ClinMic Lec c2c PDF - Introduction to Urinalysis

TRANS: Introduction to Urinalysis MT TERM CLINICAL MICROSCOPY...

TRANS: Introduction to Urinalysis MT TERM CLINICAL MICROSCOPY OLIGURIA (DECREASE IN URINE OUTPUT) Fluid loss in both diseases is compensated by increased 05 A decrease in urine output and this is mainly when the ingestion of water Polydipsia, producing an even greater body enters a state of dehydration. urine volume. Polyuria accompanied by increased fluid LECTURE \ CASTRO o There is excessive water loss that is maybe from intake is often the first symptom of either disease. vomiting, Diarrhea, perspiration or severe burns. MODULE 1: INTRODUCTION TO CLINICAL MICROSCOPY ANURIA (CESSATION OF URINE FLOW) This result from serious damage to the kidneys or OUTLINE URINE COMPOSITION decrease of blood flow to the kidneys. Thus, there is little I History and Importance Urine is composed of 95% water and 5% solute. Its major to no urine output. II Unique characteristics of a urine sample metabolic waste product is Urea. III Urine composition If the patient has formed elements which are RBC, WBC NOCTURIA (INCREASE IN NOCTURNAL and Epithelial cells. When there is an increase amount of EXCRETION OF URINE) these formed elements in the patients urine, these are OBJECTIVES often indicative of disease because normally they are not Normally, kidneys excrete 2 or 3 times more urine during Outline the history and importance of urinalysis found in a patients urine or in a normal urine. the day than during the night. Explain the clinical importance of performing urinalysis in Urea is produced in the liver from the breakdown of In cases of nocturia, a patient tends to urinate excessively the laboratory proteins and amino acids. Urea accounts for nearly half during the night than the day time. List the urine composition and volume and differentiate of the total dissolved solids in the urine. Polydipsia is the intense/excessive sense of thirst, which Diabetes Mellitus from Diabetes Insipidus Chloride is the major inorganic solid dissolved in the POLYURIA (INCREASE DAILY URINE VOLUME) in turn will result to polyuria. o When the patient suffers from polydipsia, there is an urine. If the patient has formed elements Excretion of large volumes of urine daily HISTORY AND IMPORTANCE excessive sense of thirst and the patient will want to Approximately greater than 2.5L per day in adults and In earlier times, the contributors in urinalysis are URINE COMPOSITION drink more volume of fluid (increased fluid intake) and 2.5 to 3 mL/kg per day in children. o Hippocrates ORGANIC INORGANIC will produce an even greater urine volume which is Oftentimes polyuria is associated with diabetes mellitus described as polyuria. o Summerians Urea (Major metabolic NaCl (Major metabolic and diabetes insipidus. o Hindu cultures waste) waste) TYPES OF URINE SPECIMEN This can also be artificially induced by diuretics, intake of o Uroscopy Creatinine K First Morning Specimen caffeine, or alcohol. All of these suppress secretion of the In the 1140AD, Color charts were developed. These Uric Acid Sulfate antidiuretic hormone (ADH) if it is artificially induced. This is collected immediately on arising from sleep. color charts describe the significance of 20 different urine Hippuric Acid Phosphate This is the urine that is retained in the bladder for colors that aid the physicians in earlier times. Other substances Ammonium approximately 8hrs. DIABETES MELLITUS AND DIABETES INSIPIDUS It progressed into chemical testing, ant testing, to taste Magnesium Patients with diabetes mellitus and Diabetes Insipidus, It is the ideal screening specimen to test substances testing for glucose. Since ants are attracted to sweets, Calcium that require concentration or incubation e.g, Nitrites the physician would order urinalysis because it is very they did Ant testing. They also did taste testing for and protein. important in the differential diagnosis of the two glucose not until Fredrick Deckers discovery in 1694 of it is ideal for patients subjected to pregnancy testing URINE BREAKDOWN Albuminuria. In which, he discovered this by boiling the because it prevents false negative pregnancy test urine. 0.05% Ammonia DIABETES MELLITUS results. 0.18% Sulphate In diabetes mellitus, there is a defect in pancreatic o Typically, when you boil the patient’s urine and the It evaluates and confirm orthostatic proteinuria 0.12% Phosphate production of insulin or in the function of insulin itself. patient has albuminuria, there will be white precipitate upon boiling of the urine. 0.6% Chloride The function of insulin is to control glucose. Random Specimen 0.01% Magnesium Both defects in the insulin that is in the Production and This is the most commonly received urine specimen. 0.015% Calcium its Function causes increase in the body’s glucose RICHARD BRIGHT formation. Patients with Diabetes Mellitus kidneys do not Useful for routine screening tests to detect obvious 0.6% Potassium He contributed that urinalysis should be a part of doctor’s reabsorb the excess glucose. abnormalities 0.1% Sodium May show erroneous results due to the different factor routine patient examination in 1827. 