Laboratory Quality Assessment Quiz
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Questions and Answers

What is the primary goal of an effective quality assessment program in a laboratory setting?

  • To guarantee the consistent use of standard precautions.
  • To ensure all patients are properly educated about their tests.
  • To ensure the laboratory is functioning correctly and within regulatory guidelines.
  • To obtain consistent and accurate test results, unaffected by procedural or personnel variations. (correct)

    • Which body fluid is considered potentially infectious and requires standard precautions?

  • Blood
  • Urine
  • Saliva
  • All of the above (correct)

    • When handling urine samples, why is proper mixing essential?

  • To aid in the preservation of the sample for longer storage.
  • To ensure uniformity and accuracy of the sample for testing. (correct)
  • To eliminate any potential for sedimentation.
  • To activate chemical reactions within the urine.

    • In the context of urine sample handling, why is labeling the urine cup, not the lid, crucial?

    <p>The urine cup holds the sample and cannot be exchanged. (C)</p> Signup and view all the answers

    Regarding preanalytical components of quality assurance, what does the term 'patient education, preparation, and instructions' encompass?

    <p>Providing directions on how to properly collect and submit specimens. (A)</p> Signup and view all the answers

    What medical term is used to refer to the kidneys?

    <p>Nephr/o, ren/o (D)</p> Signup and view all the answers

    Where does the process of urine formation initiate?

    <p>Kidneys (B)</p> Signup and view all the answers

    The content states that the average adult filters approximately 200 liters of blood every day. Which of these statements BEST explains this process?

    <p>The body's total blood volume is filtered approximately 60 times throughout the day, resulting in a total of 200 liters of filtered blood. (A)</p> Signup and view all the answers

    What is the main function of the kidneys in maintaining homeostasis?

    <p>All of the above (D)</p> Signup and view all the answers

    Where does most of the water reabsorption occur in the nephron?

    <p>Proximal Convoluted Tubule (A)</p> Signup and view all the answers

    Which of the following is NOT a function of Angiotensin II?

    <p>Increase glomerular filtration rate (A)</p> Signup and view all the answers

    What is the functional unit of the kidney?

    <p>Nephron (A)</p> Signup and view all the answers

    Which of the following conditions is characterized by the involuntary discharge of urine?

    <p>Enuresis (D)</p> Signup and view all the answers

    What is the term for a stone located in the ureter?

    <p>Ureterolith (B)</p> Signup and view all the answers

    What is the significance of urinalysis in clinical settings?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the term for the concentration of solute particles in a solution?

    <p>Osmolality (B)</p> Signup and view all the answers

    Which of the following is NOT a colligative property of a solution?

    <p>pH (B)</p> Signup and view all the answers

    What is the most common methodology for measuring osmolality in the clinical laboratory?

    <p>Freezing Point Depression (D)</p> Signup and view all the answers

    What is the normal range for serum osmolality?

    <p>275 - 300 mOsm/kg (D)</p> Signup and view all the answers

    Which of the following disease states is characterized by increased serum osmolality?

    <p>Diabetes Mellitus (A)</p> Signup and view all the answers

    What is the major contributor to serum osmolality?

    <p>Sodium (D)</p> Signup and view all the answers

    What is the normal range for urine osmolality after a 10-hour fluid deprivation?

    <p>850 mOsm/kg or greater (B)</p> Signup and view all the answers

    What is the term for the ratio in weight of a given solution to an equal volume of water at a specified temperature?

    <p>Specific Gravity (B)</p> Signup and view all the answers

    Which of the following solutes has a minimal impact on Specific Gravity?

    <p>Salt (A)</p> Signup and view all the answers

    Which of the following conditions can cause a clear red urine sample?

    <p>Hemoglobinuria (A), Myoglobinuria (C)</p> Signup and view all the answers

    A patient presents with a urine sample that is cloudy and has a foul odor. What is the most likely cause?

