CENTRAL LUZON

DOCTORS’ HOSPITAL EDUCATIONAL

INSTITUTION

MEDICAL TECHNOLOGY
DEPARTMENT

ANALYSIS
OF URINE
AND OTHER
BODY

Medical Technology
 CLINICAL LABORATORY SAFETY

The handling of specimen is crucial amongst Medical Technologist. Any mistake or mishandling of the
specimen can cause serious problems that can lead to one’s license being revoked. With that being said, proper
storage must also be overseen for the safety of the specimen and the technician. These are the safety hazards one
must remember in order to prevent accidents inside the laboratory.

Type Source Possible Injury

Biological Infectious agents Bacterial, fungal, viral, or parasitic
infections
Sharps Needles, lancets, broken glass Cuts, punctures, or blood-borne
pathogen exposure
Chemical Preservatives and reagents Exposure to toxic, carcinogenic, or
caustic agents
Radioactive Equipment and radioisotopes Radiation exposure
Electrical Ungrounded or wet equipment; Burns or shock
frayed cords
Fire/explosive Bunsen burners, organic chemicals Burns or dismemberment
Physical Wet floors, heavy boxes, patients Falls, sprains, or strains
From Strasinger, SK and DiLorenzo, MA: Phlebotomy Workbook for the Multiskilled Healthcare Professional, FA Davis, Philadelphia, 1996, p 62

Biosafety
 The application of knowledge, techniques and equipment to prevent personal, laboratory and environmental
exposure to potentially infectious agents or biohazards.
 Describes the containment principles, technologies and practices that are implemented to prevent the unintentional
exposure to pathogens and toxins, or their accidental release.

Biorisk
 The probability or chance that a particular adverse event (in the context of this document: accidental infection or
unauthorized access, loss, theft, misuse, diversion or intentional release), possibly leading to harm, will occur.

Biosecurity
 Describes the protection, control and accountability for valuable biological materials within laboratories, in order
to prevent their unauthorized access, loss, theft, misuse, diversion or intentional release.

BIOLOGICAL HAZARDS
Health-care practitioners are always susceptible to infectious microorganisms due to their work setting. One must
always practice good hygiene and caution in handling specimen to stop the chain of infection.

Chain of Infection
 Requires a continuous link between a source, a method of transmission, and a susceptible host.
BIOHAZARD SIGN
SOURCE
Hand washing
Biohazardous waste disposal
Decontamination
Specimen bagging

Standard precautions Hand washing

Immunization Personal protective equipment
Healthy lifestyle Aerosol prevention
Exposure control plan
HOST TRANSMISSION Sterile/disposable equipment
Postexposure prophylaxis Pest control
In 1996 the CDC combined the major features of UP (Universal Precautions) and BSI (Body substance isolation)
guidelines and called the new guidelines Standard Precautions.

Standard Precautions are as follows

 Handwashing
 Gloves
 Mask, eye protection, and face shield
 Gown
 Patient care equipment
 Environmental control
 Linen
 Occupational health and blood-borne pathogens
 Patient placement

Handwashing
 Hand contact is the primary method of infection transmission. Laboratory personnel must always wash hands
after gloves are removed, prior to leaving the work area, at any time when hands have been knowingly
contaminated, before going to designated break areas, and before and after using bathroom facilities.

Steps in proper handwashing:

 Wet hands with warm water.
 Apply antimicrobial soap.
 Rub to form lather, create friction, and loosen debris.
 Thoroughly clean between fingers, including thumbs, under fingernails and rings, and up to the
wrist, for at least 15 seconds.
 Rinse hands in a downward position.
 Dry with a paper towel.
 Turn off faucets with a clean paper towel to prevent recontamination.

DISPOSAL OF LABORATORY WASTES

All biological waste, except urine, must be placed in appropriate containers labeled with the biohazard symbol.
This includes both specimens and the materials with which the specimens come in contact. The waste is then
decontaminated following institutional policy: incineration, autoclaving, or pickup by a certified hazardous waste
company.

Sharp Hazards
 Sharps or needle-stick injuries are generic terms for injuries where infectious blood or other body fluids
can come into contact with wounds or mucous membranes. The most common injuries are needle-stick
punctures or cuts with medical instruments, but also include: Contamination of broken skin with blood.

Chemical Hazards
 Generally refers to a type of occupational hazard caused by exposure to chemicals in the workplace.
 Chemical hazards and toxic substances pose a wide range of health hazards (such as irritation,
sensitization, and carcinogenicity)
 Chemical Spills
 When skin contact occurs, the best first aid is to flush the area with large amounts of
water for at least 15 minutes and then seek medical attention. For this reason, all
laboratory personnel should know the location and proper use of emergency showers and
eye wash stations. Contaminated clothing should be removed as soon as possible. No
attempt should be made to neutralize chemicals that come in contact with the skin.
Chemical spill kits containing protective apparel, nonreactive absorbent material, and
bags for disposal of contaminated materials should be available for cleaning up spills.
  Chemical Handling
 Chemicals should never be mixed together unless specific instructions are followed, and
they must be added in the order specified. This is particularly important when combining
acid and water. Acid should always be added to water to avoid the possibility of sudden
splashing caused by the rapid generation of heat in some chemical reactions. Wearing
goggles and preparing reagents under a fume hood are recommended safety precautions.
Chemicals should be used from containers that are of an easily manageable size. Pipetting
by mouth is unacceptable in the laboratory. State and federal regulations are in place for
the disposal of chemicals and should be consulted.

