RENAL ANATOMY AND - 0~1 to 1.

5 million in each • TUBULAR REABSORPTION: • EFFERENT ARTERIOLE

PHYSIOLOGY kidney Returning of filtered substances - Carries blood FROM the
- Parts: back to the blood glomerulus
URINARY SYSTEM OR ✓ GLOMERULUS or • TUBULAR SECRETION: - has a smaller size
EXCRETORY SYSTEM RENAL CORPUSCLE Passage of non-filtered - to maintain GLOMERULAR
• KIDNEYS - where urine is formed ✓ PROXIMAL substances to the blood for PRESSURE
• URETERS - carry the urine to the CONVOLUTED excretion • PERITUBULAR CAPILLARIES
bladder TUBULE or PCT - Surround the PCT and DCT
• URINARY BLADDER - stores the ✓ DESCENDING LOOP • RENAL BLOOD FLOW • VASA RECTA
urine OF HENLE - Waste products of - Located adjacent to the
• URETHRA - delivers the urine for ✓ ASCENDING LOOP OF metabolism are moved from LOOPS OF HENLE in the
excretion outside the body HENLE DISTAL the circulatory system to the juxtamedullary nephrons
CONVOLUTED urine and excreted from the
TUBULE or DCT body via the kidney. A SLIDE TO REMEMBER!!
✓ COLLECTING DUCT or - Without the proper blood • TOTAL RENAL BLOOD FLOW:
CD volume and pressure, urine ~1,200 mL/min
• CORTICAL NEPHRONS cannot be formed. • TOTAL RENAL PLASMA
- seen in the CORTEX alone ✓ DIRECT FLOW: 600-700 mL/min
- for tubular reabsorption RELATIONSHIP
and secretion between kidney's • GLOMERULAR FILTRATION
- make up -85% of nephrons functional ability and - Happens in the
THE KIDNEYS AND THE • JUXTAMEDULLARY its blood supply GLOMERULUS
PROCESS OF URINE FORMATION NEPHRONS ✓ ~25% of CARDIAC ✓ coil of ~8 capillary lobes
• ANATOMY OF THE KIDNEYS - Loops of Henle extend into OUTPUT (capillary tuff)
- Bean-shaped paired organs the MEDULLA ✓ located within
- Adult male: 150 g each - for concentration of the • BLOOD FLOWS IN THE Bowman's capsule
- Adult female: 135 g each urine KIDNEY THRU: ✓ NON-SELECTIVE
- RENAL CORTEX RENAL ARTERY FILTER/SIEVE of
- RENAL MEDULLA  plasma substances with
- RENAL PELVIS AFFERENT ARTERIOLE MW of <70,000
- RENAL ARTERY  - FACTORS AFFECTING
- RENAL VEIN GLOMERULUS FILTRATION PROCESS
 ✓ cellular structure of the
EFFERENT ARTERIOLE glomerulus
 ✓ hydrostatic and oncotic
PERITUBULAR CAPILLARIES pressures
 ✓ feedback mechanisms of
VASA RECTA → RENAL VEIN the renin angiotensin-
RENAL FUNCTIONS
aldosterone system
• RENAL BLOOD FLOW: Urine
formation is dependent on renal • AFFERENT ARTERIOLE - Filtration rate is ~120
- Carries blood TO the mL/minute (or 1/5 of renal
• NEPHRONS blood flow plasma flow) as a result of the
glomerulus
- Functional units of the • GLOMERULAR FILTRATION: glomerular mechanisms
kidney Process of filtering blood to form
an ultrafiltrate

1
 • RENIN-ANGIOTENSINO PLASMA PROTEIN, PROXIMAL CONVOLUTED
ALDOSTERONE-SYSTEM ANY PROTEIN-BOUND TUBULE (PCT)
(RAAS) SUBSTANCES and ✓ Accounts for 65%
- controls the regulation of CELLS (>80%-Grafts)
blood flow to and within the ✓ SPECIFIC GRAVITY: ✓ With brush border of
glomerulus 1.010 microvilli which provides
- JUXTAGLOMERULAR a large surface area for
APPARATUS • TUBULAR REABSORPTION reabsorption and
✓ CELLS: Juxtaglomerular - substances removed from secretion a
• SHIELD OF NEGATIVITY cells the filtrate are returned to the ✓ Glucose Renal
- term describing the ➢ LOCATION: Afferent blood threshold: 160-180
impediment produced by arteriole - REABSORPTION 179/4L
negatively charged  Blood Pressure MECHANISMS - RENAL THRESHOLD
components (eg, (Stimulus) ✓ ACTIVE TRANSPORT: a ✓ plasma concentration at
proteoglycans) of the ✓ CELLS: Macula densa carrier protein in the which ACTIVE transport
glomerular filtration barrier cells membrane of the renal stops
- present on both sides of and ➢ LOCATION: DCT tubular cells is involved ✓ FLUID leaving the PCT
throughout the filtration  Plasma Sodium ➢ Glucose, amino has the same
barrier (Stimulus) acids, salts - PCT concentration as the
- effectively limit the filtration of ➢ Chloride - ascending ultrafiltrate (SPECIFIC
negatively charged Low blood pressure or low plasma loop of Henle GRAVITY: 1.010)
substances from the blood sodium ➢ Sodium - DCT ✓ ~2/3 of reabsorbed
(e.g., albumin) into the  ✓ PASSIVE TRANSPORT: SODIUM IS
urinary space RENIN (secreted by the JG cells) movement of molecules ACCOMPANIED BY
 across a membrane as PASSIVE
• GLOMERULAR PRESSURES ANGIOTENSINOGEN is converted result in the difference in REABSORPTION OF
to ANGIOTENSIN I their concentration THE SAME AMOUNT
 gradients OF WATER
ANGIOTENSIN CONVERTING ➢ Water - All parts of - URINE CONCENTRATION
ENZYME (ACE) Converts the nephron ✓ begins in the
ANGIOTENSIN I to ANGIOTENSIN EXCEPT ascending DESCENDING and
II loop of Henle ASCENDING LOOPS of
➢ Urea - PCT and HENLE
ascending loop of ✓ filtrate is exposed to the
- AUTOREGULATORY
Henle high osmotic (salt)
MECHANISM:
➢ Sodium – ascending gradient of the
✓ DECREASE in BLOOD
loop of Henle MEDULLA
PRESSURE - DILATION of
End effect: INCREASE IN BLOOD - URINE CONCENTRATION ✓ COUNTER CURRENT
the afferent arterioles
PRESSURE ✓ TUBULAR MECHANISM – selective
✓ INCREASE in BLOOD
CONCENTRATION reabsorption
PRESSURE -
• GLOMERULAR FILTRATION ✓ COLLECTING DUCT ➢ Water is removed via
CONSTRICTION of the
- THE GLOMERULAR CONCENTRATION OSMOSIS in
afferent arterioles
ULTRA FILTRATE - MAJOR SITE OF DESCENDING
✓ Same composition as REABSORPTION – LOOP OF HENLE
blood-BUT is FREE OF

