PATHOPHYSIOLOGY

OF BODY FLUIDS

URINE
Normal Adult 1200 ml/min of blood perfuses
the kidney (25% of CO).
Blood afferent arterioles ultrafiltrate on
Glomeruli Bowmans space tubules
reabsorption or secretion and concentration on
collecting ducts.
Original glomerular filtrate vol. = 180 L in 24hrs
reduced 1-2L, depending on status of hydration.
Urine formed in the kidney passes from collecting
ducts renal pelvis ureters bladder
urethra voided.

 Through glomerular filtration and tubular

secretion, numerous waste products are
eliminates from body, including :
Nitrogenous products
Organic acids and bases
Inorganic acids and bases.
The kidney provide important hormonal
regulation with erythropoietein and renin prod.,
as well as vitamin D activation.
Derangement of renal function chemically or
cytologically alteres urine.

Component of basic (routine) urinalysis

I. Specimen evaluation
II. Gross/physical examination : Appearance,
Clarity (character), Odor, Urine volume, specific
Gravity and Osmolality
III.Chemical Screening pH, protein, glucose,
ketones, blood, bilirubin, urobilinogen
IV. Examination of urine sediment : cells, casts,
crystals, abnormal cells & other formed
elements

Various Urinary System Disease

Acute glomerulonephritis
Chronic glomerulonephritis
Acute pyelonephritis
Chronic pyelonephritis
Nephrotic syndrome
Acute tubular necrosis
Cystitis
Dysuria-Pyuria syndrome
Acute renal allograft rejection
Urinary tract neoplasia
Viral infection

CEREBROSPINAL FLUID (CSF)

In adults, 500ml of CSF produced each day
(0.3-0.4 mL/min).
Total vol. = 90-150mL 25mL in ventricles and the
remainder in subaracnoid space (SAS).
Total CSF vol. replaced every 5-7hrs.
70% of CSF derived by ultrafiltration and secretion
through the choroid plexuses.
Ventricular ependymal lining and cerebral SAS account
for the remainder.

 CSF leaves the ventricular syst. Through medial

and lateral foramina, flowing over the brain and
spinal cord surface within SAS.
Arachnoid villi CSF resorption, along the
superior sagittal sinus.
Blood-brain barrier (BBB) derived from dyeexclusion studies.
Consists of 2 morphologically distinct comp. :
A unique capillary endothelium held together
by intercellular tight junctions
The choroid plexus, a single layer of
specialized choroidal ependyma cells
connected by tight junctions overlies
fenestrated capillaries.

 CSF Major functions :

Provides physical support
Confers a protective effect against
sudden changes in acute venous and
arterial blood pressure
Provides an excretory waste function
Pathway whereby hypothalamus
releasing factors are transported to the
cells of median eminence
Maintains central nervous system ionic
homeostasis.

 CSF ionic components (e.g. H+, K+, Ca2+,

Mg2+ , bicarbonate, etc) tightly
regulated by specific transport systems,
whereas glucose, urea, and creatinine
diffuse freely but require 2 or more hours
to equilibrate.
Proteins cross by passive diffusion at a
rete proportional to their molecular
weight and hydrodinamic vol.
BBB maintains the relative homeostasis
of the central nervous systems
environment during acute perturbations
of plasma comp.

Diseases Detected by Laboratory

Examination of CSF
High sensitivity, high specificity
Bacterial, tuberculous, and fungal meningitis
High sensitivity, moderate specificity
Viral meningitis
Subarachnoid hemorrhage
Multiple sclerosis
Central nervous system syphilis
Infectious polyneuritis
Paraspinal abscess

Moderate sensitivity, high specificity

Meningeal malignancy
Moderate sensitivity, moderate specificity
Intracranial hemorrhage
Viral encephalitis
Subdural hematoma

Recommended CSF Laboratory Tests

Routine
Opening CSF pressure
Total cell count
(WBC and RBC)
Differential cell count
(stained smear)
Glucose
(CSF/plasma ratio)
Total protein

