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199 Cards in this Set

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Part of the urinary system
1.Paired organ system

2.Each divided into an outer cortext and inner medulla

3.One million nephrons
Nephron definition and what is included in a nephron
The basic microscopic structural and functional unit

1. Glomerulus
2. Proximal convuluted tubule
3. Descending and ascending loops of Henle
4. Distal convuluted tubule
5. Collecting ducts
Glomerulus (general)
Is a capillary network responsible for the filtration of blood

Is surrounded by Bowman's capsule

Is afferent (blood enters) and efferent (blodd away)
Proximal Convuluted tubule (general)
Is the primary site of reabsorption of essential constituents.

Is the closests to Bowman's capsule

Filtrate back into the blood
Descending and ascending loops of henle
Water and electrolyte exchange here
Distal Convuluted tubule
Where concentration of urine begins
Collecting ducts
Where final concentration and secretion takes place
Recieves the blood during renal blood flow
Renal artery
The pic is red, not blue
In renal blood flow, blood can enter the glomerulus because of this
Afferent arteriole
In renal blood flow, unfiltered blood is able to leave the glomerulus due to this
Efferent Arteriole
What divides into a capillary network surrounding the tubles and (maybe....) returns blood to the renal vein
Efferent Arteriole
The average amount of blood flowing through the kidneys
1200ml/min or 120mL filtered a day
The average amount of blood flow is directly related to this
Renal blood pressure +/blood
The average amount of blood flow is controlled by this
Renin-angiotension-aldersterone (RAA) system
Results from Renin-angiotension-aldersterone
Sodium reabsorption-->Blood is now more concentrated
What is renin
A hormone that triggers angiotension, which triggers aldersterone
What angiotension does
Squeezes vessels to add more pressure
What aldersterone does
Causes kidneys to suck in more sodoium
When you have more sodium, more water follows and what results?
An increase in blood pressure and volume occur after these to substances mix
Allows passage of compounds with a molecular weight of greater than 70,000
Glomerular filtration
Glomerular filtration will not let these pass though
Blood cells and protein. It creates a protein-free ultrafiltrate
Glomerular Filtration Rate (GFR)
120 ml/min (170-190 L of fluid per day)
Tubular Reabsorption
The return of certain constituents from the filtrate back into the blood
What is the primary site in Tubular Reabsorption?
Proximal Convuluted tubule is the primary site in this
In Tubular Reabsorption, what is the principle of reabsorption according to need?
Some substances (glucose, amino acids) are completely reabsorped while others (H2O, Na, Cl) are reabsorbed according to the body's need at the time (electrolytes)
Reabsorption by BLANK requires cellular energy
Active transport
Reabsorption by BLANK occurs by diffusion
Passive transport
Renal threshold and normal range
The plasma concentration of a substance at which reabsorption stops and the subst6ance begins to appear in urine

Normal range: 75-100mg
Glucose renal threshold range
Tubular Secretion (definition)
The passage of substances from the blood into the tubular filtrate
Tubular Secretion (function)
Removes large unfilterable waste and excretes H ions for maintenance of blood acid-base balance
Concentration (definition)
Final reabsorption of water
Concentration (location)
Begins in the distal convoluted tubule and continues in collecting ducts
Amount of water reabsorbed during the concentration process depends on this
The body's state of hydration
Concentration of urine is under the control of This
Antidiuretic Hormone (ADH) (reatains urine)
Funtions of the kidneys
1. Removes waste products

2. Retention (retains?) of nutrients and essential compounds

3. Acid-base balance

4. Water balance

5. Hormone synthesis (renin, erythropoitin, Vitamin D)
Composition of urine depends on these things:
Dietary intake, physical activity, body metabolism, age, and hormones
The endproduct of protein metabolism and is the #1 waste product. Able to pass though the glomerulus b/c it was smaller than protein
Uric acid
End product of purine metabolism
The endproduct of muscle metabolism
Major inorganic substances found in urine:
Chloride, sodium, and pottassium
Formed elements which may be seen in the urine:
RBCs, WBCs, epithilial cells, casts, crystals, bacteria
Normal range of urine a day
600-2000ml/day; 1500ml/day average
Decreased urine output
Lack (cessastion, stopped) of urine output
Increased output
Painful flow
Increased output of urine at night
Purposes of performing urinalysis
1. To aid in the diagnosis of disease

