ANALYSIS OF URINE AND OTHER BODY FLUIDS  The total pressure that

promotes filtration
 Normal: 100 mmHg
RENAL PHYSIOLOGY  Formula:
 GBHP – CHP –
Kidney BCOP
- Excretion of urine - Renin-Angiotensin-Aldosterone System
- Weighs 150 g o ↓ BP, SNS stimulates
Cortex juxtaglomerular cells to produce
- Plasma filtration renin, converting. . .
- Reabsorption o Angiotensinogen (plasma
Medulla protein) to Angiotensin I
- Concentration of urine o Circulates into the lungs
Cortical nephrons converting it to Angiotensin II by
- Most abundant (85-90%) Angiotensin-converting enzyme
Bowman’s capsule o Angiotensin II stimulates:
- Encapsulates glomerulus  Vasoconstriction
- Membranous (afferent arterioles to ↑
Glomerulus BP)
- Collection/tuft of capillaries  Hypothalamus to
- Site of filtration release ADH
 Adrenal gland to
RENAL BLOOD CIRCULATION release Aldosterone
Vasa recta Tubular Reabsorption
- Adjacent to the loop of Henle - Reabsorption of important substances
- Exchanges of Sodium and water to - 99% of water is reabsorbed
maintain the osmolarity of medulla - 65% of filtrate is reabsorbed also

3 BASIC RENAL PROCESSES Active transport

Glomerular Filtration - Needs a carrier protein and energy
- Afferent arteriole supplies blood to (electrochemical energy)
glomerulus - PCT (glucose, amino acids, salts)
- Filtrate (pre-urine) - ALoH (chloride)
- 4x higher in blood pressure - DCT (sodium)
- Factors: - Osmotic Gradient (medulla)
Cellular Structure of the Capillary Wall - Maximal Reabsorptive Capacity (Tubular
o 1st layer: Endothelium Maximum)
o Fenestra o Highest level a substrate is
 Specialized pores reabsorbed before appearance
 Allows passage of all of substance in the urine
substances except o E.g. glucose (350 mg/min)
blood cells - Renal Threshold
o 2nd layer: Basal Lamina o Plasma concentration at w/c A.T
 Restriction of protein stops
o 3rd layer: Visceral membrane o E.g. glucose (160-180 mg/dL)
 Contains filtration slits o Dependent on the amount of
 Passage of very small substance in the plasma
substances - MRC and RT importance:
o Podocytes o Distinguishes excess solute
 Little foot processes filtration and extent renal tubules
 Holds filtration damage
membrane - Minimal RC
o All layers are negatively- o Glucose
charged o CHON
 Shield of Negativity o Phosphates
Hydrostatic and Oncotic Pressure o Sulfates
(Starling Forces)
o Glomerular Blood Hydrostatic Passive Transport
Pressure - Movement of molecules as results of
 Favors filtration differences in the electrical potential
 Force exerted by blood - PCT, DLoH, CT (water)
in order to push - PCT, ALoH (urea)
substances - ALoH (sodium)
o Glomerular Colloid (Oncotic) Renal Concentration
Pressure - LoH
 Opposition of filtration o Initial concentration of urine
process - Permeable to salts (osmolarity)
o Bowman’s Capsule Pressure - Impermeable to water (ADH)
 Oppose fluid - Counter-current mechanism/multiplier
o Net Filtration Pressure
 - Keep the renal medulla at high  Fishberg
osmolarity so water can move passively  Deprived of
out of the filtrate fluids for 24 hrs
 Mosenthal
Water diuresis  Compare the
- Water is allowed to pass out the body volume and s.g
- Aquaporin channels of day and
night urine
TUBULAR SECRETION samples
- Passage of substances from peritubular - Osmolality
capillaries to the tubular filtrate o Measures number of particles in
- Major functions: a solution
o Eliminating waste products not o For more accurate evaluation of
filtered by the glomerulus renal concentrating ability
o Regulating acid-base balance - Freezing point osmometers
- Proteins have higher affinity to tubular - Vapor pressure osmometers
cells - Free water clearance
o Determined by calculating the
Acid-Base Balance osmolar clearance then
- Buffer capacity of blood depends on subtracting the value from the
bicarbonate ions urine volume in mL/min
- Reabsorption of bicarbonate ions
depends on the secretion of hydrogen TUBULAR SECRETION, RENAL BLOOD FLOW TESTS
ions of renal tubular cells
- Excretion of hydrogen ions in 2 ways: P-AMINOHIPPURIC ACID TEST
o Combination with phosphate ion - The substance used should be removed
o Combination with ammonia ion from the peritubular capillaries rather
(product of synthesis of than being filtered in the glomerulus
glutamine) - PAH
o Loosely bound to plasma
GLOMERULAR FILTRATION TESTS proteins
- Volume of plasma flowing thru the
CLEARANCE TESTS kidneys determines the amount of PAH
- Measures the filtering capacity of excreted in the urine
glomeruli
- Rate at w/c the kidney are able to PHENOLSULFONPHTHALEIN TEST
remove or to clear filterable substances - Used to evaluate these function
from the blood - Disadvantages:
- Substances analyzed should not be o Producing anaphylactic shock
reabsorbed nor secreted o Interference by medications
o Elevated waste products in
Inulin clearance patients’ serum
- Polymer of fructose o Necessity to obtain several very
- Reference method accurately timed urine
- Should be infused by IV at a constant specimen
rate during the procedure
- Extremely stable URINALYSIS
- Provides info about:
Cystatin C o State of the kidney and UT
- Produced at a constant rate by all o Can reveal diseases
nucleated cells
Oldest Lab Tests
Beta2-Microglobulin - Physical examination
- Dissociates from HLA at a constant rate - Chemical examination
- Rise in plasma level indicates a decrease - Microscopic examination
in GFR
Urine composition
Radionucleotides - Urea
- 125𝐼−𝑖𝑜𝑡ℎ𝑎𝑙𝑎𝑚𝑎𝑡𝑒 provides a method for - Creatinine and Uric acid
determining GF thru plasma - Inorg. Substances: Cl, Na, K
disappearance of radioactive material - SO4 and PO4
and enables visualization of both kidneys

