Patient presents with S/S of pneumonia. What do they need?
Chest films
Patient presents with burning on urination and flank pain. What do they need?
Kidney test
Patient presents with pain in the right upper quadrant of the abdomen. What do they need?
Liver function test
Patient presents with signs and symptoms of anemia. What do they need?
CBC test
A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is considered…
normal
A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered…
prediabetes
A fasting blood sugar level 126 mg/dL (7 mmol/L) or higher on two separate tests is considered…
diabetes.
Patient presents with mid back pain. The history includes polyuria, polydipsia and family members with adult onset diabetes. What 2 tests should you order?
UA and FBS (fasting blood sugar)
Patient presents with mid back pain. The history includes polyuria, polydipsia and family members with adult onset diabetes. What is the Dx and what do you do????
- -UA reveals 3+ glucose and ketones
- -FBS levels are 325 mg/dl
Diabetes Melitus and Ketosis
–concurrent care for diabetic care
All labs are governed by…
CLIA (clinical laboratory improvement amendments)
A patient with a UTI may have subluxations in what spinal region?
lumbar region
A patient with liver disease may have subluxations in what spinal region?
T5 - T9
Kidneys are involved in the production what hormone that stimulates RBC production, and renin, an enzyme for controlling blood pressure.
erythropoitin
Routine UA consists of what 3 things?
- ) physical properties
- ) chemical properties
- ) microscopic properties
What is the functional uni of the kidney?
nephron
The glomerular filtrate becomes urine after it leaves…
distal convoluted tubule
What are the 7 principle solutes of urine?
- -urea
- -sodium
- -chloride
- -potassium
- -creatinine
- -uric acid
- -ammonia
The body excretes approximately how many grams of dissolved material/24 hours
–one half is what?
60 grams
–half is urea
Urine formation is a result of what 3 things?
- -glomerular filtration
- -tubular reabsorption
- -tubular secretion
What % of urine is water?
95% water; 5% dissolved solids
What is the average daily volume of urine?
1200-1500 ml
–normal range is 600-2000 ml/day
What is it called when:
– > 2000 ml/24 hours
polyuria
What is it called when:
– < 500 ml/24 hours
oliguria
What is it called wen you have an absence of urine?
anuria
What is it called when the patient has excessive water intake?
polydipsia
What are 2 causes of polyuria?
- Diabetes melitus
- - Diabetes Insipidus
What are 3 causes of oliguria?
- -renal tubule dysfunction
- -end stage renal disease
- -obstruction
What are 3 causes of anuria?
- -renal failure
- -obstruction
- -heart attack
When is the best time to perform a UA?
early morning
When does a UA begin to decompose?
- -w/in 30 min at room temp
- -w/in 4 hrs if refigerated
What happens to unpreserved urine:
- -color
- -turbidity
- -smell
- -color darkens
- -turbidity increases
- -odor is more foul smelling
What happens to unpreserved urine:
- -pH
- -glucose
- -ketones
- -bilirubin
- -urobilinogen
- -pH increases
- -glucose decreases
- -ketones decrease
- -bilirubin decreases
- -urobilinogen decreases
What happens to unpreserved urine:
- -nitrites
- -bacteria
- -RBC’s
- -WBC’s
- -casts
- -nitrites increase
- -bacteria increase
- -RBC’s lyse
- -WBC’s disintegrate
- -casts disintegrate
What 2 things does color indicate on a UA?
degree of hydration and concentration
What UA color is considered normal?
straw to amber (light yellow to dark yellow)
A red, dark brown urine found with excessive hemoglobin, RBC, and myoglobin is associated with what 3 things?
- -menses
- -UTI
- -malignancy
What does orange urine indicate?
dehydration
What does bright yellow urine indicate?
excessive B vitamins
What does black urine indicate?
