Urinary Health and Vegetable Effects

Urine Examination (T&P)

• Physical examination
• Chemical examination
• Microscopic examination
• Microbiological examination

Collection of Urine for Analysis

• Preservative added (toluene, chloroform, thymol, formalin) to prevent contamination
• Change in pH causes degeneration of casts and cell lysis
• If urine is kept for longer than 8 hours, nitrite may be falsely positive
• If urine is kept >8 hours, keep at 2-8°C
• Keeping urine in the refrigerator is recommended in hot weather
• Urea-producing organisms degrade urea to ammonia, changing pH to alkaline
• Urine should be collected and analyzed within one hour of collection if held at room temperature

Factors that will interfere with the urine analysis

• Certain foods may alter urine color
  • Carrots: dark yellow
  • Beets: red
  • Rhubarb: red or brown
  • Asparagus: typical odor
• Bacteria in the urine will change pH, making it alkaline and ammonia is produced
• Citrus fruits, dairy products, and vegetables may make urine alkaline
• High protein diets and some foods (cranberries) make urine acidic
• Radiopaque contrast media causes false-positive urine protein for at least 3 days
• Vaginal secretions contaminate urine and increase WBCs
• Traumatic catheterization may increase hematuria and false RBCs in the urine
• Contamination with stool, vaginal secretions, or contaminated test tubes/hands/clothes will cause false-positive urine culture results

Urine Analysis, Physical Examination

• Volume (normal range: 600-2000 mL in 24 hours)
• Specific Gravity
• Aspect
• Color
• Odor
• Deposit
• Reaction (pH)

Specific Gravity (SG)

• Measures solute concentration (urea, sodium)
• Weight of 1 mL of urine in grams divided by 1 mL of water
• Normal range: 1.010-1.030

Types of Urine According to Specific Gravity

• Isosthenuria: fixed specific gravity (around 1.010), not influenced by water intake/dehydration
• Hyposthenuria: low specific gravity (<1.010) - Diabetes insipidus
• Hypersthenuria: high specific gravity (>1.010) - Diabetes mellitus

Normal Urine Specific Gravity

• Adult: 1.005 to 1.030 (mostly 1.010 to 1.025)
• Newborn: 1.003 to 1.025
• Older people: Value decreases

Urine Analysis Procedure (measuring Specific Gravity)

• Urinometer (hydrometer)
• Refractometer

Chemical Reagents Strips

• Disposable colorimetric reagent strips
• Do not require an instrument

Appearance (Transparency)

• Normal fresh urine: clear and colorless
• Cloudy urine: indicates possible abnormal constituents: WBCs, epithelial cells, crystals, bacteria

Urine Clarity Variables

• Clear
• Hazy
• Cloudy
• Turbid

Urine Odor

• Normal: faintly aromatic
• Abnormal: fruity (acetone in urine – diabetic ketoacidosis) or ammonia (bacteria) or foul (infection)

Causes of Acidic and Alkaline Urine

• Alkaline urine: vomiting, vegetable diets, low carbohydrate diets, chronic renal failure, bacteria (ammonia-producing), respiratory and metabolic alkalosis, acetazolamide therapy.
• Acidic urine: starvation, dehydration, diarrhea, protein diet, metabolic acidosis, sleep, acid-producing bacteria, diabetic acidosis.

Urine Protein

• Normal: less than 10 mg/dL or 100 mg in 24 hours
• Proteinuria: presence of protein in urine > normal, suggestive of renal disease
• Pre-renal causes: intravascular hemolysis, muscle injury, congestive heart failure, multiple myeloma, hyperthyroidism
• Renal causes: glomerulonephritis, autoimmune disease (lupus nephritis), renal amyloidosis, toxic agents (drugs), diabetic nephropathy, lipoid nephrosis, hypertension, pre-eclampsia, Fanconi syndrome
• Post-renal causes: lower urinary tract infections, vaginal secretions, spermatozoa, renal stones or injury, malignancy

