General Laboratory: Urinalysis: Clinical Significance Online Training

Continue Button Continue Continue Continue Continue Continue Course Content Master Template HILS2218 | Effective Date: 25-Mar-2022 ? Urinalysis: Clinical Significance Online Training Urinalysis test results help physicians diagnose many medical conditions and diseases. In this course you’ll learn about the results and clinical significance of tests performed using urinalysis test strips. 1 Explain normal versus abnormal values for several chemical urinalysis test results Identify certain medical conditions and diseases and describe how they can be detected by analyzing combined urinalysis test strip results 3 Describe the clinical significance of individual test results that yield abnormal values 2 Welcome 1-1-welcome.mp3 Welcome to the Routine Urinalysis Clinical Significance course. Urinalysis test results help physicians diagnose many medical conditions and diseases related to carbohydrate metabolism, urinary tract health, kidney and liver function, acid-base balance, and many other medical conditions. In this course you’ll learn about the results and clinical significance of tests performed using urinalysis test strips. You’ll also learn about several medical conditions and diseases that can be ruled in or ruled out by analyzing the combined results of tests included on urinalysis strips. This course will cover the following three learning objectives. For navigation help, select the question mark button located in the lower right corner of each slide. Urinalysis Test Results & Clinical Significance Performing a chemical analysis of urine using urinalysis strips allows laboratories to perform a single test and obtain results for a number of different analytes. Note: In the Resource tab on the upper right corner, you can download and print a chart of average normal values for routine and non-routine tests performed during a urinalysis. Select the cards on the right to learn more about normal and abnormal test results and their clinical significance. Specific Gravity pH pH Osmolality Albumin Protein Creatinine P:C ratio A:C ratio Glucose Ketones Bilirubin Blood Nitrites Leukocyte Esterase Urobilinogen ? Urinalysis Test Results & Clinical Significance 1-2-testresults.mp3 Performing a chemical analysis of urine using urinalysis strips allows laboratories to perform a single test and obtain results for a number of different tests. In this section, you will learn about normal and abnormal results for tests performed during routine chemical urinalysis. You’ll also learn the clinical significance of individual test results, which help physicians rule in or rule out many medical conditions and diseases. Please refer to the Resource tab for further information about average normal values for routine and non-routine tests performed during a urinalysis. Select the cards on the right to learn more about normal and abnormal test results and their clinical significance. ? ? Medical Conditions & Diseases Performing a chemical analysis of urine using urinalysis strips allows laboratories to perform a single test and obtain results for a number of different analytes. Note: In the Resource tab on the upper right corner, you can download and print a list of some important proteins, along with medical conditions in which they may be found. Select the cards on the right to learn more about common medical conditions and diseases as well as test parameters aid in their diagnosis. UTIs UTIs Kidney Diseases Eating Disorders Kidney Stones Kidney Stones Liver Diseases Liver Diseases Pregnancy Disorders Diabetes Medical Conditions & Diseases 1-3-medconditions.mp3 Physicians can obtain clinically relevant information to help diagnose as well as rule out many medical conditions and diseases related to carbohydrate metabolism, urinary tract health, kidney and liver function, or acid-base balance by analyzing the combined results of certain test parameters available on urinalysis test strips. In this section, you’ll get an overview of some common medical conditions and diseases as well as view which test parameters performed during a urinalysis aid in their diagnosis. Please refer to the Resource tab for further information about important proteins, along with medical conditions in which they may be found. Select the cards on the right to learn more about common medical conditions and diseases as well as test parameters aid in their diagnosis. ? Course Review Congratulations. You have completed the Urinalysis: Clinical Significance Online Training course. Select the numbered buttons below to review the material before proceeding to the final assessment. Explain normal versus abnormal values for several chemical urinalysis test results 1 1 1 Describe the clinical significance of individual test results that yield abnormal values 2 2 2 Identify certain medical conditions and diseases and describe how they can be detected by analyzing combined urinalysis test strip results 3 3 3 Course Review Certain medical conditions and diseases and how they can be detected Please refer to the Resource tab to download and print a list of some important proteins, along with medical conditions in which they may be found. Clinical significance of individual test results Table with 4 columns and 6 rows Specific Gravity Low: Diabetes insipidus High: Adrenal insufficiency Fixed: Isosthenuric Glucose Pathological: Diabetes mellitus Benign: Emotional stress pH Indicates acidic / alkaline urine, kidney tubular acidosis, kidney stones Bilirubin Detects liver dysfunction (jaundice, clinical illness) Osmolality High: Inappropriate ADH secretion, dehydration, glycosuria, etc. Low: Diabetes insipidus, excess hydration, acute renal insufficiency, etc. Ketones Ketonuria: Diabetes mellitus, fevers, anorexia, gastrointestinal, cachexia, neurological disorders, etc. Ketosis: Diabetic acidosis Albumin Microalbuminuria can indicate glomerular kidney damages Blood Indicates infectious disease, neoplasms, transfusion reaction, poisoning, severe burns, traumatic muscle injury, etc. Creatinine Used to calculate P:D and/or A:C ratios Nitrite, Leukocyte Esterase Used to detect urinary tract infection P:C Ratio Detects higher levels of protein A:C Ratio Detects low levels of albuminuria Normal values for chemical urinalysis test results Please refer to the Resource tab to download and print a chart of average normal values for routine and non-routine tests performed during a urinalysis. 