HTEC 64A CH 16 (lap)

Why should a nitrite test not be performed on a urine specimen that has been left standing at room temperature.

Because a false positive result may occur from bacterial contamination from the environment.

Nocturnal enuresis

Bedwetting, the inability to control urination at night during sleep

What is the urinary meatus

external opening of the urethra

Nocturia

Excessive voluntary urination during the night

Anuria

Failure of the kidneys to produce urine

T/F A normal adult excretes approximately 250mL of urine each day

False. -It's 750mL to 2,000mL per day (A quart is equal to approximately 1000 ml.) -Varies based on amount of fluid consumed and Amount lost through other means Ex: perspiration/feces

T/F A 24 hr urine specimen may be collected to assist in the diagnosis of a UTI

False. -UTI is a clean-catch midstream collection and 24 hr is for quantitative measurement of specific urinary components -24 hr specimen has a greater accuracy of measurement than with random specimen because they are collecting for 24 hrs. (Body, metabolism, exercise, and hydration can affect the excretion rate of substances in the urine.)

T/F Dysuria is the inability to control urination at night

False. Dysuria is for difficult/painful urination Nocturnal enuresis is bedwetting (Inability to control urination at night)

T/F Casts are formed in the urinary bladder

False. Formed in the Lumen

T/F A urine specimen that is light yellow indicates that bacteria are present in the specimen

False. Light yellow is for diluted urine, bacteria urine is cloudy

T/F If a urine specimen is allowed to stand for more than 1 hour at room temperature, the pH becomes more acidic

False. The longer it stands out, makes it less acidic and can get cloudy

T/F Urea is a waste product derived from the breakdown of water

False. Urea is derived from break down of proteins.

T/F The pH of most urine specimens is neutral

False. Urine is acidic with pH below 7.

What is the purpose of performing a microscopic exam of the urine

Helps clarify the results of the physical & chem exams

? Why is first-voided specimen recommended for a microscopic exam of the urine

It is more concentrated and contains more dissolved substances; small amounts of abnormal substances are more likely to be detected.

specific gravity

Measures weight of a substance compared with the weight of an equal volume of distilled water (standard?) -indicates amount of dissolved substance present -provides info on ability of kidneys to dilute/concentrate urine -decreases when kidneys can't concentrate urine (chronic renal insufficiency, diabetes insipidus, malignant hypertension: bp 180/120 med. emergency) -increases in patients with: adrenal insufficiency, CHF, hepatic disease, diabetes mellitus w/glycosuria, conditions that causes dehydration ( fever, vomiting, diarrhea) Normal range 1.003-1.030 (varies w/fluid intake and state of hydration) Distilled urine has lower SG b/c fewer dissolved substances Concentrated urine has higher SG b/c of increased amount of dissolved substances

What is the name of the vaginal infection caused by yeast

Candidiasis

Inorganic waste

Chloride, sodium, potassium, calcium, magnesium, phosphate, sulfate

Classifications used to describe color

Color of urine specimen assists in determining additional tests that may be necessary: -Light yellow -Yellow -Dark yellow -Amber -Dark Amber

Dysuria

Difficult or painful urination

What is the name of the most common pathogen that infects the bladder?

Escherichia coli.

Types of urine sample and collection method

Preg. test: first-voided morning specimen UTI test: clean catch midstream collection.

Why is a clean-catch specimen desired

Reduces possibility of having to obtain urine specimen by: -Bladder catheterization (catheter through the urethra into the bladder) -Suprapubic aspiration of bladder (needle through abdominal wall into the bladder)

