Lab med urine analysis

dilute urine

straw

amber urine

concentrated

Dark red urine

Renal bleeding

bright red urine

bladder bleeding

aromatic odor

acids

sweet, strong acetone

DKA patients

Foul smelling

infection

Infection would be associated with what kind of pH most likely

Alkaline**

Dehydration would be associated with what kind of pH most likely

Acidic

Citrus/veggies would _______ the pH

increase (alkaline)

What med would make more alkaline pH?

Streptomycin neomycin*

The most important indicator of renal disease

Protein*

Normal protein

0-8

If significant protein is found in the urine, what is your next step?

Re check with a 24 hour protein catch**

Should their be glucose in urine

No

If glucose is seen in the urine, this indicates

Diabetes

How must you confirm the diagnosis of diabetes?

Fasting glucose

HgA1C

Glucose tolerance

When does blood glucose start to spill over into the urine?

> 180

HgA1C indicates

Long standing*

What is the normal specific gravity?

1.005 - 1.030

What is the only thing that decreases specific gravity (on the notes)

Overhydration (anything related to dehydration would increase it)

When you get a Leukocyte esterase, or a WBC esterase, what are you looking for?

> 100,000 colonies

> 100, 000 colonies most commonly indicates a

UTI

After you get a positve WBC esterase, what is your next step?

Dipstick

What shade of dipstick will give you a positive result

Purple

What are the three ketones?

acetoacetate, beta-hydroxybutyrate, acetone

What are ketones important in evaluating for

ketoacidosis

What can cause ketoacidosis

Alcohol

Starvation

High protein

Ispropanol ingestion

Positve ketones in what 2 conditions

DM

Hyperglycemia

(basically same thing)

A liver function test that is not very specific, but tells you you need other liver tests (typically the first test ordered related to liver function)

Bilirubin

Urobilogen is increased in

Liver Disease**

Urobilinogen is decreased in

Poor function of the liver* (diff than liver disease!!)

If your bilirubin/urobilogen comes back positve, what is your next step?

Order LFTs, these are not specific enough to make any diagnosis*

What can crystals in the urine indicate?*

Renal stone

Uric acid levels high

Calcium oxalate (mc)

Sludge cells build up in the renal tubules due to an increased concentration and congested flow

Casts (these can stay in the shape of the tube)

Casts are usually associated with

proteinuria and stasis in the renal tubules

Mostly benign cast that indicates proteinuria

Hyaline Cast

Cast that indicates hard physical activity (marathon runner), but could also indicate renal disease

Granular

gRANular = Ran = think marathon

When would you see a fatty cast?

DM/obesity

nephrotic syndrome

renal disease

Further degeneration of granular casts seen with decreased urine flow

Waxy cast (think it gets so waxy so it blocks flow)

Waxy cast can be seen specifically with

Chronic renal disease/failure

FM

Maligant HTN glomerulonephriits

What is normal - a low or high epithelial cast?

Low

A high epithelial cast could indicate?

Post strep GN *

Where are epithelial casts shed from?

Bladder, tumor, polyps

Presence of 5 or more WBC/RBC casts, what should you consider?

UTI*

WBC casts specifically are seen with

infection of the kidney (pyelonephritis, inflammatory nephritis) **

RBC cast less than ___ is normal

2

What is a common group to have high RBC casts?

Sickle cell anemia**

What else can cause high RBC casts?

any trauma to the body (stones, etc.)

Urine pregancy test measures

HCG

HCG can be ____ or ____

Qualitative or Quantitative

What is the MC panel to order

Comprehensive Metabolic panel

comprehensive metabolic panel

Basic metabolic panel PLUS albumin, alkaline phosphate, ALT, AST, total bilirubin, and total protein

Basic metabolic panel

Electrolyte panel + BUN, Creatinine, Glucose

Normal Na value

135-145

What is the critical value for Sodium?

<120 or >160

what should you check Na with

specific gravity

IV fluids would ____ the Na

increase (they typically have Na in them)

Diabetes inspidus would ___ the Na

increase

Any type of fluid loss would ___ Na

Increase

Osmotic dieuresis would ____ Na

increase

any type of fluid gain would ____ Na

decrease

(Increased water intake, CHF, inappropriate ADH)

What other non-obvious things decrease the Na?

Hyperglycemia

Chronic renal insufficency

What is the normal K?

3.5-5.5

What is the critical K?

< 2.5 or > 7.5

What would increase the K

Hypoaldosteronism, ACE inhibitor, K sparing dieuretics, Renal failure(think ab no aldosterone, nothing to remove the K, and K SPARING means it leaves the K in the body)

Hemolysis & Addison's Disease

What will decrease the K?

Hyperaldosterone, dieuretics, GI disorder (now your flushing out alot of K!!)

Cushings, insulin administration, ascites (fluid dilutes)

What is the Cl range

98-106

Critical Cl range

< 80 or > 115

Increased Cl

Dehydrated, renal tubular acidosis, cushings

Decreased Cl

Overhydrated, SIADH, CHF, Addison's

Best way to test CO2

ABG

Normal Co2

23 - 30

Critical CO2

< 6

Co2 is an indirect measurement of

HCO3 (think about it as bicarb!)

Increased CO2

COPD, dehydrated, vomitting, metabolic alkalosis

Decreased CO2

Renal failure (kidneys produce bicarb) , DKA, Metabolic acidosis, (ACIDS because "CO2" aka BICARB is low, so more acidic), Shock (why you give bicarb)

Why don't we keep gastric suction in the mouth

Increase "CO2" (increase bicarb) ... because your actually sucking out all of the CO2 making them alkalitic

BUN normal

10 - 20

BUN is decreased in 4 things (everything else is increased)

Liver failure, Overhydration, Pregancy, Nephrotic syndrome

-Nephrotic syndrome & Liver failure make sense bc theres a malfunction...think of overhydration and preg as diluting ..?

(if its not one of these 4 its increased)

Normal creatinine

0.5 - 1.2

What is important to know about the creatinine?

a 1 point change will affect the ability to filter the GFR by 50% **

Most sensative for evaluating kidney function

Creatinine

Only thing creatine is decreased in

Decreased muscle mass (makes sense bc people take creatine to increase there muscle mass, so if its low muscle mass is decreased)

-everything else increases (that we learned)

Normal calcium

9 - 10.5

Critical Calcium

< 6 or > 13

Hyperparathyroid causes?

Hypercalcemia (hyper goes with hyper)

Milk alkali does what

Increases Ca**

Rickets & Vitamin D would do what to Ca?

Decrease

Bone mets & Pagets disease do what to Ca

increase it **

Malababdorption & Pancreatitis do what to Ca?

Decrease

Renal failure ___ Ca

Decreases

Congugated bilirubin is water ____, unconjugated bilirubin is water _____

Soluble (see in stool and urine)

Insoluble (overload causes jaundice)

Normal total bilirubin

0.3 to 1.9

Normal direct bilirubin

0-0.3

Pt has RUQ pain after a fatty meal... what test are we ordering?**

Direct bilirubin *** --> this indicates that the biliary ducts are obstructed******

What is more specific to liver pathology, ALT or AST?**

ALT (L for Liver = better)

Injury to the liver results in release of ____ to the blood

ALT

Alkaline phosphatase normal

30-110

What should you order when concerned about cancer?

Alkaline phosphate*