 Chemical Hygiene Plan

 The purpose of the plan is to detail the following:
1. Appropriate work practices
2. Standard operating procedures
3. PPE
4. Engineering controls, such as fume hoods and flammables safety cabinets
5. Employee training requirements
6. Medical consultation guidelines
Each facility must appoint a chemical hygiene officer, who is responsible for
implementing and documenting compliance with the plan.

 Chemical Labeling
 Hazardous chemicals should be labeled with a description of their particular hazard, such
as poisonous, corrosive, or carcinogenic. The National Fire Protection Association
(NFPA) has developed the Standard System for the Identification of the Fire Hazards of
Materials, NFPA 704.7 This symbol system is used to inform fire fighters of the hazards
they may encounter with fires in a particular area. The diamond-shaped, color-coded
symbol contains information relating to health, flammability, reactivity, and personal
protection/special precautions. Each category is graded on a scale of 0 to 4, based on the
extent of concern. These symbols are placed on doors, cabinets, and containers

Red Diamond (Fire Hazard)

Flash points:
4 – Below 73°F
3 – Below 100°F
2 – Above 100°F but not exceeding 200°F
1 – Above 200°F
0 – Will not burn

Yellow Diamond (Reactivity Hazard)

4 – May detonate
3 – Shock and burn; may detonate
2 – Violent chemical change
1 – Unstable in heated
0 – Stable

White Diamond (Special Hazard)

ACID – Acid
ALK – Alkaline
Blue Diamond (Health Hazard) COR – Corrosive
4 - Deadly OXY – Oxidizer
3 – Extreme Danger W – Use no water
2 – Hazardous
1 – Slightly Hazardous 0 – Normal Material
  Material Data Sheet
 The OSHA Federal Hazard Communication Standard requires that all employees to have
a right to know about all chemical hazards present in their workplace. The information is
provided in the form of Material Safety Data Sheets (MSDSs) on file in the workplace.
By law, vendors are required to provide these sheets to purchasers; however, the facility
itself is responsible for obtaining and making MSDSs available to employees.

Information contained in an MSDS includes the following:

1. Physical and chemical characteristics
2. Fire and explosion potential
3. Reactivity potential
4. Health hazards and emergency first aid procedures
5. Methods for safe handling and disposal

Radioactive Hazards
 Radioactivity is encountered in the clinical laboratory when procedures using radioisotopes are
performed. The amount of radioactivity present in the clinical laboratory is very small and represents little
danger; however, the effects of radiation are cumulative related to the amount of exposure. The amount of
radiation exposure is related to a combination of time, distance, and shielding. Persons working in a
radioactive environment are required to wear measuring devices to determine the amount of radiation they
are accumulating.

Electrical Hazards
 The laboratory setting contains a large amount of electrical equipment with which workers have frequent
contact. The same general rules of electrical safety observed outside the workplace apply. The danger of
water or fluid coming in contact with equipment is greater in the laboratory setting. Equipment should not
be operated with wet hands. Designated hospital personnel monitor electrical equipment closely;
however, laboratory personnel should continually observe for any dangerous conditions, such as frayed
cords and overloaded circuits, and report them to the appropriate persons. Equipment that has become wet
should be unplugged and allowed to dry completely before reusing. Equipment also should be unplugged
before cleaning.

Fire/Explosive Hazards
 The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that all health-
care institutions post evacuation routes and detailed plans to follow in the event of a fire. Laboratory
personnel should be familiar with these procedures. When a fire is discovered, all employees are expected
to take the actions in the acronym RACE:

o Rescue—rescue anyone in immediate danger

o Alarm—activate the institutional fire alarm system
o Contain—close all doors to potentially affected areas
o Extinguish—attempt to extinguish the fire, if possible; exit the area

Types of Fires and Fire Extinguishers

Fire Type Extinguishing Type of Fire Extinguisher
Material Composition of Fire
Class A Wood, paper, clothing Class A Water
Class B Flammable organic Class B Dry chemicals, carbon
chemicals dioxide, foam, or halon
Class C Electrical Class C Dry chemicals, carbon
dioxide, or halon
Class D Combustible metals None Sand or dry powder
Class ABC Dry chemicals
From Strasinger, SK and DiLorenzo, MA: Skills for the Patient Care Technician, FA Davis, Philadelphia, 1999, p 70
Physical Hazard
 Physical hazards are not unique to the laboratory, and routine precautions observed outside the workplace
apply. General precautions to consider are to avoid running in rooms and hallways, watch for wet floors,
and bend the knees when lifting heavy objects, keep long hair pulled back, avoid dangling jewelry, and
maintain a clean, organized work area. Closed-toe shoes that provide maximum support are essential for
safety and comfort.