- -alkaptonuria
- -melanin problems like malignant melanoma
What does colorless urine indicate?
diabetes insipidus
What does brownish yellow/green urine indicate?
liver problems
If you find brownish yellow/green urine, what 2 urine properties should be checked?
bilirubin and urobilinogen
Patient has jaundice skin and sclera, right upper quadrant pain, and brownish yellow/green urine. What do you suspect?
hepatitis/liver disease
What is milky urine turbidity associated with?
hyperlipidemia (risk factor for heart disease)
What does clear urine turbidity indicate?
normal
What does slightly hazy urine turbidity indicate?
usually normal (check sediment, if negative then insignificant)
What does frothy urine turbidity indicate?
protein
What does white, small amount of foam in urine indicate?
normal
What does white, large amount of foam in urine indicate?
possible protein
What does yellow, large amount of foam urine indicate?
may be due to bile/bilirubin
What does specific gravity evaluate?
kidneys ability to concentrate urine
What is the normal range of specific gravity in the adult?
1.015 - 1.035
What is the specific gravity, technically?
The weight of the urine compared to distilled water (SpG of water = 1.000)
What is low specific gravity called?
hyposthenuria
What is high specific gravity called?
hypereshenuria
What is a fixed specific gravity at 1.010 called?
isosthenuria
What does isosthenuria indicate?
Protein free plasma and the end stage of renal failure
What does increased specific gravity indicate?
concentrated urine (ie proteinuria, glucosuria)
What does decreased specific gravity indicate?
dilute urine (ie glomerulonephritis, pyleonephritis, diabetes insipidus)
What does foul, fishy urine odor indicate?
UTI
What does fruity, sweet urine odor indicate?
diabetes mellitus/ketosis
What does feces odor urine indicate?
asparagus, enterobladder fistula
Urinalysis chemical characteristics pH indicates the ____ of the patient.
acid-base balance
What is a normal urinalysis pH range?
4.5 - 7.5
Why does standing urine become alkaline?
due to bacterial growth and breakdown of urea
We are able to maintain normal pH primarily through reabsorption of ___ and secretion of ____ and ____ ions.
- -resorption of Na+
- -secretion of H+ and ammonium ions
What diet type will produce an acidic pH?
animal products
What diet type will produce an alkaline pH?
citrus fruits and vegetables
What are 3 pathological causes of acidic pH?
- Emphysema (respiratory acidosis)
- Ketoacidosis (metabolic acidosis)
- Diabetes mellitus
A patients UA shows the following, what do you suspect????
- -pH 4
- +2 sugar
- small amount of ketones
diabetic/ketosis
A patients UA shows the following, what do you suspect????
- -pH 4
- history of smoking
- -barrel chest
Emphysema (respiratory acidosis)
What are 3 pathological causes of alkaline pH?
- Hyperventilation (respiratory alkalosis)
- Metabolic alkalosis
- UTI
If a patient has a UTI what type of fluids would you recommend to them?
blueberry, cranberry juices to make more acidic
A patients UA shows the following, what do you suspect and recommend????
- pH 8
- 20-30 WBC’s
- 2 bacteria
UTI
- recommend cranberry juice
- rerun UA in 7 - 10 days
A patients UA shows the following, what do you suspect and recommend????
- pH 5
- 20-30 WBC’s
- 2 bacteria
UTI
- no cranberry juice, its already acid
- increase fluids
Acidic urine is associated with what 3 types of stones and should be kept alkaline.
- xanthine,
- cystein,
- uric acid
Alkaline urine is associated with what 3 types of stones and should be kept acidic?
- calcium carbonate
- -calcium phosphate
- magnesium phosphate
What protein is UA sensitive to?
Albumin
Is it normal to release protein in the urine?
Only in trace amounts… (150mg/day aka non measurable)
Albuminuria is used synonymously with…
proteinuria
Does protein in the urine indicate an upper or lower UTI?
Upper
Why is it important to always analyze for proteinuria?
Primary indicator for renal disease
What part of the nephron is damaged when proteinuria is seen?
Glomerular filter
What does a positive dipstick for proteinuria need to be confirmed with?
Sulfosalicylic Acid Precipitation Test (SSA)
A 13 year old remale patients UA shows the following, what do you suspect and recommend????
- color: yellow, clear
- pH 5
- protein +1
- urobilinogen 0.01
- spg 1.020
- WBC/HPF 0-1
- -RBC/HPF 0-2
Proteinuria
–pt consider stop exercising and redo after a few days
What is the term for when a patient presents with normal urine when supine and displays proteinuria when standing?
Orthostatic proteinuria
Orthostatic proteinuria is associated with what spinal change?
Exaggerated lumbar lordosis
Massive proteinuria (+4), frothy (white) in appearance
nephrotic syndrome