Urinalysis

Question 1

Red colored urine suggests the presence of?

Answer 1

hemoglobin, myoglobin, or red blood cells

Question 2

Cloudy or turbid urine suggests the presence of?

Answer 2

crystals, cells or casts

Question 3

hematuria from hemolysis

Answer 3

hemoglobinuria

Question 4

hematuria from skeletal muscle injury or rhabdomyolysis

Answer 4

myoglobinuria

Question 5

How do you determine whether red colored urine contains hemoglobin, myoglobin or RBCs?

Answer 5

Look for cloudiness. This would indicate the presence of red blood cells, which would only be present in hematuria. Alternatively, one can centrifuge the urine and see if the red color moves into the heavier pellet (red blood cells), or stays in the supernatant (hemoglobin or myoglobin).

Question 6

higher specific gravity of urine indicates?

Answer 6

more concentrated urine

Question 7

Urine protein by dipstick uses the free amino groups on proteins to bind to pH indicators on the strip. This is not really measuring protein directly and tends to better detect (1) more than (2)

Answer 7

1. charged proteins like albumin 2. globulins

Question 8

Patients can have quite a bit of proteinuria from (3) like the (1) proteins found in (2) and have dipstick negative urine

Answer 8

3. globulins 1. Bence-Jones 2. multiple myeloma

Question 9

Interpreting the dipstick for blood requires comparison with the microscopic exam and generally there should be (1) on microscopic exam when there is positive blood on dipstick

Answer 9

red cells (erythrocytes)

Question 10

If the dipstick shows blood without red cells present, then this could be (1), indicating that hemolysis has occurred (for (2) or muscle injury (for (3).

Answer 10

1. hemoglobulinuria or myoglobinuria 2. hemoglobulinuria 3. myoglobin

Question 11

If nitrite is present in urine by dipstick, it may be an indication that (1) are present

Answer 11

1. nitrite producing bacteria

Question 12

Another dipstick test for urinary tract infection is the detection of (1) which is not normally found in urine unless the white cells which express (1) are present

Answer 12

1. leukocyte esterase

Question 13

pyuria

Answer 13

white cells in urine; pus

Question 14

Microscopic examination of urine is performed on centrifuged sediment which means it is a (1) sample

Answer 14

concentrated

Question 15

The most important concept in urinalysis is that casts indicate (1) and cells indicate (2)

Answer 15

1. renal location of disease 2. disease anywhere else

Question 16

form when cells or protein are trapped in tubules and form molds of their surroundings

Answer 16

casts

Question 17

In stained samples or by light microscopy, red blood cells are (1), whereas by phase contrast, (2)

Answer 17

1. red 2. one notices a lack of nuclei without the aid of color

Question 18

Red cells, either alone or within casts, lack nuclei so can generally be readily distinguished from (1) casts

Answer 18

white cell or epithelial cell

Question 19

White cells are usually?

Answer 19

neutrophils

Question 20

Red cells are found in conditions of bleeding (1) is always a concern) and white cells are found in (2)

Answer 20

1. cancer 2. infection

Question 21

Red blood cell casts generally indicate (1) and white blood cell casts indicate (2)

Answer 21

1. glomerular inflammation/type of glomerulonephritis 2. infection within the kidney which is called pyelonephritis

Question 22

Epithelioid cell casts are found in (1) but often degenerate into (2)

Answer 22

1. acute kidney injury (previously called acute tubular necrosis or ATN) 2. granular casts

Question 23

Protein can form casts in the renal tubules in patients with (1) which is also useful for diagnosis

Answer 23

1. nephrotic syndrome

Question 24

found frequently in urine even in asymptomatic patients and are often not very diagnostically useful other than as another measure of urine pH

Answer 24

crystals

Question 25

(1) crystals tend to form in acidic urine while (2) crystals tend to form in alkaline urine

Answer 25

1. Uric acid and cystine 2. triple phosphate

Question 26

one strategy to try and prevent crystal formation is?

Answer 26

making urine pH more or less alkaline in order to decrease crystal formation

Question 27

There is one time when the microscopic exam can be wrong, and that is when the urine is so (1) it lyses the red cells, because red cells can’t survive in a (2) fluid

Answer 27

1. dilute 2. hypotonic

Question 28

Urinalysis can be \_\_\_, \_\_\_\_, and \_\_\_\_

Answer 28

Macroscopic; chemical; or microscopic`

Question 29

Gross examination of the urine to determine whether there is serious renal disease

Answer 29

macroscopic urinalysis

Question 30

what is clarity of urine

Answer 30

Measure of transparency; NOT color;

Question 31

Red urine: centrifuge it to differentiate RBCs from Hbemia/myoglobinemia

Answer 31

centrifuge the urine to see if the red color moves into the heavier pellet (indicates RBCs, i.e. hematuria) or stays in the supernatant (Hbemia or myoglobinemia)