--- END OF DISCUSSION ---

 RENAL
FUNCTION
PREPARED BY: ALTON JOSHUA S. MASANQUE, RMT, DTA
 RENAL PHYSIOLOGY
• EACH KIDNEY CONTAINS APPROXIMATELY 1 TO 1.5 MILLION
FUNCTIONAL UNITS CALLED NEPHRONS.
• THE HUMAN KIDNEY CONTAINS TWO TYPES OF NEPHRONS.
CORTICAL NEPHRONS AND JUXTAMEDULLARY NEPHRONS
• THE ABILITY OF THE KIDNEYS TO CLEAR WASTE PRODUCTS
SELECTIVELY FROM THE BLOOD AND SIMULTANEOUSLY TO
MAINTAIN THE BODY’S ESSENTIAL WATER AND ELECTROLYTE
BALANCES IS CONTROLLED IN THE NEPHRON BY THE FOLLOWING
RENAL FUNCTIONS: RENAL BLOOD FLOW, GLOMERULAR
F I LT R AT I O N , T U B U L A R R E A B S O R P T I O N , A N D T U B U L A R
SECRETION.
ADDITIONAL NOTES:
• Nephron, functional unit of the kidney, the structure that
actually produces urine in the process of removing waste
and excess substances from the blood
• Cortical nephrons, which make up approximately 85% of
nephrons, are situated primarily in the cortex of the kidney.
They are responsible primarily for removal of waste
products and reabsorption of nutrients.
• Juxtamedullary nephrons have longer loops of Henle
t.hat extend deep into the medulla of the kidney. Their
primary function is concentration of the urine.
 RENAL BLOOD FLOW
• THE RENAL ARTERY SUPPLIES BLOOD TO THE KIDNEY.
• B LO O D E N T E R S T H E C A P I LLA R I E S O F T H E N E P H R O N T H R O U G H T H E
AFFERENT ARTERIOLE.
• IT THEN FLOWS THROUGH THE GLOMERULUS AND INTO THE EFFERENT
ARTERIOLE.
• BEFORE RETURNING TO THE RENAL VEIN, BLOOD FROM THE EFFERENT
ARTERIOLE ENTERS THE PERITUBULAR CAPILLARIES AND THE VASA RECTA
AND FLOWS SLOWLY THROUGH THE CORTEX AND MEDULLA OF THE KIDNEY
CLOSE TO THE TUBULES.
• THE PERITUBULAR CAPILLARIES SURROUND THE PROXIMAL AND DISTAL
CONVOLUTED TUBULES, PROVIDING FOR THE IMMEDIATE REABSORPTION OF
ESSENTIAL SUBSTANCES FROM THE FLUID IN THE PROXIMAL CONVOLUTED
TUBULE AND FINAL ADJUSTMENT OF THE URINARY COMPOSITION IN THE
DISTAL CONVOLUTED TUBULE.
ADDITIONAL NOTES:
• The human kidneys receive approximately 25% of the blood
pumped through the heart at all times.
• The varying sizes of t hese art erioles help t o creat e t he
hydrostatic pressure differential important for glomerular
filtration and to maintain consistency of glomerular capillary
pressure and renal blood flow within the glomerulus.
• The vasa recta are located adjacent to the ascending and
descending loop of Henle in juxtamedullary. In this area, the major
exchanges of water and salts take place between the blood and
the medullary interstitium. This exchange maintains the osmotic
gradient (salt concentration) in the medulla, which is necessary for
renal concentration.
 GLOMERULAR FILTRATION
• THE GLOMERULUS CONSISTS OF A COIL OF APPROXIMATELY
EIGHT CAPILLARY LOBES REFERRED TO COLLECTIVELY AS THE
CAPILLARY TUFT.
• ALTHOUGH THE GLOMERULUS SERVES AS A NONSELECTIVE
FILTER OF PLASMA SUBSTANCES WITH MOLECULAR WEIGHTS OF
LESS THAN 70,000, SEVERAL FACTORS INFLUENCE THE ACTUAL
FILTRATION PROCESS.
• PLASMA FILTRATE MUST PASS THROUGH THREE CELLULAR
LAYERS: THE CAPILLARY WALL MEMBRANE, THE BASEMENT
MEMBRANE (BASAL LAMINA), AND THE VISCERAL EPITHELIUM
OF BOWMAN’S CAPSULE.
ADDITIONAL NOTES:
• It is located within Bowman’s capsule, which
forms the beginning of the renal tubule.
• These include the cellular structure of the capillary
walls and Bowman’s capsule, hydrostatic and
oncotic pressures, and the feedback mechanisms
of the renin-angiotensin-aldosterone system.
 RENIN-ANGIOTENSIN-
ALDOSTERONE SYSTEM
• THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
(RAAS) CONTROLS THE REGULATION OF THE FLOW OF
BLOOD TO AND WITHIN THE GLOMERULUS.
• LOW PLASMA SODIUM CONTENT DECREASES WATER
RETENTION WITHIN THE CIRCULATORY SYSTEM,
RESULTING IN A DECREASED OVERALL BLOOD VOLUME
AND SUBSEQUENT DECREASE IN BLOOD PRESSURE.
ADDITIONAL NOTES:
The system responds to changes in blood pressure
