AUBF

6000

Laboratory medicine began ______ years ago with the analysis of human urine.

uroscopia

Uroscopy, from the word ‘________,’ means ‘scientific examination of urine.’

ouron

Greek word meaning ‘urine?’

skopeo

Greek word meaning ‘behold, contemplate, examine, inspect?’

Hippocrates

He is credited with being the original uroscopist. He hypothesized that urine was a filtrate of the humors, which came from the blood and was filtered through the kidneys. He also believed that no harm should be done to the patient, used gentle therapies, and approached medicine with a holistic attitude.

water, phallus

In ancient times, the symbol for urine was a pairing of _______ and _______.

Sumerian, Babylonian, 4000

_________ and _________ physicians of ______ BC recorded their assessment of urine on clay tablets.

100, 20

Sanskrit medical works from ____ BC describe __ different types of urine.

Sumer

Ancient ______, one of the earliest civilizations, recognized that urine characteristics were altered with different diseases.

Hindu

______ cultures were aware that some people's urine tasted sweet, and that black ants were attracted to this sweet urine, a characteristic of the disease now known as diabetes mellitus.

siphon

‘Diabetes’ stems from what Greek word?

Areteus the Cappadocian

He coined the term ‘diabetes’ in the 2nd century, and described it as as ‘a melting down of flesh and limbs into urine.’

blood, phlegm, black bile, yellow bile

The predominant theory of disease causation, accepted into the 16th century, was that of which four humors?

Aphorisma, proteinuria

In his work, _________, Hippocrates describes bubbles that lay on the surface of fresh urine as an indication of long-term kidney disease. Bubbles on the surface of urine are in fact often owing to __________.

Rufus of Ephesus

The first century physician, ___________, hypothesized that patients urinated blood owing to the widening of the channel therefore letting blood and other thick substances into the kidney.

Galen

He refined Hippocrates’ ideas, theorizing that urine represented, not a filtrate of the four humors and overall condition, but rather, a filtrate of the blood. He also sought to make urine diagnosis more specific, and used the phrase, ‘diarrhea of urine’ to describe excessive urination (noted that it was an atypical symptom).

De Urinis

This manuscript from Byzantium was the first publication exclusively on the subject of urine. The book described a range of colors of ‘the urines’ and their implications.

Theophilus Protospatharius

He wrote De Urinis and had the idea that adding heat to urine might present more insight, thus inventing the first documented laboratory technique?

Paraclesus

Heat would precipitate proteins, causing proteinuria to manifest through cloudiness. Hundreds of years later, in the 16th century, __________ used vinegar to bring out cloudiness.

Acid

______, like heat, will precipitate or ‘cook’ proteins.

Frederick Dekkers

Physician ___________ matched laboratory findings of precipitated proteins (cloudiness) to proteinuria, which remains a useful diagnostic indicator today.

Ismail of Jurjani

___________, an 11th century physician, recommended collecting the full amount over 24 hours in a large clean vessel and keeping it out of the sun or heat, which could alter color. He also recognized that food and aging altered urine, and required a good nights sleep and empty stomach before collection. He wrote about this in the most comprehensive instructional book on urine collection and examination.

Gilles de Corbeil

_____________, royal physician to King Philippe-Auguste of France, built on Protospatharius’ and Judaeus’ writings. His teachings related 20 different types of urine to conditions of the body, he noted differences in sediment and color. He also introduced the matula.

Matula

This is a glass vessel in which a physician viewed urine, assessing color, consistency, and clarity. It was to be held only in the right hand.

jorden

The matula is also known as a/an?

Gilles de Corbeil

He taught at the Medical School of Salerno, wrote a piece called, ‘Poem on the Judgment of Urines,’ in which he incorporated his ideas along with those of Protospatharius and Judaeus into a lyrical tune that made it easy for medical students to memorize.

William of Saliceto

During the 13th century, ______________, an Italian physician, noted and accurately described what would later be known as chronic nephritis. He stated, ‘The signs of hardness in the kidneys are that the quantity of the urine is diminished, that there is heaviness of the kidneys, and of the spine with some pain: and the belly begins to swell up after a time and dropsy is produced the second day.’

Joannes Actuarius

Some physicians, including _____________ from Constantinople, warned of the dangers of diagnosis based on urine alone. He became chief physician to the empire and wrote On Urine, a treatise so extensive that it was divided into seven books. He also concentrated on urine's sediment, hypothesizing that the body's elements separated based on their densities.

On Urine

What treatise did Joannes Actuarius write?

Joannes Actuarius

More sophisticated than previous scholars, _____________ sought to explain metabolism by examining all waste, predominantly urine. He categorized urine into different kinds, diagnostic values, abnormalities, disease, and prognosis. He also believed in physiology based on four humors, but modified the theory by classifying the body into four types of digestion, based on temperature.

sanguine, choleric, phlegmatic, melancholic

What were the four fundamental temperatures according to Joannes Actuarius’ types of digestion?

phlegmatic

Urine was believed to have stemmed from which type of digestion?

Fasciculus Medicinae

During the renaissance, uroscopy entered the household through the best selling book, __________________. In it, the author explained current theories and included a self-diagnostic color wheel with which individuals could self-diagnose their condition.

Johannes de Ketham, 1491

Fasciculus Medicinae was published by who, and when?

Merck Manual

Fasciculus Medicinae became exceedingly popular. Some authors have compared it to the _______________ (which is sold in consumer bookstores and arguably used more by consumers than physicians).