2. To screen population for asymptomatice, congenital, or hereditary diseases (to monitor wellness)

3. To monitor the progress of disease

4. To monitor the effectiveness or complications of thereapy
Physical properties of urinalysis
Color, clarity, and specific gravity
Chemical tests of urinalysis
1. Screen using reagent strips

2. Confirm positive reaction with other chemical tests

3. Indicate the likelihood or certain finding in the microscopic
Microscopic examination of urinalysis
Aids in the confirmation of kidney and urinary tract diseases
Normal urine color is due to this
Colorless/pale urine
Color of urine due to dilute urine, or diabetes mellitus
Dark yellow or amber urine
Color of urine due to:
a. Concentrated urine (1st morning urine is more concentrated)
b. Dehydration
Amber urine
Color of urine is due to:
a. Bilirubin (liver disease)
b. Look for yellow foam
Orage urine
Color of urine is due to: pyridium, a drug
Brown urine
Color of urine is due to:
a. Bilirubin or biliverdin (breakdown product or hemoglobin)
Red, cloudy urine
Color of urine is due to: Intact RBCs (hematuria)
Red, clear urine
Color of urine is due to:
a. Hemoglobin (from lysed RBCs/hemoglobmuria)
b. Myoglobin (from muscle trauma)
Red-purple (port wine) urine
Color of urine is due to: Porphyrins (intermediate products in producting of heme. Rare
Black urine
Color of urine is due to: Melanin or homogentisic acid. Rare
Intacts red blood cells
Breakdown products of hemoglobin
Lysed red blood cells
Muscle trauma (crash, heart attack)
Intermediate products in production of heme
Visual examinations of urine are viewed through this
A clear container
The color of fresh urine with the exception of

1st morning specimen
Clear urine description
Transparent/ no visible particulates
Hazy urine description
Few particulates
Cloudy urine description
Print is blurred through urine
Turbid urine description
Print not seen through urine
Milky urine description
May precipitate or clot
Nonpathological hazy, cloudy, or turbid urine
1. Mucus
2. Talcs, creams
3. Fecal contamination
4. Sperm
5. Crystals
6. Squamous epithelial cells
7. Dyes
Pathological hazy, cloudy, or turbid urine
1. Red cells
2. White cells
3. Bacteria, yeast, trichomonas
4. Renal epithelial cells
5. Crystals
6. Lipids
Specific gravity
The density of a solution compared witht he density of an equal volume of pure water. It is influenced by size and number of particles
Specific gravity (function)
It measures dissolved substances present in a solution and reflects the hydration of the patient
Specific gravity of pure water
Specific gravity of urine
Specific gravity increase during?
Darker the urine the higher the SG
Specific gravity decreases during?
The paler the pee, the lower the SG
What happens if the Specific gravity ever becomes fixed at 1.010 and why?
Diseased kidneys. They lose their ability to concentrate +/or dilute urine and the SG becomes fixed.
A refractometer determines this
Refractive index
Refractive index definition
A comparison of the VELOCITY of light in the AIR with the velocity of light in a SOLUTION
What does refractive index depend on?
Dependent on teh concentration of dissolved particles present in the sample and determines the angle at which ligh passes through a solution
What performs corrections in the refractive index?
If the Specific gravity is greater than 1.035, dilute the urine 1:2 and re-run. Now what?
Multiply only the decimal protion (.035) by 2 (the dilution factor)
EXAMPLE: .035 x 2 = .07
.07 + 1.000 = 1.007
Harmonic Oscillation Densitometry
The frequency of a sound wave entering a solution will change in proportion to the density of the solution. Changes in sound waves are converted to Specific gravity by a MICROPROSESSOR
Creates a thirsty sensation
Reasons for a low Specific gravity (dilute or hypotonic) according to a refractometer
Diabetes insipidus, and high water intake
inSIPidus like you SIP a lot of water
Reasons for a high Specific gravity (concentrated or hyPERtonic and dissolved more substances than normal)according to a refractometer
1. Proteinuria
2. Diabetes mellitus w/ glycosuria
3. Dehydration (fever, vomiting)
5. High molecular weigh IZV solutions
Specific gravity fixed at 1.010 on multiple samples according to a refractometer concludes?
Chronic renal disorder. Lost the ability to reabsorb.
Major organic substances found in urine
Urea, Uric acid, and Creatinine
Techniques for the dipstick
1. Do not touch pads with hands

