Urine Trouble
There is something in the water
Infection
To the microscope
Urine fun facts
100
Involuntary loss of urine; associated with frequency, urgency and nocturia; lose urine on the way to the toilet
What is urge incontinence
100
Name 3 anatomic areas that could have issues leading to hematuria.
-kidney: glomerular, tubular
-Ureters, bladder, prostate: tumors, calculi, infection
-exercise induced (distance running)
100
What infection is this associated with?
proteus
This is a staghorn calcui seen on xray.
100
Dysmoprhic RBCs signal issue in what part of the kidney?
glomerulus
100
True or false. Astronauts recycle their own urine to make it into drinking water.
True! (for some)
-Astronauts recycle their urine into drinking water.
Normal human urine is about 95 percent water and presents a very appealing target for recycling—especially where potable water is scarce, like the International Space Station. On the ISS, the American crew derives its drinking water supply by recycling urine (and condensate from air). Astronauts pass their urine through a Water Recovery System (WRS) that consists of a Urine Processor Assembly (UPA) and Water Processor Assembly (WPA) [PDF], which produces about 3.6 gallons of water per day. The Russian crew doesn’t recycle their urine, though—they collect it in bags and send them over to the American side, where it's added to the supply for recycling.
200
Name 1 physical exam finding associated with stress incontinence
-positive cotton swab test: increased valsalva, cough leads to urine leakage
-could see pelvic organ prolapse
200
Name 2 things that can make urine appear red in color.
hematuria, hemoglobinuria, myogloninuria, beets
200
This end product is produced by bacteria in the setting of infection and can be seen on a U/A.
nitrites
-bacteria reduce urinary nitrates --> nitrites
*specific, not sensitive (- does not rule out; + = UTI)
200
Name 2 things that can be found in the U/A that can signal a kidney stone
-calcium oxylate crystals
-uric acid
-triphosphate crystals (seen with proteus)
200
Possibly a medical myth, but before microscopy, how could doctors determine if a patient had glucose in his or her urine?
leaving urine cups out and looking for the presence of ants on the urine
300
A 55 year old female presents with loss of urine when she laughs and sneezes. She does not have any issues with holding her urine during other times, and always makes it to the bathroom.
She wants some conservative measures. How do you describe the exercise she should try? What is it called?
Kegels
-trying to tighten muscles you use to hold your urine in.
-do 3x per day; clench hold for 3 seconds, relax for 3 seconds ---do 10x
300
What condition could lead to a patient's specific gravity of their urine being 1.00 (normal is 1.003-1.030).
<1.010: well hydrated/dilute urine
-diuretics, diabetes insipidus, adrenal insuff
300
A 45 year old male presents to the office with pain on urination, increased frequency, and fevers that started yesterday. He also mentions some rectal pain/pressure. He is sexually active with one female partner.
His rectal exam shows a tender prostate.
What is first line treatment and duration of treatment.
prostatitis
Either cipro 500mg BID x4-6 weeks or TMP-SMX x 4-6 weeks
300
On epic, if you want to see if there are any RBC casts, what do you need to order when ordering a U/A?
U/A with microscopy
300
By inhibiting the production of this hormone, alcohol can lead to increased urination.
vasopressin (ADH)
400
Name two medications that can be used to treat urge incontinence?
1. mirabegron
2. oxybutynin
400
When screening diabetics for proteinuria:
1. what values on a U/A would indicate microalbuminuria?
2. name one class of drugs that can help this
1. mircoalbuminuria: 30 to 150 mg/day
1+ 30mg/dL
2+ 100mg/dL
3+ 300mg/dL
4+ 1000mg/dL
2. ACE/ARBs, SGLT-2 inhibitors
400
What type of bacteria produce nitrites?
usually gram negative bacteria
400
What type of cells should you look for in the U/A to see if it was contaminated? Why do they show up there?
Bonus: 100 points--how can you avoid this
squamous cells -- come from the skin outside of the urinary tract
avoid this by doing a "clean catch". urinate a little bit, then use the cup to catch the urine midstream. Also have women use the OB wipes first.
400
It's a sunny day on the beaches of Mexico, and you hear someone scream that they just got stung by a jellyfish. Someone yells to pee on the sting. What do you advise? Will this help?
Do not pee on the sting
-it will not help the pain; can lead to the stinging cells to release more venom
500
Name 2 red flag symptoms in urinary incontinence that would warrant referral to a specialist.
1. pelvic organ prolapse
2. symptoms of a fistula
3. Hx radiation
4. Hematuria
5. Proteinuria
500
A 60 year old male presents with increased in urinary frequency, but also dark urine. In his ROS he has diffuse body aches and muscle pain, no fevers or chills, and no nocturia. He said he wanted to get fit again and has been drinking lots of water, going to the gym, and walking to work.
If you were worried about rhabdomyolysis, what could you see on the U/A?
+ Blood
0 RBCs
(Urine dipstick tests for peroxidase of erythrocytes; this can be seen with Hb and myoglobin)
500
A 22 year old female patient has burning with urination and frequency. She has recently become sexually active. Her U/A shows 50-100 WBCs, but urine culture is negative. If you are worried about infection, what should you screen her for?
-if pyuria, but negative culture, think Chlamydia and ureaplasma
500
A 35 year old female with a hx of GERD presents with increased edema, HTN, and is found to have 4+ proteinuria. She is eventually diagnosed with granulomatosis with polyangiitis.
What type of casts you expect to see on urine microscopy?
RBC casts
500
What drug is given to horses before horse races to help them urinate more.
furosemide (Lasix)
This is thought to be where the term: "pee like a racehorse" comes from
-given to horses to decrease exercise-induced pulmonary hemorrhage
-also drop some weight before the race