clin chem mt1 urinalysis

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1.

18 years old screening

includes

*pap smears on all female

patients
every year after*

2.

20 years old screening

includes

cholesterol on all patients

every 5 years after

3.

45 years old screening

includes

blood glucose on all patients

every 3 years after

4.

50 years old screening

includes

guiac test (occult blood in stool) in

all patients
every 4 years after
PSA level on all male patients
(prosthetic specific antigen)
every year after until 80 yrs old
colonoscopy on all patients
every 10 years until 80 years old

5.

78% of ketone bodies are

what?

beta #2

6.

anuria & its causes

<100mL/day (no urine)

severe hypotension
complete bladder obstruction
early stages acute glomerular
nephritis
tubular/cortical necrosis

7.

are there sympathetic

fibers in the kidney?

yes! all of them

8.

are urinary cultures in a

normal urinalysis?

no - have to order special

have to tell lab when ordering
what you think the issue is

9.

bacterial casts

12.

13.

calcium oxide crystals

calculus formation
-foods such as spinach and
rhubarb
-excessive vit C intake
11.

calcium phosphate
cystals

urine on alkaline side, long

slender crystals
cystitis
benign prostitic hypertrophy

crenated cells
suggest what?

shrunken RBCs

exposure to very cold environment

pain
hemmorrhage
emotions
exercise

14.

crystal casts

metabolic disorder
stone formation (calculi)

15.

crystals are the ____

important and the
____ apparent

least
most
-can be seen in normal patients

16.

crystals - uric acid

most common
slightly acidic
many morphologies
present in gouty arthritis

17.

cupric sulfate
(CuSO4 + urine +
heat)

copper reduction test

will be reduced to Cu2O (cuprous
oxide) in presence of sugar (but doesn't
say what type of sugar)
(color change shows concentration of
sugar)

18.

diaoctophyma
renale

giant kidney worm eggs infected fish

(fish tape worm)

19.

does the
sympathetic
nervous system
have an effect in
urinalysis?

no

20.

eGFR <15

renal failure

21.

eGFR 15-29

severe rena damage

22.

eGFR 30-59

moderate renal damage

23.

eGFR 60

good renal function, normal, refers to

1500mL/day

24.

elderly testing
includes

thyroid pannel - 65 yrs

hard to see

pH >7.0
kidney stones

theoretically (has to be strong for effect)

hypertonic urine w/ high specific

gravity and a concentrated urine due
to dehydration, fever, diabetes mellitus,
or glomerular nephritis

pyleonephritis
10.

can the
sympathetic
nervous system be
stimulated
(urinalysis)?

iron level tests

25.

epithelial casts
suggests what?

tubular injury
nephrotic syndrome
glomerular nephritis

26.

fatty casts

missing a galactosidase A
enzyme (fairy's dz)
nephrotic syndrome

27.

28.

functional proteinuria

granular casts are what?

what do they suggest?

no assoc w/ dz
orthostatic (no protein when
supine, protein when WB)
excessive exercise
exposure to cold
pregnancy (temporary)
protein + cell debris
(RBC+WBC+epithelial)

37.

how do you store

cytomegalovirus

room temperature storage

38.

how long does it take

to get results from a
urinary culture?

takes a day to grow

takes a day to analyze
takes a day to cultured (optional)
>/= 3-4 days

39.

how long do you have

to test if there is
urobilinogen in the
urine?

~30 min or else it oxidizes to urobilin

which is not testable

40.

how many RBCs do

you find in the urine?

ideally, none
0-3 per high powered field
>3 suggests pathology

41.

how many WBCs

should we see in the
urine?

ideally, none
0-4 cells per high powered field is
normal
>5 indicates pathology

42.

if there is glucose in
the urine, what do we
do to confirm
diabetes?

elevation in blood sugar

(hyperglycemia)

43.

inclusion casts

tamm-horsefall protein with

something in it

strenuous exercise
dehydration
29.

how can you have

glycosuria w/
hyperglycemia?