Diueresis

Secretion and passage of large amounts of urine

Frequency

The condition of having to urinate often

urgency

The immediate need to urinate

retention

The inability to empty the bladder, urine is being produced normally but is not being voided

urinary incontinence

The inability to retain urine

Micturition

The normal act of voiding urine

Bilirubinuria

The presence of bilirubin in the urine

Glycosuria

The presence of glucose in the urine

Ketonuria

The presence of ketone bodies in the urine (Body rids itself of excess ketones by excreting them in urine) 3types: Beta-hydroxy botyric acid, acetoaetic acid, and acetone. Normal presence of fat metabolism can be used by muscle tissues as source of energy. But muscles can not handle all of the ketones. Conditions causing ketonuria: -Uncontrolled diabetes -Starvation -Diet composed almost entirely of fat

proteinuria

The presence of protein in the urine

pyuria

The presence of pus in the urine

Why should a patient not void directly into a 24 hour urine specimen container that contains a preservative

The preservative could splash onto the patient, resulting in a chemical burn.

pH

The unit that describes the acidity or alkalinity of the solution Normal range: 4.6-8.0 (patient w/normal diet = 6.0 Alkaline > 7 Neutral : 7 Acidic < 7 Abnormal high pH is bacterial infection of the urinary tract

void

To empty the bladder

Why must a small amount of urine first be voided into the toilet

To flush out microorganisms.

What is the purpose of cleansing the urinary meatus

To remove microorganisms that are normally present on the meatus.

Why should the inside of the specimen cup not be touched

Touching the inside would contaminate it, and the test results may then be inaccurate.

T/F An excessive increase in urine output is called polyuria

True

T/F Approximately 95% of urine consists of water

True

T/F Frequency is the condition of having to urinate often

True

T/F HCG is a hormone that is present in the urine and blood of a pregnant woman

True

T/F Hematuria refers to the presence of blood in the urine

True

T/F Urinalysis consists of a physical, chemical, and microscopic examination of urine

True

T/F The distal urethra normally contains microorganisms

True As well as the urinary meatus

T/F If a freshly voided specimen is cloudy, the patient may have a urinary tract infection

True Can mean presence of bacteria, pus, blood, fat, yeast, sperm, mucous thread, fecal contaminated too. (Microscopic exam should be performed to determine the cause of cloudiness) - b/c sometimes becomes cloud standing out too long

T/F Vomiting can result in Oliguria

True Other causes: decreased fluid intake, dehydration, profuse perspiration, diarrhea, kidney disease

T/F A clean-catch midstream urine specimen is required for a urine culture and examined for bacteria

True To prevent contamination of the specimen with normally present microorganisms

T/F The normal specific gravity or urine ranges from 1.003 to 1.030

True. -normal ranges are usually between 1.010 and 1.025 -Specific gravity of distilled water: 1.000

T/F Blood may normally be present in the urine due to menstruation

True? But most prefer to do urine testing when the patient is clear of period and a few days after last day of cycle sometimes is considered abnormal constitute of urine (hematuria: caused by injury, cystitis, tumors of the bladder)

The urine drains from the Kidneys into the urinary bladder through what

Ureters: -10 to 12 inches in length and ½ inch in diameter -Propel urine into the urinary bladder (By force of gravity and the peristaltic waves of the ureters)

Chemical Examination of Urine

Used to assist in diagnosis of: -Kidney function -Urinary tract infections -Carbohydrate metabolism (diabetes mellitus) -Liver function -Substances present in excess (abnormal) amounts in the blood are usually removed by urine Example: glucose is normally present in blood - if it exceeds a certain level: excess is excreted in urine -Indirect means of detecting abnormal amounts of chemicals in the body -Detection of substances that do not normally appear in the absence of disease Example: blood and nitrite

Fresh urine

Usually clear or transparent

Abnormal color of urine may be due to

Abnormal color helps to determine additional tests needed: -Presence of hemoglobin or blood (reddish color) -Bile pigments (yellow-brown or greenish fluid produce by the liver) -Fat droplets or pus (milky color)

How does the function of the urethra differ in the male and female

*Urethra is a tube that extends from urinary bladder to outside of the body -Male: transports urine and reproductive secretions -Females: transports urine only