    <p>Bacteria in the urine (C)</p> Signup and view all the answers

    Which of the following is NOT a normal characteristic of urine?

    <p>Clear appearance (A)</p> Signup and view all the answers

    A patient has a urine sample that is clear, yellow, and produces stable white foam when shaken. What is the most likely cause of the foam?

    <p>Albumin in the urine (B)</p> Signup and view all the answers

    What is the most likely color of urine that contains a large amount of bilirubin?

    <p>Amber (C)</p> Signup and view all the answers

    A blood transfusion reaction can cause urine to be what color and clarity?

    <p>Clear and Red (D)</p> Signup and view all the answers

    What is the most likely cause of a sweet, fruity odor in urine?

    <p>Ketones (D)</p> Signup and view all the answers

    Which of the following is NOT a factor that can affect the clarity of urine?

    <p>Presence of bilirubin (A)</p> Signup and view all the answers

    What is the most likely cause of a mousy or moldy odor in urine?

    <p>Phenylketonuria (D)</p> Signup and view all the answers

    Which of the following is part of the physical portion of a urinalysis?

    <p>Specific gravity (B)</p> Signup and view all the answers

    What indicates that a urine sample may not be valid?

    <p>Specific Gravity below 1.003 (B)</p> Signup and view all the answers

    How is the dilution factor calculated when mixing 1 mL of urine solution with 1 mL of distilled water?

    <p>2 (C)</p> Signup and view all the answers

    What is the purpose of calibrating the Refractometer with DI water?

    <p>To ensure equipment accuracy for urine tests (C)</p> Signup and view all the answers

    Which of the following urine samples should be rejected?

    <p>Sample with less than 12 mL volume (B)</p> Signup and view all the answers

    What is the primary indicator of dehydration in urine testing?

    <p>Increased Specific Gravity (B)</p> Signup and view all the answers

    Which home-made quality control solution yields a Specific Gravity of approximately 1.034?

    <p>9% sucrose solution in DI water (A)</p> Signup and view all the answers

    What is the significance of using a dipstick test for Specific Gravity?

    <p>It serves as a backup for manual SG testing (A)</p> Signup and view all the answers

    What is a normal value for Isosthenuric urine?

    <p>1.010 (B)</p> Signup and view all the answers

    What should be done if multiple Refractometers are used for urine testing?

    <p>All Refractometers should be QC’d (B)</p> Signup and view all the answers

    Which of the following statements accurately differentiates Osmolality from Specific Gravity?

    <p>Osmolality is based on solute number, SG includes size and weight (B)</p> Signup and view all the answers

    Which of these would be the BEST reason to reject a urine sample that was collected for a culture?

    <p>The sample was collected in a container that had not been properly sterilized. (C)</p> Signup and view all the answers

    Flashcards

    Quality Assessment Program

    A program aimed at achieving accurate and reproducible lab results.

    Standard Precautions

    Infection prevention practices applied to all patients, considering all body fluids potentially infectious.

    Safety Data Sheets (SDS)

    Documents providing safety information about hazardous materials with universal symbols.

    Preanalytical Components

    Procedures before testing, including specimen collection and patient preparation.

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    Kidney Terminology

    Terms related to kidneys: nephro-, reno-, pyelo-, etc.

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    Urine Composition

    Urine comes from filtering blood through the kidneys, averaging 200 liters a day.

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    Proper Mixing of Urine Samples

    Crucial to mix urine samples before testing to ensure a homogenous solution.

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    Documentation in Lab

    Essential for tracking all procedures and any issues in testing.

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    Specific Gravity

    A measure of urine concentration compared to water.

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    Refractometer Calibration

    Adjusting the refractometer to ensure accurate readings using DI water as a standard.

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    Dilution Factor

    A number used to correct Specific Gravity when mixing solutions.

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    Quality Controls (QC)

    Procedures to verify the accuracy of the refractometer readings.

