URINE VOLUME, COMPOSITION & TYPES OF SPECIMEN Flashcards
is a complex, yellowish fluid that is considered as an ultrafiltrate of plasma from which glucose, amino acids, water and other substances essential to body metabolism have been reabsorbed.
Urine
The average daily urine output
1200-1500 ml
Urine is normally how many percent if water & solutes
95% water
5% solutes
a metabolic waste product produced in the
liver from the breakdown of protein and amino acids, accountsfor nearly half of the total dissolved solids in urine.
Urea
Other organic substances include primarily
creatinine and uric acid
Inorganic substances in urine:
chloride, sodium and potassium
Formed elements:
cells, casts, crystals, mucus, and bacteria
Formed elements:
cells, casts, crystals, mucus, and bacteria
Factors that could affect urine concentration:
● Dietary intake
● Physical activity
● Body metabolism
● Endocrine functions
PRIMARY COMPONENTS IN NORMAL URINE
Urea
Creatinine
Uric acid
Chloride
Sodium
Potassium
Phosphate
Ammonium
Calcium
Primary organic component.
Product of metabolism of protein and amino acids
Urea
Primary organic component.
Product of metabolism of protein and amino acids
Urea
Product of metabolism of creatine by muscles
Creatinine
Product of breakdown of nucleic acid in food and cells
Uric acid
Primary inorganic component.
Found in combination with sodium (table salt) and many other inorganic substances
Chloride
Primarily from salt, varies by intake
Sodium
Combined with chloride and other salts
Potassium
Combines with sodium to buffer the blood
Phosphate
Regulates blood and tissue fluid acidity
Ammonium
Combines with chloride, sulfate, and phosphate
Calcium
How do you determine whether a specimen is urine?
Creatinine, urea, sodium and chloride content are higher in urine than in other body fluids.
Determines by the body’s state of hydration
Urine volume
Normal daily urine output
1200-1500mL
Normal range or urine output
600-2000 ml
Urine volume is influenced by factors including:
• Fluid intake
• Fluid loss from nonrenal sources
• Variations in secretion of ADH
• Excretion of increased amounts of dissolved solids (e.g., glucose, salts)
It is because of persistent production of more than 2000-3000ml of urine in 24 hours.
Polyuria
It is related to an abnormal decrease in urine output. It is always accompanied by hypersthenuria (1.030). It is observed in dehydration, renal insufficiency, poorly compensated heart disease, calculi formation, kidney tumors.
Oliguria
It pertains to the total suppression of urine production or complete cessation or blockage or urine flow. It can be seen in severe acute nephritis, mercury poisoning, obstructive uropathy and kidney failure.
Anuria
It is related to the excretion of more than 500 ml urine at night.
Nocturia
It is related to the excretion of more than 500 ml urine at night.
Nocturia
Causes excessive water loss from
vomiting, diarrhea, perspiration, severe burns
Oliguria
Causes any serious damage to the kidneys or from a decrease in the flow of blood to the kidneys
Anuria
apparent in individuals with chronic progressive renal failure
Nocturia
associated with diabetes mellitus and diabetes insipidus.
May be induced artificially by diuretics,
caffeine, or alcohol.
Polyuria
Indicates a concentrated urine.
Hypersthenuria
SG of hypersthenuria
> 1.010
Indicates a urine that is neither concentrated nor diluted.
Isosthenuria
SG of Isosthenuria
≈ 1.010
Indicates a dilute urine.
Hyposthenuria
SG of hyposthenuria
< 1.010
It is transitory increase in urine volume due to intake of diuretics (alcohol, caffeine, polydipsia)
Diuresis
Caused by defects in insulin production or function, leading to high body glucose levels.
Diabetes Mellitus
Results from decreased ADH production or function, leading to inadequate water reabsorption from plasma filtrate.
Diabetes Insipidus
Hormone involve in D. mellitus
Insulin
Hormone involved in D.insipidus
ADH
Hyperglycemia in D.mellitus
Present
Hyperglycemia in D.insipidus
Absent
SG in D.mellitus
Increased
SG in D.insipidus
Decreased
Polyuria in D.mellitus
Present
Polyuria in D.insipidus
Present
Color of urine in D.mellitus
Darker
Color of urine in D.insipidus
Clearer
True or false:
Both D.mellitus and D.insipidus cause increased fluid intake and urine volume, with polyuria often being the initial symptom.
True
____________ hydration status = ADH is suppressed = increased urine output/volume = diluted urine specimen = low specific gravity (Physical exam: lighter
urine color)
Increased
__________hydration status = ADH is preserved = decreased urine output/volume = concentrated urine specimen = high specific gravity (Physical exam: darker urine color)
Decreased
Confirmation if a specimen is a urine:
• Urea nitrogen = 600mg/100mL
• Creatinine = 50mg/100mL
TYPES OF URINE SPECIMEN
Random urine sample
First morning urine sample
Fasting/second morning urine sample
2-hour post prandial
Glucose tolerance specimen
Early afternoon specimen
12-hour morning specimen
24-hour specimen
Drug specimen
Midstream clean-catch
Three-glass urine collection
Catheterized specimen
Suprapubic aspiration
Stamey-Meares test
• It is a specimen that is collected anytime of the day and is commonly used as a routine screening test for disease diagnosis.
• Is affected by the most recent food, most recent activity, and most recent medication and supplement.
Note/s: Also known as occasional urine sample
Random urine sample
It is the first urine that is voided in the day after a person has assumed a supine position. It is used for routine screening, pregnancy testing and detection of orthostatic proteinuria.
First morning urine sample
A concentrated specimen (acidic), ensuring
detection of chemicals and formed elements that may not be present in a dilute random specimen.
