Urinalysis

Created by rsmcenhill 

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554 terms · Phase II @ Travis AFB, CA

What are the 5 major functions of the kindney?

1) Remove waste products; primarily nitrogenous wastes from protein metabolism and acids, 2) Retention of nutrients, such as: electrolytes, protein, water, and glucose, 3) Acid-base balance, 4) Maintain water and electrolyte balance, 5) Hormone synthesis (erythro protein, renin, vitamin D)

The urinary system consists of these four interconnected parts:

Kidneys, ureter, bladder, urethra

Most important part of the urinary system

Kidney

Two, kidney bean-shaped organs located on the back of the abdominal cavity near the spinal column

Kidneys

The principal function of the kidney is:___________, Other functions include: ______

The formation of urine; regulate water, acid/base, and electrolyte balance

The formation of urine involves the removal of waste products from the blood (_____), and the retention of essential substances (______)

Filtration, asbsorption

Each kidney weighs what?

150 grams

Kidneys are larger in the female in the male. True or False.

False

What are the six major parts of the kidney?

the capsule, cortex, medulla, renal pelvis, renal arteries, and renal veins

The functional unit of the kidney

Nephron

Funnel shaped tubules 10 to 12 meters long, muscular organs that go from the kidneys to the back of the bladder at a slight angle

Ureter

What is the function of the ureter?

Carry urine from the kidneys to the bladder

How do the ureters transfer urine to the bladder?

Gravity and waves of contractions

A contractible sac that lies in the lower abdomen and serves as a reservior for the urine

Bladder

What is the capacity of the bladder?

500 mL

A tubule that carries urine from the bladder to the outside of the body

Urethra

What is special about the urethra of the male?

Serves as both the passage of urine and semen

The outermost shell or lining, which encloses and protects the kidney

Capsule

The capsule is made up of how many layers?

3

What are the functions of each layer of the capsule?

Intermost First Layer- directly surrounds the kidney, Second Layer- middle layer of fat that protects the kidney, Outermost Third Layer- surround kidney and anchors it to surrounding structures

The outermost region of the kidney, just inside the capsule

Cortex

This area of the kidney contains the functional filtering units of the kidney called the nephron units

Cortex

How many nephrons are present in the kidney?

1-1.5 million

Each nephronis made up of the: (5)

glomerulus, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting ducts

Consists of coiled capillaries inside the Bowman's capsule

Glomerulus

Semi-permeable membrane in the nephron in which the filtration takes place

Bowman's Capsule

Afferent arterioles take blood ____ the kidney, while efferent arterioles take blood _____ the kidneys

to, away from

What is the job of the proximal convoluted tubule?

To reabsorb substances before they are excreted in the urine

What percentage of fluid and electrolytes is reabsorbed by the proximal convoluted tubule?

80%

The maximum amount of an analyte that will be reabsorbed from the glomerular filtrate and controls the amount which is reabsorbed

Renal Threshold

The reddish brown inner region of the kidney that contains the collecting tubules and renal pyramids

Medulla

Collect the urine formed by the nephrons and carry it to the ureters; found in the medulla

Collecting Tubules

How many renal pyramids are found in the medulla?

5-18

Triangular structures foudn in the medulla and serve as collecting points for all the collecting tubules of the nephron units

Renal Pyramids

The second twisted regions of the Loop of Henle

Distal Convoluted Tubule

Explain the final reabsorption of sodium in order to maintain water/electrolyte balance

Final reaborption of sodium takes palce in the distal convoluted tubule. Renin, an enzyme, is released. Released Renin forms angiotensin and causes the secretion of aldesterone. Kidneys, in response to the aldesterone, actively retains sodium and passively retains water

Water reabsorption is controlled by?

ADH

In the distal convoluted tubule, excess acid is also removed from the body. This helps in:

maintaining the body's pH balance

Collecting ducts slant in the _____ and end in the _______

cortex, medulla

Long, straight portions of the nephron after the distal convoluted tubule that lead to the renal pelvis, and establishes the final concentration of urine while under the control of APH

Collecting Ducts

These are present in the brain and monitor the level of sodium in the blood stream

Chemoreceptors

This is released when sodium concentration is high in an effort to prevent additional water loss

ADH

A funnel shaped cavity in the kidney that funnels the urine from the collecting tubules to the ureters

Renal pelvis

These blood vessels carry the blood from circulation to kidneys; carrying the blood that is going to be filtered

Renal arteries

These are the veins carrying blood away from the kidneys; carrying the blood that is going to be filtered

Renal veins

What is the funciton of the urinary system?

To filter out certain substances fromt he blood such as waste products and excess fluids

A modified ultrafiltrate of the plasma

Urine

What are the three main processes involved in urine formation?