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    Home-brewed Controls

    Custom solutions used for quality control in refractometer calibration.

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    Urinalysis Dipstick

    A tool to analyze urine that now includes a pH and specific gravity test pad.

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    Hyposthenuria

    A condition where urine has a Specific Gravity below 1.010.

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    Hypersthenuria

    A condition where urine has a Specific Gravity above 1.010.

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    Sample Rejection Reasons

    Criteria for rejecting urine samples, including leakage and incorrect labeling.

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    Urine Collection Containers

    Containers for urine that must be clean, leak-proof, and of sufficient volume.

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    Sample Rejection

    Documenting urine samples that are rejected to maintain accuracy.

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    Transportation Time

    Urine samples must be sent to the lab within 1 hour of collection.

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    Boric Acid

    A chemical preservative used to prevent bacterial growth in urine cultures.

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    Random Urine Sample

    A urine sample collected at any time without restrictions.

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    First Morning Urine Sample

    Urine collected after overnight fasting, most concentrated for testing.

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    24-Hour Urine Collection

    Collecting all urine over a 24-hour period for thorough analysis.

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    Creatinine Clearance Test

    Measure of kidney function based on urine and blood creatinine levels.

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    Preeclampsia

    Pregnancy condition marked by high blood pressure and protein in urine.

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    Urinalysis Components

    Includes physical, chemical, and microscopic examination of urine.

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    Urine Clarity

    Describes turbidity of urine, indicating possible contamination or infection.

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    Elevation of Total Protein

    High protein levels in urine may indicate kidney disease or diabetes.

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    Suprapubic Aspiration

    Sterile urine collection directly from the bladder using a needle.

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    Midstream Clean-Catch

    Method for collecting urine to avoid contamination, requires patient instructions.

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    UPEP (Urine Protein Electrophoresis)

    Test to analyze types of protein present in urine for diagnostics.

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    Chemical Preservation for Urine

    Chemical agents, like Boric Acid, used to stabilize urine for testing.

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    Normal Urine Clarity

    Normal urine should be clear, but may appear hazy due to squamous epithelial cells, mucus, sperm cells, contaminants, or amorphous phosphates/urates.

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    Causes of Cloudy Urine

    Cloudy or turbid urine is never normal and can indicate the presence of bacteria, yeast, casts, lipids, white blood cells, or red blood cells.

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    Red Urine Clarity

    Red urine may be clear or cloudy. Clear red urine typically indicates hemoglobinuria or myoglobinuria, while cloudy red indicates intact red blood cells (hematuria).

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    Transfusion Reactions

    Receiving incompatible ABO blood can lead to hemolysis, clearing urine as red blood cells are destroyed and hemoglobin is released.

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    Stable White Foam

    Stable white foam in urine indicates large amounts of albumin, suggestive of proteinuria or kidney issues.

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    Stable Yellow Foam

    Stable yellow foam indicates high bilirubin levels in urine, suggesting liver issues or hemolysis.

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    Normal Urine Odor

    Normal urine has an aromatic odor, while certain foods or diseases can alter it (like foul from UTIs).

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    Urine Color and Causes

    Urine is normally yellow due to urochrome; other colors indicate various substances (amber for bilirubin, red for blood, etc.).

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    Evaluation of Clarity

    Clarity should be assessed against a background; normally affected by cells, crystals, and casts.

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    Correlation of Urinalysis Results

    All urinalysis results (color, clarity, foam, odor, etc.) must correlate for accurate diagnoses.

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    Kidney Functions

    Kidneys maintain homeostasis by regulating water, salts, and acids.

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    Nephrons

    Functional units of kidneys responsible for urine production through filtration.

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    Blood Urea Nitrogen (BUN)

    Measures urea levels in the blood to assess kidney function.

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    Osmolality

    Concentration of solute particles in a solution, not affected by solute size.

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    Freezing Point Depression

    Method used to determine osmolality by cooling a sample below freezing.

