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135 Cards in this Set
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Functional Unit of the Kidney |
Nephrons |
Approx 1-1.5 Million
2 Types: 1. Cortical 2. Juxtamedullary |
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Nephrons responsible primarily for removal of waste products and reabsorption of nutrients
85% of the Nephrons
Situated in the Cortex of the Kidney |
Cortical Nephrons |
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Nephron which its primary function is concentration of the urine Have longer loops of henle, situated deep into the medulla |
Juxtamedullary Nephrons |
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The human kidney receive approx _____% of the blood pumped through the heart at all times |
25% |
1,200 mL each minute |
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Renal Blood Flow |
Renal Artery (Blood In) 1. Afferent 2. Glomerulus 3. Efferent 4. Peritubular Capillaries 5. Vasa Recta 6. Cortex 7. Medulla Renal Vein (Blood Out) |
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Arterioles have varying sizes these helps create |
1. Hydrostatic Pressure differential important for glomerular filtration 2. Maintain consistency of glomerular capillary pressure & renal blood flow w/in the glomerulus |
Smaller size of Efferent - Inc Glomerular capillary pressure |
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Surrounds the Proximal & Distal convoluted tubules |
Peritubular Capillaries |
Provides for: 1. Immediate reabsorption of essential substances from fluid in PCT 2. Final Adjustment of the urinary composition in DCT |
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Where major exchanges of water & salts takes place b/w blood & medullary interstitium which maintains osmotic gradient (salt conc) in the medulla |
Vasa Recta |
Located adjascent to ascending & descending loops of henle |
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Total Renal Blood Flow |
1200 mL/min |
Based on average body size 1.73 m^2 of surface |
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Total Renal Plasma Flow |
600 - 700 mL/min |
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1 |
1 |
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Functions as sieve or filter
A nonselective filter of substances with MW <70,000 d Located w/in Bowman's Capsule |
Glomerulus |
Consists of a coil of approx 8 capillary lobes (Capillary Tuft), with walls referred to as Glomerular Filtration Barrier |
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Factors that influence the Actual Filtration Process: |
1. Cellular structure of the capillary walls & bowman's capsule
2. Hydrostatic & Oncotic Pressure
3. Feedback mechanisms of RAAS |
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Highly Impermeable to water No Water Reabsorption |
Ascending loop of Henle |
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Regulates the flow of blood to and w/in the glomerulus
Responds to changes in blood pressure & Plasma Na Content
Monitored by Juxtaglomerular Apparatus |
Renin-Angiotensin- Aldosterone System (RAAS) |
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Juxtaglomerular Apparatus is consist of: |
1. Juxtaglomerular Cells 2. Macula Densa |
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RAAS Mechanism |
1. LOW BP, PLASMA NA 2. Renin 3. Angiotensinogen 4. Angiotensin 1 5. Angiotensin Converting Enzyme (ACE) 6. Angiotensin II |
Renin enzyme produced by Juxtaglomerular cells reacts w/ blood borne substrate Angiotensinogen, to produce the hormone Angiotensin I, passes thru the alveoli of the lungs, ACE changes it to the active form Angiotensin II (correct renal blood flow) |
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Angiotensin II corrects renal blood flow by: |
1. DACE = Dilates Afferent, Constricts Efferent 2. NA & Water Reab in PCT 3. Release of Aldosterone & ADH |
Aldosterone - Na Reab & K Excre in the DCT & CD - Released by Adrenal Cortex ADH - Water Reab in Collecting Duct - Released by Hypothalamus |
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Glomerular Filtrate: |
1. SG 1.010 2. (-) Albumin (Shield Of Negativity) |
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Body Hydration is ____________ proportional to Urine ____________ proportional to ADH |
Directly
Inversely |
AIDU Inc Body Hydration, Urine Dec ADH
Dec Body Hydration, Urine Inc ADH |
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Water-retaining Hormone Water Reab in DCT & CD
Produced on the Hypothalamus
Stored in Posterior Pituitary Gland w/ Oxytocin |
Anti-Diuretic Hormone (ADH) /Vasopressin |
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Sodium-retaining Hormone |
Aldosterone |
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Sodium is _________ proportional to Aldosterone _________ proportional to K |
Directly Inversely |
DAKI Dec K Inc NA, Aldosterone Dec Na, Aldosterone Inc K |
