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Additive: None Collection of serum |
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Additive: None, serum separator Used for Serum |
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Additive: EDTA Whole blood, binds Calcium |
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Additive: Heparin Inhibits thrombin |
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Additive: buffered citrate Coagulation studies, binds calcium |
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Additive: Buffered citrate Westergren ESR |
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Additive: Fluoride Glucose |
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Additive: Citrate dextrose(ACD) Preserves RBCs |
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= (TN + TP)
(TN+ TP+ FN+ FP) X 100
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TN/ (TN + FP ) * 100 healthy people |
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Positive Predictive Value PPV |
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| Negative Predictive Value |
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| Hematoxylin is a __________ stain |
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| Eosin is a __________ stain |
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Dysmorphic RBCs are often a sign of __________ _______
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| Proteinuria of over 4g/day is seen in the ______ ___ |
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| What urine is the best for urinalysis? |
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| Morning urine is the most concentrated. |
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| The most common abnormal pee color is ___ |
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Definition
Red - Red/Brown - in congenital erythropoietic porphyria, porphyria cutanea tarda -drugs, dyes (phenolsulfonphthalein) -pts. with unstable hemoglobin |
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| Yellow-Brown or Green-Brown Pee |
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Definition
-Associated with bile pigments (bilirubin) - seen with yellow foam |
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| Urine is dark green when? |
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| Severe obstructive jaundice |
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| Orange-Red or Orange-Brown Pee |
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Urobilinogen-->in high pH to Urobilin = Dark Yellow/Orange Won't color the foam |
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-acid urin (containing Hgb) will darken on standing due to the formation of methemoglobin -Cola-colored urine is seen with rhabdomyolysis and l-dopa -homogentisic acid (alkaptonuria) and melanin are causes of brown urine
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Nonpathological : - uric acid, urates (white, pink, orange cloud) -PO4, ammonium urate, carbonate Pathological: - Leukocytes (white cloud that remains after acidification) - Bacterial growth - Turbidity ( RBCs, epithelial cells, spermatozoa, prostatic fluid)
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- rare condition - Urine contains lymph --> milky color - etiology: Parasitic infection with Wuchereria bancrofti (filiasis) - Clots may form, and if sufficient lymph is present the urine may layer with the chylormicrons on top and fibrin and cells beneath --> can be extracted using ether or chloroform. - Pseudochyluria occurs with vaginal creams
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- Nephrotic syndrome : fat globets in the urine - fractures of long bones or pelvis (fatty marrow) need microscopic examination
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| Miscellaneous stuff in the urine |
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Definition
- Mucus ( from LRT or genital tract) - blood clots - menstrual discharge, tissue - small calculi, clumps of pus, fecal material
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Definition
- Isovaleric acidemia and glutaric acidemia: Sweaty feet
- Maply syrup urine disease: Maple Syrup
- Methionine malabsorption: Cabbage, hops
- PKU: Mousy
- Trimethylaminuria: Rotting fish
- Tyrosinemia: Rancid
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Definition
- pH = 6 (4.6-8) - metabolic/respiratory acidosis -DKA: large amts of H+ ions are excreted mostly as ammonium ion -Hypokalemic alkalosis (vomitting) or with diuretic use there may be acid urine with metabolic alkalosis -may also be produced by diet high in meat protein and with cranberries -high levels of urinary bicarb is made (ammonia decreases) -pH may be as high as 7.8 -respiratory alkalosis (increased excretion on bicarb) - diets high in citrus fruits
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Definition
Normal: 150mg/day --> 2-10mg/dL - 1/3 is albumin.. rest is alpha, beta, and gamma globulins -Tamm-Horsfall glycoprotein (uromucoid) --> secreted by distal tubular cells is 1/3 of the the total normal protein loss -IgA, enzymes, tubular epi.cell proteins, leukocytes contribute to urine protein - <.5 g/day (seen with dehydration, CHF, cold exposure, and fever). - both hyaline and granular can be seen - resolves with trtment or rest in 2-3 days -Transient proteinuria may occur in normal pregnancy - Persistent proteinuria of 1-2 g/day in an asym. person, (or with hematuria) has a poorer prognosis.
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- noted in chronic pyelonephritis, may be intermittent, and in relatively inactive phases of glomerular diseases - also see in nephrosclerosis, chronic interstitial nephritis, congentital diseases such as polycystic disease, medullary cystic disease, renal tubular diseases
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-vast majority of renal diseases -nephrosclerosis -multiple myeloma -toxic nephropathies -Lower urinary tract conditions, calculi
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| Proteinuria: Heavy/Severe |
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Definition
-Nephrotic syndrome (low serum albumin, edema, increased serum lipids) - HDL is seen in urine - gamma-globulin is also lost in the urine (make pt. susceptible to bacterial infections) - associated with glomeruluar dysfxn b/c of: 1. primary renal diseases 2. systemic diseases with renal involvement -Transient or mechanical causes: severe CHF, constrictive pericarditis, renal vein thrombosis
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| Proteinuria: glomerular pattern |
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Definition
-glomerular disease ->3-4 g/day b/c of a loss of negative charge on GBM --> albumin permeates Bowman's space (more than can be reabsorbed by the PCT) -As larger proteins appear in the urine = proteinuria is less selective = greater damage to glomerulus (membranous nephropathy and proliferative GN) |
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Proteinuria: Tubular pattern |
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Definition
-associated with loss of a small amt. of urinary protein that would otherwise be largely reabsorbed. -usually of low molec. wght (Beta-2 microglobulin --> normally is 100 microgram/day) -Occurs with Fanconi's syndrome, cystinosis, Wilson's disease, and pyelonephritis, and with RT rejection -amt. of protein is lower than with glomerular diseases --> 1-2g/day - may be missed by reagent strip bc of low albumin
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Definition
b/c of excess levels of a protein inthe circulation seen with Hgb, myoglobin, or Ig loss into the urine
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- ass. w/ MM macroglobuilinemia and lymphomas - may be missed if only using a reagant strip - Need electrophoresis and immunofixation electrophoresis
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-albumin in the urine above normals but below detectable range of urine dipstick test - in Diabetes Mellitus, it increases cardiovascular mortality and an indicator of early and reversible glomerular damage.
