RENAL SYSTEM URINALYSIS DISEASES OTHER BODY FLUIDS
ANALYSIS OF URINE
AND OTHER BODY
FLUIDS
prepared by:
JULIE ROSE E. DE GUZMAN, RMT, MLS (ASCPi)CM
Lesson outline:
I. RENAL SYSTEM: Physiology and Function
II. URINALYSIS: Physical, Chemical and Microscopic
III. DISEASES: Renal and Metabolic disorders
IV. OTHER BODY FLUIDS
Learning objectives:
✓ To summarize and highlight the must know concepts
✓ To correlate expected urinalysis findings to certain disease processes
✓ To analyze abnormal characteristics & contents of other body fluids in relation to particular clinical impressions
RENAL SYSTEM
REMEMBER !!!
o 1 – 1.5 million nephrons
o TOTAL RENAL BLOOD FLOW: 1,200 mL/min
o TOTAL RENAL PLASMA FLOW: 600-700
mL/min
RENAL SYSTEM
REMEMBER !!!
o 1 – 1.5 million nephrons
o TOTAL RENAL BLOOD FLOW: 1,200 mL/min
o TOTAL RENAL PLASMA FLOW: 600-700
mL/min
MAJOR RENAL FUNCTIONS
GLOMERULAR FILTRATION TUBULAR REABSORPTION AND SECRETION
1. CELLULAR STRUCTURE: SHIELD OF NEGATIVITY A. Reabsorption mechanism
2. GLOMERULAR PRESSURES
B. Major functions of secretion
3. RAAS
MAJOR RENAL FUNCTIONS
GLOMERULAR FILTRATION TUBULAR REABSORPTION AND SECRETION
1. CELLULAR STRUCTURE: SHIELD OF NEGATIVITY A. Reabsorption mechanism
2. GLOMERULAR PRESSURES
B. Major functions of secretion
3. RAAS
REMEMBER !!!
nonselective filter of plasma substances with molecular weights less
than 70,000 daltons or 70kD
MAJOR RENAL FUNCTIONS
GLOMERULAR FILTRATION TUBULAR REABSORPTION AND SECRETION
1. CELLULAR STRUCTURE: SHIELD OF NEGATIVITY A. Reabsorption mechanism
2. GLOMERULAR PRESSURES
B. Major functions of secretion
3. RAAS
REMEMBER !!! * GLUCOSE RT: 160-180 mg/dL
MAJOR RENAL FUNCTIONS
GLOMERULAR FILTRATION TUBULAR REABSORPTION AND SECRETION
1. CELLULAR STRUCTURE: SHIELD OF NEGATIVITY A. Reabsorption mechanism
2. GLOMERULAR PRESSURES
B. Major functions of secretion
3. RAAS
• Elimination of waste products not
filtered by the glomerulus
• Regulation of ACID-BASE balance
through secretion of H ions:
1. Bicarbonate ions
2. Phosphate ions
3. Ammonia
GLOMERULAR FILTRATION TEST REMEMBER !!!
1. Clearance tests CREATININE CLEARANCE FORMULA
1. Inulin
2. Creatinine
3. B-2-macroglobulin
4. Cystatin C
5. Radionucleotide
2. Calculated Glomerular Filtration estimates
1. Cockcroft and Gault
2. MDRD (Modification of Diet in Renal Disease)
REABSORPTION TESTS
1. Water deprivation test
1. Fishberg
2. Mosenthal
2. Osmometry
3. Free Water Clearance
1. Osmolar clearance
SECRETION TESTS
1. PAH test
2. PSP test
3. Urinary ammonia and titratable acidity
GLOMERULAR FILTRATION TEST
1. Clearance tests
1. Inulin
2. Creatinine
3. B-2-macroglobulin
4. Cystatin C
5. Radionucleotide
2. Calculated Glomerular Filtration estimates
1. Cockcroft and Gault
2. MDRD (Modification of Diet in Renal Disease)
REMEMBER !!!