Casts

-**Cylindrical structures: formed in lumen of nephron tubules -Materials in tubules harden and are flushed out: appear in urine as casts -Generally indicate diseased condition -Named according to what they contain -Hyaline casts: pale, colorless cylinders with rounded edges (Vary in size) -Granular casts: hyaline casts that contain granules -Fatty casts: hyaline casts that contain fat droplets -Waxy casts: light yellowish with serrated edges (Appear to be made of wax) -Cellular Casts: hyaline casts that contain organized structures Named for what they contain RBC casts WBC casts Epithelial casts

Random specimen

-A urine specimen that is collected at any time. -Often performed on freshly voided, random specimens. -MA instructs the patient to void into a clean, dry, wide mouthed container, and the urine is tested immediately.

Leukocytes

-Accompanies inflammation of kidneys and lower urinary tract -Conditions causing leukocyturia: Acute and chronic pyelonephritis Cystitis Urethritis -Recommended specimen for women: Clean-catch midstream collection Prevents contamination of specimen with leukocytes from vaginal secretions Can cause false-positive test results

increased specific gravity

-Adrenal insufficiency -Congestive heart failure -Hepatic disease -Diabetes mellitus with glycosuria -Conditions causing dehydration (eg: fever, vomiting, and diarrhea)

A urine specimen that has been allowed to stand at room temperature for a long period of time will have what type of odor

-Ammonia odor (as a result from breakdown of urea by bacteria) Other Odors: -Freshly voided urine has aromatic odor -Urine of diabetic patients may have fruity odor: presence of ketones -Urine of patient with UTI: foul-smelling odor -Certain foods (e.g., asparagus causes a musty smell) [Odor not generally used in diagnosis of the patient's condition]

urinalysis

-Analysis of urine -Consists of physical analysis of urine, chemical analysis of urine and microscopic examination of urine sediment -plays role as screening measures and physical examination -performed one fresh/preserved specimen within 1 hr (or preserved in refrigerator in closed container and then returned to room temp and mixed before testing) -chemical additives are preservatives used for prolonged storage: specimens that must be shipped long distance

**Rapid Urine Cultures

-Assist in: **Diagnosis of UTI Assessment of effectiveness of antibiotic therapy for UTI Used in medical office: to culture a urine specimen (Provides more immediate results) -Two brand name tests are Uricult and UriCheck. -Consists of slide attached to a screw cap -Each side of slide is coated with agar medium -Slide suspended in clean plastic vial: protects it from contaminants -Recommended urine specimen: clean-catch midstream Collected after urine has been in bladder for 4 to 6 hours Slide is dipped into the urine specimen Slide is incubated Slide is compared with a reference chart (Do not use agar if it is dehydrated, or if mold or bacteria growth is present.)

A 24 hour urine specimen is used to diagnose what condition

-Cause of kidney stone formation -Control and prevention of new stones -Kidney functions -Examples of substances measured: Calcium, Creatinine, Lead, Potassium, Protein, Urea nitrogen -use large wide-mouthed container (holds 3,000ml) -must be frigerated to prevent changes or kept in ice chest -preservatives: hydrochloride acid, boric acid, acetic acid, toluene -hazardous warning labeled for containers a/preservatices (The volume of urine is also measured. This is important with certain diseases.)

What effect does concentrated urine have on red blood cells in it

-Causes the red blood cells to become shrunken or crenated -Diluted urine: swells them

Decreased specific gravity

-Chronic renal insufficiency -Diabetes insipidus -Malignant hypertension

Appearance of Urine

-Clear -Slightly cloudy -Cloudy -Very cloudy

Guidelines for Clean-Catch method

-Collected by patient at office -MA provides complete instructions: To prevent contamination of specimen with bacteria and avoid patient having to collect another specimen -Test specimen immediately (or refrigerate), to ensure reliable test results -If sent to outside laboratory: Complete the laboratory request form and record in patient's chart information on transport of specimen to laboratory

Blood in Urine

-Considered abnormal (unless due to menstruation) Hematuria: presence of blood in the urine -Conditions causing hematuria: -Injury -Cystitis -Tumors of bladder -Urethritis -Kidney stones -Certain kidney disorders

Why is a first-voided morning specimen often desired

-Contains greatest concentration of dissolved substances. -A small amount of an abnormal substance that is present would be more easily detected.