diabetes
^ intracranial pressure due to
cerebral hemorrhage/tumor
endocrinopathy - cushings,
hyperthyroidism, etc.
heart attack (sometimes)
alimentary (diet)
stress

how can you have

glycosuria w/out
hyperglycemia?

renal glucosuria (decreased

ability to absorb glucose)
chemical damage to kidney:
mercuric chloride, CO, lead
pregnancy/gestational
diabetes

31.

how do you confirm a

potential dx?

labs
x-rays
biopsies

32.

how do you determine if

there is bacteria in the
urine?

must have bladder stay for at

least 4 hours to see bacteria

30.

nitrite test
leukocyte esterase
(both tests should be run)
33.

34.

how do you do a clean

catch?

clean urethral opening w/

antiseptic whips
begin urinating then stop
finish collection

how do you get ketone

bodies in the urine?

fat catabolism-> acetoacetic

acid-> B hydroxyl butyric
acid+acetone
normally not detectable in
healthy urine

35.

how do you measure

amount for a urinalysis?

use a graduated cylinder

normal = 900mL

36.

how do you store

cultures

refrigerate up to 2 hours

RBCs w/ no nucleus in it
- glomerular nephritis, runnersw/
hematuria
WBCs nucleated
- pyleonephritis
44.

in which dz do you
find a whole bunch of
normal RBCs?

dz of ureter, bladder or urethra

(NOT RENAL DZ)
polyonephritis
prostatitis
systemic dz- TB or malaria

45.

is proteinuria normal?

slight to moderate in the morning is

normal
there should be no blood in the
urine

46.

lab findings for

alkaptonuria

add 10% HCl to urine -> will turn

black
however, can get a false + for sugar
in urine (copper reduction
procedure/bennedics test) b/c of
acid in urine

47.

lab findings for

prophyria cutanea
tarda (PCT)

if you add 10% HCl to urine ->

observe under woods light -> will
fluoresce

56.

polyuria & its causes

fluid overload
caffeine/diuretics (includes alcohol)
diabetes
polydipsia
renal dz (UTIs or pyleonephritis)

abnormal liver findings

48.

49.

50.

leukocyte esterase

lower urinary tract

pathology proteinuria

mixed casts

better test
WBC in urine to fight infection
+ suggests bacteria present

57.

ureter infection
crystitis
urethritis
vaginitis/prostatitis

portal/hepatic
jaundice

dz liver is the problem

goes to kidney
slightly more bilirubin
very pale stool

58.

prehepatic/hemolytic
jaundice

massive hemolysis of RBC

not uncommon in infants
liver not to blame- liver gets jammed
so goes to kidney
stool sample will be dark

59.

random sample vs
early morning sample

random- given at any time of day

(not as accurate)

RBCs WBCs epithelial etc.

glomerular nephritis

51.

52.

53.

nitrite test

obstructive/post
hepatic jaundice

oliguria & its causes

>2000mL/day (^ urine volume)

limited test - must be in the form of

nitrite
from vegetable sources in diet
+ suggests gram- bacteria (not
e.coli)->pt w/ UTI
bile duct is the problem
no urobilnogen b/c none goes into
intestines
no bilirubin in urine (only in
blood)
stool is chalk white

early morning - with no influence

from exercise or food substances
best method (should be more
concentrated)
60.

RBCs from urine seen

under microscope
can indicate what?

bleeding from somewhere (renal dz,

kidney stone, smoking)
bleeding disorder
anti-coagulents-> pt w/
hematurina

61.

reddish-orange urine
indicates...

prophyria cutanea tarda (PCT) ->

missing uroporphyrinogen
decarboxylase

62.

signs and sx for

alkaptonuria

acid build up in spinal joints & large

WB joints (sometimes IVD)

<400mL/day
dehydration (lack of ingestion,
vomit, ^ salt)
^ sympathetic NS
bladder outlet obstruction (stone
in ureter, prostatic hypertrophy)
renal dz

54.

