Summary of Reagent Strip tests

Reagents Sensitivity Sources of error Correlations

pH Methyl red 5–9 No known interfering substances Nitrite
Bromthymol blue Runover from adjacent pads Leukocytes
Old specimens Microscopic
Protein Multistix: Multistix: 15–30 mg/dL False-positive: Blood
Tetrabromphenol blue albumin Highly buffered alkaline urine Nitrite
Chemstrip: Chemstrip: 6 mg/dL albumin Pigmented specimens, phenazopyridine Leukocytes
3′, 3′′, 5′, 5′′ tetrachlorophenol Quaternary ammonium compounds (detergents) Microscopic
3, 4, 5, 6-tetrabromosulfophthalein Antiseptics, chlorhexidine
Loss of buffer from prolonged exposure of the
reagent strip to the specimen
High specific gravity
False-negative
Proteins other than albumin
Microalbuminuria
Glucose Multistix: Multistix: 75–125 mg/dL False-positive: Ketones
Glucose oxidase Chemstrip: 40 mg/dL Contamination by oxidizing agents and Proteins
Peroxidase detergents
Potassium iodide False-negative:
Chemstrip: High levels of ascorbic acid
Glucose oxidase High levels of ketones
Peroxidase High specific gravity
Tetramethylbenzidine Low temperatures
Improperly preserved specimens
Ketone Sodium nitroprusside Multistix: 5–10 mg/dL False-positive: Glucose
Glycine (Chemstrip) acetoacetic Phthalein dyes
acid Highly pigmented red urine
Chemstrip: 9 mg/dL Levodopa
acetoacetic acid; 70 mg/dL Medications containing free sulfhydryl groups
acetone False-negative:
Improperly preserved specimens
Blood Multistix: Multistix: 5–20 RBCs/mL, False-positive: Protein
Diisopropylbenzene dehydroperoxide 0.015–0.062 mg/dL Strong oxidizing agents Microscopic
tetramethylbenzidine hemoglobin Bacterial peroxidases
Chemstrip: Chemstrip: 5 RBCs/mL, Menstrual contamination
dimethyldihydroperoxyhexane hemoglobin corresponding False-negative:
tetramethylbenzidine to 10 RBCs/mL High specific gravity/crenated cells
Formalin
Captopril
High concentrations of nitrite
Ascorbic acid _25 mg/dL
 Unmixed specimens
Bilirubin Multistix: Multistix: 0.4–0.8 mg/dL False-positive: Urobilinogen
2,4-dichloroaniline diazonium salt bilirubin Highly pigmented urines,
Chemstrip: Chemstrip: 0.5 mg/dL phenazopyridine
2,6-dichlorobenzene-diazonium salt bilirubin Indican (intestinal disorders)
Metabolites of Lodine
False-negative:
Specimen exposure to light
Ascorbic acid _25 mg/dL
High concentrations of nitrite
Urobilinogen Multistix: Multistix: 0.2 mg/dL Multistix: Bilirubin
p-dimethylaminobenzaldehyde urobilinogen False-positive:
Chemstrip: Chemstrip: 0.4 mg/dL Porphobilinogen
4-methoxybenzene urobilinogen Indican
diazoniumtetrafluoroborate p-aminosalicylic acid
Sulfonamides
Methyldopa
Procaine
Chlorpromazine
Highly-pigmented
urine
False-negative:
Old specimens
Preservation in formalin
Chemstrip:
False-positive:
Highly-pigmented urine
False-negative:
Old specimens
Preservation in formalin
High concentrations of nitrate
Nitrite Multistix: Multistix: 0.06–0.1 mg/dL False-negative: Protein
p-arsanilic acid nitrite ion Nonreductase-containing bacteria Leukocyte
Tetrahydrobenzo(h)-quinolin-3-ol Chemstrip: 0.05 mg/dL Insufficient contact time between bacteria and Microscopic
Chemstrip: nitrite ion urinary nitrate
Sulfanilamide Lack of urinary nitrate
Hydroxytetrahydrobenzoquinoline Large quantities of bacteria converting nitrite to
nitrogen
Presence of antibiotics
High concentrations of ascorbic acid
High specific gravity
False-positive:
 Improperly preserved specimens
Highly pigmented urine
Leukocyte Multistix: Multistix: 5–15 WBC/hpf False-positive: Protein
Derivatized pyrrole amino acid ester Chemstrip: 10–25 WBC/hpf Strong oxidizing agents Nitrite
Diazonium salt Formalin Microscopic
Chemstrip: Highly pigmented urine
Indoxylcarbonic acid ester Nitrofurantoin
Diazonium salt False-negative:
High concentrations of protein
glucose, oxalic acid
ascorbic acid
gentamicin,
cephalosporins
tetracyclines
inaccurate timing
Specific Gravity Multistix: 1.000–1.030 False-positive:
Poly (methyl vinyl ether/maleicanhydride) High concentrations of protein
bromthymol blue False-negative:
Chemstrip: Highly alkaline urines (_6.5)
Ethyleneglycoldiaminoethylethertetraacetic
Acid
bromthymol blue
Microalbumin Testing Summary
Principle: Sensitivity: Reagents: Interference:
Micral-Test Enzyme immunoassay 0–10 mg/dL Gold-labeled antibody False negative: Dilute urine
B-galactosidase
Chlorophenol red galactoside
Immunodip Immunochromographics 1.2–8.0 mg/dL Antibody coated blue latex particles False negative-dilute urine
Albumin: Creatinine Ratio Sensitive albumin tests related to Albumin: 10–150 mg/L Albumin: Visibly bloody or abnormally
Clinitest Microalbumin creatinine concentration to correct Creatinine: 10–300 mg/dL, 0.9– diodo-dihydroxydinitrophenyl colored urine
Strips/Multistix-Pro for patient hydration 26.5 mmol/L tetrabromosulfonphtalein Creatinine: Cimetidine-False
Creatinine: Positive
Copper sulfate
Tetramethylbenzidine
Diisopropylbenzenedihydroperoxide
Summary of Urinary Sediments
Appearance: Sources of Error Reporting: Correlation
RBCs Non-nucleated biconcave disks Yeast cells Average number per 10 hpfs Color
Crenated in hypertonic urine Oil droplets Reagent strip blood reaction
Ghost cells in hypotonic urine Air bubbles
Dysmorphic with glomerular membrane damage
WBCs Larger than RBCs Renal tubular epithelial Average number per 10 hpfs Leukocyte esterase
Granulated, multilobed neutrophils cells Nitrite
Glitter cells in hypotonic urine Specific gravity
Mononuclear cells with abundant cytoplasm pH
Squamous Cells Largest cells in the sediment with abundant, irregular Rarely encountered, Rare, few, moderate, or many Clarity
cytoplasm and prominent nucleii folded cells may per lpf
resemble casts
RTE Cells Rectangular, columnar, round, oval or, cuboidal with Spherical transitional Average number per 10 hpfs Leukocyte esterase and nitrite
an eccentric nucleus possibly bilirubin-stained or cells (pyelonephritis)
hemosiderin-laden Granular casts Color
Clarity
Protein
Bilirubin (hepatitis)
Blood