2
 ➢ Na & Cl are • TUBULAR SECRETION ✓ polymer of fructose
reabsorbed in the - passage of substances from ✓ extremely stable
ASCENDING LOOP to the filtrate for excretion substance
OF HENLE blood ✓ NOT REABSORBED
- FILTRATE leaving the - Serves 2 (two) major nor SECRETED by the
ASCENDING LOOP is functions: tubules
DILUTED ✓ Elimination of waste ✓ EXOGENOUS
- Final concentration begins products root filtered by *GLOMERULAR FILTRATION
in the late DISTAL the glomerulus *TUBULAR REABSORPTION • CREATININE CLEARANCE
CONVOLUTED TUBULE ✓ Regulation of the acid- *TUBULAR SECRETION - ROUTINELY DONE FOR
and continues in the *BLOOD
base balance thru *URINE
SCREENING GFR
COLLECTING DUCTS secretion of hydrogen - Characteristics of
- Reabsorption of water and ions RENAL FUNCTION TESTS creatinine
sodium in the DISTAL - ELIMINATION OF WASTE ✓ ENDOGENOUS
• GLOMERULAR FILTRATION
CONVOLUTED TUBULE PRODUCTS NOT ✓ Some creatinine is
- Clearance fests
AND COLLECTING DUCTS FILTERED BY THE secreted by the tubules,
- Calculated glomerular
is CONTROLLED BY GLOMERULUS and secretion
filtration estimates
HORMONES ✓ MAJOR SITE OF increases as blood
• TUBULAR REABSORPTION
SECRETION levels rise.
- Water Deprivation Tests
ALDOSTERONE CONVOLUTED TUBULE ✓ Influenced by a diet
- Osmometry
• responds to the body's need for (PCT) heavy in meat
- Free water clearance
SODIUM - REGULATION OF THE
• RENAL BLOOD FLOW &
• produced and released from the ACID-BASE BALANCE • PROCEDURE
TUBULAR SECRETION
adrenal cortex THRU SECRETION OF - Involves collection of blood
- PAH test
• promotes SODIUM HYDROGEN IONS
- titratable acidity and
and urine for creatinine
REABSORPTION in the DCT ✓ H+ is secreted in testing
ammonia
and POTASSIUM SECRETION exchange for - URINE SPECIMEN: 24-
BICARBONATE IONS in HOUR URINE
• CLEARANCE TESTS
ANTIDIURETIC HORMONE/ADH or the PCT ✓ GREATEST SOURCE
✓ Secreted H+ combines - STANDARD TEST used to
VASOPRESSIN OF ERROR in any
measure the filtering
• responds to body's state of with a filtered
capacity of the glomeruli
clearance procedure is
HYDRATION PHOSPHATE ION and is the IMPROPERLY
- measure the rate at which
• produced in the hypothalamus & excreted
the kidneys are able to
TIMED URINE
released by posterior pituitary ✓ Secreted H+ combines SPECIMEN
with AMMONIA remove (to clear) a
gland - FORMULA
produced by DISTAL filterable substance from
• makes the walls of the DCT & the blood
CD permeable or impermeable CONVOLUTED
to water TUBULE to form
AMMONIUM ION which • INULIN CLEARANCE
V= urine volume in ml/min
is then excreted - ORIGINALLY THE U= urine creatinine concentration in
REMEMBER!! REFERENCE METHOD mg/dL
- NOT CURRENTLY used for P= plasma creatinine concentration in
GFR testing mg/dL
- CHARACTERISTICS OF
INULIN Reported in mL/min

3
 Computing for creatinine ✓ Modifications: IDEAL *UREA has no Importance to the • FREEZING POINT
clearance BODY WEIGHT and evaluation of renal concentration ability OSMOMETERS
Calculate the GFR of a patient with ADJUSTED BODY - First principle incorporated
urine creatinine of 120 mg/dl, plasma WEIGHT • WATER DEPRIVATION TESTS into clinical osmometers
creatinine of 1.0 mg/dl and urine - Useful for screening only and - 1 mol will LOWER the
volume of 1,440 ml per 24 hours. not used nowadays freezing point by 1.86°C
- FISHBERG - patients were - NaCl-reference standard
deprived of fluids for 24 hours
- MODIFICATION OF DIET IN prior to measuring specific
RENAL DISEASE (MDRD) • VAPOR PRESSURE
gravity
SYSTEM or LEVERY OSMOMETERS
- MOSENTHAL - compares
FORMULA - Uses microsample
the volume and specific
✓ Newer and utilizes (<0.01mL)
gravity of day and night urine
- OTHER PROCEDURES additional variables such - Measures DEW POINT
samples
✓ Injection of as ETHNICITY, BLOOD (temperature at which
- NORMAL VALUES:
radionucleotides such as UREA NITROGEN and water vapor condenses to a
✓ Urine specific gravity of
125
I-iothalamate SERUM ALBUMIN, but liquid)
1.025
✓ Clearance of beta-2- does not include body - Depression of dew point
✓ Urine osmolarity of 800
microglobulin weight temperature by solute is
mOsm or above
(MW=11,800) ✓ Several variations of the proportional to the decrease
✓ Clearance of Cystatin C formula are available, in vapor pressure
• OSMOMETRY
(MW=13,359) utilizing one or more of - Quantitative measurement
the additional variables of renal concentrating
• CALCULATED GLOMERULAR ability
FILTRATION ESTIMATES - Reported in milliosmole
(eGFR) (mOsm)
- Provide estimates of the - Determined by measuring a • FREE WATER CLEARANCE
GFR based on the SERUM colligative property - calculate the osmolar
CREATININE without the - Osmolality: Solute dissolved clearance and subtract it from
• TUBULAR REABSORPTION
urine creatinine in 1 KILOGRAM (kg) of the urine volume in mL/min
TESTS
- TWO FORMULA: solvent - OSMOLAR CLEARANCE:
- measure the concentrating
✓ COCKCROFT AND - Osmolarity: Solute dissolved ✓ Indicates how much
ability of the kidney
GAULT in 1 LITER (L) of solvent water must be cleared
- Specific gravity
✓ MODIFICATION OF *in clinical laboratory, these terms are used each minute to produce a
✓ NUMBER and DENSITY interchangeably, in as much as the difference
DIET IN RENAL urine with the same
of PARTICLES in normal temperature conditions with water as
DISEASE (MDRD) osmolarity as the plasma
✓ Urea CONTRIBUTES the solvent is minimal.
SYSTEM - (-) = less water is being
more
excreted; possible state of
- Osmolarity • COLLIGATIVE PROPERTIES
- COCKCROFT AND GAULT dehydration
✓ Depends on the - INCREASE/ELEVATION
✓ Most frequently used - 0 = no renal concentration or
NUMBER OF BORING POINT &
formula dilution
PARTICLES ONLY OSMOTIC PRESSURE
✓ Variables included in the - (+) = excess water is being
✓ Sodium, chloride and - DECREASE/DEPRESSION
ORIGINAL formula are: excreted
urea CONTRIBUTE in FREEZING POINT &
AGE, SEX and BODY
EQUALLY VAPOR PRESSURE
WEIGHT (kg)

4
• Total renal blood flow through - PROXIMAL CONVOLUTED • Other substances such CHO
the nephron must be measured TUBULE impaired tubular pigments, fatty acids, mucin,
by a substance that is secreted secretion of H+ enzymes and hormones
rather than filtered - DISTAL CONVOLUTED
TUBULE - defective 95% H₂O & 5% solutes
• P-aminohippuric acid (PAH) ammonia secretion
Test INORGANIC COMPONENTS
- Exogenous procedure SUMMARY OF THE RENAL • CHLORIDE - MAJOR
- Nontoxic substance PHYSIOLOGY INORGANIC
RENAL RENAL FUNCTION TESTS
SPECIMEN PRESERVATION
secreted by the PCT FUNCTIONS • NaCl - PRINCIPAL SALT • Physical - REFRIGERATION
- used to calculate the •
GLOMERULAR - CLEARANCE TESTS Potassium • Chemical use of preservatives
effective renal plasma flow FILTRATION - eGFR-
• Sulfate, Phosphate, Ammonium,
TUBULAR - WATER DEPRIVATION
REABSORPTION TESTS Magnesium, Callum • PHYSICAL - REFRIGERATION
• Phenolsulfonphthalein (PSP) - OSMOLARITY &
SPECIFIC GRAVITY - TEMPERATURE: 2°C to 8°C
Test - not currently performed - FREE WATER - EFFECTS:
CLEARANCE
✓ decreases bacterial
• Urinary ammonia and TUBULAR
SECRETION
- PAH TEST
- PSP TEST growth and metabolism
Titratable Acidity RENAL BLOOD - TITRATABLE ACIDITY ✓ if urine is to be cultured, it
- Determines the defective FLOW AND AMMONIA
should be refrigerated
function in the ability of the SPECIMENS FOR URINE during transit and held
kidney to produce an acidic HISTORY AND IMPORTANCE ANALYSIS refrigerated until cultured
urine • HIPPOCRATES - wrote • IMPROPERLY LABELED AND
"uroscopy" in the 5th Century for up to 24 hours
COLLECTED SPECIMENS ✓ increases specific gravity
• Color charts had been developed SHOULD BE REJECTED BY when measured by
that described the significance of THE LABORATORY Urinometer
20 different colors (1140 AD) ANDREQUEST FOR A NEW - PRECIPITATION OF
• FREDERIK DEKKERS - SPECIMEN AMORPHOUS
- run simultaneously on either discovered albuminuria (1694) - Specimens in unlabeled PHOSPHATES AND
fresh or toluene-preserved • THOMAS ADDIS - developed containers URATES
urine specimens collected at methods for quantitating - Nonmatching labels and ✓ Amorphous urates -
2-hour intervals microscopic sediment (17th requisition form pink precipitates
- AMMONIUM century) - Specimens contaminated ✓ Amorphous
CONCENTRATION is • RICHARD BRIGHT - introduced with feces or toilet paper phosphates - white
computed as difference urinalysis as part of the doctor's - Containers with precipitates
between titratable acidity routine patient examination contaminated exterior
(free H+) and total acidity (1827) - Specimens of insufficient • CHEMICAL
quantity - the routine use of
• RENAL TUBULAR ACIDOSIS ORGANIC COMPONENTS - Specimens that have been preservatives is not
- Inability to produce an acid • UREA (60% to 90%) - MAJOR improperly transported recommended
urine in the presence of ORGANIC - IDEAL PRESERVATIVE
metabolic acidosis • Creatinine ✓ bactericidal
- Associated with • Uric acid ✓ can inhibit urease
CONSTANTLY ALKALINE • Hippuric acid ✓ can preserve formed
URINE elements in the sediment

