Analysis of Urine and Body

Fluids

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INTRODUCTION
• The urinary system is composed of four main components:
• The kidney, where urine is formed from the filtration of blood
• The ureters that carry the urine to the bladder
• The bladder that stores the urine produced
• The urethra that delivers the urine for excretion outside the body
• The kidneys are paired organs that are located inside the small of the
back.

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Renal Physiology
• Functions of Kidneys
• 1.Excrete waste products of metabolism
• 2.Regulate acid-base Balance
• 3.Regulate Electrolyte balance
• 4.Regulate Blood pressure
• 5.Regulate red cell production(erythropoiesis)

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• The kidney is a bean-shaped organ and its medial border contains an
indentation
• The renal hilus, through which the renal artery enters the kidney and
the renal vein and the ureter leave the kidney.
• Each kidney is covered by a capsule and capped with an adrenal
gland, which is an endocrine gland
• The internal structure of the kidney consists of three regions: the
cortex, the medulla, and the renal pelvis.
• The cortex is the outer layer of the kidney, located just below the
renal capsule.
• Regions of the cortex, called renal columns, extend into the renal
medulla or middle areas of the kidney

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• Blood vessels that supply the cortex and the medulla pass through
the renal columns.
• Also within the medulla are the triangular renal pyramids, located
between the renal columns.
• The tips of the renal pyramids, the papillae, project into a funnel-
shaped space, a minor calyx, and several minor calyces join together
to form a major calyx.
• The renal cortex and medulla contain the renal tubules, which include
the nephrons tubules and the collecting ducts. There are
approximately 1 million or slightly more nephrons in each kidney.
• The nephron is the main functional unit of the kidney

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Nephron
• The nephron is the functional unit of the kidney and there are
approximately 1 million or slightly more nephrons in each kidney.
• The nephron consists of a capillary network, called the glomerulus
(also known as the renal corpuscle), and a long tubule which is
divided into three parts: the proximal convoluted tubule, the loop of
Henle, and the distal convoluted tubule

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Nephron
• Functional unit of the kidney
• 1-1.5 millions of nephrons in each kidneys

• A. Glomerulus
• B.Renal tubules
• Proximal Convoluted Tubules
• Loop of Henle
• Distal Convoluted Tubules

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URINE FORMATION
• 1.Renal Blood Flow
• 2.Glomerular Filtration
• 3.Tubular Reabsorption
• 4.Tubular Secretion

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• The formation of urine involves the complex processes of blood
filtration, the reabsorption of essential substances including water,
and the tubular secretion of certain substances.
• After formation in the kidney, the urine passes down the ureter into
the bladder, where it is temporarily stored before being excreted
through the urethra.

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RENAL BLOOD FLOW

• 1200 ml/min
(depends on body
size)
• Renal Plasma flow
600-700 ml/min
GLOMERULAR FILTRATION
• Factors that influence filtration process
• A.cellular structure of the capillary walls and Bowman’s capsule
• 3 layers
• - capillary wall membrane
• -basement membrane
• -visceral epithelium (podocytes)
• B. hydrostatic pressure
• C.oncotic pressure
• D. renin-angiotensin-aldosterone system

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Renin-angiotensin-aldosterone system
• -controls the regulation of the flow of blood to and within the kidneys
• -responds to changes in blood pressure and plasma content

• Renin production =low plasma pressure and plasma sodium

• Angiotension II corrects renal blood flow by:
• Vasoconstriction of renal arterioles
• Proximal Convuluted Tubules reabsorption of sodium
• Release of aldosterone (Na retaining hormone) from the adrenal cortex
• Triggers release of Anti Diuretic Hormone
• Glomerular Filtrate-specific gravity 1.010 pH 7.4
• GFR= 120 ml/min

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Tubular Reabsorption
• Cellular Transport mechanisms
• Active transport-substances to be reabsorbed combine with a carrier
protein in the membranes of the tubular cells.
• Electrochemical energy- produced by this interaction transfers the
substance across the cell membrane
• Ex. Glucose, amino acids, salts, chloride, Sodium
• Passive Transport- movement of molecules across a membrane as a
result of differences in their concentration or electrical potential on
opposite sides of the membrane.
Ex. Water,Urea,Sodium

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Tubular Secretion
• Involves the passage of substances from the blood in the peritubular
capillaries to the tubular filtrate
• 2 major functions
• 1.elimination of waste products not filtered by the glomerulus
• 2.regulation of acid-base balance

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• Urine is the most conveniently obtainable specimen used in
laboratory testing. Test results often depend on the collection and
handling of specimens.
• Several techniques and preservatives are used in the collection of
urine, which should be used appropriately to allow for the most
accurate results.
• The physical examination of urine includes the observation of urine
appearance and concentration and to a lesser extent urine odor and
the presence of foam. These observations, along with chemical
testing of urine, aid in the screening and diagnosis of disease

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Specimen Collection and Handling
• Clean dry container
• Label patient’s name, date and time of collection
• Examine within 1 hour (not more than 2hours)
• Preservation-refrigeration,freezing,chemical

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COLLECTION
• Clean-catch or clean-voided midstream specimen is usually the
method of choice for obtaining noncontaminated specimens. It is
easy to perform and it provides a sample that can be used for
bacteriologic examination as well as for routine urinalysis.
• Prior to collection, the external genitalia are thoroughly cleansed with
a mild antiseptic solution.
• During the collection the initial portion of the urine stream is allowed
to escape while the midstream portion is collected into a sterile
container.

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COLLECTION
• Three-glass collections are similar to the clean-catch collectionand
are used to determine prostate infection. In the three-glass collection,
all portions, beginning, middle, and final portion of the void, are
collected in three separate containers.
• The prostate is massaged prior to collection in the third container.