Transitional Spherical, polyhedral, or caudate with centrally Spherical forms Rare, few, moderate, or many Clarity; blood,if malignancy-
Cells located nucleus resemble RTE cells per hpf associated
Oval Fat Bodies Highly refractile RTE cells Confirm with fat stains Average number per hpf Clarity
and polarized Blood
microscopy Protein
Free fat droplets/fatty casts
Bacteria Small spherical and rod-shaped structures Amorphous phosphates Few, moderate, or many per pH
and urates hpf, the presence of WBCs Nitrite
may be required LE
WBCs
Yeast Small, oval, refractile structures with buds and/or RBCs Rare, few, moderate, or many Glucose
mycelia per hpf, the presence of urinalysis LE
WBCs may be required correlations: WBCs
Trichomonas Pear-shaped, motile, flagellated WBCs, renal tubular Rare, few, moderate, or many LE
epithelial cells per hpf urinalysis WBCs
Spermatozoa Tapered oval head with long, thin tail None Present, based on laboratory Protein
protocol
Mucus Single or clumped threads with a low refractive index Hyaline casts Rare, few, moderate, or many None
per lpf
Summary of Urine Casts
Appearance: Sources of error: Reporting: Correlations Clinical significance:
Hyaline Colorless homogenous Mucus, fibers, hair, Average number per lpf Protein Glomerulonephritis
matrix increased Blood (exercise) Pyelonephritis
lighting Color (exercise) Chronic renal disease
Congestive heart failure
Stress and exercise
RBC Orange-red color, cast RBC clumps Average number per lpf RBCs Glomerulonephritis
matrix containing RBCs Blood Strenuous exercise
Protein
WBC Cast matrix containing WBC clumps Average number per lpf WBCs Pyelonephritis
WBCs Protein Acute interstitial nephritis
LE
Bacterial Bacilli bound to protein Granular casts Average number per lpf WBC cast Pyelonephritis
matrix WBCs
LE
Nitrite
Protein
Bacteria
Epithelial Cell RTE cells attached to WBC cast Average number per lpf Protein Renal tubular damage
protein matrix RTE cells
Granular Coarse and fine granules Clumps of small crystals Average number per lpf Protein Glomerulonephritis
in a cast matrix Columnar RTE cells Cellular casts Pyelonephritis
RBCs Stress and exercise
WBCs
Waxy Highly refractile cast with Fibers and fecal material Average number per lpf Protein Stasis of urine flow
jagged ends and notches Cellular casts Chronic renal failure
Granular casts
WBCs
RBCs
Fatty Fat droplets and oval fat Fecal debris Average number per lpf Protein Nephrotic syndrome
bodies attached to Free fat droplets Toxic tubular necrosis
protein matrix Oval fat bodies Diabetes mellitus
Crush injuries
Broad Wider than normal cast Fecal material, fibers Average number per lpf Protein Extreme urine stasis
matrix WBCs Renal failure
RBCs
Granular casts
Waxy casts
Chapter VIII: Renal Disease
Clinical Information Associated With Glomerular Disorders
Disorder
Acute glomerulonephritis
Rapidly progressive
glomerulonephritis
Goodpasture syndrome
Wegener’s granulomatosis
Henoch-Schönlein purpura
Membranous glomerulonephritis
Membranoproliferative
glomerulonephritis
Chronic glomerulonephritis
IgA nephropathy
Nephrotic syndrome
Minimal change disease
Focal segmental glomerulosclerosis
Alport Syndrome
Etiology
Deposition of immune complexes, formed in conjunction with
group A Streptococcus infection, on the glomerular membranes
Deposition of immune complexes from systemic immune
disorders on the glomerular membrane
Attachment of a cytotoxic antibody formed during viral
respiratory infections to glomerular and alveolar basement
membranes
Antineutrophilic cytoplasmic auto-antibody binds to
neutrophils in vascular walls producing damage to small vessels
in the lungs and glomerulus
Occurs primarily in children following viral respiratory
infections; a decrease in platelets disrupts vascular integrity
Thickening of the glomerular membrane following IgG immune
complex deposition associated with systemic disorders
Cellular proliferation affecting the capillary walls or the
glomerular basement membrane, possibly immune-mediated
Marked decrease in renal function resulting from glomerular
damage precipitated by other renal disorders
Deposition of IgA on the glomerular membrane resulting from
increased levels of serum IgA
Disruption of the electrical charges that produce the tightly
fitting podocyte barrier resulting in massive loss of protein and
lipids
Disruption of the podocytes occuring primarily in children
following allergic reactions and immunizations
Disruption of podocytes in certain areas of glomeruli associated
with heroin and analgesic abuse and AIDS
Genetic disorder showing lamellated and thinning of
glomerular basement membrane
Clinical Course
Rapid onset of hematuria and edema
Permanent renal damage seldom occurs
Rapid onset with glomerular damage and possible progression to
end-stage renal failure
Hemoptysis and dyspnea followed by hematuria
Possible progression to end-stage renal failure
Pulmonary symptoms including hemoptysis develop first followed
by renal involvement and possible progression to endstage renal
failure Initial appearance of purpura followed by blood in sputum
and stools and eventual renal involvement
Complete recovery is common, but may progress to renal failure
Slow progression to the nephrotic syndrome or possible
remission
Slow progression to chronic glomerulonephritis or nephrotic
syndrome
Noticeable decrease in renal function progressing to renal failure
Recurrent macroscopic hematuria following exercise with slow
progression to chronic glomerulonephritis
Acute onset following systemic shock
Gradual progression from other glomerular disorders and then to
renal failure
Frequent complete remission following corticosteroid treatment
May resemble nephrotic syndrome or minimal change disease
Slow progression to nephrotic syndrome and end-stage renal
disease
Summary of Clinical Information Associated With Metabolic and Tubular Disorders
Disorder Etiology Clinical Course
Acute tubular necrosis Damage to the renal tubular cells caused by ischemia or toxic Acute onset of renal dysfunction usually resolved when the
agents underlying cause is corrected

