Urinalysis and Body Fluids

seven observations of urine

formulated around 1000AD; are quantity, consistency, colour, odour, transparency, sediment, and froth

ADH

anti-diuretic hormone; decreases the amount of urine produced

albuminuria

albumin detected in urine

aldosterone

produced by the adrenal cortex to retain sodium and water and excrete potassium

angiotensis

causes vasoconstriction and releases aldosterone

anuria

no urine produced, can be caused by renal tubular necrosis due to drugs and chemicals or by complete obstruction of the urinary flow

bowman's capsule

the collection capsule of the glomerulus

cystitis

inflammation of the bladder

cystogram

visualization of the bladder

dialysis

removal of toxic waste form the blood when kidneys do not work

diuretic

a drug given to a patient to increase urine flow educe fluids and blood pressure

diuresis

abnormal increased output of urine

dysuria

painful or difficult urination

epispadius

urethral opening of the penis at the top

erythropoietin

hormone produced by the kidney to stimulate RBC production

frequency

urinating often

glomerulus

filtration unit of the nephron; filtering system and a tubule through which the filtered liquid passes

glycosuria (glucosuria)

detectable glucose in urine

hematuria

detectable blood in urine

hypospadius

opening of the urethra on the ventral (underside) of the penis

IVP

Intra Venous Pyelography- visualization of the renal pelvis

incontinence

inability to prevent urine leaking from the urethra

ketonuria

detectable ketones in urine

ketosis

increased levels of ketones in the blood

KUB

kidney, ureter, and bladder x-ray

micturation

the act of voiding urine

nephrectomy

removal of kidney

nephron

functional unit of the kidney

nephrosis

nephrotic syndrome with proteinuria and edema

nitrites

chemical produced from breakdown of nitrates from bacteria

nocturia

excessive urination at night

nocturnal enuresis

bed wetting; inability to control urination at night during sleep

oliguria

polyuria

excessive urine production at >2L per day. Normal response to increase fluid intake, diuretic drinks, and meds. Seen in diabetes and renal disease. Can indicate loss of concentration of re-absorption ability in the kidneys

proteinuria

detectable protein in urine

pyuria

pus cells in urine

R and M

urinalysis routine and microscopic

renal calculi

kidney stones

renal cortex

outer area of the kidney

renal medulla

inner portion of the kidney

renin

produced by the kidney, controls production of aldosterone

stress incontinence

inability to control urination during stressful times such as sneezing, coughing, and laughing

urgency

immediate need to urinate

uremia

kidney failure with increased BUN. End stage renal failure where 90% of the nephrons are lost

routine urinalysis

referred to as R&M which stands for Routine and Microscope

urinary incontinence

inability to control voiding of urine

purpose for performing routine urinalysis

to detect endocrine or metabolic disorders; to observe physical, chemical, and microscopic characteristics which indicate disease or damage to the urinary system

urine formation (normal)

made up of 95% water and 5% solids. normally contains water, urea, uric acid, and sodium chloride

urine formation (diseases)

may contain protein, glucose, ketones, hemoglobin, lipids, bacteria, pus, bilirubin, or calculi

microscopic examination

of urine sediment; can detect cells, casts, crystals, bacteria, yeasts, parasites, and other structures

kidneys

two small fist-sized organs located behind the peritoneal cavity, one on each side of the spine, at about the level of the first lumbar vertebrae

kidney function

- removes metabolic wastes from the body
- maintain body water balance
- regulate blood pH

nephron

functional unit of the kidney; 1-1.2 million in each kidney. Consists of glomerulus
Form urine through three mechanisms:
- glomerular formation
- tubular re-absorption
- tubular secretion

glomerular filtration

blood enters through renal artery --> smaller arteries --> afferent arteriole --> capillary network (aka glomerulus) --> efferent arteriole. High blood pressure in glomerular capillaries, water and dissolved substances are driven out of capillaries in to bowmans capsule

tubular re-absorption

urine filtrate passes from Bowman's capsule to renal tubule, filtrate moves down tubule where water and dissolved substances are re-absorbed into blood. Filtrate very concentrated when reaches distal convoluted tubule

tubular secretion

substances are moved from the blood capillaries surrounding the renal tubule directly into the distal convoluted tubule and collecting tubule. substances include ammonia, H+, potassium, drugs

urine volume

in adults is 750-2000 ml/day and averages 1200-1500ml/day

urine volume influences

1. fluid intake
2. fluid loss through lungs, feces, and skin
3. concentration of solutes in the filtrate
4. cardiac output
5. hormonal influences

mid stream urine

Type of urine specimen; first portion of urine passed into toilet and middle of sample is collected. Flushed out urethra to eliminate most contaminating bacteria cells

random urine

Type of urine specimen; single urine specimen which may be collected at any time without regard to dietary or fluid restrictions

first morning urine

Type of urine specimen; collected from the first voiding of the day immediately after the patient wakes up

second voided urine

Type of urine specimen; sometimes used by diabetics so that no residual glucose form night before is present. Done less frequently

random sample is poorest type

concentration of urine varies through a 24-hour period depending on the patient's fluid intake and activity. various solutes appear in greater or lesser amounts at various times of the day. Casts and RBCs will lyse in dilute urine, various solutes could be missed

first morning urine specimen preferred

- it is more concentrated
- contains more formed elements
- is bladder incubated
- has a lower pH

postprandial urine

Type of urine specimen; collected 2 hours (sometimes 4) after a meal, mainly used for glucose testing to detect or monitor diabetes mellitus

clean catch mid stream urine (CCMSU)

