Patient Assessment II: GU Labs and dx

Major nitrogen containing product of protein metabolism

Urea

pontaneous breakdown product of muscle energy metabolism

Creatinine

Measures the rate at which kidneys clear creatinine from the blood

Creatinine clearance

ate in mL/min that substances (ex: creatinine) are filtered through the glomeruli; Reflects number of functioning nephrons

Glomerular Filtration Rate (GFR)

presence of albumin in the urine

Albuminuria

low-grade, increase in urine albumin excretion

• Useful in monitoring renal status of individuals prone to renal impairment from other diseases (Ex: Hypertension, Diabetes, etc.)

Microalbuminuria

Blood in the urine

Hematuria

presence of pus in the urine

Pyuria

presence of bile in the urine (Coca-Cola Appearance)

Choluria

Lack of urine output (<50 mL/day)

Anuria

Decreased urine output (<400 mL/day)

Oliguria

protein aggregates, outlined in the shape of renal tubules excreted into the urine (Matrix is the Tamm-Horsfall Protein)

Casts

too much nitrogen, creatinine and other waste products in the

blood

Azotemia

Inflammation of the kidney leading to problems filtering waste from the blood

Nephritis

Nephritis accompanied by inflammation of the capillary loops in the glomeruli of the kidney damaging the filtration (occurs in acute, subacute, & chronic forms

Glomerulonephritis

Disease involving increased glomerular permeability leading to too much protein in the urine (Hyperlipidemia, Hypoalbuminemia, & Massive Proteinuria)

Nephrotic Syndrome

Hematuria, Elevated BP, decreased urine output, and edema

Nephritic Syndrome

Cell's in Bowman's Capsule that wrap around the Capillaries

Podocytes

In nephrotic syndrome _____ dissappear due to destruction

Podocytes

______is the Most Common Cause of Nephrotic Syndrome in the USA

Diabetes

What sympt will you see in nephrotic syndrome

Proteinuria

edema

fatigue

Immune Complex that Attacks the Capillaries

Nephritic Syndrome

What sympt will be seen in Nephritic Syndrome

Hematuria

low GFR

oliguria

MC cause of Glomerulonephritis worldwide

IgA nephropathy

test that is Great for monitoring established disease

UA

3 Components of the Complete Urinalysis

-Macroscopic Examination (Gross Assessment)

• Urine Dipstick Analysis (aka Rapid U/A)

• Microscopic Evaluation (examination of urine sediment)

Indications to perform UA?

-Suspected kidney disease

-Reduction in GFR

-unexplained albuminuria

What is preferred for UA that is most concentrated?

First morning collection (particularly for protein and serum glucose)

What type of catch is preferred for UA?

Clean Catch:

1. collected into clean/dry container

2. pt asked to clean external genitalia with antiseptic wipe

3. 1st portion of urine voided in toilet

4. provide midstream specimen

5. indwelling catheters --> sample should be obtained directly from tubing

UA needs to be tested within ___ hrs of collection but ___ hrs is ideal

2

1

What can cause red urine?

foods --> beets

kidney stones

UTI

what can cause orange urine?

meds --> rifampin and pyridium

what can cause green urine ?

UTI

dyes --> methylene blue

what can cause blue urine?

methylene blue

tryptophan malabsorption --> blue diaper syndrome

what can cause brown urine?

gilberts syndrome (bilirubin present)

what can cause white urine?

pyuria

what is the rapid semiquantitative assessment urinary characteristics

Urine Dipstick Analysis (U/A)

may be the first signal of Chronic Kidney Dz

Microalbumin

Large amounts of proteinuria what should you think about?

Nephrotic Syndromes and Advanced Kidney Dz

Bence-Jones Proteins in urine are associated with what?

Multiple myeloma

What is normal proteinuria?

NO protein

Protein in the Urine is the Single Most Important Indication of ____

Renal Disease

Often benign and Self-Limited d/t CHF, Fever, Strenuous Exercise, Seizure Disorder, Orthostatic Proteinuria

Transient proteinuria

When will you have persistently postivie proteinuira?

Nephrotic Syndrome, Diabetic Nephropathy, Tubulointerstitial Nephritis, obstruction

What is the average pH of urine

around 6

When is pH most often used clinically in pts

metabolic acidosis

Acdidic urine (pH<7) may indicate

DKA

Alkalotic urine (pH > 7) may indicate

Proteus

pseudomonas

Acidic pH w/ Calculi may indicate changes need to be made with...

