ANALYSIS OF URINE AND OTHER BODY FLUIDS 2ND YEAR BSMEDTECH CEU MNL

(table salt) and many other

inorganic substances
URINE INFORMATION SODIUM Primarily from salt, varies
by intake
 The kidneys continuously form urine as an POTASSIUM Combined with chloride
ultrafiltrate of plasma. and other salts
 Reabsorption of water and filtered substances PHOSPHATE Combines with sodium to
essential to body function converts approximately buffer the blood
170,000 mL of filtered plasma AMMONIUM Regulates blood and tissue
fluid acidity
 1200 mL is the average daily urine output
CALCIUM Combines with chloride,
URINE COMPOSITION sulfate and phosphate

 In general, urine consists of urea and other

URINE VOLUME
organic and inorganic chemicals dissolved in
water. Urine is normally 95% water and 5%  Urine depends on the amount of water the
solutes. kidneys excrete
 Affected by dietary intake, physical activity, body  Normal urine output is usally – 1200 to 1500 mL,
metabolism and endocrine functions. a range of 600 to 2000 mL is considered normal.
 Urea, a metabolic waste product produced in the
liver front The breakdown of protein and amino OLIGURIA – decrease in urine output
acids, accounts for nearly half of the total
Less than 1 mL/kg/hr in infants.
dissolved solids in urine.
 Other organic substances include primarily Less than 0.5 mL/kg/hr in children.
creatinine and uric acid.
Less than 400 mL/kg/hr in adults.
 The major inorganic solid dissolved In urine is
chloride, followed by sodium and potassium Oliguria leading to anuria
 Although not a part of the original plasma filtrate,
the urine also may contain formed elements such ANURIA – cessation of urine flow
as cells, casts, crystals, mucus and bacteria.
NOCTURIA – increase in the nocturnal excretion of
Increased amounts of these formed elements are
urine
often indicative of disease.
POLYURIA – increase in daily urine volume
PRIMARY COMPONENTS IN NORMAL URINE
Greater than 2.5 L/day in adults
COMPONENT COMMENT
UREA Primary organic 2.5 to 3mL/Kg/day in children
component. Product of
protein and amino acids SPECIMEN COLLECTION
CREATININE Product of creatinine
metabolism by muscles - The recommended capacity of the container is 50
URIC ACID Product of nuclei acid mL, which allows 12 mL of specimen needed for
breakdown in food and microscopic analysis.
cells
CHLORIDE Primary inorganic LABELS
component. Found in
combination with sodium - Patient’s name
 ANALYSIS OF URINE AND OTHER BODY FLUIDS 2ND YEAR BSMEDTECH CEU MNL
- Identification number causes the
- Date & time of collection breakdown of urea
into ammonia
And additional information such as

- Patient’s age and location

- Healthcare provider’s name
- A requisition form (manual or computerized) must
accompany specimens delivered to the
laboratory.

SPECIMEN REJECTION

- Improperly labeled and collected specimens

should be rejected
1. Specimens in unlabeled containers
2. Nonmatching lables and requisition forms
3. Specimens contaminated with feces or toilet
paper
4. Containers with contaminated exteriors
5. Specimens of insufficient quantity
6. Specimens that have been improperly
transported

SPECIMEN INTERGRITY

- Specimens should be delivered to the laboratory

promptly and tested within 2 hours.
- Specimen that cannot be delivered and tested
within 2 hours should be refrigerated

