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Urinalysis
Purpose: - aid in diagnosis - screen for asymptomatic, congenital or hereditary disease - monitor disease progression - monitor therapy effectiveness/complications
ideal specimen: - midstream clean catch specimen - first morning specimen
Physical Examination:
Color: yellow - normal urine urochrome, urobilin, uroerythrin
Physical Examination:
Color: yellow brown/amber - bilirubin
Black
Green/blue
- melanin
- Chlorophyll Pseudomonas
Physical Examination:
Clarity: - transparency of specimen - terms: Clear hazy Cloudy Turbid Odor:
Physical Examination:
Urine Volume: - done during timed collection - average daily volume: 600-2000 mL - average night volume: <400 mL Polyuria - > 4 liters/day - Compulsive water intake - diabetes mellitus - diabetes insipidus - renal disease - drugs
Nocturia - > 500 ml sp. Grav. <1.018 Oliguria - <400 mL/day; sp. grav. 1.030 - dec. renal blood flow dehydration shock, hypotension - Renal disease Urinary tract obstruction end stage renal disease
Anuria - no urine excreted - acute Renal failure ischemia nephrotoxicity - Urinary tract obstruction - Hemolytic transfusion reaction
- ratio of density of urine to the density of an equal volume of water - normal: 1.005-1.035 - Urea, NaCl, sulfate, phosphate - included in chemical examination with reagent strip method
Urinometer - direct determination of Specific gravity - glass float - disadvantages: large volume of urine required daily calibration temperature correction done for difference of 3C from calibrated temp
rapid screening of large number of specimen easy to use complex, multiple chemical reactions examines: pH bilirubin proteins urobilinogen glucose nitrite ketone leukocyte esterase blood sp. gravity ascorbic acid
- double indicator system methyl red bromthymol blue - reflection of the renal ability to maintain normal hydrogen ion concentration
- normal pH - 4.6 - 8
Chemical Examination: Protein: - protein errors of pH indicators - normal: 150 mg CHON/day - Proteinuria pre-renal - overflow proteinuria hemoglobin myoglobin acute phase reactants Renal - Glomerular Tubular Post-renal - inflammation, malignancy injury
Chemical Examination: Protein: Bence Jones protein - multiple myeloma macroglobulinemia - coagulated proteins at 40-60C and redissolve at 100C Heavy Proteinuria - (>3 to 4 grams/day) nephrotic syndrome congestive heart failure connective tissue disease
Moderate Proteinuria - (1-3 or 4 g/day) renal disease multiple myeloma toxic nephropathies Minimal Proteinuria - (<1.0 g/day) chronic pyelonephritis congenital diseases
Chemical Examination:
Microscopic Examination:
Formed elements in Urine: Blood cells Red blood Cells White blood Cells Epithelial Cells Squamous Epithelial cells Transitional Epithelial cells Renal tubular epithelial cells
Microscopic Examination:
Casts
Matrix
Inclusion
Pigments Cells
Hyaline Waxy granular fat globules hemosiderin granules crystal melanin granules hemoglobin, myoglobin, bilirubin Erythrocytes Leukocytes Renal tubular epithelial cells Mixed cells
Microscopic Examination:
Crystals found in Normal acidic Urine Amorphous Urates
Uric Acid
Calcium oxalates
Microscopic Examination:
Crystals found in Normal alkaline Urine Amorphous phosphates
Crystalline phosphates
Calcium carbonates Ammonium biurate
Microscopic Examination:
Crystals found in abnormal Urine Cystine tyrosine Leucine
Sulfonamides/Sulfadiazine Ampicillin
Cholesterol
Microscopic Examination:
Other formed elements: Mucus Threads
Bacteria
Yeast Trichomonas vaginalis