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Urine FEME

Urine FEME

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    Urine FEME Urine FEME Presentation Transcript

    •  
      • The kidneys and bladder work together to make urine and remove it from our body.
      • The kidneys filter waste products and water from the blood to form urine.
      • The urine moves from the kidneys through tubes called ureters to the bladder, which stores the urine until it is full.
      • From the bladder, urine leaves the body through another thin tube, the urethra.
      • After the bladder starts to empty, it normally empties all of the urine.
      URINARY TRACT
    • TEST OVERVIEW
      • Tests on urine provide information and clues to many diseases, and can also be indications of the condition of a patient's health.
      • A routine urine-screening test may be done to help find the cause for a number of different symptoms.
      • The kidneys remove waste material, minerals, fluids, and other substances from the blood for elimination through urine.
      • Therefore, urine can contain hundreds of different bodily waste products.
      • Many factors (such as diet, fluid intake, exercise, and kidney function) affect the constituents of urine.
    • WHY IT IS DONE???
      • A urine test may be done:
      • To check for a disease or infection of the urinary tract. Symptoms of a urine infection may include colored or bad-smelling urine, pain when urinating, hard to urinate, flank pain, blood in the urine (hematuria), or fever.
      • To check the treatment of conditions such as diabetes, kidney stones, a urinary tract infection (UTI), or some kidney or liver diseases.
      • As part of a regular physical examination.
    • STANDARD OPERATION PROCEDURE FOR URINE FEME
      • SAMPLE: Fresh Urine
      • MATERIAL REQUIRED: Urine Strip (10 parameters), 10mL sample tube, pasteur pipette, microscope slide, cover slip, microscope and urine analyzer (Urisys 1100 or Urisys 1800).
      • PROCEDURE:
        • Full Examination
        • 1) Put 10mL urine in urine tube
        • 2) Dip 1 urine strip in urine
        • 3) Wipe and put it in the reader and press start
        • 4) Analyzer will read the strip and result will be printed out
        • 5) Record result and proceed to spin urine at 1500rpm for 5 minutes.
        • Microscopy Examination
        • 1) Discard 9mL of urine and mix the remaining 1mL
        • 2) Put 1 drop of urine on a microscope slide using a pasteur pipette and put a cover slip on it.
        • 3) Examine urine slide with microscope at 40x magnification and report the observation per high power field.
    • URINE FULL EXAMINATION
      • A regular urinalysis often includes the following tests.
      • Color
      • Many factors affect the color of urine, including fluid balance, diet, medications and disease.
      • Normal color – pale to dark yellow
      • The intensity of the color generally indicates the concentration of the urine; pale or colorless urine indicates that the urine is dilute, and deep yellow urine indicates that it is concentrated.
      • Vitamin B supplements can turn urine bright yellow. Reddish brown urine is usually caused by certain medications, eating blackberries or beets or by the presence of blood in urine.
      • Clarity
      • Also called opacity or turbidity - determines the cloudiness of the urine.
      • Urine is normally clear, but bacteria, blood, sperm, crystals, or mucus can make urine appear cloudy.
      • Odor
      • Normal odor : Slightly "nutty" odor.
      • Some diseases cause a change in the normal odor of urine.
      • For example, an infection with E. coli bacteria can cause a foul odor while diabetes or starvation can cause a sweet, fruity odor.
      • Specific gravity
      • Measures the amount of substances dissolved in the urine.
      • It also indicates how well the kidneys are able to adjust the amount of water in urine.
      • The higher the specific gravity, the more the solid material dissolved in the urine.
      • Normal SG : 1.005 – 1.025
      • When a person drinks a lot of liquids, the kidneys generally produce greater than normal amounts of dilute urine.
      • When a person drinks very little liquid, the kidneys generally make only small amounts of concentrated urine.
      • PH
      • To measure of how acidic or alkaline the urine is.
      • Normal pH: 4.6 – 8.0
      • A high (alkaline) pH can be caused by severe vomiting, a kidney
      • disease, some UTIs, and asthma. A low (acidic)
      • pH may be caused by severe lung disease (emphysema),
      • uncontrolled diabetes, aspirin overdose, severe diarrhea,
      • dehydration, starvation or drinking too much alcohol.
      • Protein
      • Normally there is no protein in the urine (negative).
      • Sometimes a small amount of protein is released into the urine when a person stands up (this condition is called postural proteinuria).
      • Fever, strenuous exercise, normal pregnancy, and some diseases (especially kidney disease) may also cause protein in the urine.
      • Glucose
      • Glucose is the type of sugar usually found in blood.
