AUBF: WEEK 1 to 4
Romie Solacito, MLS3C
URINAYSIS: HISTORY & IMPORTANCE
 Analyzing the urine was actually the beginning of
laboratory medicine
 Drawing of caveman: physicians holding a bladder-
shaped flask of urine
 Physicians never saw these patients, only their urine
 Hippocrates: (5th Century B.C.) “uroscopy” – Father
of Medicine; four humors.
 1140 AD: Urine Color Charts
 Frederick Dekkers (1694): discovered Albuminuria
(achieved by boiling the urine) – protein found in
urine
 Tammhorsfall Protein/Uromodulin – main
component of cell cast.
 Thomas Bryant (1627): Pisse Prophets
 17th Century: Urine Microscopy
 Thomas Addis: discovered the sediment
quantitation: 3C (Crystal [bilirubin], Cast, Cells [WBC,
RBC, and Epithelial Cell])
 1827, urinalysis become a part of a doctor’s routine
patient examination
 1930, increase in number and test complexities lead
to disappearance of urinalysis.
Development of Modern Testing Techniques
 Examination:
o Physical – color, volume, and odor
o Chemical – 10 parameters
o Microscopy
URINE FORMATION
 Three processes: Filtration, Reabsorption, and
Secretion
 Reabsorption of water and filtered substance
essential to the body function converts 170,000mL of
filtered plasma to average daily urine output of
1200mL. Except for: bound proteins and conjugated.
URINE COMPOSITION
 In general, urine consist of urea and other organic
and inorganic chemicals dissolved in water
 It is composed of: Urea and Creatinine
URINE: FOUNTAIN OF INFORMATION
 Liquid tissue biopsy of the urinary tract
 Painlessly obtained
 Yields a great deal of information quickly and
economically
 Urine tests need to be carefully performed and
properly controlled
 Examination of urine: diagnosis and management of
renal or urinary tract diseases; detection of metallic
and systemic diseases.
RENAL ANATOMY, PHYSIOLOGICAL, & FUNCTION
TESTING
 Kidney – as an endocrine gland secretes hormones:
o Erythropoietin
o Calcitriol (1,25 [OH]2 Vitamin D3) – the active
form of Vit-D-regulates calcium and phosphate
concentration in the bloodstream
o Renin – enzyme
 Nephrons – functional unit of the kidney; 1 to 15
million per kidney; two types of nephron:
o Cortical – removal of waste products and
reabsorption of filtered nutrients
o Juxtamedullary – urine concentration (salty)
 In 24 hours the kidney reclaim:
o 1300g of NaCl
o 400g of NaHCO3 – use for Acid-Base Balance
o 180g of glucose
o Increase carbon dioxide may lead to acidity
 Renal Artery – supply blood in kidney (25%)
o Specific gravity of blood: 0.055
o Specific gravity of urine: 1.010
 Nephron Function:
o Renal blood flow
o Glomerular filtration
o Tubular reabsorption
o Tubular Secretion
Urine Formation
 Kidney - >1L (1200ml) of blood per fuses the kidney
per minute (25%)
 Renal Blood Flow
o Afferent arteriole (renal artery)
 Blood enters the glomerulus
o Efferent arteriole
 Blood leaves the glomerulus
o Peritubular capillaries/Proximal convoluted
tubules
o Vase Recta/Loop of Henle
 o Peritubular Capillaries/ Distal convoluted
tubules
o Renal Vein
1. Podocytes – specialized cells of Bowman’s Capsule;
fenestrated or pores; function as a filter <70,000MW
2. Blood – Heart – Kidney = Afferent Arteriole –
Glomerulus – Bowman’s Capsule – Proximal
Convoluted Tubule – Loop of Henle – Distal
Convoluted Tubule – Calyx – Ureter – Bladder –
Urethra
o Glomerular filtrate volume per 24 hours = 180L
and reduced to 1 – 2 L as urine
 Glomerular Filtration:
o Glomerulus – located in Bowman’s Capsule;
nonselective filtration; less than 70,000MW;
cellular structure
 Hydrostatic (H2O) and Oncotic (CHON)
Pressure – if not balance can lead to
Nephrotic syndrome and edematous
 Renin Angiotensin Aldosterone System
 Cellular Structure: Three Layers
1. Capillary wall – endothelial cells have
pores (fenestrated); large molecules and
cells are blocked
2. Basement membrane – further
restrictions of large molecules
3. Bowman’s Capsule – inner layer;
intertwining podocytes; membrane
covered filtration slits
o Filtration Pressure – regulation of arteriole size
 Must maintain consistent glomerular
pressure
 Low systemic blood pressure
 Larger afferent and smaller efferent
 Prevent decrease glomerular blood flow
 High systemic blood pressure
 Smaller afferent and larger efferent
 Prevents over filtration and glomerular
damage
o Normal: 120mL/min of filtrate
o Composition – Ultrafiltrate of Plasma
 Same composition minus plasma proteins,
protein-bound substances are cells
 Untrafiltrate Specific Gravity – 1.010
 Tubular Reabsorption:
o Active Transport – cellular energy and carrier
protein needed for transport back to blood;
glucose, salts (highest), amino acids in Proximal
Convoluted Tubules (SWAGU – Sodium, Water,
Amino Acid, Glucose, Urea); Chloride in
ascending Loop of Henle; Sodium in Distal
Convoluted Tubules
o Passive Transport – Water in PCT, DLoH, &
Collecting Ducts; Urea I PCT, ALoH; Sodium in
ALoH.