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The 1st function to be affected in Renal Dse |
Tubular Reabsorption |
Plasma Ultrafiltrate enters proximal convoluted tubule, thru cellular transport mechanisms, the nephrons begins reabsorbing these essential substances & water |
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The Major site of reabsorption of Plasma Substances (65%) |
Proximal Convoluted Tubule |
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Movement of substances across cell membranes into the bloodstream by electrochemical energy |
Active Transport |
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Active Transport: |
1. Glucose, AA, Salts (GACS) - PCT 2. Chloride - Ascending LH 3. Sodium - PCT, DCT |
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Movement of molecules across a membrane by diffusion beacause of a physical gradient |
Passive Transport |
2 Different Osmotic System |
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Passive Transport: |
1. Water - PCT, Descending LH, CD 2. Urea - PCT, Ascending LH 3. Sodium - Ascending LH |
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Two Major Functions of Tubular Secretion: |
1. Eliminating Waste Products not filtered by the glomerulus 2. Regulating acid-base balance (Secretion of Hydrogen Ions) |
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The original glomerular filtrate volume of about 180 L in 24 Hrs is reduced to about |
1-2 L |
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Tests used to evaluate Glomerular Filtration Measures rate at which the kidneys are able to remove (clear) a filtrate substance from the blood |
Clearance Tests |
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Clearance Tests: |
1. Crea 2. B2-Microglobulin 3. Cystatin C 4. Radioisotopes |
Urea - measured by erliest glomerular filtration test |
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Original Reference Method for Glomerular Filtration
Polymer of Fructose
Extremely Stable substance that is not reabasorbed or secreted by tubules |
Inulin Clearance |
*Normal Body Constituent *Infused by IV at constant rate t/out the testing period |
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A measure of the completeness of a 24-Hr urine collection |
Creatinine Clearance |
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A small protein produced @ constant rate by all nucleated cells
Readily filtered by glomerulus & reabsorbed & broken down by Renal Tubular Cells
Serum Conc is directly related to GFR |
Cystatin C |
No Cystatin C is secreted by the tubules
MW = 13,359 |
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Dissociates from HLA @ constant rate
Rapidly removed from plsma by GF
Not reliable in Px who have history of immunologic disorders & malignancy
Enzyme-immunoassay sensitive |
B2- Microglobulin |
Inc in Plasma Level = Dec GFR |
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Injecting radionucleotides such as 125I-iothalamate provides a method of determining GF thru the plasma disappearance of the radioactive material
Enables visualization of filtration in one or both kidneys |
Radioisotopes |
Can also be used to measure viability ty of a transplanted kidney |
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Parameters in Cockroft-Gault Formula |
1. Body Weight in Kg 2. Age 3. Gender 4. Serum Crea |
BAGS |
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Parameters in MDRD |
1. Race 2. Age 3. Gender 4. Serum Crea |
RAGS |
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The greatest source of error in any clearance procedure |
Improperly Timed Urine Specimens |
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Tests used to evaluate Tubular Reabsorption |
Concentration Tests |
SG, Osmolality |
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Obsolete Conc Tests: |
1. Fishberg Test 2. Mosenthal Test |
Fishberg Test - Px is deprived of fluids for 24 Hrs - Then SG is measured - SG should be >/= 1.026 Mosenthal Test - Compared the volume & SG of a Day & Night urine samples to evaluate concentrating ability |
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Most useful as screening procedure & quantitative measurement of of renal concentrating ability, which is best assessed thru osmometry |
Specific Gravity |
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SG is influenced by |
Number & Density of particles in a solution |
Osmolality = influenced by number of particles only |
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Performed for a more accurate evalutation of renal concentrating ability |
Osmolality |
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Test most commonly associated with tubular secretion & renal blood flow |
PAH (p-aminohippuric acid) Test |
Historically, excretion of dye Phenolsulfonphthalein (PSP) was used to evaluate this functions |
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Urine Composition: |