After refrigeration

Acidic – amorphous

Alkaline/neutral – amorphous phosphate

CHANGES IN UNPRESERVED URINE – 72 HOURS

ANALYTE CHANGE CAUSE

Color Modified / Oxidation or
darkened reduction of
metabolites
Clarity Decreased Bacteria growth
and precipitation of
amorphous
material
Odor Increased Bacteria
ammonia smell multiplication
 ANALYSIS OF URINE AND OTHER BODY FLUIDS 2ND YEAR BSMEDTECH CEU MNL
pH Increased Breakdown of urea Types of Specimens
to ammonia=
urease producing Random Specimen
bacteria/ loss of
CO2  most commonly received specimen
Glucose Decreased Glycolysis and  collected anytime but the
bacteria use  actual time of voiding or collection = recorded on
Ketones Decreased Volatilization and the container
bacteria  useful for routine screening tests = detect
metabolism obvious abnormalities
Bilirubin Decreased Exposure to  show erroneous results = results show dietary
light/photo- intake or physical activity before collection
oxidation to  postural or orthostatic proteinuria = increased
biliverdin protein due to prolonged standing
Urobilinogen Decreased Oxidation to
urobilin First Morning Specimen
Nitrite Increased Multiplication of
nitrate-reducing  ideal screening specimen
bacteria  essential for preventing false-negative pregnancy
Red and white Decreased Disintegration/lyse tests
blood cells and in dilute alkaline  for evaluating orthostatic proteinuria
casts urine  instructed to immediately collect the sample upon
Bacteria Increased Multiplication arising and deliver it to the laboratory= 2 hours or
Trichomonas Decreased Loss of motility, keep it refrigerated
(PARASITE) death  specimen of choice = urinalysis and microscopic
analysis
 Beta HGC = Pregnancy Hormone mataas
SPECIMENT PRESERVATIVES (refrigeration, boric and morning

24-Hour or Timed Specimen

 patients must begin and end the collection with

an empty bladder = accurately timed specimen
 diurnal variations = hormone that promotes 2
measurements of quantity in the morning and
night
 concentration = calculated from the urine volume
 volume = accurately measured and recorded
 aliquot = amount saved must be adequate to
permit repeat or additional testing
 2 containers = combined and thoroughly mixed
before aliquoting
 3 Separate Sections for Urine Testing
o Bacteriology = Urinary culture
o Clinical Chemistry = 24 hr (TIMED)
specimen (naka balde)
o Clinical Microscopy = Urine Analysis
formalin important) (LAHAT)