5
 ✓ should not interfere with ✓ detection of chemicals • EARLY AFTERNOON • PROSTATITIS SPECIMEN
chemical tests and formed elements that SPECIMEN FOR (THREE-GLASS COLLECTION)
may not be present in a UROBILINOGEN - For PROSTATIC
dilute random specimen DETERMINATION (2pm to 4pm) INFECTION determination.
- For preventing false- - Urobilinogen excretion is - PROCEDURE:
negative pregnancy test enhanced in alkaline urine ✓ FIRST SPECIMEN: first
- For evaluating orthostatic - Specimen of choice is a 2- portion of urine
proteinuria hour collection following the ✓ SECOND SPECIMEN:
midday meal (ie., 2 pm to midstream portion of
• FASTING (SECOND MORNING) 4pm) with correlates with urine
- Second voided specimen the "alkaline tide" ✓ THIRD SPECIMEN:
after a period of fasting PROSTATE IS
- Recommended for glucose • 12-HOUR SPECIMEN - for MASSAGED FIRST so
monitoring ADDIS COUNT that prostate fluid will be
passed with the
• 2-HOUR POST PRANDIAL remaining urine
- For monitoring INSULIN - Quantitative cultures are
THERAPY in diabetic performed on ALL
patients SPECIMENS
- Microscopic examination
• GLUCOSE TOLERANCE • CATHETERIZED done on FIRST AND THIRD
SPECIMEN - Most commonly used for SPECIMENS
- Collected to correspond with bacterial culture - SECOND SPECIMEN is
the blood samples drawn - If a routine urinalysis is also used as CONTROL
during an OGTT requested, the culture should ✓ If POSITIVE, results from
- May include fasting, half- be performed first to prevent the third specimen are
hour, 1-hour, 2-hour and 3- contamination of the INVALID because
hour specimens specimen infected urine has
TYPES OF SPECIMENS
contaminated the
• RANDOM •
• 24-HOUR (TIMED) SPECIMEN Midstream Clean-Catch specimen
- most commonly received Specimen - RESULTS:
- Required for analytes that
specimen - Alternative to the ✓ PROSTATIC
exhibit diurnal variations
- collected at any time INFECTION
✓ Catecholamines catheterized specimen
- useful for ROUTINE ➢ If WBC/HPO count
✓ 17-hydroxysteroids - For bacterial culture and
SCREENING TESTS & bacterial count on
✓ Electrolytes which are routine urinalysis
lowest in the early third specimen is
• FIRST MORNING (8-HOUR
morning and highest in • SUPRAPUBIC ASPIRATION 10X that of the first
SPECIMEN) - External introduction of a specimen
the afternoon
- Collected immediately on
- All specimens should be needle through the abdomen
arising and delivered to the into the bladder • PEDIATRIC SPECIMEN
refrigerated or kept on ice
lab within 2 hours - for bacterial culture - Soft, clear plastic bags with
during the collection period
- IDEAL SCREENING - also used for cytologic hypoallergenic skin adhesive
and may also require addition
SPECIMEN examination to attach to the genital area of
of a chemical preservative.
- Concentrated specimen both boys and girls

6
 - Sterile specimens may be - VARIATIONS: • The kidneys excrete increased • ABNORMAL URINE COLOR
obtained by ✓ OLIGURIA-DECREASE amounts of water to remove the - DARK
CATHETERIZATION or by in urine output dissolved glucose YELLOW/AMBER/ORANGE
SUPRAPUBIC ➢ <1 mL/kg/hr in • The urine will have a HIGH ✓ BILIRUBIN - produces a
ASPIRATION infants SPECIFIC GRAVITY YELLOW FOAM when
➢ <0.5 mL/kg/hr in specimen is shaken vs
• DRUG SPECIMEN children DIABETES INSIPIDUS WHITE FOAM in
COLLECTION ➢ <400 mL/day in • Problem is related with ADH increased protein
- Chain of Custody (COC) - adults • The water needed for adequate concentration
process that provides ➢ seen in dehydration body hydration is not reabsorbed ✓ UROBILIN - when
documentation of proper as a result of • The urine will have a LOW UROBILINOGEN IS
sample identification from the excessive water loss SPECIFIC GRAVITY PHOTO-OXIDIZED (NO
time of collection to the from vomiting, yellow foam when
receipt of laboratory results diarrhea, - Normal urine has a wide shaken) vs photo-
- Forms of tampering of perspiration or range of color-mainly oxidation of bilirubin
specimen inelude severe burns determined by its which imparts a yellow-
substitution, adulteration or - ANURIA-CESSATION Of CONCENTRATION green color
dilution urine flow ✓ PALE YELLOW → ✓ Medications:
✓ may result from any DILUTE URINE ➢ PHENAZOPYRIDIN
serious damage to the ✓ DARK YELLOW → E (Pyridium) or azo-
kidneys CONCENTRATED gantrisin
✓ or from a decrease in URINE compounds - also
blood flow to the kidney causes yellow foam
- NOCTURIA-INCREASE in Examine the specimen under a when shaken which
PHYSICAL/MACROSCOPIC nocturnal excretion of can be mistaken for
good light source, looking down
EXAMINATION urine bilirubin physical
through the container against a
• Volume - POLYURIA - INCREASE in examination of urine
white background
• Color daily urine volume
• Clarity ✓ 2.5-3 mL/kg/day in • RED/PINK/BROWN
• Specific gravity children - RED BLOOD CELLS
• Odor ✓ >2.5 L/day in adults ✓ PRODUCE RED AND
✓ often associated with • UROCHROME - causes the CLOUDY URINE
• URINE VOLUME diabetes mellitus and YELLOW color of urine ✓ Imparts red color (usual)
- Affected by insipidus - named by Thudichum in 1864 to brown color depending
✓ Fluid intake ✓ may be artificially • UROERYTHRIN - PINK pigment on the amount of blood,
✓ Fluid loss from non-renal induced by diuretics, most evident in REFRIGERATED urine pH and length of
sources caffeine or alcohol- SPECIMENS as a result of contact
✓ Variations in ADH suppress the secretion of AMORPHOUS URATES ✓ RBCs remaining in an
✓ Necessity to excrete ADH PRECIPITATION acidic urine for several
increased amounts of • UROBILIN - oxidation product of hours produce BROWN
dissolved solids such as DIABETES MELLITUS urobilinogen and imparts an urine (due to oxidation of
glucose or salts • Problem is related with ORANGE-BROWN color to hemoglobin to
- NORMAL DAILY OUTPUT- INSULIN leading to urine that is not fresh methemoglobin)
600 to 2000mL (average of INCREASED GLUCOSE - HEMOGLOBIN &
1200- 1500 mL) CONCENTRATION MYOGLOBIN

