UA Review Spring2009

7/30/2019 UA Review Spring2009

1/56

BODY FLUID ANALYSIS

Urine Mini-review for UA COURSE

Final Exam part 1


2/56

Urine Anatomy & Physiology

Anatomy of the Urinary System


3/56


Micro-Anatomy of the Urinary System

Nephron functional or working unit of the kidney

@ 1 million / kidney


4/56


Micro-Anatomy of the Urinary System - nephron

Glomerulus

Renal Tubules


5/56


Micro-Anatomy of the Urinary System

Nephron What size substances are filtered?

Examples of substances that cannot filter.


6/56


Physiology of the Urinary System

What are Functions of the kidney?


7/56



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.


8/56




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


9/56




Retention of substances necessary for normal body function (glucose, amino acide, etc)

Regulation of electrolyte balance and osmotic pressure of bodyfluids (BP)


10/56




Hormone production

What hormones are produced by the kidney?


11/56



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.


12/56



What hormones affect the kidney?


13/56




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


14/56




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


15/56


Provide an example of Renal threshold /

maximal re-absorptive capacity?


16/56



Acid Base balance

What 2 body systems are most involved with body

acid / base balance?

What is the overall goal?


17/56



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)


18/56

Routine Urinalysis

What substances make-up urine?


19/56

Routine Urinalysis

Composition

Normal constituents

@ 95% water

Urea, organic &inorganic chemicals


20/56

Routine Urinalysis

How should the urine specimen be collected?


21/56

Routine Urinalysis

How should the urine specimen be collected?

Container characteristics

Times / types of collection


22/56

Routine Urinalysis

How should the urine specimen be

preserved? Why?


23/56

Routine Urinalysis

What happens to the urine sample over time?

Why?


24/56

Urine Testing

Physical properties

What are the physical properties of urine that

are evaluated ?


25/56

Urine Testing

Physical properties


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.


26/56

Urine Testing

Physical properties


are evaluated ?

Volume For routine UA, not normally measured

Review the terms used to describe urine volume

characteristics.


27/56

Urine Testing

Physical properties


are evaluated ?

Clarity / transparency


28/56

Urine Testing

Physical properties


are evaluated ?

Odor & foam not routinely reported


29/56

Urine Testing

Physical properties


are evaluated ?

Specific Gravity

What is it? / what does it say about the specimen?

What is isosthenuria ?


30/56

Urine Testing

Chemical properties

Review dipstick chemical reactions,

Know indicators


31/56

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


32/56

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


33/56

Urine Testing

Chemical properties

Use of commercial controls and course of

action if results are not as expected


34/56

Urine Testing

Chemical properties

Back-up tests?

Are they always performed?

Which ones for which test?


35/56

Urine Testing

Chemical properties

Which urine test is most sensitive to

impending kidney disease?


36/56

Urine Testing

Chemical properties

Which urine test(s) are more liver disease

oriented?


37/56

Urine Testing

Chemical properties

What dipstick results indicate UTI?


38/56

Urine Testing

Chemical properties

What characteristics (physical, chemical,microscopic) does a urine from a diabetic

exhibit?


39/56

Urine Testing

Chemical properties

What urine results would you expect to see

from a child with a fever lasting 2 days?


40/56

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


41/56

Review kidney diseases

Terms

Cystitis inflammation of the bladder wall,

often associated with infection

Urethritis - inflammation of the urethra


42/56

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


43/56

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


44/56

Microscopic Sediment

A number of s l ides wi th m icroscop ic

elements

RBC, WBC, yeast


45/56

Microscopic Sediment Epithelial Cells

Squamous epithelial cells (stained with Sternheimer-Malbin)


46/56


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


47/56


RTEs; 250x magnification

Also WBC and RBCs


48/56


49/56

Microscopic Sediment Casts

RBC cast


50/56



elements

CRYSTALS,

Uric acid


51/56

Microscopic Sediment Crystals

Calcium oxalate

envelope; may be dumbbell

shaped. Usually appear

as a square with a

retract i le cross


52/56



elements

Alkal ine


53/56



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


54/56



elements

Mucous threads

Bacter ia, yeast, tr ichom onas sperm

Lo ts o f art i facts


55/56

Microscopic

What are oval fat bodies?

How can you (quickly,cheaply) provide

tentative proof they contain fat?


56/56

Microscopic

UA Review Spring2009

Documents