Unit 1. Intro to Urinalysis (History)

1. Physical exam

2. Chemical exam

3. Microscopic exam

3 Phases/Exams in Urinalysis

1. color

2. clarity

3. odor

4. taste

4 Parameters under Physical Exam

straw → amber

color of urine

1. blood

2. leukocyte esterase

3. nitrite

4. bilirubin

5. bilirubilinogen (urobilinogen)

6. glucose

7. proteins

8. specific gravity

9. pH

10. ketones

10 Parameters under Chemical Exam

1. cells (RBC, WBC, epithelial cells)

2. microorganisms (bacteria, parasite, fungi)

3. crystals (insoluble material; e.g., CaOx)

4. casts

5. miscellaneous structures

Parameters under Microscopic Exam

Vit. C overdose

what causes CaOx crystal formation in urine?

Physical exam

The phase in urinalysis that

• must be correlated with the other 2 phases

• and is the initial step.

Chemical exam

The phase in urinalysis that

• assesses the dissolved substances in urine

• and for confirmation of the changes that have happened on its physical characteristics

Microscopic exam

The phase in urinalysis that

• reveals the formed elements present in urine

• and tells you the “cause” of the changes in urine

ampicillin crystals;

UTI

• formed substance in urine derived from ampicillin antibiotics

• this suggests ____

T

T or F

Urinalysis is part of the basic routine tests and screening tests.

• Urinalysis

• CBC

2 safest tests to perform if you have no idea on the pathology

A. 95% water

B. 5% solutes

• B.1. Organic - urean creatinine

• B.2. Inorganic - chloride, sodium, potasssium

2 major components of urine

1. Glomerular/Renal

2. Tubular

3. Interstitial

3 types of Abnormalities/Diseases in Urine

1. Renal blood flow

2. Glomerular filtration

3. Tubular secretion

4. Tubular reabsorption

5. Hormone production

5 Functions of Kidneys

• Tubular secretion: circulation → renal tubule

• Tubular reabsorption: renal tubule → circulation

Differentiate Tubular secretion from Tubular Reabsorption

nephron

basic functional unit of kidneys

• Glomerulus - filtration

• Tubules - sorting what is needed from what is not

2 structural units of nephron

Distal convoluted tubule

Reabsorption of water/nutrients, as induced by ADH, happens in which part of the nephron.

1. Bowman’s capsule

2. Proximal convoluted tubule

3. Loop of Henle (ascending & descending)

4. Distal convoluted tubule

5. Collecting duct

Bowman’s capsule → PCT → Loop of Henle → DCT → Collecting duct

5 parts of the tubules

• semen

• CSF

• synovial fluid

• amniotic fluid

• serous fluid (pleural, pericardial, peritoneal)

• gastric lavage

• vaginal secretions

• sweat

• bronchial lavage

• sputum

Enumerate the other body fluids

Urinalysis

• “urine + analysis”

• marked the beginning of laboratory medicine even during the pre-modernization era.

• During his time, it includes observations of color, turbidity, odor, volume, viscosity and even sweetness of urine

70-100 mg/dL

70-110 mg/dL

Normal value for FBS

Hippocrates (5th Century BC)

• began urine physical exam

• started methods to analyze urine 4,000-6,000 years ago

• Father of Medicine

Uroscopy

Aristotle wrote a book on _________ which served guidelines on the examination of urine through simple specimen inspection.

Galen;

clarity

Together with _____, Hippocrates concerned with the physical characteristics of urine in various disease states.

They observed urine ______ (clear, cloudy, bloody, yellow, milky, etc.) and ventured on how drinking water altered the urine.

• ↑ hydration ; ↑ urine volume ; ↑ clarity ; ↑ lighter

• ↓ hydration ; ↓ urine volume ; ↓ clarity ; ↓ darker

Relationship between hydration level of the patient, volume, color, and clarity of urine.

