MLS 1113 Exam 3

What does RTS stand for?

Reagent Test Strip

What is on the RTS chemical test?

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

What are tablet/reagent tests?

These are usually confirmatory tests

What are some of the tablet/reagent tests?

Ictotest, Clinitest, and SSA test.

What is the Ictotest for?

To confirm bilirubin

What is a Clinitest for?

It is a sugar test.

What is a SSA test for?

To confirm proteins

What are other methods used in chemical analysis?

Specific Gravity, Osmolality, and Solute concentration.

What is osmolality?

The concentration of solute particles expressed as a # of solutes per wight of solvent.

Why would osmolality be useful to a clinician?

Osmoality takes into consideration the way certain substances dissociate in solutions. Gives the ratio of solutes to urine produced. It is also used to see what the concentrating ability of the kidney, and monitors renal disease.

What are the two ways to see the osmolality?

The freezing point and the vapor pressure.

What does freezing point mean?

When a solute (particles) is dissolved in a solvent (water), the freezing point of that solution is lower than that of the solvent alone. As more solute is added, the freezing point decreases further. By precisely measuring the freezing point of the solution, the osmolality, or concentration, can be determined.

Lower freezing point = higher solutes, and higher osmo

What is the normal urine osmilality?

It should be 3 times normal serum osmiliality.

What does Specific gravity measure?

Measures the particles in the urine by density.

How is specific gravity measured?

With a refractometry

How does a refractometer work?

With refractive index, the way a sample bends light.

How do you correct a specific gravity by refractometry?

1.032 - [2(.004) + 3(.003)] = 1.015

What is a RTS?

A plastic strip with pads attached to it that contain chemicals and indicator substance.

What are these indicator called?

chromagens

What are the different reactions on the strips?

colorimetric, enzymatic, or catalytic.

What types of results come from the RTS?

Qualitative, quantitative, and semi quantitative

What are the quantitative results like?

They give positive and negative. ex. nitrite

What are the quantitative results like?

They give numbers/approximation ex. specific gravity

What are the semi quantitative results like?

They give estimates like 1+, 2+, 3+ and 4+

What is the purpose of quality controls for a urinalysis?

Run a positive and negative controls daily, record results, repeat if out of range only once, date bottles when received and when in use, and do a QC on new lot #'s.

The normal range for specific gravity are what?

1.005 -1.030

Pathology for specific gravity?

This is an indicator of hydration.

If someone has a high SG what will be noticed?

Concentrated urine, dehydration, x-ray contrast, and diabetes.

If someone has a low SG what will be noticed?

Dilute urine, renal failure - tubular necrosis, and diabetes insipidus - ADH problems.

What is the chemical reaction for SG?

The pad on the test strip has polyelectrolyte at an alkaline pH. The chromagen on the pad that changes color is the bromthymol blue.

What is the corresponding microscopic elements you might find with abnormal SG ranges?

Crystals, mucus, and casts.

Normal pH range?

4.5 - 8.0.

Pathology of pH?

Not usually that significant to one sickness/disease.

What is the chemical reaction for pH?

Methyl red acid and bromthymol blue alkaline.

Normal range for blood in urine?

Negative.

What are the 3 types of blood found in urine?

Hematuria, hemoglobinuria, and myoglobin.

What is hematuria?

RBC's in the urine that are intact, the urine will appear red and cloudy.

What is hemoglobinuria?

Lysed RBC's in urine, the urine will appear red and clear.

What is myoglobin?

Muscle hemoglobin urine will appear more brown in color.

What are the pathogenic causes of hematuria?

Kidney dysfunction, kidney damage, kidney stones, UTI, and trauma.

Are there any non pathogenic that may cause hematuria?

Yes, menstruation.

What are the pathogenic causes of hemoglobinuria?

Intravascular hemolysis, hemolytic anemia/ sickle cell, blood transfusion issue, and extreme trauma.

What are the pathogenic causes of myoglobin?

Muscle trauma, seizures, muscle diseases, electric shock, alcoholism.

How do we tell the difference between the three different bloods?

The color and the clarity.

What is the active chemical on the RTS pad for blood?

Tetramethylbenzidine

What would cause a false negative for blood?

Protein, high S.G., increased nitrite.

What interfering substance may cause a false negative?

Ascorbic acid/ vit C

What are the normal ranges for leukocyle esterase?

Negative

What is the significance of WBC's in urine?

This means there is infection or inflammation.

What does the RTS pad contain to see WBS's?

Ester and diazo salt + aromatic compound = color change.

What are some interfering substances that can produce a WBC false positive?

Vaginal discharge, medications, food byproducts, and UTI medications.

What would you see in a microscope if the chem test was positive for WBC?

You would see WBC's and WBC casts.