7
 ✓ PRODUCE RED AND ✓ Imparts black color to
CLEAR URINE (vs ALKALINE urine in
RBCs-red and cloudy) ALKAPTONURIA
- MELANIN
DIFFERENCES BETWEEN ✓ Oxidation product of the - VARIATIONS:
HEMOGLOBINURIA & colorless pigment ✓ ISOSTHENURIA - fixed
MYOGLOBINURIA MELANOGEN specific gravity of 1.010
➢ Seen in END-
• HEMOGLOBIN ✓ Produced in excess
when MELANOMA is STAGE RENAL
- Results from the IN VIVO
DISEASE
- BREAKDOWN OF RBCs present • CLARITY
- MEDICATIONS ✓ HYPOSTHENURIA
- Accompanied by RED - Refers to the
✓ Levodopa, Methyldopa, consistent specific gravity
PLASMA TRANSPARENCY
<1.010
• MYOGLOBIN Phenol-derivatives, TURBIDITY of a urine
Metronidazole (Flagyl) ✓ HYPERSTHENURIA-
- Results from BREAKDOWN specimen
specific gravity >1.010
OF SKELETAL MUSCLES - Determined by visually
- NO CHANGE in color of • BLUE/GREEN examining the urine
SUMMARY OF METHODS FOR
plasma - BACTERIAL INFECTIONS- specimen in a clear container
DETERMINING SPECIFIC
*Fresh urine containing myoglobin frequently GREEN color while holding it in a front of a
GRAVITY & THEIR PRINCIPLES
exhibits a more reddish-brown color than ✓ UTI by Pseudomonas light source
haemoglobin. spp.
✓ Intestinal tract infections
- PORPHYRINS - causes resulting in INCREASED
PORT WINE color and URINARY INDICAN
results from the OXIDATION - CLORETS - a breath
OF PORPHOBILINOGEN deodorizer Which imparts a • NORMAL CLARITY • DIRECT METHODS
- NON-PATHOLOGIC GREEN color - Usually clear (particularly if - Urinometer (Hydrometer)
CAUSES - MEDICATIONS - may cause midstream clean-catch ✓ LESS ACCURATE than
✓ Menstrual contamination BLUE urine specimen) the other methods; NOT
✓ Ingestion of highly ✓ Methocarbamol recommended by the
pigmented foods (Robaxin) CLSI
➢ Beets-red color in ✓ Methylene blue ✓ MAJOR
ALKALINE urine ✓ Amitriptyline (Elavil) DISADVANTAGE
➢ Blackberries-red ✓ Azure A (Diagnex Blue REQUIRES A LARGE
color in ACIDIC urine Test) VOLUME (10 ΤΟ 15 ML)
✓ MEDICATIONS • SPECIFIC GRAVITY ✓ Usually CALIBRATED
➢ Rifampin, - used to measure the AT 20°C
Phenolphthalein, concentrating and diluting ✓ CORRECTIONS on
Phenindione, ability of the kidney in its TEMPERATURE
Phenothiazines effort to maintain REQUIRED
homeostasis in the body ➢ If specimen is COLD,
• BROWN/BLACK ✓ TUBULAR subtract 0.001 from
- HOMOGENTISIC ACID REABSORPTION- the reading for every
✓ Metabolite of FIRST FUNCTION TO 3°C that the
phenylalanine DIMINISH IN RENAL specimen is below
DISEASE 20"C

8
 ➢ If specimen is ✓ CALIBRATED between ✓ pH of 9.0 =
WARM, add 0.001 15°C to 38°C (60°F to UNPRESERVED URINE
from the reading for 100°F) - Treatment of UTI
every 3°C that the ➢ TEMPERATURE
specimen is above CORRECTIONS
20°C ARE NOT
✓ CORRECTIONS needed NECESSARY
for GLUCOSE and ✓ CORRECTIONS needed UNUSUAL ODOR - Ingestion of
PROTEIN for GLUCOSE and onions, garlic and asparagus
➢ Subtract 0.004 for PROTEIN
every 1g/dL ➢ Subtract 0.004 for CHEMICAL EXAMINATION
GLUCOSE every 1g/dL. • pH • PROTEIN
➢ Subtract 0.003 for GLUCOSE • Protein - NORMAL: <10 mg/dL or 100
every 1g/dL ➢ Subtract 0.003 for • Glucose mg/24 hours (150mg/24
PROTEIN every 1g/dL • Ketones hours -Henry)
PROTEIN • Blood - Proteins found in urine:
✓ CALIBRATION ✓ Albumin - major serum-
• Bilirubin & Urobilinogen
➢ Distilled water - protein found in urine
• Nitrite & Leukocyte esterase
1.000 ✓ serum and tubular
- Harmonic oscillation ➢ 5% NaCl - 1.022 ± microglobulins
densitometry (HOD) or 0.001 • pH ✓ Tamm-Horsfall protein
Harmonic Resonance ➢ 9% Sucrose - 1.034 ± - DETERMINED BY THE (uromucoid) - produced
✓ PRINCIPLE: 0.001 CONCENTRATION OF THE by the tubules and forms
➢ the frequency of a FREE H+ MATRIX OF ALL TYPES
sound wave entering - as H+ increases, pH
• ODOR OF CASTS
a solution changes in decreases (becomes more ✓ proteins from prostatic,
- Seldom of clinical
proportion to the acidic) seminal and vaginal
significance
density of the - as H+ decreases, pH secretions
- Not part of the routine
solution increases (becomes more
urinalysis
alkaline)
- Freshly voided urine has a
• INDIRECT METHODS FAINT AROMATIC odor and
- Refractometer or (Total as the specimen stands, the
Solids Meter) odor of ammonia (due to • CLINICAL PROTEINURIA -
✓ PRINCIPLE: breakdown of urea) becomes presence of increased proteins
➢ Measures the more prominent • CLINICAL SIGNIFICANCE in urine (230 mg/dL (300 mg/L))
REFRACTIVE - LACK OF ODOR in urine - Metabolic acidosis or - Causes are grouped into
INDEX which is a from patients with ARF metabolic alkalosis three major categories:
comparison of the suggests ACUTE TUBULAR - Renal tubular acidosis PRERENAL, RENAL,
velocity of light in NECROSIS - Renal calculi formation POSTRENAL
air with the velocity - PRECIPITATION/IDENTIFIC
of light in a solution ATION OF CRYSTALS • PROTEINURIA
✓ ADVANTAGE: uses - DETERMINATION OF - PRERENAL - NOT indicative
SMALL VOLUME OF UNSATISFACTORY of actual renal disease; NOT
SPECIMEN (1 to 2gtts) SPECIMEN detected by reagent strip