and plasma sodium content that are monitored by
the juxtaglomerular apparatus.
 RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
• RENIN, AN ENZYME PRODUCED BY THE JUXTAGLOMERULAR CELLS, IS
S E C R E T E D A N D R E A C T S W I T H T H E B L O O D - B O R N E S U B S T R AT E
ANGIOTENSINOGEN TO PRODUCE THE INERT HORMONE ANGIOTENSIN I. AS
ANGIOTENSIN I PASSES THROUGH THE LUNGS, ANGIOTENSIN CONVERTING
ENZYME (ACE) CHANGES IT TO THE ACTIVE FORM ANGIOTENSIN II.
ANGIOTENSIN II CORRECTS RENAL BLOOD FLOW IN THE FOLLOWING WAYS:
CAUSING VASODILATION OF THE AFFERENT ARTERIOLES AND CONSTRICTION
OF THE EFFERENT ARTERIOLES, STIMULATING REABSORPTION OF SODIUM IN
THE PROXIMAL CONVOLUTED TUBULES, AND TRIGGERING THE RELEASE OF
THE SODIUM-RETAINING HORMONE ALDOSTERONE BY THE ADRENAL CORTEX
AND ANTIDIURETIC HORMONE BY THE HYPOTHALAMUS. AS SYSTEMIC BLOOD
PRESSURE AND PLASMA SODIUM CONTENT INCREASE, THE SECRETION OF
RENIN DECREASES. THEREFORE, THE ACTIONS OF ANGIOTENSIN II PRODUCE A
CONSTANT PRESSURE WITHIN THE NEPHRON.
ADDITIONAL NOTES:
• As a result of the above glomerular mechanisms, every
minute approximately two to three million glomeruli filter
approximately 120 mL of water-containing low-molecular
weight substances.
 Actions of the RAAS
Dilation of the afferent arteriole and constriction of the efferent
arteriole
Stimulation of sodium reabsorption in the proximal convoluted tubule
Triggers the adrenal cortex to release the sodium-retaining hormone,
aldosterone, to cause reabsorption of sodium and excretion of
potassium in the distal convoluted tubule and collecting duct
Triggers release of antidiuretic hormone by the hypothalamus to
stimulate water reabsorption in the collecting duct
 TUBULAR REABSORPTION
• THE BODY CANNOT LOSE 120 ML OF WATER-
CONTAINING ESSENTIAL SUBSTANCES EVERY
MINUTE. THEREFORE, WHEN THE PLASMA
ULTRAFILTRATE ENTERS THE PROXIMAL
CONVOLUTED TUBULE, THE NEPHRONS,
THROUGH CELLULAR TRANSPORT MECHANISMS,
BEGIN REABSORBING THESE ESSENTIAL
SUBSTANCES AND WATER .
 REABSORPTION MECHANISMS
• THE CELLULAR MECHANISMS INVOLVED IN T UBULAR
R E A B S O R P T I O N A R E T E R M E D A C T I V E A N D PA S S I V E
TRANSPORT.
• FOR ACTIVE TRANSPORT TO OCCUR, THE SUBSTANCE TO
BE REABSORBED MUST COMBINE WITH A CARRIER PROTEIN
CONTAINED IN THE MEMBRANES OF THE RENAL TUBULAR
CELLS.
• PASSIVE TRANSPORT IS THE MOVEMENT OF MOLECULES
ACROSS A MEMBRANE AS A RESULT OF DIFFERENCES IN
THEIR CONCENTRATION OR ELECTRICAL POTENTIAL ON
OPPOSITE SIDES OF THE MEMBRANE.
ADDITIONAL NOTES:
• Active transport is responsible for the reabsorption of
glucose, amino acids, and salts in the proximal
convoluted tubule, chloride in the ascending loop of
Henle, and sodium in the distal convoluted tubule.
• Passive reabsorption of water takes place in all parts of
the nephron except the ascending loop of Henle, the walls
of which are impermeable to water. Urea is passively
reabsorbed in the proximal convoluted tubule and the
ascending loop of Henle, and passive reabsorption of
sodium accompanies the active transport of chloride in
the ascending loop.
 REABSORPTION MECHANISMS
• ACTIVE TRANSPORT, LIKE PASSIVE TRANSPORT, CAN BE
INFLUENCED BY THE CONCENTRATION OF THE SUBSTANCE
BEING TRANSPORTED. WHEN THE PLASMA CONCENTRATION OF A
SUBSTANCE THAT IS NORMALLY COMPLETELY REABSORBED
REACHES AN ABNORMALLY HIGH LEVEL, THE FILTRATE
CONCENTRATION EXCEEDS THE MAXIMAL REABSORPTIVE
CAPACITY (TM) OF THE TUBULES, AND THE SUBSTANCE BEGINS
APPEARING IN THE URINE.
• THE PLASMA CONCENTRATION AT WHICH ACTIVE TRANSPORT
STOPS IS TERMED THE RENAL THRESHOLD.
ADDITIONAL NOTES:
• For glucose, the renal threshold is 160 to 180 mg/dL, and
glucose appears in the urine when the plasma
concentration reaches this level.
 TUBULAR REABSORPTION
Substance Location
Glucose, amino acids, salts Proximal convoluted tubule