What is a urinary cast

-Cylindrical structures formed in the lumes of the nephron tubules -Presence of casts generally indicates disease

Oliguria

-Decreased or scant urine output (less than 400 ml in 24hrs) -Caused by: Decreased fluid intake, Dehydration, Profuse perspiration, Vomiting, Diarrhea, Kidney disease

What may cause glycosuria

-Diabetes mellitus -Consumption of large amounts of sugary foods

Specific gravity

-Dilute urine: lower SG (fewer dissolved substances) -Concentrated urine: higher SG (more dissolved substances) -In the medical office, specific gravity is most commonly measured using a reagent strip.

For a 24 hour urine specimen, the MA should provide both written and verbal instructions, which are

-Drink normal amount of fluid during collection period -Avoid alcohol for 24 hours before and during collection -Some foods may also interfere with the test. -Choose 24-hour period when you will be at home: So urine won't have to be transported -Do not perform during menstruation -Physician may want patient to discontinue certain medications for 1 week before the test -An example of a drug that may interfere with the test is aspirin.

Quality Control Testing

-Ensures reliability of test results -Determines if strips are reacting properly -Confirms that the test is being properly performed and accurately interpreted Example: Chek-Stix control checks reliability of Multistix -Consists of a plastic strip with seven synthetic ingredients -Reconstituted in distilled water for 30 minutes -Ingredients dissolve in the water -Perform quality control -When you open a new bottle of strips -Question of reliability with testing strips

What condition may cause bilirubin to appear in the urine

-Excessive hemolysis of red blood cells -Infectious hepatitis -Cirrhosis -Congestive heart failure -Mononucleosis

polyuria

-Excessive increase in urine output exceeding 2,000 ml in 24hrs Caused by: -Excessive intake of fluids -Intake of fluids that contain mild diuretics (caffeine, tea, cola) -Drugs (diuretic: water pills) -Pathologic conditions (diabetes mellitus, diabetes insipidus, renal disease)

Urobilinogen

-Excreted by liver into intestinal tract -Bacteria in the intestines convert urobilinogen -50% of it is reabsorbed into the body for reexcreation by liver. (Small amounts appear in urine but most excreted by feces Conditions causing increase in urobilinogen in urine: -Excessive hemolysis of red blood cells -Infectious hepatitis -Cirrhosis -Congestive heart failure (CHF) -Mononucleosis (increase of urobilinogen in urine)

Kidney (Produce urine)

-Filters 42 gallons of blood per day or 4.5 removing solutes waste and liquid from the circulating blood -Urine drains from the Kidneys to the urinary bladder through two tubes called ureters -Solutes are medication, alcohol, or illicit drugs -Bean-shaped organs: 4.5 inches long and 2 to 3 inches wide -Located in lumbar region

**Conditions causing bilirubinuria

-Gallstones -Hepatitis -Cirrhosis of the liver

What is the name of the hormone that is present only in the urine and blood of a pregnant woman

-Human chorionic gonadotropin (HCG) HCG: produces positive result

How should urine reagent strips be stored

-In the bottle with cap closed tightly -Placed in cool dry area -Not exposed to sunlight. -Room temp. 59 to 86 degrees F. (Not in fridge or freezer.)

Quantitative test results for urine

-Indicate exact amount of chemical substance present in the body -Results reported in measurable units. Example: 14 mg/dL (Obtaining quantitative test results on a urine specimen usually involves the use of more complex equipment and testing procedures than are found in the medical office; they also are more time-consuming to run.)