0.1% Creatinine If there is decrease production or non-functional insulin In 1930s, Urinalysis began to disappear from routine 0.03% Uric Acid then there will be excess glucose in the body. When this that could affect the content or the composition of the examinations. However, the development of modern goes to the kidneys, the kidneys cannot reabsorb the patient’s urine sample 2% Urea testing techniques rescued routine urinalysis and excess glucose and excrete it to the urine. When the For Random specimen collection, the patient is 95% Water instructed for proper hydration. They are instructed to remained an integral part of the patient examination up kidneys excrete excess glucose to the urine, it until today. necessitates water. To remove the excess glucose in the drink 24 – 32 ounce of water each hour for 2 hours FACTORS THAT INFLUENCE VARIATIONS IN body the kidney must excrete increased amounts of before they collect their urine specimen. UNIQUE CHARACTERISTICS OF A URINE CONCENTRATION OF THE SOLUTES water. That is why patients with Diabetes Mellitus has Timed collection: 24-hour Specimen SPECIMEN There are factors that affect the solutes and these are: Polyuria. This is ideal for quantitative urine assay it can be 12 o Dietary intake hour or 24 hours urine specimen. Unlike blood in which you’ll have to undergo a needle to The urine specimen with Diabetes Mellitus is Dilute but its collect. Urine is: o Body Metabolism urine has high specific gravity because of the increased There are 2 types of time collection other than 12 hour o Physical Activity glucose content. and 24 hours collection and that is collected during o Readily available o Endocrine functions the specific time of day and collected for o Easily collected A diluted urine appears light yellow, it’s similar to water o Body Positions predetermined length of time. o Contains information about many of the body’s major but because of pigments it appears as light yellow. metabolic functions. Examples of collecting during the specific time of day URINE VOLUME DIABETES INSIPIDUS o 2pm to 4pm WHY PERFORM URINALYSIS? There are factors to consider in the urine volume. And Diabetes insipidus results from a decrease in the o 2hour collection for determining for urinary these are: urobilinogen. It aids in the diagnosis of disease production or function of antidiuretic hormone (ADH). o Fluid intake ▪ The maximal excretion of this urine Screens asymptomatic populations for undetected thus, the water necessary for adequate body hydration is ▪ Since water is a major body constituent, it is not reabsorbed from the plasma filtrate. composition is only between 2pm to 4pm disorders, congenital, or hereditary diseases determined by the body’s state of hydration Examples of predetermined length of time collections Monitors progress of disease o Fluid Loss from non-renal sources The water needed for adequate body hydration is not o 2hours Monitors the effectiveness of therapy or complications o Variations in the secretion of ADH (antidiuretic reabsorbed (excreted). o 12 hours especially for patients who have kidney disease. The urine of patients with Diabetes insipidus is truly dilute hormone) o 24 hours and with a low specific gravity. o Need to excrete increased amounts of dissolved What is collected here is quantitative urine assay such HOW IS URINE FORMED? solids such as glucose and salts BODY COMPENSATION TO DM AND DI PATIENTS as: Urine is an ultrafiltrate of plasma, it can be used to The normal urine output is in the range of 1200mL – o Albumin evaluate and monitor body homeostasis and many 1500mL. However, the range 600mL – 2000mL is also o Creatinine metabolic disease processes. considered normal when the factors are taken into o Albumin to creatinine ratio 170,000 plasma is converted to average daily urine consideration. output of 1200mL. TRANS BY: AUGUSTO | 3B-MT 1 TRANS BY: AUGUSTO | 3B-MT 2  TRANS: Introduction to Urinalysis TRANS: Introduction to Urinalysis 24hour Specimen collection It allows collection of a specimen SPECIMEN REJECTION In the case of a 24 hours urine specimen collection that represents elements and Grounds for specimen rejection are: SPECIMEN PRESERVATION must begin and end the collection period with an empty analytes from the bladder, ureters, o Unlabeled containers Refrigeration is the most routinely used preservative bladder. and the kidneys. ▪ Automatically reject once unlabeled because it prevents bacterial growth up to 24 hours. Upon arising/waking up of the patient (e.g., 8:00AM), Midstream clean-catch specimen o Nonmatching labels and requisition forms A disadvantage is that the urines specimen specific the patient should void the first morning specimen at eliminates source of o Contaminated with feces or toilet paper gravity is greatly increased. 8:00AM the during that day and is not collected since contamination when done o Contaminated exteriors Precipitates amorphous materials that first morning specimen was the urine that was properly. o Insufficient quantity collected in the bladder while the patient was asleep o Improper transportation IDEAL PRESERVATIVE (not part of the 24-hour period). ▪ If its more than an hour already before they 24 hours within the day, all of the voided urine must be SUPRAPUBIC ASPIRATION It should be Bactericidal submitted the specimen. External introduction of a needle through the abdomen o To prevent proliferation of bacteria collected up until nighttime, as long as it is within the 24-hour period that has been allotted for the collection. into directly into the bladder Inhibit urease IS THIS FLUID URINE? o To prevent the nitrite from being broken down 8:00AM the following day, when the patient arises, the It can be used for bacterial cultures especially for Ph should be in the range of 4-8 Preserve formed elements patient should also collect the first morning specimen anaerobic microbes and in infant’s specimen is often Specific gravity should be in the range of 1.002 – 1.035 Not interfere with chemical tests and include in the 