www.medlib.med.utah.edu/webpath/TUTORIAL/URINE.html
·
HTN
can be detected on a UA
·
In
rough terms trace positive results are equivalent to 10mg/100ml or about
150mg/24hr.
·
Trace
amounts of protein can be seen afet an athletci event but is not dangerous
·
Diabetes,
HTN, and CHF can all cause proteinuria
Glucose
·
Less
than .1% of glucose is normally filtered by th glomerulus and appears in the urine.
·
Type
I—(Insulin dependent) auto antibodies attack beta cells
·
teenagers
·
Type
II—(nonisulin diabetes) disuse can lead to insulin receptors diappearing
·
Obesity
·
Sedentary
lifestyle
·
Receptors can be rejuvenated by exercise and
diet
·
Fiber
supplementation is critical to treatment—competes with glucose absorption at
the intestinal brush border.—Regulated glucose absorption.
·
Exercise
helps insulin production
·
Chromium
picolinate is also used to treat
·
Dipsticks
emplooing the glucose oxidase reaction for screenin gfor glucose, but can ,iss
other reducing sugars such as galactose and fructose.
·
Other
tests can be used which are Benedicts—in infants
·
Ketones
(acetone, acetoacetic acid, beta-hydroxybutyric acid) resulting from either
diabetic ketosis or some other form of calorie deprevation (starvation) are
easily detected by dipsticks or test tablets containing sodium nitroprusside.
·
Diabetes—glucose
can’t get into the cell and therefore the body converts proteins and fat to
ketones to burn.
·
In the geriatric age individual the glucose
range fluctuates therefore glucoseuria may occur in the morning and disappear
by evening—therefore blood tests are often done.
Nitrites
·
A
positive test indicates bacteria may be in sugnificant numbers in the urine.
·
E.Coli
are the most common infection.
·
In
cultures exceeding 100,000 organisms/ml
·
Test
has a high number of false positives.
Leucocyte
esterase
·
A
positive test represents the prescence of white blood cells either whole or
lysed cells.
·
Pyuria
can be detected even if the urine sample contains damaged or lysed WBC’s
·
A
– test means that infection is unlikely.
Microscopic
Urinalysis
Examination
·
Sediments
in the urine are 1st examined under low field looking for crystals
cells squamous cells, and other large objects.—LPF
·
Same
is done at high power (HPF)
Red
Blood Cells
·
Hematuria
is the presence of abnormal numbers of red cells in th eurine due to glomerular
damage, tumors which erode the urinary
tract anywhere along its length, kidney trauma, urinary stones, renal
infarcts, acute glomerular necrosis, upper and lower urinary tract infections,
nephrotoxins, and physical stress.
·
Red
cells may also contaminate the urine from the vagina in mestrating women or
from trauma produced by bladder catherterization.
·
Theoretically
no RBC’s should be found in urinebut find their way in very healthy
individuals.
·
Years
ago no abnormals were excepted.
·
Today
up to 3-4 per high power field is percieved.
·
Anemia
may accompany running and is known as runner’s anemia
·
Shape
of the RBC’s
·
May
appear swollen in a dilute urine
·
Or
crenated in hypertonic urine.
·
Pyuria—abnormal
numbers of white cells in the urine
·
Appear
w/ infection
·
White
cells of the vagina and cervix can contaminate the urine
·
8
or more leukocytes per HPF is considered abnormal
·
Specificity
¯ if 1 WBC is used instead if 8 therefore
there are more false positive.
·
Epithelial
Cells
·
Renal
tubular cells in the presence of hematuria can indicate kidney damage
·
They
are therefore a marker.
·
Casts
are other markers—and means upper track disorder.
·
Formed
in the tubules and in collecting ducts
·
Proteins
clump in the tubule which then take on the shape of the tubule.
·
Predominently
Tamm-Horsfall protein
·
Marker
of glomerular injury both red and white cells.
·
And
is usually red blood cell casts
·
Clot—distal
urinary tract disorder.
·
Pelvic
viscera can refer to hip or lateral thigh pain.
·
Transitional
epirthilial cells are not a marker and are usually sloughed from the bladder