Term
| What are used to perform routine chemical tests on urine? |
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Definition
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Term
| What do strips consist of? |
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Definition
| chemical-impregnated absorbent pads on plastic strip |
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Term
| Reagent strip test = performed for what? (10) |
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Definition
| pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leukocyte esterase, specific gravity (SG) |
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Term
| What kinds of strips are available? (2) |
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Definition
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Term
| 2 major types o reagent strips sold under what names? |
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Definition
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Term
| variations occur b/w Multistix & Chemstrip with regard to _ and _ and _ _; users should be familiar w/product lit |
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Definition
| sensitivity & specificity & interfering substances |
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Term
| Reagent strips are also used w/_ _. |
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Definition
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Term
| What are supplied by the manufacturer (of strips)? |
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Definition
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Term
| Several degrees of _ are shown to provide semiquantitative readings of ? (6) |
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Definition
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Term
| estimates of what units are also provided for many of the test areas? |
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Definition
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Term
| reagent strip technique (5) |
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Definition
dips trip into well=mixed specimen at room temp
remove excess urine by touching edge of strip to container as strip is withdrawn
blot edge of strip on absorbent pad (paper towel)
wait specified amount of time
compare color rxn (hold strip horizontally) to manufacturer's chart under good lighting |
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Term
| improper technique errors of reagent strip testing (5) |
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Definition
RBCs & WBCs sink to bottom of unmixed specimen
enzyme rxns = based on room temp readings
reagents leach off strip remaining in urine too long
excess urine --> reagent runover among pads
time of reactions specified by manufacturer (leukocyte esterase = longest @ 2 min) |
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Term
| How should you store reagent strips? temp? |
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Definition
| with desiccant in opaque, tightly closed container because pads = very hydroscopic; below 30 C but not freezing |
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Term
| What should reagent strips not be exposed to? |
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Definition
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Term
| When should reagent strips not be used? (2) |
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Definition
past expiration date
discolored pads |
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Term
| When should reagent strips not be used? (2) |
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Definition
past expiration date
discolored pads |
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Term
| When should strips be removed? |
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Definition
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Term
| quality control of reagent strips - how often should (+) & (-) controls be run on? |
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Definition
| every 24 hours/each shift/change in lot # |
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Term
| When should reagent strip controls be run? (3) |
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Definition
| opening new strip bottle, questionable results, strip integrity concern |
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Term
| Should DI water be used as (-) control for reagent strip? |
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Definition
| no: reactions = designed for urine ionic conc. |
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Term
| Control reading results should show what? |
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Definition
(-) controls = (-)
(+) controls = readings agreeing w/published control values by +/- 1 color block |
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Term
| reagent strip QC: _ and _ tests are available for some rxns. |
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Definition
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Term
| QC of reagent strips - must have (+) & (-) controls performed whenever what tests are required? (4) |
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Definition
protein: sulfosalicylic acid/acidify specimen
galactose: clinitest
ketones: acetest
bilirubin: ictotest (primary confirmatory test) |
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Term
| _ are major regulators of acid-base balance. |
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Definition
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Term
| 1st morning specimen - normal pH? |
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Definition
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Term
| postprandial specimen pH vs. 1st morning |
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Definition
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Term
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Definition
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Term
| Are absolute values assigned to urine pH? |
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Definition
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Term
| Normal fresh urine can't reach pH _. |
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Definition
| 9 - indicates old bacteria-contaminated urine |
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Term
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Definition
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Term
| urine pH from vegetable diet |
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Definition
| alkaline pH, except cranberry juice |
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Term
| meds for UTI cause what pH? |
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Definition
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Term
| reagent strip for pH - double indicator reaction measures b/w _ and _. |
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Definition
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Term
| reagent strip for pH - double indicator reaction: 2 indicators = ? |
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Definition
methyl red = 4-6, red/orange to yellow (+ H+)
bromthymol blue = 6-9 green to blue (- H+) |
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Term
| reagent strip for pH - double indicator reaction: interference? |
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Definition
| runover b/w acid from protein pad |
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Term
| phenol red colors in pH's |
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Definition
yellow = acid
red = alkaline |
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Term
| What's most indicative of renal disease? |
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Definition
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Term
| _ is seen in early renal disease. |
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Definition
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Term