First morning urine sample
Type of proteinuria:
• Physiologic
• Not associated to a disease
Orthostatic proteinuria
Type of proteinuria
• Pathologic
• Kidney problem
• Damaged glomerular filtration
Renal proteinuria
analyte in urine will be taken back in the systematic circulation
Reabsorption
allows analyte to be secreted to be part of the urine
Secretion
Positive pregnancy test w/out intercourse in male indicates
testicular cancer
Positive pregnancy test w/out intercourse in female indicates
Ovarian cancer
It is concentrated during the first three months of pregnancy
b-HCG
It is intended for diabetic screening or monitoring.
Fasting/second morning urine sample
Urine sample for Monitoring Insulin Therapy
2-hour post prandial
• Collected along with OGTT Samples
• Tested for Glucose and Ketones
Glucose tolerance specimen
The plasma concentration of an analyte in blood wherein tubular reabsorption stops when glucose is ________, the proximal convoluted tubule stops absorbing glucose and excrete it in the urine.
> 160-180
It is intended for urobilinogen determination (alkaline tide). Usually collected at 2-4pm
Early afternoon specimen
37% - 47% Formalin is used
ADDIS COUNT
12-hour morning specimen
Used for measuring the Glomerular Filtration Rate (GFR) and for hormonal studies.
24-hour specimen
Adding urine formed before the start of the
collection period will falsely _______ the results.
elevate
failure to include the urine produced at the end of the collection period will falsely ________ the results.
decrease
It is a sample designed for drug analysis wherein about 30-45 ml. of urine is collected within 4 minutes.
Drug specimen
Drug specimen temperature is also measured, and it should be within what range
32.5 to 37.7°C.
a documented process that
tracks the collection, transfer, handling, and storage of evidence or samples to ensure their integrity and prevent tampering throughout the testing or legal process.
Chain of custody
NRL for Confirmatory Drug Test (URINE)
East Avenue Medical Center (NRL)
It is the least traumatic routine screening for urinalysis and bacterial culture. It is usually the method of choice for obtaining non-contaminated specimens.
Midstream clean-catch
It is used for prostatic infection determination.
Three-glass urine collection
______________ will show increased white blood cell counts and bacteria in the second and third containers, while _________________ will demonstrate white blood cell counts and bacteria higher in the third container than in the first specimen.
Urinary tract infections will show increased white blood cell counts and bacteria in the second and third containers, while prostate infections will demonstrate white blood cell counts and bacteria higher in the third
container than in the first specimen.
It is used if the patient is having difficulty voiding. It can also be used in a female patient to avoid vaginal contamination, especially during menstruation.
Catheterized specimen
• It is a process of collecting bladder urine for bacterial culture and cytology. Sometimes, it is used in place of
catheterization for obtaining a single urine sample.
• Completely free of extraneous contamination, particularly in infants or children.
Suprapubic aspiration
Test for prostatitis that includes examination of four urine specimens
Stamey-Meares test
Urine preservatives
Refrigeration
Acids(biric acid, HCL, acetic acid, tartaric acid)
Formalin(Formaldehyde)
Sodium fluoride
Commercial preservative tablets
Urine Collection Kits4(becton, Dickinson, Rutherford, NJ)
Light gray and gray C&S tube
Yellow UA plus tube
Cherry red/yellow preservative plus tube
Preservative that prevents bacterial growth for 24 hours
Refrigeration
Advantage: does not interfere with chemical tests
Disadvantage: precipitates amorphous and urates
Refrigeration
Advantage: Prevents bacterial growth and metabolism
Disadvantage: Interferes with analysis of drugs and hormones
Acids (boric acid, HCL, acetic acid, tartaric acid)
Keeps pH at about 6.0 Can be used for transport of urine cultures
Acids
Advantage: Excellent sediment preservative
Disadvantage: Acts as a reducing agent, interfering with chemical tests for glucose, blood, leukocyte esterase, and copper reduction
Formalin (formaldehyde)
Advantage: Good preservative for drug analyses
Disadvantage: Inhibits reagent strip tests for glucose, blood, and leukocytes
Sodium fluoride
Advantage: Convenient when refrigera- tion not possible. Have controlled concentration to minimize interference
Disadvantage: Check tablet composition to determine possible effects on desired tests
Commercial preservative tablets
Contains collection cup, transfer straw, culture and sensitivity (C&S) preser- vative tube, or UA tube
Urine Collection Kits4 (Becton, Dickinson, Rutherford, NJ)
Advantage: Specimen stable at room temperature (RT) for 48 hours; prevents bacterial growth and metabolism
Disadvantage: Do not use if urine is below minimum fill line
Addtnl: Preservative is boric acid, sodium borate, and sodium formate. Keeps pH at about 6.0
Light gray and gray C&S tube
Advantage: Use on automated instruments
Disadvantage: Must refrigerate within 2 hours
Addtnl: Round or conical bottom, no preservative
Yellow UA Plus tube
Advantage: Specimen stable for 72 hours at RT; instrument-compatible
Disadvantage: Must be filled to minimum fill line. Bilirubin and urobilinogen may be decreased if speci- men is exposed to light and left at RT
Addtnl: Preservative is sodium pro- pionate, ethyl paraben, and chlorhexidine. Round or conical bottoms
Cherry red/yellow Preservative Plus tube
What fixative is best for cell cytology?
Saccomanno fixative
What analytes will increase when urine is unpreserved
pH
Bacteria
Odor
Nitrite
What analytes will decrease when urine is unpreserved?
Clarity
Glucose
Ketones
Bilirubin
Urobilinogen
RBCs & WBCs and casts
Trichomonas
Color of urine when unpreserved
Modified/darkened