Uric Acid, and Calcium Oxalate

Alkalotic pH w/ Calculi may inidcate changes need to be made with...

Calcium Carbonate

Measurement of urine concentration

Compares the amount of solutes (density) in urine compared to pure water

Urine specific gravity

____ is a more exact measurement

Osmolality

When will specific gravity of urine be increased?

Dehydration

When will specific gravity of urine be decreased?

impaired Urinary Concentrating Ability: diabetes insipidus

Early Sign of Hepatocellular Destruction or Biliary Obstruction

Bilirubin in urine

When is Bili increased?

Liver diseases- gallstones

Formed by bacterial conversion of conjugated bilirubin in the intestine

Urobilinogen

Urobilinogen is One of the most _____ tests to determine impaired liver function

sensitive

Urobilinogen is One of the earliest signs of liver disease and ___ disorders

hemolytic

WHen is urobilinogen increased

Hemolytic anemia

malaria

hepatitis

cirrhosis

When is urobilinogen decreasd?

cholelithiasis

obstructive biliary dz

If postiive blood in the urine what is that a sign of

Hematuria

Hemoglobinuria

Presence of RBCs on Urine Dipstick NEEDS to be verified____

Microscopically

If dipstick (+) for blood, but not seen on microscopic exam

hemoglobinuria

If dipstick (+) for blood, and RBCs seen on microscopic exam

Hematuria

what can cause hematuria

UTI

Tumors

kidney stones

glomerulonephritis

trauma

anticoagulants

what can cause hemoglobinuria

transfussion rxns

malaria

hemolytic disorder

If glucose increased in urine what may we suspect

diabetes mellitus (primary)

endocrine disorders (cushing's, thyrotoxicosis)

If ketones in urine increased what would we suspect

• Uncontrolled Diabetes Mellitus

• DKA

• Starvation/ Fasting/ Anorexia

low carb diet

Positive leukocyte esterase in urine

Pyuria

What do we suspect with postivie Leukocyte esterase

UTI or pyelonephritis

All (+) leukocyte esterase results should be examined microscopically for____ and ____

WBCs and Bacteria

if you see nitrates in urine, what should you think of?

bacterial infection

If postive bacteria with nitrite what do you need to get

urine culture

What does urine sediment technique detect (microscopic urinalysis)

• WBC

• RBC

• Bacteria

• Epithelial Cells (skin contamination)

• Casts

• Crystal

When to Perform a Microscopic U/A

AKI

+ urine dipstick

CKD

Solid forms of a particular dissolved substance in the urine

Crystals

What has a predisposition to form certain kidney stones

Crystals

Most common crystal and envelope shaped

Calcium oxalate

Hexagonal shaped crystal

Cystine

Coffin shaped crystal that forms when urine is alkaline and can be present in UTIs

struvite

Rhomboid shape crystal what happens when urine too acidic and is present in gout

uric acid

Shape of the Cast represents a ____ of the renal tubule from where they arise

mold

What cast only has Tamm- Horsfall Mucoprotein is clear and colorless and associated with all reanl diseases

Hyaline casts

What casts indicate parenchymal infection and is most common in pyelonephritis

White blood cell casts

What casts indicate hemorrhage in nephron and is assocaited with acute glomerulonephritis?

Red cell casts

What casts are muddy brown and associated with acute tubular necrosis (ATN)

Granular casts

What casts are waxy and granular and associated with severe renal failure

Waxy casts

What casts have an oval fat body and have a maltese cross appearance. Most associated with nephrotic syndrome

Fatty casts

Test that assesses for Urinary Tract Infections or Pyelonephritis by revealing if Bacteria is present in the Urine

Urine culture

What time of day is preferred for urine culture

early morning

What is required before abx therapy begins

clean catch specimen

Bacterial Count ____ colonies/mL on urine culture indicate infection

>100,000

Bacterial Count ____ colonies/mL on urine culture in symptomatic, immunosuppressed or antibiotic treated patients indicate infection

> 10,000

Mixed Bacterial count of <100,000 CFU/mL suggests _____

contamination

Growth of any bacteria from samples obtained by straight ____ or _____ is clinically significant

catheterization

suprapubic aspiration

Most common STI

Chlamydia

How fast do you get results for PCR STI testing

30 min

Specimen of Choice for STI testing in Males

First Void Urine

Specimen choice for STI testing in females

vaginal swab