Qualitative test results for urine

-Indicate whether or not a substance is present in urine -Provide approximate indication of amount of substance present (Interpretation of results usually involves use of color comparison chart) -Results recorded in terms of trace, 1+, 2+, 3+ (Trace, small, moderate, large, negative or positive) (Qualitative tests are useful for screening purposes in the medical office because they are easy to perform and can be used to screen large numbers of individuals - a procedure that otherwise might be too expensive and time-consuming.)

Nitrite in urine

-Indicates presence of a pathogen in urinary tract (UTI) -Pathogens present in the urine in the bladder: Causes nitrate to convert to nitrite Nitrate: normally present in the urine Nitrite: normally absent in the urine -Perform on urine that has been in bladder 4 to 6 hours (first-voided specimen): To ensure the pathogens have converted nitrate to nitrite

What may cause blood to appear in the urine

-Injury -Disorders such as: cystitis, bladder tumors, urethritis, kidney stones, kidney disorders

Why is concentrated urine dark yellow

-Less water, more concentrated, darker urine / diluted urine is lighter yellow. (after fluid consumption) -Yellow pigment, urochrome, produced by breaking down of hemoglobin -First voided urine in the morning is tended to be most concentrated because consumption of fluids is decreased during the night and increased amount of dissolved substances in the morning

Guidelines for Urine Collection

-Make sure to obtain an adequate volume (usually 30 to 50 ml) -Properly label each specimen: avoids mix-up of specimens (Patient's name & DOB, Date & Time of collection, Type of specimen. ie urine) -Record medications patient is taking on laboratory requisition and in patient's chart: Some medications interfere with the accuracy of test results -Do not collect a specimen during menstruation (May contaminate the specimen with blood and Result in false-positive results on test for blood) -Difficult for some patients to void under stress and anxiety (Be patient and relay understanding to patient) -May be difficult to obtain from a child (May need to use another collection method: Urine collection bag, Suprapubic aspiration, Catheterization)

Analysis of Urine

-May be performed as screening measure (part of physical examination) -Assist in the diagnosis of patient's conditions -Evaluate effectiveness of therapy (after treatment has been initiated) -Perform urinalysis on a fresh or preserved specimen only -If specimen cannot be examined with 1 hour of voiding: Preserve immediately in refrigerator. Before testing: return to room temperature; thoroughly mix specimen and rotate urine container

Clean-catch midstream specimen

-Microorganisms are normally present in distal urethra or urinary meatus (external opening) -Microorganisms are NOT normally present in urinary bladder or most of urethra

Reagent Strips

-Most common test used in medical office to test urine -Disposable plastic strips: contain reagent areas for testing chemicals in urine -Provide qualitative test results -Positive result: requires further testing -Number and type of reagent areas depend on the particular brand -Always read manufacturer's instructions before performing the test

Urine testing kits

-Most frequently used in the medical office for chemical testing of urine Advantages: -Contain premeasured reagent -Easy to perform -Provide immediate results -Most are qualitative test results: Positive result indicates need for further testing -Most manufactured in the form of reagent strips Rely on color change for interpretation of results: Color chart used to make a visual comparison -To ensure accurate and reliable test results: Carefully read and follow manufacturer's instruction sheet -Test strips that contain more than one reagent: May require different time intervals for reading results -Certain medications may affect results: listed in instructions -Expiration date must be checked before using (Do not use if past the expiration date: Test results may be inaccurate) -Should not be used if: Color change has occurred on strip and tested strip is a color that does not match chart -**Light, heat, and moisture can affect strips: Store in cool, dry area (Tests are packaged in a light-resistant container) -Never transfer from original container to another (Another container may contain moisture, dirt, chemicals/ Could affect test results) -Recording test results: Indicate brand name of test (e.g., Multistix 10SG)

Epithelial Cells

-Most structures making up urinary system: composed of several layers of epithelial cells -Outer layer: constantly being sloughed off Replaced by cells underneath -Squamous epithelial cells: large, clear, flat cells with irregular shape -Contain small nucleus -Come from urethra, bladder, vagina -Normally present in small amounts in urine (Urine sediment usually contains squamous epithelial cells.) -Renal epithelial cells: round with large nucleus -Come from deeper layers of urinary tract -Presence in urine is abnormal (The presence of renal epithelial cells can indicate inflammation and serious damage to the kidneys.)