Chloride Ascending loop of Henle

Active transport
Sodium Proximal and distal convoluted
tubules
Water Proximal convoluted tubule,
descending loop of Henle, and
collecting duct
Passive transport
Urea Proximal convoluted tubule and
ascending loop of Henle
Sodium Ascending loop of Henle
 TUBULAR CONCENTRATION
• RENAL CONCENTRATION BEGINS IN THE DESCENDING AND
ASCENDING LOOPS OF HENLE, WHERE THE FILTRATE IS
EXPOSED TO THE HIGH OSMOTIC GRADIENT OF THE RENAL
M E D U L L A . WAT E R I S R E M O V E D B Y O S M O S I S I N T H E
DESCENDING LOOP OF HENLE, AND SODIUM AND CHLORIDE
ARE REABSORBED IN THE ASCENDING LOOP.
• EXCESSIVE REABSORPTION OF WATER AS THE FILTRATE
PASSES THROUGH THE HIGHLY CONCENTRATED MEDULLA IS
PREVENTED BY THE WATER-IMPERMEABLE WALLS OF THE
ASCENDING LOOP.
ADDITIONAL NOTES:
• This selective reabsorption process is called the
countercurrent mechanism and serves to maintain the
osmotic gradient of the medulla.
• The sodium and chloride leaving the filtrate in the
ascending loop prevent dilution of the medullary
interstitium by the water reabsorbed from the descending
loop. Maintenance of this osmotic gradient is essential for
the final concentration of the filtrate when it reaches the
collecting duct
 COLLECTING DUCT CONCENTRATION
• THE FINAL CONCENTRATION OF THE FILTRATE
THROUGH THE REABSORPTION OF WATER BEGINS IN
THE LATE DISTAL CONVOLUTED TUBULE AND
CONTINUES IN THE COLLECTING DUCT. REABSORPTION
DEPENDS ON THE OSMOTIC GRADIENT IN THE MEDULLA
AND THE HORMONE VASOPRESSIN