URINE : SERUM OSMOLARITY RATIO
REABSORPTION TESTS
1. Water deprivation test
1. Fishberg
2. Mosenthal
2. Osmometry
3. Free Water Clearance
1. Osmolar clearance
SECRETION TESTS
1. PAH test
2. PSP test
3. Urinary ammonia and titratable acidity
GLOMERULAR FILTRATION TEST
1. Clearance tests
1. Inulin
2. Creatinine
3. B-2-macroglobulin
4. Cystatin C
5. Radionucleotide
2. Calculated Glomerular Filtration estimates
1. Cockcroft and Gault
2. MDRD (Modification of Diet in Renal Disease)
REABSORPTION TESTS
1. Water deprivation test
1. Fishberg
2. Mosenthal
2. Osmometry
3. Free Water Clearance
1. Osmolar clearance
SECRETION TESTS
1. PAH test
2. PSP test
3. Urinary ammonia and titratable acidity
URINALYSIS: URINE
- Urine is normally 95% water and 5% solutes
- UREA is about 60-90%
- Inorganic concentration: Cha > Na > K
BaNiCo PO: Bacteria-Nitrite-Color-pH-Odor = INCREASE
PHYSICAL EXAMINATION:
COLOR
▷ Normal: Colorless, Pale to Dark Yellow, Amber
Urobilin
Urochrome Uroerythrin
(Orange-
(Yellow) (Pink)
Brown)
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PHYSICAL EXAMINATION:
COLOR
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PHYSICAL EXAMINATION:
COLOR
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PHYSICAL EXAMINATION:
COLOR
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PHYSICAL EXAMINATION:
COLOR
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PHYSICAL EXAMINATION:
VOLUME
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PHYSICAL EXAMINATION:
CLARITY
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PHYSICAL EXAMINATION:
SPECIFIC GRAVITY
▷ Normal: 1.002 to 1.035 (Ave: 1.015 to 1.030)
▷ Isosthenuric: 1.010
○ Hyposthenuric: below 1.010
○ Hypersthenuric: above 1.010
➢ METHODS:
1. URINOMETER
2. HOD
3. REFRACTOMETER
4. REAGENT STRIP
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PHYSICAL EXAMINATION:
ODOR
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CHEMICAL EXAMINATION
PARAMETER REAGENT PRINCIPLE REACTION-COLOR READING
TIME
Glucose oxidase; peroxidase DOUBLE SEQ. ENZYME RXN Glucose + O2 → gluconic acid + H2O2
GLUCOSE H2O2 + chromogen → oxidized chromogen + H2O 30 secs
Sodium nitroprusside NITROPRUSSIDE RXN Acetoacetic acid + sodium nitroprusside → purple
KETONES 40 secs
Polyelectrolyte, bromthymol blue indicators; PKA CHANGE OF
SG buffers POLYELECTROLYTE 45 secs
methyl red and bromthymol blue DOUBLE INDICATOR SYSTEM
pH 60 secs
Citrate buffer at pH 3; tetrabromphenol blue PROTEIN ERROR OF
PROTEIN indicator INDICATOR 60 secs
H2O2, tetramethylbenzidine PSEUDOPEROXIDASE RXN
BLOOD 60 secs
Dichloroaniline or dichloro-benzenediazonium DIAZO RXN Bilirubin + diazonium salt → tan to purple
BILIRUBIN 60 secs
Dimethylaminobenzaldehyde ERHLICH’S RXN Urobilinogen + dimethylaminobenzaldehyde → yellow to
UROBILINOGEN brown-orange 60 secs
Para-arsanilic acid, tetrahydrobenzo(h)- GREISS RXN Nitrite + para-arsanilic acid → diazonium + tetra-hydrobenzo(h)-
NITRITE quinolin-3-ol quinolin-3-ol → pink 60 secs
Indoxylcarbonic acid ester, diazonium salt LEUKOCYTE ESTERASE RXN Indoxylcarbonic acid ester + leukocyte esterases → indoxyl +
LE diazonium salt + purple 120
secs
CHEMICAL EXAMINATION
CHEMICAL EXAMINATION- CLINICAL SIGNIFICANCE:
pH SG
CHEMICAL EXAMINATION- CLINICAL SIGNIFICANCE:
BLOOD PROTEIN
CHEMICAL EXAMINATION- CLINICAL SIGNIFICANCE:
GLUCOSE KETONES
CHEMICAL EXAMINATION- CLINICAL SIGNIFICANCE:
BILIRUBIN-UROBILINOGEN
CHEMICAL EXAMINATION- CLINICAL SIGNIFICANCE:
NITRITE LE
CHEMICAL EXAMINATION
Standardization of Sediment preparation
Factors
Urine Volume : 12mL
Centrifugation: 400-450 @ 5mins
Sediment preparation: technique
Sediment volume: 0.02mL/ 20µL
Sediment examination: min.10 fields
Reporting format: Quantitative/Semi-quantitative
MICROSCOPIC EXAMINATION: Epithelial cells
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Squamous Transitional
•largest; most
common •“urothelial cells”
RTE •degenerating tubular
•most clinically epithelial cells
significant
Oval Fat Bodies
MICROSCOPIC EXAMINATION: Miscellaneous
A. C.
B.