pigment casts

hemolysis (free Hb)

rabdomyolysis-> casts filled w/
myoglobin

55.

plain casts

only tamm-horsefall protein inside

(non-specific)
hylaine - clear
-suggests dehydration, diuretics,
stress reaction
waxy - slightly more gradular due
to degraded protein mix
-suggests advanced renal failure

ochronosis -> light blue/gray

cartilage in ear, sclera of eye, lenula
of nail plates
63.

signs and sx of
prophyria cutanea
tarda (PCT)

hyper pigmentation of face

hypertrichosis (increased hair
length)
large blisters on dorsum of hand
possible liver dz

64.

smoky urine can

indicate

RBCs in the urine

65.

steps for macro eval

measure amount
observe color
observe scent & transparency (and
foam)

66.

substances
responsible to ^
blood cortisol levels?

caffeine

67.

substance that
caffeine can lower

cholesterol

68.

tamm-horsefall
protein

secreted by tubular epithelium

acts as a substrait and forms casts (not
testable)

69.

____ ____ tends to

push water out of
the glomerulus

hydrostatic pressure

70.

T/F: biliruibin is
normally found in
the urine

false

71.

trichomonas
vaginalis

female w/ infection
common
(can involve male prostate-uncommon)

72.

triple phosphate
crystals

also called coffin lids

alkaline urine
urinary stasis

tubular damage
proteinuria

small proteins aren't reabsorbed

pylenoephritis
acute tubular necrosis
polycystic kidney dz
heavy metal intoxication
wilsons dz

73.

74.

75.

76.

77.

urine florescence
under wood light:
what does this?

lack of uroprofinogen

urine in closed
flask: get a head
suggests what?

*if yellow = bilirubin in urine

what are age

biological false +
problems?

+Rh factor w/out evidence for

arthropathy
ANA w/out evidence for CVD
^ ESR
male PSA (prostate specific antigen)
w/out evidence
^ VDRL (vineral dz research lab)

what are
autocoids?

80.

what are causes of urine

having a pH of <4.8?

high protein diets (^

phosphates & sulfates)
excessive physical exertion
dz -> diarrhea, ketouria
(diabetes-due to diet),
starvation, renal TB
crystals form in urine (uric
acid, calcium oxidase,
cysteine)

81.

what are causes of urine

having pH >8.0?

strong alkaline -> can be

normal
-patient had just eaten
-high fruits/veggies in diet
-stale sample/bacteria
present
-bladder overstay
dz -> UTIs (pseudomonas
and proteas, vomitting,
hyperventilation, acidosis
calcium phosphate crystal
formation

82.

what are clue cells? what do

they suggest?

female epithelial cells crusted

squamos cells
suggests bacterial vaginitis

83.

what are different methods

for acquiring the sample in a
urinary culture?

calibrated loop (not

anymore)
calibrated micropipette (now
use this)
CFUs - colony forming unites
(not significant unless
>100,000)

84.

what are eosinophils? what

are they due to?

WBC in urine

if white: protein and casts*

endothelium from damaged capillary

endothelial cells on afferent and efferent
arterioles (pregnancy, chronic uremia)

reddish-orange granules
must have Hansel stain
drug hypersensitivity
(penicillin)
85.

what are examples of

problems related to
specimen collection?

failure to preserve
too much time between
collection & analysis
not enough of sample
wrong or improper sample
improper labeling

86.

what are findings? what do

you list when taking notes?

anything you discover on a

physical exam

angiotensin 2
78.

what are budding

yeast cells?

candida albicans
indicates yeast infection
common

79.

what are casts?

unorganized portion of the sediment

everyone organizes differently

only list findings assoc. w/

complaint!
87.

what are gender biological

false + problems?

males tend to have high

serum uric acid level

88.

what are ghost cells? where

do you see this?

(also called shadow cells)

when round/swollen RBC
has burst

89.

what are more specific

reagents to test for type of
sugar? (also the components
of a dipstick)

glucose oxidase->H2O2
peroxidase
chromogen reduced (specific
test for glucose only)

what are neutrophil/glitter

cells? what do they indicate?