Question 32

Note: these are SCREENING tests

Answer 32

Chemical urinalysis

Question 33

\_\_\_\_\_\_ detects esterase enzyme present in certain WBCs (neutrophils and monocytes) --\> indicates urinary tract infection, since seeing host response

Answer 33

Leukocyte esterase

Question 34

If there is bacteria present w/o a host rxn (WBCs) then it is likely a _____ (since bacterial diseases usually produce neutrophilic response)

Answer 34

contaminan

Question 35

Microscopic exam: ___ urine to get concentrated sediment (for better determination). Examination can be viewed either 1) 2)

Answer 35

Centrifuged; 1. with a stain or unstained by phase contrast 2. light microscopy.

Question 36

\_\_\_\_ can be present anyplace between kidney and the collection system—i.e. indicates disease anywhere

Answer 36

Cells

Question 37

RBCs--\> indicates \_\_\_\_, thus worry about \_\_\_

Answer 37

bleeding, cancer

Question 38

* Result of bleeding at any point in the urinary system. * No nuclei

Answer 38

) RBCs

Question 39

* (b) WBCs --\> Indicates \_\_\_ * Usually ____ (type of cell) * Presence of a few is normal * High numbers indicate inflammation or infection. See nuclei and cytoplasm—so more internal structure

Answer 39

infection; neutrophils (poly-lobed nuclei)

Question 40

RBCs vs. WBCs on histo

Answer 40

RBCs have NO nuclei; WBCs have nuclei and are multi-lobed

Question 41

\_\_\_\_ are much smaller than the cells; small numbers--\> \_\_\_\_; high numbers--\> more likely to be contamination

Answer 41

bacteria; infection;

Question 42

\_\_\_\_ --\> indicate glomerulonephritis (both acute and chronic; this is a more severe disorder than pyelonephritis)

Answer 42

RBC Casts;

Question 43

\_\_-\>indicate pyelonephritis; suggests acute inflammation (if \_\_\_\_) or chronic (if \_\_\_); can be treated w/ antibiotics and less severe than \_\_\_\_\_

Answer 43

WBC Casts; neutrophils; lymphocytes; glomerulonephritis

Question 44

* Cells are large and flat. * Normal cells that line the urinary and genital tract or renal tubules + transitional cells (bladder)

Answer 44

Epithelial cells

Question 45

epithelial cells vs. epithelioid casts

Answer 45

Normal cells that line the urinary and genital tract or renal tubules + transitional cells (bladder Epithelioid Casts --\> indicate Acute Renal Injury (AKI)

Question 46

* ) ____ --\> indicate Acute Renal Injury (AKI) (pts will have low urine output/oligouria). * Often degenerate into granular casts go from coarse granular cast -\> fine granular cast -\> waxy cast (not much internal structure) as gets older. Form in the loops of Henle, distal tubules, and collecting ducts

Answer 46

Epithelioid Casts

Question 47

indicate nephrotic syndrome, can be normally present, or in those w/ dehydration

Answer 47

Hyaline Casts

Question 48

Hyaline casts * \_\_\_ and fatter than mucus. * A few are normal; a lot indicates \_\_\_. * May be increased after \_\_\_\_. From when ___ solidifies in the nephron

Answer 48

Colorless; nephrotic syndrome; strenuous exercise;protein

Question 49

Found frequently in urine, even in asymptomatic pts; more distraction than useful—clinical correlation required

Answer 49

Crystals

Question 50

•colorless; octahedron; found in acidic urine

Answer 50

Calcium oxalate crystals

Question 51

•in cystinuria in small children; hexagon (6 sides); acidic urine

Answer 51

Cystine Crystals

Question 52

•in MSUD (important to diagnoses, especially in children); round shape w/ clear border and a darker center.

Answer 52

Leucine Crystals

Question 53

•colorless; coffin-lid prism; common finding and not usually significant (pH info).; alkaline urine

Answer 53

Triple Phosphate Crystals

Question 54

Acidic urine (1) \_\_\_: colorless; octahedron. (2) \_\_\_: sharper borders * (3) Other urates: sodium urate, amorphous urates (all sharp borders) * (4) Cystine Crystals: in cystinuria in small children; hexagon (6 sides) * (5) Leucine Crystals: in MSUD (important to diagnoses, especially in children); round shape w/ clear border and a darker center.

Answer 54

Calcium Oxalate Crystals; Uric Acid Crystals;

Question 55

(1) Triple Phosphate Crystals: colorless; coffin-lid prism; common finding and not usually significant (pH info). (2) Calcium phosphate (spear-head) and amorphous phosphates Found in \_\_\_

Answer 55

alkaline urine