Tubular Reabsorption Test

1. Osmometry 1. PAH (Para-aminohippuric Acid Test)

2. Fishberg Test
3. Mosenthal Test
1. Osmolarity Test
Specific gravity and urine osmolality measures
total solute concentration
Specific gravity depends on the number and
weight of the solute
Osmolarity depends on the number of
particles present in the solution
o Osmolarity is the number of particles
presentin 1 L of solution
Osmolality is unaffected by density of solutes;
better
o Osmolality is the number of particles
present in 1 kg of solution
Why is OSMOLALITY not included in Routine Urine Test?
1. More time
2. More expensive
3. More equipment
Osmolality of Normal Adult (Graffs)
Normal diet: 500-850 mOsm/kg water
Excessive hydration: 40-80 mOsm/kg
During dehydration: 800-1400 mOsm/kg water
Terminal Renal Failure: Around 285 mOsm/kg
o Must be almost the same as the blood
because no filtering occurred
o Plasma and Glomerular Filtrate osmolality
equal
BLOOD Normal Osmolality: 275-300 mOsm/kg;
average 300 mOsm/kg
Principle: Clearance test for GFR
Most common exogenous method
Radioactive hippurate
Principle:
a. It measures the exact amount of blood flowing
through the kidneys
b. Uses substances that is completely removed
from the blood primarily in the peritubular
capillaries (excreted in the proximal convoluted
tubules)
2. Titratable Acidity and Ammonia
Significance: the inability to produce an acid
urine in the presence of metabolic acidosis
(renal tubular acidosis) due to:
o Impaired Hydrogen ion secretion in
the proximal convoluted tubules
o Defects of ammonia secretion in
Distal convoluted tubules
How would you know?
Measure:
o Urine pH
o Titratable acidity: quantitate hydrogen ions in
the urine
o Alkaline urine: 2-hour Post Prandial
o Acid Urine: Night time
Factors Affecting Urine Production
1. Amount of water excreted
Average daily is 1200 ml
2. Bodys state of hydration

Plasma and Glomerular Filtrate Osmolality Variation in Urine Production and Volume
2 Ways to Measure:
a. Freezing Point Osmometer Class Age Group Production
A solution that contains 1000 mOsm/kg water Children 1 6 years old 300 1000 mL/day
lowers the freezing point 1.86 oC below that Children 6 12 years old 500 1500 mL/day
of water (O oC) Adult 13 - above 800 1600 mL/day
The lower the freezing point, the higher the Urine production per hour = 40 50 mL
osmolality (NaCl)
b. Vapor Pressure Osmometer Factors Affecting Volume of Urine:
Dew point (temperature at which water vapor 1. Fluid intake
condenses to a liquid) 2. Kidney and other diseases (DM)
The depression of dew point temperature Kidneys do not reabsorb excess glucose
parallels the decrease in vapor pressure Excrete more water to remove dissolved
glucose
2. Fishberg Concentration Test 3. Diabetes Insipidus
Patient deprived of fluid per 24 hours then Decrease secretion or function of ADH
measure specific gravity 4. Food and drugs
SIADH (Syndrome of Inappropriate ADH)
3. Mosenthal Concentration Test 5. Temperature
Comprises of the volume and specific gravity Cold temperature
of day and night urine sample 6. Metabolism
7. Emotions
Tubular Secretion Test and Renal Blood Flow Test 8. Age
Urinary Bladder See Tables 3-2 and 3-3
Volume of 300 400 mL
o (To feel a conscious) desire to urinate
Volume of 600 800 mL
o (A feeling of urgent) need to urinate Types of Specimen Collection
Amount of urine secreted per day 1. Random Urine
o 3x greater than during night Commonly received specimen
Collected anytime
Residual Urine No specificity
Amount of urine that remains in the bladder after a
voluntary urination 2. First Morning Specimen
Preferred specimen for pregnancy test (pH) to
Different Terms prevent false negative results
a. Oliguria More concentrated
Decreased urine output Ideal for screening of urinary tract infection
Less than 400 mL/24hour (UTI)
Evaluation of orthostatic (prolonged standing)
Clinical Significance: proteinuria
Dehydration (vomiting, diarrhea, excessive 12 15 mL in a clean container
perspiration) o Standard Urine Container 50 mL
Obstruction o Analysis should be done within 2
Severe burn hours
Shock
Acute nephritis 3. Fasting Specimen
Second specimen voided after a period of
b. Anuria fasting
Complete cessation in the urine output Recommended for glucose monitoring
Less than 100 mL/24hour
4. 2-Hour Postprandial Specimen
Clinical Significance: First specimen collected before meal (for
Acute glomerulonephritis comparison)
Renal obstruction 2nd specimen will be collected 2 hours after
Decreased blood flow (heart failure) meal
Monitoring of insulin therapy
c. Nocturia
An excessive urination during night Clinical Significance:
Impaired glucose tolerance or Diabetes
d. Polyuria mellitus
Excessive daily urine output
More than 3000 mL/day 5. Glucose Tolerance Specimen
Measures the ability of an individual to
Clinical Significance: metabolize glucose
Caffeine and alcohol (suppress production of
ADH) 6. 24-Hour Specimen
Diabetes Insipidus and Diabetes mellitus Collection of specimen will begin and end with
an empty bladder (example: from 6PM to
Specimen Collection and Handling 6PM the following day)

Urine
A biohazardous substance
Uses disposable container
Reject improperly labeled specimen Diagnostic Purposes:
o Hospital No., name, date and time To determine exact amount of urine chemical
Reject if specimen is more than 2 hours substance (ex. Creatinine Total Protein and
other metabolites)
Specimen Integrity Specimen must be thoroughly mixed
Urine specimen should be examined within 2 hours Exact volume must the measured
after voided Specimen should be refrigerated
7. Catheterized Specimen
Urine collection under sterile condition
through a hollow tube from urethra into the
bladder
Measures individual functions of the kidney
(left and right)
Used for bacterial culture

8. Midstream Clean-Catch Specimen

Same as midstream collection
Patient only instructed to collect specimen
from a clean genitalia with the use of mild
antiseptic towelletes
An alternative to catheterized specimen for
bacterial culture (use sterile conical tube)

9. Suprapubic Aspiration
It is a direct puncturing of the urinary bladder
at the suprapubic region
It is applied commonly in infants
For bacterial culture and cytologic
examination

10. (Prostatitis Specimen) Three Glass Specimen

Collection of urine into 3 sterile containers
For quantitative culture
Determines prostatic infection

a. First urine (passed into urethra)

Microscopic examination
b. Midstream Urine Collection
Used as control
c. Urine collected during prostatic massage
Microscopic examination

Stamey-Mears Four Glass Method

a. Initial voided urine (VB1)
For bacterial culture
Clinical correlation: Urethral
infection or inflammation
b. Midstream urine (VB2)
Clinical correlation: Bladder
infection
c. Expressed prostatic secretions (EPS)
Prostatic massage urine
Clinical correlation: 10 20 WBC =
infection

11. Pediatric Specimens

Urine collected by the use of an adhesive
pediatric bag for infants
For routine analysis

12. Drug Specimen Collection

Collection must follow the correct protocol
with documentations
Specimen should be kept between 32.5 oC to
37oC and examined immediately