ASCP: Urinalysis and Body Fluids Polansky Cards

2-hr postprandial urine collection is used to monitor what?

Diabetes mellitus monitoring

Needle inserted through abdomen into bladder

Suprapubic aspiration

The normal daily volume of urine produced is

600-2,000 mL (average 1,200-1,500mL)

Term: ↑ urine production

Diuresis

Term: Marked ↑ in urine flow

Polyuria

Polyuria:

Adult: >------ mL/day

Children: ------mL/kg/day

Adult: >2,500 mL/day

Children: 2.5-3 mL/kg/day

Term: Marked ↓ in urine flow

Oliguria

Oliguria:

Adult: <---- mL/day

Children: <----mL/kg/hr

Infants: <---mL/kg/hr

Adult: <400 mL/day

Children: <0.5 mL/kg/hr

Infants: <1 mL/kg/hr

Term: No urine production

Anuria

The color of urine: Normal

Yellow due to urochrome

The color of urine Dilute urine

Colorless, pale yellow

The color of urine Concentrated urine

Dark yellow, amber

The color of urine Bilirubin Amber

orange, yellow-green; yellow foam on shaking

The color of urine Urobilin Amber

orange; no yellow foam on shaking

The color of urine Homogentisic acid

Normal on voiding; brown or black on standing

The color of urine Melanin

Brown or black on standing

The color of urine Methemoglobin

Brown or black

The color of urine Myoglobin Red

brown on standing

The color of urine Blood/hemoglobin

Pink or red when fresh; brown on standing

The color of urine Porphyrin

Port-wine

The color of urine Drugs: medications: food

Green, blue, red, orange

The color of urine Pseudomonas infection

Green, blue-green

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

↑ Multiplication of bacteria, precipitation of amorphous crystals

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

↑ Conversion of urea to ammonia by bacteria

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

↓ Metabolism by bacteria

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

↓ Volatilization of acetone, breakdown of acetoacetate by bacteria

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

↓ Oxidation to biliverdin

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

↓ Oxidation to urobilin

Changes in Unpreserved Urine at Room Temperature >2 hr: WBCs/RBCs casts

↓ Lysis in dilute or alkaline urine

Normal pH of Urine

Random: 4.5-8.0

First Void: 5-6

Chemical Urinalysis by Reagent Strip: Principle: Double indicator system

pH

Chemical Urinalysis by Reagent Strip: Principle: Protein error of indicator

Protein

Chemical Urinalysis by Reagent Strip: Principle: Glucose oxidase/ peroxidase

Glucose

Chemical Urinalysis by Reagent Strip: Principle: Sodium nitroprusside rxn

Ketones

Chemical Urinalysis by Reagent Strip: Principle: Pseudoperoxidase activity of hgb

Blood

Chemical Urinalysis by Reagent Strip: Principle: Diazo reaction

Bilirubin

Chemical Urinalysis by Reagent Strip: Principle: Ehrlich's aldehyde rxn or diazo rxn

Urobilinogen

Chemical Urinalysis by Reagent Strip: Principle: Greiss reaction

Nitrite

Chemical Urinalysis by Reagent Strip: Principle: Leukocyte esterase rxn

Leukocyte esterase

Chemical Urinalysis by Reagent Strip: Principle: pKa change of polyelectrolyte

Specific gravity (SG)

improperly preserved specimen pH

pH 9

Most sensitive to acetoacetic acid.

Less sensitive to acetone. Doesn't

react with beta-hydroxybutyric acid.

Ketones

Urine:

Uniform color = ------

Speckled = -----

Uniform color = hgb or myoglobin.

Speckled = RBCs.

Normal renal threshold of glucose = ------ mg/dL

Normal renal threshold of glucose =

160-180 mg/dL.

POSSIBLE EFFECT: Urine Failure to mix specimen well

False-neg leukocyte, blood

Comments: WBCs, RBCs settle out.