2. Dip completely into WEL MIXED urine.

3. Remove excess urine by running edge of strip along the top of the container

4. Hold strip horizontally to avoid run-over from adjacent pads.

5. Compare color development to manufacturer's chart AT THE PROPER TIME

6. The intensity of the color formed is generally proportional to the amount of chemical present
Automation eliminates variation by:
1. Improving reproducibility
2. Improving color discrimination
Utilizes reflectance photometry

As intensity of color increases, reflection decreases
The biggest variable among lab personnel when performing D.S. analysis is in the interpretations of the color reactions
Dipstick consideration
Correlate dipstick findings to each other, and to the physical and microscopic results
The major regulators of the acid-base content in the body
Lungs and kidneys
breathe and pee
What reabsorbs or secretes acids (H+)and bases (bicarbonate ions)
Normal range of pH in urine
What determines the acidity of the pH in urine?
1. Starvation
2. Diabetet mellitus
3. Respiratory disease
4. High protein diets
5. Meds
What determines the basisity (alkaline) of the pH of urine?
1. Vomiting
2. UTI (bacteria convert urea to ammonia)
3. Vegetarians and dairy
4. Improperly stored urine (pH >9.0 and bacteria is present)
Double indicator system
Principle of the pH reaction
Methyl red measures acid, brothymol blue measure alkaline
pH interfering factors:
None, Unless urine has been improperly stored.
Protein positive indicates what?
A protein POSITIVE urine is the most indicative of RENAL DISEASE
Normal rate for protein
Less than 10 mg/dl or less than 100 mg/24hours
The major protein detected in urine
Makes up half the protein in our bodies
3 major reasons for clinically significant proteinuria:
1. Pre-renal proteinuria (not yet in kidney)

2. Renal Proteinuria (in the kidney)

3. Post-renal proteinuria (kidney and urethra not the problem)
Pre-renal proteinuria includes:
Acute phase reactants and
Bence Jones Proteins which may not be detected by routine urinalysis
Bence Jones Proteins is associate with this
Multiple Myeloma
Renal Proteinuria includes:
Glomerular disorders or damage by toxins and

Diabetic nephropathy (renal disease)
Albumnin levels are too low to detect on a dipstick. (small amounts passed through)

Characteristic of early problems associates with diabetes.

Requires a more sensitive method than a dipstick for detection
Renal Proteinuria includes:
*Glomerular disorders or damage by toxins
*Diabetic nephropathy (renal disease)
*Tubular Disorders due to trauma, or chemicals
*Transient- small amounts of urine protein in normal persons associated with fever, or exercise
Albumnin levels are too low to detect on a dipstick. (small amounts passed through)

Characteristic of early problems associates with diabetes.

Requires a more sensitive method than a dipstick for detection
Orthostatic proteinuria
Occurs in renal proteinuria. Protein appears when a person is in an upright position, but disappears after lying down due to pressure on the renal artery. Benign. Usually disappears with age
Post-renal proteinuria includes:
Lower UTIs
Mentrual contamination
Error of indicators
The presense of BLANK will alter the COLOR of acid-base indicators in the test pad regardless of the pH of the urine
Protein alters the color
The dipstick is more sensitive to BLANK than other proteins
Albumin on the dipstick
False positive for proteins
1. Highly alkaline urine-check pH

2. Bacteria and cells contain protein and make it seem positive
False negative for proteins
The presense of proteins other than albumin (Bence Jones Proteins)
Confirmatory testing for protein
If D.S reads more than a trace, use Sulfosalicylic acid ppt (SSA)
Confirmatory tesing for protein.