Urine Glucose

• Normal: <100mg/24 hours and <180 mg/dL
• Glycosuria with hyperglycemia: diabetes mellitus, other endocrine disorders, pancreatic diseases, CNS dysfunction, massive metabolic disorders, drug-induced disorders
• Glycosuria without hyperglycemia: Fanconi syndrome, advanced renal disease, familial renal glucosuria

Urine Ketones

• Presence of acetone, acetoacetic acid, ß-hydroxybutyric acid
• Clinical significance: diabetic acidosis, alcoholism, hyperthyroidism, starvation, malabsorption, pancreatic disorders, strenuous exercise, or vomiting.

Urine Blood

• Presence of RBCs, hemoglobinuria, or myoglobinuria
• Clinical significance: Renal calculi, glomerulonephritis, pyelonephritis, tumors, trauma, exposure to chemicals, anticoagulant therapy , thrombocytopenia

Urine Bilirubin

• Yellow-orange bile pigment from hemoglobin breakdown
• Clinical significance: Hepatitis, cirrhosis, other liver disorders, biliary obstruction

Urine Urobilinogen

• Formed in the small intestine from bilirubin reduction by bacteria
• Clinical significance: Increased levels: liver disorders, hepatitis, cirrhosis, hemolytic disorders, malaria; Decreased levels: biliary obstruction, renal insufficiency, or severe diarrhea

Urine Specific Gravity

• Normal range: 1.003-1.035
• Isosthenuria: 1.010
• Clinical significance: hydration, dehydration, renal tubular concentrating ability, diabetes insipidus, or diabetes mellitus

Urine Leukocytes/WBCs

• Normal: < 5 WBC per microliter
• Significance: bacterial or non-bacterial urinary tract infection
• False Negative result: delay in examination, bacteria not converting nitrate to nitrite, or low dietary nitrate

Urine Nitrite

• Formed when bacteria convert nitrate to nitrite
• Positive result: indicative of significant bacteriuria, perform urine culture
• Negative result: may not necessarily mean absence of bacteriuria
• False Positive result: delay, colored substances (e.g., phenazopyridine)
• False Negative result: inadequate time, low dietary nitrate, high specific gravity, or vitamin C high

CSF Formation, Function, and Composition

• Site of formation: choroid plexus (70-80%) and ependymal cells
• Volume: ~150 mL produced at a rate of 450-500 mL per day
• Circulation pathway: lateral ventricles --> third ventricle --> fourth ventricle --> subarachnoid space --> venous system
• Function: protection (cushion), buoyancy (reducing brain weight), chemical stability (removes waste, provides nutrients), transport (delivers hormones), immunological defense (protects against infections)
• Normal composition: Appearance (clear, colorless), Cells (<5 white blood cells/μL), Protein (15-45 mg/dL), Glucose (50-80 mg/dL), pH (7.28-7.32), Chloride (115-130 mEq/L)

CSF Collection Techniques

• Lumbar Puncture (Spinal Tap)
• Ventricular Puncture
• Cisternal Puncture

CSF Analysis in Laboratory

• Bacterial meningitis: Elevated WBC count (polymorphonuclear cells), decreased glucose, elevated protein, turbid appearance.
• Viral meningitis: Elevated lymphocytes, Normal or slightly reduced glucose, slightly elevated protein, clear appearance.
• Subarachnoid hemorrhage: Xanthochromia, increased RBCs
• Multiple sclerosis: Oligoclonal bands on electrophoresis

CSF Handling and Distribution to the Lab

• Tubes: Tube 1: Chemistry (glucose, protein, lactate) Tube 2: Microbiological (culture, Gram stain) Tube 3: Cell count and differential (WBC, RBC count) Tube 4: Additional/special tests (immunology, PCR)

Test your knowledge on how certain vegetables can affect urine color and odor. This quiz covers important aspects of urinary analysis and general dietary recommendations. Understand the implications of vegetable intake on urinary health.