Bacteria
Yeast -most common: Trichomonas
-maybe cocci / bacilli Parasite
-refractile with buds
D. E.
Mucus thread Sperm
-low refractile index
MICROSCOPIC EXAMINATION: Formed elements
RBCs Pus cells
-ghost cell; may appear -degenerated pyocytes;
swollen or crenated anucleated granular cytoplasm
Leukocytes Glitter cells
-spherical nucleated -WBCs in
granular cytoplasm hypotonic urine
MICROSCOPIC
EXAMINATION:
CASTS
NORMAL 10
min
ABNORMAL
Chemical
Physical
Microscopic
CORRELATION
RENAL DISEASE:
CLASSIFICATION
1. GLOMERULAR
2. TUBULAR & INTERSTITIAL
3. VASCULAR
Four distinct morphologic changes
a.Cellular proliferation
b.Leukocyte infiltration
c.Glomerular basement
d.Hyalinization
CATEGORY
A.PRIMARY
B.SECONDARY
C.HEREDITARY
Pathogenesis
I. PRIMARY MODE
GLOMERULAR
A. IMMUNE COMPLEXES
B. AG-AB INTERACTION
II. FACTORS INVOLVED DISEASE
PRIMARY GLOMERULAR
DISEASES
NEPHROTIC SYNDROME
NEPHRITIC SYNDROME
1. MEMBRANOUS NEPHROPATHY
1. ACUTE GLOMERULONEPHRITIS
2. MINIMAL CHANGE DISEASE
2. RAPIDLY PROGRESSIVE GLUMERULONEPHRITIS
3. FOCAL SEGMENTAL GLUMERULOSCLEROSIS
3. IGA NEPHROPATHY
4. MEMBRANOPROLIFERATIVE GLUMERULONEPHRITIS
OTHER CLINICALLY SIGNIFICANT CONDITION
A GOODPASTURE
SYNDROME
Urinalysis: Hematuria, Proteinuria, RBC casts
AUTOIMMUNE
DISEASES
B Wegener's
granulomatosis
Urinalysis: Hematuria, Proteinuria, RBC casts
SECONDARY & HEREDITARY GLOMERULAR DISEASES
HSPn:
HENOCH- DIABETIC
ALPORT SCHÖNLEIN
SYNDROME NEPHROPATHY
PURPURA
KIMMELSTIEL-WILSON
GENE MUTATION IGA DEPOSITION DISEASE
Urinalysis: Hematuria, Proteinuria, RBC casts Micral Test (Microalbuminuria):
Other tests: (+) Stool Occult Blood (+) suggest onset of Diabetic
Nephropathy
TUBULOINTERSTITIAL
DSES/DYSFXN
1. ACUTE TUBULAR NECROSIS
2. FANCONI SYNDROME
3. NEPHROGENIC DI
4. RENAL GLYCOSURIA
5. ACUTE PYELONEPHRITIS
6. CHRONIC PYELONEPHRITIS
7. ACUTE INTERSTITIAL NEPHRITIS
8. CYSTITIS
TUBULOINTERSTITIAL
DSES/DYSFXN
INTERSTITIAL DISORDERS:
URINARY TRACT INFECTION (UTI)
CYSTITIS PYELONEPHRITIS
▷ Urinary frequency, Burning ▷ Fever, Flank Pain,
sensation (+/-) symptoms of Cystitis
▷ Urinalysis: ▷ Urinalysis:
Leukocyturia, Bacteriuria, Leukocyturia, Bacteriuria,
Microscopic Hematuria, Microscopic Hematuria,
Increased pH Casts
▷ Other test: Urine Culture ▷ Other test: Urine Culture
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RENAL FAILURE
▷ Loss of Renal Function
(Glomerular Filtration, Tubular
Reabsorption/Secretion, Excretion)
▷ Acute or Chronic
▷ Urinalysis: depends on the primary
cause
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RENAL LITHIASIS (KIDNEY STONES)
▷ Most common composition: Calcium (Calcium oxalate or phosphate)
▷ Conditions favoring formation of kidney stones:
○ pH
○ Chemical concentration
○ Urinary stasis
▷ Urinalysis: Microscopic Hematuria
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SUMMARY
IV. OTHER BODY FLUIDS
✓CSF
✓SEMEN
✓SEROUS
✓SYNOVIAL
✓AMNIOTIC
✓VAGINAL
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