*It reacts with ALL proteins
*Urine must be centrifuged to remove turbidity
*Mix equal parts urine and SSA
*Grade precipitation as compared to standards
False positives of SSA
*Radiographic dyes
*Drugs. Do a microscopic exam and look for DYE o drug crystals
If dipstick is NEGATIVE and SSA is POSITIVE....
Suspect something OTHER than albumin.

Perhaps dye crystals or Bence Jones Proteins
The frequent chemical analysis performed on urine
Almost all filtered glucose is reabsorbed in where?

Urine contains how much glucose?
Proximal convoluted tubule. Because of this filteration, urine contains zero to minute amounts of glucose
Renal threshold of glucose
When the blood level glucose becomes so elevated (hyperglycemia)that tubular reabsorption capability has been exceeded, glucose will appear in urine
Renal threshold for Glucose occurs during these disorders:
*Diabetes mellitus (RT is 160-180 mg/dl
*Impaired tubular reabsorption
*Following ingestion of large amounts of sugar
*Gestational diabetes
*Hormone disorders that work in opposition to insulin
Glucose oxidase double sequential enzyme reaction is specific for what?
False negatives for glucose
Ascorbic acid (vitamin C)
Unpreserved specimens allowing glycolysis
Dipsticks are specific for what?
Glucose and will not detect other sugars
Confirmatory testing for glucose is appropriate if what?
If D.S. is positive for glucose OR if another sugar is suspected in the urine
Copper reduction test
*Clinitest or Benedict's Reaction (All sugars)

*Based on ability of sugars to reduce copper sulfate to curpous oxide

*Positive for ALL sugars but NOT as senstivei as the dipstick
An enzyme defect. Causes retardation, failure to thrive, and death in newborns. Screen kids less that 2 years old
By products of fat metabolism such as: Acetone, Acetoacetic acid, and Beta-hydroxybutyric acid
Ketones are detected in urine only when?
When large amounts of body fat is metablolized for energy
Ketones in urine are caused by:
1. Low carb diets
2. Diabetes mellitus-ketones indicates a difencieny in insulin. Increased levels lead to acidosis.
3. Starvation or dieting
4. Vomiting
5. Strenuous exercise
The reaction produced by ketones
Sodium nitroprusside reaction
False positve for KETONES
Pigmented urine (drugs, meds, dyes)
False negative for KETONE
Evaportation due to improperly stored urine
Confirmatory testing for Ketones
Acetest. A tablet test
Always clinically significant
Causes for a positive dipstick for blood
1. Hematuria
2. Hemoglobinuria
3. Myoglobinuria
The presense of intact RBCs
*Urine is red and hazy/cloudy
*Trauma or injury
*Kidney stones
*Glomerulonephritis (infection in kidney)
Hemoglobinuria and what conditiond can you find it?
The presense of hemoglobin causing a CLEAR, red urine
*Intravascular hemolysis in transfusion reaction, hemolytic anemias and severe burns
The presense of the muscle protein myoglobin
*Causes clear RED BROWN urine. NO red cells will be seen
*Strentuous exercise
*Muscle wasting disease
*Confirmed with special testing
Principle of blood
Peroxidase enzyme will oxidize peroxide in the pad to cause a color change
*Free hemoglobin or myoglobin causes a uniform color reaction

*INTACT red cells cause a SPECKLED pattern on the pad
False positive for BLOOD
Menstrual contamination (nonpathological)

