INTRODUCTION TO URINALYSIS Flashcards
What are the 4 components of urinary system?
- Kidney
- Ureters
- Bladder
- Urethra
Carry the urine to the bladder
Ureters
Delivers the urine for excretion
Urethra
Where urine us formed by filtration of blood
Kidney
Stores the urine produced
Bladder
What is the kidney’s function?
- Maintaining homeostasis
- Regularion of body fluids
- Excretion of waste products
The functional unit of the kidney
Nephron
Enumerate parts of nephron
- glomerulus
- bowman’s capsule
- proximal convoluted tubule (PCT)
- loop of henle
- distal convoluted tubule
- afferent arteriole
- efferent arteriole
- peritubular capillaries
- vasa recta
Two types of nephron
- cortical nephron
- juxtamedullary nephron
Primary function is concentration of the urine
Juxtamedullary nephron
Responsible for removal of waste products and reabsorption
Cortical nephron
Point of entry unfiltered blood
Afferent arteriole
Point of exit filtered blood
Efferent arteriole
Located adjacent to the ascending descending loop of henle
Vasa recta
Supplies blood to the kidney
Renal artery
Total renal blood flow
1200/mL/min
Total renal plasma flow
600-700 mL/min
Consusts of coil approximately 8 capillary lobeds referred to as a capillary tuft
Glomerular filtration
Contains pores and are referred to as fenestrated
Capillary wall membrane
Presence podocytes
Basement membrane
Necessary to overcome the opposition of pressure from the fluid from the bowman’s capsule and the oncotic pressure of unfiltered plasma protein
Hydrostatic pressure
Dilation of the afferent arterioles and construction of the efferent arterioles
BP drops
Caused by size afferent and efferent arteriole
Presence of hydrostatic pressure
Ultrafiltrate of plasma
Urine
Only organ with such a noninvasive means by which to directly evaluate its status
Kidney
Readily available and easily collected specimen
Urine
The testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe, and coft effective manner
Urinalysis
References to the study of urine can be found in the drawinfs of caveman and in Egyptian hieroglyphics
Edwin Smith Surgical Papyrus
When was book of uroscopy written?
5th century BC
When was color charsts had bern developed that described the significance of 20 different colors
1140 AD
Who discovered albuminuria by boiling urine?
Frederik Dekkers
Where did glucose test originated?
From ant testing anf taste testing
What is the title of the book Thomas Bryant written?
Pisse prophets
When did invention of the microscope and led to the examination of urinary sediment happened?
17th century
Methods for quantitating the microscopic sediment
Thomas Addis
Concept of urinalysis as part of a docto’s roytine patient examination
Richard Bright
When did urinalysis befan to disappear from routine examination
1930
What is the only organ with such a noninvasive means by which to directly evaluate its status
Kidney
Enumerate reasons for performing urinalysis
- aiding in the diagnosis of disease
- screening asymptomatic population for undetected disorders
- monitoring the progress of disease and
- effectiveness of therapy
What are the internal structure of the kidney?
- cortex
- medulla
- renal pelvis
The outer layer of the kidney, located just below the renal capsule
Cortex
Innermost part of tge kidney
Medulla
Renal medulla split up into a number of section known as
Renal pyramids
The funnel-like dilated part of the ureter in the kidney
Renal pelvis
What is the urine composition?
95% of water and 5% of solutes
Organic component of urine
- urea
- creatinine
- uric acid
- hippuric acid
Major organic component, product of protein and amino acid metabolism
Urea
Product of creatinine metabolism by muscles
Creatinine
Common component in kidney stones; derived from catabolism of nucleic acid in food
Uric acid
Benzoic acid is eliminated in this form, increases with high vegetable diet
Hippuric acid
What are the other substances that is included in organic component of urine
Carbohydrates
Fatty acids
Enzymes
Pigments
Inorganic component of urine composition
- chloride
- sodium
- potassium
- sulfate
- phosphate
- ammonium
- calcium
Primary inorganic component. Found in combination with sodium and many other inorganic substance
Chloride
Primarily from salt, varies by intake
Sodium
Derived from amino acids
Sulfate
Combines with sodium to buffer the blood
Phosphate
Regulates blood and tissues fluid acidity
Ammonium
Combines with chloride, sulfate, and phosphate
Calcium
How do we verify if the fluid in the urine container is in fact urine?
