Complete Urin Analysis - Fall Semester 2022 PDF

complete urin analysis Mrs. Baraa AL-Qarem Fall semester 2022  Importance Diagnose a medical problem, or to monitor a medical condition, including: UTI Diabetes Kidney problems Pregnancy Liver problem  Risk factor of UTI 1. Iatrogenic 2. Behavioral 3....

complete urin analysis Mrs. Baraa AL-Qarem Fall semester 2022  Importance Diagnose a medical problem, or to monitor a medical condition, including: UTI Diabetes Kidney problems Pregnancy Liver problem  Risk factor of UTI 1. Iatrogenic 2. Behavioral 3. Anatomic/physiologic 4. Genetics: susceptible uroepithelial cells, mucus properties. Important aspect of microbiological examination of UTIs 1. Pre-analytical stage: urine collection 2. Analytical stage: urine analysis 3. Post analytical stage: interpretation of lab results  Methods of specimens collection Mid-stream urine Adhesive bag Catheter sample Suprapubic aspiration Random specimens 24 hrs collection  Methods of urine collection 1. Random sample: collected anytime during the day. used only for routine screening because the composition of urine changes throughout the day. 2. First voided specimen: a first morning specimen. collected the first time the patient urinates in the morning. A first voided specimen is the most concentrated and is the preferred specimen for pregnancy testing, bacterial cultures and microscopic examinations. 3. Timed specimens: used when the physician requires urine samples to be taken at specific intervals during the day. 24-hour urine specimens are required for creatinine clearance tests and many other hormone studies. 4. Clean-catch midstream specimen: collected if the urine is going to be cultured and examined for bacterial growth or used for cytology. 5. Suprapubic: used for patients that cannot take any instruction, sample collected using sterile needle by aspiration directly from bladder. 6. Catheterized specimen: obtained by inserting a catheter or sterile flexible tube into the bladder via the urethra to withdraw urine.  The Urine analysis includes: Chemical Tests Microscopic Physical Include: Examination Includes: 1. pH Properties 2. Specific gravity 1. Red blood cells Include: 3. Protein 2. White cells 4. Glucose (WBC) 1. Color 5. Ketones 3. Casts 2. Appearance 6. Bilirubin 4. Crystals (opaque or 7. Urobilinogen 8. Blood 5. Epithelial cells colorless) 9. Nitrite 6. Bacteria and 3. Odor 10. Leukocyte another esterase microorganism physical characterization  Turbidity Physiological causes Pathological causes 1. Mucus 1. White blood cells 2. Squamous epithelial cells 2. Red blood cells 3. Present of sperms 3. Presence of bacteria 4. Crystaluria 4. Presence of yeast 5. Fecal contamination 5. Presence pf crystals 6. Lymph fluids and lipids  Abnormalities in color Dark yellow Colorless or pale yellow Low fluid intake Using of diuretic Excessive sweating Diabetes mellitus Dehydration High fluid intake Vitamin A –orange urine Diabetes insipidus Antibiotic used against E.coli in UTI Alcohol ingestion The chemical analysis of urine Microscopic examination UTI Identification  Technique of Microscopic Examination of Urine Deposits 1-Centrifuge at least 5 to 10 ml of fresh urine, (crystals, blood, pus, and casts require only a few minutes, but if bacteria are being looked for, longer periods at high speeds are necessary). 2-Pour off the supernatant fluid, leaving the deposit at the bottom of the tube. 3-Mix the deposit with the remaining few drops of urine. 4-Transfer a small amount to a microscopic slide, cover with a cover glass. Examine under the microscope with reduced illumination.  