Antidiuretic hormone (ADH)

Hormone releases by the hypothalamus in response to hydration levels, to regulate water balance.

This stimulates the DCT in the kidneys to reabsorbs water/nutients

1. Urochrome - normal yellow color

2. Urobilin - orange to brown color ; unpreserved urine

3. Uroerythrin - pink precipitates when urine is preserved/ refrigerated

3 pigments of urine and their purpose

2 hrs TAT

TAT for urine

Albumin

_________ is considered the most important protein to detect in urine because it is normally too large and too negatively charged to pass through the kidney filter.

Glomerular Proteinuria

• Cause: Damage to the glomerular filtration barrier

• Mechanism: Increased permeability → proteins (especially albumin) leak into urine

• Protein type: Mostly albumin

• Amount: Can be mild to very high

• Seen in:

  • Glomerulonephritis

  • Diabetic nephropathy

  • Hypertension-related kidney disease

Tubular proteinuria

• Cause: Damage to renal tubules (especially PCT)

• Mechanism: Tubules fail to reabsorb normally filtered small proteins

• Protein type: Low-molecular-weight proteins (not mainly albumin)

• Amount: Usually mild to moderate

• Seen in:

  • Tubulointerstitial diseases

  • Acute tubular necrosis

  • Heavy metal toxicity

  • Drug-induced kidney damage

GFB (glomerular filtration barrier)

• a specialized filtration structure in the kidney that controls what passes from blood into the Bowman’s capsule.

• Allows passage of water, ions, glucose, small solutes

• Prevents passage of blood cells and large proteins (especially albumin)

• damage of this structure leads to proteinuria

Alcohol

_______ tends to block the receptors of ADH, it fails then to preserve water in the body expecting an increased urine output

1140 AD;

20;

colorimetric principle

• Color charts were developed and were used to describe the clinical significance of ____different urine colors

• This started the integration of urine color as one parameter in the physical examination of urine that is still used even today, leading to the development of the principle called “____________”

Theophilus

• He had the earliest recognition of proteinuria. He heated urine and noted that it became cloudy in certain disease states.

• Even until today, this phenomenon is still observable in disease processes that involve abnormalities in protein formation, metabolism and conservation.

glucose in urine = pancreatic problems

proteins in urine = renal problems

bilirubin in urine = liver problems

glucose in urine = ________

proteins in urine = ________

bilirubin in urine = ________

Paracelsus

• In doing alchemical methods, in the examinations of urine, he invented a special flask that is used in the distillation of urine.

• It had graduations on its sides and was in the form of a human body.

Thomas Bryant (1627)

• He wrote a book about charlatans (merchants) or the pisse prophets which inspired the passing of the first medical licensure exam in England.

• They diagnose based on the appearance of urine.

17th Century;

Thomas Addis;

40% formalin;

12 hrs

• Microscope was invented which led to the examination of urinary sediment and to the development of a method for quantitating microscope sediment.

• This method was introduced by ___________ where he used __________ to preserve urine for ________.

Hemocytometer

• Equipment is used to quantify urinary elements

[CREW]

• Casts: ≤ 5,000

• RBC: ≤ 500,000

• Epithelial cells: ≤ 500

• WBC: 1,800,000 – 2,000,000

Urinary elements quantified by the Hemocytometer

Addis Count

• 12-hour urine collection

• Start with empty bladder → collect all urine for 12 hours → end with empty bladder

• Used to quantify urine formed in a day (microscopic elements)

A. Physical: Refrigeration

B. Chemical: 37-40% formalin

2 types of Urine preservation

Richard Bright (1827);

Glomerulonephritis (Bright’s disease)

• He introduced the concept of urinalysis as part of routine patient examination.

• He was able to examine _______________

Golding Bird

• He demonstrated the importance of studying urinary sediment and described urinary casts in patients with Bright’s disease.

• He introduced the integration of chemical tests on urine examination.