9
 ✓ Conditions associated IMMUNOELECTROPHORE ✓ Quantitative procedures - SSA (SulfoSalicylic Acid
include SIS for albumin using 24 hour Test) / Cold Protein
➢ Septicemia/severe specimen Precipitation
infection or • RENAL - associated with TRUE ➢ 30 to 300 mg/24 ✓ Reagents: 3% SSA
inflammation - RENAL DISEASE hours ✓ Principle: most proteins
acute phase a - GLOMERULAR ➢ Albumin Excretion are precipitated by dilute
reactant proteins PROTEINURIA Rate (AER) of 20 to SSA
➢ Hemoglobinuria - ✓ most common type of 200 µg/min
after a hemolytic proteinuria encountered
episode and most serious • MICRAL TEST - strip employing
➢ Myoglobinuria - clinically ab-enz conjugate for human
follows muscle injury ✓ Immune complex albumin
➢ Immunoglobulin disorders - PRINCIPLE: Enzyme
paraproteins (and A (glomerulonephritis, immunoassay ✓ FALSE (+): radiographic
monoclonal light SLE), amyloidosis, toxic - Sensitivity: o to 10 mg/dL. dyes, tolbutamide
chains) - abnormally agent, diabetic metabolites,
produced in multiple nephropathy, strenuous • IMMUNODIP cephalosporins,
myeloma and exercise, dehydration, - PRINCIPLE: penicillins and
macroglobulinemia hypertension, orthostatic Immunochromographies sulfonamides
proteinuria - Sensitivity: 1.2 to 8.0 mg/dl. ✓ FALSE (-): highly
• BENCE-JONES PROTEIN (BJP) - TUBULAR PROTEINURIA alkalinë urine, very dilute
first recognized in 1847 by Henry ✓ a occurs when normal • POSTRENAL samples
Bence- Jones tubular reabsorptive - Urine includes proteins
- abnormal protein excreted function is altered or produced by the urinary tract • GLUCOSE
by patients with MULTIPLE impaired lower UTI (ureters, bladder, - NORMAL: 15 mg/dL
MYELOMA (proliferative ✓ Fanconi's syndrome, urethra, prostate and vagina) - RENAL THRESHOLD FOR
disorder of the toxic-agents/heavy - or the urine is contaminated GLUCOSE: 160 to 180
immunoglobulin-producing metals, pyelonephritis, with proteins during excretion mg/dL
plasma cells) acute tubular necrosis, ✓ menstrual contamination - CLINICAL SIGNIFICANCE -
- MONOCLONAL polycystic kidney ✓ vaginal secretions detection of DIABETES
IMMUNOGLOBULIN LIGHT disease, phenacetin ✓ prostatic fluid/sperms MELLITUS
CHAIN damage ✓ hemorrhoidal blood
- SCREENED by its UNIQUE
SOLUBILITY • PROTEINURIA • Tests for Albumin
CHARACTERISTICS - MICROALBUMINURIA - Heat and Acetic Acid Test
✓ precipitates at 40 to 60°C ✓ proteinuria NOT (Reference Method)
✓ disappears at 100°C detected by the routine ✓ Principle: urine is
- NOT all patients with reagent strip coagulated by heat and • Tests for Glucose
multiple myeloma will ✓ signifies onset of renal precipitated by acetic - Benedict's Test - general
excrete detectable levels of complications of acid (5-10%) and the test for glucose and other
BJP and suspected cases Diabetes mellitus (called degree of turbidity reducing sugars
should be diagnosed by diabetic nephropathy) produced is ✓ Reagent: Benedict's
performing serum - METHODS: proportional to the Solution
ELECTROPHORESIS & amount of protein ✓ Principle: relies on the
present ability of the glucose and

10
 other reducing abnormal carbohydrate nitrobenzene-diazonium-p-
substances to reduce utilization toluenesulfonate, SSA,
copper sulfate to cuprous ✓ acetone (2%) sodium carbonate, and boric
oxide in the presence of ✓ acetoacetic acid (20%) acid
alkali and heat ✓ B-hydroxybutyric acid - POSITIVE RESULT: BLUE
- Copper Reduction Method (78%) TO PURPLE COLOR
Clinitest Tablet - non-specific - NEGATIVE RESULT: colors
for glucose • CLINICAL SIGNIFICANCE other than blue or purple
✓ SENSITIVITY: 200 - INSULIN DOSAGE
mg/dL MONITORING • OTHER TESTS
✓ Reagents - Diabetes Mellitus - Foam-Shake Test, Oxidation
➢ COPPER SULFATE - Diabetic acidosis Test, Gmelin's Test, Fouchet
- main reacting agent - Starvation/fasting Test
➢ SODIUM - Weight - Harrison Spot Test
CARBONATE AND reduction/dieting/strenuous
CITRIC ACID - exercise
effervescent - Vomiting
➢ SODIUM
HYDROXIDE -
provides alkaline • UROBILINOGEN
medium - A colorless pigment formed
➢ sodium hydroxide • BILIRUBIN from the breakdown of
with water and citric • ACETEST - yellow pigmented bilirubin in the intestines
acid-provides heat - provides sodium degradation product of - Appears in urine because as
✓ 5 gtts urine + 10 gtts of nitroprusside, glycine, hemoglobin it circulates in the blood
H₂O Clinitest = disodium phosphate, and - CLINICAL SIGNIFICANCE: enroute to the liver, it may
POSITIVE REACTION: lactose in tablet form SCREENING OF pass through the kidney and
blue to orange/red - LACTOSE - added for better ABNORMAL be filtered by the glomerulus
color differentiation HEPATOBILIARY - Same clinical significance as
• PASS-THROUGH - Can be used to test urine, FUNCTION bilirubin
PHENOMENON serum plasma or whole blood ✓ Pre-hepatic jaundice
- May occur if > 2 g/dL sugar is - About 10x more sensitive to (hemolytic anemias)
present in urine DIACETIC ACID than ✓ Hepatic jaundice
- Prevented by changing 5 gits ACETONE (hepatitis, cirrhosis)
to 2 gtts of urine - DOES NOT DETECT B- ✓ Post-hepatic jaundice
hydroxybutyric acid (biliary obstructions,
gallstones, carcinoma)

• ICTOTEST
- MORE SENSITIVE (0.05 to
• KETONES • BLOOD 0.30 mg/dL.) than the diazo
- NORMALLY NOT IN URINE reaction in reagent strips
- Presence of ketone bodies in (0.40 mg/dL.)
urine results from increased - Consist of testing mats ad
fat metabolism due to tablets containing p-

11
 capable of REDUCING buffered in an acid • QUALITY CONTROL
NITRATE TO NITRITE medium - Test open bottles of
- most common organisms that ➢ Detects 5 mg/dL. of reagent strips with known
infect the urinary tract: ascorbic acid in urine positive and negative
✓ Proteus spp., E. coli, after 10 seconds N controls every 24 hr.
Klebsiella pneumonia ✓ Stix and Multi-stix: - Resolve control results that
and Pseudomonas impregnated with are out of range by further
aeruginosa methylene green testing.
- CLINICAL SIGNIFICANCE ➢ Detects 25 mg/dL of - Test reagents used in backup
✓ Cystitis, Pyelonephritis, ascorbic acid in urine tests with positive and
Evaluation of antibiotic at 60seconds negative controls. a
• Tests for UROBILINOGEN therapy, Monitoring of - Perform positive and
- Ehrlich's Tube Test - not patients at high risk for • PRINCIPLE of the REAGENT negative controls on new
specific urinary tract infection, STRIP reagents and newly opened
✓ Reagent: p- Screening of urine - Consist of chemical- bottles of reagent strips.
dimethylaminobenzaldeh culture specimens impregnated (absorbent pads - Record all control results
yde, sodium acetate attached to a plastic strip and-reagent lot numbers.
(added to enhance • LEUKOCYTE ESTERASE - A color-producing chemical
reaction) - presence in urine implies that reaction takes place when
✓ Result: cherry red color an inflammatory process is the absorbent pad comes in
- Hoesch Test (Inverse occurring in the kidney or contact with urine a
Ehrlich) urinary tract - Reactions are interpreted by
✓ Rapid screening test for - indicates pyuria comparing the color
urine porphobilinogen (z - CLINICAL SIGNIFICANCE produced on the pad with a
2 mg/dL) ✓ Bacterial and chart supplied by the
✓ Hoesch reagent (Ehrlich nonbacterial urinary Ent manufacturer
reagent dissolved in 6M infection - By careful comparison,
HCI) ✓ Inflammation of the results are described as
✓ Presence of urinary tact TRACE, 1+, 2+, 3+ OR 4+
porphobilinogen = RED ✓ Screening of urine
upon addition of reagent culture specimens • CARE OF THE REAGENT
✓ Urobilinogen is inhibited STRIPS
by the acidic pH • ASCORBIC ACID or VITAMIN C - Store with desiccant in an
- Schwartz-Watson - Source of interference due opaque, tightly closed
Differentiation Test to its strong reducing container.
✓ classic test to property leading to FALSE- - Store below 30°C; do not
differentiate urobilinogen NEGATIVE results freeze.
from porphobilinogen - Affects blood, bilirubin, - Do not expose to volatile
leukocyte esterase, nitrite fumes,
and glucose - Do not use past the expiration
- Principle used in some date
reagent strips: - Do not use if chemical pads
• NITRITE ✓ C-Stix: impregnated with become discolored.
- RAPID, INDIRECT METHOD phosphomolybdates - Remove strips immediately
for detection of BACTERIA prior to use.

