INTRODUCTION TO URINALYSIS Flashcards
Wrote a book in uroscopy
Hippocrates
evidence of ancient Egyptian hieroglyphics depicting urinalysis
Edwin Smith Surgical Papyrus
When was color charts developed. 20 different colors of urine and their significance.
1140 C.E.
Wrote a book called “Fasciculus Medicinae” in 1491. 1st illustrated medical book printed which depicted urine wheel.
Johannes de Ketham
Discovered albuminuria (presence of protein albumin in the urine) by boiling his own urine in 1694
Frederik Dekkers
No medical credentials Pisse prophets
Charlatans
Published the satirical book “The Pisse Prophet” or “Certain Pisse-Pot Lectures” in 1627 which exposes the fraudulent use of uroscopy by the Charlatans. His book led to the passing of the first medical licensure laws in England.
Thomas Bryant/Thomas Brian
Invented the microscope in the late 16th century that led to the examination of urinary sediment or microscopic examination of urine
Zacharias-Hans Janssen
Development of methods for quantitating the microscopic sediment
Thomas Addis.
ADDIS COUNT - blood cell count in from urine specimen (12hr)
2 Urine Sterile Specimen
Suprapubic aspirate
Catheterized
Introduced the concept of urinalysis as part of a doctor’s routine patient examination.
1827- urinalysis became routine test.
Richard Bright
Urinalysis began to disappear from routine examinations due to the growing number and complexity of tests (not until modern testing techniques rescued routine urinalysis).
1930s
Test for glucose in urine
ANT TESTING/ TASTE TEST
Two unique characteristics of a urine specimen
- A urine specimen is readily available and easily collected
- Urine contains information, which can be obtained by inexpensive laboratory tests, about many of the body’s major metabolic functions.
Hereditary Disease
Inborn Errors of Metabolism (IEMS)
CLSI
Clinical and Laboratory Standards Institute
CLSI defines urinalysis as
the testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe, and cost-effective manner.
The kidney continuously forms ___ as an ultrafiltrate of plasma
urine
Urine consists of ___ and other organic and inorganic chemicals dissolved in water.
a metabolic waste product produced in the liver from the breakdown of protein and amino acids, accounts for nearly half of the total dissolved solids in urine.
urea
Urine is normally ___% water and ___% solutes.
95, 5
Other organic substances include primarily________________________
creatinine and uric acid.
The major inorganic solid dissolved in urine is ____, followed by sodium and potassium.
chloride
The urine may also contain formed elements, such as ____. Increased amount of these formed elements are often indicative of disease.
cells, casts, crystals, mucus, and bacteria.
_____, _____, sodium, and chloride are significantly higher in urine than in other body fluids.
Creatinine, urea
_____ and _____ are not present in a normal urine specimen.
Protein and glucose
Normal daily urine output is usually ____ to ____ mL. A range of 600 to 2000 mL is considered normal.
1200 to 1500
A decrease in urine output (less than 1 mL/kg/hr in infants, less than 0.5 mL/kg/hr in children, and less than 400 mL/day in adults)
seen commonly when the body enters a state of dehydration as a result of excessive water loss from vomiting, dairrhea, perspiration, or severe burns.
Oliguria
True or False:
The kidneys excrete two to three times more urine during the night than during the day
False
An increase in the nocturnal excretion is termed. (>500 mL/night). SG: 1.018
Nocturia
An increase a daily urine volume (greater than 2.5 L/day in adults and 2.5 to 3 mL/kg/day in children)
often associated with diabetes mellitus and diabetes insipidus; however, it may be induced artificially by diuretics, caffeine, or alcohol, all of which suppress the secretion of ADH.
Increase glucose and urine SPG
Polyuria
Invasive method for urine collection
Suprapubic aspirate and Catheterized collection
Urine processed within ____ hrs upon collected
2hr
> 2hrs of urine specimen sample should be subjected to ____
preservation
BOARD: How much inorganic compounds/components of urine
Total Dissolved Solids:
Organic= 35g
25g.
Most abundant/Major organic molecule
Urea. 35g
Second most abundant
Creatinine. 1.5g
To Identify if urine:
Increased urea and creatinine
Principal salt in the urine
NaCl
Proteins in the urine due to prolonged standing
Orthostatic proteinuria
hormones that affects urine composition
ADH/AVP (Arginine Vasopressin): Increase water reabsorption (concentrated urine sample)
and Aldosterone: Increase sodium reabsorption/retention (diluted urine concentration)
Diuresis
process of increasing urine output
Micturition/Urination
Urinating
reflects an individual’s state of hydration
Urine volume
Complete cessation/stoppage of urine flow. (Less than 100 mL/24hrs or Less than 100 mL/min)
Anuria
BOARDS: 1 mL of urine sample
Anuria
Increase ingestion of water
polydipsia
Excessive hunger. Unused glucose
polyphagia
A color chart of ___ were transcribed for comparison of urine color
20
(H) TYPE OF URINALYSIS: commonly performed in screening laboratory, physician offices, patient home testing
Dipstick urinalysis (Reagent strips)
(B) TYPE OF URINALYSIS: provides a real-time “snapshot” of a person’s urinary tract and metabolic status. Most commonly performed U/A
Basic urinalysis (Routine)
TYPES OF SPECIMENS:
Most routinely encountered urine sample.