24-hour specimen since the first unavailable. Temperature of the urine should be 32.5 – 37.5°C morning specimen of the second day was the urine High creatinine concentration that is approximately 15x that was collected in the bladder overnight, and that CATHETERIZED SPECIMEN that of the plasma concentration. time period still encompasses the 24-hour period Collected under sterile conditions Urea sodium and chloride are significantly higher in urine allotted for the collection. It has two types: than in other body fluids. If two first morning specimens are included in a single o Urethral 24-hour collection, erroneous results may happen due ▪ The catheter is inserted to the additional volume and analyte added. into the bladder via the CHANGES IN UNPRESERVED URINE Refrigerated or added with a chemical preservative to urethra. The urine flows Analyte Change Cause prevent proliferation of bacteria. directly from the bladder Color Modified/darkened Oxidation or reduction of metabolites Fasting Specimen to the plastic bag. Its significance is for the Odor Increased Bacterial multiplication or breakdown of urea to ammonia 2nd voided specimen after fasting. bacterial culture and routine screening as well. pH Increased Breakdown of urea to ammonia by urease-producing For glucose monitoring o Ureteral bacteria/loss of CO2 2hour post prandial specimen ▪ Same collection procedure but urine is directly Nitrite Increased Multiplication of nitrate reducing bacteria Patient void before consuming routine meal collected from the left or the right ureters. That is Bacteria Increased Multiplication 2 hours after eating. Specimen is collected and to differentiate kidney infection. Clarity Decreased Bacterial growth and precipitation of amorphous material tested for glucose Glucose Decreased Glycolysis and bacterial use Glucose Tolerance Specimen PEDIATRIC SPECIMEN Ketones Decreased Volatilization and bacterial metabolism Collection corresponds with blood samples drawing Soft, Clear plastic bag with hypoallergenic skin adhesive Bilirubin Decreased Exposure to light / photo oxidation to biliverdin during glucose tolerance test. attach to genital area. Urobilinogen Decreased Oxidation to urobilin Urine is tested for glucose and You have to check every 15 minutes for urine. RBC and WBC casts Decreased Disintegration in dilute alkaline urine ketones. Usually, pregnant patients are subjected for DRUG SPECIMEN COLLECTION glucose tolerance specimens. The chain of custody (COC) documentation of proper REFERENCES To help the physician in sample ID (Time of collection Lab results receipt) Notes from the discussion and PPT by Arbee Castro, determining if they are at risk There should be a witness for those who will be submitting for urine for drug testing. MSMT, RMT for diabetes mellitus during their pregnancy. Results are reported along with THINGS TO REMEMBER IN SPECIMEN the blood test results. COLLECTION Prostatic specimen Observe standard precaution it determines prostatic infection. Clean, dry, leak-proof containers should be used It uses three-glass collection procedure Disposable containers Gloves should be worn at all times COLLECTION TECHNIQUES RECOMMENDED TOOLS TO USE A mandatory cleaning The container for the urine sample should have a wide before collecting the mouth to facilitate collection from female patients and flat specimen to prevent bottom to facilitate over turning contamination from It must be made of clear material to allow identification of appearing in the urine color and clarity sample. The capacity of the urine container is 50mL o 10 to 50 mL is used for microscopic analysis, ROUTINE VOID chemical testing and etc. No patient preparation Before checking for physical properties of the urine, mix Simply have the patient urinate in an appropriate it by swirling the urine in a flat surface. container. MIDSTREAM CLEAN-CATCH SPECIMEN LABELING Cleansing materials provided Patient’s name Sterile container Date and time of collection This is also ideal for bacterial culture specimen and Labels must be attached to the container. routine urinalysis. The interior of the container should Never label on the top of the container not come in contact with patient’s hand or perianal area. o To instruct the patient; ▪ In midstream clean-catch urine specimen you REQUISITION allow the passage of initial urine that contains any Accompany specimens delivered to the laboratory urethral washings that contains normal bacterial flora of the distal urethra into the toilet bowl. TRANS BY: AUGUSTO | 3B-MT 3 TRANS BY: AUGUSTO | 3B-MT 4 MT 119: THE URINARY SYSTEM cortex and the deep,dark red region called the renal medulla. The renal medulla consists of several The urinary system is composed of the kidney, cone-shaped renal pyramids. The base ureters, bladder, and urethra. (wider end) of each pyramid faces the renal cortex, and its apex (narrower end), called a renal papilla, points toward the renal hilum. The renal cortex is the smooth textured area extending from the renal capsule to the bases of the renal pyramids and into the spaces between them. ○ It is divided into an outer cortical zone and an inner juxtamedullary zone. Those portions of the renal cortex that extend between renal pyramids are called renal columns. A renal lobe consists of a renal GLOMERULUS pyramid, its overlying area of the A capillary tuft surrounded by an renal cortex, and one-half of each expanded end of the renal tubule known There are two organs involved in as the Bowman’s capsule. adjacent renal column. acid-base balance: the kidney and the ○ This is supplied by the afferent and KIDNEYS