12
• Parameters affected by 0/1+/2+/3+/4+ or neg,
ASCORBIC ACID (FALSE- rare, few, moderate,
NEGATIVE) -- BBLNG many
- Blood
- Bilirubin TECHNIQUES OF MICROSCOPIC
- Leukocyte Esterase
- Nitrite
- Glucose

MICROSCOPIC EXAMINATION
• PREPARATION AND
EXAMINATION OF URINE
SEDIMENT PARTS OF THE MICROSCOPE
- Specimen Volume
✓ usually between 10 and
15 mL
✓ 12-mL volume is
frequently used because
multiparameter reagent
strips are easily
immersed in volume this
volume, and centrifuge
tubes are often calibrated
to this • TOTAL MAGNIFICATION =
- CENTRIFUGATION OBJECTIVE MAGNIFICATION X
✓ 400 RCF for 5 MINUTES OCULAR MAGNIFICATION
✓ Centrifuge calibration • OCULAR MAGNIFICATION =
should be routinely 10X
performed EVERY 3 • OBJECTIVE MAGNIFICATION
MONTHS - LPO=10x
✓ Centrifuges are - HPO = 40x
routinely disinfected on - OIO = 100x
a WEEKLY basis
- VOLUME OF SEDIMENT • OCULARS - adjusted horizontally
AFTER DECANTATION = to adapt to differences in
0.5 to 1.0. mL interpupillary distance between
- VOLUME OF SEDIMENT operators for optimal viewing
EXAMINED = 20 µL conditions
- REPORTING • DIOPTER ADJUSTMENT KNOB
✓ RBC/WBC, RTE cells & - can be rotated to compensate
O Oval fat bodies = ave for variations in vision between
#/10 HPF the operators' eyes
✓ Casts = ave #/10 LPF • OBJECTIVES - perform the
✓ Epithelial cells, crystals initial magnification
and others =

13
• RHEOSTAT - regulates the • WHITE BLOOD CELLS/PUS (causative agent of bacterial Henle & DCT and have the
intensity of light CELLS vaginosis) which covers most same significance as casts
• CONDENSER - focuses the light - NORMAL VALUE: 0 to of the cell surface and extend - CYLINDRURIA -
on the specimen 5/HPF beyond the edges of the cell PRESENCE OF CAST IN
• APERTURE DIAPHRAGM - - appear as granular spheres, THE URINE
controls the amount of light about 12 microns in diameter, • OVAL FAT BODIES - DEGENERATION OF
and the angle of light that will usually neutrophils - LIPID-CONTAINING RENAL CASTS:
pass through the specimen and - usually distinguished from TUBULAR CELLS found in ✓ hyaline cast cellular cast
lens RBC by the addition of 2% lipiduria (associated with coarsely granular →
HAC damage to glomerulus finely granular → waxy
SEDIMENT STAINS - Pyuria - increased WBC in caused by nephrotic cast
urine syndrome, severe tubular
- Glitter cells pale blue necrosis, DM and trauma)
leukocytes usually producing ✓ seen in conjunction with
a "sparkling appearance" in free floating fat droplets
their cytoplasm, they exhibit ✓ under polarized light,
Brownian movement and light, they exhibit TYPES OF CASTS
seen in dilute or hypotonic "maltese cross • Hyaline casts
MICROSCOPIC EXAMINATION OF - NORMAL: 0 to 2/LPF
URINE – ORGANIZED SEDIMENT urine appearance"
- CLINICAL SIGNIFICANCE: ✓ Identification is confirmed - colorless, homogenous and
• RED BLOOD CELLS has same refractive index as
- NORMAL VALUE: 0 to ✓ bacterial infection by Sudan Ill or Oil Red
(pyelonephritis, cystitis, O urine
2/HPF - made up entirely Tamm-
- colorless disks without prostatitis, urethritis)
✓ non-bacterial • BUBBLE CELL Horsfall Protein
nucleus, 7-microns in - indicates "mild renal damage
diameter (glomerulonephritis, - RENAL TUBULAR
SLE, interstitial nephritis, EPITHELIAL CELL - Clinical Significance:
- frequently confused with air ✓ non-pathologic:
bübbles, yeast cells, oil tumors) containing large, nonlipid
✓ Eosinophils >1% is filled vacuoles strenuous exercise,
droplets and calcium dehydration, heat
oxalate CONSIDERED
SIGNIFICANT • CASTS exposure, emotional
- In HYPOTONIC (dilute and stress
alkaline) URINE - appears as associated with drug - ONLY ELEMENTS FOUND
induced interstitial IN THE URINE THAT ARE ✓ pathologic: acute
swollen/ghost cells or glomerulonephritis,
shadow cells nephritis (UTI and renal UNIQUE TO THE KIDNEYS
transplant) - FORMED primarily within the pyelonephritis, chronic
- In HYPERTONIC renal disease,
(concentrated) URINE - lumen of DCT AND
COLLECTING DUCTS congestive heart failure
appears as crenated/shrink
- CLINICAL SIGNIFICANCE: - TAMM-HORSFALL
PROTEIN - major constituent • RBC CASTS
✓ glomerular membrane - indicates hemorrhage in the
damage of casts
✓ Glycoprotein produced renal tubules - "active acute
(glomerulonephritis) nephritis"
✓ vascular injury within the • CLUE CELLS by the RTE cells
- CYLINDROIDS - casts with - found in healthy individual
genitourinary tract - SQUAMOUS EPITHELIAL following participation in
✓ microscopic examination CELLS STUDDED with TAPERED ENDS produced
at t at the ascending loop of "contact sports”
of urine organized Gardnerella vaginalls
sediments

14
• WBC casts • MUCUS THREADS - found in urine after sexual
- presence signifies "infection - protein material produced by intercourse or nocturnal
and inflammation within glands and epithelial cells in emissions of masturbation
the nephron" genitourinary tract and RTE - (+) CHON reagent strip in
- most frequently seen in cell increase amount of semen
pyelonephritis - Tamm-Horsfall Protein-major
- presence indicates the need constituent
to perform bacterial cultures - increased amounts occur in
"vaginal contamination"
• EPITHELIAL CELL CASTS and "irritation" of any kinds
- observed in conjunction with
RBC and WBC cast in • BACTERIA
glomerulonephritis and - only reported when observed
pyelonephritis in fresh specimens in
conjunction with WBC
• GRANULAR CASTS - confirmed with positive urine • CRYSTALS
- usually seen accompanying culture - formed by the precipitation of
hyaline casts following - presence is indicative of urine solutes: inorganic salts,
periods of stress and lower or upper UTI organic compounds,
strenuous exercise medications
• YEAST CELLS ✓ affected by changes in
pH, temperature, or
• WAXY CASTS - seen in Diabetes Mellitus,
vaginal moniliasis, solute concentration
- indicates "extreme stasis of
immunocompromised - pH-most valuable in the
urine flow" PREGNANCY TEST
patients identification of crystals
- refractile with rigid texture,
✓ organic and iatrogenic • Pregnancy testing may be
which causes them to be - easily confused with RBC performed on urine or on blood.
- observed with budding forms compounds crystallize
fragmented as the pass - Preferred urine specimen is
more easily in an acidic
through the tubules FIRST MORNING URINE to
pH
- DOES NOT EXHIBIT • PARASITES avoid false negative because
✓ inorganic salts are less
MALTESE CROSS - Trichomonas vaginalis - hCG only acts in acidic
soluble in neutral and
MOST FREQUENT urine.
alkaline solutions
• FATTY CASTS PARASITE encountered in • Chorionic gonadotropin is a
✓ CALCIUM OXALATE -
- seen in conjunction with Oval the urine; "PING-PONG" glycoprotein hormone with two
precipitates in both acidic
Fat Bodies in disorders disease non-identical subunits (alpha
and neutral urine
causing "lipiduria" such as - Schistosoma haematobium and beta polypeptide chains),
- Reported as rare, few,
nephrotic syndrome - may cause hematuria - synthesized and secreted by
moderate, or many per HPF
because it lacerates the trophoblast cells of the
- Abnormal crystals may be
• BROAD CASTS bladder
averaged and reported per placenta
- presents grave prognosis - Enterobius vermicularis - - helps maintain the uterine
LPF
- referred to as "Renal Failure MOST COMMON FECAL lining the endometrium, with
Casts” CONTAMINANT an adequate uterine blood
- associated with widening and supply until placenta
destruction of tubular walls • SPERMATOZOA synthesis of progesterone
- NOT REPORTED unless begins
medico-legal case