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    Symptoms of Diabetes Insipidus

    Characterized by polyuria and extreme thirst due to lack of ADH.

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    Acute Renal Failure

    Sudden onset of kidney failure leading to uremia; can be fatal.

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    Isosthenuria

    Consistent Specific Gravity level of 1.010, often in end-stage renal disease.

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    Angiotensin II

    Hormone that increases blood pressure and stimulates aldosterone production.

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    Urinary Retention

    Inability to fully empty the bladder, potentially leading to infections.

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    Normal Urine Output

    Normal urine production ranges from 600 to 1,800 mL per day.

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    Uremia

    Toxic condition due to elevated urea levels in the blood from kidney failure.

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    Study Notes

    Introduction to Urinalysis

    • Urinalysis is a laboratory test used to evaluate urine for diagnostic purposes
    • It involves 3 parts: physical, chemical, and microscopic analysis

    Goal of Effective Quality Assessment Program

    • Accurate and reproducible test results are the goal
    • Results should reflect the patient's condition, not be altered by procedures.
    • Lab technicians are required to document all actions performed.

    Biological Hazards

    • Standard Precautions and transmission-based precautions (established in 1996) must be followed
    • All body fluids, secretions, and excretions are considered potentially infectious
    • Apply infection prevention practices in all healthcare settings
    • Appropriate Personal Protective Equipment (PPE) should be used.
    • Proper disinfectants, spill kits, and post-exposure treatment are necessary

    Global Harmonization Program Safety Data Sheets (SDS)

    • Universal symbols on SDS are understood by all cultures and languages
    • Hazard pictograms are provided for health hazards, flammables, corrosives, and explosives
    • Precautionary statements and hazard statements describe potential dangers of substances.

    QA - Preanalytical Components

    • All procedures before testing (collection, transport, storage, handling) are important
    • Proper patient education, preparation, and instructions are essential
    • Accurate procedure manuals and adequate personnel training are necessary
    • Label urine cups, not lids, to avoid mislabeling.
    • Mix urine samples thoroughly before testing to ensure homogeneity.

    Renal Medical Terminology

    • Medical terms for body parts related to the kidneys, including nephrons.
    • Medical prefixes and suffixes for renal-related conditions.

    Renal Anatomy and Physiology

    • Kidneys are the primary organs for urine production through filtration, secretion, and absorption.
    • The process involves filtering blood plasma, reabsorbing essential substances, and excreting waste products.

    Where does urine come from?

    • The average adult has around 6 liters of blood
    • Kidneys filter the plasma volume (about 3 liters) around 60 times a day (nearly 200 liters daily)
    • Kidneys remove water and waste from the blood and send it to the bladder for storage.
    • Urine is a protein-free ultrafiltrate of plasma.

    Functions of the Kidneys

    • Homeostasis is maintained through the balance of water, salts, and acids.
    • Water is mainly reabsorbed in the Distal Convoluted Tubule.
    • Kidneys reabsorb bicarbonate (HCO3-) and secrete hydrogen (H+) to maintain acid-base equilibrium in the blood
    • Urea, creatinine, uric acid, and other wastes are removed.
    • Maintaining blood pressure, erythrocyte production, and Vitamin D activation are functions.

    Regulation of Blood pH

    • Blood-Bicarbonate Buffer System, Pulmonary System, and Renal System regulate blood pH within normal ranges (7.35-7.45).
    • These systems work together to prevent pH changes, exhale carbon dioxide, and excrete or retain hydrogen ions.

    Hormones in the Urinary System

    • Hormones (Angiotensinogen, Renin, Angiotensin-Converting Enzyme, ACE, Aldosterone, Antidiuretic Hormone (ADH)) affect blood pressure and the filtration rate; this is important to understand urinalysis.

    Nephrons and Kidney Structure

    • Nephrons are the functional units of kidneys.
    • 1.3 million nephrons are present in each kidney.
    • Nephrons are involved in urine production via filtration, reabsorption, and secretion.
    • The glomeruli are clusters of capillaries in nephrons, which are the place where the main filtration process takes place.

