Chapter 6 urbedndenernernrnrnrnrnine.ppt

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1. CHAPTER 6 Basic Urinalysis 08/03/2024 Clinical laboratory method by Bedasa A 1

2. Chapter objective At the end of this chapter, students are expected to: To state different urine specimen type Describe about urine formation and its composition Explain macroscopic, chemical and microscopic examination on urine 08/03/2024 Clinical laboratory method by Bedasa A 2

3. Introduction to Urinalysis Urinalysis means the analysis of urine 3 Produces urine Transports urine towards bladder Temporarly store urine Transports urine to exterior Anatomy of Urinary system 08/03/2024 Clinical laboratory method by Bedasa A

4. Significance of Urinalysis Provides information about kidneys Provides information about metabolic processes To test urinary tract infections (UTIs) 08/03/2024 Clinical laboratory method by Bedasa A 4

5. Introduction to Urinalysis…….. 2. Physiology of Urinary System : Excretion & Elimination of wastes products (urea, creatinine , uric acid) through urine Homeostatic regulation of w ater-salt & a cid -base Balance Endocrine function: Hormones production 08/03/2024 Clinical laboratory method by Bedasa A 5

6. 2. Urine Urine Formation : t here are four processes Filtration : small molecules move from the capillaries into the bowman's capsule Re-absorption : molecules are reabsorbed from the nephron into the capillary blood. e.g.  Glucose Secretion : substances are actively removed from blood & added to tubular fluid. e.g . H + , Excretion : removal of waste products through urine 6 08/03/2024 Clinical laboratory method by Bedasa A

7. 2. Urine composition Urine consists of: (96%) water Inorganic: Cl - , Na, K. trace amounts of: sulfate, HCO 3 etc.) (4%) dissolved solids: (2%) Urea: ( half) (2%) Other compounds Organic: creatinine , uric acid 7 08/03/2024 Clinical laboratory method by Bedasa A

8. Factors Affecting Urine Composition Dietary intake Physical activity Body metabolism Endocrine function 8 08/03/2024 Clinical laboratory method by Bedasa A

9. Types of Urine Specimens Random: Collected any time of the day First voided / first morning specimen: s pecimen collected for routine test as it is most concentrated. Timed specimens : 2-Hours Postprandial: Patient emptying their bladder & then all urine produced will be collected over a specified period 2 hrs. 24-Hour Specimen: The patient voids & discards specimen and collects all urine for the next 24 hrs. 9 08/03/2024 Clinical laboratory method by Bedasa A

10. Types of Urine Specimens… 4. Mid-stream: The patient begins voiding in toilet & place container into the continuing urine stream until the cup is ½ filled. 5. Clean Catch: Prior to the voiding process, the patient should be provided clean cup. 6. Catheterized Specimen: Collected from a hollow tube threaded up the urethra into the bladder. 7. Supra-pubic needle aspiration: For culture purpose 10 08/03/2024 Clinical laboratory method by Bedasa A

11. Handling & Preserving Urine Specimens When urine placed at room temperature Bacteria multiply Glucose decreases Casts and cellular elements decompose So, examine within 2 hrs of collection OR use of preservatives like Physical methods ( Refrigeration @ 4-6° C for up to 8 hrs) Chemical methods (boric acid, thymole , toluene, formalin, chloroform, HCL, …) 11 08/03/2024 Clinical laboratory method by Bedasa A

12. Types of Urine examination = Urinalysis Macroscopic examination Chemical examination Microscopic examination 12 08/03/2024 Clinical laboratory method by Bedasa A

13. 1. Macroscopic/Physical/ Exam Physical examination of urine, usually give hint for the subsequent urinalysis Physical properties include…. Volume Color Transparency Odor Foam 08/03/2024 Clinical laboratory method by Bedasa A 13

14. 2. Chemical examination: using Urine strip Strip is filter paper which has chemical substance (reagent) coated on it on different pads. It gives color when react with substance in urine. The produced color is compared with chart color visually assessed. It include proteinurea , glucoseurea , ketourea , haematourea , hemoglobinuria , bilirubin (Bile), nitrite & urine leucocytes 08/03/2024 Clinical laboratory method by Bedasa A 14

15. Chemical examination Glucose Bilirubin Ketones Specific Gravity Blood pH Protein Urobilinogen Nitrite Leukocyte Esterase Urine Dipstick 08/03/2024 Clinical laboratory method by Bedasa A 15

16. 3. Microscopic examination It done by pouring 10 ml urine into a test tube & centrifuging it for 5 minutes with the speed of 1500-2000 rpm. The top liquid part (the supernatant) is discarded. The sediment ( solid part in the bottom) is mixed with the remaining drop of urine A drop is analyzed under a microscope to look for cells, parasites, casts & crystals 16 08/03/2024 Clinical laboratory method by Bedasa A

17. Classification of Urinary Sediments Urine sediments can grossly be categorized into two based on the substances they are composed of. Organized Non-organized sediments 08/03/2024 Clinical laboratory method by Bedasa A 17

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19. Microscopic Examination: Abnormal Findings Per High Power Field (HPF) (400x) > 3 erythrocytes > 5 leukocytes > 2 renal tubular cells > 10 bacteria Per Low Power Field (LPF) (200x) > 3 hyaline casts or > 1 granular cast > 10 squamous cells (indicative of contaminated specimen) Any other cast (RBCs, WBCs) Presence of: Fungal hyphae or yeast, parasite, viral inclusions Pathological crystals ( cystine , leucine , tyrosine) Large number of uric acid or calcium oxalate crystals 08/03/2024 Clinical laboratory method by Bedasa A 19

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21. Collection of Cerebro -spinal fluid (CSF ) CSF provides a physiologic system to supply nutrients to the nervous tissue, remove metabolic wastes, and produce a mechanical barrier to cushion the brain and spinal cord against trauma. CSF is produced in the choroid plexuses of the two lumbar ventricles and the third and fourth ventricles. In adults, approximately 20 mL of fluid is produced every hour. 08/03/2024 Clinical laboratory method by Bedasa A 21

22. 22 CSF: in b/n subarachnoid space located between the arachnoid and pia mater

23. CSF… Its volume is 90 to 150 mL in adults and 10 to 60 mL in neonates. The circulating fluid is reabsorbed back into the blood capillaries in the arachnoid granulations/ villae at a rate equal to its production Collection by lumbar puncture done by experienced medical personnel About 1-2ml of CSF is collected for examination lumbar puncture is made from the space between the 3 rd to 5 th lumbar vertebrae under sterile conditions. 08/03/2024 Clinical laboratory method by Bedasa A 23

24. Collecting CSF specimen Location of CSF Can be Collected in three sequentially labeled tubes Tube 1-Chemical and immunologic tests Tube 2-Microbiology Tube 3-Hematology (gross examination, total WBC & Diff) This is the least likely to contain cells introduced by the puncture procedure 24

25. Thank you !!!!! 25 08/03/2024 Clinical laboratory method by Bedasa A