| normal protein levels in urine |
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Definition
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Term
| Low MW serum proteins are _; many are _. |
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Definition
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Term
| What are larger proteins? (3) |
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Definition
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Term
| What is the primary protein of concern? |
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Definition
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Term
| clinical proteinuria: protein levels? |
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Definition
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Term
| causes of proteinuria (3) |
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Definition
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Term
| prerenal proteinuria - conditions affect _, not _. |
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Definition
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Term
| prerenal proteinuria - can this be seen on reagent strip? (not albumin) |
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Definition
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Term
| Transient, increased levels of low MW plasma proteins, acute phase reactants, exceed reabsorptive capacity - b/c of what? |
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Definition
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Term
| What indicates multiple myeloma? |
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Definition
| Bence Jones Protein (BJP) |
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Term
|
Definition
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Term
| How do you screen for BJP? |
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Definition
BJP coagulates b/w 40 & 60 C; dissolves @ 100 degrees
therefore, heat + observe turbidity |
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Term
| required confirmation for BJP |
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Definition
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Term
| prerenal tubular disorders (4) |
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Definition
intravascular hemolysis
muscle injury
acute phase reactants
multiple myeloma |
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Term
| 2 kinds of renal proteinuria |
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Definition
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Term
| Glomerular proteinuria causes damage where? |
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Definition
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Term
| Impaired selective filtration cuases increased protein filtration. What disorder is this? |
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Definition
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Term
| Abnormal substances deposit on glomerular membrane. Primarily immune disorders results in immune complex formation, i.e. Lupus erythematosus, streptococcal glomerulonephritis. What disorder am I? |
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Definition
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Term
| Glomerular proteinuria --> increased pressure on filtration mechanism --> from what? (4) |
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Definition
hypertension
strenuous exercise
dehydration
pregnancy (preeclampsia) |
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Term
| glomerular proteinuria, benign (from increased pressure on renal vein) (transient), a.k.a. ?, from _? (4) |
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Definition
orthostatic proteinuria
exposure to cold, exercise, dehydration, high fever |
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Term
| Orthostatic (postural) proteinuria occurs in _ position and disappears in _ position |
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Definition
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Term
| What is frequently picked up on random specimen? |
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Definition
| Orthostatic (postural) proteinuria |
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Term
| When will specimen be (-) for protein? |
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Definition
| empty bladder before bed + collect specimen immediately upon rising |
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Term
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Definition
immune complex disorders
amyloidosis
toxic agents
diabetic nephropathy
strenuous exercise
dehydration
hypertension
preeclampsia
orthostatic/postural proteinuria |
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Term
| Tubular proteinuria causes tubular damage that affects what? |
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Definition
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Term
| tubular proteinuria - acute tubular necrosis from what? (4) |
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Definition
toxic substances
heavy metals
viral infections
Fanconi syndrome (generalized PCT defect) |
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Term
| tubular proteinuria - amounts of protein (2) |
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Definition
glomerular - up to 4 g/day
tubular - much lower |
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Term
| Postrenal proteinuria - protein added where? (@) |
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Definition
lower urinary
genitourinary tract |
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Term
| Postrenal proteinuria - microbial infections cause what? (2) |
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Definition
inflammations
release of interstitial fluid protein |
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Term
| Postrenal proteinuria - contamination of specimen from what? (4) |
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Definition
menstrual
semen/prostatic fluid
vaginal secretions
traumatic injury |
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Term
| Traditional reagent strip testing for protein uses principle of the _ _ _ _. |
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Definition
| protein error of indicators: indicators change color in presence of protein at constant pH |
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Term
| Reagent strip rxns: protein, primarily albumin, accepts what from indicator? |
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Definition
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Term
| Why are reagent strips most senstitive to albumin? |
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Definition
| Albumin has more amino groups to accept H+ than other proteins. (then turns from yellow to green/blue) |
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Term
| What's in reagent strips to detect protein? (2/3) |
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Definition
tetrabromophenol blue OR
tetrachlorophenol tetrabromsulfonphthalein AND acid buffer |
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Term
| If pH = 3, what are the colors of indicators of protein in reagent strips? |
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Definition
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|
Term
| protein reagent strip rxn colors |
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Definition
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Term
| Trace values of protein indicated by reagent strips are _. |
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Definition
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Term
| reagent strips - protein - interference (6) |
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Definition
highly buffered alkaline urine
leaving reagent pad in urine too long (removes buffer)
higly pigmented urine
quaternary ammonium compounds, detergents, antiseptics, chlorhexidine
false-(-) to proteins other than albumin