• ↑BODY HYDRATION = ↓ADH = ↑URINE VOLUME

• ↓BODY HYDRATION = ↑ADH = ↓URINE VOLUME
ADDITIONAL NOTES:
• Vasopressin, also known as Antidiuretic hormone (ADH) is a
small peptide hormone which regulates the body's retention
of water.
• ADH - It's a hormone made by the hypothalamus in the brain
and stored in the posterior pituitary gland. It tells your kidneys
how much water to conserve.
 TUBULAR SECRETION
• IN CONTRAST TO TUBULAR REABSORPTION, IN WHICH
SUBSTANCES ARE REMOVED FROM THE GLOMERULAR
F I LT R AT E A N D R E T U R N E D TO T H E B L O O D , T U B U L A R
SECRETION INVOLVES THE PASSAGE OF SUBSTANCES
FROM THE BLOOD IN THE PERITUBULAR CAPILLARIES TO
THE TUBULAR FILTRATE.
• TUBULAR SECRETION SERVES TWO MAJOR FUNCTIONS:
ELIMINATION OF WASTE PRODUCTS NOT FILTERED BY THE
GL OMERUL US AND REGUL AT I O N O F T H E A C I D - B A S E
BALANCE IN THE BODY THROUGH THE SECRETION OF
HYDROGEN IONS.
ADDITIONAL NOTES:
Many foreign substances, such as medications, cannot be
filtered by the glomerulus because they are bound to
plasma proteins. However, when these protein-bound
substances enter the peritubular capillaries, they develop a
stronger affinity for the tubular cells and dissociate from
their carrier proteins, which results in their transport into the
filtrate by the tubular cells. The major site for removal of
these nonfiltered substances is the proximal
convoluted tubule.
 ACID-BASE BALANCE
• TO MAINTAIN THE NORMAL BLOOD PH OF 7.4, THE
BLOOD MUST BUFFER AND ELIMINATE THE EXCESS ACID
FORMED BY DIETARY INTAKE AND BODY METABOLISM.
• THE BUFFERING CAPACITY OF THE BLOOD DEPENDS ON
BICARBONATE (HCO3 - ) IONS, WHICH ARE READILY
F I LT E R E D B Y T H E G L O M E R U L U S A N D M U S T B E
EXPEDIENTLY RETURNED TO THE BLOOD TO MAINTAIN
THE PROPER PH. 100% REABSORPTION OF FILTERED
B I C A R B O N AT E A N D O C C U R S P R I M A R I LY I N T H E
PROXIMAL CONVOLUTED TUBULE
ADDITIONAL NOTES:
• The buffering capacity of the blood depends on bicarbonate (HCO3 -
) ions, which are readily filtered by the glomerulus and must be
expediently returned to the blood to maintain the proper pH. 100%
reabsorption of filtered bicarbonate and occurs primarily in the
proximal convoluted tubule
• As a result of their small molecular size, hydrogen ions are readily
filtered and reabsorbed. Therefore, the actual excretion of excess
hydrogen ions also depends on tubular secretion. Additional
excretion of hydrogen ions is accomplished through their reaction
with ammonia produced and secreted by the cells of the distal
convoluted tubule. In the proximal convoluted tubule, ammonia is
produced from the breakdown of the amino acid glutamine. The
ammonia reacts with the H to form the ammonium ion (NH4 ). The
resulting ammonium ion is excreted in the urine.
RENAL FUNCTION TESTS
 GLOMERULAR FILTRATION
TESTS
• THE STANDARD TES T U S E D TO M E A S U R E T H E F I LT E R I N G
CAPACITY OF THE GLOMERULI IS THE CLEARANCE TEST.
• TO ENSURE THAT GLOMERULAR FILTRATION IS BEING MEASURED
ACCURATELY, THE SUBSTANCE ANALYZED MUST BE ONE THAT IS
NEITHER REABSORBED NOR SECRETED BY THE TUBULES
• O T H E R FA C TO R S TO C O N S I D E R I N T H E S E L E C T I O N O F A
CLEARANCE TEST SUBSTANCE INCLUDE THE STABILITY OF THE
SUBSTANCE IN URINE DURING A POSSIBLE 24-HOUR COLLECTION
PERIOD, THE C O N S I S T E N C Y O F T H E P L A S M A L E V E L , T H E
SUBSTANCE’S AVAILABILITY TO THE BODY, AND THE AVAILABILITY
OF TESTS FOR ANALYSIS OF THE SUBSTANCE
 ADDITIONAL NOTES:
• As its name implies, a clearance test measures the rate at
which the kidneys are able to remove (to clear) a filterable
substance from the blood.
 GLOMERULAR FILTRATION
TESTS
• T H E E A R L I E S T G L O M E R U L A R F I LT R AT I O N T E S T S
MEASURED UREA BECAUSE OF ITS PRESENCE IN ALL
URINE SPECIMENS AND THE EXISTENCE OF ROUTINELY
USED METHODS OF CHEMICAL ANALYSIS. BECAUSE
A P P R O X I M AT E LY 4 0 % O F T H E F I LT E R E D U R E A I S
REABSORBED, NORMAL VALUES WERE ADJUSTED TO
REFLECT THE REABSORPTION, AND PATIENTS WERE
HYDRATED TO PRODUCE A URINE FLOW OF 2 ML/MIN TO
ENSURE THAT NO MORE THAN 40% OF THE UREA WAS
REABSORBED.
 INULIN CLEARANCE
• INULIN, A POLYMER OF FRUCTOSE, IS AN EXTREMELY STABLE
SUBSTANCE THAT IS NOT REABSORBED OR SECRETED BY THE
TUBULES. IT IS NOT A NORMAL BODY CONSTITUENT, HOWEVER,
AND MUST BE INFUSED AT A CONSTANT RATE THROUGHOUT THE
TESTING PERIOD.
• A TEST THAT REQUIRES AN INFUSED SUBSTANCE IS TERMED AN
EXOGENOUS PROCEDURE AND IS SELDOM THE METHOD OF
CHOICE IF A SUITABLE TEST SUBSTANCE IS ALREADY PRESENT IN
THE BODY (ENDOGENOUS PROCEDURE). THEREFORE, ALTHOUGH
INULIN WAS THE ORIGINAL REFERENCE METHOD FOR CLEARANCE
T E S T S , I T I S C U R R E N T LY N O T U S E D F O R G L O M E R U L A R
FILTRATION TESTING.
ADDITIONAL NOTES:
EXOGENOUS PROCEDURE – ANY PROCEDURE
PERTAINING TO SUBSTANCES NOT ORGANICALLY
MADE BY THE BODY.
 CREATININE CLEARANCE
• C R E AT I N I N E , A W A S T E P R O D U C T O F M U S C L E
M E TA B O L I S M T H AT I S N O R M A L LY F O U N D AT A
RELATIVELY CONSTANT LEVEL IN THE BLOOD, PROVIDES
THE LABORATORY WITH AN ENDOGENOUS PROCEDURE
FOR EVALUATING GLOMERULAR FUNCTION.
• CURRENTLY, ROUTINE LABORATORY MEASUREMENTS
OF GFR EMPLOY CREATININE AS THE TEST SUBSTANCE.
• T H E U S E O F C R E AT I N I N E H A S S E V E R A L
D I S A D VA N TA G E S N O T F O U N D W I T H I N U L I N , A N D
CAREFUL CONSIDERATION SHOULD BE GIVEN TO THEM.
 DISADVANTAGES OF CREATININE
CLEARANCE
• SOME CREATININE IS SECRETED BY THE TUBULES, AND SECRETION INCREASES AS BLOOD
LEVELS RISE.
• CHROMOGENS PRESENT IN HUMAN PLASMA REACT IN THE CHEMICAL ANALYSIS. THEIR
PRESENCE, HOWEVER, MAY HELP COUNTERACT THE FALSELY ELEVATED RATES CAUSED BY
TUBULAR SECRETION.
• MEDICATIONS, INCLUDING GENTAMICIN, CEPHALOSPORINS, AND CIMETIDINE (TAGAMET),
INHIBIT TUBULAR SECRETION OF CREATININE, THUS CAUSING FALSELY LOW SERUM LEVELS.
• BACTERIA WILL BREAK DOWN URINARY CREATININE IF SPECIMENS ARE KEPT AT ROOM
TEMPERATURE FOR EXTENDED PERIODS.
• A DIET HEAVY IN MEAT CONSUMED DURING COLLECTION OF A 24-HOUR URINE SPECIMEN WILL
INFLUENCE THE RESULTS IF THE PLASMA SPECIMEN IS DRAWN PRIOR TO THE COLLECTION
PERIOD
• MEASUREMENT OF CREATININE CLEARANCE IS NOT A RELIABLE INDICATOR IN PATIENTS
SUFFERING FROM MUSCLE-WASTING DISEASES
ADDITIONAL NOTES:
Muscle wasting - A weakening, shrinking, and loss
of muscle caused by disease or lack of use. Muscle
wasting decreases strength and the ability to move.