Its high creatinine concentration
Also concentration of urea, sodium and chloride
What is the normal daily urine output
1200 - 1500 ml a range of 600-2000 ml is considered normal
Decrease in urine output
Oliguria
Result of excessive water loss from vomiting, diarrhea, perspiration or severe burn
Oliguria
What is the measurement of urine for infants when you have oliguria
1 ml/kg/hr
What is the measurement of urine for children when you have oliguria
0.5 ml/kg/hr
What is the measurement of urine for adults when you have oliguria
409 ml/day
Cessation of urine flow results from any serious damage to the kidney or decrease flow of blood to the kidney
Anuria
Normally kidneys excrete 2 or 3 times more urine during the day
Nocturia
Increase in daily urine volume
Polyuria
What is the measurement of urine for adult when you have polyuria
2.5 L/day
What is the measurement of urine for children when you have polyuria
2.5- 3 mL/day
Caused by defect in production of insulin or its function resulting in increase in body glucose concentration
Diabetes mellitus polyuria
Decrease in production or function of ADH
Diabetes insipudus polyuria
Urine is dilute with low SG
Disbetes insipidus polyuria
Compensated with polydipsia
Diabetes mellitus polyuria
Water is not reabsorbed from the plasma filtrate
Diabetes insipidus polyuria
Exceed renal threshold for glucose
Diabetes mellitus polyuria
What is the recommended specimen container?
Clean, dry, leak-proof container
Labels must be attached to the _______ not on the ______
Container ; lid
Must accompany specimens delivered to the laboratory
Requisition form
Enumerate specimen rejection
- specimens in unlabeled containers
- nonmatching labels and requisition form
- specimens confaminated with feces or toilet paper
- container with contaminated exteriors
- specimens of insufficient quantity
- specimens that have been improperly transported
What is the measurement of required routine urinalysis
10-15 ml
The container should have:
50-100 ml capacity
An opening of at least 4-5 cm
How long does specimen must be delivered to the laboratory?
Within 2 hours
First morning specimen also known as
8 hour specimen
What is the ideal screening specimen
First morning specimen
Essential for preventing false negative pregnancy test
First morning specimen
For evaluating orthostatic proteinuria
First morning specimen
Can be collected anytime
Random specimen
Specimen is tested for glucose
2 hour postprandial specimen
Results are used primarily for insulin therapy monitoring
2 hr postprandial specimen
The second voided specimen after a period of fasting
Fasting specimen
Also known as second morning
Fasting specimen
Usually satisfactory for routine screening
Random specimen
Collected correspond with blood samples drawn during GTT
Glucose tolerance specimen
The most commonly received specimen
Random specimen
Recommended for glucose monitoring
Fasting specimen
Urine is tested for glucose and ketones
Glucose tolerance specimen
Results are ysed primarily for insulin therapy monitoring
2 hr postprandial specimen
Specimen is for urine quantitative assay
24 hr specimen
All specimen should be refrigerated or kept on ice during the collection period
24 hour specimen
Less traumatic method for obtaining urine
Midstream “clean catch” specimen
The specimen is obtained when the patient passess some urine in the toilet and then stops and urinate the midportion to the container
Midstream clean catch specimen
Involves collecting urine directly from the bladder by puncturing the abdominal wall and distended bladder ysing needle and syringe
Suprapubic aspiration specimen
Provides a sample for bacterial culture that is completely free of extraneous contamination
Suprapubic aspiration specimen
Suprapubic aspiration specimen can also be used for
Cytologic examination
Commercially available plastic utine collection nags with hypoallergenic skin adhesive are use
Pediatric collection
Also known as three glass collection
Prostatitis specimen
First container for prostatitis specimen
First passed urine
2nd container for prostatitis specimen
Midstream portion of urine
3rd container for prostatitis specimen
Urine with prostatic fluid
4th container for prostatitis specimen
Post prostatic massage urine specimen
Importance of 1st container
Urethral infection
Importance of 2nd container
Urinary bladder infection
Importance of 3rd container
Prostatic infection
Provides this documentation of proper sample identification from the time of collection to the receipt of laboratory results
Chain of custody
Withstand legal scrutiny
- no tampering of sample
- sample must be handled securely
- proper id is required
- 30-45 ml required amount
Most routinelu used method of preservation is refrigeration at 2 C to 8 C
Specimen preservation
Examples of chemical preservatives
- thymol
- formalin
- sodium fluoride
- phenol
- toluene
- sodium carbonate
Ideal preservatives
Bactericidal
Inhibit urease
Able to preserve formed elements
Must not interfere with chemical test
Sediment preservation
Thymol
Cytology
Formalin
Capillary lobe is rest to as
Capillary tuft