Catheterized Specimen
 ANALYSIS OF URINE AND OTHER BODY FLUIDS 2ND YEAR BSMEDTECH CEU MNL
 collected under sterile conditions o after prostate massaged = 2nd specimen
 uses a hollow tube (catheter) through the urethra o positive = bacteriuria in post-massage is
to the bladder 10x greater than pre-massage
 most common test requested = bacterial culture
Pediatric Specimen
Midstream Clean-Catch Specimen
 presents a challenge
 the most common way of collecting urine  uses a soft clear plastic bag for routine
 less contaminated by epithelial cells and bacteria specimens
 more representative of the urine than the  avoid the anus when attaching the bag to prevent
routinely voided specimen contamination
 first void = increased epithelial cells  enough specimen has collected = label the bag
 patients were provided instruction and cleansing or transfer to a sterile container and label
materials following the institutional policy
 strong bacterial agents such as hexachlorophene
or povidone-iodine should not be used as Drug Specimen Collection
cleansing agents = false decrease in bacteria
 preferred for culture and sensitivity testing =  should have legalities
reduce the incidence of cellular and microbial  NECESSARY = prove that no tampering with the
contamination specimen occurred (substitution, adulteration, or
dilution)
Suprapubic Aspiration  all personnel handling = noted
 proper identification of the individual info =
 sterile way of collection indicated on the label is required
 collected through a needle directly to the bladder  requesting by the company
 external needle collection  “witness collection” = indicated if the donor is
 bladder = sterile under normal conditions suspected to alter or substitute or policy of the
 for bacteria culture and cytologic examination client ordering the test
 same gender collector observe the collection =
Prostatitis Specimen 30-45 ml of urine
 immediately handed to the collector
 several methods to detect the presence of  collector = accredited specified specimen
prostatitis collector hand to RMT That trained for DTA
 Three Glass Collection  urine temperature = taken within 4 mins from the
o area cleansed = male midstream clean collection to confirm no adulterated occurred
catch procedure  temperature range = 32.5 celsius to 37.7 celsius
o 1st urine = collected not discarded  temperature not in range = recorded and notify
o Midstream = collected supervisor or employer to be contacted
o The prostate is massaged after mid-  recollection of a second specimen = is needed if
stream urine = prostate fluid kasama sa the temperature of urine is not in the range
urine to be collected  urine color = inspected to identify any signs of
o 1st and 3rd specimen = microscopic contaminants
examination  Reference Lab for Drug Testing = East Avenue
o 2nd specimen = control ( + = 3rd Medical Center (EAMC)
specimen to be invalid)
o 3rd specimen = white blood cell/ high
Renal Function
power field count with 10x bacterial count
 Pre and Post Massage Test (PPMT)
o 2 glass collection  kidney = asymmetrical
o clean catch midstream = 1st specimen
 ANALYSIS OF URINE AND OTHER BODY FLUIDS 2ND YEAR BSMEDTECH CEU MNL
Kidney  renal artery = supplies blood to the kidneys
 kidneys = receive approximately 25% of the
 maintains all body fluids balance blood pumped through the heart
 regulates and filters minerals from = blood, blood  starts with blood entering the capillaries of the
filtering waste materials from food, medication, nephrons = afferent arteries
and toxic substances  flows through the glomerulus through the efferent
 creates hormones (Erythropoietin EPO) = arteries
produce red blood cells (RBC)  sizes of arterioles = help create the hydrostatic
 promote bone health pressure differential
 regulate blood pressure  hydrostatic pressure = important for glomerulus
 process around 1 to 2 liters of waste filtration to increase the glomerular capillary
 kidney’s surface = 1.73 m2 of surface pressure
 total renal blood flow = 1200ml/ min
 total renal plasma flow ranges = 600 to 700 Glomerular Filtration
ml/min
 urine = ultrafiltrate of plasma (asa urinalysis  consists of a coil of 8 capillary lobes = walls are
notes to pls) called glomerular filtration barrier
 found within the Bowman’s capsule = forms at
Renal Artery the beginning of the renal tubule
 Cellular Structure of the Glomerulus
 provide oxygen to the kidneys o plasma filtrate must pass through 3
glomerular filtration barrier cellular
Renal Veins layers: capillary wall membrane,
basement membrane (basal lamina), and
 responsible for the excretion of metabolic waste visceral epithelium of Bowman’s capsule
= originated from the exchange of nutrients from o endothelial cells of the capillary wall =
the kidneys contain pores and are referred to as
fenestrated endothelium
o Pores = increase capillary permeability
Renal Physiology but DO NOT ALLOW PASSAGE OF
LARGE MOLECULES AND BLOOD
 each kidney contains = 1 to 1.5 million functional CELLS
units called nephrons o barrier contains a shield of negativity =
repels molecules with a positive charge
2 Types of Nephrons even if small enough to fit in the barrier
 Glomerular Pressure
 Cortical Nephrons o presence of hydrostatic pressure
o responsible for the removal of waste resulting from the smaller size of the
products and reabsorption of nutrients efferent arteriole and glomerular
 Juxtamedullary Nephrons capillaries enhances filtration
o responsible for renal concentration o increase or decrease of the size of
afferent and efferent arterioles =
4 Renal Functions autoregulatory mechanism within the
juxtaglomerular apparatus
 Blood Flow o autoregulatory juxtaglomerular apparatus
 Glomerular Filtration = maintains the glomerular blood
 Tubular Reabsorption pressure at a consistent rate regardless
 Tubular Secretion of fluctuations in systemic blood pressure

Blood Flow
 ANALYSIS OF URINE AND OTHER BODY FLUIDS 2ND YEAR BSMEDTECH CEU MNL
o increase in blood pressure = constriction  the body cannot lose 120 mL of water containing
of the afferent arterioles to prevent over- essential substances every minute.
filtration or damage to the glomerular  reabsorption mechanisms
o Dialysis = too high of blood pressure  Polyuria = increased urination (might lose
overpowers the juxtaglomerular essential substances)
regulatory process.