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Assessment questions must be answered completely to receive full credit. Partial credit will not be given for assessment questions that require multiple answers. You may repeat the assessment as many times as needed. Assessment Select the best answer. ? Question 1 of 10 Which specific gravity in a random urine specimen indicates normal concentrating ability? 1.025 or above 1.000 or below 1.010 Multiple Choice Incorrect Incorrect Correct Select the best answer. ? Question 2 of 10 In diseases where tubular damage renders the kidney incapable of concentrating urine, what would the specific gravity test results be? Low High Normal Multiple Choice Incorrect Incorrect Correct Select the best answer. ? Question 3 of 10 Which of the following does the kidney stone formation significantly depend on? pH Osmolality Temperature Multiple Choice Incorrect Incorrect Correct Select the best answer. ? Question 4 of 10 What is usually the pH of urine excreted by people with (1) an uncontrolled diabetes mellitus and (2) a urinary tract infection? Highly acidic, highly alkaline Highly alkaline, highly acidic Acidic, alkaline Multiple Choice Incorrect Incorrect Correct Select the best answer. ? Question 5 of 10 The average normal concentration of protein in the urine varies from 2 to 8 mg/dL. Urinalysis test strips are sensitive to about 15 to 30 mg/dL of protein. What is the urine protein test results for a normal sample? Negative Protein Trace Multiple Choice Incorrect Incorrect Correct Select the best answer. ? Question 6 of 10 Which of the following is indicated at 20-200 mg/L and may be detected in people with kidney damage? And at which state of the disease can it be found? Microalbuminuria, early Microalbuminuria, late Albuminuria, early or late Multiple Choice Incorrect Incorrect Correct Select the best answer. ? Question 7 of 10 What is diabetes insipidus characterized by? Low osmolality, low specific gravity, and polyuria Glycosuria and ketonuria Anuria Multiple Choice Incorrect Incorrect Correct Select the best answer. ? Question 8 of 10 The concentration of bilirubin excreted in the urine follows the concentration of which of the following? Conjugated bilirubin Unconjugated bilirubin Conjugated and unconjugated bilirubin Multiple Choice Incorrect Incorrect Correct Select the best answer. ? Question 9 of 10 Why is the leukocyte esterase test often used in conjunction with the nitrite test if the clinician suspects urinary tract infections? Bacteria in the absence of WBCs could be due to contamination of the specimen The leukocyte esterase test indicates that bacteria are present The nitrite test indicates that WBCs are present Multiple Choice Incorrect Incorrect Correct Select the best answer. ? Question 10 of 10 Which of the following will be presented with disease processes that cause an excessive destruction of red blood cells, such as in hemolytic anemias? Hemoglobinuria and urobilinogenuria Bilirubinuria and hemoglobinuria Bilirubinuria Multiple Choice Incorrect Incorrect Correct Assessment Results YOUR SCORE: PASSING SCORE: Review Retry Retry Continue Continue Continue %Quiz1.ScorePercent%% %Quiz1.PassPercent%% ? Assessment Results You did not pass the course. Take time to review the assessment then select Retry to continue. Congratulations. You passed the course.. Exit To access your Certificate of Completion, select the Launch button drop down on the course overview page. You can also access the certificate from your PEPconnect transcript. ? You have completed the Urinalysis: Clinical Significance Online Training. Completion Navigation Help Select the icon above to open the table of contents. Click Next to continue. Next Welcome Slide The timeline displays the slide progression. Slide the orange bar backwards to rewind the timeline. Click Next to continue. Next Tmeline Select the CC icon to display closed captioning (subtitles). Click Next to continue. Next Caption Icon Select the X to close the pop-up. Click Next to continue. Next Layer Slide Select Submit to record your response. Click the X in the upper right corner to exit the navigation help. Assessment Slide Knowledge Check: Chemical Analysis of Urine Knowledge Check You have just learned about the kidney structure and its functions. Select Start to test your knowledge of the presented content. Start ? Knowledge Check Ketonuria … is the condition seen in patients with diabetes mellitus. The A:C ratio 30-300 mg/g test … is a good indicator of early kidney damage associated with diabetes. Bilirubinemia … is the condition seen in patients with liver disease. Drag each response from the right column to its corresponding item in the left column. What is the description of the following conditions? ? Question 1 of 2 Matching Incorrect One or more answers are incorrect. Correct Polyuria and low specific gravity conditions … characterize patients with diabetes insipidus. Drag each response from the right column to its corresponding item in the left column. What is the description of the following conditions? Proteinuria ? Question 2 of 2 … is the condition that is considered one of the most important indicators of kidney disease. Matching Incorrect One or more answers are incorrect. Correct Knowledge Check Completion Review Retry Continue Continue ? You have just completed the Knowledge Check. Select Review to assess how your responses compare to the correct answers. Select Retry to test your knowledge again or select Continue to advance through the course. Knowledge Check Completion Knowledge Check: Medical Conditions & Diseases Knowledge Check You have just learned