Bacterial enzymes found in UTIs
False negative in BLOOD
High specific gravity when crenated cells are present
Degradation product of hemoglobin. Normally metabolized in the LIVER
What is the final endproduct or bilirubin
Urobilinogen which is excreted in feces and urine
Is biliribin normally found in urine?
What may indicate early liver disease, before the development of jaudince?
Conjugated (direct) bilirubin in the urine
Physical characteristics of bilirubin in the urine

And what causes these results?
A vivid yellow pigment. A large amount of yellow foam is produced when shaken

*Cirrhosis and other liver disorders
*Bililary obstruction

*Pale stool = positive for bilirubin
Reaction used for bilirubin
Diazo reaction
Bilirubin reacts with diazonium salt to produce a color
False positive for BILIRUBIN
Pigments from drugs or dyes
False negative for BILIRUBIN
Exposure to light beacause bilirubin breakdowns in light
Confirmatory test for Bilirubin
Ictotest. More sensitive than the dipstck and less affected by interfering substances. Produces a shaper color reaction
A normal by-product or RBC degradation. Formed by the REDUCTION of bilirubin by backterial enzymes in the intestines

*Excreted in both the feces and urine
Normal rate of UROBILINOGEN
Less than 1mg/dL or EHRLICH UNIT
Urobilinogen is present in these disorders:
*Liver diseases
*Hemolytic disorder, hemolytic anemias and intravascular hemolysis
*Biliary obstruction will cause a DECREASED level
Reagent uesd for Urobilinogen
Ehrlich-->cherry red color
False positive for UROBILINOGEN
Presence of other Ehrlich reacting compounds

False negative for UROBILINOGEN
Improper storage=>light sensitive and exposure
A positive Nitrite indicates
Bacteria and may help detect cystitis in asymptomatic patients

Does NOT replace urine culture for testing UTIs
How nitrite test works:
Bacteria in urine (not all) that produces the enzyme reductase can convert nitrate to nitrite
Cystitis diagnosed by nitrite test indicates
bladder infection
CysTiTis has two Ts. TT is held where?
Pyelonephritis diagnosed by nitrite test
Kidney infection
What Nitrite testing does
Monitor patiens at high risk for UTIs and evaluates anitibiotic therapy
What test involves a diazo reaction for nitrite?
Griess test
WHat does nitrite react with to produce a color reactio?
Aromatice amine
False positive for NITRITE
Unpreserved urine may allow bacterial growth
False negative for NITRITE
*Not all bacteria produce UTIs
*Lack of dietary nitrates in veggies
*Urine not held in bladder long enough
Leukocyte esterase
Indicates the esterase released from WBCs in the urine. Indicates INFECTION OF INFLAMMATION in the urinary tract

*Dipstick is (+) during intact or lysed WBCs
Leukocyte esterase tests for:
*UTI-bacteria plus WBC
*Infection with trichomonas, Chlamydia, or yeast
*Inflammation-WBC WITHOUT bacterial infection
How does Leukocyte esterase create a purple color?
Esterase enzymes shown in granulocytic WBCs hydrolze an acid ester in the pad
False positive for Leukocyte esterase
False negative for Leukocyte esterase
High levels of glucose, protein, and high SG
For a UTI, look for:
High pH, +/-nitrite, Infection with trichomonas
Specific gravity
Density in the urine based on size and # of dissolved particles present
How Specific gravity works:
A polyelectrolyte in the pad interacts with IONS in the urine sample
Specific gravity WILL detect
Ionizable substances
Specific gravity WILL NOT detect
Glucose and radiographic dyes
Refractometer WILL detect
Glusse and radiographic dyes
False positive for Specific gravity
High levels of protein
False negative for Specific gravity
Urine pH of 6.5 or lower
Normal foam looks like
Small amount or white foam when shaken
Protein foam looks like
Abundant white foam
Bilirubin foam looks like
Vivid yellow foam
Normal urine odor
Faintly aromatic
Bacterical infection urine odor
Staong unpleasant odor/foul
Diabetes urine odor
Sweet ot fruity due to the presence of ketones
Matabolic defect urine ordor
Maple syrup