Together, the renal cortex and renal lungs efferent arteriole. The filtrate goes Paired, bean-shaped organs, reddish in pyramids of the renal medulla constitute the parenchyma (functional portion) of the to the convoluted tubule known as color kidney. Within the parenchyma are the the proximal convoluted tubule Located retroperitoneally on either side of functional units of the kidney—about 1 responsible for tubular secretion the spinal column (posterior wall of the million microscopic structures called and reabsorption. abdominal cavity), just above the waist nephrons. ○ The first part of the loop of Henle ○ Located between the levels of the Urine formed by the nephrons drains into or nephron loop dips into the renal last thoracic and third lumbar large papillary ducts, which extend medulla, where it is called the vertebrae where they are protected through the renal papillae of the pyramids. descending limb of the loop of by the ribs 11 and 12 The papillary ducts drain into cuplike Henle. It then makes that hairpin Right kidney is slightly lower than the right structures called minor and major calyces. turn and returns to the renal cortex kidney because of the liver that occupies ○ Each kidney has 8 to 18 minor as the ascending limb of the loop the right side superior to the kidney calyces and 2 or 3 major calyces. of Henle. Macroscopically, a fibrous capsule of The concave medial border of each kidney A minor calyx receives urine from ○ After, the filtrate will go to the distal connective tissue encloses each kidney faces the vertebral column. the papillary ducts of one renal convoluted tubule where there will Capped with an adrenal gland or ○ Near the center of these concave papilla and delivers it to a major be reabsorption and secretion also. suprarenal gland borders is the indentation called calyx. ○ Within Bowman’s capsule Measurements of the kidneys: the renal hilum. ○ The epithelium of the nephron and ○ Non-selective filter of plasma ○ 10-12 cm long ○ Renal hilum - the ureter emerges the ducts become a transitional substances with molecular weights ○ 5-7 cm wide from the kidney along with its blood epithelium in the calyces. less than 70,000 ○ 3 cm thick vessels, lymphatic vessels, and the ○ 135-150 g weight nerves ○ From the major calyces, the filtrate becomes urine because there will RENAL PHYSIOLOGY Two regions can be discerned: The renal capsule is a smooth, dense be no further reabsorption that will 1 to 1.5 million nephrons ○ Renal cortex irregular connective tissue that is occur. Contains two types of nephrons: ○ (Inner) Renal medulla continuous with the outer coat of the ○ From the major calyces, urine ○ Renal cortex - approximately 85% Essential for maintaining homeostasis ureter. It serves as a barrier against drains into a single large cavity of nephrons including the regulation of body fluids, trauma and helps maintain the shape of called the renal pelvis (pelvis = ○ Renal medulla acid-base balance, electrolyte balance, the kidney. basin) and then out through the Ability of the kidney to clear waste and excretion of waste products The two main regions of the kidney are the ureter to the urinary bladder. products selectively from the blood and superficial, light red region called the renal simultaneously maintain the body’s  essential water and electrolyte balances is that will constitute the urine and are The varying sizes of these arterioles, the afferent controlled in the nephron. excreted. and efferent arterioles, will create a hydrostatic pressure. It is important for glomerular filtration By filtering, reabsorption, and secretion, the and maintaining consistency of the glomerular RENAL FUNCTIONS nephrons will help maintain homeostasis by the capillary pressure renal blood flow. Renal Blood Flow blood’s volume and composition. If there will be a Glomerular Filtration decreased blood flow to the kidneys, the kidneys When we say hydrostatic pressure (important for Tubular Reabsorption will be able to sense that and with the glomerular filtration|), this is the fluid that pushes Tubular Secretion mechanism, they will be able to whether conserve out of the blood vessels. Oncotic pressure forces water or (idk naa bitaw nag open mic). the fluid to get in at the blood vessels. In some books, the three major functions of the kidneys include glomerular filtration, tubular RENAL BLOOD FLOW CELLULAR STRUCTURE OF THE reabsorption, and tubular secretion. GLOMERULUS GLOMERULAR FILTRATION First step in urine production. ○ Water and most solutes in the Based on average body size of 1.7 m2 of blood plasma will move across the surface: wall of the glomerular capillaries. ○ Total renal blood flow is approximately 1200 mL/min FACTORS IN GLOMERULAR FILTRATION RENAL TUBULAR REABSORPTION ○ The total renal plasma flow ranges Cellular structures of the glomerulus As the filtered fluid flows to the renal Now let's go to the cells in the Glomerulus. 