    Urine Volumes and Terminology

    • Normal urine production (600-1800ml)
    • Terms like anuria, oliguria, diuresis, and polyuria describe abnormal urine production.

    Renal Failure Terminology

    • Azotemia is elevated non-protein nitrogenous compounds in the blood, often due to renal dysfunction.
    • Uremia involves toxic levels of urea in the blood, a serious complication of kidney failure.
    • Acute and chronic kidney disease are progressive losses of renal function that can be severe.
    • Nephritis, glomerulonephritis, and pyelonephritis are types of kidney inflammation.

    Stones (Renal Calculi)

    • Stones, also called calculi, are mineral deposits in the kidneys, ureters, or bladder.
    • Nephrolithiasis refers to stones in the kidneys.
    • Ureterolithiasis is the presence of stones in the ureters.
    • Cystolithiasis refers to stones in the bladder.
    • Shockwave lithotripsy and percutaneous nephrolithotomy are surgical treatments for stones.

    History of Urinalysis

    • The analysis of urine dates back thousands of years.
    • Early evaluations assessed color, smell, and clarity of urine for diagnostic purposes.
    • Microscopes, chemical dipsticks, and urinalysis automated systems have improved diagnostic capabilities.

    Significance of Urinalysis

    • Urine samples are easily obtained for a relatively quick, inexpensive test.
    • Urinalysis is used as a screening test for various medical conditions including urinary tract infections, kidney, liver disease, among other conditions.

    Urinary Laboratory Tests

    • Urinalysis, Osmolality, Sodium levels, Electrophoresis, Glomerular Filtration Rate, Blood Urea Nitrogen, Blood pH, Creatinine/Ratio, Creatinine clearance, are important tests that evaluate the different factors involved with the functions of the kidney.

    Review

    • Kidneys filter the blood to produce urine.
    • Proper handling and labeling of urine samples are crucial.
    • Urinalysis is a valuable diagnostic tool for many conditions.

    Osmolality

    • Osmolality measures the concentration of solute particles in a solution, only affected by solute number, not size.
    • Measurements can be evaluated by different methods (colligative properties), the most common being freezing point depression.
    • High osmolality means more concentrated solutions, low osmolality means more diluted solutions.

    Freezing Point Depression

    • A method to measure osmolality, freezing point depression occurs as solute particles decrease the freezing point.
    • The amount of freezing point depression is proportional to the concentration, or osmolality.

    Osmolality of Urine and Serum

    • Serum osmolality is often measured along with urine for comparison (1-3x).
    • The 3 most prevalent solutes in urine are urea, chloride, and sodium.
    • Several diseases affect osmolality.

    Calculated Osmolality and Osmol Gap

    • The Calculated serum osmolality is a method using predominant serum solutes to calculate the serum osmolality.
    • Osmol Gap is the difference between measured and calculated serum osmolality.
    • Larger gaps may suggest the presence of toxic substances or abnormal molecules in the blood.

    Causes of Elevated Osmolar Gap

    • Toxic alcohols and elevated ketone levels contribute to elevated osmol gaps.

    Normal Ranges

    • Normal ranges for various osmolality levels are provided, typically affected by hydration and other factors.

    Comparing Urine and Serum Osmolality

    • Varying fluid consumption and exercise can affect urine osmolality measurements.
    • Correlation between serum and urine is vital for diagnostics, best when tested at the same time.

    Disease States-Increased Serum Osmolality

    • Conditions that usually increase Serum Osmolality include Diabetes Mellitus, Renal Tubular Disorders, Severe Burns, Primary Aldosteronism, Dehydration, Sepsis, and Alcohol Poisoning, as well as numerous others.

