1. Urine Chemistry

2. Urine 96% 4% OrganicInorganic Water NORMAL CONSTITUENTS OF URINE 2A 2U 2C 2P

3. Organic nitrogenous part: It is also called non protein nitrogenous constituent = (NPN): non protein nitrogenous constituent = (NPN): 8

4. 1.Urea: 20 - 40 g/d. 20 - 40 g/d. Constitutes 85% of total urinary nitrogen excretion.Constitutes 85% of total urinary nitrogen excretion. It is the principal end product of protein metabolism in mammals.

5. Urea excretion is directly proportional to protein intake. Protein – rich Diet Urea excretion More Urea excretion

6. Urea excretion is increased whenever protein catabolism is increased as in  fever,  diabetes mellitus or  excess adrenocortical activity.

7. Urea is synthesized in the liver, so decreased urea excretion is met with in advanced liver diseases. Retention occurs in nephritis which results in smaller output and increase in urea concentration in the blood.

8. 2. Ammonia:  0.8-1.2 g/day in urine.  Its formation and excretion are important mechanisms that protect the body against acidosis.

9. f Ammonia is derived from glutamine by glutaminase enzyme in the kidney.

10. The formed ammonia drags with it H + to be excreted as ammonium ions (NH4 + ) which is excreted in the urine in the form of NH 4 Cl. The formed ammonia drags with it H + to be excreted as ammonium ions (NH4 + ) which is excreted in the urine in the form of NH 4 Cl.

11. 3. Creatinine It is the metabolic end product of creatine in muscles Urinary creatinine is proportional to the muscle bulk, but regardless to the amount of protein in diet. Urinary Cr. Excretion  1-1.8 g/day.

12. 3. Creatinine

13. Creatinine level in blood and its Excretion in urine is a good index of kidney functions 3. Creatinine ( creatinine clearance ). ( creatinine clearance ).

14. 4. Creatine: 60-150 mg /day. 60-150 mg /day. Urinary creatine represent 7% of total creatinine output.

15.  Creatinuria 1. In pregnancy, 2. infancy - childehood 3. Athletes Physiological Creatinuria in pathological states such as hyperthyroidism, starvation and impaired carbohydrate metabolism hyperthyroidism, starvation and impaired carbohydrate metabolism in diseases involving loss of muscle mass ( myopathies ). in diseases involving loss of muscle mass ( myopathies ).

16. 0.8-1.2 g/day. 0.8-1.2 g/day.  The most important end product of oxidation of purines in the body  Occurs in urine in the form of urates.  It is derived from 1. dietary nucleoproteins 2. breakdown of cellular nucleoproteins. 5. Uric acid:

17.  Soluble in alkaline urine, but it is precipitated in acid urine.  Increase in Urine In Leukaemia Leukaemia Gout Gout severe liver diseases and. severe liver diseases and.

18. 6. Hippuric acid: 6. Hippuric acid:  0.7 g/day.  It is formed by conjunction of benzoic acid with glycine.

19.  Vegetables and fruits contain high content of benzoic acid.  Also, benzoic acid is derived from putrefaction of aromatic amino acids  from benzoate of preserved food.

20. 7. Amino acids: 7. Amino acids:  150-200 mg/day.  Aminoacidurias  ???

21. Amino acidurias  Occur in case of extensive destruction of the liver as in liver poisoning by: chloroform and tetrachlorocarbon  Also, inborn error known as ( cystinuria ) which is a tubular defect in reabsorption of cystine, arginine, lysine and ornithine.

22. 8. Purines: 8. Purines:  Only traces.  Several purines are found in urine some of them are derived from the caffeine and theobormine found in coffee and tea. Methyl Xanthines

23. 9. Indican: 9. Indican:  It is a product of tryptophan putrefaction in gut,  normally present in small amounts  and increases in constipation

24. Organic non-nitrogenous part: 1- Oxalic acid  whose amount is very low.  It is found as calcium oxalate crystals in urinary deposits  It is increased after ingestion of fruits and vegetables of high oxalate content,  is increased in inherited metabolic disease ( primary hyperoxaluria ) large amount of oxalates may be continuously excreted.

25. 2- Organic acids : These include citric acid, lactic acid and glucuronic acid.

26. Urinary Inorganic constituents

27. 1. Chlorides :  9-16g/day.  Next to urea, chlorides are the most abundant substances in urine  Mainly excreted as sodium chloride.  Its output depends upon its intake

28. 2. Sulfates :  2-3 g/day.  These are derived mainly from sulfur containing amino acids of proteins.  Urinary sulfates can be divided into 3 forms: a) Inorganic sulfates (85%): is proportional to the output of the total nitrogen since both originate from protein metabolism. a) Inorganic sulfates (85%): is proportional to the output of the total nitrogen since both originate from protein metabolism.

