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Fron Stacy's Review 11/17/10

What reagent stick test takes two minutes?

Leukocytes

What reagent stick tests or protein in the urine?

Albumin

What causes a protein cast?

The Tamm-Horsfall glycoprotein

What urine crystals are described as envelopes?

Calcium oxalate

What urine crystals are described as coffin lids?

Triple phosphate

What is an early renal test for diabetes?

Microalbuminuria

What urine test is most closely associated with renal disease?

Protein

What urine test is most closely associated with bacteria?

Nitride

What urine test is most closely associated with liver disease?

Biliruibin

Why would a stick test show negative for glucose but positive by Clinitest?

Other reducing sugars present impact the Clinitest.

What are the precursors for oval fat bodies?

RTE cells

What metabolic disorder shows uric acid crystals present?

Lesch-Nyhan syndrome

What metabolic disorder shows port wine color?

Porphyria

What are three mucopolysaccharide syndromes?

Hurlers, Hunters and Sanfilippo

What disease comes from a failure to produce Phenylalanime hydroxylase and gives a mousey order?

PKU

What causes albinism and produces dark colored urine?

Melanuria

What disease comes from a deficiency of homogentisic acid oxidase?

Alkaptonuria

What causes yellow foam when the urine specimen is shaken?

Bilirubin

What is the final phase in the degenration of a granular cast?

Waxy cast

What strip reagent is never negative?

Urobiligen

What would you with a sample that has a pH of 6.5 and Ammonium Biurate Crystals?

Recheck it. Ammonium Biurate Crystals are alkaline.
It is the only urate sediment which forms in an alkaline urine.

What renal disease causes raised red patches on the skin?

Henoch-Schönlein Purpura.

What renal disease shows oval fat bodies, fatty casts and marked proteinuria?

Nephrotic syndrome.

What disease shows a decrease in the antiglomular basement membrane antibody?

Good pasture syndrome.

What disease shows no bacteria, proteinuria, allergic reaction, causes allergic reaction, inflammation and hematuria?

Acute interstitial nephritis.

What disease shows IgA complexes on the glomerular membrane?

Berger's disease. IgA nephropathy.

What disease shows antineutrophil cytoplasmic antibodies?

Wegener's granulomatosis

What disease shows proximal convoluted tubule is reabsorbtion failure?

Facconni syndrome

What are Acetic acid, acetone, and beta hydroxy acid?

Keto acids (Ketone bodies)

What reacts Acetic acid?

Sodium nitroprusside.

Crystal and pH: Triple phosphate

Coffin lid. Alkaline.

Crystal and pH: Calcium oxalate

Dumbell. Acid.

Crystal and pH: Ammonium biurate

Thorny apple. Alkaline.

Crystal and pH: Cystine

None. Acid.

Crystal and pH: Cholesterol

Notched plates. Acid

Crystal and pH: Amorphous urates

None. Acid

RBC's in the urine are associated with?

Glomerulonephritis

WBC's in the urine are associated with?

Pyelonephritis

What crystal render calculi?

Cystine.

These crystals are associated with blood:

Amorphous urates.

These crystals are associated with bilirubin:

Uric acid.

These crystals are associated with triple phosphate:

Bacterial growth.

These crystals are associated with calcium oxalate:

Kidney stones.

Nitrite chemical principle:

Greiss reagent. Reduces nitrates to nitrides. Negative does not rule out bacteria.

Color change from cream to pink.

Urobilinogen chemical principle:

Erhlich reagent: p-(dimethylamino) benzaldehyde.
Pink/red colors.
Bile duct: Normal
Liver damage: ++
Hemolytic dis: +++

Protein chemical principle:

Tetrabromophenol blue.

Highly buffered alkaline urine overrides acid buffer system.

Color change from yellow through green to blue will occur in the presence of protein.

pH chemical principle:

A dual indicator system.

Color change from orange, through green to blue over a pH range.

Blood chemical principle:

Pseudoperoxidative activities of the haemoglobin.

and myoglobin components of blood are responsible for the catalytic oxidation of the indicator, in the presence of the organic hyperoxide.

Color change from yellow through green to blue

Ketone chemical principle:

Acetoacetic Acid (the physiological ketone) reacts with Sodium Nitroprusside.

Acetest confirming.

Diabetes mellitus
Vomiting
Starvation, malabsorption, dieting
Can result in diabetic acidosis

Produces a pink or mauve colour.

Bilirubin chemical principle:

Diazo.
Produces tan to brown colours.

Bile duct: +++
Liver damage: + or -
Hemolytic dis: negative

Glucose principle:

The test is based on the glucose oxidase/peroxidase chromogen reaction.
More sensitive than Clinitest.
Clinitest alternate.
Color change from green to brown.

