proteins in tissues and organs (amyloidosis)

Clinitest

detects reducing substances (method: copper reduction)

Acetest

detects ketones (method: Sodium nitroprusside reaction)

Ictotest

detects bilirubin (diazo reaction)

Squamous epithelial cells (not clinically significant)

increased numbers usually seen in urine from females. May obscure RBCs & WBCs. Reduced by collecting midstream clean-catch specimen.

description: 40-50 μm. Flat. Prominent round nucleus.

origin: lower urethra, vagina

Transitional epithelial cell

May form clumps

description: 20-30μm. Spherical, pear-shaped, or polyhedral. Round central nucleus

origin: Renal pelvis, ureters, bladder, upper urethra

Renal tubular epithelial cells

Slightly larger than a WBC (12 μm).

Round. Eccentric round nucleus

significance: Tubular necrosis, toxins, viral infections, renal rejection

differentiate WBCs from renal tubular epithelial cells by

Add 2% acetic acid to visualize nucleus & differentiate from WBC

Oval Body Fat (located in renal tubules)

Renal tubular epithelial cell containing fat

droplets.

significance: Tubular necrosis, toxins, viral infections, renal rejection

Oval Body Fat polarized

Maltese crosses with polarized light

WBC in urine

granular appearance

origin: Kidney, bladder, or urethra

clinical significance: Cystitis, pyelonephritis, tumors, renal calculi.

clumps of WBCs could indicate (normal range)

0-8/HPF; clumps could indicate acute infection

Glitter cells

WBC with Brownian movement of granules. Stain faintly or not at all.

origin: Kidney, bladder, or urethra

glitter cells is seen in

hypotonic urine

Red Blood Cells in urine

Biconcave disk, about 7 μm. Smooth. Non-nucleated.

significance: Infection, trauma, tumors, renal calculi. Dysmorphic RBCs indicate glomerular

bleeding.

blood in hypotonic/hypertonic urine + normal range

Normal: 0-3/HPF. Crenate in hypertonic urine. Lyse in hypotonic urine & with 2% acetic acid.

crenated RBCs in urine

Amorphous urates (normal crystals)

found in acidic urine; irregular granules;

Form pink precipitate in bottom of tube. May obscure significant sediment. Dissolve by

warming to 60oC.

Uric Acid (normal crystal)

found in acidic urine: Pleomorphic. 4-sided, 6-sided, star-shaped, rosettes, spears, plates. Colorless, red-brown, or yellow.

Calcium oxalate (normal crystal)

occasionally found in slight alkaline urine; Octahedral (8-sided) envelope form is most common. Also dumbbell & ovoid forms. (stems from oxalate-rich foods)

Amorphous phosphates (normal crystal)

found in alkaline urine; irregular granules

Form white precipitate in bottom of tube. Dissolve with 2% acetic acid.

triple phosphate (normal crystal)

colorless prisms resembling "coffin lids" in alkaline urine

Ammonium biurate crystals (normal crystal)

-Yellow brown "thorny apples"

-will convert to uric acid when acetic acid is added

-Alkaline pH

-Old specimen

calcium phosphate (Normal)

Needles, rosettes, "pointing finger"; Only needle form seen in alkaline urine.

calcium carbonate (normal crystals)

found in alkaline urine; Colorless dumbbells or aggregates

Leucine crystals in urine (abnormal crystals)

Fine yellow needles in sheaves or rosettes; seen in severe liver disease

often seen w/ tyrosine

Tyrosine crystals (abnormal crystals)

Fine yellow needles in sheaves

or rosettes; Severe liver disease

Often seen with leucine.