    Disease States - Decreased Serum Osmolality

    • Multiple conditions can be screened by testing for decreased Serum Osmolality including Potassium Deficiency, Diuretic overuse, Ketonuria, Severe Burns, Renal Failure, Congestive Heart Failure, Nephrotic syndrome, Liver Cirrhosis, prolonged vomiting, and diarrhea.

    Connection Between Serum Sodium

    • Sodium accounts for a large percentage of Serum Osmolarity.
    • Variations in the levels of sodium heavily affect osmolality.
    • Many disease states will alter sodium levels.

    Disease States- Diabetes Insipidus

    • Conditions characterized by excessive urination (polyuria) and extreme thirst (as well as other symptoms), resulting from abnormal levels of Antidiuretic Hormone or other related hormones.

    Panic/Alert/Critical Values

    • Serum osmolality values lower than 240 or higher than 420 mOsm/kg can prove life-threatening.

    Other Uses for Freezing Point Depression

    • Freezing Point Depression is used for detecting toxic substances and chemicals.

    Advanced Instruments 3320

    • This advanced instrument uses freezing point depression to measure osmolality.
    • Features include sample size (20uL), testing time (60 seconds), and the use of multiple calibrators and QC levels.

    Procedure

    • Follow steps to prepare the sample, insert into the instrument and read the results.
    • Clean and maintain the instrument.

    Review

    • Osmolality is the concentration of solutes, measured in the laboratory by different methods, most notably Freezing Point Depression.
    • Osmolar gap is the difference between the measured and calculated values.
    • Sodium levels affect serum osmolality.

    Specific Gravity

    • Specific Gravity is the ratio of the weight of a solution to an equal volume of water.
    • A ratio without units.
    • It's used in various fields like determining the purity of substances, assessing the concentration of solutions, and diagnosing medical conditions.

    Applications of Specific Gravity

    • Specific Gravity is utilized in various fields, including assessing water purity, determining soil quality for agriculture, assessing cement concentration for construction purposes, and evaluating the composition of various substances like stones and gems.

    Solutes in Specific Gravity

    • Glucose, Protein, Bilirubin, Red Blood Cells heavily impact specific gravity.
    • Salt does not, unlike osmolality, affect specific gravity because it is primarily influenced by weight.

    Refractometry

    • Refractometry measures the refractive index of light as it passes between two different mediums (air and a solution).
    • Changes in the medium (higher density = more solutes) influence the angle of light refraction.
    • Measured using a refractometer, evaluating color and clarity of different solutions.

    Using a Refractometer

    • Follow procedure to acquire urine and place it on the prism; close the plate, then read the refractive scale through the eyepiece, and clean up
    • Use DI water to calibrate the instrument.

    Normal Urine Specific Gravity

    • Normal urine specific gravity range is 1.005-1.030, largely affected by hydration, exercise, and diet.

    Decreased Specific Gravity Results

    • Hyposthenuria is a low specific gravity, mostly related to decreased tubular reabsorption and excess water output.
    • Conditions such as nephrogenic diabetes insipidus, pyelonephritis, renal failure, acute tubular necrosis, and preanalytical errors (light, time, temperature) can result in decreased specific gravity.

    Elevated Specific Gravity Results

    • In hypersthenuria, the presence of elevated levels of certain substances (glucose, UTI bacteria, dehydration, kidney function, or in disease conditions) can increase specific gravity.

    Consistent Specific Gravity Results

    • Isosthenuria (a urine specific gravity of 1.010) consistently indicates renal failure, the kidneys' inability to concentrate urine properly.

    Is it Urine?

    • Questionable urine samples with a specific gravity less than 1.003 need further evaluation and often need to be recollected until higher specific gravity is reached.

    Specific Gravity Dilutions

    • If the instrument doesn't read the specific gravity or a solution exceeds the limit of the instrument, a solution using DI water will be required to dilute the sample.
    • Different dilutions may be required depending on the concentration and desired readout.