Useful under certain conditions

Cultures
Gram stain, acid-fast stain
Fungal & bacterial antigens
Enzymes
Lactate
PCR
Cytology
Electrophoresis
Proteins
VDRL
Fibrin-derivative D-dimer
Tuberculostearic acid

SYNOVIAL FLUID (SF)

Synovium tissue lining synovial tendon
sheaths, bursae, and disarthrodial joints
except articular surface.
Composed 1-3 cell layers form
discontinuous surface overlying fatty,
fibrous, or periosteal joint tissue.
SF is an imperfect ultrafiltrate of blood
plasma combined with hyaluronic acid
produced by synovial cells.

 Small ions and molecules readily

pass into the joint space and similar
concentration to plasma.
Resorption by lymphatics and is not
size dependent.
SF acts as a lubricant and adhesive,
and provide nutrients for the
avascular articular cartilage.

Recommended Synovial Fluid Tests

Routine tests

Useful tests in certain

circumstances

Gross examination
Total & diff. leucocyte
counts
Grams stain & culture
Crystal examination with
polarizing microscope &
compensator

Fungal & acid-fast stain &

culture
PCR
Serum-synovial fluid glucose diff.
Lactate & other organic acids
Complement
Enzymes
Uric acid

PLEURAL FLUID
The pleural cavity is a potential space
lined by mesothelium of the visceral and
parietal pleura.
The pleural cavity normally contains a
small amount of fluid that facilitates
movement of 2 membranes against each
other.
This fluid is a plasma filtrate derived from
capillary of the parietal pleura.

 Its produced continuously at a rate dependent

on capillary hydrostatic pressure, plasma
oncotic pressure, and capillary permeability.
Pleural fluid is reabsorbed through the
lymphatics and venules of visceral pleura.
An accumulation of fluid effusion
imbalance of fluid production and reabsorption.
This fluid accumulation in the pleural,
pericardial, and peritoneal cavities known as
serous effusion.

Pleural Effusion : Recommanded Tests

Routine Tests
Gross examination
Pleural fluid/serum protein ratio
Pleural fluid/serum LD ratio
Examination of Romanowsky-stained
smear (malignant cells, LE cells)
Useful tests in most patients
Stains & culture
Cytology

Useful tests in selected cases

Pleural fluid cholesterol
Pleural fluid/serum cholesterol ratio
Albumin gradient
pH
Lactate
Enzymes
Interferron-gamma
CRP
Lipid analysis
Tumor markers
Immunologic studies
Tuberculostearic acid
Pleural biopsy

PERICARDIAL FLUID
From 10-50 mL of fluid is normally present in
the pericardial space, produced by transudative
process pleural fluid.
Pericardial effusions are most often caused by
viral infection, enterovirus being the most
common.
They may also develop as a result of bacterial,
tuberculous or fungal infections, autoimmune
disorders, renal failure, myocardial infarctions,
mediastinal injury, the effects of various drug or
idiopathic.

Pericardial Fluid : Recommanded Tests

Gross Examination
Exudates and Transudates
Microscopic Examination
Chemical Analysis : protein, glucose, pH,
lipids, enzymes, INF-gamma, PCR
Immunologic Studies
Microbiological Examination

PERITONEAL FLUID
Ascites is the pathologic accumulation of
excess fluid in the peritoneal cavity.
Up to 50 mL of fluid is normally present
in the mesothelial-lined space.
As with pericardial and pleural fluids, its
produced as an ultrafiltrate of plasma
dependent on vascular permeability, and
hydrostatic and oncotic starling forces.

Recommended Tests in Peritoneal Effusion

Useful in most patients
Gross examination
Cytology
Stains & culture
Serum-ascites albumin concentration
gradient

Useful in selected disorders

Total leucocyte & diff. cell counts
RBC counts (lavage)
Bilirubin
Creatinin/urea nitrogen
Enzymes
Lactate
Cholesterol (malignant ascites)
Fibronectin
Tumor markers
Immunocytology/flow cytometry
Tuberculostearic acid

Thank you for your kind

attention