CH12 (Part 1) - Urinalysis

i miss her (there is no 'her', i just like saying that) (unless) (?)

Define “Urinalysis“

The macroscopic, physical, chemical, and microscopic analysis of the urine.

True or False: You can diagnose a patient just by urinalysis test.

True.

What is the renal anatomy and physiology of urine?

It is a fluid composed of the blood’s waste materials; an ultrafiltrate of blood.

What are some functions of our kidneys?

• Provides homeostasis

• Maintains blood pressure

• Eliminates metabolic waste (medications, vitamins, any in/organic substances)

• Helps regulate hormones

The function of the hormone Erythropoietin (EPO) is?

Induction of RBC production

The function of the hormone aldosterone is?

Salt and water regulation

Anti-diuretic hormone (ADH) allows for?

Release of less water

If urine output is increased,..

…then ADH secretion is decreased.

If urine output is decreased,..

…then ADH secretion is increased.

ADH is also known as?

Vasopressin

What is a nephron?

The basic functional unit of the kidney

How many nephrons are inside each kidney?

1-1.5 million

What is the map of the kidney? (6)

1. Glomerulus

2. Bowman’s Capsule

3. Proximal Convoluted Tubule

4. Loop of Henle

   • Descending Loop of Henle

   • Ascending Loop of Henle

5. Distal Convoluted Tubule

6. Collecting Tubules

What is the Glomerulus, and its function?

• A tuft of anastomosing capillaries, inside Bowman's Capsule

  • When blood exits this, it is called glomerular filtrate

What is Bowman’s Capsule?

Semi-permeable membrane that allows passage of substances with MW of less than 70,000 Daltons

What does the Proximal Convoluted Tubule do?

It reabsorbs majority of essential substances from the glomerular filtrate, like ions and sugars

What is the Loop of Henle?

It is the major exchange site for salt and water.

What is the Descending Loop of Henle for?

It is freely permeable to water, and reabsorbs water

What is Ascending Loop of Henle for?

Exchanges salt.

What is Distal Convoluted Tubule for?

Secretion of aldosterone and ADH

What are the Collecting Tubules for?

Allocation of the final concentration of urine.

What does the bladder do?

Store urine

What does the urethra do?

Expel urine (you pee)

What is responsible for the contraction of the bladder?

Sphincter muscle

What is the percent composition of urine?

96% water. 4% dissolved substances.

Free table on urine!

What are some factors that affect urine composition?

• Dietary intake (nuts, legumes, red meat)

• Physical activity

• Body metabolism

• Endocrine functions

What are the two most important factors before urine examination?

1. Patient’s full name

2. Patient’s date of birth

What does Px mean?

Patient

What does Spx mean?

Specimen

What does Tx mean?

Treatment

What does Dx mean?

Diagnosis

What does DDx mean?

Differential Diagnosis

What is the most commonly received spx in the laboratory?

Single/Random Specimen

What is the ideal screening spx, and the most concentrated?

First Morning Specimen

What are some characteristics regarding the Fasting Specimen (2nd Morning)?

• Second voided spx after a period of fasting

• In conjunction with fasting blood glucose for blood extraction

• Px needs to empty bladder before fasting for 8-10 hours

• Fasting spx used for glucose monitoring

What is the 24hr timed spx used for?

Used to measure total amount of solutes in urine, creatinine clearance

What is the 12hr timed spx used for?

Addis count (quantitative), 40% formalin to preserve

What is the 2hr timed spx, Postprandial spx used for?

Glucose testing. Also used to monitor insulin therapy.

Includes insulin dependent, type I diabetes

What is the afternoon (2-4pm) spx used for?

Determines urobilinogen.

The peak concentration for afternoon spx is at 2-4PM due to?

Diurnal activity

What is the Glucose Tolerance spx used for?

To tolerate glucose flow subjected to patient; 75g normal

What is the Mid-Stream Clean Catch spx for?

Most common

What is the Three-Glass Collection for?

• Male patients only

• Screens prostatic infection

In the three-glass collection specimens, what is the FIRST glass for?

Consists of first voided urine

In the three-glass collection specimens, what is the SECOND glass for?

Mid-stream portion, serves as a control

In the three-glass collection specimens, what is the THIRD glass for?

Consists of prostatic secretions, subjected to microbiology section for bacterial culture

What is the Catheterized spx for?

Bacterial culture.

What does Suprapubic Aspiration include?

Bacterial culture and psychologic studies; anesthetic in bladder, physician uses syringe to puncture bladder

What is the Pediatric Specimen for?

To collect toddlers’ urine sample.

How much mL of urine does the Drug Testing Specimen usually need?

30-45

In some drug testing facilities, how much mL of urine does the Drug Testing Specimen require?

60

What is the temperature range for Drug Testing Specimens?

32.5'C - 37.7'C

What is required regarding Specimen Integrity? (3)

• Urine must be delivered to lab and examined within 2 hours

• Refrigeration, between 2-8'C, to inhibit bacterial growth and metabolism

• Chemical preservative, like 40% formalin, or boric acid

In macroscopic/physical examination, what is the volume of urine needed?

600-2000 mL

In macroscopic/physical examination, what is the color range for urine?

Light yellow (dilute random spx.) to dark yellow (concentrated spx.)

In macroscopic/physical examination, what does it mean when urine is colorless?

Recent fluid consumption (you just had water)

In macroscopic/physical examination, if patient is infected, what color might their urine be?

Green, black, or red

In macroscopic/physical examination, what is the normal transparency of urine?

Clear transparency

In macroscopic/physical examination, if there are any sediments in the urine, to what length can the transparency vary?

Clear, hazy, cloudy, curbid, milky

In macroscopic/physical examination, what is the normal odor?

Faintly aromatic

In macroscopic/physical examination, what could be said if there is a fruity sweet smell?

Presence of ketones, or MSUD (maple syrup urine disease)

In macroscopic/physical examination, what is the range of specific gravity?

1.005 - 1.035

What if there is less specific gravity?

Less concentrated spx.

What if there is more specific gravity?

More concentrated spx.