600-700 mL/min Glomerular pressure tubules to the collecting ducts, the tubule Again, systemic blood flow occurs through the The renal artery supplies blood to the Renin-Angiotensin-Aldosterone System cells reabsorb 99% of the water and many glomerulus and filtration rate depends on its kidney and then the blood will now go to useful solutes. arterial blood flow, systemic arterial blood segmental arteries that supply the renal The water and solutes return to the blood pressure, and eternal flow pressure within the pelvis. So in Cellular structure, they are the ones that as it flows through the peritubular kidney. After, it will go to the interlobar artery. will filter large and smaller substances. So they capillaries. These arteries are the ones that supply are the ones that filter out, they will not allow ○ After the glomerulus connects to Remember that water and dissolved minerals of the renal pyramids. passage of large substances. the vessels near the tubules, we small molecular size, primarily electrolyte, can Then, it will go to the arcuate artery that call that as the peritubular pass through the glomerular filter. And the filter supplies the boundary between the renal However for Glomerular pressure, if there will capillaries. retards the passage of large proteins. This cortex and their renal medulla. be an increase in pressure, if there will be Reabsorption - refers to the return of process of separating the colloid from crystalloid After, the blood will go to smaller branches increase in the dilation of the afferent arteriole substances to the bloodstream. is what we call the Ultrafiltration. that lie in the renal cortex known as the and constriction of the efferent arteriole, then interlobular artery then into the afferent more blood is filtered. And so if there will be TUBULAR SECRETION So there are tubular epithelial cells, the cells in arteriole into the glomerulus then into the constriction of the afferent arteriole, then there will As the filtered fluid flows to the renal the tubules, will modify the filtrate to affect efferent arterioles. be lesser blood that is filtered. tubules and the collecting ducts, the renal homeostasis and excretion. Vasa recta supports the thick descending tubules and duct cells will secrete other and thin descending loop of Henle. Then after, there are also the controlling materials such as wastes, drugs, and After the vasa recta or the juxtamedullary hormones and factors in the excess ions into the fluid that is not nephron, it goes now into the interlobular Renin-Angiotensin-Aldosterone System. needed by the body. vein into the arcuate vein, into the Removes substances from the blood. So interlobar vein, and exits to the renal vein. the fluids will be drained into the minor and major calyces and into the renal pelvis  So the Podocytes have several extending and also the oncotic pressure of the unfiltered a pressure to allow filtration. So there must be a processes that will adhere to the basement plasma protein. By increasing or decreasing the force to counteract this pressure (capsular membrane covering the Fenestrated squamous size of the afferent arteriole, there must be an hydrostatic pressure and colloid osmotic endothelium of the glomerular capillaries. autoregulatory mechanism within the pressure) because these 2 pressures does not Juxtaglomerular Apparatus that will maintain the allow filtration, so there must be a force so that In addition, the endothelial cells will have a glomerular blood pressure at a constant rate filtration can happen and that is the glomerular negative charge referred to as the Shield of regardless of the fluctuations in the systemic blood hydrostatic pressure. Now with the dilation negativity which will serve to repel most plasma blood pressure. So there is a baroreceptor within of the afferent arteriole and the constriction of the proteins to prevent their loss from the blood. And the juxtaglomerular apparatus of the kidney, they efferent arteriole, so these can enhance filtration. the extending podocyte processes form an can sense an increase or decrease of the blood elaborate network of small slits between them pressure. and we call this as the filtration slits. For example: - The dilation of the afferent arteriole and The plasma filtrate will pass through 3 cellular constriction of the efferent arteriole, when layers: the blood pressure drops, will prevent a 1. Capillary wall membrane decrease in blood flow through the kidney 2. Basement membrane thus preventing an increase in the blood 3. Visceral epithelium of the Bowman’s level of toxic waste products because the capsule afferent arteriole is dilated and so there So the endothelial cells of the capillary wall will RENIN-ANGIOTENSIN-ALDOSTERONE will be an increase blood flow to the differ from other capillaries because it has pores SYSTEM kidney. So the toxic waste products are in it and are referred to as Fenestrae. The pores The RAAS controls the regulation of blood secreted. So likewise, an increase in blood will increase the capillary permeability but they do to and within the glomerulus. The system pressure results in a constriction of the not allow the passage of large molecules, only responds to changes in blood pressure afferent arteriole to prevent overfiltration or small molecules can pass through these pores. GLOMERULAR PRESSURE and plasma sodium content that are damage of the glomerulus. monitored by juxtaglomerular cells in the - If the afferent arteriole is dilated, if there Then, further restriction of the large molecules afferent arteriole and the macula densa of will be an increase in blood pressure, occurs as the filtrate passes through the the distal convoluted tubule. more blood will flow to the kidneys and are basement membrane and the thin membranes ○ Low plasma sodium content filtered so it can result in overfiltration and covering the filtration slits formed by intertwining decreases water retention within may damage the glomerulus resulting in foot processes we call as the Podocytes. So mas the circulatory system (where acute kidney injury. ma filter pa gud siya because of these slits of sodium goes, water follows), - So a mechanism should be: an increase in intertwining foot processes we call as the resulting in a decreased overall blood pressure, the