Fanconi syndrome Inherited in association with cystinosis and Hartnup disease or Generalized defect in renal tubular reabsorption
acquired through exposure to toxic agents requiring supportive therapy

Nephrogenic diabetes insipidus Inherited defect of tubular response to ADH or acquired from Requires supportive therapy to prevent dehydration
medications

Renal glucosuria Inherited autosomal recessive trait Benign disorder

Summary of Clinical Information Associated With Interstitial Disorders

Disorder
Cystitis
Acute pyelonephritis
Chronic pyelonephritis
Acute interstitial nephritis
Etiology Clinical Course
Ascending bacterial infection of the bladder Acute onset of urinary frequency and burning resolved with
antibiotics
Infection of the renal tubules and interstitium related to Acute onset of urinary frequency, burning, and lower back pain
interference of urine flow to the bladder, reflux of urine from resolved with antibiotics
the bladder, and untreated cystitis
Recurrent infection of the renal tubules and interstitium caused Frequently diagnosed in children; requires correction of the
by structural abnormalities underlying structural defect
affecting the flow of urine Possible progression to renal failure
Allergic inflammation of the renal interstitium in response to Acute onset of renal dysfunction often accompanied by a skin
certain medications rash
Resolves following discontinuation of medication and treatment
with corticosteroids

Causes of Acute Renal Failure

Prerenal Renal Postrenal
Decreased blood pressure/cardiac output Acute glomerulonephritis Renal calculi
Hemorrhage Acute tubular necrosis Tumors
Burns Acute pyelonephritis Crystallization of ingested substances
Surgery Acute interstitial nephritis
Septicemia