Type of urine specimen; collected from the middle portion of urine stream and requires special skin cleansing. Collected in sterile container. Goes to microbiology for culture. Collected as random or first morning specimen

CCMSU use

- C and S: culture and sensitivity to diagnose urinary tract infections
- R and M: when vaginal discharge or menstrual blood might otherwise contaminate the specimen

24 hour urine collection

Type of urine specimen; give accurate way to quantitatively measure actual amount of particular substance that is being excreted, as in the total amount of protein which is being lost in conditions of chronic renal disease can be determined. To monitor and detect disease. Preservatives used

quality assurance in urinalysis

programs monitor and maintain lab performance by using constant checks to detect and locate the source of random and systematic errors. Ensures reliable results

specimen identification

to ensure patient's specimen is actually the specimen tested and recorded. Common errors include testing the wrong specimen and recording results form one patient's specimen onto another patient's report

specimen handling

urine must be tested within one hour or put in fridge. If not can get false negatives and positives. Is invalid if passes one hour period and nor refrigerated

control specimens

samples with predetermined test values

known controls

values are known by lab personnel . results are plotted and must fall within acceptable limits. Assure thats tests are performed properly, reagents have not deteriorated, and instruments are properly calibrated

unknown controls

test values not known by lab personnel. Useful in evaluating performance of lab personnel and lab as a whole

three steps of R and M

- physical examination
- colour
- turbidity/ clarity

odour and foam

Part of physical examination; not reported unless there is an abnormality

abnormal odour

Part of physical examination;
- ammonia: stale urine
- fruity odour: presence of ketones
- foul odour: presence of bacteria
- foam: white when normal and shaken, excessive white foam from protein, yellow foam from bilirubin

Urine colour

always reported, normal colour is yellow due to urochrome, and different shades depending on concentrated. Can be affected by foods, dyes, disease states

red

Abnormal urine colour, Part of physical examination;
may indicate presence of blood, normal in menstrual blood contamination

coffee brown

Abnormal urine colour, Part of physical examination; presence of old blood and often indicated bleeding high up in urinary tract

dark yellow (yellow/ brown, yellow/ green)

Abnormal urine colour, Part of physical examination; bile pigments

greenish yellow

Abnormal urine colour, Part of physical examination; excessive B vitamins

green/ blue

Abnormal urine colour, Part of physical examination; methylene drugs or dyes in amitriptyline

pale yellow green

Abnormal urine colour, Part of physical examination; large amounts of glucose

dark red brown

Abnormal urine colour, Part of physical examination; porphyrins

black/ brown

Abnormal urine colour, Part of physical examination; melanin or porphyrins

black

Abnormal urine colour, Part of physical examination; when turns this colour on standing often indicates a disorder of tyrosine metabolism called Alcaptonuria

Turbidity/ Clarity

Part of physical examination; normally fresh urine is clear or transparent, always ensure is well mixed when assessing

amorphous phosphates

turbidity/ clarity; white sediment present in neutral or alkaline urine. Amount of phosphate deposit increases in old urine as pH rises, disapear if urine is acidified

amorphous urates

turbidity/ clarity; may form pink sediments in acid urine, usually disappear if urine is warmed to 37C

pus

turbidity/ clarity; macroscopically identical to amorphous phosphates but don't disappear if urine is warmed. Mucoid in alkaline urine and crumbly in acid urine

blood

turbidity/ clarity; produces smoky or red/ brown turbidity

bacteria

turbidity/ clarity; uniform cloud or opalescence, will usually multiply in urine after testing and should be tested asap

fat

turbidity/ clarity; lipiduria produces a milky or greasy cloudiness

chyle

turbidity/ clarity; gives urine a cream colour and may be caused by filarial parasites, thoracic duct obstruction, trauma, or tumour

specific gravity (S.G.)

determines concentration or dilution of a urine specimen

SG uses

- interpret significance of most R&M results i.e. trace amounts of proteins are more significant in a dilute urine than a concentrated one
- assess the ability of the kidney to concentrate or dilute urine

SG normal range

1.003-1.030, avg 1.010-1.025

refractive index

method for determining SG; velocity of light in air compared to the velocity of light in urine.

urinometer

method for determining SG; weighted bulb shaped device which is floated in cylinder of urine, SG read on scale at bottom of meniscus