95% Water 5% Solutes |
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TS in 24 H = 60 g _____g Organic _____g Inorganic |
35
25 |
Organic: Urea, Crea, Uric Acid Inorganic: Chloride, Na, K |
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A metabolic waste product produced in the Liver from beakdown of protein & AA Accounts for nearly half of the total dissolved solid in urine |
Urea |
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The Major inorganic solid dissolved in Urine |
Chloride |
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Method of urine collection used for routine screening & bacterial culture |
Midstream |
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Method of urine collection used for bacterial culture |
Catheterized |
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Method of urine collection for bladder urine used for bacterial culture & cytology |
Suprapubic Aspiration |
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Method of urine collection used for Prostatic Infection |
Three-glass Technique |
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In Three-glass Technique which is indicative of Prostatic Infection |
3rd Specimen WBC & Bacterial Count 10 times of the First Specimen |
Macrophages containing lipids may also be present |
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In Three-glass Technique which specimen is used as a control for bladder & kidney infection |
2nd Specimen |
If this is (+), the results from the 3rd specimen are invalid because infectes urine has contaminated the specimen |
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Pediatric Specimen: |
1. Use of Soft, clear plastic bag w/ adhesive 2. Sterile specimen obtained by catheterization or suprapubic aspiration |
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A step-by-step documentation of the handling and testing of legal specimens
Process that provides this documentation of proper sample ID from the time of collection to the receipt of lab results |
Chain of Custody (COC) |
Donor - individual from whom the specimen is collected |
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Appropriate volume of urine for Drug Specimen Collection |
30-45 mL |
Blueing Agent (Dye) - Added to the toilet water reservoir to prevent specimen adulteration |
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The appropriate Temp of Urine for Drug Specimen Collection |
32.5-37.7 Deg C |
Must be taken w/in 4 Mins |
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Urine Type used for Routine Screening & Qualitative UA |
Random/Single/Occasional |
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Urine type used for Quantitative Chemical Tests |
Timed |
24H, 12H, 4H, Afternoon |
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Begin and End the collection w/ an empty bladder |
24H |
Falsely Elevate - Addition of urine formed before the start of collection Falsely Decreased - Failure to add urine produced at the end of collection |
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Type of urine specimen used for Addi's Count |
12H |
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Type of Urine specimen used for Nitrite Determination |
4H |
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Appropriate time of urine collection for Urobilinogen Determination |
Afternoon (2-4pm) |
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Type of Urine Specimen Ideal for routine screening, pregnancy tests (hCG) & for evaluation of Orthostatic Protein |
First Morning |
Most Conc, Most Acidic: For well preservation of cells & cats |
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Type of urine specimen used for Glucose Determination |
Fasting/ Second morning |
2nd voided urine after a period of fasting |
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Increased in Unpreserved Urine |
1. pH 2. Bacteria 3. Odor 4. Nitrite |
Color - Modified/Darkened
pH & odor - d/t conversion of Urea <urease> to Ammonia Bacteria, Nitrite - d/t Bacterial Multiplication PBaON |
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Decreased in Unpreserved Urine: |
1. RBC/WBC 2. Urobilinogen 3. Bilirubin 4. Glucose 5. Clarity 6. Ketones |
RBC/WBC/Cast - disintegrate in Alkaline Urine Urobilinogen - oxidation to urobilin Glucose - Glycolysis Ketones - Volatilization Bilirubin - Light Exposure Clarity - Bacterial X, precipitation of amorphous urates (pink) or amorphous phosphates (white) Trichomonas - Immobilized/Die, MisID as WBCs |
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Following collection, specimen should be delivered & tested within |
2 Hrs |
If Cannot - should be refrigerated & have an appropriate chemical preservative |
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Does not interfere w/ chemical tests Precipitates amorphous phosphates & urates Prevents bacterial growth in 24 Hrs |
Refrigeration |
