URINANLYSIS. Pre-Lab Guide
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1 URINANLYSIS Pre-Lab Guide NOTE: A very useful Study Guide! This Pre-lab guide takes you through the important concepts that where discussed in the lab videos. There will be some conceptual questions on the lab practical it will not be all anatomy! So, besides knowing the models, dissections and slides, make sure you know the following: Study Guide Check Your Knowledge, before the Practical: 1. Know all terms/definitions outlined in this guide, especially those related to clinical conditions. 2. Know why we visually examine urine, and what the term turbidity means, Understand dehydration. 3. Know how to read a Chemstrip. 4. Know what specific gravity is, and be able to define it. 5. Be able to ID RBCs, WBCs, and hyaline casts 6. Understand the concepts outlined in Clinical Considerations Also, answer the questions at the end of this document. I will make the questions available individually.
2 I. Urinalysis: Visual Inspection and the Chemstrip Visual Inspection We will be doing some very basic visual analysis in lab:. Chemstrip COLOR: Urine comes in many colors. See 1 st yellow box for some examples (no, you are not responsible for these!). All we will be looking at is different shades of yellow, which usually indicates dehydration. TURBIDITY: This refers to how clear the urine is. See 2 nd yellow box for some examples (no, you are not responsible for these!). We will also provide instruction for performing a chemical analysis using a urine dipstick. The testing may consist of any or all of the following: ph, protein (as a semi-quantitative analysis), glucose, bilirubin, ketones, hemoglobin (blood), urobilinogen, nitrite, leukocytes (leukocyte esterase) and specific gravity. Some examples of Urine Color, and possible causes: RED, ORANGE UTI, hemoglobinuria, kidney stones, Beets, Blackberries, laxatives, many medications BLACK, BROWN Fava beans, some plastics, hemolytic anemia, many medications GREEN Asparagus, black licorice, porphyruria, some medications PURPLE, BLUE Gram negative UTI, porphyria, herbicide ingestion URINE WHITE Albuminuria, proteinuria, pus Some things that will make urine cloudy/turbid: Heat exposure or dehydration Pregnancy Urinary tract infection Bladder cancer Kidney problems Inflammation or infection of the prostate gland Sexually transmitted diseases Cardiovascular diseases, including hypertension and heart failure Certain autoimmune diseases Diabetes Sickle cell anemia Leukemia Lymphoma Know these terms for lecture and lab: Anuria Dysuria Proteinuria Glycosuria Hematuria Pyuria Ketonuria Albuminuria Urinary nitrites Pyelitis
3 II. Urinalysis: The Specific Gravity Using a refractometer to measure specific gravity. Specific gravity measures urine density or the ability of the kidney to concentrate or dilute the urine over that a plasma. Specific gravity is directly proportional to urine osmolality, which measure solute concentration. In other words, specific gravity = density sample density pure water The sample is always denser than pure water, so the number is always greater than 1. By User:Kandschwar (Own work) [CC BY-SA 2.0 de ( via Wikimedia Commons Specific gravity should be between and on a random sample of urine. Any measurement below this range indicates hydration, and any measurement above indicates dehydration. If specific gravity is below (that is more like pure water), without having ingested any food or water for 12 hours, renal concentrating abilities are impaired, and the patient is losing water in the patient either has generalized renal impairment or diabetes insipidus. Any urine having a specific gravity over is either contaminated (something else has entered their urine, such as dye), or contains very high levels of glucose (glucosuria). III. Microscopic Exam of Urine Red Blood Cells Hematuria is the presence of abnormal numbers of red cells in urine due to: Urinary tract infections (UTI), glomerular damage, kidney trauma, urinary tract stones, etc. White Blood Cells Pyuria (pus in urine) refers to the presence of abnormal numbers of leukocytes that may appear with infection in either the upper or lower urinary tract or more severe kidney disease, such as acute glomerulonephritis. Usually, the WBC's are granulocytes, and their nuclei can be seen. White cells from the vagina, especially in the presence of vaginal and cervical infections, or the external urethral meatus in men and women may contaminate the urine. This will be confirmed with the urinalysis sticks.
4 Casts LOTS of substances can clump together or crystalize and form casts in the urine. Some are benign, others indicate severe kidney damage. We will only talk about a couple, and how they relate to UTIs RBC can clump together and form casts. An absence of casts does not rule out renal disease. Casts may be absent or very few in cases of chronic, progressive, generalized nephritis. Even in cases of acute renal disease, casts can be few or absent in a single sample since they tend be shed intermittently. Furthermore, casts are unstable in urine and are prone to dissolution with time, especially in dilute and/or alkaline urine. Look at these cast on the wall charts: RBC: The presence of this red blood cell cast in on urine microscopic analysis suggests a bacterial infection (UTI), tubular injury (e.g.: kidney stones) or more sever glomerular or renal tubular injury. RBC often clump together and form a cast. WBC: Pus in the urine. Possibly from a UTI, tubular injury, or a more serious problem. Hyaline or Protein casts: The factors which favor protein cast formation are low glomerular filtration rate, high salt concentration, and low ph, all of which favor protein denaturation and precipitation. Hyaline casts can be seen even in healthy patients. IV. Clinical Considerations I mentioned along the way: A high number of red blood cells may mean that you have kidney disease, urinary tract infection, a drug reaction, or cancer. A high number of white blood cells may mean that you have an infection or inflammation in your urinary tract. A high number of eosinophils may mean that you have problems in your urinary tract. A high number of certain kidney cells may mean that you have kidney damage. Substances created in the kidney, called casts, can suggest different diseases. Hyaline casts are common among healthy people. Glycosuria alone does not mean the person has diabetes. Ketonuria will also be present. People without diabetes can also have ketones in the urine if their body is using fat for fuel instead of glucose. This can happen with chronic vomiting, extreme exercise, lowcarbohydrate diets, or eating disorders. Pyelitis (Pus) often means a UTI. The presence of Nitrites is the gold standard test for the presence of a bacterial infection (gram negative). The actual presence of bacterial is often missed. RBCs and WBCs are often also present.
5 Q1. 2 parts: Define Specific gravity. Tell me what we are determining when we look at the specific gravity of urine. Q2. Name the presence of an elevated amount of in the urine: Glucose: Protein: Albumin: Ketones: Pus: RBCs: Q3. If you are suspicious of diabetes mellitus that is not being controlled by the patient, you should look for elevated levels of both glucose and in the urine test: Q4. What is pyelitis? If you are suspicious of a UTI, you should look for what in the urine test? Name 4 commonly found things. Also, what will the urine look and smell like (possibly)? Q5. People on a high protein diet might exhibit what in their urine? Q6. What layer of the kidney contains the renal pyramids? Q7. What is the smooth semitransparent membrane that adheres tightly to the outer surface of the kidney? Q8. What is the area of the kidney where the renal blood vessels and ureter are attached to the kidney. Q9. What are the calyces? How would you describe their function?
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