For routine and qualitative UA.
Not reliable due to its diurnal variation, physical activity, and dietary intake.
Random urine specimen
TYPES OF SPECIMENS:
Most ideal for urine sample for routine and pregnancy testing
Most concentrated and most acidic
Best for cast and crystal retrieval
First Morning Urine/ 8hrs spx
TYPES OF SPECIMENS:
2nd voided urine after the first morning urine.
For glucose determination.
Fasting Urine/Second Morning urine sample
TYPES OF SPECIMENS:
Diabetic monitoring (insulin therapy)
Specimen collection after a routine meal and 2 hours after
Comprehensive result is compared to FBS and Fasting urine
2 hours Post Prandial urine specimen
TYPES OF SPECIMENS:
Collected together with blood GTT
Number of spx to be collected depends on the number of GTT’s (also tested for ketones)
Glucose Tolerance Urine Specimen
TYPES OF SPECIMENS:
Contains least amount of normal flora contaminants from the distal urethra and external genitalia.
Alternative to catheterized spx.
For routine and CS/GS
Make use of antiseptic towelletes
Midstream Clean-Catch Urine Specimen
TYPES OF SPECIMENS:
More preferred than midstream catch for urine culture.
Passage of hollow tubing through the urethra into the bladder.
Catheterized Urine Specimen
TYPES OF SPECIMENS:
Aspiration directly from the bladder
For urine culture and cytologic examinations
Uses 1% lidocaine as anesthesia
Needle: 22 gauge or 23 gauge
Suprapubic Aspirate
TYPES OF SPECIMENS:
Difficult to obtain
Make use of a soft, clear plastic bags with hypoallergenic skin adhesive to attach to the genitalia for spx collection
Spx may also be obtained by catheterization/aspiration
Pediatric Specimen
Most common IEMS in the Philippines
Maple Syrup Urine Disorder (MSUD)
Smell: Burnt Sugar Odor/ Caramel
specimen sample for Newborn Screening
Dried blood spot
Test for Newborn Screening for diagnosis of IEMS
Gastromatography and Mass spectrometry (GC/MS)
Spx: Urine and/or dried blood spot
Indicative of early renal damage. Shows little amounts of albumin in the urine. (does not detected via reagent strip)
Microalbuminuria
Test used to detect Microalbuminuria
Micral test
determines the level of substance in the urine (e.g. electrolytes, hormones, proteins, porphyrins etc.)
FOR CONFIRMATORY TEST
12hr/24h urine (BUT PREFERRABLY 24HR)
Quantitative Urine Assay
detects the presence or increased amount of a substance (E.g. Rapid pregnancy test, test to detect microbial DNA and RNA) chlamydia and trichomonas
FOR SCREENING TEST
Qualitative Urine Assay
Urine from the Latin word
Urina
An ultrafiltrate of the plasma
Urine
A “fluid biopsy” of the kidneys (Brunzel)
Urine
A waste material that is secreted by the kidneys
Urine
Protein in the urine due to prolong standing
Erthostatic proteinuria
2 hormones that affects urine composition
ADH/AVP
Aldosterone
Process of increasing urinary excretion which leads to polyuria
Diuresis
Process of urinating
Micturition/ Urination
Increases sodium retention/ absorption
Aldosterone
Concentration of solute per kilogram of solvent
Osmolality
solvent in the urine
water
Major factors that affect urine composition
Dietary intake
Metabolism
Endocrine System
HOT WEATHER: urine volume _____
decreases
COLD WEATHER: urine volume _____
increases
Indicative of severe renal damage, acute kidney injury (crush injuries), obstruction
Anuria
Kidney stones.
Lithiases
Increase glucose levels in the blood. Accompanied by Polyuria, Polydipsia and Polyphagia.
Comes from the word “mellitein” meaning sweet tasting.
Diabetes Mellitus
DIABETES MELLITUS TYPE: No or low receptors of insulin in the tissue cells.
Type 2
DIABETES MELLITUS TYPE: No or low insulin.
Type 1
Renal Glucose Threshold
160-180 mg/dL or >180 mg/dL
True dilution of urine. Accompanied by Polydipsia and Polyuria.
Low SPG
Negative urine glucose
Comes from the word “insipid” meaning tasteless
Diabetes Insipidus
DIABETES INSIPIDUS TYPE: No or low production of ADH
Neurogenic
DIABETES INSIPIDUS TYPE: ADH tolerance. Decrease or no receptors in kidneys’ collecting ducts.
Nephrogenic
Disadvantages of Refrigeration of Urine
Precipitation of amorphous urates causes turbid pink urine (uroerythrin)
Decrease specific gravity
Remedy for turbid urine due to amorphous urates
Heat 40-60 degrees
CHANGES IN AN UNPRESERVED URINE SPECIMEN INCREASES (5)
PBaCON
pH
Bacteria
Odor
Nitrite
Color
CHANGES IN AN UNPRESERVED URINE SPECIMEN DECREASES (6)
Clarity
Glucose
Ketones
Bilirubin
Urobilinogen
Cell and Casts