1) Filtration, 2) Reabsorption, 3) Secretion

How much blood, on average, flows through the kidneys every minute?

1 liter

On average, how long does it take the entire volume of blood in the body to be filtered?

4 hours

Having more solids in the blood, the higher the presssure. As a result, a filtering of material will be from _____ to _______

An area of high pressure, an area of lower pressure

The filtrate is essentially free of _____. Why?

Plasma protein and blood cells, the molecules are large and only smaller molecules can make it through the glomerulus

After filtration, blood becomes _____

plasma

Substances are ______ reabsorbed or secreted by the kidneys, resulting in urine

selectively

The mechanisms of reabsorption include:

active transport, passive transport, osmosis

The movement of a molecule from low area of concentration to a high area of concentration

active transport

The method of molecular transport requires energy

Active transport

What form of energy is used during active transport?

ATP

The movement of molecules from an are of high concentration to an area of low concentration

Passive transport

This type of molecular transport does not require energy

Passive transport

In passive transport, the molecules are said to follow a:

Natural concentration gradient

This transport method deals only w/ the movement of water

Osmosis

Maximum amount of a substance that can be reabsorbed

Renal Threshold

The level of substance that is greater than the reabsorption capacity of the kidney and the excess substance remains in the urine filtrate

Renal Threshold

When the concentraion of a certain substance in the blood becomes too high, it may be _____ from the kidneys to the urine; also used to eliminate substances that are too large to be filtered by the glomerulus

Secreted

What is the primary purpose of secretion?

To regulate acid-base balance via secretion of hydrogenious and maintain the 7.4 pH of blood

Urine consists of:

Urea and other organic and inorganic chemicals and water

What percentage of urine is urea and other organic and inorganic chemicals?

4%

What percentage of urine is water?

96%

The concentration of the dissolved elements in urine varies based on which criteria? (5)

dietary intake, physical activity, metabolism, hormones, and body position

Organic substances in urine include mainly:

urea, creatinine, and uric acid

Inorganic substances in urine include mainly:

sodium, chloride, and potassium

True or False: Urine is a biologically hazardous substance

True

Urine samples should be collected in a ________ w/ a ________

clean disposable container, screw top lid

A urine specimen must be delivered to the lab w/ in what time period?

30 min.

If the specimen cannot be delivered to the lab w/ in 30 min, it should be _____ for up to ______

refrigerated, 8 hrs

If a delay in testing occurs, what must happen to the urine?

it must be preserved

There are two methods of urine preservation. What are they?

physical and chemical

What is the best method of preservation for short periods of up to 8 hours, or during a 24-hour urine collection?

Refrigeration

If a urine is preserved using refrigeration, what must you make sure to do before analysis?

The sample must be brought back to room temp.

Refrigeration is an example of what method of urine preservation?

Physical

Preservation in which preservatives are added to the urine either after or during collection

Chemical

For the best result, which method of urine preservation should be used?

Both should be used together for best results

Preferred characteristics of chemical preservatives include: (4)

Bactericidal, inhibits urease activity, preserves formed elements, does not interfere w/ testing

Preservative used to preserve the cellular materials found in urine; may cause false positive test for glucose

Formalin

Preservative used to retard and prevent bacterial growth

Toluene, phenol, and thymol

Preservative used to maintain pH to help preserve cellular and chemical elements of the urine; also retard bacterial growth

Acids

Preservative that is a convenient method w/ controlled concentration of chemicals to minimize interference

Commercial Preservative Tablets

Preservative that prevents glycolysis and is good for drug analysis

Sodium Flouride

Changes in unpreserved urine include:

Increase in bacteria, turbidity (precipitation of amorphous sediments); Decreased ketones, bilirubin (exposure to light), urobilinogen (due to oxidation); Deterioration of formed elements, Color change due to oxidation/reduction of metabolites

What are the effects of increased bacteria?

deteriorate specimen, urea to ammonia, increase pH, may use up glucose as a food source, nitrates to nitrites, increased turbidity

Most commonly used urine specimen?

Random specimen

Random specimens are primarily collected for?

Routine Analysis

What is included in a routine urinalysis?

Color, pH, Appearance, S.G., and Microscopic examination

A random specimen requires a minimum of what volume? Collected in?

10-15 ml. a non-sterile container @ anytime of the day

What do you do if an abnormal finding is collected in a random urine sample?

Have the patient recollect under more controlled conditions

This type of specimen is collected immediately upon arising

First morning specimen

What is the benefit of a first morning specimen?