Amyotrophic lateral sclerosis.

Muscular dystrophy.
Multiple sclerosis.
Spinal muscular atrophy.
INTRODUCTION
TO URINALYSIS
 HISTORY
⚫ Laboratory medicine began with the
analysis of human urine, which was called
uroscopy and today is termed urinalysis.

⚫ Uroscopy, from the word ‘uroscopia,’

means scientific examination of urine. The
word is derived from the Greek ‘ouron’
meaning urine and ‘skopeo’ meaning to
behold, contemplate, examine, or inspect.
⚫ Ancient Babylonian and Sumerian physicians
first inscribed their evaluations of urine into clay
tablets as early as 4,000 B.C.
⚫ In ancient Greece, Hippocrates, often called
the father of Western medicine, expanded on
urine's importance: "No other organ system or
organ of the human body provides so much
information by its excretion as does the urinary
system".
⚫ 5th century BC – Hippocrates wrote a book on
uroscopy
⚫ 1140 AD – col or charts w e r e d e v e l o p e d t h a t
described the significance of 20 different colors.
⚫ 1627 – Thomas Bryant wrote a book about
charlatans (pisse prophets) which inspired the
passing of the first medical licensure law in England.
⚫ 1694 – Frederik Dekkers’ discovered albuminuria by
boiling urine.
⚫ The credibility of urinalysis became compromised
when charlatans without medical credentials began
offering their predictions to the public for a healthy
fee. These charlatans, called “pisse prophets,”
⚫ 17th century – microscope was invented which led
to the examination of urinary sediment and to the
development by Thomas Addis of methods for
quantitating the microscopic sediment.
⚫ 1827 – Richard Bright introduced the concept of
urinalysis as part of routine patient examination.
⚫ 1956 - Helen Murray Free and her husband, Alfred
Free, pioneered dry reagent urinalysis, resulting in
the development of Clinistix (also known
as Clinistrip), the first dip-and-read test for glucose
in urine for patients with diabetes.
⚫ There was also a time when technicians taste
urine to see if it has a fruity/sweet flavor which is
associated with DM. They also used ants to see if
the urine has glucose in it.
 UTILITIES OF ANALYSIS
⚫To aid in the diagnosis of diseases.
⚫To screen asymptomatic populations for undetected disorders.
⚫To monitor the progress of disease and the effectiveness of therapy.
ADDITIONAL NOTES:
⚫For example the patient is having difficulty in urinating, the increase
in pus cells or white blood cells in the urine will indicate infection thus
aiding the diagnosis of a urinary tract infection.
⚫Screen asymptomatic populations for undetected disorder for
example the patient doesn’t know he is exhibiting glucose in his urine.
This might indicate that the patients is already suffering from DM.
Remember that the renal threshold for glucose is 160 – 180 mg/dl.
While normal blood sugar level is 70 to 100 mg/dl.
⚫Monitoring the effectiveness of the therapy for example again the
patient suffering from UTI earlier was given medicines and antibiotics.
A marked decrease in pus cells or wbc in the urine will indicate that
the medication is effective to the patient.
Two unique characterist ics of a urine
specimen account for this continued
popularity:

⚫ 1. Urine is a readily available and easily

collected specimen.
⚫ 2. Urine contains information, which can
be obtained by inexpensive laboratory
tests, about many of the body’s major
metabolic functions.
 URINE FORMATION
The kidneys continuously form urine as an
ultrafiltrate of plasma. Reabsorption of water
and filtered substances essential to body
function converts approximately 170,000 mL
of filtered plasma to the average daily urine
output of 1200 mL.
 URINE COMPOSITION
⚫ In general, urine consists of urea and other organic
and inorganic chemicals dissolved in water. Urine is
normally 95% water and 5% solutes.
⚫ Dietary intake, physical activity, body metabolism,
endocrine functions, and even body position can alter
or influence the concentrations of these solutes.
⚫ Urea, a metabolic waste product produced in the liver
from the breakdown of protein and amino acids,
accounts for nearly half of the total dissolved solids in
urine.