TUBULAR REABSORPTION TESTS Factors influencing its conc:

- Dietary intake
CONCENTRATION TESTS - Physical activity
- Water Deprivation Test - Body metabolism
o Measures specific gravity - Endocrine functions
o Types: - May contain:
 o Cells o Physical activity
o Casts
o Crystals 1ST MORNING
o Mucus and Bacteria - Ideal screening sample
- Prevents false-negative pregnancy
Urine volume results
- Depends the amount of water excreted - For calculation of Orthostatic Proteinuria
- Factors: - More concentrated
o Fluid intake - Disadvantage:
o Fluid loss from non-renal sources o Should be delivered to the lab
o Secretion of ADH immediately

Anuria FASTING URINE

- Cessation of urine flow - Second voided spx after a period of
fasting
Oliguria
- Excretions of decreased amount of urine 2-HR POST PRANDIAL URINE
- Urine before eating
Polyuria - Collect 2 hrs after eating
- Diurnal Excretion of increased amount of - Monitors insulin therapy in px w/ DM
urine
GTT
Nocturia - For glucose and ketones
- Nocturnal excretion of increased
amount of urine 24-TIMED
- Quantitative purposes
Diabetes insipidus
- Excessive thirst CATHETERIZED
- Deficiency of vasopressin - For bacterial culture