Hematuria

Renal calculi
Glomerulonephritis
Pyelonephritis
Tumors
Trauma
Exposure to toxic chemicals
Anticoagulants
Strenuous exercise

Hemoglobinuria

Transfusion reactions
Hemolytic anemias
Severe burns
Infections/malaria
Strenuous exercise/RBC trauma
Brown recluse spider bites

Glucose oxidase interpretation

1+ positive: Small amount of glucose present
4+ positive: Possible oxidizing agent interfering
Negative: Nonglucose reducing substance present

Possible interfering substance for reagent strip.

Hartnap

Indicanuria.

Blue diaper syndrome. Exposure of urine to air = indigo blue

Inherited disorder affects intestinal reabsorption of indole and renal tubular reabsorption = Fanconi syndrome.

Fanconi syndrome

Disease of the proximal renal tubules of the kidney.

Glucose, amino acids, uric acid, phosphate and bicarbonate are passed into the urine, instead of being reabsorbed.

5 HIAA

Intestinal cell tumors = ↑ ↑ 5-HIAA in urine from excess serotonin produced

Cyctineuria

Defect in metabolism of homosystine.

Produces increased methionine in body.

Failure to thrive, cataracts, mental retardation, thromboemboli, death.

Cyctinosis

Defect in lysosomal membranes.

Prevents release of cystine into cytoplasm for metabolism = crystalline cystine deposits in body.

Renal tubules are affected by deposits causing Fanconi syndrome

Mucopolysaccharidoses

Inherited.
No metabolism of glycoaminoglycans in the connective tissue.

Incompletely metabolized polysaccharides accumulate in connective tissue.

CTAB test positive: turbitiy in the urine.

Lesh Nyphan

Purine disorder.
Uric acid crystals.
Orange sand.
Pediatric patients.

Clinitest interpretation

Negative: Small amount of glucose present
Negative: Possible oxidizing agent interfering
Negative: Nonglucose reducing substance present

Possible interfering substance for reagent strip.

What is reported as LPF?

Casts

47. What is the primary component of urinary mucus?

Tamm-horsfall protein

What color does acetest turn when postive?

Blue/puple

What does speckled pattern mena on a dipstick for blood?

Intact RBC's

Which would be bilibrubin stong positive and normal for urobilinogen?

Bile duct obstruction

How can you tell by clarity hematuria or hemoglobinuria?

Hematuria = cloudy red urine
Hemoglobinuria = clear red urine

How will failure to detect a pass through affect the results?

A strong positive will be "passed through" and show negative.

What is the confirming test for protein?

SSA

What is the confirming test for Bilirubin?

Icotest

What is the confirming test for Ketones?

Acetest

What is the significance of urine pH of 9?

The urine is too old.

What is the primary cause of false neg test result for glucosia?

Ascorbic acid

What condition are Tyrosine crystals seen in and what other crystal could also be seen?

Severe liver disease. Cystine would also be seen.

In what other forms does calcium oxalate appear besides the "envelope".

Less commonly, it can be dumb-bell shaped or ovoid. When ovid, it may be mistaken for RBCs.

What is the clinical significance of fatty casts in the urine sediment?

They are associated with nephrotic syndrome.

What is the clinical significance of granular casts in the urine?

0-1/LPF is considered normal. Increased numbers seen in glomerulonephritis and pyelonephritis. Granular casts may form the degeneration of cellular casts.

Oval fat bodies
What is the stain that is used to confirm oval fat bodies as seen in the above picture?

Sudan III or Oil Red O fat stains

Is Lacto bacilli normal?

Lacto bacilli are normal flora in the female genital tract.

What are the three types of epithelial cells found in the urine and which has the most clinical significance?

Squamous, Transitional and Renal.

What is the clinical significance of waxy casts in the urine sediment?

They are the final stage in the degeneration of cellular cast and point to severe urinary stasis.

What is the color of the precipitate formed when amorphous phosphates are present in large amounts?

Amorphous phosphate crystals are White in large amounts

Squamous epithelial, RBC, WBC
How would you report cells and casts differently?

RBC and WBC cells are reported per high power field and casts are reported per low power field?

How do you check for hyline casts and mucus?

Because the refractive index of hyline casts and mucus is close to that of urine, they are only seen if the light is subdued.

What is the clinical significance of ammonium biurate crystals?

Usually none. They are seen in old urine.

Name four things that can be mistaken for RBCs in the urine sediment.

Name four things that can be mistaken for RBCs in the urine sediment.

Acid or Base

Ammonium Biurate Alkakine
Amorphous Phophates Alkaline
Calcium Phosphate Alkaline
Triple Phosphate Alkaline

Amorphous Urates Acid
Calcium Oxalate Acid
Chloesterol Acid
Cyctine Acid
Leucine Acid
Tyrosine Acid

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