about collecting urine specimens. Select Start to test your knowledge of the presented content. Start ? Knowledge Check UTI … is assessed by confirming positive nitrate, positive leukocyte esterase, positive blood, and alkaline pH test results. Kidney disease … is assessed by confirming protein, albumin, leukocytes, and blood in urine as well as cellular casts. Kidney stones … are assessed by reviewing blood, pH, and specific gravity test results. Drag each response from the right column to its corresponding item in the left column. How are these following conditions be assessed? ? Question 1 of 2 Matching Incorrect One or more answers are incorrect. Correct Diabetes … is assessed by reviewing glucose, ketones, A:C ratio, nitrate, and leukocyte esterase test results. Eating disorder … is assessed by reviewing ketones and specific gravity test. Drag each response from the right column to its corresponding item in the left column. How are these following conditions be assessed? ? Question 2 of 2 Matching Incorrect One or more answers are incorrect. Correct Knowledge Check Completion Review Retry Retry Continue Continue ? You have just completed the Knowledge Check. Select Review to assess how your responses compare to the correct answers. Select Retry to test your knowledge again or select Continue to advance through the course. Knowledge Check Completion Test Results ? Specific Gravity Urine specific gravity ranges from 1.003 to 1.030, but usually falls between 1.010 and 1.025. Specific gravity is highest in the first-morning specimen, with levels typically greater than 1.020 A specific gravity of 1.025 or above in any random urine specimen indicates normal concentrating ability Note: Water has a specific gravity of 1.000. Since urine is a solution of minerals, salts, and organic compounds in water, the specific gravity of normal urine is greater than 1.000. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results Specific Gravity If test results are questionable or inconsistent with expected results, perform creatinine and osmolality tests. Note: Abnormally high amounts of some of the urinary constituents such as glucose, or the presence of X-ray contrast media may increase the specific gravity as measured by some procedures, such as the Total Solids (TS) Meter and the urinometer. However, the colorimetric strip test is not affected by such materials and thus gives a more clinically relevant specific gravity. Other Facts Low Specific Gravity: diabetes insipidus is a disease characterized by large volumes of urine with low specific gravity between 1.001 and 1.003. Low specific gravity may also occur in people with glomerulonephritis, pyelonephritis, and various kidney anomalies. In these cases, tubular damage renders the kidney incapable of concentrating urine. High Specific Gravity: specific gravity is high in people with adrenal insufficiency, hepatic disease, and congestive cardiac failure. It is also elevated in cases where there has been excessive loss of water, as with sweating, fever, vomiting, and diarrhea. Fixed Specific Gravity: urine with a fixed low specific gravity (approximately 1.010), which varies little from specimen to specimen, is known as isosthenuric. This condition is indicative of severe kidney damage with disturbance of both the concentrating and diluting abilities of the kidney. Clinical Significance ? pH Urine pH is a measure of its hydrogen ion concentration. A pH below 7 indicates acidic urine A pH above 7 indicates alkaline urine Normal kidneys are capable of producing urine that can vary from a pH of 4.5 to slightly higher than 8.0. Freshly voided urine from people not on special diets is acidic and has a pH of about 6.0. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results 7 14 0 Acidic Neutral Alkalotic pH If test results are questionable or inconsistent with expected results, measure the urine pH using a pH meter for confirmation. Other Facts Secretion of an acidic urine or alkaline urine by the kidneys is one of the most important mechanisms the body uses to maintain the body’s normal acid-base balance. The following conditions can be caused by acid-base imbalances: Acidic Urine Kidney Tubular Acidosis Alkaline Urine Kidney Stones Clinical Significance ? Osmolality Normal urine osmolality ranges between 50 - 1400 mOsm/kg water, and averages about 500 - 800 mOsm/kg. A random urine osmolality should average between 300 - 900 mOsm/kg. Clinical Significance Clinical Significance Test Results Test Results Test Results Osmolality A higher-than-normal result may indicate inappropriate ADH secretion, dehydration, glycosuria, adrenal insufficiency, or high protein diet. A lower-than-normal result may indicate diabetes insipidus, excess hydration, acute renal insufficiency, or glomerulonephritis. Clinical Significance ? Protein The protein results on urinalysis test strips are reported when using the plus system of results as negative (yellow color), trace, or 1+ to 4+ positive range. Trace readings may detect 15 to 30 mg/dL of protein Plus (+) readings approximate protein concentrations of 30, 100, 300, and over 2,000 mg/dL, respectively Between 40 and 80 mg of protein are excreted daily, but as much as 100 to 150 mg maybe considered normal. The average normal concentration of protein in the urine varies from 2 to 8 mg/dL. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results This slide contains audio. Protein 5-4-protein_1.mp3 The protein results on urinalysis test strips are reported when using the Plus system of results as negative (yellow color), trace, or 1+ to 4+ positive range. These readings are reliable indicators of increasingly severe proteinuria. Albumin reacts with the indicator more strongly than the other proteins. Highly buffered, alkaline urine may give false positives when the buffer system in the reagent area is overcome. Normally, between 40 and 80 mg of protein are excreted daily, but as much as 100 to 150 mg per day may be considered normal. Since the average daily urine volume may range from 1,000 to 1,500 mL, the average normal concentration of protein in the urine varies from 2 to 8 mg/dL. This wide range of normal values is the result of biological variations and differences in the methods used for the determination of protein. 