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BODY FLUID ANALYSIS
Urine Mini-review for UA COURSE Final Exam part 1
Urine Anatomy & Physiology
Anatomy of the Urinary System
Urine Anatomy & Physiology
Micro-Anatomy of the Urinary System Nephron – functional or working unit of the kidney
@ 1 million / kidney
Urine Anatomy & Physiology
Micro-Anatomy of the Urinary System - nephron Glomerulus Renal Tubules
Urine Anatomy & Physiology
Micro-Anatomy of the Urinary System Nephron
What size substances are filtered? Examples of substances that cannot filter.
Urine Anatomy & Physiology
Physiology of the Urinary System What are Functions of the kidney?
Urine Anatomy & Physiology
Physiology of the Urinary System What are Functions of the kidney?
Elimination of excess water
Elimination of waste products of metabolism. ie. Urea, creatinine, etc. ** These two substances are sometimes measured to determine if unknown fluid is urine.
Urine Anatomy & Physiology
Physiology of the Urinary System What are Functions of the kidney?
Elimination of foreign substances If not by filtration, then may secrete some:
Secretion of unwanted substances not filtered drugs, some waste products Acid – base balance through the reabsorption of filtered bicarbonate ion secretion of H+ ions attached to bicarbonate secretion of H+ ions attached to phosphate secretion of H+ ions attached ammonia
Urine Anatomy & Physiology
Physiology of the Urinary System What are Functions of the kidney?
Retention of substances necessary for normal body function ( glucose, amino acide, etc)
Regulation of electrolyte balance and osmotic pressure of body fluids (BP)
Urine Anatomy & Physiology
Physiology of the Urinary System What are Functions of the kidney?
Hormone production
What hormones are produced by the kidney?
Urine Anatomy & Physiology
Physiology of the Urinary System What are Functions of the kidney?
Hormones produced by the kidney:
Erythropoietin – RBC stimulus
Renin – enzyme like substance that acts on plasma angiotensinogen ---- Angiotensin I….which becomes Angiotensin II and causes vasocontriction of arteries , and other things…– Kidneys responsible for long term regulation and maintenance of blood pressure.
Urine Anatomy & Physiology
Physiology of the Urinary System What hormones affect the kidney?
Urine Anatomy & Physiology
Physiology of the Urinary System What hormones affect the kidney?
Aldosterone From adrenal cortex Acts on distal and collecting tubules Promotes active reabsorption of sodium from the
glomerular filtrate (and concurrent secretion of potassium).
Also increases water retention
Urine Anatomy & Physiology
Physiology of the Urinary System What hormones affect the kidney?
Anti-diuretic hormone (ADH) / Vasopressin from posterior pituitary gland Makes tubules more permeable to water Effects decrease urine volume concentrates urine increases water into circulation dilutes blood’s solids
Urine Anatomy & Physiology
Provide an example of Renal threshold / maximal re-absorptive capacity?
Urine Anatomy & Physiology
Physiology of the Urinary System Acid – Base balance
What 2 body systems are most involved with body acid / base balance?
What is the overall goal?
Urine Anatomy & Physiology
Physiology of the Urinary System Acid – Base balance
Generation of bicarbonate ions Filtered buffers - kidney secretes buffers into the
urine (when the pH is < 4.5) to protect its tissues. Secretion of ammonia (ammonium)
Routine Urinalysis
What substances make-up urine?
Routine Urinalysis
Composition – Normal constituents
@ 95% water Urea, organic &
inorganic chemicals
Routine Urinalysis
How should the urine specimen be collected?
Routine Urinalysis
How should the urine specimen be collected? Container characteristics Times / types of collection
Routine Urinalysis
How should the urine specimen be preserved? Why?
Routine Urinalysis
What happens to the urine sample over time? Why?
Urine Testing
Physical properties What are the physical properties of urine that
are evaluated ?
Urine Testing
Physical properties What are the physical properties of urine that
are evaluated ?
Color – review the normal and abnormal colors of urine - *** and what causes them (urochrome, bilirubin, blood, homogentisic acid, etc.)
Know the abnormals as well.