Miscellaneous Structures

-Mucous threads: normally present in small amounts in urine Long, wavy, threadlike structures with pointed ends -Bacteria: rod shaped or round Should not normally be present Presence of more than a few: -May indicate contamination of specimen during collection -UTI (The urine may appear cloudy due to the presence of bacteria.) -**Yeast cells Smooth, refractile bodies with oval shape Small buds project from cells In females: usually vaginal contaminant caused by Candida albicans (yeast infection) May also be present in patients with diabetes -Parasites May be present as a contaminant from fecal or vaginal material Trichomonas vaginalis: parasite that causes trichomoniasis vaginitis -Spermatozoa May be present in men or women after intercourse Have round heads, long, slender, hairlike tails (What is the treatment for trichomoniasis vaginitis? Metronidazole or Trinidazole. OK for pregnant women to take.)

pH readings

-Neutral: 7.0 -Acid: Below 7 -Alkaline: Above 7 (Patients with heart and lung disease may have a high pH. )

Ketone

-Normal products of fat metabolism -Can be used by muscle tissue as a source of energy -When more than normal amounts of fat are metabolized -Muscles cannot handle all of the ketones that result -In healthy individuals, ketones are formed in the liver.

Urine analyzer

-Performs chemical examination of urine automatically -Uses reagent strips Advantage: -Quick and easy -Results are interpreted automatically Clinitek Analyzer: Automatically reads Multistix Results printed out (Abnormal results are flagged)

Guidelines for Reagent strip

-Preferred type of specimen: freshly voided and thoroughly mixed -If not possible: refrigerate specimen -Before testing: allow to return to room temperature; thoroughly mix specimen -Type of collection: Most designed to be used with a random specimen Certain tests require a special collection procedure: Nitrite test: First-voided morning specimen Leukocyte test: Clean-catch midstream specimen -Time intervals Read results at exact time intervals -Specified on color chart -Do not read any test results after 2 minutes

hCG (human chorionic gonadotropin)

-Produced by developing fertilized egg -Small amounts secreted into urine and blood -Immediately after conception and implantation: level of HCG rises rapidly Can detect pregnancy with a serum pregnancy test as early as 6 days before the first missed period. Highest level: occurs 8 weeks after conception (after this time: HCG declines) -72 hours after delivery: HCG disappears entirely -Pregnancy tests are more sensitive in the first trimester -May even show a negative reaction during the second and third trimester

Protein

-Proteinuria: Presence of protein in the urine -Temporary increase may be caused by stress or strenuous exercise -Conditions causing proteinuria Glomerular filtration problems -Renal diseases Bacterial infections of the urinary tract (Urine that contains large amounts of protein may be foamy.) If proteinuria occurs: -Physician usually orders examination of sediment -To see what is causing the protein to be in the patient's urine (e.g., bacteria)

What is the purpose of testing the specific gravity of urine

-Provides info on the ability of the kidneys to dilute or concentrate the urine. -A decrease or increase can be sign of disease. -Measures weight of urine as compared with the weight of an equal volume of distilled water -Indicates amount of dissolved substances present in urine

What is the difference between qualitative and quantitative test results.

-Qualitative: whether substance is present and approximate amount -Quantitative: exact amount of substance present in measurable units

Serum Pregnancy Test

-Radioimmunoassay (RIA) for HCG: used to detect HCG in serum of blood -More sensitive than urine testing (can detect pregnancy earlier with more accuracy) -Can detect pregnancy at approximately eighth day after fertilization (6 days before first missed period) -Uses radioisotope technique (capable of detecting minute amounts of HCG in the blood)

Urine Color

-Ranges from almost colorless to dark yellow -Dilute urine: lighter yellow (Occurs as day progresses and more fluids are consumed) -Concentrated urine: darker yellow (e.g., first-voided specimen). Occurs because fluid consumption is decreased at night -Color due to yellow pigment: urochrome (From breakdown of hemoglobin) -Color varies among different shades of yellow throughout the day.