Raises SG by Hydrometer |
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Chemical preservative that preserves glucose & sediments well Interferes w/ acid precipitation tests for protein |
Thymol |
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Preserves protein & formed elements Does not interfere w/ routine analyses other than pH May precipitate crystals when used large amounts |
Boric Acid |
Keeps pH at about 6.0 |
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Excellent sediment preservative Reducing Agent Used to rinse specimen container to preserve cells & casts |
Formalin |
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Does not interfere w/ routine tests Floats on surface of specimens and clings to pippetes & testing materials |
Toluene |
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Prevents Glycolysis Good preservative for Drug Analyses Inhibits Rgnt strip test for glucose, blood, leukocytes |
Sodium Fluoride |
For Reagent Strip testing - use Na Benzoate |
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Does not interfere w/ routine tests Causes an odor change |
Phenol |
Use 1 drop per ounce of specimen |
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Preserves Cellular Elements
Used for Cytology Studies |
Saccomanno Fixative |
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Normal 24H Urine Volume |
600-2,000 mL Average of: 1,200-1,500 mL |
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Urine Volume Night:Day Ratio |
1:2-1:3 |
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Increase in daily urine volume Adults >2.5 L/day Children 2.5-3 L/day |
Polyuria |
1. Diuresis 2. Inc Fluid Intake 3. Diuretic Medication, Drinks 4. Nervousness 5. DI, DM DI - Inc Vol, Dec SG DM - Inc Vol, Inc SG |
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Decrease in urine output Infants <1 mL/kg/hr Children <0.5 mL/kg/hr |
Oliguria |
1. Calculus or Tumor of the Kidney 2. Dehydration |
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Complete cessation of Urine Flow <100 mL/24 Hrs |
Anuria |
1. Complete Obstruction (Stones, Carcinomas) 2. Toxic Agents 3. Dec Renal Blood Flow |
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Excretion of >500 mL of urine at night SG <1.018 |
Nocturia |
Pregnancy |
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Yellow pigment that increases in the urine that stands at room temp
Actual amount produced is dependent on the body's metabolic state, w/ increased amounts produced in thyroid conditions & fasting state |
Urochrome |
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Attaches to the urates producing a pink color to the sediment Brick Dust |
Uroerythrin |
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An oxidation product of the normal urinary constituent urobilinogen, imparts an orange-brown color to urine that is not fresh |
Urobilin |
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Care should be taken to examine the specimen under what conditions |
1. Good light source 2. Looking down thru the container against a white background |
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Normal Urine Color |
Colorless/Pale Yellow |
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Coloreless/ Pale Yellow Urine |
1. Recent fluid consumption 2. Polyuria 3. DM 4. DI |
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Dark Yellow/ Amber/ Orange |
1. Conc specimen 2. Acriflavine 3. Bilirubin 4. Pyridium 5. Nitrofurantoin 6. Phenindione |
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Yellow-Green/ Yellow-Brown |
Bilirubin oxidized to Biliverdin |
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Green Blue-Green |
1. Pseudomonas inf 2. Clorets 3. Indican 4. Methylene Blue 5. Phenol |
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Pink Red Urine |
1. RBCs 2. Hgb 3. Myoglobin (25 mg/dL) 4. Porphyrin 5. Beets 6. Rifampin 7. Menstrual Contam |
Burgundy/Purplish Red, Portwine - Porphyrins |
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Brown Black Urine |
1. RBCs oxidized to methgb (Acidic Urine) 2. Homogentisic Acid (Alkaptonuria) 3. Melanin or melanogen (Upon air exposure) 4. Methyldopa or levodopa 5. Metronidazole (Flagyl) |
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Purple |
1. Catheter bags caused by Indicans 2. Bacterial Inf caused by Klebsiella or Providencia Spp. |
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Urine Clarity Measurement: |
1. Thoroughly mix the specimen 2. Examine the specimen while holding in front of a light source 3. View thru a newsprint paper |
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Faint cloud in urine after standing, due to WBCs, epithelial Cells, & Mucus |
Nubecula |
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Turbidity Reporting: |
1. CLEAR - Transparent, no visible prtcles 2. HAZY - Few prtcles, print easily seen 3. CLOUDY - Many prtcles, print blurred 4. TURBID - Print cannot be seen 5. MILKY - May precipitate or clot |