afferent arteriole will podocytes of the inner layer of the Bowman’s blood volume and subsequent constrict. That is to prevent overfiltration or capsule. decrease in blood pressure. damage to the glomerulus. As mentioned previously, the presence of the hydrostatic pressure resulting from the smaller size of the efferent arteriole and the glomerular capillaries enhances the filtration. So this pressure is necessary to overcome the opposition of pressures from the fluid within the Bowman’s capsule and the oncotic pressure of the unfiltered plasma proteins in the glomerular capillaries. Again, the presence of the hydrostatic pressure So here, as mentioned, there must be blood Now a decrease … (niungot gud si doc di ko results from the smaller size of the efferent colloid osmotic pressure, these are from the kasabot, 24:16 - 24:23) … mohinay ang renal arteriole and the glomerular capillary enhances proteins. And we have a capsular hydrostatic blood flow kay small man ang imong blood filtration. So we need a pressure to oppose pressure that is from the Bowman’s capsule. Now volume. pressures from the fluid of the Bowman’s capsule for filtration to happen, the glomerulus must have The system responds to changes in blood pressure and plasma sodium content increases, 2. Passive Transport distinguished between excess pressure and plasma sodium content that are the secretion of renin decreases. So with the The movement of molecules solute filtration and renal tubular monitored by juxtaglomerular apparatus. increasing water and salt retention, it will have a across a membrane caused by damage Epithelial cells near the afferent arteriole negative feedback to the kidney that is to differences in their concentration or ○ For example: The glucose and the macula densa of the distal decrease the secretion of renin and therefore, the electrical potential on opposite appearing in the urine of a person convoluted tubule so it has baroreceptors actions of the Angiotensin 2 produces a constant sides of the membrane with normal (di ma dungog 4:57) is that can sense changes in the blood pressure within the nephron to maintain ○ The renal concentration in a result of tubular damage but not pressure. homeostasis. the medulla differs from the diabetes mellitus. So again, when So low plasma sodium decreases water renal cortex. the plasma glucose is above 180 retention and results in a decrease in the GLOMERULAR FILTRATION ○ As the filtrate goes to the milligrams per deciliter, that’s the overall blood volume and subsequent Every minute, approximately 2-3 million inner part, mag ka increase time that it has exceeded the renal decrease in blood pressure. glomerular filtrate 120 mL of water ang concentration gradient threshold and so, active transport So when the macula densa senses such containing low molecular weight in the renal parenchyma. stops so it cannot be reabsorbed changes, a cascade of reactions within the substances ○ Water will be easily anymore and so they will appear in Renin-Angiotensin-Aldosterone System Now because this filtration is absorbed through passive the urine. Mao na during urinalysis, will occur. Non-selective, the only difference between transport you will have positive for glucose the compositions of the filtrate and the These physical differences are because the filtrate concentration plasma is the absence of plasma protein called GRADIENTS exceeds the Maximal Tubular and any protein bound substances and Passive reabsorption of WATER Reabsorptive Capacity (Tm). also cells takes place in all parts of The specific gravity of the filtrate as it NEPHRON except the leaves the glomerulus is 1.010 and ASCENDING loop of Henle confirms that it is chemically an ultrafiltrate UREA in proximal convolute tubule of plasma and ascending loop of Henle ○ Because again, they don’t have SODIUM in the ascending loop of proteins (non-selective filtration) Henle (accompanied by the active transport of CHLORIDE) TUBULAR REABSORPTION There are processes that allows the reabsorption TUBULAR REABSORPTION of solutes and water As the active transport, like the passive transport, can be influenced by the So what happens is that if there will be decrease 1. Active Transport concentration of the substance being in blood pressure, renin is produced by the The substance to be reabsorbed transported kidney. must combine with a carrier protein When the plasma concentration of a contained in the membranes of the substance that is normally completely In this picture, you can see that the osmotic So the Renin is an enzyme produced by the renal tubular cells reabsorbed reaches an abnormally high gradient increases as it goes down to the inner juxtaglomerular cells and secreted. And this will Responsible for the reabsorption of level, the filtrate concentration exceeds medulla, from 300 ni increase siya og 1200 react to the bloodborne substrate GLUCOSE, AMINO ACIDS, & the Maximal Tubular Reabsorptive mOsm. angiotensinogen to produce the inner hormone SALTS in the proximal convoluted Capacity (Tm) and that’s the time that the angiotensin 1. As the Angiotensin 1 passes to the tubule substance begins appearing in the urine. Now the active transport of the filtered sodium out lungs, the ACE (Angiotensin Converting Enzyme) Reabsorption of CHLORIDE in the So there is a threshold of reabsorption of of the proximal convoluted tubule is accompanied changes it to its active form called the ascending loop of Henle these solutes by the passive reabsorption of an equal amount Angiotensin 2. SODIUM in the distal convoluted The plasma concentration at which active of water. So