urine composition Flashcards
normal urines clarity
clear and transparent
-look once it is mixed
urine turbidity
pathological - UTI or kidney disease
non-pathological- mucous, squamous epi cells, urates
normal urine odor
not a strong odor
can smell ammonia in older urine as bacteria break down urea to ammonia
other urine smells
fruity- diabetes due to ketones
maple syrup- seen in maple syrup urine disease
mousy odor- PKU due to presence of phenylpyruvic acid in urine
non pathological urine turbidity
mucous
squamous epi cells
standing at RT
refrigeration
semen
fecal contamination
etc.
pathological turbidity
RBCs
WBCs
bacteria
non-squamous epithelial cells
yeast
crystals
lymph fluid
lipids
urine specimen collection RULES
- bring to lab within 2 hours; if not should refrigerate or add preservative
- needs to be sterile for culture; doesn’t have to really for urine analysis
- if both ordered, do culture first
- should bring to RT before testing !!
- don’t forget to mix before testing as formed elements will sink
substances found in urine
96% water and other solutes
urea
creatinine - muscle breakdown
vitamins, drugs, hormones
formed elements
random specimen
most common
has most junk in it
best specimen
first morning specimen - most concentrated
see most formed elements
need to determine what in first morning specimen
orthostatic proteinuria
protein present due to pressure on renal vein
-increased amounts throughout the day
should be no protein in morning and present later in day
midstream urine
part you want to collect
catheterized specimen
should see no bacteria since bladder is sterile
-any growth is significant
-transitional cells
suprapubic aspiration
needle is inserted through abdomen into the bladder (surgical procedure)
sterile
24 hour urine specimen
used to detect the amount of protein seen in 24 hours so used to access EXACT amount of protein present
-kidney damage can be seen
-void first urine and start
boric acid
preservative for formed elements but may interfere with pH
gray tubes
-keeps down bacterial growth
-interfere with drug testing
chlorhexidine
preservatives
-very common
-keeps down bacterial growth, but preserve glucose
-red/yellow tubes
refrigeration
does not interfere with chemical testing
-more formed elements = kinda bad
kills trichomonas- look like WBCs when dead
-most common method of non chemical preservation
-needs to be RT before analyzed
Glomerular diseases
does damage to glomeruli
-immune complexes that deposit on glomular basement membrane
-complement does damage
“glomerulonephritis”
normal urine volume
1200-1500
can be as low as 600mL
decrease in volume
oliguria
dehyrdation, burns, vomitting
glomularnephritis
sterile inflammatory process that affects glomerular
common findings in glomularnephritis
blood !!! protein and casts
anuria
almost no urine flow
severe kidney damage or decreased blood flow to kidney
-kidney function totally depends on amount of blood flowing to kidney
polyuria
increase in volume
seen most commonly in diabetes or when taking diuretics or caffeine intake or decrease of ADH
nocturia
increases of urine at night
-elders or pregnancy
normal color of urine
yellowish due to urochrome pigment
refrigerated urines
uroerythrin
-pinkish pigment that can attach to amorphous urates giving pink or brick dust appearance
what gives brownish color to urine
urobilin
-older urine
-breakdown product of bilirubin
amber or orange urine
seen with sulfa drugs or in cases where bili present in urine
-if bili present may see yellow foam when shaken
red urine
present with hemoglobinuria or hematuria
or when on period
dark red/ brownish urine
myoglobin
serum will remain yellow
port wine color
porphyria
heightened when placed in light
brown or black urine color
cases of alkaptonuria due to presence of homogentisic acid
-may be darker when acidic and Hgb converted to methemoglobin
blue or green urine
due to presence of medication or dyes
-some cases infection of pseudomonas aeruginosa
common findings in glomularnephritis in urine
blood, protein, casts
cause of untreated Beta strep A
seen in children
urine has protein, dysmorphics RBCs, and RBC casts
can be reversible
acute poststreptococcal
rapidly progressive glomerulohpritis
more permanent damage