      • Normally there is very little or no glucose in urine.
      • However, when the blood sugar level is very high, as in uncontrolled diabetes, it spills over into the urine.
      • Glucose can also be present in urine when the kidneys are damaged or diseased, adrenal gland problem, liver damage, brain injury or certain types of poisoning.
      • Ketones
      • Normal : no ketones (negative).
      • When fat is broken down for energy, the body produces by-products called ketones (or ketone bodies) and releases them into the urine.
      • Large amounts of ketones in the urine may signal a dangerous condition known as Diabetic Ketoacidosis.
      • A diet low in sugars and starches (carbohydrates), starvation, or prolonged vomiting may also cause ketones in the urine.
        • Bilirubin
        • Normal : Negative
        • Substance formed by the breakdown of RBCs.
        • It is passed from the body in stool and should not found in urine.
        • If it is present, it often means the liver is damaged or that the flow of bile from the gallbladder is blocked.
        • Urobilinogen
        • Normal : Negative
        • Substance formed by the breakdown of bilirubin.
        • It is also passed from the body in stool and only small amounts of urobilinogen are found in urine.
        • Urobilinogen in urine can be a sign of liver disease (cirrhosis, hepatitis) that the flow of bile from the gallbladder is blocked.
      • Nitrites
      • Normal : Negative
      • Bacteria that cause a urinary tract infection (UTI) make an enzyme that changes urinary nitrates to nitrites.
      • Nitrites in urine show a UTI is present.
      • Leukocyte esterase (WBC esterase)
      • Normal : Negative
      • Leukocyte esterase shows leukocytes (WBCs) in the urine. WBCs in the urine may mean a UTI is present.
    • URINE MICROSCOPIC EXAMINATION
      • It will typically be done when there are abnormal findings on the physical or chemical examination and also to verify the results produced from the urine analyzers.
      • It is performed on urine sediment – urine that has been centrifuged to concentrate the substances in it at the bottom of a tube.
      • The fluid at the top of the tube is then discarded and the drops of fluid remaining are examined under a microscope.
      • In healthy people, the urine contains small numbers of cells and other formed elements from the entire urinary tract, and epithelial cells from the kidney, ureter , bladder, and urethra.
      • A microscopic examination of urine sediment detects the presence and amounts of red blood cells, white bloods cells, crystals, casts and bacteria or yeast.
      • Red Blood Cells (RBCs) Normally, a few RBCs are present in urine sediment (0-5 per hpf).
      • Inflammation, injury, or disease in the kidneys or elsewhere in the urinary tract can cause RBCs to leak out of the blood vessels into the urine.
      • RBCs can also be a contaminant due to an improper sample collection and blood from hemorrhoids or menstruation.
      • RBCs may appear normally shaped, swollen by dilute urine or crenated by concentrated urine.
      • Hematuria is the presence of abnormal numbers of red cells in urine due to: .... glomerular damage .... tumors which erode the urinary tract .... kidney trauma, .... urinary tract stones, .... upper and lower urinary tract infections, .... nephrotoxins, and physical stress
    •  
      • White Blood Cells (WBCs) The number of WBCs in urine sediment is normally low (0-5 per hpf).
      • When the number is high, it indicates an infection or inflammation somewhere in the urinary tract.
      • WBCs can also be a contaminant, such as those from vaginal secretions.
      WBCs
      • Epithelial Cells Normally, a few epithelial cells from the bladder (transitional epithelial cells) or from the external urethra (squamous epithelial cells) can be found in the urine sediment.
      • Cells from the kidney (kidney cells) are less common.
      • In urinary tract conditions such as infections, inflammation, and malignancies, more epithelial cells are present.
      Squamous epithelial cells Transitional epithelial cells
      • Microorganisms The urinary tract is sterile, so there will be no microorganisms seen in the urine sediment.
      • 1) Bacteria from the surrounding skin can enter the urinary tract at the urethra and move up to the bladder, causing a UTI.
      • If the infection is not treated, it can eventually move to the kidneys and cause pyelonephritis.
      • Less frequently, bacteria from a blood infection (septicemia) may move into the urinary tract and also can cause UTI.
      • A urine culture and sensitivity may be performed if a UTI is suspected.
      Bacteria : Cocci Bacteria : Rods
      • 2) Yeast and Fungal (Hyphae)
      • They are most often present in women who have a vaginal infection, because the urine has been contaminated with vaginal secretions during collection.
      Hyphae Yeast : Candida
      • 3)Trichomonads Trchomonas Vaginalis are parasites that may be found in the urine of women or men (rarely).
      • These actually infecting the vaginal canal and their presence in urine is due to contamination.