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COLLECTION
• Catheterization of the bladder is sometimes necessary to obtain a
suitable specimen. This method may be used if the patient is having
difficulty voiding. It can also be used in a female patient to avoid
vaginal contamination, especially during menstruation

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COLLECTION
• Suprapubic aspiration of the bladder is sometimes used in place of
catheterization for obtaining a single urine sample.
• It involves the insertion of a needle directly into the distended
• bladder. This technique avoids vaginal and urethral contamination
and can also be useful in getting urine from infants and small
children. The specimen obtained by this method can also be used for
cytology studies
• Pediatric urine collection bags, which are attached to the genitalia

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Drug Specimen Collection
• Chain of Custody
• Required amount-30-45ml (DOH 60 ml )
• Urine Temperature -32.5-37.7 C within 4mins from the time of
collection

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Specimen Evaluation
• For single specimen submitted for multiple measurements,
bacteriologic exam should be done first 50 ml disposable container =
10-15 ml urine

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Physical Examination
• A. Color – varies ,metabolic function,physical activity, diet
• Normal =yellow
• Yellow Pigment- urochrome named by Thudichum in 1864
• Orange Brown-Urobilin
• Pink to Red Pigment- Uroerythrin

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Urine color Changes with Commonly Used
Drugs
• 1.Levodopa(Ldopa) = Red then brown
• 2.Metronidazole(Flagyl)= Reddish Brown
• 3.Nitrofurantion(Furadantin)=Brown Yellow
• 4.Phenozopyridine(Pyridium) = Orange-Red (Acid pH)
• 5.Phenindione anticoagulant = Orange/Red
• 6.Rifampin =Bright Orange Red
• 7.Riboflavin = Bright Yellow

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Transparency/Clarity
• Bacterial Growth-uniform opalescence that is not removed by
filtration nor acidification
• Leukocytes-white cloud(remains after acidification)
• Pink Cloud-Urates
• Orange Cloud-Uric Acid

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Odor
• Normal Odor- faint aromatic
• Urinoid- Substance responsible for urine odor

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Volume
• Average
• Adults= 1,200-1,500 ml
• Range = 600- 2,000
• Night Urine in General does not excess
• with a volume of 400ml
• Factors that influence urine volume
• 1.Fluid Intake
• 2.Fluid Loss
• 3.Variations in secretions of ADH

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 Polyuria
• Increase Urine Volume
• Volume is more than 2,000ml/24hr
• Diabetes Mellitus
• Diabetes Insipidus
• Increased salt intake and high protein diet
• Drugs-caffeine, alcohol, thiazides, and other diuretics
• Intravenous saline or glucose solution
• Chronic Progressive renal failure

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Nocturia
More than 500ml with a specific gravity of less than1.018 at night

Oliguria
Excretion of less than 500ml of urine daily

Anuria
Complete or total suppression of urine formation

Residual Urine
Urine that is left in the bladder after voluntary urination

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Specific Gravity
• Used in assessing the kidney’s ability to reabsorb
• Detects possible dehydration or abnormalities in ADH secretion
• Aids in evaluating the concentrating and diluting abilities of the kidneys
• Clinical Corrections:
• Normal value average 1.003
• Range 1.035
• Isosthenuric- below 1.010
• Hyposthenuric- above 1.010
• Hypersthenuric- above 1.010

• Excretion of radiographic contrast media and dextran will give a very high
urine specific gravity reading (over 1.035)

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Methods:
• 1.Urinometry-uses urinometer or hydrometer
• Principle : water displacement or buoyancy
• Disadvantage: requires 10-15ml
• Accuracy maybe checked by measuring the specific gravity of
• Distilled water: 1.001
• Potassium Sulfate: 1.015
• Specimen cold- subtract
• Specimen warm- add

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Reading is affected by:
• A. Temperature – subtract 0.001 from the reading for every 3 degrees
centigrade that the specimen temperature is below the urinometer
temperature
-add 0.001 to the reading for every3 degrees C that
the specimen temperature is above the urinometer temperature
B.Glucose-subtract 0.004 for every gram of glucose/dL
c.Protein- subtract 0.003 for every gram of protein/dL
Dilution of urine- multiply the decimal factor by the dilution factor to
get the actual specific gravity reading.

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Refractometry
• Refractometry determines the concentration of dissolved particles in
a specimen by measuring refractive index
• Refractive Index- comparison of the velocity of light in a solution and
velocity of light in air
• Total Solids Meter

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Refractometer maybe calibrated using the ff:
• A.Distilled water: 1.000
• B.5% Nacl: 1.022
• C. 9%sucrose: 1.034

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Advantages:
• 1.uses small amount of urine(1-2 drops)
• 2.Simple to operate
• 3.Gives Rapid Reliable Results

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Harmonic Oscillation Densitometry
• Sound wave frequency
• Automated instruments

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Falling Drop
• Timing the fall of a drop of body fluid of known size, through a
definite distance in a mixture
• Heavier drop will fall faster

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Osmolality
• The concentration of a solution in terms of osmoles of solute per
kilogram of solvent
• Osmometers:
• -Freezing point of osmometers
• -Vapor pressure osmometers

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ASSIGNMENT
• 1. HISTORY
• 2. Compare and contrast the processes of reabsorption
• and tubular secretion.
• 3. Label the parts of the kidney.
• 4. Label the structures of the nephron that are involved
• in urine formation and excretion.
• 5. List the primary constituents of urine.
• 6. Patients with diabetes typically have higher urine output
• volumes; this is referred to as:
• a. oliguria
• b. anuria
• c. polyuria
• d. pyuria
• 7. Discuss and draw renal blood flow and urine formation
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