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Urine presentation

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Urine presentation

  1. 1. The importance of urine testing in the clinical laboratory PFC Eaker
  2. 2. How is urine produced?  Produced by the kidneys  Drained by ureter into bladder  Urethra brings out urine from bladder
  3. 3. Kidneys
  4. 4. Nephrons  Structural and functional unit of the kidney  Eliminates wastes  Regulates pH, blood pressure and blood volume
  5. 5. Nephrons
  6. 6. Glomerulus  Basic filtration unit of the kidney  First place where urine is formed in the body  Along with the Bowman’s capsule, comprises the renal corpuscle  Overall function of the kidney is measured by the glomerular filtration rate (GFR), which is the rate that blood is filtered through all glomeruli
  7. 7. Glomerulus
  8. 8. Glomerulus Bowman’s capsule
  9. 9. Glomerulus Afferent arteriole
  10. 10. Glomerulus Efferent arteriole
  11. 11. Glomerulus Proximal convoluted tubule
  12. 12. How is this process controlled?  Anti diuretic hormone (ADH)  Concentration of water in the blood decreases  Increase in the osmotic pressure stimulates the osmoreceptors in the hypothalamus  Hypothalamus signals the posterior pituitary gland to secrete ADH  Blood carries ADH to the kidneys  ADH causes the distal convoluted tubules and collecting ducts to increase water absorption through osmosis  Urine becomes more concentrated and volume decreases
  13. 13. Normal composition  95% water  0.4% Sodium  0.05% Ammonia  0.6% Phosphates  2% Urea  0.2% Sulfate  Creatine and Urobilinogen in minute amounts
  14. 14. What can urine indicate?  UTI  Systemic illness  Metabolic disorders  Diabetes  Pregnancy
  15. 15. Symptoms or problems  Dark, strong smelling urine  Burning urination  Oliguria, Polyuria, Anuria  Glycosuria, Haematuria, Semonorrhoea  Backache, Lower abdominal pain, Suprapubic pain
  16. 16. Clinical tests  Reagent strips
  17. 17. Clinical tests  Protein  Blood  Leukocytes  Nitrite  Glucose  Ketone  pH  Specific gravity  Bilirubin  Urobilinogen
  18. 18. Protein  Expected Values: <15mg/dl  Sensitivity: 15-30mg/dl Albumin  Limitations: A visibly bloody urine may cause falsely elevated results
  19. 19. Blood  Expected values: <0.010 mg/dl or 3 rbc/ul  Sensitivity: 0.015-0.062 mg/dl  Limitations: Some medications may cause false positives
  20. 20. Leukocytes  Expected values: <10 leukocytes  Sensitivity: 5-15 leukocytes  Limitations: Elevated glucose, medications, and contamination may cause false results
  21. 21. Nitrite  Expected values: <0.075mg/dl  Sensitivity: 0.06-0.1 mg/dl  Limitations: Negative results do not rule out significant bacteriuria
  22. 22. Glucose  Expected values: <30mg/dl  Sensitivity: 75-125 mg/dl  Limitations: Ketone bodies reduce sensitivity of the test
  23. 23. Ketone  Expected values: <2mg/dl  Sensitivity: 5-10 mg/dl  Limitations: Highly pigmented urine may cause false trace results
  24. 24. pH  Expected values: 4.6-8.0  Sensitivity: 5-8.5  Limitations: Bacterial growth may cause alkaline shift (pH >8.0)
  25. 25. Specific Gravity  Expected values: 1.001-1.035  Sensitivity: 1.000-1.030  Limitations: Dependent upon ions in urine
  26. 26. Bilirubin  Expected values: ~0.02mg/dl  Sensitivity: 0.4-0.8 mg/dl  Limitations: bilirubin derived bile pigments may mask the bilirubin reaction
  27. 27. Urobilinogen  Expected values: <1.0 mg/dl  Sensitivity: >0.02 mg/dl  Limitations: Test pad may react with interfering substances known to react with Ehrlich’s reagent
  28. 28. Confirmation tests  Ictotest  Acetest  Clinitest
  29. 29. Confirmation tests  Ictotest  Confirmation test for bilirubin  Reaction based on combining a solid diazonium salt with bilirubin
  30. 30. Confirmation tests  Acetest  Confirmation test for ketones  Acetoacetic acid or acetone in urine or blood reacts with nitroprusside in presence of glycine
  31. 31. Confirmation tests  Clinitest  Used to determine amount of reducing substances (glucose) in urine  Copper sulfate in tablet reacts with reducing substances in urine converting cupric sulfate to cuprous oxide  5-drop method  2-drop method
  32. 32. Questions

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