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less likely to contain sugar or protein if these observations are significant
Most ideal is a 1 st morning specimen. It is the most uniform in excretion and best reflects
the kidney's function, i.e., its ability to concentrate and reveal pus or bacterial infections;
however, it is less likely to contain sugar or protein if these observations are significant
If bacterial evaluation is needed, the specimen should be evaluated within
one hour
If the specimen cannot be analyzed in a reasonable period it should be
put in a fridge
Normally fresh voided urine has a characteristic odor imparted by
volatile acids
foul smelling ammonialike
odor
bacteria make this
Normally glucose will not be detected in the urine until the blood level exceeds the renal
threshold of
ormally glucose will not be detected in the urine until the blood level exceeds the renal
threshold of 160-180
mg/dl.
based on an enzymatic reaction that
oxidizes potassium iodide to produce a color from green to brown in proportion to the glucose
present
The glucose measurement
increased conjugated (unbound to
protein) bilirubin in the blood is easily filtered from the plasma by the glomerulus of the
kidneys, allowing bilirubin detection in the urine AS A RESULT OF WHAT
As a result of liver cell damage or obstructive jaundice
a measurement of the urine concentrating ability of
the kidneys.
specific gravity
It is one of the first functions lost as a result of tubular damage.
The measurement of specific gravity is a measurement of the urine concentrating ability of
the kidneys. It is one of the first functions lost as a result of tubular damage
The reagent strips measure it by a shift in the pKa as ionic concentration increases and is reflected by color changes of indicators present to produce a color range from blue to green/yellow.
specific gravity tests
Falsely reduced values may occur with urine of high pH and increased values may be obtained in the presence of increased protein.
specific gravity
Random urine has a specific gravity of .
1.005 to 1.030.
reagent strips testing blood (hemoglobin) in the urine work by
The reagent strips detect hemoglobin by the peroxidase like
activity of hemoglobin on a benzidine complex that results in a green to blue
color reaction.
blood reagent testing is sensitive to what entities?
The test is sensitive to RBCs or hemoglobin or myoglobin, and may be
positive in the absence of seeing RBCs in the urine sediment. Microbial peroxidase produced
by certain bacteria in urinary infections could cause false positive results
The pH measurement is based on a double indicator principle giving a color change of
orange at a pH of
4
The pH measurement is based on a double indicator principle giving a color change of
orange at a pH of 4.0 to green at pH of?
7
The pH measurement is based on a double indicator principle giving a color change of
orange at a pH of 4.0 to green at pH 7.0 to blue at a pH
8.5
Normally there is 0.21 - 1
E.U. present in the urine.
urobilinogen
The nitrite test is used for the detection of many common
gram neg bacterias
The nitrite test is based on a diazo reaction which produces a pink color in proportion to the intensity of the nitrites present. The test is based on three assumptions
(1) Nitrate reducing bacteria are present; (2) Nitrate substances are present for reduction and (3) The bacteria has been in contact with the substances for 2-4hours.
This test is used to detect the presence of abnormal levels of granulocytic leukocytes in the
urine. The reaction is based on the fact that granulocytic leukocytes produce
esterases that catalyze a pyrrole amino acid ester to produce a phenyl pyrrole which is purple
Refractometer or TS Meter:
The total solids meter is used to quantitate
urine specimens with specific gravity readings that
exceed 1.030 or to verify the specific gravity reading on results of specimens that have a pH
of 8.0 or greater.
The Ictotest is
the only backup test that is specifically required as a confirmatory test for a positive dipstick reaction. The reaction principle is similar to that of the dipstick; however, refinement of the Ictotest has rendered it more sensitive and specific for bilirubin. The detection of conjugated bilirubin in the urine is very significant for the detection of early obstructive jaundice and is therefore looked upon as a significant confirmatory test
The reagent strips are specific for glucose only and do not measure quantities >1000 mg/dl.
The Clinitest reaction measures???
all reducing substances present in the urine (reducing sugars such as glucose, fructose, lactose, and galactose) creatinine, uric acid, amino acids, etc.) and can be quantitated to 5000 mg/dl. It is therefore used to further quantitate positive dipstick reactions or to detect other reducing substances that may be present. This is particularly significant in infants and small children who have increased amino acids which are derived
from congenital metabolic abnormalities which may lead to mental retardation
The dipstick reactions are mainly sensitive to albumin and frequently there is a need to screen for other proteins, i.e., Bence Jones protein, glycoproteins, myoglobin, and other globulins for which this procedure and other acid precipitation tests are known to be sensitive. And that is why we have......
Exton (Sulfosalicylic Acid) Test:
The albuminboundbilirubin
(indirect or unconjugated bilirubin) cannot
be excrete by the kidneys because it is water insoluble, In the
liver it is separated from albumin and conjugated with glucuronic acid to form watersolubleconjugated
bilirubin or direct bilirubin.