Urine Testing
Physical properties What are the physical properties of urine that
are evaluated ?
Volume – For routine UA, not normally measured Review the terms used to describe urine volume
characteristics.
Urine Testing
Physical properties What are the physical properties of urine that
are evaluated ?
Clarity / transparency
Urine Testing
Physical properties What are the physical properties of urine that
are evaluated ?
Odor & foam not routinely reported
Urine Testing
Physical properties What are the physical properties of urine that
are evaluated ?
Specific Gravity What is it? / what does it say about the specimen? What is isosthenuria ?
Urine Testing
Chemical properties
Review dipstick chemical reactions, Know indicators
Urine Testing
Chemical properties
Handling and Storage Keep strips in original container, stored at RT Protect from moisture and volatile fumes Use before expiration date Do not touch reagent pad areas
Urine Testing
Chemical properties Review sources of error
Testing cold specimens Not mixing samples before dipping Leaving the dipstick in the specimen too long Not blotting away the excess Inadequate / improper timing Bad lighting Not being familiar with color chart and changes
Urine Testing
Chemical properties
Use of commercial controls and course of action if results are not as expected
Urine Testing
Chemical properties Back-up tests?
Are they always performed?
Which ones for which test?
Urine Testing
Chemical properties Which urine test is most sensitive to
impending kidney disease?
Urine Testing
Chemical properties Which urine test(s) are more liver disease
oriented?
Urine Testing
Chemical properties What dipstick results indicate UTI?
Urine Testing
Chemical properties
What characteristics (physical, chemical, microscopic) does a urine from a diabetic exhibit?
Urine Testing
Chemical properties What urine results would you expect to see
from a child with a fever lasting 2 days?
Diseases & UA correlation
Pathways of renal infections Ascending: Most often infectious agents
ascend up the urethra - bladder ureters - into the kidney (if unchecked)
Common organisms: E. coli, Proteus, & Enterobacter
Descending: Infection result of circulating organisms getting trapped in kidney.
Common organisms: Staphlococcus, E. coli
Review kidney diseases
Terms Cystitis – inflammation of the bladder wall,
often associated with infection Urethritis - inflammation of the urethra
Review kidney diseases
Terms Nephritis – general term for inflammation of
kidney tissue. Glomerular nephritis - refers to sterile
inflammatory process affecting glomerulus Pyelonephritis - When the inflammation is caused
by an infection, the term pyelonephritis is used
Diseases & UA correlation
Nephrotic syndrome (pg. 125) Increased urine protein
Massive proteinuria > 3.5 g/dL NV = 30-150 mg/24 hr
Decreased serum albumin
Many abnormal UA (as well as chemistry and clinical) results
Uremia – old term no longer used; literal meaning is ‘urine in the blood’
Microscopic Sediment
A number of slides with microscopic elements
RBC, WBC, yeast
Microscopic Sediment – Epithelial Cells
Squamous epithelial cells (stained with Sternheimer-Malbin)
Microscopic Sediment – Epithelial Cells
Transitional epithelial cells Spherical, polyhedral and caudate are terms
describing shapes. All have distinct centrally located nuclei. Sometimes called bladder cells, may be more often found in
elderly. Can be found as fragments or as reactive.
Microscopic Sediment – Epithelial Cells
RTEs; 250x magnification Also WBC and RBCs
Microscopic Sediment – Casts
Microscopic Sediment – Casts
RBC cast
Microscopic Sediment
A number of slides with microscopic elements CRYSTALS, Uric acid
Microscopic Sediment – Crystals
Calcium oxalate – envelope; may be dumbbell shaped. Usually appear as a square with a retractile cross
Microscopic Sediment
A number of slides with microscopic elements Alkaline
Microscopic Sediment
A number of slides with microscopic elements
The rarely ever seen, abnormal crystals Cystine Tyrosine Leucine Bilirubin (occasionally seen in premies) Cholesterol
Microscopic Sediment
A number of slides with microscopic elements Mucous threads Bacteria, yeast, trichomonas sperm Lots of artifacts
Microscopic
What are oval fat bodies?
How can you (quickly,cheaply) provide tentative proof they contain fat?
Microscopic