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92978422 basic urine examination rov

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C L I N P A T H F I N A L S : B A S I C E X A M I N A T I O N O F U R I N E - D R . A Y O C H O K ( R O V Z )
Page 1-2
ND
SEMESTER
Basic examination of urine
Formation
Ultrafiltrate of blood
Average daily output
o 1200 to 1500 ml/day
600cc/day still considered normal
o 170,000 filtered plasma/day
o 18L glomerular filtrate reduced to 1-2L
o 20 25 % of total blood volume
Parts of nephron
o
Glomerulus
o
Bowman's capsule
Cortical nephron and ?
PCT and DCT located in the cortex
Glomerulus: only type of capillary that can filter; 2 arterioles
(afferent and efferent)
o
Compared to normal capillary: 1 venule and 1
arteriole
Composition of urine
Organic:
Urea (50%),
creatinine,
uric acid
Inorganic:
Chloride,
sodium,
potassium
o Traces: calcium, phosphate
Water:99%
Amino acids, peptides
Formed elements:sediments
o Cells: RBC, epithelial, WBC
o Casts (UNIQUE TO URINE)
o Crystals
o Mucus, bacteria
Mucus threads
Yeast, sperm cell
URINE VOLUME
Normal: 600-2000 ml/day
Night: >400ml
Factors that influence volume:
o State of hydration
o ADH secretion: caffeine: inhibit ADH
o Excretion of dissolved solids
Glucose, salts
Anuria: complete cessation of urine flow
o Decreased renal blood flow
o Severe renal failure
Oliguria: decreased normal daily urine
output (< 30 ml/hr)
o Vomiting, diarrhea, perspiration, severe burns,
hydronephorsis
o Refer
o Renal: vascular d/o, AGN, ATN, CGN, CRF,
glomerulus, tubules or both are affected
Polyuria: increase in daily urine volume
o More than 2L in 24 hrs
o DM- excess glucose requires water for excretion,(
osmolarity: excrete a lot of concentrated urine)
o Diabetes Insipidus-decrease in secretion of ADH,
(diluted urine)
o caffeine, alcohol
Nocturia: increase in nocturnal urine output
o DM
o More than 500cc at night
Types of urine specimens
Random: routine screening (most frequent)
o ease of collection
o anytime
o prob: menstruation, hormonal evaluation
First morning:
o Ideal screening specimen
o Concentrated specimen
o Pregnancy test- false negative results (random
urine is not concentrated)
o Orthostatic proteinuria: happends when patient
stands at prolonged standing due to pressure on
thee renal vein which increases the GFR
Upon waking up: collect 1
st
Let patient walk: collect 2
nd
Positive if first is negative and 2
nd
is
positive
Fasting specimen (2
nd
morning)
o Glucose monitoring (ideal specimen)
FOR INSULIN THERAPY for diabetics
Why not first: will no tell the efficiency
of insulin therapy due to its high
concentration
Because 2
nd
morning is more accurate
2 hour post-prandial
o Monitoring insulin therapy in DM
o Or in conjunction with OGTT
o To further correlate amount of glucose in
comparison to the 1
st
morning specimen
GTT specimens: corresponding blood samples (and urine)
o Glucose and ketones
24-hour (timed) specimen
o Accurate chemical quantitative tests
For accurate renal function (not routinely
done)
o Discard 1
st
urine
o Include last urine after a 24 hour period
Detect creatinine
Quantify creatinine, total protein,
albumin
For creatine clearance; protein content
Catheterized specimen
o Bacterial culture
o Renal functions
For difficulty of voiding
Sterile specimen and no contamination
Midstream clean catch: incorporated in a random and 1
st
morning urine
o Bacterial culture
o Safer, less traumatic method

