2 - ANALYSIS OF OTHER BODY FLUIDS

Kidneys

two, bean-shaped, located on each side of the body

150

each kidney weighs approximately _ g and measures 12.5 cm x 6 cm 2.5 cm

Ureter

transports urine from the kidneys to the bladder

measures 25 cm long

Urinary Bladder

150

storage site for urine

when approximately _ mL urine accumulates, a nerve reflex is initiated

Urethra

transports urine outside the body

4 cm long in women and 24 cm long in men

Ancient Egyptians

History

Recorded urine observations in hieroglyphics (e.g., Edwin Smith Papyrus)

Egyptians and Babylonians

History

Practiced “taste testing” of urine to detect diabetes

Hindu Physicians

History

Noticed that “honey urine” attracted ants

Hippocrates

History

Uroscopy; developed humoral theory foundations; first documented the importance of sputum examination

Galen

History

Systematized the four humors/temperaments: sanguine (blood), choleric (yellow bile), phlegmatic (phlegm), melancholic (black bile)

Johannes de Ketham

History

Published Fasciculus Medicinae (1491), which featured the urine wheel (a large circle surrounded by thin-necked urine flasks, showing how the color and consistency of urine could be matched to a diagnosis)

Frederik Dekkers

History

Discovered albuminuria by boiling urine

Thomas Bryant

History

Wrote a book about “pisse prophets” (charlatans)

Thomas Addis

History

Introduced examination of urine sediment

Richard Bright

History

Introduced urinalysis as part of doctor’s routine patient examination

Ludwig Thudichum

History

Urochrome

Domenico Cotugno

History

Cerebrospinal fluid (CSF)

Ivan Følling

History

Phenylketonuria (PKU)

Archibald Garrod

History

Alkaptonuria

Frederick William Pavy

History

Orthostatic (cyclic) proteinuria

William Wollaston

History

Cystine calculi

Stanley Benedict

History

Benedict’s reagent

95-97

3-5

60

Urine Composition

_-_% water

_-_% solids (_ grams)

35

Urea

Urine Composition

3-5% solids (60 grams)

_ grams organic

_ (major)

Creatinine (2nd), hippuric acid, uric acid, CHO, pigments, fatty acids, mucins, enzymes, hormones

25

Chloride

Sodium chloride

Urine Composition

3-5% solids (60 grams)

_ grams inorganic

_ (major) > Sodium > Potassium

_ _ (principal salt)

Sulfate, phosphate, ammonium, magnesium, calcium

Random / Occasional / Single

Types of Urine Specimen

Collected at any time

Random / Occasional / Single

Types of Urine Specimen

For routine and qualitative urinalysis

5

Types of Urine Specimen

Random / Occasional / Single

Ideal for cytology studies (ONLY IF with prior hydration and exercise _ minutes before collection!)

First morning

Types of Urine Specimen

Ideal specimen for routine urinalysis, pregnancy testing (hCG), and evaluation of orthostatic proteinuria

First morning

Types of Urine Specimen

Often preferred for cytology studies / cytodiagnostic urine testing

First morning

Types of Urine Specimen

Most concentrated and most acidic (allows well preservation of cells and casts)

First morning

Types of Urine Specimen

Patient should empty their bladder before going to sleep, and collect the first morning urine specimen immediately upon rising

Second morning / Fasting

2-hour post-prandial

Glucose tolerance

Fractional specimen

Types of Urine Specimen

Specimens for Glucose Monitoring (4)

Second morning / Fasting

Types of Urine Specimen

Specimens for Glucose Monitoring

2nd voided urine after a period of fasting

Second morning / Fasting

Types of Urine Specimen

Specimens for Glucose Monitoring

For glucose determination

2-hour post-prandial

Types of Urine Specimen

Specimens for Glucose Monitoring

For diabetic screening or monitoring

2-hour post-prandial

Types of Urine Specimen

Specimens for Glucose Monitoring

Preferred for glucose

Glucose tolerance

Types of Urine Specimen

Specimens for Glucose Monitoring

Optional with blood samples in glucose tolerance test

Fractional specimen

Types of Urine Specimen

Specimens for Glucose Monitoring

At least 2 voided collections

Fractional specimen

Types of Urine Specimen

Specimens for Glucose Monitoring

Series of blood and urine samples are collected at specific time intervals to compare concentration of a substance in urine with its concentration in the blood

Fractional specimen

Types of Urine Specimen

Specimens for Glucose Monitoring

Used in the diagnosis of diabetes

Midstream clean-catch

Catheterized

Suprapubic aspiration

Types of Urine Specimen

Sterile Specimens (3)