5-4-protein_2.mp3 Proteinuria refers to an increased amount of protein in the urine and is one of the most important indicators of kidney disease. Detection of protein in the urine, combined with the microscopic examination of the urinary sediment, forms the basis of the differential laboratory diagnosis of kidney disorders. Proteinuria may, at times, reflect urinary tract or physiological conditions rather than intrinsic kidney disorders. The types of proteins excreted in disease states are typically related to serum proteins. In fact, in severe cases, they are the serum proteins. Smaller proteins, such as albumin and alpha-1 globulin, are excreted more readily than larger proteins. Albumin constitutes between 60% and 90% of protein excreted in most disease states. Certain diseases are characterized by the excretion of specific globulins rather than by a diffuse proteinuria. The urine of people with multiple myeloma contains increased amounts of a low molecular weight globulin (Bence Jones protein). Proteinuria depends on the precise nature of the clinical and pathological disorder and upon the severity of the specific disease. Some examples are shown here. If test results are questionable or inconsistent with expected results, run a quantitative urine protein for confirmation. Other Facts Proteinuria refers to an increased amount of protein in the urine. Smaller proteins, such as albumin and alpha-1 globulin, are excreted more readily than larger proteins. Albumin constitutes between 60% and 90% of protein excreted in most disease states. Proteinuria depends on the precise nature of the clinical and pathological disorder and upon the severity of the specific disease. Some examples are: Transient proteinuria Minimal proteinuria Marked proteinuria Postural proteinuria Moderate proteinuria Functional proteinuria Clinical Significance ? Albumin Albuminuria and microalbuminuria both refer to the presence of albumin in the urine. The difference between the two is in the quantity of albumin detected. Albuminuria is indicated at 20 mg/dL albumin and may be detected in people with kidney damage either early or late in the course of the disease Microalbuminuria is indicated at 20-200 mg/L albumin per urine sample. It describes the very low levels of albumin found in the urine in the absence of other clinical signs or symptoms of kidney damage, and is a good indicator of early kidney damage, especially in people with diabetes Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results Albumin If test results are questionable or inconsistent with expected results, run a quantitative urine albumin for confirmation. Other Facts Microalbuminuria is an accepted early marker for kidney damage in groups such as those with diabetes. Microalbuminuria constitutes the critical factor in the routine test for glomerular kidney damage, especially in the case of diabetes. If the microalbuminuria test is positive, it is recommended that the test be repeated within six to eight weeks. A positive test result should be defined as two out of the three tests being positive to assure persistent rather than intermittent positive results. Clinical Significance ? Creatinine The normal creatinine concentration in adults is 0.6 to 2.0 gram of creatinine per day (strip results of approximately 50 to 200 mg/dL), with men having higher values than women due to muscle mass. Random urine may have strip results that vary from 10 to 300 mg/dL Concentrated urine from dehydrated individuals, or first-morning specimens, will typically have elevated concentrations (strip results of > 200 mg/dL) Diuresis will typically result in lower concentrations (strip results of < 50 mg/dL) Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results Creatinine If test results are questionable or inconsistent with expected results, run a quantitative urine creatinine for confirmation. Other Facts The value of the creatinine test is that it can be used to calculate P:C and/or A:C ratios that correct for varying urine concentrations. It provides meaningful results from random samples and minimizes the need for inconvenient timed or 24-hour urine samples. Creatinine is reported as a separate result for quality control purposes. Clinical Significance ? P:C ratio A "normal" P:C ratio result indicates that the P:C ratio of the sample is below the cutoff. A "normal dilute" P:C ratio result indicates that the sample may be too dilute to reliably detect protein. If a "normal dilute" result is obtained, consider recollecting the sample, preferably a first-morning collection to obtain a more concentrated sample. A P:C ratio of 150 mg/g is considered abnormal and should prompt the physician to evaluate the patient for early kidney disease. Values > 300 mg/g are indicative of clinical proteinuria. Clinical proteinuria is indicated at a P:C ratio result of > 300 mg/g or SI units of 33.0 mg/mmol. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results P:C ratio If test results are questionable or inconsistent with expected results, run a quantitative urine protein and a urine creatinine for confirmation. Other Facts The P:C ratio result is adjusted for varying urine concentration; therefore, an abnormal P:C ratio is an indicator of kidney disease. The patient should be tested with a quantitative method and if the abnormal result is confirmed, a nephrologist or other specialist should be consulted. The P:C ratio test detects higher levels of protein than the A:C ratio, and is therefore more appropriately used with a broader population. Clinical Significance ? A:C ratio An A:C ratio of 30 - 300 mg/g (SI units = 3.4 - 33.9 mg/mmol) is abnormal, and defined as microalbuminuria. An A:C ratio of > 300 mg/g (SI units > 33.9 mg/mmol) is defined as albuminuria. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results A:C ratio If test results are questionable or inconsistent with expected results, run a quantitative urine protein and a urine creatinine for confirmation. Other Facts The A:C ratio detects very low levels of albumin (microalbuminuria), and is therefore most appropriate for testing people with diabetes. Clinical Significance ? Glucose Small amounts of glucose are normally excreted into the urine. This level is normally below the sensitivity of the test, but on occasion may produce a color that is between the negative color block and 100 mg/dL color block. Certain individuals have a reduced kidney threshold that results in glucose being excreted into the urine when the blood glucose level has not reached the "normal" kidney threshold level of approximately 180 mg/dL. In these cases, physiologically normal blood glucose levels can result in glucose being found in the urine. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results Glucose 5-9-glucose_2.mp3 The presence of detectable amounts of glucose in urine is known as glycosuria. Glycosuria occurs whenever the blood glucose level exceeds the reabsorption capacity of the kidney tubules (kidney threshold); that is, when the glomerular filtrate contains more glucose than the tubules can reabsorb. The condition may be either benign or pathological; the physician must distinguish between the two types. Diabetes mellitus, a pathological state, is the chief cause of glycosuria. This condition is associated with a marked elevation of blood glucose and usually an increase in urine volume. The glucose content of diabetic urine may reach as high as 10% (10,000 mg/dL), though 2-5% (2,000-5,000 mg/dL) is more common. Kidney glycosuria occurs with normal blood glucose levels when tubular reabsorption of glucose is below normal, thus permitting some glucose to spill into the urine. This is a benign condition, as is the occurrence of glycosuria after eating a heavy meal or in conjunction with emotional stress. If test results are questionable or inconsistent with expected results, run a serum glucose test for confirmation. Other Facts The presence of detectable amounts of glucose in urine is known as glycosuria, this condition may be either benign or pathological. Diabetes mellitus, a pathological state, is the chief cause of glycosuria. The glucose content of diabetic urine may reach as high as 10% (10,000 mg/dL), though 2-5% (2,000-5,000 mg/dL) is more common. Kidney glycosuria occurs with normal blood glucose levels when tubular reabsorption of glucose is below normal, thus permitting some glucose to spill into the urine. This is a benign condition. Clinical Significance This slide contains audio. ? Ketones Detectable levels of ketones may occur in urine during physiological stress conditions such as fasting, pregnancy, and frequent strenuous exercise. In ketoacidosis, starvation, or with other abnormalities of carbohydrate or lipid metabolism, ketones may appear in urine in large amounts before serum levels are elevated. High protein/low carbohydrate diets are also known to produce ketones in the urine. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results Ketones 5-10-ketones_2.mp3 Diabetes mellitus is the most important disorder in which ketonuria occurs. Ketonuria also accompanies the restricted carbohydrate intake that occurs in association with fevers, anorexia, gastrointestinal disturbances, fasting, starvation, cyclic vomiting, pernicious vomiting of pregnancy, and cachexia. It also occurs following anesthesia and as a result of certain neurological disorders. When diabetes is untreated or inadequately treated, excessive amounts of fatty acids are metabolized, resulting in the accumulation of ketone bodies in the blood (ketosis), which are excreted in urine (ketonuria). Ketone bodies are excreted in combination with normal basic ions, leading to a reduction in the carbon dioxide-combining power and causing systemic acidosis. Progressive diabetic ketosis is the cause of diabetic acidosis, which can eventually lead to coma and even death. The term ketoacidosis is frequently used to designate the combined ketosis and acidosis of diabetes. If test results are questionable or inconsistent with expected results, run serum B-hydroxybutyric acid and electrolytes for confirmation. Other Facts When diabetes is untreated or inadequately treated, excessive amounts of fatty acids are metabolized, resulting in the accumulation of ketone bodies in the blood (ketosis), which are excreted in urine (ketonuria). Clinical Significance This slide contains audio. ? Bilirubin Bilirubin appears in the urine at a concentration of approximately 0.02 mg/dL, reflecting the normally low blood levels of conjugated bilirubin. This amount is not detected by routine qualitative or semi-quantitative techniques. Urinalysis test strip results are reported when using the Plus system of results as negative or small (+), moderate (++), or large (+++) amounts of bilirubin. The test has a sensitivity of 0.4 to 0.8 mg/dL bilirubin. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results Bilirubin 5-11-bilirubin_2.mp3 Bilirubin excretion in the urine will reach significant levels in any disease process that increases the amount of conjugated bilirubin in the bloodstream. In some liver diseases due to infectious or hepatotoxic agents, liver cells are unable to excrete all of the conjugated bilirubin into the bile. Therefore, sufficient amounts are returned to the blood to elevate blood levels and cause significant bilirubinuria. In obstructive biliary tract disease, biliary stasis interferes with the normal excretion of conjugated bilirubin via the intestinal tract. This causes a buildup in the bloodstream with resulting bilirubinuria. Bilirubin may appear in the urine before other signs of liver dysfunction (jaundice, clinical illness) are apparent. An increase in the amount of unconjugated bilirubin in the circulation will not change the amount of bilirubin excreted in the urine. This increase of unconjugated bilirubin in the circulation occurs in hemolytic anemias