      • When alive, T. vaginalis can readily be identified due to the motility of the flagella and the rapid and irregular movements of the body across the microscopic field.
      Trichomonas Vaginalis
      • Casts Casts are cylindrical particles sometimes found in urine that are formed from coagulated protein secreted by kidney cells.
      • When a disease process is present in the kidney, other things such as RBCs or WBCs can become trapped in the protein as the cast is formed.
      • When this happens, the cast is identified by the substances inside it, for example, as a RBCs cast or WBCs cast.
      WBCs cast
      • Most typical for acute pyelonephritis, but they may also be present with glomerulonephritis.
      • Their presence indicates inflammation of the kidney.
    • RBCs cast Granular cast
      • Have a textured appearance which ranges from fine to coarse.
      • Usually form as a stage in the degeneration of cellular casts .
      • Red blood cells may stick together and form red blood cell casts.
      • Indicative of glomerulonephritis, with leakage of RBC's from glomeruli, or severe tubular damage.
    • Hyaline cast
      • Have a smooth texture.
      • Are not always indicative clinically significant disease.
      • Greater numbers may be seen associated with proteinuria of renal (such as glomerular disease).
      Waxy cast
      • Have a smooth consistency, squared off ends, as if brittle and easily broken.
      • Found especially in chronic renal disease, diabetic nephropathy, malignant hypertension and glomerulonephritis.
    • Fatty cast
      • Identified by the presence of refractile lipid droplets.
      • Often, they are seen in urines in which free lipid droplets are present as well.
      • Crystals Urine contains many dissolved substances (solutes) – waste chemicals that body needs to eliminate.
      • These solutes can form crystals, solid forms of a particular substance, in the urine if:
      • urine pH is increasingly acidic or basic
      • the concentration of dissolved substances is increased
      • the urine temperature promotes their formation.
      • Crystals are identified by their shape, color, and by the urine pH
      • When crystals form as urine is being made in the kidney, they may group together to form kidney "stones" or calculi.
      • These stones can become lodged in the kidney itself or in the ureters, tubes that pass the urine from kidney to the bladder, causing extreme pain.
    • Calcium Oxalate Dihydrate Crystals Calcium Oxalate Monohydrate Crystals
      • In acid urine.
      • Have different shapes like colorless squares whose corner are connected by intersecting lines, spindle, oval or dumbbell shape.
      • Most common constituent of kidney stones.
    • Uric Acid Crystals Ammonium Urate (or Biurate)
      • In acid urine.
      • Looked like leave shapes.
      • Often yellow to orange-brown in color
      • In alkaline urine.
      • Golden brown color with thorn apple shape.
      • The only urate crystals appear in alkaline urine
    • Calcium Phosphate Triple Phosphate
      • In alkaline urine.
      • Also called struvite crystals
      • Appear as colorless, prism-like crystal or coffin lids
      • UTI with urease producing bacteria can promote struvite crystalluria by raising urine pH and increasing free ammonia.
      • In alkaline urine.
      • Usually found as rosette and pointed finger forms.
    • Cystine Crystals Amorphous Phosphate
      • In acid urine.
      • Is an amino acids
      • Seen as flat colorless hexagonal plates.
      • Often aggregate in layers.
      • In alkaline or neutral urine
      • Looked very scattered and bright around the field.
      • As fine, colorless or slightly brown granules.
      • White precipitate is observed on centrifugation.
    • Amorphous urate
      • In acid urine.
      • Appear as fine pink or brownish granules.
      • Salts of uric acid.
      • Pink precipitate is observed on centrifugation.
      Cholesterol Crystal
      • Found as transparent plates.
      • Usually one or more corners are cut off or notched
      • Also called ‘stair step crystals’.
      • Usually accompanied by proteinuria, but they are only rarely seen.
    • Leucine Crystals Tyrosine Crystals
      • In acid urine.
      • Found as colorless to yellowish brown, needle shaped crystals
      • Usually appear together with leucine crystals.
      • Products of protein metabolism and appear in urine people with tissue degeneration or necrosis (such as severe liver disease).
      • In acid urine.
      • Same clinical conditions like tyrosine.
      • Found in form of spheroids and appear as yellowish brown bodies.
    • What Affects the Test
      • foods that can color the urine, such as blackberries, beets, and rhubarb.
      • exercise strenuously before the test.
      • menstruating or close to starting menstrual period.
      • taking certain medicines that color the urine include vitamin B, phenazopyridine (Pyridium), rifampin, and phenytoin (Dilantin).
      • Having an X-ray test with contrast material in the past 3 days.
    • THANK YOU