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