because the greater release of hemoglobin leads to greater production of albumin-bound bilirubin. However, a normal, non-diseased liver can conjugate all the excess bilirubin and excrete the entire amount into the biliary tract. Bilirubin is an unstable compound that disappears from urine on standing, especially if exposed to light. It is very important that urine be tested for bilirubin as soon after excretion as possible. The instability and reactivity of bilirubin and its derivatives are shown in the table. If test results are questionable or inconsistent with expected results, use the Ictotest Reagent Tablet plus run serum bilirubin and liver enzymes for confirmation. Other Facts Table with 6 columns and 3 rows Glucuronide - Bilirubin - Glucuronide Soluble and reactive On Standing Glucuronide - + Hydrolosis Glucuronide + Free Bilirubin Insoluble and less reactive On Standing Glucuronide - + Oxidation: Glucuronide + Biliverdin Green and non-reactive In some liver diseases due to infectious or hepatotoxic agents, liver cells are unable to excrete all of the conjugated bilirubin into the bile. Therefore, sufficient amounts are returned to the blood to elevate blood levels and cause significant bilirubinuria. Clinical Significance This slide contains audio. ? Blood Normally, there is no detectable amount of occult blood present in urine, even with very sensitive chemical methods. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results Blood If test results are questionable or inconsistent with expected results, perform a standard microscopic examination. Other Facts The presence of blood in urine, as indicated by a positive test for occult blood, most likely indicates bleeding in the urinary tract. This may occur in a variety of kidney disorders, infectious disease, neoplasms, or trauma affecting any part of the urinary tract. Hemoglobinuria is likely to be found in any of the above disorders as well as transfusion reaction, hemolytic anemia, or paroxysmal hemoglobinuria. It may also appear in various poisonings, or following severe burns A positive chemical test without the presence of red blood cells may indicate myoglobinuria as a result of traumatic muscle injury Clinical Significance ? Nitrites Positive results: positive tests for nitrite and leukocyte esterase on any random urine specimen generally indicates bacteriuria and often prompts the physician to immediately initiate therapy. Negative results: a negative test result should never be interpreted as an absence of bacteriuria. There are several reasons for this: First-morning urine: is more likely to yield a positive nitrite test result in the presence of significant bacteriuria than a random urine sample that may have been in the bladder only a short time In the latter type of specimen, there may have been insufficient time for the conversion of nitrate to nitrite by the infecting bacteria Some strains of urinary pathogens do not produce the enzyme necessary to reduce nitrate to nitrite, but these organisms are the least common pathogens A negative test result may occur if dietary nitrates are absent Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results This slide contains audio. Nitrites 5-13-nitrites_1.mp3 The combination of positive reactions for both nitrite and leukocyte esterase indicates the need to perform a microscopic examination of the urine sediment for White Blood Cells and bacteria, or directly confirm bacteriuria and Urinary Tract Infection by microbiological culture testing. Positive tests for nitrite and leukocyte esterase on any random urine specimen generally indicates bacteriuria and often prompts the physician to immediately initiate therapy. A negative test result should never be interpreted as an absence of bacteriuria. There are several reasons for this, which are listed on this slide. 5-13-nitrites_2.mp3 Significant urinary tract infections may be present in people experiencing no symptoms. Despite an absence of symptoms, these infections are serious because they have the potential for causing severe kidney damage before the person is aware of them. This condition is known as significant asymptomatic bacteriuria. The availability of simple, inexpensive, semi-quantitative methods for detecting bacteriuria makes it easy for physicians to test high-risk patients with and without symptoms for bacteriuria. High-risk patients include pregnant women, school children (especially girls), people who are pregnant or elderly, or people who have diabetes or a previous history of urinary tract infections. Gram-negative bacteria of the types normally present in the large intestine are the organisms most commonly identified in urinary tract infections. If test results are questionable or inconsistent with expected results, perform a standardized microscopic examination and a urine culture for confirmation. Other Facts Bacteriuria is considered significant when microbiological laboratory findings show the presence of 100,000 (105) or more bacteria per mL in 3 separate urine specimens. If bacteria from an external source contaminates an otherwise "sterile specimen", the count may be as low as 10,000 (104) or even 1,000 (103) or less per mL. When the count is between 103 and 105, the possibility of an incipient urinary tract infection is suggested. Significant urinary tract infections may be present in people experiencing no symptoms. This condition is known as significant asymptomatic bacteriuria. Clinical Significance ? Leukocyte esterase Leukocyte esterase test results when using the Plus system of reporting range from negative, trace, small (+), moderate (++), and large (+++). The test may detect levels as low as 5 - 15 cells/µL in clinical urine. Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results Leukocyte esterase If test results are questionable or inconsistent with expected results, perform a standardized microscopic examination and a urine culture for confirmation. Other Facts Like the nitrite test, the leukocyte esterase test is useful in detecting urinary tract infections. This is because normal urine does not contain large numbers of white blood cells, but infected urine does. Leukocyte esterase is often used in conjunction with the nitrite test when the clinician suspects infection. Clinical Significance ? Urobilinogen Normally, between 1 and 4 mg (1 to 4 Ehrlich units) of urobilinogen is excreted in urine in a 24-hour period. The concentration of urobilinogen in a random normal urine is 0.1 to 1.0 Ehrlich unit/dL (1 EU/dL - 1 mg/dL). Clinical Significance Clinical Significance Other Facts Other Facts Test Results Test Results Test Results Urobilinogen 5-15-urobilinogen_2.mp3 Urinary urobilinogen is increased by any condition that causes an increase in the production of bilirubin and by any disease that prevents the liver from normally removing the re-absorbed urobilinogen from the portal circulation. It is also increased whenever there is excessive destruction of red blood cells, as in hemolytic anemias, pernicious anemia, and malaria, as well as with infectious hepatitis, toxic hepatitis, portal cirrhosis, or congestive heart failure. More comprehensive information is obtained when the physician can correlate test results for both bilirubinuria and urobilinogenuria. As indicated in this table, the two findings, considered together, provide more helpful information for differential diagnosis than either finding alone. If test results are questionable or inconsistent with expected results, repeat the test using a fresh sample for confirmation. Other Facts Urinary urobilinogen is increased by any condition that causes an increase in the production of bilirubin and by any disease that prevents the liver from normally removing the re-absorbed urobilinogen from the portal circulation. Clinical Significance Table with 5 columns and 3 rows Healthy Hemolytic Disease Hepatic Disease Biliary Obstruction Urine Urobilinogen Normal Increased Increased Low or Absent Urine Bilirubin Negative Negative Positive or Negative Positive This slide contains audio. Medical Conditions ? UTIs (Urinary Tract Infection) UTIs are among the most common medical problem encountered in primary care practice. 40-50% of women will have at least one UTI diagnosed in their lifetime 25% of all identified infections among the elderly population are UTIs. These represent the second most common form of infection 30% of infections recur in 3 months, 60% recur within 1 year, and 80% recur within 2 years 6.7 million physician office visits result in a UTI diagnosis and 2.6 million ER visits result in a UTI diagnosis Diagnostic Tests Diagnostic Tests Other Facts Other Facts Overview Overview Overview UTIs Some urinary tract infections do not produce symptoms and, if undetected for a long time, can cause damage to the kidneys or urinary system. This situation, called asymptomatic bacteriuria, is most common in young women, pregnant women, and people with diabetes. Other Facts In combination, the following tests were found to be a better predictor of the presence or absence of UTIs, than any one parameter alone: Nitrite: detects nitrate-reducing, gram-negative bacteria Leukocyte: detects leukocyte esterase found in white blood cells Blood: may indicate damage to the urinary tract pH: typically high or alkaline if UTI is present Urinalysis test strips are an effective "rule-out" tool for people with suspected UTI. A key advantage of combining the results of leukocyte and nitrite is that if both tests are negative, very few UTIs will be missed. Diagnostic Tests ? Kidney Disease Kidney disease is recognized as a public health problem. In the United States: 1 in 9 adults (or 20 million persons) have chronic kidney disease More than 20 million adults are at increased risk and may be unaware Incidence of end-stage renal disease (ESRD) is increasing by 6% per year The presence of continuous proteinuria, and/or the presence of cellular casts observed by microscopic examination of the urine sediment, may indicate that a patient's kidneys are not functioning properly. In addition, if blood is also found in the urine, this may give further clues regarding compromised kidney function. Diagnostic Tests Diagnostic Tests Other Facts Other Facts Overview Overview Overview Kidney Disease A single urinalysis test strip can measure both the protein and creatinine or both the albumin and creatinine, at the same time, to correct for varying urine concentration. The P:C and/or A:C ratios in a first-morning or random, untimed "spot" urine specimen are effective for the clinical evaluation of people at an increased risk of developing chronic kidney disease. The P:C and A:C ratios are recognized by the National Kidney Foundation and the American Diabetes Association as diagnostic indicators of the presence of kidney disease. These tests, along with testing for the presence of blood and leukocytes, help physicians detect early stages of kidney disease in people who are at risk for kidney damage, enabling fast initiation of therapy to slow or stop the progression of kidney damage. Other Facts The following tests provide useful information regarding kidney disease: Protein: detects the presence of proteinuria which may be caused by kidney malfunction Albumin: a common type of urine protein Leukocyte: indicates urinary tract infections that can lead to kidney disorders Blood: detects blood in urine, which may indicate damage to the kidney P:C Ratio & A:C Ratio: correct for varying urine concentration, which improves the accuracy of result interpretation, without a timed or 24-hour urine collection Diagnostic Tests ? Kidney Stones There are over 1 million cases of kidney stones reported in the U.S. annually. Kidney stone formation depends significantly on the pH of urine. Phosphate and calcium carbonate stones develop in alkaline urine Uric acid, cystine, and calcium oxalate stones precipitate in acid urine Diagnostic Tests Diagnostic Tests Overview Overview Overview Kidney Stones The following tests provide useful information regarding kidney stones: Blood: may indicate damage to the kidney pH: used to determine type