false-(+) trace from high SG |
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Term
| sulfosalicylic acid confirmation (SSA) - common? |
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Definition
| no, due to instrumentation |
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Term
| SSA precipitates _ without heat. |
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Definition
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Term
| SSA - use _ specimen, compare against standards for 1-4+ |
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Definition
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Term
| SSA: other substances precipitated (granular) - (3) |
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Definition
radiographic dye
antibiotics
tolbutamide |
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Term
| What is the newest testing? |
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Definition
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Term
| Diabetic nephropathy - need to control what? (2) |
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Definition
hypertension
glucose levels |
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Term
| WHat is common in diabetics? |
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Definition
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|
Term
| Diabetic nephropathy leads to increased risk of _ disease. |
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Definition
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Term
| microalbuminurea - early screening for albumin levels _ than seen on routine reagent strip. |
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Definition
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Term
| microalbuminurea used to require what? |
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Definition
| 24-hour collection --> reported mg/24 hr albumin |
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Term
| 2 kinds of reagent strip microalbumin tests |
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Definition
Clinitek microalbumin reagent strips
Meltistix Pro reagent strips |
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Term
| What can simultaneously measure albumin and creatinine? |
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Definition
| reagent strip microalbumin test |
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Term
| What can provide estimate of 24-hour albumin concentrations from random urine? |
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Definition
| reagent strip microalbumin test |
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Term
| Reagent strip microalbumin test: albumin pad uses what for specific albumin testing? |
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Definition
| dye-binding rxn (albumin strip dye) |
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Term
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Definition
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Term
| What is the major screening test for diabetes mellitus? |
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Definition
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Term
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Definition
|
|
Term
| placental hormones block action os insulin --> ? |
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Definition
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Term
| gestational diabetes: high fetal glucose stressing baby's pancreas --> ? |
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Definition
fat baby
mom = prone to type 2 diabetes |
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Term
| renal glycosuria --> ? (4) |
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Definition
tubular reabsorption disorder
end-stage renal disease
Fanconi syndrome
temporary lowering of renal threshold in pregnancy |
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Term
| clinical significance of urine glucose --> ? (5) |
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Definition
hyperglycemia-assoc.
diabetes mellitus
pancreatitis
pancreatic cancer
gestational diabetes |
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Term
| clinical significance of urine glucose, renal-assoc. (4) |
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Definition
Fanconi syndrome
advnaved renal disease
osteomalacia
pregnancy |
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|
Term
| glucose - reagent strip: what rxn? what's on pad? |
|
Definition
glucose oxidase rxn (double sequential enzyme rxn)
glucose oxidase, peroxide, chromogen, buffer on test pad |
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Term
| glucose - reagent strip sensitivity |
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Definition
| 100 mg/dL - 2 g/dL (2000 mg/dL) |
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Term
| glucose reagent strip false-(+) |
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Definition
| peroxide, oxidizing detergents (bleach) |
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Term
| glucose reagent strip false-(-) |
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Definition
enzymatic rxn interference:
ascorbic acid/vitamin C
strong reducing agents
(unlikely) high ketone levels
high SG + low temp
biggest error = old specimens due to glycolysis |
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Term
|
Definition
5 drops urine + 10 drops DI water + 1 tablet
rxn complete after boiling (hot! - use glass tt)
wait 15 sec, shake
compare color of mixture to color chart
result in mg/dL or % |
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Term
| Clinitest - pass-through phenomenon |
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Definition
high levels of reducing substance
blue through red, back to green-brown (rapid)
done on kids <2 years old to detect galactose intolerance |
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Term
| if pass-thru phenomenon, repeat with ? |
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Definition
| 2-drop procedure: 10 drops water + 2 drops urine --> values up to 5 g/L vs. 2 g/L |
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Term
| Clinitest hygroscopic tablets: strong blue color & excess fizzing indicates what? |
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Definition
|
|
Term
| copper reduction test consists of what? |
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Definition
| reduction of copper sulfate to cuprous oxide w/alkali & heat |
|
|
Term
| what makes up copper reduction test |
|
Definition
Na citrate + NaOH = heat
Na carbonate = CO2 blocks room air
Reducing substance + CuSO4 = color |
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Term
|
Definition
copper sulfate
sodium carbonate
sodium citrate
sodium hydroxide |
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Term
| Clinitest rxn interference |
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Definition
| no specific for glucose - reducing substances: GALACTOSE, lactose, fructose, maltose, pentoses, ASCORBIC ACID, cephalosporins |
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Term
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Definition
| quizk screen for galactosemia in newborns; new screening programs using blood = being incorporated. |
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Term
| 3 intermediate products of fat metabolism (ketones) |
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Definition
acetone
acetoacetic acid
beta-hydroxybutyric acid
[in urine when fat is broken down to glucose for energy] |
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|
Term
| clinical significance - primary causes of ketonuria |
|
Definition
diabetes mellitus
vomiting/carb loss
starvation, malabsorption, dieting |
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|
Term
| ketonuria shows inadequate _. |
|
Definition
insulin - need to monitor diabetes b/c can result in diabetic acidosis
[hospitalized pts often +; illness = decreased intake, poor absorption] |
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