WBC in urine

90.

99.

what are the 3 paths

for urobilinogen to
get in the urine?

portal system back to liver

stercobilinogen (fecal matter its color)
via blood to kidney (in urine until
exposed to air)

100.

what are the 3 types

of history taking?

very brief
comprehensive history
comprehensive geriatric assessment
(CGA)

101.

what are the

different kind of
casts?

plain
inclusion
grandular
pigment
fatty
mixed
crystal
bacterial

102.

what are the normal

pigments in the
urine?

yellow -> urochrome

red -> uroerythrin
= pale yellow; amber color urine is
normal

103.

what are the steps

for a routine urine
eval?

macro
chemical
micro
(culture, if indicated)

104.

what are the types of

jaundice?

prehepatic/hemolytic
portal/hepatic
obstructive/post hepatic

hypotonic urine
granules are scintillated
seen in lower UTIs
chronic pyleonephritis
91.

92.

what are polarizing

microscopes used for?

what are problems related to

patient activity?

determine biophringents
rarely used
IDs fat and starch crystals
present
diet
tobacco
drugs
posture
exercise

93.

what are race biological false

+ problems?

african americans have high

creatine phophokinase levels

94.

what are some abnormal lab

findings?

fluid imbalance
(homeoconcentration v.
dehydration)

95.

96.

97.

98.

what are some diet issues?

what are some examples of

patients that are considered
high risk?

105.

taking of drugs (most

common reason or altering of
lab tests) -> NSAIDs,
diuretics, antibiotics

what are the types of

ways to obtain a
urinary culture?

clean catch
catheterization
suprapubic aspiration (bladder) (last
stage of sample attempt)

106.

^ TGs w/ high fat diets or

after a meal
^ creatine levels w/ diets high
in cooked meats

what are types of

causes for
proteinuria?

functional
glomerular
tubular damage
lower urinary tract pathology

107.

what can alcohol

abuse cause?

short term -> hypoglycemia and ^

uric acid (metabolic acidosis;
everything back to normal in 2 days)

anemia
diabetes
hypertension
coronary heart dz
bacturia

108.

what are some

intrinsic/biological false
positive factors w/out the
presence of dz

age
gender
race

what can an
increased of vitamin
C cause?

BFP of guiac test (includes over the

counter)

109.

what can chronic

tobacco use cause?

>2 packs/day

what are storage regulations

for urine?

container tightly kept

analyzed within 1-2 hours
refrigerate at 4 degrees C for
up to 6-8 hours

long term -> ^ TGs, ^HDLs

polycythemia (^RBC, WBC, platelets,

Hb, and crit)
110.

what can drugs

cause?

side effects on other organs

111.

what can exercise

cause?

short term-> ^ blood glucose,

serum uric acid, RBC count
long term-> decrease serum uric
acid and RBC count

124.

what does a
dysmorphic (distorted
and irregular shape)
RBC suggest?

glomerular bleeding

125.

what does a phase

contrast microscope
work best for?

hyaline casts
mucous casts
bacteria

126.

what does a positive

dipstick indicate?

RBCs in the urine

free Hb in urine
myoglobin in urine

127.

what does a
round/swollen RBC
suggest?

can rupture
esp with more alkaline pH
RBC membrane w/ no trace of Hb

strenuous -> Granular casts or

hyaline
112.

113.

114.

what can posture (bed

bound) cause?

tissue fluids move to vascular

compartments and dilutes the
blood (decrease blood cells,
electrolytes, serum proteins)

what can stimulation

of the sympathetic
nervous system
(urinalysis) cause?

increase vasoconstriction on
afferent and efferent arterioles

what can surface from

glomerular
proteinuria?

damage to glomerulus
problem w/ peripheral edema w/
decreased albumin
hypoalbuminemia, acites and
pulmonary edema->nephrotic
syndrome

hyportonic urine w/ low specific

gravity (dilute) due to increased
intake, diuretic use, and diabetes
insipidus

no real affect

128.