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C L I N P A T H F I N A L S : B A S I C E X A M I N A T I O N O F U R I N E - D R . A Y O C H O K ( R O V Z )
Page 2-2
ND
SEMESTER
Suprapubic aspiration
o Most sterile
o Bacterial culture
o Cytologic examination (ideal)
o For tumors of UB: has a low yield specimen
o Biopsy still superior
Three-glass collection
o Prostatic infection: evaluation for prostatitis
Compare 1
st
and 3
rd
specimen (10x the
amount of bacteria compared to 1
st
)
o 1
st
urine, midstream, massage prostate, remaining
urine
o Interpretation
1
st
: if + for WBC
2
nd
: control
3
rd
: if + for bacteria = Prostatitis
(negative control and in either 1 & 3 (+)
UTI?
IF all are positive: recollect thru 3 glass
4 glass also for prostatitis
Pediatric specimen
o Pediatric Urine Collector (PUC): routine
Has an adhesive attached to 1 end
Px: ensure that fecal contamination is
avoided: recheck
o Sterile: catheter, suprapubic
Aspiration
Note:
Plastic cups are used: wide mouth disposable
Bottle :contamination if not sterilized properly
Routine urinalysis
Physical examination
clarity, color, specific gravity, odor
Chemical examination
glucose, protein, pH, ketones, etc
Microscopic study
cells, crystals, casts, microbes
Urine sediment examination
urine test strips cover some of physical and chemical
parameters
PHYSICAL EXAMINATION
Appearance
Color
o Normal: straw to amber (pale yellow)
o if dilute or concentrated (dark yellow)
Normal urine pigments:
o Urochrome (yellow): major pigment
Excretion proportional to metabolic rate
Increased: feer, thyrotoxicosis, starvation
o Uroerythrin (red)
o Urobilin (orange-red)
Odor
pH
ABNORMAL URINE COLOR
Dark orange:
o Bilirubin, pyridium, nitrofurantoin
Fat soluble: unconjugated
Excreted: conjugated
o Carrots, vitamin A
Yellow-green, yellow-brown
o Biliverdin (from bilirubin oxidation)
Not common
Green, blue-green
o Pseudomonas infection, amitriptyline
Chek for fruity smell
o Methocarbamol, Indican (a potassium salt), phenol
Pink, Red
o RBCs, Hgb, porphyrins
o Beets (jams), menstrual, phenindione
Brown, blacks
o Methemglobin, homogentisic acid (alkaptonuria:
inherited d/o of metabolism), melanin (melanoma)
o Argyrols, methyl/levodopa, metronidazole
NORMAL CLARITY
APPEARANCE
Normal: clear
Non-pathologic causes of turbid urine:
o Squamous epithelial cells
Vaginal contamination (common in
women)
o Mucus threads
o Amorphous phosphates, carbonates
o Sperms cells in females
o Fecal contamination: esp in Peds
o Radiographic contrast medium
o Talcum, vaginal creams
Pathologic causes of turbid urine:
o Red blood cells: not from menstrual blood
o White blood cells
o Bacteria, yeast
o Abnormal crystals: tyrosine and eosine?
o Lymph fluid:Pyuria
o Lipids: Lipiduria
o Malignant cells
SPECIFIC GRAVITY
Normal: 1.015 to 1.035
o Urea, NaCl, Sulfate, Phosphate (major components
of urine)
o Proportion of dissolved solid components to total
of specimen
Evaluation of renal concentrating ability
Isosthenuria: 1.010
o Same with initial filtrate
Hyposthenuric: < 1.010: DI, PN, GN
o Pyelo and glomerulonephritis
o Diluted urine
Hypersthenuric: > 1.010: CHN, DHN
o Concentrated urine
Urinometer
Refractometer
NORMAL ODOR
Normal: faint odor (volatile acids)
Aromatic
Odorless: severe kidney dysfunction
ABNORMAL ODOR
Foul, ammonia-like: UTI, old specimen (Standing)
Fruity, sweet: DKA, starvation, vomiting
o Nilalangam!

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Basic examination of urine Formation • Ultrafiltrate of blood • Average daily output o 1200 to 1500 ml/day ▪ 600cc/day still considered normal o 170,000 filtered plasma/day o 18L glomerular filtrate reduced to 1-2L o 20 – 25 % of total blood volume o o • Nocturia: increase in nocturnal urine output o DM o More than 500cc at night Types of urine specimens • Random: routine screening (most frequent) o ease of collection o anytime o prob: menstruation, hormonal evaluation Parts of nephron o o • • • Glomerulus Bowman's capsule Cortical nephron and ? PCT and DCT located in the cortex Glomerulus: only type of capillary that can filter; 2 arterioles (afferent and efferent) o Compared to normal capillary: 1 venule and 1 arteriole • First morning: o Ideal screening specimen o Concentrated specimen o Pregnancy test-  false negative results (random urine is not concentrated) o Orthostatic proteinuria: happends when patient stands at prolonged standing due to pressure on thee renal vein which increases the GFR ▪ Upon waking up: collect 1st ▪ Let patient walk: collect 2nd ▪ Positive if first is negative and 2nd is positive • Fasting specimen (2nd morning) o Glucose monitoring (ideal specimen) ▪ FOR INSULIN THERAPY for diabetics ▪ Why not first: will no tell the efficiency of insulin therapy due to its high concentration ▪ Because 2nd morning is more accurate • 2 – hour o o o • GTT specimens: corresponding blood samples (and urine) ...
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