aubf prelim 1

Urinalysis

Has remained an integral part of the patient examination

Two Unique Characteristics

1. Readily available

2. Information collected by inexpensive lab tests

3. Suitable for screening large number of individuals

Reasons for performing urinalysis by clsi

- Aiding diagnosis

- screening asymptotic populations

- monitoring progress of disease

- effectiveness of therapy

Analysis of urine

Beginning of laboratory medicine

Edwin Smith Surgical Papyrus

Reference of the study of urine found in cavemen drawings in Egyptian hieroglyphics

Bladder-shaped flask of urine

Early physicians examined urine through?

Color, Turbidity, Odor, Volume, Viscosity, Sweetness

What diagnostic information did the bladder shaped flask provide?

Uroscopy

Earliest practice of examining urine

Matula

Transparent glass flask/cup shaped container used in the middle ages

Hippocrates

He wrote a book about uroscopy in 5th BCE

- said hat disease are a natural result of a malfunction in the body

1140 CE, 20

This is when color charts had been developed to describe the significance of ____ different colors

Thomas Bryant

He published a book in 1627 hat subjeced "pisse prophets"

Charlatans

"Pisse prophets" aka fake doctors

England

Where was the passing of the first medical licensure?

Richard Bright (1827)

He introduced urinalysis as a part of a doctor's routine patient examination

Ludwig Thudichum (1864)

Isolated urochrome pigment in the urine

Microscope

It was introduced in 17th century which lead to the examination of urinary sediment

Thomas Addison (1925)

He developed methods of quantitating microscopic sediment

Addis count

Made by thomas Addis, it was involved in examining sediment of a 12 hour time urine collection

Type and number of cells and casts

What was assessed in the addis count?

Frederik Dekkers (1964)

He found albumin, a fractional component of urine by boiling the specimen and obtain a cloudy color at a certain temp

Domenico Cotugno

Discovered the erebrospinal fluid

Ivan Folling

Found Phenylketonuria

Archibald Garrod

Found Alkaptonuria

William Wollaston

Found Cystine calculi

Stanley Benedict

Discovered benedict's reagent

170,000ml

The amount of filtered plasma to the average daily urine output of 1200ml to 1500ml

Urine composition

Urea, other organic and inorganic chemicals dissolved in water

Fluid homeostasis

This is regulated by urine. There shouldnt be no excessive nor low excretion of fluids and blood output is NOT normal

95% water, 5% solutes

What is the composition of urine? (In percentage)

60g = 35g organic + 25g inorganic

What is the total solids in 24 hours?

Primary components of urine

Urea

Creatinine

Uric acid

Chloride

Sodium

Potassium

Phosphate

Ammonium

Calcium

Urea

Primary organic component, nearly half of the total dissolved solids in urine.

- metabolic waste product produced in the liver from the

breakdown of protein and amino acids

Creatinine

Product of creatine metabolism by muscles

Uric acid

Product of nucleic acid breakdown in foods and cells

Chloride

Primary inorganic component

- Found in combination with sodium (table salt) and many inorganic substances

Sodium

Primarily from salt, varies by intake

Potassium

Combined with chloride and other salts

Phosphate

Combines with sodium to buffer the blood

Ammonium

Regulates blood and tissue fluid acidity

Calcium

Combines with chloride, sulfate, and phosphate

Urine volume

Depends on the amount of water that he kidneys excrete.

Tissue perfusion

This is when the body priorities maintaining blood volume and pressure to ensure organs reciee sufficient blood

Water

The major body constituent thus, the amount excreted is usually determined by the body's state of hydration.

Factors that influence urine volume

Fluid intake

Fluid loss from non-renal sources

Variations in the secretion of antidiuretic hormone

Need to excrete increased amounts of dissolved solids

Glucose and salts

What are the examples of dissolved solids?

1,200ml - 1500ml

What is the average daily urine output

600 - 2000ml

How much ml is considered normal

Types of urine volume

Oliguria

Anuria

Nocturia

Polyuria

Diuresis

Oliguria

Decrease in urine output

Urine less than 1ml/kg/hr

What is considered Oliguria in infants

Urine less than 0.5ml/kg/hr

What is considered Oliguria in children

Urine less than 400ml/day

What is considered Oliguria in adults

Anuria

cessation of urine flow (totally no urine output)

<100ml/24hrs

How much urine output is considered as anuria

nocturia

an increase in the nocturnal excretion of urine

>500ml at night

How much urine output is considered as nocturia

Polyuria

An increase in daily urine volume

Greater than 2.5 to 3 ml/kg/day

How much urine output is considered as polyuria in children?