    SG Calibration and Standards

    • Calibration screws are used on refractometers to calibrate and adjust the specific gravity readings.
    • DI water, with a specific gravity of 1.000, is frequently used as a standard.

    SG Quality Controls

    • Quality control (QC) measures (often multiple levels required) must be taken to ensure the instrument is properly calibrated.
    • Homebrew controls (using a known concentration solution) can be used alongside reagent controls supplied by manufactures.

    Other Methodologies

    • Chemical dipsticks provide another way to measure SG.
    • Dipsticks change colors and can be tracked along the colors on a scale.

    Review

    • The main differentiator between specific gravity and osmolality is that specific gravity is affected by the size and weight of solutes, while osmolality only by the number of solute particles.
    • Isosthenuria, commonly identified through specific gravity tests, can indicate impaired renal function and the inability of the kidneys to concentrate urine.

    Urine Collection

    • Sterile, leak-proof, dry, and properly labeled containers are necessary for urine collection.
    • 12 ml is the minimum required volume for testing.

    Sample Rejection

    • Urine samples should not be rejected if it doesn't meet the criteria for acceptance (e.g. if it isn't properly labeled, volume is too low, or it isn't appropriately transported within the proper timeframe).

    Importance of Transport Time

    • Proper transport time ensures urine samples are analysed within proper conditions that will provide an accurate result, this will ensure the samples aren't affected by bacterial growth or solute degradation or alteration.

    Unable to Meet the Transport Time

    • If 1-hour transport time is not possible, preserve samples by refrigeration (2-8°C) or preservatives.

    Urine Culture Tubes (Boric Acid)

    • Boric Acid is a preservative used for urine specimens requiring a culture and analysis.

    Urine Specimen Types

    • Random urine samples are collected without restrictions, ideal for routine tests, affected by exercise and fluid intake.
    • First Morning and Fluid Deprivation samples are preferable for detecting trace amounts of proteins, and more concentrated.
    • 24-hour samples are used for analyses and screenings, often tested via spectrometry.

    24-Hour Urine Samples

    • 24-hour sampling involves collecting all urine excreted in a 24-hour period, often using a calibrated container.
    • Sample preparation including maintaining a constant temperature or chilling throughout the 24-hour period with careful patient instructions and records.

    Examples of 24-Hour Urine Tests

    • Examples of tests conducted on 24-hour urine samples include testing for creatinine, total protein, protein/creatinine ratio, albumin, albumin/creatinine ratios, protein electrophoresis, cortisol, glucose, cystine levels, sodium.

    24-Hour Urine Creatinine

    • The rate of creatinine excretion in 24 hours is calculated from various factors including creatinine content in serum and urine, and body mass—often measured via spectrometry.

    24-Hour Urine Creatinine Clearance

    • Calculation requires urine creatinine, serum creatinine, body mass, and total volume, to determine the average creatinine clearance rate in the glomeruli per day.
    • Normal ranges vary between males and females.

    24-Hour Urine Total Protein

    • 24-hour total protein collection testing involves obtaining, collecting, mixing, centrifuging the sample to measure total protein in the urine.

    Preeclampsia Pathology

    • Preeclampsia is hypertensive, edema, and proteinuric condition related to pregnancy.
    • It's related to damage to endothelial cells within the blood vessels of nephrons.
    • Edema, hypertension, and proteinuria result from a series of events related to blood vessels.

    Preeclampsia Lab Results

    • Lab tests for evidence of preeclampsia include measurements of urine total protein, creatinine-protein ratio, amounts of protein in the urine, and other additional measures such as low platelet counts and abnormal liver enzymes.

    Urine Protein Electrophoresis

    • Used to identify proteins present in urine, especially helpful in diagnosing conditions like multiple myeloma and nephrotic syndrome.
    • The Electrophoresis process separates proteins by charge and size.

    Urine Protein Electrophoresis Patterns

    • Different diseases can be identified by examining electrophoresis patterns.
    • These patterns represent presence/absence/differences in albumin, gamma globulins, and abnormal serum proteins.