It is produced in the intestine from the reduction of conjugates bilirubin by the intestinal bacteria.
urobilinogen
will appear in the urine when the normal metabolic cycle is disrupted by obstruction of the bile duct or when the liver is damaged, allowing
conjugated
Hepatitis and cirrhosis are common examples of conditions that produce liver damage, resulting in
bilirubinemia
Note that jaundice due to increased destruction of RBC’s does not produce bilirubinuria because the serum bilirubin is
present in the unconjugated form and cannot be excreted by the kidney
Consequently bilirubin is found in the urine but urobilinogen is not found when does this occur
Obstruction of the bile duct prevents passage of bilirubin into the intestine and its reduction to
urobilinogen. Consequently bilirubin is found in the urine but urobilinogen is not found
Increased urine urobilinogen is seen in liver disease and
hemolytic disorders
The lack of urobininogen in the urine and feces is also diagnostically significant and represents
an
an obstruction of the bile duct that prevents the normal passage of bilirubin into the intestine.
they swell and lyse and are called "ghost or shadow" cells
RBCs in hypotonic urine sediment
In hypertonic urine they crenate and disappear
RBCs
Leukocytes also swell and are destroyed by hypotonic or
Leukocytes also swell and are destroyed by hypotonic or alkaline urine and are observed as "glitter cells".
Leukocytes occur as a result of an inflammatory process in or adjacent to the urinary tract. They can also be found in noninfectious conditions, i.e.,......
i.e., glomerulonephritis, dehydration, stress, fever and other conditions
Pyuria (pus in the urine) can also be
derived from infectious conditions outside of the urinary tract, i.e.,
appendicitis and pancreatitis
They contain a small central nucleus and abundant cytoplasm. This is what type of epithelial cell seen in the urine
squamous
are usually 2-4 times larger than a WBC. They may be round or pear shaped and have taillike projections. What type of epithelial cell is this seen in the urine?
Transitional epithelial cells
are slightly larger
than a WBC or ¼1/
2 as large as a transitional cell and can be round, cuboidal or columnar and have a large eccentrically placed nucleus....what type of cell
renal tubular cells
Increased numbers of renal epithelial cells suggests tubular damage. This
is of particular significance
in transplant patients where kidney rejection should be suspected.
Casts are formed in....
Casts are formed in the lumen of the tubules of the kidney and are called casts because they are molded in the tubules
believed to form the matrix of all casts
The tubules secrete a material known as TammHorsfall mucoprotein and is believed to form the matrix of all casts
suggests renal hematuria and always denote a pathologic condition.....
RBC casts
Red cell casts suggests renal hematuria and always denote a
pathologic condition. The casts may contain few or many RBCs. If the cast has degenerated and takes on a reddishbrown color it is then known as a . . . .
hemoglobin or blood cast.
White Cell Casts: The majority of white cell casts are
PMNs
White Cell Casts: can be seen in?
They can be seen in acute pyelonephritis, interstitial nephritis and lupus nephritis
Granular casts may be the result of the degeneration of cellular casts
or represent the aggregation of....
serum proteins into the matrix of the TammHorsfall mucoprotein. Initially they are large and coarse, but when the stasis is prolonged they break down into fine granules
Renal tubular cell casts form as a result of ....
stasis and the desquamation of the renal tubular epithelial cell
Renal tubular cell casts form as a result of stasis and the desquamation of the renal tubular epithelial cells. There prescence suggests what
ATN
results from the degeneration of granular casts. They are indicative of chronic renal failure and stasis in the tubules
It is believed that waxy casts results from the degeneration of granular
casts. They are indicative of chronic renal failure and stasis in the tubules
Waxy casts are indicative of what and appear as...
They are indicative of chronic renal failure and stasis in the tubules. They appear as yellow, gray or colorless and have blunt or broken ends and often cracked or serrated edges.
They are indicative of chronic renal failure and stasis in the tubules. They appear as yellow, gray or colorless and have blunt or broken ends and often cracked or serrated edges.
waxy casts
They can be waxy, granular or cellular. They appear in the collecting tubules as a result of markedly decreased urinary output due to severe renal disease.
broad casts
Bacteria may be reported as few, moderate and many, or preferably by...
numerical estimate
are smooth, colorless, usually ovoid cells with doubly retractile walls.
yeast
They are often confused with red cells but unlike RBCs are not destroyed in acid or alkaline urine.
yeast
are long, thin, wavy threads of ribbon-like structures. They can be present in normal urine in small numbers, but may be very abundant in the presence of inflammation or irritation of the urinary tract.
mucous threads
globular in shape and highly retractile, frequently giving them a yellowbrown to black appearance.
fat bodies
In lipuria, the fat droplets may be seen doing what
floating on the surface of the urine
If fat droplets are composed of cholesterol, they form
maltese crosses under polarized light
they do not polarize but stain with Oil Red O or Sudan III
fat bodies made of triglycerides
most frequently occurring parasite in
urine and may be found in both males and females originating usually from either the
urinary tract or vagina.