A 24-hour urine specimen must be kept, how

-Refrigerated or placed in ice chest -Large container used (3000 ml): Used to store urine collected over 24 hours -Some containers also contain a preservative: Maintains quality of specimen, Hazardous chemical warning label should be attached to container, Instruct patient not to discard or touch the preservative -Patient is also provided with container to collect specimen: Female urine hat, placed over commode under the toilet seat & Male container is a collection cup

Red Blood Cells

-Round, colorless, biconcave discs -Normal: 0 to 5 per high-power field -More than 5 per high-power field: may indicate bleeding along the urinary tract -Concentrated urine: causes RBCs to become shrunken or crenated -Dilute urine: causes RBCs to swell and hemolyze (Will not be seen under a microscope but still show a positive on reagent strip test for blood)

White Blood Cells

-Round, granular, with a nucleus Approximately 1.5 times larger than RBC -**Normal: 0 to 8 per high-power field -More than 8 per high-power field: may indicate inflammation of genitourinary tract

Glucose

-Should not normally be present in urine -Glucose in the blood: filtered through nephrons and reabsorbed into the body -If glucose concentration in blood becomes too high: renal threshold is exceeded -Kidneys unable to reabsorb all of the glucose back into the blood -Results in glycosuria: glucose in the urine

Urine sediment

-Solid materials contained in urine -Sediment sample is placed on a slide by MA -Viewed under a microscope by physician -Helps clarify results of physical and chemical examination

Physical Examination of Urine

-Specimen must be in a clear plastic or glass container -Good lighting is also needed to inspect the urine.

Clean-catch procedure

-Sterile container is used -To prevent contamination of specimen with normal flora: -Microorganisms are removed from urinary meatus by having patient cleanse the meatus) - Microorganisms are flushed out of distal urethra by having patient void a small amount into toilet

What is the function of the urinary bladder

-Store and expel urine -Hollow, muscular sac (holds approximately 500 ml of urine)

What conditions may cause proteinuria

-Stress or strenuous exercise may cause it temporarily -Glomerular filtration problems -Renal disease -Bacterial UTI

Nephron

-The functional unit of the kidney. -each kidney contains about 1mil. smaller units of nephrons -Function: 1. Filters wastes from blood and dilutes them with water to produce urine 2. Reabsorption. Ex: water, glucose, and electrolytes are reabsorbed or returned to the body for use

What may cause ketosis

-Uncontrolled diabetes mellitus -Starvation -Diet composed entirely of fat

pH of Urine

-Unit that indicates acidity or alkalinity of a solution (Another word for alkalinity is basic.) -Range of pH scale: 0.0 to 14.0 -Lower the number: greater the acidity -Higher the number: greater the alkalinity -Perform test on freshly voided urine -pH of urine: ranges from 4.6 to 8.0 (usually around 6.0, which is acidic) -High reading on a fresh specimen: may indicate bacterial infection of urinary tract (If a urine test is abnormal, do not discard the urine until the physician approves of discarding it. The physician may want to run further tests on the urine.)

Why does urine become more alkaline if it is not preserved

-Urea is converted to ammonia by bacterial action as urine sits out (Ammonia is alkaline)

Organic Waste

-Urea, uric acid, ammonia, and creatinine -Urea is present in greatest amounts - derived from breakdown of proteins -Too much uric acid aids in the formation of kidney stones.

Advantages of urine testing

-Urine is easily available -Does not require: An invasive procedure or use of special equipment -Urine testing is a quick method used to detect the presence of pathological conditions.