Midstream clean-catch

Types of Urine Specimen

Sterile Specimens

For routine screening and bacterial culture

Midstream clean-catch

Types of Urine Specimen

Sterile Specimens

Patient should carefully clean the tip of the penis (for males) or the opening of the urethra (for females) before collection

Catheterized

Types of Urine Specimen

Sterile Specimens

May be urethral or ureteral

Catheterized

Types of Urine Specimen

Sterile Specimens

For bacterial culture

Suprapubic aspiration

Types of Urine Specimen

Sterile Specimens

Abdominal wall is punctured, and urine is directly aspirated from the bladder

Suprapubic aspiration

Types of Urine Specimen

Sterile Specimens

For anaerobic bacterial culture and urine cytology

Pediatric specimen

Types of Urine Specimen

Use of soft, clear plastic bag with adhesive

Pediatric specimen

Types of Urine Specimen

Sterile specimen obtained by catheterization or suprapubic aspiration

Pediatric specimen

Types of Urine Specimen

Urine collected from diaper is not recommended for testing

Three-glass collection

Types of Urine Specimen

For prostatic infection (1)

First portion of voided urine

Middle portion of voided urine

Urine after prostatic massage

Types of Urine Specimen

Three-glass collection

1st glass:

2nd glass:

3rd glass:

1st, 3rd

Prostatitis

Types of Urine Specimen

Three-glass collection

Examine the _ and _ specimen microscopically, then compare the no. of WBCs and bacteria

If the no. of WBCs and bacteria in the 3rd specimen is 10x greater than that of the 1st specimen = _

Invalid

Types of Urine Specimen

Three-glass collection

_ _ = control for bladder and kidney infection

If control is (+) for WBCs and bacteria = the results from the 3rd specimen are considered = _

Four-glass collection (Stamey-Meares Test)

Types of Urine Specimen

For prostatic infection (2)

Initial voided urine

Midstream urine

Expressed prostatic secretions

Post-prostatic massage urine

Types of Urine Specimen

Four-glass collection (Stamey-Meares Test)

VB1

VB2

EPS

VB3

Types of Urine Specimen

Four-glass collection (Stamey-Meares Test)

_____________ = tests for urethral infection or inflammation

_____________ = tests for urinary bladder infection

_____________ = tests for prostate infection or inflammation (>10-20 white blood cells per high-power field = ABNORMAL)

24-hour

12-hour

4-hour

Afternoon (2-4 PM)

Types of Urine Specimen

Timed Specimens (4)

24-hour

Types of Urine Specimen

Timed Specimens (4)

At start time, patient empties their bladder into the toilet → then, all urine passed after that is collected

24-hour

Types of Urine Specimen

Timed Specimens (4)

At end time, patient empties their bladder into the collection container

INCREASED

Types of Urine Specimen

Timed Specimens (4)

Addition of urine before the start of 24-hour collection period causes FALSE-_ results

DECREASED

Types of Urine Specimen

Timed Specimens (4)

Failure to include urine at the end of 24-hour collection period causes FALSE-_ results

Schistosoma haematobium

Types of Urine Specimen

Timed Specimens (4)

24-hour

For detection of _ _

preservative

Types of Urine Specimen

Timed Specimens (4)

24-hour

Requires _

3 L

Types of Urine Specimen

Timed Specimens (4)

24-hour

Containers should hold up to _ L and may be colored to protect light sensitive analytes

12-hour

Types of Urine Specimen

Timed Specimens (4)

For Addis count

4-hour

Types of Urine Specimen

Timed Specimens (4)

For ___________________ determination

Urine remains in bladder for at least 4 hours before voiding

Afternoon (2-4 PM)

Types of Urine Specimen

Timed Specimens (4)

For urobilinogen determination

chain of custody

Types of Urine Specimen

Drug specimen collection

Process providing documentation of proper sample ID from the time of collection to the receipt of laboratory results:

30-45 mL

Types of Urine Specimen

Drug specimen collection

Required urine volume:

Types of Urine Specimen

Drug specimen collection

Container capacity:

32.5-37.7 C

Types of Urine Specimen

Drug specimen collection

Temperature:

Types of Urine Specimen

Drug specimen collection

Added to the toilet water reservoir to prevent specimen adulteration:

>9

<1.005

Types of Urine Specimen

Drug specimen collection

pH _, S.G. _: possibly adulterated

wide

4

Types of Urine Specimen

Urine containers should:

• have a _ base (to prevent spillage)

• have an opening of at least _ cm (to allow easy and accurate urine collection)

• be made of clear, disposable, single-use material

culture

Types of Urine Specimen

When both routine UA and culture are requested, the _ should be performed first

2 hours

30 minutes

Specimen Integrity

Following collection, urine specimens should be delivered to the laboratory promptly and tested within _ _ OR ideally within _ _

voided

Specimen Integrity

Physical, chemical, and microscopic characteristics of a urine specimen begin to change as soon as the urine is _

Specimen Integrity

Urine Preservatives

An ideal preservative (bactericidal, inhibits urease, preserves elements, and causes no interference) does not exist!