(toxins, immune reactions,

infections vascular dz)
115.

what causes decrease

urinary output?

hypotension
oliguria

116.

what causes increase

urinary output (dz)?

pyeleno nephritis

129.

what does a specific

gravity of <1.003
mean?

low specific gravity

what does a specific

gravity of >1.035
mean?

high specific gravity

polyuria
diabetes

excessive fluid intake

inadequate mineral intake
diuretics
diabetes insipidus

dehydration
excessive perspiration
diabetes mellitus
febrile states (fever in kids)
glomerular nephritis

117.

what do chem sticks

tell you relating to
specific gravity?

only tells us the ionic concentration

130.

what does colloidal

osmotic pressure tend
to do?

bring fluid back in

118.

what do epithelial
cells suggest?

nothing

131.

untreated diabetes (polyuria)

^ fluid intake/diuretics

119.

what does a blood

glucose level of
<40mg% suggest?

hypoglycemia

what does colorless

urine (looks like
water) indicate?

132.

what does a blood

glucose level of 100126% suggest?

prediabetic

what does dark brown

almost charcoal urine
indicate?

alkaptonuria -> breakdown of

tyrosine produces hemogenistic
acid due to its missing oxidase

121.

what does a blood

glucose level of
180mg% suggest?

renal threshold for glucose

no sx

133.

what does dark

orange-red urine
indicate?

porphyrins in urine
normally shouldn't be any

122.

what does a blood

glucose level of
200mg% suggest?

sx appear (of diabetes)

134.

what does fasting for

24-48 hours do?

^ serum bilirubin
^ TGs
decreased blood glucose

123.

what does a bright

field microscope work
best with?

stained samples
sedi/kova stain- crystal violet and
saferin-o

135.

what does glucose in

the urine (or blood)
suggest?

diabetes

120.

liver failed

(this is a LAB dx, NOT CLINICAL)

136.

what does Hb seen under

the microscope w/ no
RBCs indicate?

intravascular hemolysis due to

parasite infestation

137.

what does milky urine

indicate?

presence of WBCs
fat/mucus in urine
purulent exudate

138.

what does myoglobin

seen under the
microscope indicate?

very rare
rabdomyolysis

139.

what does occult blood

show in the urine?

nothing obvious

140.

what does orange colored

urine (concentrated)
indicate?

febrile patients (children)

vitamin intake
very low fluid intake
excessive sweating
bladder overstay
greatest sugar concentration

what does reddish-brown

urine indicate?

presence of Hb (serious) or
myoglobin (rare)

141.

food (lots of beets)

drugs (pink/red)
hemoglobinemia
142.

what does smoky urine

indicate?

too much RBCs present

143.

what does the type of uric

acid crystals depend on?

the kind of crystal that is

formed is dependent on the
pH of the urine

what does urine density

relate to?

state of hydration

what do hormones do?

epinephrine/norepinephrine->
increase vasoconstriction on
afferent and efferent arterioles
affecting filtration

144.

145.

what do ideal casts look

like?

cylindrical
parallel sides w/ = diameter
longer than they are wide
rounded tips at the end

147.

what food has an effect

on blood occult studies?

red meat, fish, turnips,

horseradish

148.

what happens if urine of a

normal pH sits around?

bacteria present -> urea

broken down to ammonia ->
more alkaline/basic

146.

150.

what happens to old

urine? (>2 hours w/out
refrigeration)

darkens as sits b/c urobilin

present
things have deteriorated
(sediment)
ketone bodies in diabetics
dissipated
bacteria multiplied (cloudy)
shift pH to more alkaline

151.

what happens when a

urine sample is exposed
to air?

oxidized within 30 min

urobilinogen->urobilin which is
not testable

152.

what happens when

there is a mix of RBC
and WBC in the urine?

there is always a predominance of

RBC
aspirin overdose
anti-coagulants overdose
tumor
trauma

153.

what is a ddx?

anything that could cause +

findings
longer the list the better

154.