It represents a concentrated specimen

A first morning urine specimen must be delivered to the lab w/ in:

2 hours

A first morning specimen is essential for:

preventing false neg pregnancy tests and evaluating orthostatic proteinuria

The patient is instructed to void two hours after consuming a normal meal describes which urine specimen?

Two-hour post prandial

Two hour post prandial urines are used to test ______ and to maintain patients w/ _________

glucose, diabetes mellitus

During a glucose tolerance test, a _______ is collected and tested for glucose before a glucose tolerance test is performed

fasting urine sample

24 hour urine samples are collected often for a ______ than a ______

quantitative analysis, qualitative analysis

In a 24 hour urine sample, is the first morning sample collected as well? 1st morning? 2nd morning?

No, the first morning urine is voided and discarded
Yes, the urine is voided and added to the previously collected period

What is the average normal adult daily output of urine?

1200-1500 ml/24hrs

Performed when a patient is at risk to infection or perforation or the urethra or bladder by the physician or nurse inserts a catheter (hollow tube) in the urethra of he bladder

Catheterized specimen

Catheterized specimens are primarily used for:

microscopic examinations and microbiological cultures

Which part of a catheterized routine urinalysis is performed first?

Culture

A safer, less traumatic method of obtaining urine for bacterial culture, also offering a more representative and less contamination

Mid-Stream Clean Catch

How does a midstream differ from a MSCC specimen?

A midstream collection is the same as a MSCC except, a sterile container is not required and the external genitalia do not have to be washed

A suprapubic specimen is collected by who?

the provider

Sample in which a needle is placed directly into the bladder through the abdomen to obtain urine for bacterial culture or cytological exam

suprapubic

What are the methods that may be used to get urine from a pediatric patient that is not "potty-trained"?

Sterile plastic bags, cath, or suprapubic

Macroscopic urinalysis includes:

volume, color, appearance, pH, and S.G.

Factors that affect the volume of urine excreted in a 24 hour period are?

fluid intake, fluid loss, diuretics (tea or coffee), and pathologic states (diabetes, renal failure, and obstruction)

What is the chief factor in determining the volume of urine?

Intake of water and other fluids

Normal (adult) output of urine

600-2000ml in 24hours

Average daily output of urine for adults

1200-1500 ml in 24 hours

Which of the following does not increase output of urine: Drugs, caffiene, alcohol, diabetes mellitus, and diabetes insipidus

None of the above, all increase output of urine

What conditions can cause reduced urine output?

Renal failure, glomerular dysfunction

Urine output below 500 ml in 24hours

Oliguria

Complete suppression of urine output

Anuria

Excessive urination @ night

Nocturia

Urine output above 2000ml in 24hours

Polyuria

Passage of abnormally large amounts of urine for a specific patient

Diuresis

The normal color of urine is a result of the prescence of which pigment?

Urochrome

Specimens should be reported as _____ only when no pigmentation can be seen when viewed against a white background

colorless

Normal urine colors include:

Straw, yellow, amber

Yellow-brown, icteric

Bilirubin or medication

Red shades

Hemoglobin, myoglobin, RBCs, beets, PSP dye, or food w/ dyes

Bright or dark orange

Pyridium

Brown-black

Melasin, methemoglobin, methyldopa, or hemogenistic acid

Blue-green

Pseudomonas spp. (pigment-producing bacteria

Bright or dark blue

GSP dye

Urine appearance can be reported as:

clear, hazy, cloudy, or opaque

A urine that can be seen through easily is reported to have an appearance of ______ and is usually indicative of:

Clear, normal dilute urine

A urine that can be seen through w/ difficulty and is reported as _______ and indicative of:

Hazy, small amounts of phosphate, urates, or cellular material (normal if stored properly, WBCs or RBCs in high amounts (abnormal))

A urine that cannot be seen through is reported to have an appearance of ______ and is usually indicative of:

Cloudy, large amounts of phospate, urates or cellular material (normal if stored properly, WBCs or RBCs in high amounts (abnormal))

A urine sample that cannot be seen through, nor will light pass through is reported to have an appearance of ______ and is usually indicative of:

Turbid (Opaque), WBC/RBC , epithelial cells, bacteria

Is odor part of the usual urinalysis exam?

No

Urine w/ bacterial infection smells?

Very strong, unpleasant

Urine w/ diabetes mellitus smells?

Sweet or fruity

Urine w/ maple syrup urine disease smells?

Maple syrup

Is foam a part of the usual urinalysis exam?

No

White foam is indicative of?

Protein

Yellow foam is indicative of?

Bilirubin

The density of a solution compared w/ the density of DI water @ a similar temp

S.G.

What does urine S.G. measure?

Concentrating and diluting function of the kidney

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