    24-Hour Urine Cortisol – Cushing's Syndrome

    • 24-hour Cortisol is used to evaluate the 24-hour excretion of cortisol.

    Glucose and Gestational Diabetes

    • 24-hour urine is often used to determine glucose levels in patients with suspected gestational diabetes.

    24-Hour Urine Cystine- Cystinuria

    • 24-hour collection is used in diagnoses of Cystinuria or Cystinosis, involving amino acid and transport molecule analysis.

    Managing Cystinuria and Cystinosis

    • Treatment for cystinuria and cystinosis involves addressing the root cause, often through diet changes, medication, and/or genetic counselling to help prevent stones or buildup.

    Urine Collection Types

    • Collection methods vary widely, utilizing clean-catch procedures, suprapubic aspirations, catheterization, and bag-based collection techniques.

    Midstream Clean-Catch

    • The clean-catch method requires cleansing of the area prior to urination.

    Suprapubic Aspiration

    • Suprapubic aspiration is a method for collecting urine from the bladder when other methods are unavailable or unsuitable.

    Catheterized Specimen

    • A catheterized specimen involves inserting a sterile tube through the urethra for urine collection.

    Types of Catheters

    • Different types of catheters (indwelling, intermittent, external, and suprapubic) based on their use and how the specimen is collected.

    Bagged Collections

    • Plastic urine collection bags are used for infants, and children.

    Review

    • The different methods of urine collection and preservation, including the appropriate circumstances and time limits for analysis.

    Physical Urinalysis

    • The physical examination of urine includes color, clarity, odor, and foam, with each differing characteristic indicating the possible presence of various conditions.

    Urinalysis

    • Urinalysis evaluates urine for diagnostic purposes.
    • Physical, chemical, and microscopic tests aid in accurate diagnosis when correlating the patient's signs and symptoms.

    Normal Urine Color

    • Urine is typically yellow due to urochrome.
    • Darker yellows indicate more concentrated urine; lighter yellows indicate more diluted urine.

    Substances That Change Urine Color

    • Various substances cause changes in urine color (e.g., blood, bilirubin, bacteria, medications)

    Urine Clarity

    • Clarity refers to urine's transparency.
    • Normal urine is almost clear
    • Turbid or cloudy urine may indicate various issues, including contamination and the presence of particles (RBCs/WBCs/crystals/bacteria).

    Normal, Hazy Urine?

    • Hazy urine can be normal when caused by certain substances like mucous or squamous epithelial cells.
    • Caution is necessary to prevent misdiagnosis.

    Abnormal Urine Clarity

    • Conditions like high WBC counts and bacteria are never normal and can alert to further investigation into the patient's overall health.

    Correlating Color and Clarity in Red Urine

    • Different causes of red urine (e.g., hemolysis, myoglobinuria, hematuria) manifest depending on other characteristics of the sample.

    Transfusion Reactions

    • Incompatibility of blood types can lead to harmful effects in patients.
    • Hemolysis of RBCs in blood transfusions can be identified in urine samples.

    Foam in the Urine

    • Normal urine produces little to no foam when shaken.
    • Significant, stable foam (white or yellow) may indicate high albumin or bilirubin levels.

    Urine Odor

    • Normal urine has an aromatic smell.
    • Various disease states (UTI, diabetes, starvation, etc.) can cause abnormal smells.

    Review

    • A comprehensive summary and overview of the discussed topics in urinalysis.
    • Correlation of various factors including color, clarity, SG, odor, and foam in urine testing is frequently used to indicate possible issues.

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    Related Documents

    Introduction to Urinalysis PDF

    Description

    Test your knowledge on the key aspects of quality assessment in a laboratory setting, specifically related to urine sample handling and kidney function. Explore the importance of proper techniques, patient instruction, and understanding the renal system in maintaining homeostasis.

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