BCH 376 Lecture Notes

Urinalysis
It is a test that checks many body functions in one exam. Once you know what to look for, you can see what’s going on with various systems. 1 L of urine requires that 1000 L of blood is filtered.

Physical Characteristics of Urine: 1. Color Normal = pale yellow due to a pigment called urochrome. Color is associated with solute concentration. Increased solutes = darker urine; Decreased solutes = colorless urine, like water. Solute concentration is measured using a urinometer to determine specific gravity. Specific gravity of water = 1.000 Specific gravity of normal urine = 1.001 to 1.030

2. Transparency Normal = clear Abnormal = cloudy, which may be caused by bacteria, blood, cells, crystals, etc.

3. Odor Normal = slightly aromatic when freshly voided. Bacteria = ammonia odor Asparagus, drugs and diseases my also impart a characteristic odor. Diabetes mellitus = urine smells "fruity" or like acetone. 4. pH pH homeostasis = NH3 + H+ >>>>>> NH4 Normal pH = 4.5 to 8.0 (average is about 6.0) High protein diet = acid urine Vegetarian diet = alkaline urine 5. Specific gravity Normal = 1.001 to 1.030. Low Specific Gravity may be due to: 1. Excess fluid intake 2. Use of diuretics 3. Diabetes insipidus 4. Chronic renal failure High Specific Gravity may be due to: 1. Low fluid intake 2. Fever 3. Pyelonephritis Excessively concentrated urine may lead to kidney stones (renal calculi), that are made of cyrstals of salts that are present in urine such as uric acid, calcium oxalate or calcium phosphate. Decreased water intake and increased calcium intake may also cause kidney stones. Lithotripsy = thousands of shock waves pulverize stones. Patient is sedated and placed in a water tank for 30-60 minutes of shock waves. Find the ratio of the weight of urine versus the weight of distilled H2O. Ratio = Weight of urine/ Weight of distilled H2O Therefore, the higher the number (of the above ratio), the more concentrated the urine is. If a patient is dehydrated, no water in, specific gravity is higher. If a patient is well hydrated, and there is a higher volume of water going into the urine, then the specific gravity is lower. Abnormal Constituents of Urine Glycosuria = glucose Hematuria = Red blood cells Pyuria = White blood cells Bacteriuria = bacteria Ketonuria = ketones

Normal Constituents of Urine Water Urea Sodium and potassium Phosphate and sulfate ions Creatinine Uric acid Calcium Magnesium Bicarbonate ions Terminology of Urine Output Polyuria = excessive production of urine Anuria = decreased production of urine Dysuria = painful urination Urinary Disorders: Diabetes mellitus = decreased production or utilization of insulin. (Ketonuria with glycosuria is usually diagnostic for diabetes mellitus). Diabetes insipidus = large amounts of dilute urine is excreted, usually 5-20 liters per day. Cause may be inadequate secretion of antidiuretic hormone (ADH). UTI = bacterial infection of the urinary tract.

Urethritis = inflammation of the urethra Cystitis = inflammation of the urinary bladder Pyelonephritis = inflammation of the kidneys Glomerularnephritis = inflammation of glomeruli in kidneys Acetonuria = ketone bodies in the urine Azotemia = presence of urea in the blood Enuresis = bed wetting Nephrotic syndrome = protein in the urine due to increased permeability of the glomerular capillary endothelium Cystocele = hernia of the urinary bladder Polycystic kidney disease = most common inherited disorder of the kidneys Nephrotosis = floating kidney Micturition = urination Glomerulus = afferent arteriole, capillary, efferent arteriole Urine Dipstick: It provides the following information:

The dipstick looks like this, and each of the squares corresponds to something being tested. You are supposed to compare the colors of each square to a suggested color on the box to determine if things are normal. (see #’s below) 1. Glucose Renal threshold for glucose is such that after a certain point is reached, the glucose spills over. The specific threshold level depends on the patient. Even within an individual, the personal threshold varies daily. Therefore the dipstick test for glucose is really inaccurate. 2. Ketones Produced from fatty acids. a. Causes of ketones in the urine are starvation and diabetes mellitus ketoacidosis, etc.

b. Two major ketones in the body i. Beta hydroxybutyric acid ii. Acetoacetate 1. the dipstick test is non-specific and only sensitive to the second type of ketone (acetoacetate). 2. if you do a dipstick test, and it comes back ketone +, perform a serum ketone level because something is definitely going wrong. 3. Blood in the urine: Two situations c. HEMOGLOBINURIA = blood in the urine but the red blood cell (RBC) are NOT intact. The cause is hemolysis. d. HEMATURIA = intact red blood cells in the urine. This points to the urinary tract as the source of the problem i. Kidney ii. Ureter iii. Bladder 4. Protein: a. proteins are NOT supposed to be in the urine b. prevention of proteins into the urine is done by glomerular membrane 5. Bilirubin: NOT supposed to be in the urine 6. Urobilinogen: Grade this from 1 – 5 (5 being the highest) a. with high RBC destruction 7. Nitrates: Made by many bacteria species (with the exception of Staph & Strep) a. e.g. e. coli, proteus, pseudomonas etc. b. if nitrate +, urinary tract infection is suggested (UTI) c. a – test does NOT rule out a UTI 8. Leukocyte esterase: enzyme a. White blood cell (WBC) in urine noted by implication b. The enzyme esterase is normal in urine c. + for this enzyme then probably a UTI 9. Casts: lots of different material clumped together inside of the renal tubule. a. As a general rule if a cast is present, then something is going on b. Exception to the above rule is if you see a hyaline cast, which is a normal finding c. Clumped cells come from the kidney d. Casts can be RBC or WBC casts i. If you see these in the urine, tells you that there is a disease from the bladder => kidney (moving up) AKA pyelonephritis (probably) e. Cells i. If you see RBC – kidney problem

1. Could be: a. Pyelonephritis b. SLE c. Kidney stones d. Trauma (e.g. hit in the flank/abdomen) ii. If you see WBC casts – probably due to infection 10. Crystals: a. some is normal b. could be due to gout or liver disease 11. Bacteria: urine is considered sterile, therefore bacteria in the urine is not normal a. if + for bacteria, probably due to a UTI

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