Organic components – urea, creatinine, uric acid,

ammonia, undetermined nitrogen, others
Inorganic components – Cl-, Na+, K+, P, Ca2+,
phosphates, sulfates
 URINE VOLUME
⚫ Urine volume depends on the amount of water that the
kidneys excrete. Water is a major body constituent; therefore,
the amount excreted is usually determined by the body’s state
of hydration.
⚫ Factors that influence urine volume include: fluid intake, fluid
loss from non-renal sources, variations in the secretion of
antidiuretic hormone, and need to excrete increased amounts
of dissolved solids, such as glucose or salts.
⚫ normal daily urine output is usually 1200 to 1500 mL, a range
of 600 to 2000 mL is considered normal.
ADDITIONAL NOTES:
• Increased Fluid intake – increased fluid output but diluted
urine.
• Decreased fluid intake – decreased fluid output but
saturated/concentrated urine.
• Sweating is an example of fluid loss from non-renal sources.
• Normal daily urine output is usually 1200 to 1500 mL, a range of
600 to 2000 mL is considered normal
 ANOMALIES IN URINE
VOLUME
⚫ Polyuria - abnormal increase in urine output. Greater than 2.5 L/day in
adults and 2.5–3 mL/kg/day in children.
⚫ Oliguria - A decrease in urine output, which is less than 1 mL/kg/hr. in
infants, less than 0.5 mL/kg/hr. in children, and less than 400 mL/day in
adults.
⚫ Anuria/Anuresis - Total suppression of urine production.
⚫ Nocturia - excretion of more than 500 mL urine at night.
ADDITIONAL NOTES:
POLYURIA - Clinical significance: diabetes mellitus, diabetes insipidus
OLIGURIA - is commonly seen when the body enters a state of dehydration as a
result of excessive water loss from vomiting, diarrhea, perspiration, or severe burns.
ANURIA - Clinical significance: severe acute nephritis, MERCUTY (Hg)
poisoning, obstructive uropathy, kidney failure.
NOCTURIA - The kidneys excrete two to three times more urine during the day than
during the night. An increase in night urine excretion is NOCTURIA.
 SPECIMEN COLLECTION
⚫ Specimens must be collected in clean, dry, leak-proof containers.
Disposable containers are recommended because they eliminate the
chance of contamination due to improper washing. These disposable
containers are available in a variety of sizes and shapes, including
bags with adhesive for the collection of pediatric specimens and
large containers for 24-hour specimens. Properly applied screw-top
lids are less Likely to leak than Snap-on lids.

⚫ Containers for routine urinalysis should have a wide mouth to

facilitate collections from female patients and a wide, flat bottom to
prevent overturning. They should be made of a clear material to
allow for determination of color and clarity. The recommended
capacity of the container is 50 mL, which allows 12 mL of specimen
needed for microscopic analysis, additional specimen for repeat
analysis, and enough room for the specimen to be mixed by swirling
the container.
TYPES OF URINE SPECIMEN/
COLLECTION TECHNIQUES
⚫ First morning - routine screening, pregnancy test,
detection of orthostatic proteinuria
⚫ Random - routine screening
⚫ 24-hour - quantitative chemical tests, hormone studies
⚫ 12-hour - Addis count (The Addis count is a urine test
measuring urinary casts over time. It is named for
Thomas Addis.)
⚫ Afternoon specimen - urobilinogen determination
⚫ Fasting/Second morning - diabetic
screening/monitoring
⚫ 2-h Postprandial - diabetic monitoring
⚫ Glucose Tolerance - accompaniment to blood
samples in GTT
⚫ Drug testing specimen - collection requires stringent
protocols (COC); temperature should be within 32.5-
37.7ºC; blueing agent added to the toilet water reservoir
in unwitnessed collection
⚫ Midstream clean-catch - routine screening, bacterial
culture
⚫ Catheterization - bacterial culture
⚫ Suprapubic aspiration - bacterial culture, cytology
⚫ Three-glass collection - diagnosis of prostatic infection
 SPECIMEN HANDLING
⚫ Following collection, specimens should
be delivered to the laboratory promptly
and tested within 2 hours. A specimen that
cannot be delivered and tested within 2
hours should be refrigerated or have an
appropriate chemical preservative added.
 CHANGES IN
UNPRESERVED URINE
ANALYTE CHANGE CAUSE
Color Modified/darkened Oxidation or reduction of metabolites

Clarity Decreased Bacterial growth and precipitation of

amorphous material
Odor Increased Bacterial multiplication or breakdown
of urea to ammonia
pH Increased Breakdown of urea to ammonia by
urease-producing bacteria/
loss of CO2
Glucose Decreased Glycolysis and bacterial use
 ANALYTE CHANGE CAUSE
Ketones Decreased Volatilization and bacterial metabolism

Bilirubin Decreased Exposure to light/photo oxidation to

biliverdin

Urobilinogen Decreased Oxidation to urobilin

Nitrite Increased Multiplication of nitrate-reducing

bacteria

Red and white Decreased Disintegration in dilute alkaline urine

blood cells and
casts

Bacteria Increased Multiplication

 URINE PRESERVATION
Preservatives Comments

Refrigeration Prevents bacterial growth for at least 24 hours; preserves organized

sediments; maintains an acid pH up to about 8 hours; and does not
interfere with chemical tests.

Precipitates amorphous materials increasing the specific gravity.

Phenol Does not interfere with routine tests; causes an odor change.

Toluene Does not interfere with routine tests; floats on surface of specimens
and clings to pipettes and testing materials.

Thymol Preserves glucose and sediments well; interferes with acid

precipitation tests for protein.
Preservatives Comments
Formalin Excellent sediment preservative; acts as a reducing
agent, interfering with chemical tests for glucose,
blood, LE, and copper reduction

Sodium fluoride Prevents glycolysis; is a good preservative for drug

analyses; inhibits reagent strip tests for glucose, blood,
and leukocytes.

Boric acid Preserves protein and formed elements well; does not
interfere with routine analyses other than pH;

Interferes with drug and hormone analyses.

Saccomanno Preserves cellular elements; for cytology studies
Fixative