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| Glucose and other sugars in urine |
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Definition
-use reagent strip method (glucose oxidase and peroxidase method) - combo. glucose + ketone reagent strips --> detect ketonuria and detect suppression of the glucose rxn by ketones seen with some reagent strips. - low sp. gravity elevates results - NaF, high specific gravity, occasionally ascorbic acid, glycolytic enzymes fromcells and bacteria. |
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Definition
Ketonuria: Acetoacetic (diacetic) acid, acetone -forms nonreversibly, 3-hydroxybutyrate- forms reversibly (78%) - Reagent strips and tablets react to 10mg of acetoacetic acid/dL.. only correlate moderately well with acetoacetate in plasma and poorly with total blood ketones - False positive : after use of phthaleins or with lots of phenylketones - acetylcysteine produces a strong red color -AntiHtn (methyldopa and captopril give false pos.) - false negatives occur b/c of loss of reagent reactivity.
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Definition
-Relatively common -occur with: neoplastic and non-neoplastic or trauma(calculi) anywhere in the urinary tract bleeding disorders and anticoagulant usage cyclophosphamide excessive exercise (marathon runners) -urine: dark brown/red -reagent strip tests positive for blood |
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Definition
-urine dark brown/red -uncommon -reagent strip Hgb screening is more sensitive -reagent strip can be inhibited by ascorbic acid -indicates significant intravascular hemolysis -free Hgb pass through the glomerulus as alpha-beta dimers once binding capacity (to haptoglobin) is saturated -some Hgb is reabsorbed by proximal tubular cells and the rest is excreted |
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Definition
-Free Hgb is filtered by glomeruli-->reabsorbed by proximal tubular cells -->catabolized into ferritin and hemosiderin -Found as yellow-brown granules that are free or in the epi. cells and occasionally in casts -indicates a chronic hemolytic stage -Intermittent hemosiderinuria --> use urinary iron levels to see if there's intravascular hemolysis. (normal urinary iron = .1mg/day, but increases with hemochromatosis) b/c of RBCs that are traumatized by prosethetic heart valves Urinary iron levels are normal in pernicious anemia and hereditary spherocytosis |
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Definition
-caused by destroyed muscle fibers(rhabdomyolysis) -excreted as a red-brown pigment -seen in marathon running and karate -Diagnosis is made from history and lab findings -Serum is clear, elevated CK, aldolase, and normal haptoglobin, and increased serum creatinine -Serum measurments help distinguish myoglobinuria from hemoglobinuria |
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Definition
-Bilibrubin is a brkdown product of Hgb (formed in RES cells of spleen, liver, and bone marrow) -It is carried in the blood linked to albumin (as unconjugated bilirubin)-->makes it unable to pass through the glomerular barrier(water insoluble) -It gets transported to liver to get conjugated with glucuronic acid to form bilirubin glucuronide. -Conjugated bilirubin (direct bilirubin) is water soluble so it passes into the urine. -Normal adult urine has .02mg/day of bilirubin -Not detectable by usual testing methods -Alkalosis increases bilirubin excretion -Conjugated bilirubinuria = increased bilirubin in the bloodstream b/c of 1. bile outflow obstruction (gallstones or carcinoma of pancreas head ) 2. hepatocellular disease (liver cells can't excrete the bilirubin into the bile) -Seen with acute hepatitis, accompanies jaundice of acute alcoholic hepatitis -early indication of cholestasis or liver damage -appear in the urine in the Dubin-Johnson and Rotor types -yellow-brown to greenish-brown urine with yellow foam -elevated serum bilirubin(conjugated form), jaundice, pale colored feces - a + test for urinary bilirubin & - test for urobilinogen = biliary obstruction -Use reagent strip with fresh urine b/c bilirubin glucuronide (conjugated) hydrolyzes to less reactive free bilirubin (esp. when exposed to light) |
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| Urobilinogen in the Urine |
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Definition
-free bilirubin is reduced to urobilinogen, mesobilirubinogen, and stercobilinogen -~50% of urobilinogen is reabsorbed into the portal circulation and re-excreted, unconjugated, into the bile - the rest is excreted in the feces and some in the urine -Liver pathology = increased urobilinogen to be routed through the kidney into urine b/c of viral hepatitis, cirrhosis, liver congestion, cholangitis, broad spectrum antibiotics (prevent conversion of bilirubin to urobilinogen-->reduce excretion in urine) -Test using Reagent strip by ehrlich aldehyde rxn or red azo dye formation from diazonium compound - Need fresh sample b/c urobilinogen is labile (becomes non-reactive urobilin in acidic urine) |
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-untrted can cause severe renal damage -test for bacteriuria in high risk pts (elderly, pregnant, diabetic, PMHx of UTI) |
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-many bacteria that are urinary tract pathogens reduce nitrate-->nitrite = a pos. urine nitrite tests (>105-106/mL bladder urine) -common bacteria: E.coli, Klebsiella, Enterobacter, Proteus, Staph, Pseudomonas -nitrite test = + --> do a culture -use first morning clean voided midstream
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