The preservative should be chosen based on the specific needs of the test

Refrigeration

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Preservative of choice for routine urinalysis Prevents bacterial growth for 24 hours	Does not interfere with chemical tests	Raises SG by hydrometer Precipitates amorphous phosphates and urates

Thymol

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	-	Preserves glucose and sediments well	Interferes with acid precipitation test for protein (SSA)

Boric acid

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Keeps pH about 6.0 Bacteriostatic at 18 g/L For culture transport, C&S	Preserves protein and formed elements well Does not interfere with routine analyses other than pH	May precipitate crystals when used in large amounts Interferes with drug and hormone analyses

Formalin (Formaldehyde)

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Rinse specimen container with formalin to preserve cells and casts Preservative of choice for Addis count	Excellent sediment preservative	Acts as a reducing agent (interferes with chemical tests for glucose, blood, leukocytes, and copper reduction)

Toluene (Toluol)

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Best all-around preservative Ideal preservative for steroids	Does not interfere with routine tests	Floats on urine surface Clings to pipettes and testing materials

Sodium fluoride

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	May use sodium benzoate instead of fluoride for reagent strip testing	Anti-glycolytic agent (prevents glycolysis) Good preservative for drug analysis	Inhibits reagent strip tests for glucose, blood & leukocytes

Phenol

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Use 1 drop/ounce of specimen Used for transportation of urine specimen	Does not interfere with routine tests	Causes an odor change

Commercial preservative tablets

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Check tablet composition to determine possible effects on desired tests	Convenient when refrigeration not possible Have controlled concentration to minimize interference	May contain one or more of the preservatives including sodium fluoride

Saccomanno fixative

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Used for cytology studies (50 mL urine)	Preserves cellular elements	-

Urine collection kits

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Contains collection cup, C&S preservative tube or UA tube	-	-

Gray C&S tube

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Preservative is boric acid and may not be used for UA	Sample stable at room temperature for 48 hours Preserves bacteria	Decreases pH Do not use if urine is below minimum fill line

Yellow plain UA tube

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	No preservative (plain) Round or conical bottom	Use on automated instruments	Must refrigerate within 2 hours

Cherry red / yellow top tube

URINE PRESERVATIVES
Preservatives	Description	Advantages	Disadvantages
_	Preservative is sodium propionate Conical bottom	Stable for 72 hours at room temperature Instrument compatible	Bilirubin and urobilinogen may be decreased if specimen is exposed to light and left at room temperature

Physical Examination of Urine

Urine Volume

Normal urine output (24 hours): _________________ (Average: 1,200-1,500 mL)

Night urine output: _________________

Day : Night ratio: _________________

Container capacity (UA): _________________

Required for routine UA: _________________ (Average: 12 mL)

Polyuria

URINE VOLUME TERMINOLOGIES
	Definition	Causes
	Increased urine volume = >2.5 L/day (adults) = 2.5-3.0 mL/kg/day (children)	Increased fluid intake Diuretics, nervousness Diabetes mellitus Diabetes insipidus

Oliguria

URINE VOLUME TERMINOLOGIES
	Definition	Causes
	Decreased urine volume = <400 mL/day (adults) = <0.5 mL/kg/hour (children) = <1 mL/kg/hour (infants)	Dehydration Renal diseases Renal calculi or tumor

Anuria

URINE VOLUME TERMINOLOGIES
	Definition	Causes
	Complete cessation of urine flow = <100 mL/day	Complete obstruction (stones, tumors) Toxic agents Decreased renal blood flow

Nocturia

URINE VOLUME TERMINOLOGIES
	Definition	Causes
	Excretion of more than 500 mL of urine at night = S.G. <1.018	Pregnancy Renal diseases, bladder stones Prostate enlargement

Diuresis

URINE VOLUME TERMINOLOGIES
	Definition	Causes
	Any increase in urine excretion	Excessive water intake Diuretic therapy Hormonal imbalance Renal dysfunction Drug ingestion