of stone Specific Gravity and/or Creatinine: provides a relative indication of urine concentration or dilution Diagnostic Tests ? Liver Disease In the U.S., 400,000 persons have chronic liver disease, which is the seventh leading disease-related cause of death. Diagnostic Tests Diagnostic Tests Other Facts Other Facts Overview Overview Overview Liver Disease Urinary bilirubin reaches significant levels in disease processes that increase the amount of conjugated bilirubin in the bloodstream. This can occur before other signs of liver dysfunction (jaundice, clinical illness) are apparent. Urinary urobilinogen can also indicate liver problems, as well as certain types of anemia. Consequently, when urobilinogen and bilirubin results are considered together, they provide more helpful information for differential diagnosis than either finding alone. Other Facts Table with 5 columns and 3 rows Healthy Hemolytic Disease Hepatic Disease Biliary Obstruction Urine Urobilinogen Normal Increased Increased Low or Absent Urine Bilirubin Negative Negative Positive or Negative Positive The following tests, when analyzed in combination, provide more useful information regarding liver function than any one test finding alone. Bilirubin: may indicate abnormalities affecting the liver or biliary system Urobilinogen: serves as an aid in detecting and differentiating liver disease, hemolytic disease, and biliary obstruction Specific Gravity: provides a relative indication of whether other test results are affected by urine concentration or dilution Diagnostic Tests ? Diabetes In the United States: 18.2 million people (6.3% of the population) have diabetes An additional 20 million Americans have pre-diabetes 5.2 million people are unaware that they have the disease 5-10% of Americans have type 1 diabetes Diagnostic Tests Diagnostic Tests Other Facts Other Facts Overview Overview Overview Diabetes The ketone test helps assess the severity of diabetes and avoid progressive diabetic ketosis, which can eventually lead to coma and even death. The American Diabetes Association recommends the annual measurement of microalbuminuria in all people with type 2 diabetes, and in people with type 1 diabetes with at least 5 years disease duration to aid in the early detection of kidney disease. Nitrite and leukocyte tests help detect urinary tract infections, which are relatively common complications of diabetes. Other Facts The following tests provide useful information regarding diabetes when performing a routine examination and/or managing people with confirmed diabetes. Glucose: may detect unsuspected diabetes Ketones: may detect early ketoacidosis in confirmed diabetics A:C Ratio (Microalbuminuria): may detect early kidney damage associated with diabetes Nitrite: detects nitrate-reducing (usually gram-negative) bacteria Leukocyte: detects leukocyte esterase found in white blood cells Diagnostic Tests ? Pregnancy Disorders Urinary testing for glycosuria during pregnancy is routinely performed to diagnose gestational diabetes, which accounts for 33% of all pregnancy-related diabetes. Urinary protein tests are done to aid in the diagnosis of pre-eclampsia, a condition of hypertension and proteinuria that occurs in pregnancy and affects about 4% of all pregnancies (mother and unborn) and may advance rapidly with few other symptoms. Diagnostic Tests Diagnostic Tests Overview Overview Overview Pregnancy Disorders The following tests may be useful in managing women during pregnancy: Glucose: may indicate gestational diabetes Protein: may indicate pre-eclampsia during pregnancy Diagnostic Tests ? Eating Disorders Eating disorders represent the highest mortality rate than any other mental illness. In the U.S., 8 million persons have an eating disorder and 90% are women. 1 in 20 women suffer from anorexia 2 in 100 women suffer from bulimia Diagnostic Tests Diagnostic Tests Overview Overview Overview Eating Disorders The following tests, when analyzed in combination, provide useful information regarding proper hydration that may be compromised for people diagnosed with eating disorders, such as anorexia nervosa and bulimia nervosa. Ketones: detect the presence of ketones in urine that may indicate starvation or vomiting Specific Gravity: a high value may indicate excessive vomiting Diagnostic Tests Question Bank 1 HILS2296 | Effective Date: 05-Oct-2022 Average Normal Values for Urine Determinations Important Proteins and their Underlying Conditions Aliquot A measured amount of solution (n). To divide a solution into measured amounts (v). Anatomic Pathology A medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, and molecular examination of organs, tissues, and whole bodies (autopsy). Capillary One of the minute blood vessels between the terminations of the arteries and the beginnings of the veins. These blood vessels form an intricate network throughout the body for the interchange of various substances, such as blood gases, nutrients, waste products and water between blood and tissue cells. Centrifuge An apparatus that rotates at high speed and by centrifugal force separates substances of different densities such as serum and cell, or urine and sediment. Clinical Pathology A subspecialty of pathology focusing on theoretical and technical aspects of the diagnosis and prevention of disease and patient care; using laboratory methods in clinical diagnosis. Proficiency Testing A system of testing unknown samples to assess the reliability of the laboratory's analysis. Quality Control A real-time system that uses standards to accurately control materials, and to constantly monitor the accuracy and precision of all tests run in the laboratory. Most labs use a statistical system to monitor when test results fall outside of acceptable limits (standard deviation). Venipuncture Collection of blood specimen from a vein for laboratory testing. 1.1 Welcome 1.2 Urinalysis Test Results & Clinical Significance 3.1 Knowledge Check 1.3 Medical Conditions & Diseases 4.1 Knowledge Check 1.4 Course Review 1.5 Disclaimer 1.6 Assessment