therefore, the fluid leaving the tubule transport stops is termed as “renal proximal convoluted tubule remains the same In Angiotensin 2, it corrects the renal blood flow in threshold” concentration as the ultrafiltrate. the following ways. It will cause vasodilation of ○ For glucose, the renal threshold is the afferent arteriole to increase renal blood flow, 160-180 milligrams per deciliter. So in the picture above, as mentioned, glucose, and constriction of the efferent arterioles, it will Glucose appears in the urine when sodium, and amino acids are actively reabsorbed also stimulate reabsorption of sodium in the the plasma concentration reaches in the proximal convoluted tubules and then there proximal convoluted tubule and triggers the above this level is sodium reabsorption in the distal tubules and release of aldosterone in the renal gland to ○ So knowledge of the renal water reabsorption in the collecting tubules. It is stimulate reabsorption of sodium in the distal threshold and the plasma mentioned that water is reabsorbed passively in convoluted tubules. And also, as systemic blood concentration can be used to all parts of the tubule except for the ascending ○ High level of ADH increases 1. Elimination of waste products not loop of Henle. Water is reabsorbed because there PERMEABILITY, resulting in filtered by the glomerulus is an increased solute concentration in the INCREASED reabsorption of water 2. Regulation of the acid-base medulla. Water is reabsorbed so that it will (and so, ang maihi nato is a low balance in the body maintain the osmotic gradient. As it goes up into volume concentrated urine the ascending loop, diba it was mentioned that it because again water is reabsorbed Remember that in the glomerular filtration, those does not allow water or it does not reabsorb water by the body) that are not protein bound and are small because the filtrate will pass from a higher ○ ABSENCE of ADH renders the molecules, are filtered but what happens to those gradient to a lower gradient, mo pass nasad siya walls IMPERMEABLE to water that are protein bound and are large molecules from 1200 then it will go up to a 300 mOsm. Then (and so water is not reabsorbed that cannot be filtered by the glomerulus. after, it will go back to the distal tubules and so, they are excreted. This results collecting duct wherein the osmotic gradient now in a large volume of diluted urine) increases as the filtrate passes from the cortex So that’s the function of vasopressin, down to the medulla. So magka anam napud og whether permeable or impermeable ang increase imo osmotic gradient and so, more water walls of distal convoluted tubule will now be reabsorbed and the final As the production of aldosterone is concentration of gradient happens in the controlled by the body’s sodium collecting duct. Selective reabsorption process is concentration, the Production of ADH is called The Countercurrent Mechanism, and will determined by the state of body hydration serve to maintain the osmotic gradient of the medulla. ○ If there will be an increase in The actual concentration of the filtrate leaving the dobby hydration, then it senses the ascending loop is quite low, owing to the gland to decrease ADH secretion reabsorption of salt and the water in that part of and so, will have an increase urine the tubule. The reabsorption of sodium continues volume. Because the walls of the More foreign substances such as medications in the distal convoluted tubule but it is now under distal convoluted tubules and the that are not filtered by the glomerulus and are the control of aldosterone which regulates the collecting duct are impermeable bound to plasma proteins that need to be reabsorption in response to the body’s need of because of the decreased ADH excreted by the body are secreted through the So the other function of the tubular secretion is sodium. and so makaexcrete tag large tubules. However, when these protein bound the regulation of the acid-base balance in the volume of diluted urine. substances will enter the peritubular capillaries, body. Remember that the final concentration of the (diba sa renal blood flow mo agi siya sa efferent filtrate through the reabsorption of water begins in then goes to the peritubular capillaries those that ○ If the body is dehydrated, so it will It was mentioned earlier that there are 2 major the late distal convoluted tubule and continues to are not filtered by the glomerulus), these protein increase the ADH secretion and organs that are involved in the acid-base balance. the collecting duct. Reabsorption now depends on bound substances will develop a stronger affinity will allow water to come in and so One is the lungs and the second is the kidneys. the osmotic gradient on the medulla and the to the tubular cells and will dissociate from their we have a small volume So to maintain a normal blood pH of 7.4, the hormone vasopressin. As mentioned previously, carrier proteins and so, these will result to their concentrated urine. blood must buffer and eliminate excess acid the final concentration of the urine whether if it is transport into the filtrate by the tubular cells. So formed by the dietary intake. too diluted or too concentrated and ma excrete na the major site of removal of these non filtered urine is because of the distal convoluted tubule Therefore, the chemical balance in the substances happens in the proximal convoluted In terms when there is acidosis that we need to and the collecting duct. One factor also is the body is actually the final determinant of tubule. Those substances that are needed to