Crystals

-Variety may be found in urine (Type and number vary with urine pH) -Abnormal crystals: Leucine Tyrosine Cystine Cholesterol -Commonly appear in alkaline urine: Amorphous urates Uric acid Calcium oxalate Amorphous phosphate Triple phosphate Calcium phosphate Ammonium urate

Bilirubin

-an orange-yellow pigment (book says vivid yellow pigment) formed in the liver by the breakdown of hemoglobin and excreted in bile. -Life span of RBC: 120 days -RBC: contains hemoglobin -Function of hemoglobin: transports oxygen in the body -When a RBC breaks down: hemoglobin breaks down -Releases bilirubin (vivid yellow pigment) -Bilirubin: normally transported to liver and excreted with bile -Eventually leaves body through intestines (feces) -Bilirubin gives the color to the feces. -With certain liver conditions: Liver cannot accept bilirubin Bilirubin is transported to kidneys Excreted into urine: bilirubinuria - causes urine to be yellow-brown or greenish. Yellow foam appears when urine is shaken Conditions: liver issues, gallstones, hepatitis, cirrhosis of liver

What may cause an increase in urine pH

-greater alkalinity -Sample at room temp. -Took long (over 1 hour) which can indicate bacterial infection of urinary tract

Guidelines that should be followed when performing a pregnancy test.

1. Clean, disposable urine containers 2. First morning concentrated void b/c it contains highest concentration of HCG, but specific gravity should be determined before the test (Less than 1.007: too dilute for testing. Could cause a false-negative result) 3. Specimen at room temp 4. Kit check expiration 5. Follow manufacture instructions and document internal control (Most testing kits include an internal control) -Performed at same time as testing procedure -Determines: Whether sufficient amount of specimen was added to cassette If correct technique was followed-if it does not perform as expected, test results are interpreted as invalid. 6.If more than one patient is being tested Label each testing device with patient's name Prevents mix-up of specimens 7.Perform a positive and negative external control -With each new lot of urine pregnancy testing kits (Monthly thereafter) External controls are used to determine if the testing reagents are performing properly and to detect any errors in technique of the individual performing the test. Conditions that can result in a positive result (other than normal pregnancy): Ectopic pregnancy Molar pregnancy-chorionic villi (an essential element) around the fetus degenerate and form clusters of fluid-filled sacs; usually associated with the death of the fetus.

2 factors that may cause a urine specimen to become cloudy

1. Standing too long 2. Contains bacteria, pus, blood, fat, yeast, sperm, mucus, threads, fecal contaminants (Microscopic examination: performed on cloudy specimens to determine cause)

2 reasons for performing a urine culture test

1. To assist in the diagnosis of a UTI 2. Assess the effectiveness of antibiotic therapy for UTI patient

2 functions of the urinary system

1. To regulate fluid and electrolyte balance of the body 2. To remove waste products

Changes that may take place in a urine specimen if it is allowed to stand at room temperature for more than 1 hour

1. pH shift. EX: Bacteria turn urea to ammonia/alkaline increasing pH (May create false positive for protein) 2. Bacteria multiplying, makes specimen cloudy, increasing nitrite. 3. If glucose is present, it will decrease, & microorg. uses it as a source of food. 4. Blood cells break down if WBC or RBC present. 5. Casts decompose after several hours

3 reasons for performing a pregnancy test.

1.Early diagnosis for healthy pre-natal care 2. Know before procedure that may hurt fetus such as x-rays 3. Know before taking certain medications that may hurt fetus

Ketosis

An accumulation of large amount of ketone bodies in the tissues and body fluids

Hematuria

Blood present in the urine

?Why must the specimen be preserved until it is brought to the medical office

So there are no changes to the urine that could cause inaccurate test results.

**Immunologic tests often used in the office for

Test results rely on the presence of human chorionic gonadotropin (HCG)

Why must a front-to-back motion be used to clean the urinary meatus?

To avoid drawing microorganisms from the anal region into the area being cleansed