Download - UA Review Spring2009
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BODY FLUID ANALYSIS
Urine Mini-review for UA COURSE
Final Exam part 1
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Urine Anatomy & Physiology
Anatomy of the Urinary System
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Urine Anatomy & Physiology
Micro-Anatomy of the Urinary System
Nephron functional or working unit of the kidney
@ 1 million / kidney
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Urine Anatomy & Physiology
Micro-Anatomy of the Urinary System - nephron
Glomerulus
Renal Tubules
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Urine Anatomy & Physiology
Micro-Anatomy of the Urinary System
Nephron What size substances are filtered?
Examples of substances that cannot filter.
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Urine Anatomy & Physiology
Physiology of the Urinary System
What are Functions of the kidney?
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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 sometimesmeasured to determine if unknown fluid is urine.
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Urine Anatomy & Physiology
Physiology of the Urinary System
What are Functions of the kidney?
Elimination of foreign substancesIf 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
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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 bodyfluids (BP)
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Urine Anatomy & Physiology
Physiology of the Urinary System
What are Functions of the kidney?
Hormone production
What hormones are produced by the kidney?
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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.
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Urine Anatomy & Physiology
Physiology of the Urinary System
What hormones affect the kidney?
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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
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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 bloods solids
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Urine Anatomy & Physiology
Provide an example of Renal threshold /
maximal re-absorptive capacity?
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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?
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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)
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Routine Urinalysis
What substances make-up urine?
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Routine Urinalysis
Composition
Normal constituents
@ 95% water
Urea, organic &inorganic chemicals
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Routine Urinalysis
How should the urine specimen be collected?
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Routine Urinalysis
How should the urine specimen be collected?
Container characteristics
Times / types of collection
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Routine Urinalysis
How should the urine specimen be
preserved? Why?
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Routine Urinalysis
What happens to the urine sample over time?
Why?
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Urine Testing
Physical properties
What are the physical properties of urine that
are evaluated ?
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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.
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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.
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Urine Testing
Physical properties
What are the physical properties of urine that
are evaluated ?
Clarity / transparency
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Urine Testing
Physical properties
What are the physical properties of urine that
are evaluated ?
Odor & foam not routinely reported
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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 ?
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Urine Testing
Chemical properties
Review dipstick chemical reactions,
Know indicators
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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
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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
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Urine Testing
Chemical properties
Use of commercial controls and course of
action if results are not as expected
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Urine Testing
Chemical properties
Back-up tests?
Are they always performed?
Which ones for which test?
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Urine Testing
Chemical properties
Which urine test is most sensitive to
impending kidney disease?
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Urine Testing
Chemical properties
Which urine test(s) are more liver disease
oriented?
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Urine Testing
Chemical properties
What dipstick results indicate UTI?
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Urine Testing
Chemical properties
What characteristics (physical, chemical,microscopic) does a urine from a diabetic
exhibit?
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Urine Testing
Chemical properties
What urine results would you expect to see
from a child with a fever lasting 2 days?
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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
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Review kidney diseases
Terms
Cystitis inflammation of the bladder wall,
often associated with infection
Urethritis - inflammation of the urethra
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Review kidney diseases
Terms
Nephritis general term for inflammation of
kidney tissue.
Glomerular nephritis - refers to sterileinflammatory process affecting glomerulus
Pyelonephritis - When the inflammation is caused
by an infection, the term pyelonephritis is used
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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 andclinical) results
Uremia old term no longer used; literalmeaning is urine in the blood
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Microscopic Sediment
A number of s l ides wi th m icroscop ic
elements
RBC, WBC, yeast
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Microscopic Sediment Epithelial Cells
Squamous epithelial cells (stained with Sternheimer-Malbin)
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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 inelderly. Can be found as fragments or as reactive.
http://www.agora.crosemont.qc.ca/urinesediments/Imdoceng/d37d001.htm -
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Microscopic Sediment Epithelial Cells
RTEs; 250x magnification
Also WBC and RBCs
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Microscopic Sediment Casts
RBC cast
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Microscopic Sediment
A number of s l ides wi th m icroscop ic
elements
CRYSTALS,
Uric acid
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Microscopic Sediment Crystals
Calcium oxalate
envelope; may be dumbbell
shaped. Usually appear
as a square with a
retract i le cross
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Microscopic Sediment
A number of s l ides wi th m icroscop ic
elements
Alkal ine
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Microscopic Sediment
A number of s l ides wi th m icroscop ic
elements
The rarely ever seen, abno rmal crys tals
Cyst ine
Tyrosine
Leucine Bi l i rub in (occasionally seen in p rem ies)
Cholesterol
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Microscopic Sediment
A number of s l ides wi th m icroscop ic
elements
Mucous threads
Bacter ia, yeast, tr ichom onas sperm
Lo ts o f art i facts
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Microscopic
What are oval fat bodies?
How can you (quickly,cheaply) provide
tentative proof they contain fat?
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Microscopic