be eliminate hydrogen, so the hydrogen will form presence of the hormone vasopressin. urine CONCENTRATION and VOLUME secreted that are protein bound not filtered by the carbonic acid and so they are recycled to become glomerulus are secreted in the convoluted tubules water and carbon dioxide but if in excess of ANTIDIURETIC HORMONE TUBULAR SECRETION or in the tubules, majority in the proximal hydrogen, they are excreted through ammonia. Passive reabsorption of water happens In contrast to tubular reabsorption, in convoluted tubules. So they will form with ammonia to form when the dilute filtrate in the collecting which substances are removed from the glomerular filtrate and returned to the ammonium ions and the resulting ammonium ions duct comes in contact with the higher blood, tubular secretion involves the is excreted into the urine. osmotic concentration in the medullary interstitium passage of substances from the blood in the peritubular capillaries to the tubular So in times that we need to have bicarbonate, Renders the walls of the distal convoluted filtrate when there is an acid excess, the hydrogen will tubule and collecting duct permeable or Serves 2 basic functions: combine with bicarbonate to form carbonic acid impermeable to water. and so they are degrade to become water and carbon dioxide and are reabsorbed to become bicarbonate and water and then with the carbonic anhydrase, again they will form to become bicarbonate and this bicarbonate are reabsorbed back so that we will maintain the acid-base if acidic and ang plasma pH. Additional excretion of hydrogen especially if acidotic, so it will combine with the ammonia to form the ammonium ion and this ammonium ion is excreted in the urine. So this is responsible for the smell of the urine. That’s why it's mapanghi because of the ammonium ion. ACID-BASE BALANCE Acidotic blood, H ions are secreted in exchange for sodium and bicarbonate ions Also, ammonia diffuses in the tubular lumen and subsequently sodium ions are reabsorbed while ammonia ions are excreted Alkalotic blood, tubular secretion of H+ is minimized and additional bicarbonate is secreted from the body  Clinical Microscopy Lecture - 6.5) o Then divide, ▪ 6/3 = 2 ▪ 3 because of the 3˚C that is constant o Then multiply, ▪ 0.001 x 2 = 0.002 o Then we add 0.002 to the initial reading, ▪ 1.030 + 0.002 = 1.032 o Corrected Specific Gravity = 1.032 SPECIMEN DILUTION ODOR Specimen with specific gravity readings greater than the Not part of routine urinalysis report refractometer or urinometer scale can be diluted and Use whiffing technique retested. If this is necessary, only the decimal portion of the Normal Aromatic or Odorless observed specific gravity is multiplied by the dilution Ammoniacal, Foul-like Infection (Urea -> ammonia), factor. Bacterial Decomposition, UTI Fruity, Sweet Presence of KETONES (DM, EXAMPLE starvation of vomiting) A specimen diluted 1:2 with a reading of 1.025 would Rotting Fish Trimethylaminuria have an actual specific gravity of a 1.050. Rancid butter Tyrosyluria/Tyrosinemia Sweaty Feet Isovaleric Acidemia Solution: Mousy odor Phenylketonuria o Get the dilution factor which is the reciprocal of the Cabbage Methionine Malabsorption dilution. 1:2 being the dilution, 2 is the reciprocal. Maple Syrup Maple Syrup Urine Disease o Multiply the reciprocal to the reading that you get, in (leucine, isoleucine, valine in this case 1.025. blood and urine) o 1.025 x 2, (caramelized sugar, curry) ▪ (ONLY MULTIPLY THE DECIMAL Bleach Contamination PORTION) Odorless Acute Tubular Necrosis o Final Specific Gravity: 1.050 Swimming pool Hawkinsinuria syndrome 3. HARMONIC OSCILLATION DENSITOMETRY REFERENCES Principle: The frequency of the sound wave entering a solution changes in proportion to the density of the Notes from the discussion and PPT by Fritz A. Bucao, solution. MSMT, RMT A portion of the urine sample enters a U shaped glass tube with an electromagnetic coil at one end and a motion detector at the other end. An electric current is applied to the coil which causes the sound wave to pass or oscillate through the urine sample. Its frequency is altered by the density of the specimen. There is a microprocessor at the other end of the tube, it measures the change in the sound wave frequency, compensate for temperature variations and convert the reading to specific gravity that closes correlates with the gravimetric measurement. Results are linear up to a specific gravity of: 1.080 4. REAGENT STRIP METHOD Principle: pKa change of polyelectrolyte. Reagent sensitive to number of ions in the urine specimen; indicator changes color in relation to ionic concentration. Manufacturers recommend adding 0.005 to specific gravity reading when pH is 6.5 or higher due to interference with the bromthymol blue indicator. Not affected by glucose, protein, and radiographic contrast media. TRANS BY: AWATIN & CABAHUG | 3B & 3C-MT 7 Clinical Microscopy Lecture Leukocyte esterase – 120s - Test reagents used in backup tests with positive and negative Lesson 4: Chemical Examination of Urine Nitrite – 60s controls Urobilinogen – 60s - Perform positive and negative controls on new reagents and newly Urinalysis Protein – 60s opened bottles of reagent strips - Physical pH – 60s - Record all control results and reagent lot numbers - Chemical Blood – 60s - Acceptable reagent strips does not entirely rule out the possibility - Microscopic Specific Gravity – 45s of inacurate results Ketones – 40s Routine Urinalysis Bilirubin – 30s How should controls be run to ensure the precision and accuracy  Macroscopic Glucose – 30s of the reage