Formed elements from the entire genitourinary tract: Casts and epithelial cells from the nephron. epithelial cells from the kidney, pelvis, ureters, bladder, and urethra; mucous threads and spermatozoa from the prostate; and possibly RBCs or WBCs and an occasional cast. In renal parenchymal disease, the urine usually contains increased numbers of cells and casts. The constituents of such deposits can be classified into three main groups: I-Chemical Substances, Crystalline or Amorphous. II-Cells, from the blood or the various parts of the renal tract. III-Casts. substances present both physiologically and URINARY pathologically-(CALCULI (STONES)) Triple phosphates Calcium oxalate Calcium phosphate Uric acid  Cells RBCs Pus cells EP cells RBCs VS WBCs  Epithelial Cells The type of epithelial cells in the urine may also signal certain conditions. For instance, epithelial cells that contain a large amount of hemoglobin, or blood particles, may mean that you recently had red blood cells or hemoglobin in the urine, even if they weren’t there during the urinalysis. More than 15 renal tubular epithelial cells per HPF may mean your kidney isn’t working properly. Squamous epithelial cells in your urine may just mean the sample is contaminated. Casts  Other microscopic observations of urine sediment Differentiate between lower and upper UTI. The more common lower UTI can present with transitional epithelial cells that line the bladder and urethra. These can be sloughed off into the urine due to the inflammation caused by an offending UTI. In contrast, upper UTI can present with renal tubular epithelial cells (RTE) that line the proximal and distal convoluted tubules and collecting ducts. The presence of RTE in urine is the most clinically significant epithelial cell that can be found in urine and provides a strong indication of renal damage. Type of EP Specific medium (urine culture): CLED  Conventional Antibiotic Sensitivity test Disc-diffusion method: Principle – impregnated disc absorbs moisture from the agar and antibiotic diffuses into the agar medium As distance from disc increases, antibiotic concentration decreases Visible growth of bacteria occurs on the surface of agar where the concentration of antibiotic falls below the inhibitory level for the test strain. Concentration of diffused antibiotic at the interface of growing and inhibited bacteria approximates to the MIC obtained in dilution tests.  Antibiotic Sensitivity test Antibiotic discs Turbidity standard commercially prepared discs To standardize the 6mm in diameter are used inoculum density, BaSO4 turbidity standard, equivalent to 0.5 McFarland is Antibiotics delivered with used. 20 gauge wire loop, diameter 2mm. This delivers 0.005ml antibiotic to each disc  Disc Diffusion Method Procedure (Modified Kirby-Bauer method: National Committee for Clinical Laboratory Standards. NCCLS) Prepare applx. 108 CFU/ml bacterial inoculum in a saline or tryptic soy broth tube (TSB) or Mueller- Hinton broth (5 ml) Pick 3-5 isolated colonies from plate Adjust the turbidity to the same as the McFarland No. 0.5 standard. Streak the swab on the surface of the Mueller- Hinton agar (3 times in 3 quadrants) Leave 5-10 min to dry the surface of agar Zoon of inhibition  Treatment Medicines commonly used for In cases of a complicated UTI or simple UTIs kidney infection Fluoroquinolone medicine if Trimethoprim and there are no other treament sulfamethoxazole (Bactrim, options. Bactrim DS) Fosfomycin (Monurol) Nitrofurantoin (Macrodantin, Macrobid, Furadantin) Cephalexin Ceftriaxone  Factors Affecting Size of Zone of Inhibition Acidic pH of medium Tetracycline, novobiocin, methicillin zones are larger Alkaline pH of medium Aminoglycosides, erythromycin zones are larger Reading of zones Subjective errors in determining the clear edge Size of the plate Smaller plates accommodate less number of discs Depth of the agar medium (4 mm) Thin media yield excessively large inhibition zones and vice versa Proper spacing of the discs (2.5 cm) Avoids overlapping of zones Parasite- urinary Schistosomiasis Schistosoma haematobium Class:Trematoda Blood flukes: inhabit vascular system Have separate sexes. Eggs: have distinctive spines  Diagnostic symptoms Later symptoms (those that develop symptoms that develop after within 30 to 60 days of being infected) years of being infected Fever. Pain in your stomach. Chills. Enlarged liver (hepatomegaly). Cough. Blood in your urine (pee), Muscle aches and pain. also called hematuria. Difficulty or pain while urinating (dysuria). Blood in feces (poop), also called hematochezia. Miscarriage. Parasite-Schistosoma Other type haematobium Terminal spike  Diagnosis Urine aspirate from supra-pubic puncture; showing adult worms of Schistosoma haematobium