29. b) Ethereal sulfates (10%):  Are esters of sulfuric acid with certain phenols  (e.g. indoxyl, indican, and other sulfur conjuguates formed in detoxication). c) Neutral sulfates (5%): This represents the unoxidized sulfur.

30. 3. Phosphates :  2-3 g/day.  Relative proportions of NaH 2 PO 4 determines the pH of urine.  It is largely derived from the ingested food, which contains inorganic & organic phosphate (e.g. nucleoproteins, phosphoproteins..etc).

31. Increases Phosphate level in Increases Phosphate level in  hyperparathyroidism  osteomalacia. Decrease sometimes occurs in Decrease sometimes occurs in  renal diseases and  infectious diseases  hypoparathyroidism.

32. 4. Cations: Sodium, Potassium, calcium, and magnesium are the 4 cations of the extracellular fluids present in urine. Sodium, Potassium, calcium, and magnesium are the 4 cations of the extracellular fluids present in urine.

33. ABNORMAL CONSTITUENTS OF URINE  Proteis  Sugars  Ketone Bodies  Bile  Blood  Pophyrins

34. a) Proteins (proteinuria): 1. Physiological (less than 500 mg/day) after severe muscle excercise, after prolonged standing, after a high protein meal and during pregnancy. 2. Pathological :  Prerenal: The primary causes are factors operating before the kidney, e.g. heart failure.  Renal: The lesion is intrinsic in the kidney, e.g. nephritis and nephrosis.  Postrenal: The lesion is in the lower urinary tract, e.g. cystitis.

35. The increased amount of albumin in urine called albuminuria,  Microalbuminuria if  30-300 mg/day  Macroalbuminuria  if more > 300mg /day Albumin in urine is detected by Albumin in urine is detected by  heat coagulation test.  heat coagulation test. There are other types of protein which may There are other types of protein which may appear in urine as Bence-Jones Proteins. appear in urine as Bence-Jones Proteins.

36. Bence-Jones proteins:  These are abnormal globulins that appear mainly in multiple myeloma which is a bone marrow cancer, also in leukemia and lymphosarcoma.  in such conditions, urine undergo 3 phases: 1. clotting when heated to 60°C, 2. undergoes redissolving at 100°C and 3. reclotting by cooling.

37. b) Sugar : Glucose (glucosuria): Normally not more than 1 g/day (many types of glucosuria). Fructose (fructosuria): It is a rare anomaly in which the metabolism of fructose is disturbed. (Deficient Fructokinase) Galaclose (galactosuria): May occasionally occur in infants and mothers, also in congenital galactosemia. The renal threshold for glucose is 180 mg/dl

38. Glucosuria A- Hyperglycemic glucosuria: It occurs when the blood glucose level exceeds the renal threshold (180 mg/ dl). It is caused by:  1- Diabetes mellitus.  2- Epinephrine glucosuria: as emotional or stress glucosuria or in case of pheochromocytoma  3- Alimentary glucosuria: It is due to increased rate of glucose absorption as in cases of gastrectomy or gastrojejunostomy. B- Normoglycemic or renal glucosuria : In these cases, the blood glucose is within normal range.  1- Congenital renal glucosuria (benign glucosuria or diabetes innocens), due to congenital defects in renal tubular mechanism for reabsorption of glucose.  2- Acquired renal diseases as in nephritis.

39. Lactose (lactosuria): During pregnancy and lactation, may appear in mothers and infants. Pentose (pentosuria):  May occur after ingestion of food containing large amounts of pentoses.  Also appears in congenital pentosuria due to inability to metabolise L- Xylulose.

40. c) Ketone bodies (ketonuria):  They are acetone, aceto-acetate, & 3- hydroxybutyrate.  Normally 3-15 mg are excreted in urine per day.  Ketonuria is the presence of excessive amounts of ketone bodies in urine.  This may occur in uncontrolled diabetes mellitus and during prolonged starvation.  Aceto-acetate and 3-hydroxybutyrate are eleminated as salts thus depleting the alkali reserve which results in acidosis.

41. d) Bile:  Bile pigments: They appear in urine, in hepatic, obstructive and haemolytic jaundice.  Bile salts: Bile salts appear only in obstructive jaundice.

42. e) Blood (haematuria): Due to Due to  Bilharziasis,  Blood diseases,  Renal stones  Renal tumours  Haemoglobinuria

43. f) Porphyrin: The occurrance of uroporphyrins as well as increased amount of coproporphyrins in urine is termed porphyria. (Defect in Haem Synthesizing Enzymes)