what is another name

for an RBC that is
abnormally shaped?
sized?

shape = polquilocytosis
size = anosocytosis

155.

what is a wellness
screening?

screening on the basis of the

patient's age

156.

what is benedict
solution?

blue solution added to fine to

determine if there is any glucose

157.

what is bense jones

proteinuria seen?

seen in ppl w/ multiple myeloma

plasma cells become malignant ->
invade and destroy bone

158.

what is clina-test
tables?

added to urine to observe for

color changes (similar to benedict)

159.

what is eGFR? what

does it include?

significant measure of renal

function
age
gender
race
blood creatinine serum

160.

can't ID or rule out dz

149.

what happens to children

with missing galactose-1phosphate uridyl
transferase enzyme?

likely to have poor

physical/mental development
diet must be monitored

what is free bilirubin

and what color is
unconjugated/free
bilirubin?

jaundice -> free bilirubin (in

blood) gets deposited into
tissues, membranes and
conjunctiva of eye
yellow/green

161.

what is normal fasting

glucose blood level?

70-100mg%

162.

163.

what is normal pH level of

urine?
what is tamm-horsefall protein?

4.8-8.0

173.

what kind of proteins get through

filtration membrane?

small proteins

slightly acidic

174.

what measures everything on the

urine sample? what is a normal
specific gravity?

urometer

what must you be before ketonuria?

ketonemia
-ketogenic diet (^
fat ^ CHO)
-diabetes mellitus
-starvation
-liver damage
(decrease glycogen
stores)

enhance casts (substrait)

^ acidity of urine
^ osmolarity of filtrate
proteins from plasma
tubular stasis

164.

what is the bowman's capsule

and what does it contain?

capillary wall of
glomerulus with
fenestrations/openings
within the membrane

165.

what is the charge of most

substances traveling through
the blood? what is an example?

negatively charged so
have a difficult time
getting through
(positively charged pass
much easier and
quicker)

175.

-dehydrated
-febrile (fever)
176.

what pathology does a >5 WBC count

in the urine suggest?

pyuria (renal
infection)
prostatitis
febrile
excessive exercise

177.

where are the epithelial cells in the

male? female?

male membranous
portion =
pseudocolumnar
lower portion =
columnar

albumin
166.

what is the composition of

urine?

96% water
4% dissolved solutes
-2% urea
-2% electrolytes

167.

what is the first morning void

specific gravity?

1.020

168.

what is the normal rate of blood

creatine clearance? how much
of this is being absorbed by the
renal tubules? how much in
urine production?

125mL/min (7500/hr,
180,000/day)
178,500/day absorbed
by renal tubules

female - squamous
w/ islands of
pseudocolumnar
178.

1500/day (750-2000) in
urine production
169.

what is the problem with

schistisoma hematobium eggs?

170.

what is the renal artery

pressure??

80-180 normal

171.

what is the rule of thumb for

hemoglobinemia?

bright red = from lower

GI tract
dark red = bleeding

172.

what keeps pressure low as to

not damage the structure
within renal arteriole system?

which cells can be present for 6-12

months w/out any sx? when they get
sx, what are they?

autoregulation

schistisoma
hematobium eggs
sx=disura &
massive hematuria

blood fluke (4 kinds)

gets into bladder and
grows in the liver
sinusoids->deposit eggs
in bladder wall

ten oh three-ten
thirty five (1.0031.035)

179.

which is more accurate: blood test

or urine test for testing glucose?

blood test

180.

who is at risk for anemia?

lower
socioeconomic
status
immigrants
pregnant
elderly
infants being
raised on cow's milk

181.

who is at risk for bacteuria?

preschool children
>65 years old
diabetics (women w/ gestational diabetes)
morbidly obese
UTI history

182.

who is at risk for coronary heart dz?

positive family history

men
hypertensive patients
diabetics
PAD

183.

who is at risk for diabetes?

positive family history

obese
afo/hispanic/indian-americans
females w/ gestational diabetes