What is the normal range of nitrite/bacteria?

Negative

What are the chemicals on the RTS pad that detect nitrite/bacteria?

The pad contains an amine and an anomatic compound. Then it turns in to diazo salt.

The nitrite changes the amine into a diazo salt

How long does it take for nitrate to convert into nitrite?

At least 4 hours.

What is the significance of bacteria in urine?

This means that the person has an infection.

What would you see in a microscope if there was bacteria in the chem test?

You would see the bacteria moving around.

What would cause a false negative for nitrite?

Ascorbic acid and colored substances.

What is the normal range for protein in the urine?

There should never be any protein in urine.

What is the significance of protein in the urine?

Usually the first indicator of a renal disease. Can be a filtration, reabsorption, or pre- renal conditions.

Urine with large amounts of protein my appear?

Foamy

What is the chem reaction for protein?

Tetrabromphenol blue indicator.

What would you see in a microscope if the chem test is positive?

You would see casts, renal and transitional epi cells, and RBC's.

Normal range for glucose?

Negative

Whats the significance of glucose in the urine?

Diabetes mellitus pancreas problems more common, and reabsorption problems less common.

What is the chemical reaction for glucose?

Double sequential enzyme reaction test.

What my cause a false negative on the RTS.

Strong oxidizers bleach, peroxides bacteria, temperature, low S.G., and ketones.

What is a clinitest?

This is a test to see if or what kinds of sugars are in the urine.

When detected on the RTS, this parameter is known as the first sign of renal dysfunction?

Protein

TRUE OR FALSE Excess protein in the blood can lead to proteinruria.

TRUE

The presence of protein on the RTS could explain the presence of what under the microscope?

Mucous and casts.

What parameter on the RTS uses a double sequential enzyme reaction?

Glucose

What is the normal range for ketones?

Negative

What are ketones?

They happen when the metabolism of fat is used as a primary energy source, then ketones are made.

What are the three reasons your body uses fat instead of carbs?

Diabetes, low carb diet, and diarrhea/vomiting.

What are the three types of ketone bodies we see in urine?

78% betahybroxy butric acid

20% Acetoacetic acid

2% acetone

What is the only ketone body detected with a RTS?

Acetoacetic acid

What is the chem reaction on the RTS for ketones?

Na Nitroprusside.

What will cause a false negative for ketones?

High S.G., some preservatives, and improper storage.

What is the normal range for bilirubin on a RTS?

Negative

What is the chem reaction on the test strip for bilirubin?

The RTS pad is kept at an acid pH and has diazo salt. Diazo + aromatic compound = color change.

The presence of bilirubin on the RTS are conformed by what?

Ictotest.

What is the normal range for urobilinogen on a RTS?

0.2mg/dl

What is the chemical on the RTS to detect urobilinogen?

P-dimethylaminobenzaldenyde / ehrlichs reagent.

What is bilirubin?

It is a normal breakdown product of red blood cells when they die.

What is the pathology of bilirubin and urobilinogen?

There are three for disrupted bilirubin and urobilinogen. Pre-hepatic before liver

Hepatic in the liver

Post-hepatic after liver

What are the pre-hepatic pathology?

Hemolytic anemia, sickle cell, transfusion reaction, and sever trauma.

What are the hepatic pathology?

Hepatitis, Neonatal jaundice liver problems -not conjugating and cant transport.

What are the post-hepatic pathology?

Obstruction/tumor, white or gray poop.

What is Glomerulonephritis?

This is a filtration problem were the bodies own immune system over reacts the antigens get stuck in the basement membrane. This causes the glomerues to swell up.

What are Glomerulonephritis symptoms?

Fever, malaise, nausea, oliguria, hypertension,and edema.

What would you see in a microscope urinalyses of Glomerulonephritis?

High RBC's, renal epi's, RBC casts, and WBC's.

What would be on the chemical test if a person has Glomerulonephritis?

Blood, Protein, and leukocyte estease.

What is Nephrotic syndrome?

When there is a change in glumerular permeability, along with increased permeability, there is an increase in lipid production.

What are the symptoms of Nephrotic syndrome?

Edema, high lipids, blood pressure changes.

What would you see in a microscope urinalyses of Nephrotic syndrome?

Fatty casts, oval fat bodies, renal epi's casts, and fat cells.

What would be on the chemical test if a person has Nephrotic syndrome?

Proteins up and urine is foamy, and blood.

What are the glomerular diseases?

Glomerulonephritis and Nephrotic syndrome

What are the tubular diseases?

Acute tubular necrosis, Cystinuria, and Renal tubular acidosis.

What is acute tubular necrosis?

It is destruction to the renal tubular epi cells. It can be ischemic: restriction of blood, or toxic: hemogbin or myoglobin.