Specific Sources of Error with Reagent Strip Testing:

pH

INCREASED OR FALSE POSITIVE:

Improperly preserved specimen

DECREASED OR FALSE NEGATIVE

acid runover from protein square

Specific Sources of Error with Reagent Strip Testing:

Protein

INCREASED OR FALSE POSITIVE:

Highly buffered alkaline urine, prolonged

dipping, contaminated container, ↑SG

DECREASED OR FALSE NEGATIVE:

Proteins other than albumin

Specific Sources of Error with Reagent Strip Testing:

Glucose

INCREASED OR FALSE POSITIVE:

Contamination with peroxide or bleach

DECREASED OR FALSE NEGATIVE:

Unpreserved specimen, ↑ascorbic acid, ↑SG, ↓temp.

Specific Sources of Error with Reagent Strip Testing:

Ketones

INCREASED OR FALSE POSITIVE:

Red pigments, dyes, some meds

DECREASED OR FALSE NEGATIVE:

Improper storage. Acetone is volatile.

Bacteria break down acetoacetic acid.

Specific Sources of Error with Reagent Strip Testing:

Blood

INCREASED OR FALSE POSITIVE:

Menstruation, oxidizing agents, bacterial

peroxidase

DECREASED OR FALSE NEGATIVE:

↑ascorbic acid, ↑nitrite, ↑SG (crenated RBCs), unmixed specimen.

Specific Sources of Error with Reagent Strip Testing:

Bilirubin

INCREASED OR FALSE POSITIVE:

Highly pigmented urine

DECREASED OR FALSE NEGATIVE:

Exposure to light, ↑ascorbic acid, ↑nitrite

Specific Sources of Error with Reagent Strip Testing:

Urobilinogen

INCREASED OR FALSE POSITIVE:

Highly pigmented urine

DECREASED OR FALSE NEGATIVE:

Improperly preserved specimen (oxidation to urobilin), formalin.

Specific Sources of Error with Reagent Strip Testing:

Nitrite

INCREASED OR FALSE POSITIVE:

Highly pigmented urine, improperly

preserved specimen (contaminating

bacteria produce nitrites)

DECREASED OR FALSE NEGATIVE:

Non-nitrate-reducing bacteria, inadequate time in bladder, reduction of nitrites to N2, ↓dietary nitrate, antibiotics, ↑ascorbic acid, ↑SG

Specific Sources of Error with Reagent Strip Testing:

Leukocyte esterase

INCREASED OR FALSE POSITIVE:

Highly pigmented urine, oxidizing agents, formalin, nitrofurantoin, vaginal discharge

DECREASED OR FALSE NEGATIVE:

↑glucose, ↑protein, ↑ascorbic acid, ↑SG; antibiotics; reading too soon

Specific Sources of Error with Reagent Strip Testing:

Specific gravity

INCREASED OR FALSE POSITIVE:

↑ protein

DECREASED OR FALSE NEGATIVE:

Alkaline urine. (Add 0.005 if pH is 6.5 or higher. Correction is made by automated readers.)

What test detect: Albumin in low concentration

Test: Microalbumin

What test detect: All proteins, including

Bence Jones proteins

Test: Sulfosalicylic acid (SSA)

What test detect: Reducing substances

Test: Clinitest

What test detect: Ketones

Test: Acetest

What test detect: Ictotest

Test: Bilirubin

Urine test method detects/Test what: Immunoassay on 24-hr urine or albumin-tocreatinine ratio (ACR) on random sample

Detects: Microalbumin

Urine test method detects/Test what: Acid precipitation

Detects: SSA

Urine test method detects/Test what: Copper reduction

Detects: Clinitest

Urine test method detects/Test what: Sodium nitroprusside reaction

Detects: Ketones & Acetest

Urine test method detects/Test what: Diazo reaction

Detects: Bilirubin & Ictotest

Acute glomerulonephritis is associated with what type of urine output?

Oliguria is associated with acute glomerulonephritis

Tamm-Horsfall protein is produced in the what?

Renal Tubules

Maltese crosses in the urine should make you think of what diagnosis?

Nephrotic Syndrome

Maltese cross as a contamination is what type of crystal?