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Pathologic Causes of Turbidity: |
1. RBCs 2. WBCs 3. Bacteria 4. Yeast 5. Nonsquamous Epithelial Cells 6. Abnormal Crystals 7. Lymph Fluid 8. Lipids |
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Nonpathologic causes of Turbidity: |
1. SECs 2. Mucus 3. Amorphous Crystals 4. Semen, spermatozoa 5. Fecal contam 6. Radiographic Contrast Media 7. Talcum Powder 8. Viginal Cream |
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Seen in Acidic Urine: |
1. Amorphous Urates 2. Radiographic Contrast Media |
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Seen in Alkaline Urine: |
1. Amorphous phosphates 2. Carbonates |
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Soluble w/ Heat: |
1. Amorphous Urates 2. UA Crystals |
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Soluble in Dilute Acetic Acid: |
1. Carbonates 2. Amorphous Phosphates 3. RBCs |
CAR |
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Insoluble in Dilute Acetic Acid: |
1. WBCs 2. Bacteria 3. Yeast 4. Spermatozoa |
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Soluble in Ether: |
1. Lipids 2. Lymphatic Fluid 3. Chyle |
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Density of solution compared w/ density of similar volume of dist water at similar temp
Influenced by number & size of particles in solution |
Specific Gravity |
1.002-1.035 - Normal Random Specimens
<1.002 - Not Urine Hyposthenuria <1.010 Isosthenuria 1.010 (Loss of Conc & Diluting Ability) Hypersthenuria >1.010 |
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SG Determination Methods: |
1. Refractometry (TS Meter) 2. Urinometry 3. Reagent Strip 4. Harmonic Oscillation Densitometry |
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Indirect method based on Refractive Index (RI) Compensated to temp 15-38C |
Refractometry (TS Meter) |
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Corrections for Glucose & Protein in Refractometry |
1 g/dL Protein - 0.003 1 g/dL Glucose - 0.004 |
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Calibration in Refractometry: |
Distilled Water 1.000 5% NaCl 1.022 +/- 0.001 9% Sucrose 1.034 +/- 0.001 |
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Method for determination of SG that requires Temp Correction
Also requires corrections for glucose & protein |
Urinometry |
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Temp correction in Urinometry |
Subtract 0.001 - In every 3C that the sp temp is Below the urinometer calibration temp Add 0.001 - In every 3C that the specimen is Above the urinometer calibration temp |
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SG Dilution |
1. Specimens w/ very high SG readings can be diluted & retested 2. To obtain actual SG, multiply the decimal portion of SG by the dilution factor |
Ex: Dilution 1:4 Reading After Dilution 1.014 Actual SG Reading = 4 x 14 = 1.056 |
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Frequency of sound wave entering a solution will change in proportion to the density of the solution |
Harmonic Oscillation Densitometry |
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SG Measurments: Principles |
1. Urinometry - Density 2. Refractometry - Refractive Index 3. HOD - Density 4. Reagent Strip - pKa change of polyelectrolyte |
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Normal Urine Odor: |
Aromatic Odorless |
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Ammoniacal Odor |
Infection |
Conversion of Urea to Ammonia |
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Fruity Sweet Odor |
Ketones (DM) |
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Rotting Fish Odor |
Trimethylaminuria |
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Rancid Butter Odor |
Tyrosyluria |
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Sweaty Feet Odor |
Isovaleric Acidemia |
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Mousy Odor |
Phenylketonuria |
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Swimming Pool Odor |
Hawkinsinuria |
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Fecaloid Odor |
Recto-vesicular Fistula |
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Sulfur Odor |
Cystine Disorders |
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Cabbage Odor |
Methionine Malabsorption |
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Maple Syrup Odor Caramelized, Curry |
MSUD |
Inc Leucine, Isoleucine, Valine in blood & urine |
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Bleach Odor |
Contamination |
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Odorless |
Acute Tubular Necrosis |
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Normal Urine pH |
Random: pH 4.5-8.0 |
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First Morning w/ slightly acidic pH of |
pH 5.0-6.0 |
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