Trichamonas
The organism can easily be mistaken for a WBC if it is immobile
Trichomonas
blood fluke that inhabits the pelvic veins and deposits its eggs into the mucosal wall of the urinary bladder, ureters or urethra.
Schistosoma haematobium
Abscesses develop around the eggs and they are eventually
deposited in the urine along with RBCs and WBC’s. This type of schistosomiasis is endemic in south Mediterranean, African and Middle Eastern countries, especially
along the Nile River valley. The chronic inflammation that results form the bladder wall infection may result in the development . . .
SSC due to infection of Schistosoma haematobium
as the adult female worm moves from the anus to the vaginal area to deposit its ova.
Enterobius vermicularis
They occur after the urine stands for a while
and the urine is supersaturated with the particular crystalline compound or the solubility properties of the compound are altered.
crystals
Acid Urine Crystals (Usually
non pathologic
NAme the acid urine crystals
uric acid, calcium oxalate, amorphous urates, hippuric acid crystals
Occur in many different shapes, but the most common is the diamond,
rhombic or rosette shapes.
Uric acid Crystals
They may stain with urinary pigment and have a yellowbrown color. Under polarized light they take on a variety of colors.
Uric acid crystals
appear as small squares with an
enveloped shaped cross on the surface or more rarely as biconcave disks or dumbbell shapes
Ca oxalate
Ca oxalate look like
Calcium oxalate crystals appear as small squares with an envelope shaped cross on the surface or more rarely as biconcave disks or
dumbbell shapes. They appear normally, especially after ingesting oxalate rich food; however, when found in fresh urine they may suggest the presence of oxalate calculi or other pathologic situations.
They have a yellow red granular appearance and
frequently mask other important sediment that may be present. They have no clinical significance.
Amorphous Urates: Urate salts of sodium, potassium, magnesium and calcium are in a noncrystalline form
These crystals are yellowbrown
in color and resemble elongated prisms or plates. They are rarely seen and usually have no clinical significance; however they have been known to occur in patients suffering from hepatic or acute febrile conditions.
Hippuric Acid Crystals:
Alkaline Urine Crystals: ????
Triple Phosphate (ammonium magnesium phosphate):, Calcium Carbonate:Calcium Phosphate Amorphous Phosphates:Ammonium Biurate (ammonium urate)
These crystals are
colorless with 36
sides and sometimes have oblique ends. They may also
precipitate as a feathery, fernlike
crystal. They are usually found in normal urine,
but could also form urinary calculi. They also may indicate inflammatory conditions which results in the urine being retained in the bladder for prolonged periods.
Triple Phosphate (ammonium magnesium phosphate):
are small, colorless crystals
appearing in dumbbell or spherical forms or in large granular masses giving them an apparent dark color. They have no clinical significance.
calcium carbonate
long, thin, colorless prisms
with one pointed end arranged as rosettes or stars. They may also appear as needles or as an irregular granular plate. They may occur in normal urine but may also form calculi.
calcium phosphate
found in
alkaline urine but also sometimes in neutral or even acid urine. They are
yellowbrown spherical bodies with or without long irregular spicules. Their
appearance is often described as thorn apples
Ammonium Biurate (ammonium urate):
They are noncrystalline salts of phosphates which have a granular shape only distinguished from urates by the pH of the urine. They have no clinical significance but can mask the presence of other important elements
Amorphous Phosphates:
pathologic crystals....
cysteine, tyrosine, leucine, cholesterol, bilirubin, hemosiderin
These crystals are very fine, highly retractile needles occurring in
sheaves or clusters.
Tyrosine
colorless, refractile, hexagonal plates with equal or unequal side. They may appear singly or in clusters. Their presence is always
important and indicative of a congenital metabolic disorder. They can also be involved in the formation of urinary calculi.
cystine
clinically very significant as they are found in patients with
a variety of tissue degeneration diseases including hepatitis and leukemia. When there are sever liver problems, these amino acids are not metabolized.
leucine
found in acid or neutral urine. They appear as regular or irregular transparent plates either singly or in clusters. Their classic character is one or more corners are notched
cholesterol
Hemosiderin granules can be distinguished from
amorphous granules with an
prussian blue iron stain
ammonium biurate
amorphous urates
cysteine crystal
cystein crystals
finely granular casts
leucine crystals
oval fat bodies
oxalate crystals
rbc cast
sulfa crystals
triple Phosphate crystals
triple Phosphate
uric acid crystals
waxy cast
wbc casts