SPECIMEN PRESERVATION MIDSTREAM CLEAN-CATCH

- Refrigeration @ 2-8°C - Hexachlorophene and povidone-iodine
- Increases s.g when measuring using should not be used prior to collection
urinometer
o Formation of amorphous SUPRAPUBIC ASPIRATE
substances - Sample for bacterial culture and
- Ideal preservatives: cytological examination
o Bactericidal
o Inhibit urease PROSTATIC
o Preserve formed elements in the - (+) 10x higher bacterial count
sediment - Types:
o Do not interfere w/ chemical o 3-glass collected
tests  For prostatic infxn
PRESERVATIVE ADVANTAGE DISADVANTAGE o Pre- and Post- massage test
Refrigeration  Do not interfere w/  Precipitates o Stamey-mears test
chem tests amorphous  4 samples
substances  1st: UT infxn
Boric acid  Bactericidal  Interferes w/  2nd: bladder infxn
drug analysis  3rd: RECOMMENDED
Formalin  Excellent  Reducing agent  4th: flash out prostatic
fluid
NaF  Good preservative  Inhibits glucose,
for drug analysis blood and
FOR DRUG TESTING
leukocytes
- Chain of Custody
Commercial  2nd choice if no  Side effects
o Documentation for proper
refrigerator during testing
sample identification from the
Urine  Contains
time of collection to the receipt
collection kits equipment for
of lab results
collection
- 30-45 mL
Light Gray and  Stabilize sample @  Do not use if
- 32.5-37.7°C
Gray tube room temp for 48 sample is below
hrs minimum fill line
PHYSICAL EXAMINATION OF URINE
Yellow UA Plus  Use on automated  Must refrigerate
tube instruments w/in 2 hrs COLOR
Cherry red  Stable for 72 hrs @  Must be filled to  Colorless-black
tube room temp minimum fill line  Normal Color
o Yellow caused by urochrome
TYPES OF URINE SPECIMEN  Product of endogenous
RANDOM URINE metabolism
- Most common o Uroerythrin
- May produce erroneous results due to:
o Dietary intake
  A pink pigment w/c is usually  Blue/Green
present in a refrigerated spx o Pseudomonas infxn and breath
 Precipitation of amorphous deodorizers (Clorets) imparts green
urates color
 Uroerythrin + urates o Urinary indican also imparts green
o Urobilin color
 Oxidation of urobilinogen  A derivative of indole
 Orange-brown color to a formed in the intestine when
not fresh spx CHON is putrefied leading to
 Dark Yellow/Amber/Orange Indicanuria – increased
o Due to presence of bilirubin excretion of urinary indican
 Produces yellow foam when  Hartnups Disease
shaken  Malabsorption of
 May be cause by Hepa B tryptophan due to
virus bacterial
 Photo-oxidize imparts yellow- degradation or
green color due to biliverdin hereditary traits
o May be caused by administration of o Methocarbamol (Robaxin),
phenazopyridine or azo-gantrisin Methylene Blue and Amitriptyline
 Medication for UTI (Elavil) imparts blue color
 Interferes w/ chem tests  Blue Diapers Syndrome
based on color reaction  Incomplete
 Can produce a yellow foam breakdown of
 Can lead to false positive for tryptophan
bilirubin o Klebsiella and Providencia spp.
 Red/Pink/Brown imparts purple color
o Blood imparts red color
 RBC – cloudy and red CLARITY
 Free Hb and Myoglobin –  General term for transparency or turbidity of
clear and red spx
 To identify w/c is Clear No visible particulates
w/c, test there Hazy Print easily seen
plasma Cloudy Blurred Print
o Oxidation of Hb to methemoglobin Turbid Print Cannot be seen
imparts brown color Milky Clotted
o oxidize porphyrin from  Nubecula
porphobilinogen imparts port wine o Faint cloudiness on urine
color o Might be WBC, mucus or epithelial
 Porphyria Cutanea Tarda cells
 Lack of  Pseudochyluria
uroporphyrinogen o Caused by vaginal cream
decarboxylase for
heme synthesis SPECIFIC GRAVITY
 Congenital erythropoietic  Density of a sol compared w/ the density of
porphyria similar volume of distilled water at similar
 Lack of temp.
uroporphyrinogen III  Determines whether spx conc. is adequate
synthase to ensure the accuracy of chem tests
 Lead porphyria  Plasma Filtrate s.g = 1.010
 Inhibition of delta- o Isosthenuric
aminolevulinate o Hyposthenuric
dehydratase in  Below 1.010
heme pathway o Hypersthenuric
 Brown/Black  Above 1.010
o Spx that turn brown or black on  Normal random spx = 1.002 – 1.035
standing and have negative chem o NOT A URINE IF IT IS BELOW 1.002
tests for blood  Measures the dissolved chemicals in the
o Melanin imparts black color specimen
 Oxidation of melanogen  Methods for measurement:
and increase in malignant o Urinometer
melanoma  Principle of buoyancy
o Refractometer
 Alkaptonuria  Calibrated using Distilled
 Inborn-error of water, 5% NaCl, 9% sucrose
metabolism of o Reagent strip
phenylalanine and o Harmonic Oscillation Densitometry
imparts a black  ‘frequency of sound wave
color due to entering a sol changes in
homogentisic acid – proportion to the density of
oxidation of the sol
phenylalanine  Use originally in early urine
automated instruments
 ODOR
 Normal = Faint Aromatic
ODOR CAUSE
Foul, NH3-like  Bacterial decomposition
 UTI
Fruity, Sweet  Ketones in case of DM, starvation
and vomiting
Maple syrup  MSUD
Mousy  Phenylketonuria
Rancid  Tyrosinemia
Sweaty feet  Isovaleric academia
Cabbage  Methionine malabsorption
Bleach  Contamination
Rotting fish  Increase of trimethylaminuria
Pungent  Intake of onions and garlic
Asparagus-like  Increase of methylmercaptan

 Oasthouse Urine Disease

o Metabolic defect in absorption of
methionine converted by GI
bacteria to alpha-hydroxybutyric
acid characterized by diarrhea and
marked UTI producing a oasthouse-
like odor