Starch Crystals

Epithelial Cells in the Urine Sediment: Origin

Lower urethra, vagina

Squamous Epithelial Cells

Epithelial Cells in the Urine Sediment: Origin

Renal pelvis, ureters, bladder, upper urethra

Transitional Epithelial Cells

Epithelial Cells in the Urine Sediment: Origin

Renal tubular epithelial cell

Renal Tubules

Epithelial Cells in the Urine Sediment: Origin

Oval fat body

Renal Tubules

-Maltese Cross with polarized light

What is seen in the urine:

Tubular necrosis, toxins, viral infections, renal rejection

Renal Tubular epithelial cells and Oval fat bodies

What blood cell in the urine is seen with Cystitis, pyelonephritis, tumors, renal calculi.

WBC and Glitter Cells

Glitter cells are seen in ----- solution and ----- urine

Glitter cells are seen in hypotonic solutions and alkaline urine

Irregular Granules:

Form pink precipitate in bottom of tube. May

obscure significant sediment. Dissolve by

warming to 60ºC.

Amorphous Urates

Normal Crystals Found in Acid or Neutral Urine:

1.

2.

3.

Normal Crystals Found in Acid or Neutral Urine:

1. Amorphous Urates

2. Uric Acid Crystals

3. Calcium Oxalate

Normal crystals found in alkaline urine include:

1.

2.

3.

4.

5.

Normal crystals found in alkaline urine include:

1. Amorphous Phosphates

2. Triple Phosphates

3. Ammonium Biurate

4. Calcium Phosphates

5. Calcium Carbonate

"Coffin-lid" crystal

Triple Phosphate

Yellow-brown "thorn apples" & spheres

Ammonium biurate

-Seen in old specimen

Needles, rosettes, "pointing finger"

Calcium Phosphate

-Only form seen in alkaline urine-

Colorless dumbbells or aggregates

Calcium Carbonate

Abnormal Crystal: Seen in severe liver disease

Yellow, oily-looking spheres. Radial & concentric striations.

Leucine Crystals

-Often seen with tyrosine

Abnormal Crystal: Severe Liver Disease

Fine yellow needles in sheaves or rosettes.

Tyrosine Crystals

-Often seen with leucine

Abnormal Crystal: Cystinuria

Hexagonal (6-sided)

Cystine Crystals

-Must differentiate from uric acid. Doesn't polarize light. Confirm by cyanide-nitroprusside test

Abnormal Crystals: Nephrotic syndrome

-Flat plates. Notched out corners. "Stair-steps"

Cholesterol Crystals

-Birefringent

Abnormal Crystals: Liver disease

-Yellowish brown needles, plates, granules.

Bilirubin Crystals

-Chemical tests for bilirubin should

be pos.

What type of Cast?

Normal: 0-2/LPF.

↑ with stress, fever, trauma, exercise, renal disease

Hyaline Cast

Most common type. Least significant.

Tamm-Horsfall protein only.

Dissolve in alk urine. Same refractive index as urine; may be overlooked with bright light

What type of Cast?

Normal: 0-1/LPF.

↑ with stress, exercise, glomerulonephritis, pyelonephritis

Granular Cast

-From disintegration of cellular casts.

What type of Cast?

Acute glomerulonephritis, strenuous exercise.

RBC Cast

-IDs kidneys as a source of bleeding.

Most fragile cast.

Often in fragments.

What type of Cast?

Pyelonephritis.

WBC Cast

-IDs kidneys as site of infection-

What type of Cast?

Urinary stasis

Waxy Cast

-From degeneration of cellular & granular casts.

Unfavorable sign.

What type of Cast?

Nephrotic syndrome.

Fatty Cast

-Maltese crosses with polarized light if

lipid is cholesterol.

-Sudan III & Oil Red O stain triglycerides & neutral fats

What type of Cast?

Advanced renal disease

Broad Cast

-Formed in dilated distal tubules & collecting

ducts. "Renal failure casts."

Renal Disorder:

-Inflammation & damage to glomeruli

-Frequently follows untreated group A strep infection

Acute glomerulonephritis

Renal Disorder:

Increased glomerular permeability

-Hypoproteinemia, hyperlipidemia

Nephrotic Syndrome

Renal Disorder:

Kidney infection

Pyelonephritis

Renal Disorder:

Bladder infection

Cystitis

CSF Color:

slight pink, orange, or yellow due to oxyhemoglobin or bilirubin.

Seen with subarachnoidhemorrhage

Xanthochromia