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| Urine studies are popular for two principle reasons: |
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Definition
91) Urine is readily available and easily collected
(2) Urine contains information about many of the body’s metabolic functions |
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| a peripheral part and a central part |
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| Peripheral part of the kidney |
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| consisting of medullary pyramids |
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| central part of the kidney |
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| group of tubes (the calyx and the pelvis) that lead out of each pyramid and into the ureter |
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| Within the cortex and the medullary pyramids, responsible for filtering the bloodstream of an estimated 43 gallons of water a day |
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| what do nephrons filter fluid through |
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| intricate network of tubules |
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| The nephron is composed of two main parts |
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| the renal corpuscle and the renal tubule |
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| primary role of the kidney |
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| to maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as urea) and minerals from the blood and excreting them, along with water, as urine. |
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| plasma concentrations of several important ions, assist with regulation of blood pressure, glucose metabolism, and erythropoiesis |
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| The blood is filtered by nephrons, Cells, proteins, and other large molecules are removed at the glomerulus by a process of ultrafiltration. |
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| resembles plasma except it contains negligible plasma proteins |
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| the proximal tubule, the loop of Henle, the distal convoluted tubule, and a series of collecting ducts to form urine |
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| Tubular reabsorption is the process by which solutes and water are removed from the ultrafiltrate (tubular fluid) and transported back into the blood. |
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| where does Reabsorption occur? |
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Definition
| proximal tubules, distal tubules, and the loop of Henle |
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| active or passive extraction of substances from the tubule fluid into the renal interstitium (the connective tissue that surrounds the nephrons) |
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| transport of these substances from the interstitium into the bloodstream. These transport processes are driven by Starling forces, diffusion, and active transport. |
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| Tubular secretion is the transfer of materials from peritubular capillaries to renal tubular lumen |
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| what substances are secreted? |
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| Usually only a few substances are secreted. These substances are present in great excess, or are natural poisons. Many drugs are eliminated by tubular secretion |
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| amount of water excreted by the kidneys |
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| Excreted amount is usually dependent upon |
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| hydration state of the body |
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| Factors influencing hydration are (4) |
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Definition
Fluid intake
Fluid loss from non-renal sources
Levels of ADH
Necessity to excrete excess solids, i.e., glucose or salts |
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| 1200-1550mls. Range may be from 600 to 2000mls. |
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| decrease in daily urine volume. Seen in states of dehydration that can result from excessive non-renal water loss. Example: vomiting, diarrhea, perspiration, and severe burns |
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| cessation of urine flow. Usually associated with severe renal disease. It can result from damage to the kidney or impairment to renal blood flow |
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| Increased urine excretion during the night |
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| increase in daily urine volume. Maybe associated with diabetes mellitus or insipidus. Can be artificially caused by use of diuretics, caffeine, or alcohol |
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| urines should be handled in a way to ensure |
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| chemical and cellular constituents are preserved |
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| Three major rules apply to the collection and handling of urine specimens |
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Definition
(1)The specimen must be collected in a clean, dry container
(2)The specimens must be appropriate labeled
(3)The specimens must be delivered promptly and testing performed within one hour. |
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| If delivery or testing within 1 hour is impractical than the specimens should be |
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Definition
| refrigerated or an appropriate chemical preservative added |
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| The most common method of preserving urine |
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(1)Increased specific gravity
(2)Precipitation of amorphous phosphates and urates. |
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| Refrigerated specimens must return to room temperature (22 C) |
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| prior to chemical analysis |
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| The ideal chemical preservative |
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Definition
(1)Should be bactericidal
(2)Inhibit urease
(3)Preserve formed elements.
(4)It must not interfere with chemical analysis. |
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| increased because of breakdown of urea to ammonia |
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| glucose and sitting urine |
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| Decreased glucose – due to glycolysis and bacterial utilization |
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| ketones and sitting urine |
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| Decreased ketones – due to volatilization |
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| bilirubin and sitting urine |
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Definition
| Decreased bilirubin – due to exposure to light |
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| urobilinogen and sitting urine |
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Definition
| Decreased urobilinogin – is oxidized to urobilin |
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| nitrite and sitting urine |
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| Increased nitrite – bacterial reduction to nitrate |
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| bacteria and sitting urine |
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| turibity and sitting urine |
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| Increased turbidity – due to bacterial growth and precipitation of amorphous material |
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| RBC’s and Casts in sitting urine |
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| disintegrate in dilute alkaline urine |
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| changes because oxidation/reduction of metbolites |
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| Most common submitted owing to ease of collection and lack of inconvenience to the patient. Useful for routine screening |
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| Is the ideal screening specimen – Is usually a concentrated specimen and assures detection of chemical and formed elements. It is essential for preventing false-negative pregnancy and orthostatic proteinuria |
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| The second specimens of the day obtained after a period of fast. Ideal for glucose monitoring |
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| 2-Hour Postprandial specimen |
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| Collected two hours after a routine meal and use to assess glucose metabolism. Used to monitor insulin therapy in person with diabetes mellitus |
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| Specimens collected in correspondence with blood specimens during a GTT. |
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| 24 hour or Timed specimen |
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| – Used in measuring the act amount of chemical constituent and can be used to produce accurate quantitative results |
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| Most often associated with bacterial culture. If UA is also ordered the culture must be performed first. (Minimizes contamination) |
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| Provides a safe, less traumatic method for obtaining urine for bacterial culture. Is also less contaminated and offers a more representative specimens for microscopic analysis |
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| Collected by externally introducing a needle into the bladder. Sampling technique is usually reserved for bacterial culture. May be of value for cytological examination |
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| Effectively captures urine sample in its dual-chambered compartments with non-reflux valves separating them. |
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| 24-hour urine collection asseses |
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Definition
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| conditions may interfere with the accuracy of a 24-hour urine collection |
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Definition
forgetting to collect some of your urine
going beyond the 24-hour collection period and collecting excess urine
losing urine from specimen container through spilling
not keeping urine cold during collection period
acute stress
vigorous exercise
certain foods: coffee, tea, cocoa, bananas, citrus fruits, vanilla |
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