15
 - ALPHA CHAIN - structurally - Cystine - yellow-brown and conjunction with group A walls or the glomerular
similar in luteinizing hormone feel somewhat greasy Streptococcus infection, on basement membrane,
(LH) and follicle-stimulating • Determine its weight and the glomerular membranes possibly immune-
hormone (FSH) approximate size mediated
- BETA CHAIN - UNIQUE TO - May be of various sizes, • Rapidly Progressive - Minimal Change Disease
hCG commonly described as (Crescentic) ✓ Disruption of the
• The substance tested in SAND, GRAVEL or STONE Glomerulonephritis podocytes occurring
pregnancy is BETA-HUMAN • Pulverize the calculus, check its - Deposition of immune primarily in children
CHORIONIC GONADOTROPIN homogeneity and nucleation complexes from systemic following allergic
HORMONE (β-hCG) • Take a small portion of the stone immune disorders on the reactions and
• Levels of this hormone rise and ash it over a hot burner glomerular membrane immunizations
rapidly after conception and - IF ENTIRELY CONSUMED - Goodpasture Syndrome - Focal Segmental
remain elevated in pregnancy, IN THE FLAME: TOTALLY ✓ Attachment of a cytotoxic Glomerulosclerosis
PEAKING IN THE FIRST ORGANIC antibody formed during ✓ Disruption of podocytes
TRIMESTER OF PREGNANCY - IF IT DOES NOT CHANGE viral respiratory in certain areas of
• Enzyme immunoassays are the ON ASHING: MOSTLY infections to glomerular glomeruli associated with
most popular type of test kit, but INORGANIC and alveolar basement heroin and analgesic
whatever the method, follow the - membranes abuse and AIDS
manufacturer's guideline. ✓ (+) ANTI-GLOMERULAR
- Results are reported as B- BASEMENT CHRONIC
hCG negative or as B-hCG MEMBRANE ANTIBODY GLOMERULONEPHRITIS
positive. - Wegener's Granulomatosis • Marked decrease in renal
- These kits may show a ✓ Antineutrophilic function resulting from
positive result in a urine cytoplasmic auto- glomerular damage
sample in as little as 10 days RENAL DISEASES antibody hinds to precipitated by other renal
after conception. • Glomerular Disorders neutrophils in vascular disorders
• DETECTION LIMITS: • Tubulointerstitial Disorders walls producing damage
- Serum hCG: 1 to 2 mIU/mL • Others to small vessels in the IMMUNOGLOBULIN A
- Urine hCG: 20 mIU/mL lungs and glomerulus NEPHROPATHY (BERGER
- Home use: 50 mIU/ml CLINICAL PRESENTATION OF ✓ (+) DISEASE)
GLOMERULAR DISEASES ANTINEUTROPHILIC • Deposition of IgA on the
ANALYSIS OF RENAL CALCULI CYTOPLASMIC AUTO- glomerular membrane resulting
• Involves visual examination of the ANTHODY/ANCA from increased levels of serum
stone(s), noting its external - Membranous IgA
appearance Glomerulonephritis • MOST COMMON CAUSE OF
- Uric acid and urate stones - ✓ Thickening of the GLOMERULONEPHRITIS
yellow to brownish red and glomerular membrane
are moderately hard a following IgG complex HENECH-SCHÖNLEIN PURPURA
GLOMERULAR DISORDERS deposition associated • Occurs primarily in children
- Phosphate stones - pale
PRESENTING AS NEPHRITIC with systemic disorders following viral respiratory
and friable
SYNDROME IgG immune infections; a decrease in platelets
- Calcium oxalate stones -
very hard, often of a dark • Acute Poststreptococcal - Membranoproliferative disrupts vascular integrity
color, typically have a rough Glomerulonephritis Glomerulonephritis
surface - Deposition of immune ✓ Cellular proliferation
complexes, formed in affecting the capillary

16
 ALPERT SYNDROME bladder, and untreated telescoped urine - Cystine (seen in conjunction
• Genetic disorder glomerular cystitis sediment with hereditary disorders of
showing lamellated and thinning • Chronic Pyelonephritis cysteine metabolism)
of basement membrane - Recurrent infection of the ACUTE RENAL FAILURE (ARF)
renal tubules and interstitium • exhibits a sudden loss of renal MALIGNANCIES
DIABETIC NEPHROPATHY caused by structural function and is frequently • Nuclear Matrix Proteins (NMPs)
• also known as Kimmelstiel- abnormalities affecting the reversible - Detection of Bladder Cancer
Wilson disease flow of urine - also referred to as nuclear
• currently the most common • Acute Interstitial Nephritis skeletal proteins and nuclear
cause of end-stage renal - Allergic inflammation of the mitotic apparatus proteins
disease renal interstitium in response - 236 kDa proteins needed for
• This is believed to be associated to certain medications correct mitotic spindle
with deposition of glycosylated • Cystitis formation
proteins resulting from poorly - Ascending bacterial infection RENAL LITHIASIS - a number of tumor-
controlled blood glucose of the bladder • Renal calculi (kidney stones) associated NMPs has been
levels. may form in the calyces and identified, each specific for
• The vascular structure of the OTHERS pelvis of the kidney, ureters, and one of five/tumor types
glomerulus also develops • Renal Failure bladder. They may be small and (bladder, prostate, breast,
sclerosis. - May be acute or chronic be passed in the urine or large colon, and bone)
- may be a gradual and obstruct the urinary tract. - NMP22 - best studied NMP
TUBULOINTERSTITIAL DISEASES progression from the original • CONDITIONS FAVORING THE and is strongly associated
• Acute Tubular Necrosis disorder to chronic renal FORMATION OF RENAL with transitional cell
- Damage to the renal tubular failure or end-stage renal CALCULI carcinoma of the bladder
cells caused by ischemia or disease - pH
toxic agents - progression to end-stage - chemical concentration LABORATORY SAFETY
• Fanconi Syndrome renal diseases is - urinary stasis BIOLOGICAL HAZARDS
- Inherited in association with characterized by • PRIMARY CALCULI • CHAIN OF INFECTION - how
cystinosis and Hartnup ✓ a marked decrease in the CONSTITUENTS microorganisms are transmitted
disease or acquired through glomerular filtration - 75% CALCIUM OXALATE - requires a continuous link
exposure to toxic agents rate (less than 25 or PHOSPHATE (frequently between the following:
• Nephrogenic Diabetes ml/min) associated with metabolic ✓ SOURCE: contaminated
Insipidus ✓ steadily rising serum calcium and phosphate clinical specimen or an
- Inherited defect of tubular BUN and creatinine disorders and occasionally infected patient
response to ABB or acquired values (azotemia) diet) ✓ METHOD OF
from medications ✓ electrolyte imbalance - Magnesium ammonium TRANSMISSION:
• Renal Glycosuria ✓ lack of renal phosphate (frequently ➢ direct contact (eg,
- Inherited autosomal concentrating ability accompanied by urinary the host touches the
recessive trait producing an infections involving urea- patient, specimen,
isosthenuric urine splitting bäcteria; urine pH oral contaminated
• Acute Pyelonephritis
- Infection of the renal ✓ proteinuria usually >7.0) object)
✓ renal glycosuria - Uric acid (associated with ➢ inhalation of infected
tubules and interstitium
related to interference of ✓ and an abundance of increased intake of foods with material (e.g.,
granular, waxy, and high purine content: urine pH aerosol droplets from
write flow to the bladder,
broad casts, often is acidic) a patient or an
reflux of urine from the
referred to as a

