1. BODY FLUID ANALYSIS Urine Mini-review for UA COURSE Final Exam part 1

2. Urine Anatomy & Physiology Anatomy of the Urinary System

3. Urine Anatomy & Physiology Micro-Anatomy of the Urinary System Nephron – functional or working unit of the kidney  @ 1 million / kidney

4. Urine Anatomy & Physiology Micro-Anatomy of the Urinary System - nephron Glomerulus Renal Tubules

5. Urine Anatomy & Physiology Micro-Anatomy of the Urinary System Nephron What size substances are filtered? Examples of substances that cannot filter.

6. Urine Anatomy & Physiology Physiology of the Urinary System What are Functions of the kidney?

7. Urine Anatomy & Physiology Physiology of the Urinary System What are Functions of the kidney? Elimination of excess water Elimination of waste products of metabolism. ie. Urea, creatinine, etc. ** These two substances are sometimes measured to determine if unknown fluid is urine.

8. Urine Anatomy & Physiology Physiology of the Urinary System What are Functions of the kidney? Elimination of foreign substances If 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. Urine Anatomy & Physiology Physiology of the Urinary System What are Functions of the kidney? Retention of substances necessary for normal body function ( glucose, amino acide, etc) Regulation of electrolyte balance and osmotic pressure of body fluids (BP)

10. Urine Anatomy & Physiology Physiology of the Urinary System What are Functions of the kidney? Hormone production  What hormones are produced by the kidney?

11. Urine Anatomy & Physiology Physiology of the Urinary System 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. Urine Anatomy & Physiology Physiology of the Urinary System What hormones affect the kidney?

13. Urine Anatomy & Physiology Physiology of the Urinary System What hormones affect the kidney?  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. Urine Anatomy & Physiology Physiology of the Urinary System What hormones affect the kidney?  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 blood’s solids

15. Urine Anatomy & Physiology Provide an example of Renal threshold / maximal re-absorptive capacity?

16. Urine Anatomy & Physiology Physiology of the Urinary System Acid – Base balance  What 2 body systems are most involved with body acid / base balance?  What is the overall goal?

17. Urine Anatomy & Physiology Physiology of the Urinary System 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. Routine Urinalysis What substances make-up urine?

19. Routine Urinalysis Composition – Normal constituents @ 95% water Urea, organic & inorganic chemicals

20. Routine Urinalysis How should the urine specimen be collected?

21. Routine Urinalysis How should the urine specimen be collected? Container characteristics Times / types of collection

22. Routine Urinalysis How should the urine specimen be preserved? Why?

23. Routine Urinalysis What happens to the urine sample over time? Why?

24. Urine Testing Physical properties What are the physical properties of urine that are evaluated ?

25. Urine Testing Physical properties What are the physical properties of urine that 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. Urine Testing Physical properties What are the physical properties of urine that are evaluated ? Volume – For routine UA, not normally measured Review the terms used to describe urine volume characteristics.

27. Urine Testing Physical properties What are the physical properties of urine that are evaluated ? Clarity / transparency

28. Urine Testing Physical properties What are the physical properties of urine that are evaluated ? Odor & foam not routinely reported

29. Urine Testing Physical properties What are the physical properties of urine that are evaluated ? Specific Gravity  What is it? / what does it say about the specimen?  What is isosthenuria ?

30. Urine Testing Chemical properties Review dipstick chemical reactions, Know indicators

31. 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. 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. Urine Testing Chemical properties Use of commercial controls and course of action if results are not as expected

34. Urine Testing Chemical properties Back-up tests? Are they always performed? Which ones for which test?

35. Urine Testing Chemical properties Which urine test is most sensitive to impending kidney disease?

36. Urine Testing Chemical properties Which urine test(s) are more liver disease oriented?

37. Urine Testing Chemical properties What dipstick results indicate UTI?

38. Urine Testing Chemical properties What characteristics (physical, chemical, microscopic) does a urine from a diabetic exhibit?

39. Urine Testing Chemical properties What urine results would you expect to see from a child with a fever lasting 2 days?

40. 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. Review kidney diseases Terms Cystitis – inflammation of the bladder wall, often associated with infection Urethritis - inflammation of the urethra

42. Review kidney diseases Terms Nephritis – general term for inflammation of kidney tissue. Glomerular nephritis - refers to sterile inflammatory process affecting glomerulus Pyelonephritis - When the inflammation is caused by an infection, the term pyelonephritis is used

43. 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 and clinical) results Uremia – old term no longer used; literal meaning is ‘urine in the blood’

44. Microscopic Sediment A number of slides with microscopic elements RBC, WBC, yeast

45. Microscopic Sediment – Epithelial Cells Squamous epithelial cells ( stained with Sternheimer- Malbin)

46. Microscopic Sediment – Epithelial Cells 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 in elderly. Can be found as fragments or as reactive.

47. Microscopic Sediment – Epithelial Cells RTEs; 250x magnification Also WBC and RBCs

48. Microscopic Sediment – Casts

49. RBC cast

50. Microscopic Sediment A number of slides with microscopic elements CRYSTALS, Uric acid

51. Microscopic Sediment – Crystals Calcium oxalate – envelope; may be dumbbell shaped. Usually appear as a square with a retractile cross

52. Microscopic Sediment A number of slides with microscopic elements Alkaline

53. Microscopic Sediment A number of slides with microscopic elements The rarely ever seen, abnormal crystals Cystine Tyrosine Leucine Bilirubin (occasionally seen in premies) Cholesterol

54. Microscopic Sediment A number of slides with microscopic elements Mucous threads Bacteria, yeast, trichomonas sperm Lots of artifacts

55. Microscopic What are oval fat bodies? How can you (quickly,cheaply) provide tentative proof they contain fat?

56. Microscopic