CHEMICAL EXAMINATION OF URINE: URINARY PROTEIN

(renal diseases.) (Proteinuria) (10 milligrams) (100) (24 hours) (Albumin)

(Tamm Horsfall protein (uromodulin)) (pathological or not.)

PROTEIN DETERMINATION

CLINICAL SIGNIFICANCE

• Most indicative for (____________)

• (_______) – when protein is present in urine, often

associated with early renal disease.

• Normally, urine contains very little protein present

because it is being reabsorbed by the body and not

secreted. usually less than (____________) per dL or (_________)

mg per (________) in the excreted urine.

• (__________) is the major serum protein found in the normal

urine, a low molecular weight protein

• Other proteins include: (_______________)

• Demonstration of protein in the urine does not always

signify a renal disease but this would aid the physician in

ordering additional tests to determine if the protein

present is of clinical significance, if it is (_______________)

• Clinical proteinuria or Pre-Renal

• Renal Proteinuria

• Post-Renal Proteinuria

THREE MAJOR CATEGORIES OF PROTEINURIA

(Protein error of pH) (constant.) (hydrogen

ions.) (hydrogen ions.) (Tetrabromphenol Blue) (Tetrabromosulfonphthalein) (Hydrogen ion) (• Midstream, Clean-catch urine) (pH – 60 seconds) ) () () () ()

REAGENT STRIP METHOD

Principle	• (________) indicators • Certain indicators change color in the presence of protein even though the pH of the medium remains (______) • This is because the protein, primarily the albumin, would accept (_______) • Meanwhile, the indicators would lose these (___________)
pH indicators	• (_____________) (Multistix) • (_____________) (Chemstrip) • The protein would give up (________) and it will turn into Blue-Green in the reagent strip pad. • Indicator + Protein = Protein + H+, Indicator – H+ (Blue Green)
Specimen	(_____________, _____________________)

Reading time	(________)

(heat and precipitated by acid) (clear) (Centrifuge)

(• 5% acetic acid • Centrifuge) (• Midstream, Clean-catch urine) (No cloudiness) (Barely visible cloudiness) (Distinct cloudiness, non-granular)

(Distinct cloudiness, Granular)

(Heavy Cloudiness with distinct flocculi)

(Dense heavy cloud with large floccule that may solidify)

HEAT AND ACETIC ACID TEST

Principle	• Protein is denatured by (______&______). • The degree of turbidity produced is proportional to the quantity of protein present. • As the test depends on turbidity in the urine solution, urine must be (________) before use. • (___________) the specimen and after which, heat the upper portion of the tube.
Equipment and materials
Specimen

Reading

Negative	(____________)
Trace	(____________)
1+	(___________)

2+	(__________)
3+	(_________)
4+	(________)

(Protein) (acid) (• 3% Sulfosalicylic acid • Centrifuge)

(• Midstream, Clean-catch urine) (No increase in turbidity) (<6 mg/dL) (noticeable) (6-30 mg/dL)

(Distinct turbidity, with no granulation) (30-100 mg/dL)

(Turbidity with granulation, but no flocculation) (100-200 mg/dL)

(Turbidity granulation and flocculation) (200-400 mg/dL) (Clumps of protein) (>400 mg/dL)

SULFOSALICYLIC ACID PRECIPITATION

Principle	(_____) is denatured by (____) so that it becomes less soluble, and is precipitated
Equipment and materials
Specimen	(________, ________)

READING

Report	Appearance	Protein present
Negative	(_________)	(________)
Trace	(_________)	(________)

1+	(_________)	(_________)
2+	(_________)	(_________)
3+	(_________)	(_________)

4+	(_________)	(_________)

(60°C) (100°C) (60°C-80°C)

(• 5% glacial acetic acid • Water batch

• centrifuge) (Midstream,) () ()

BENCE-JONES PROTEIN DETERMINATION

Principle	• Bence-Jones protein precipitates at (______). it disappears at (____) and reappears on cooling at (______)
Equipment and materials
Specimen	(___________) (_________)

(Highly buffered or Alkaline urines) (quaternary

ammonium) (antiseptics) (detergents) (Skin cleansers (chlorhexidine)) (albumin) ((phenazopyridine) (Beet ingestion) (False positive)

PROCEDURE NOTES

Reagent strip method	• False positive o (___________/_________) o Contamination with (___________) compounds ▪ Some (_________) and (___________) o (___________________) • False negative Protein other than (_____) Drugs (___________) (___________)
Sulfosalicylic acid test and	(_____________)