17
 uncapped centrifuge - This includes both specimens CHEMICAL HAZARDS • MSDS (Material Safety Data
tube), and the materials with which • CHEMICAL HYGIENE PLAN Sheets) – information includes
➢ ingestion of a the specimens come in (CHP)-INCLUDES: the ff:
contaminated contact. - Appropriate work practices, - Physical and chemical
substance (eg, food, - The waste is then Standard operating characteristics
water, specimen) decontaminate following procedures, PРЕ, - Fire and explosion potential
➢ from an animal or institutional policy: Engineering controls, such as - Reactivity potential
insect sector bite incineration, autoclaving, or fugle hoods and flammables - Health hazards
✓ SUSCEPTIBLE HOST pickup by a certified safety cabinets, Employee - Methods of safe handling
hazardous waste company. training requirement Medical
• BIOLOGICAL SAFETY - Urine may be discarded by consultation guidelines RADIOACTIVITY HAZARD
- Most direct contact with a pouring it into a laboratory • CHEMICAL LABELING • Radioactivity is encountered in
source infection in the clinical sink. - NFPA (National Fire the clinical laboratory when
laboratory is through - Disinfection of the sink using Protection Association) procedures using radioisotopes
contact with patient a 1:5 or 1:10 dilution of Hazards Identification are performed.
specimens sodium hypochlorite should System • This symbol must be displayed on
- Primary objective of be performed daily. ✓ a diamond-shaped, the doors of all areas where
biological safety preventing - Sodium hypochlorite dilutions color-coded symbol radioactive material is present.
completion of the chain of stored in plastic bottles are contains information
infection effective for 1 month if relating to health, ELECTRICAL HAZARDS
- Handwashing (at least 15 protected from light after flammability, activity, and • All electrical equipment must be
seconds) - SINGLE MOST preparation. personal grounded with three-pronged
EFFECTIVE WAY TO - The same solution also can protection/special plugs
PREVENT THE SPREAD OF be used for routinely precautions • If electric shock accidents occur
INFECTIONS disinfecting countertops and ✓ Each category is graded never touch the person or the
accidental spills. on scale of o to 4, based equipment involved
• Universal symbol for - Empty urine containers can on the extent of concern • Turn off the circuit-
BIOHAZARDOUS MATERIAL - be discarded as breaker/unplug the
demonstrates how following nonbiologically hazardous equipment/move the equipment
prescribed safety practices can waste. using a nonconductive glass or
break the chain of infection. This - Sharp Hazards all sharp wood object
figure places particular emphasis objects (needles, lancets,
on laboratory practices broken glassware) must be FIRE HAZARD
disposed of in puncture- • When a fire is discovered, all
resistant containers employees are expected to take
Yellow - reactivity hazard the actions in the acronym RACE:
SHARP HAZARD White - specific hazard
Blue - health hazard - Rescue - rescue anyone in
• SHARP HAZARDS - all sharp Red - fire or flammable hazard immediate danger
objects (needles, lancets, broken • NUMERIC RATINGS - Alarm - activate the
• Disposal of Biological Wastes glassware) must be disposed of - 4: Extreme hazard institutional fire alarm system
- All biological waste, except in puncture-resistant containers - 3: Severe hazard - Contain - close all doors to
urine, must be placed in - 2: Moderate hazard potentially affected areas
appropriate containers - 1: Slight hazard - Extinguish - attempt to
labeled with the biohazard - 0: None extinguish the fire, if possible
symbol.

18
• The acronym PASS can be used • Automated Instrument in 50 and 200 for Clinitek ✓ Sample is stained with 2
to remember the steps in the Urinalysis Status dyes
operation: - INDIVIDUAL STRIP ✓ automated reading of ➢ PHENATHRIDINE -
- Pull pin READERS microalbumin-to- orange dye, stains
- Aim at the base of the fire - SEMIAUTOMATED creatinine and protein-to- DNA
- Squeeze handles ANALYZERS creatinine ratios and ➢ CARBOCYANINE -
- Sweep nozzle side to side ✓ dependent on an human chorionic greèn dye, stains
operator for specimen gonadotropin (hCG) nuclear membranes,
PHYSICAL HAZARD mixing, test strip, dipping, mitochondria, and
• General precautions to consider and inputting of physical • Semiautomated Chemistry negatively-charged
are to avoid running in rooms and and microscopic results Instrument cell membranes
hallways, watch for wet floors, - FULLY AUTOMATED - CLINITEK 200 ✓ Stained sample is
bend the knees when lifting heavy CHEMISTRY ANALYZERS ✓ For medium-volume to passed through the flow
objects, keep long hair pulled ✓ add urine to the reagent large-volume urinalysis cell, where it is
back, avoid dangling jewelry, and strip laboratories and features HYDRODYNAMICALLY
maintain a clean, organized work - AUTOMATED URINE CEDE a high specimen output FOCUSED and
area. ANALYZERS of one strip every 10 presented to a laser light
✓ mix, aspirate, dilute, and seconds. beam that produces
URINALYSIS AUTOMATION stain urine to classify ✓ Multistix reagent test fluorescence and light
• Automated Reagent Strip urine sediment particles strips are used, and the scatter
Readers - COMPLETELY instrument has the ability ✓ Particles are identified by
- use a spectrophotometric AUTOMATED SYSTEMS to report semiquantitative measuring the change in
measurement of light ✓ perform a complete (mg/dL) results or plus impedance of the
reflection termed urinalysis that includes (+) and SI units. sediment elements, as
REFLECTANCE the physical, chemical, ✓ The reflectometer is well as the height and
PHOTOMETRY and microscopic parts of calibrated daily and width of the fluorescent
✓ PRINCIPLE: light a routine urinalysis maintenance is required and light scatter signals,
reflection from the test each day for all areas in which are presented in
pads decreases in contact with urine test scattergrams and
proportion to the intensity strips histograms
of color produced by the - iQ 200 Automated Urine
concentration of the test • Automated Microscopy Microscopy Analyzer (IRIS)
substance - SYSMEX UF-SERIES ✓ Automatically analyses
- ULTIMATE GOAL OF ✓ Fully automated sample and classifies urine
AUTOMATION analysis with automatic particles into 12
• Waived Urine Chemistry categories a
✓ improve reproducibility classification of all 10
Instruments formed element groups ✓ Uses AUTO PARTICLE
discrimination and color
- CLINITEK 50 & CLINITEK RECOGNITION (APR)
✓ increasing productivity with SCATTERGRAMS
STATUS and HISTOGRAMS for software that classifies
and standardization for
✓ well suited for small reference urine particles in the
reporting urinalysis
volume laboratories and ✓ Laser-based FLOW photographs based on
results
physician's offices CYTOMETRY along with size, shape, texture, and
✓ Memory storage for test impedance detection, contrast cerebrospinal
results -100 for Clinitek forward light scatter, and spinal fluid assay
fluorescence

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- ADVIA120 Hematology
System
✓ First automated
instrument with an FDA-
approved automated
CSF assay
✓ Uses flow cytometry, light
scatter, and absorbance
to count the RBCS,
WBCs, and perform a
WBC differential that
includes percentages
and absolute numbers of
mononuclear cells and
PMNs on samples with
>20 WBCs/µL

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