Greater than 2.3L

How much urine output is considered as polyuria in adults?

Diuresis

Any increase in urine excretion

Clean, dry, leakproof containers

Where must specimenst be collected

wide mouth, wide flat bottom and clear material

Ideally, the containers should have a _ to facilitate collections from female patients and _ to prevent over turning

50ml

What is the recomendd capacity of a specimen contaner

10-15mL (12mL)

What is the volume of the specimen needed for microscopic analysis? (What is the average?)

2 hours

Specimens should be delivered to the laboratory promptly and tested within _________ after collection

Refrigerated at 2*C

A specimen that cannot be delivered and tested within 2 hours should be ____________ or have an appropriate chemical

preservative added

Refrigeration for 2-8*C

What is the most routinely used method of preservation?

24hrs, room temp

If the urine is to be cultured, it should be refrigerated durng transit and kept there until cultured, up to how many hours?

Speciemn then must return to ________ before chemical testing.

reagent strips

During chemical testing, what is used to Chemically analyze urine?

Bactericidal, inhibit urease, preserve formed elements, and should not interfere with chem test

What is the ideal preservation of urine sample?

7mg/dl/hr

Rate of glycolysis at room temp

Changes in unpreserved urine

Color

Clarity

Glucose

Ketones

Bilirubin

Urobilinogen

RBC/WBC and casts

Trichomonas

pH

Bacteria

Odor

Nirite

Color

Modified/darkened

Bcs of the oxidation or reduction of metabolites

Clarity

Decreased

Bcs of bacterial growth and precipitation of amorphous phosphates

Glucose

Decreased

Bcs of glycolysis and bacterial use

Ketones

Decreased

Bcs of the volatilization an bacterial metabolism

Bilirubin

Decreased

Light exposure/ photo-oxidation

Urobilinogen

Decreased

Oxidation to urobilin

RBC/WBC and casts

Decreased

Bcs Disintegration in dilute alkaline urine

Trichomonas

Decreased

Bcs of the loss of motility/death

pH

Increased

Bcs of the breakdown of urea to ammonia by urease producing bacteria or loss of co2

Bacteria

Increased

Bcs of multiplication

Odor

Increased

Bcs of bacterial multiplication causing breakdown of urea to ammonia

Aromatic

What is the normal smell of urine?

Nitrite

Increased

Bcs of the multiplication of nitrate-reducing bacteria

URINE PRESERVATIVES

Refrigeration

Thymol

Boric acid

Formaldehyde

Toluene

Sodium fluoride

Phenol

Commercial preservative tablets

Urine collection kits

Gray culture and sensitivity tube

Yellow plain tube

Cherry red/yellow top tube

Sacomano fixative

Refrigeration

Ad: no interference with chem test, prevents bacterial growth for 24hrs

Dis: raises SG by hydrometer, precipitates amorphous phosphate and urates

Thymol

Ad: preserves glucose and sediments well

Dis: interferes with acid precipitation test

Boric acid

Ad: preserved protein and formed elements, no interference with routine analysis other than pH

Dis: may precipitate crystals

Formaldehyde

Ad: excellent sediment preserve

Ds: interferes with chem tests

Toluene

Ad: does not interfere with routine test

Dis: floats on surface

Sodium flouride

Ad: prevents glycolysis and good for drug analysis

Dis: inhibits reagent strips for glucose, blood and leukocyte

Phenol

Ad: No interference with routine tests

Dis: Causes an odor change

Commercial preservative tablets

A: Convenient when ref is not available

D:may contain one or more preservatives

Urine collection kits

A: contains collection cup, culture and sensitivity preservative tube

Yellow plain tube

A: used on automated instruments

D: must ref within 2 hours

Cherry red/ Yellow top tube

A: stable for 72 hours at room temp, instrument compatible

D: may decrease bilirubin and urobilinogen

Saccomanno fixative

Preserves cellular elements ad it is used for cytology studies (50ml)

Types of specimens

Random/occasional/single specimen

First morning specimen

Second morning specimen

Glucose tolerance specimens

Catheterizd specimen

Midstream clean catch specimen

Suprapubic aspiration

Prostatitis

Pediatric specimen

Drug specimen collection