Renin Angiotensin-Aldosterone System

 regulates the flow of blood to and within the

glomerulus
 responds to the changes in blood pressure and
plasma sodium content that are monitored by the
juxtaglomerular apparatus.
 juxtaglomerular apparatus = afferent arterioles
and macula densa of the distal consulted tubule
 Renin
o an enzyme produced by juxtaglomerular
cells
o secreted and reacts with the blood-bone
substrates angiotensin = produce inert
hormone angiotensin I. Reabsorption Mechanisms
o angiotensin I pass through the lungs'
alveoli = changes to an active form of
 2 Types of Reabsorption Mechanisms
angiotensin II.
o Active Transport
 Angiotensin II
 substances to be reabsorbed =
o Corrects renal blood flow in the following
combined with a carrier
ways:
protein
 cause vasodilation of the
 carrier proteins = located in
afferent arterioles and
the membranes of the renal
constriction of the efferent
tubular epithelial cells
arterioles
 GAS = Proximal Convoluted
 stimulating reabsorption of
Tubule
sodium and water in the
 the substances to be
proximal convoluted tubules
reabsorbed (GAS =
 triggering the release of the
Proximal) :
sodium-retaining hormone
 Glucose = prevent
aldosterone by the adrenal
cortex and antidiuretic hormone hypoglycemia
 Amino acids = protein
by the hypothalamus
 too much sodium = maintains
metabolism
 Salts
solvent (water), and antidiuretic
 Chloride = ascending
hormone (ADH) keeps us from
peeing loop of Henle
 Sodium = Distal
 ADH = problem of patients with
diabetes insipidus (polyuria) Convoluted Tubule
o Passive Transport
 Insulin = issue of patients with
 movement of molecules
Diabetes Mellitus
across a membrane =
Tubular Reabsorption differences in the
concentration or electrical
 ANALYSIS OF URINE AND OTHER BODY FLUIDS 2ND YEAR BSMEDTECH CEU MNL
potential on opposite sides of  secrete hydrogen ions = prevent blood to be
the membrane too acidic
 the substances to be  hydrogen ions = renal tubular cells into the
reabsorbed: filtrate to prevent filtered HCO3 to the
 Water = all parts of plasma
the Nephrons except
for Ascending loop of
Henle Renal Function Test
 Urea = Proximal
Convoluted Tubule
and Ascending Loop
Glomerular Filtrationon Test
of Henle
 standard used to measure the filtering
 Sodium accompanied
glomerular = clearance test
by Active transport of
 accurately measure the substance analyzed by
Chloride = Ascending
one of the two, neither reabsorbed nor
loop of Henle
secreted by the tubules
 3 that must be stable during the possible 24-
hour urine collection :
o Substance availability
o Plasma level consistency
o Availability of the test to analyze the
substance
Tubular Secretion
Different Test for checking Glomerular
 substances are removed from the glomerular Filtration
filtrate and returned to the blood (di ko na
alam)  Cystatin C
 involves the passages of secretion of the o a small protein produced at a constant
blood in the peritubular capillaries to the rate by all nucleated cells
tubular filtrate o no cystatin is secreted by the tubules
 foreign substances ex. medications = cannot o presence of cystatin in tubules =
be filtered by the glomerulus problems in filtration, reabsorption of
 medications = bounded to plasma proteins tubules, or secretion of tubules
 plasma proteins = stronger affinity tubular o immunoassay procedure = available for
cells and dissociate with carrier proteins measuring cystatin c
 the major site of removal of nonfiltered o Recommended for :
substances = proximal convoluted tubule  pediatrics
 2 Major Functions  person with diabetes
o Eliminate waste products =  elderly
o Regulate the Acid-Base Balance =  critically ill patients
secretion of hydrogen ions  Tubular Reabsorption Test
o Glomerular Filtration Rate/ GFR = not a
Acid-Base Balance useful indication of early renal disease
o determine the ability of the tubules to
reabsorb the essential salt and water
 normal blood pH = 7.4
that is not filtered by the glomerulus =
 to maintain pH = blood must buffer and
Concentration Test
eliminate excess acid formed by dietary
o specific gravity that enters the tubules
intake and body metabolism
=1.010
 buffering capacity of blood = based on
bicarbonate (HCO3)
ANALYSIS OF URINE AND OTHER BODY FLUIDS 2ND YEAR BSMEDTECH CEU MNL
o if increased specific gravity = molecules,
analytes, present in urine that shouldn’t
be there
 Tubular Secretion