immune complexes circulating in bloodstream
seen in autoimmune diseases
destory the kidney
see high protein levels, low GFR, increase in FDP, cryoglobulins
IgA nephropathy
berger’s disease
MOST common cause of glomerular nephritis
IgA falling on kidney
blood seen in urine
renal glycosuria
inherited
can’t reabsorb glucose from tubules
not related to diabetes
diagnosis of renal glycosuria
normal blood sugar but increase sugar in urine
nephrotic syndrome
increase of permeability of glomerular membrane due to shield of negativity; damage to small blood vessels that filter
-higher molecular compounds can pass through
nephrotic syndrome seen in urine
massive protein >3.5
more lipids in urine- oval bodies
fatty casts
renal tubular cells
macro or micro hematuria
symptoms of nephrotic syndrome
edema
foamy urine
weight gain
tiredness
consequences of nephrotic syndrome
high BP
increased cholesterol and triglycerides
blood clots
infections
can be primary or secondary disease
interstitial disorders
infections of urinary tract
frequent urination
burning
increase WBC (pyuria)!!!, protein, blood
MOST COMMON INTERSTITIAL: UTI
acute pyelonephritis
infection of upper urinary tract
-untreated UTI
WBC casts in urine !!!!! (beyond UTI)
usually don’t have permanent kidney damage
BACK PAIN
chronic pyelonephritis
congenital urinary structural defect
permanent kidney damage
can see granular, waxy, broad casts with increase protein
acute renal failure
-sudden suppression of kidney function
prerenal
decreased blood flow to kidney
burns, surgery
volume lower
reversible
renal
most cases
can result from glomerular, tubular, interstional disease
destruction of renal tubules
may see cellular and granular casts
post renal
obstruction in urine
WBC, RBC casts
chronic renal failure
progressive loss of renal function
loss of function is irreversible
see isosthenuric kidneys - SG 1.010 kidney lost ability to concentrate
-increased BUN and creatinine levels
waxy casts – worst
uremia
increased urea in blood accompanied by kidney failure !!!!!
burr cells
kidney failure is the difference between this and azotemia!
blood smear for uremia
abnormal RBCs in smear
burr cells
urea serum: 6-20
azotemia
increased urea in blood
doesn’t associated with kidney failure
glomerular filtration tests
basically measures filtering capacity of gomeruli
have to find a substance that isn’t reabsorbed or secreted by tubules
creatinine clearance test
known for measuring GFR- gold standard
rate kidney can remove creatinine from the blood
disadvantage at looking for creatinine
muscle wasting disease
elders
eating a lot of meat
bacteria can break down
creatinine testing important
24 hour timed collection
milliliters per minute -need to convert from hours to min
shorten formula for creatinine clearance
C= u x v / P
u=urine creatine
v= urine volume per min
p= plasma or serum creatinine
normal values 90-120 /min
decreased= kidney disease
modification of diet in renal disease
is age dependent, gender dependent and ethinic
inulin testing
another way to measure GFR
exogenous test
-adminster inulin thorughout test
not secreted/ absorbed by tubules
2 tests that may not detect early renal failure
creatinine and inulin
non-clearnace testing for GFR
Cystatin C testing
monitor and screen GFR once kidney disease diagnosed
-immunoassay
filtered by glomerulus and reabsorbed by renal tubules = none returns to blood circulation
BUN and creatinine testing
determine kidney function
ratio- 10:1-20:1
BUN increased bc
high protein diet
GI bled
creatinine to be skewed
muscle mass/ loss
eating a lot of meat
microalbumin testing
screen diabetic nephoronpathy
small amounts of albumin
-not used to diagnose diabetes, but associated
microalbumin 24 hr urine should be
less than 30/ per day
microalbumin random urine
> 30 albumin is abnormal
beta 2 microglobin testing
better marker of reduced renal tubular function than of glomerular function
-passes through glomeruli and reabsorbed
-none found in urine
when reabsorption decreased, urine values increase
renal blood flow
PAH test- para- aminohippuric acid test
measure amount of blood flowing through kidney
if this is abnormal than tubular and glomerular will also be abnormal
-need something that can be completely removed from blood everytime