o Maximal Reabsorption Capacity
 Plasma level at which Active Transport
ceases
 Renal Threshold – plasma level active
transport to ceases
 Normally reabsorbed substance
appears in urine
 Glucose Threshold = 160 to
180mg/dL
 Normal blood sugar, Increase urine
glucose = Tubular Damage
o Tubular Concentration
 Countercurrent Mechanism
 Maintain the concentration in the
medulla
 Medulla is diluted by the water from the
descending Loop of Henle
 Concentration by Sodium and Chloride
from the filtrate in the Ascending Loop
of Henle
 PCT – aldosterone controlled Sodium
reabsorption is needed by body.
o Collecting Duct Reabsorption
 Final filtrate concentration – Water
reabsorption by ADH in response to body
hydration
 ADH/Vasopressin – controls the
permeability of Distal and Proximal
Convoluted Tubules walls to water; amount
of ADH produced by Hypothalamus
determines permeability
 INCREASE Body Hydration = DECREASE ADH
= INCREASE Urine Volume; DECREASE Body
Hydration = INCREASE ADH = DECREASE
Urine Volume
 Functions
o Reabsorption – filtrate to blood
o Secretion – blood to filtrate
o Eliminate nonfiltered waste:
 Protein – blood substance
 Regulate Acid Base Balance
 Secrete Hydrogen Ions to return filtered
buffers to the blood
 Excretion of excess Hydrogen Ions
 Bicarbonate – secretion of H+ present
excretion of HCO3; filtered bicarbonate is
returned to the plasma
 Phosphate – small hydrogen ions are readily
reabsorbed and may need to be excreted;
excess Hydrogen Ions not needed to return
filtered bicarbonate and excreted as H2PO4
 Ammonia – produced and secreted by the
Distal Convoluted Tubules; H+ combines to
form NH4 that cannot be reabsorbed;
additional ammonia is produced from the
metabolism of glutamic in the Proximal
Convoluted Tubules.
RENIN ANGIOTENSIN ALDOSTERONE SYSTEM
 Kidneys sense a decrease in blood pressure, blood
volume and releases renin from the juxtaglomerular
apparatus
 Renin converts angiotensinogen into angiotensin I
 In lungs, angiotensin-converting enzyme (ACE)
converts angiotensin II to angiotensin II.
 Regulation blood flow
 Responds to blood pressure and plasma sodium
changer
 Juxtaglomerular apparatus
o Juxtaglomerular cells – afferent
o Macula densa – Distal Convoluted Tubules
 Macula densa initiate RAAS in response to blood
flow pressure changes
 Function of Angiotensin II:
o Dilates afferent arterial
o Constricts afferent arteriole
o Stimulates sodium reabsorption in proximal
convoluted tubule
o Trigger release of aldosterone
 Reabsorption of sodium in distal convoluted
tubule
 Increase potassium excretion
o Trigger release antidiuretic hormone
 Stimulate water reabsorption
CHEMICAL EXAMINATION OF URINE
Reagent Strips
 Used to perform the routine chemical test on urine.
 Chemical analysis of urine, including pH, protein,
glucose, ketones, blood, bilirubin, urobilinogen,
nitrite, leukocytes, and specific gravity.
 Consist of chemical-impregnated absorbent pads
attached to a plastic strip.
 Sold under the names Multistix and Chemstrip
 Some variations occurs between the strip with
regards to sensitivity and specificity and interfering
substances, uses should be familiar with the product
literature.
 Also used with automated instruments
 Color comparison charts are supplied by the
manufacturer
 Several degrees of color are shown to provide semi
quantitative reading of trace, 1+, 2+, 3+, or 4+.
 Estimated of md/dL are also provided for many of
the test areas
Reagent Strip Technique
 Dip strip briefly into well-mixed specimen at room
temperature.
 Remove excess urine by touching edge of strip to
container as strip is with drawn
 Blot edge of strip; compare color reaction to
manufacturer’s chart.
Improper Technique Errors
 RBCs and WBCs sink to the bottom of an unmixed
specimen
 Enzyme reaction on strip are based on room temp
readings
 Reagents will leach off a strip remaining in the urine
too long
 Excess urine on the strip will cause runover of
reagents among the pads
 The amount of the time for reading to occur is
specified by the manufacturer; leukocyte esterase is
the longest at 2 minutes
Handling & Storage of Strips
 Reagent strips are packaged in opaque containers
with a desiccant to protect them from light and
moisture.