Voswinckel

By the 15th century, urinary diagnosis had transformed the patient–doctor dynamic. The author __________ describes the situation, ‘The belief in progress and the overestimation of instrument and experiment led to a deep change in both the understanding of disease and the relationship between doctor and patient.’

Thomas Linacre

_____________, the founder of the College of Physicians in London, was opposed to the primacy of urine diagnosis, and mockingly commented that if patients brought in a shoe instead of their urine, either specimen would have an equal chance of an accurate diagnosis.

leches

As texts circulated outside the circle of the university educated, laymen began to take on the roles of healers. The amateurs were called ‘______’; the term was used to describe medicinal practitioners who were not physicians.

uromancy

By the 17th century, the uses of uroscopy had spiraled far beyond the edge of reason. Physicians and leches started telling fortunes and predicting the future with urine, a practice known as ‘__________.’

Thomas Brian

Activist and author ____________ led a medical rebellion against all uses of uroscopy over the centuries.

Pisse Prophet, 1637

Thomas Brian published the _____________ in the year _______, a book that devastated uroscopy.

pisse prophets, pissemongers, water-caters, pisse-procrastinators, urinarians

Those who used urine diagnoses were derisively called (5)?

urine analysis / urinalysis

Today, uroscopy is no longer practiced, but ____________ remains an effective diagnostic tool, with a long and colorful history.

50 mL

Recommended urine volume in container

12 mL

Recommended urine volume for microscopic analysis

adhesive bags / pee bags

What is used for pediatric urine collection?

anus

What area is avoided when using an adhesive bag?

15 minutes

Adhesive bags are checked at what interval?

diaper

If not yet collected, adhesive bags are covered with a?

insufficient volume

Specimen rejection criterion that requires cross-checking of patient status

2 hours

Unpreserved specimens are tested within?

refrigeration

Most common method of urine preservation

2-8 C

Refrigeration temperature

boric acid

Chemical preservative that inhibits bacterial growth

formalin

best chemical preservative for sediment

ph, nitrite, bacteria, color, odor

analytes that increase in unpreserved urine exceeding 2 hours from collection (5)

bilirubin, urobilinogen, clarity, cell cast, ketones, glucose, Trichomonas

analytes that decrease in unpreserved urine exceeding 2 hours from collection (7)

Random

Most common type of urine specimen

Random

Type of urine specimen that can be collected at any time

Random

Type of urine specimen that is useful for routine screening but may be affected by diet and activity

First morning

Most ideal type of urine specimen

First morning

Most concentrated type of urine specimen

First morning

Type of urine specimen for routine screening tests, pregnancy tests, and orthostatic proteinuria

Glucose Tolerance Test

Type of urine specimen collected to correspond with blood samples

Glucose Tolerance Test

Type of urine specimen correlated with the renal threshold of glucose

Glucose Tolerance Test

Type of urine specimen that tests ketones and glucose

2-hour postprandial

Type of urine specimen for monitoring diabetes mellitus and insulin therapy

12-hour specimen

Type of urine specimen for sediment quantification using a hemocytometer

Addis count

Term for sediment quantification using a hemocytometer

0 to 500,000

RBC normal range

0 to 1,800,000

WBC and EC normal range

0 to 5,000

Hyaline casts normal range

24-hour timed specimen

Type of urine specimen that begins and ends with an empty bladder

24-hour timed specimen

Type of urine specimen for the quantitative measurement of diurnal analytes

24-hour timed specimen

Type of urine specimen for glomerular filtration (clearance) tests

falsely elevated

Result of 24-hour timed specimen if Day 1 first morning is collected

falsely decreased

Result of 24-hour timed specimen if Day 2 first morning is NOT collected

catecholamines, 17-hydroxysteroids, electrolytes

Examples of diurnal analytes (3)

refrigeration / kept on ice

24-hour timed specimen is preserved through?

50 mL

The quantity aliquoted from a 24-hour timed specimen for testing

45 seconds

SG reading time

leukocyte esterase

Urine parameter with the longest reading time

120 seconds

reading time for leukocyte esterase

60 seconds

reading time of blood

catheterized specimen

Type of urine specimen collected under sterile conditions using a hollow tube passed through the bladder

bladder

The most sterile urine in the body is found in which part of the urinary tract?

bacterial culture

For catheterized specimens and suprapubic aspirates, what is done before routine testing?

suprapubic aspirate

Type of urine specimen that uses a needle to collect urine through the abdomen and directly from the bladder

suprapubic aspirate

Most invasively collected type of urine specimen

suprapubic aspirate

Type of urine specimen collected from bed-ridden patients who cannot be catheterized

suprapubic aspirate

Type of urine specimen for bacterial culture and cytology

Midstream clean-catch specimen

Type of urine specimen that is a safer, less traumatic alternative to catheterized specimens

Midstream clean-catch specimen

Type of urine specimen that is less contaminated by ECs and bacteria

hexachlorophene, povidone-iodine

Strong bacterial agents that should not be used when collecting midstream clean catch specimens (2)

Prostatitis specimen

Type of urine specimen that detects prostatitis

Three-glass collection, Stamey-Meares Test (Four-glass technique)

The two types of prostatitis specimens

All

For prostatitis specimens, which tubes will undergo bacterial culture?

1, 3

For three-glass collection, which tubes will be observed microscopically?

UTI

For three-glass collection, what does a positive result for tube 1 indicate?

prostatitis

For three-glass collection, what does a positive result for tube 3 indicate?