5699 Lecture 2
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Transcript of 5699 Lecture 2
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URINALYSIS (MLT 305)
The Open Note Project
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BLOOD
REAGENT STRIP REACTIONS
- Two color charts are provided that correspond to the
reactions that occur with hemoglobinuria and hematuria.
- In the presence of free hemoglobin:
-A strongly positive blue will appear on the pad.
- In contrast, intact red blood cells:
-A speckled pattern will appear on the pad.
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BLOOD
CLINICAL SIGNIFICANCE OF URINE BLOOD
Hematuria
1. Renal calculi
2. Glomerulonephritis
3. Pyelonephritis
4. Tumors
5. Trauma
6. Exposure to toxic chemicals or drugs
7. Strenuous exercise
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BLOOD
CLINICAL SIGNIFICANCE OF URINE BLOOD
Hemoglobinuria
1. Transfusion reactions
2. Hemolytic anemia
3. Severe burns
4. Infections
5. Strenuous exercise
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BLOOD
CLINICAL SIGNIFICANCE OF URINE BLOOD
Myoglobinuria
1. Muscular trauma
2. Prolonged coma
3. Convulsions
4. Muscle-wasting diseases
5. Extensive exertion
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BILIRUBIN
- The appearance of bilirubin in the urine is the first
indication ofliver disease and is often detected
long before the development of jaundice.
- Bilirubin provides early detection of hepatitis,
cirrhosis, gallbladder disease, and cancer, andshould be included in every routine urinalysis.
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Bilirubin
Bilirubin, a highly pigmented yellow compound, is a degradation
product of haemoglobin
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Bilirubin
OXIDATION TESTS (FOUCHETS TEST)
- Urine containing bilirubin usually appears dark yellow or
amber and produces a yellow foam when shaken, thisfoam test was actually the first test for bilirubin.
- Oxidation tests utilize the ability of feric chloride dissolved
in trichloracetic acid (Fouchet's reagent) to oxidizebilirubin to biliverdin, producing a green color.
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Bilirubin
REAGENT STRIP (DIAZO) REACTIONS
- Routine testing for urinary bilirubin by reagent striputilizes the diazo reaction, in an acid medium to produce
colors ranging from increasing degrees of tan or pink toviolet, respectively.
- Questionable results should be retested using theIctotest which produces a more sharply colored diazoreaction.
- Colors other than blue or purple appearing on the matare considered negative.
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Bilirubin
CLINICAL SIGNIFICANCE OF URINE BILIRUBIN
1. Hepatitis
2. Cirrhosis
1. Biliary obstruction
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Bilirubin
- The presence or absence of bilirubin can be used in
determining the cause of clinical jaundice.
( Urine Bilirubin and Urobilinogen in Jaundice )Urine Bilirubin Urine Urobilinogen
Bile duct obstruction +++ Negative
Liver damage + or- ++
Haemolytic disease Negative +++
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UROBILINOGEN
- Like bilirubin, urobilinogen is a bile pigment thatresults from the degradation of hemoglobin.
- It is produced in the intestine by the oxidation ofbilirubin by the intestinal bacteria.
-Approximately half of the urobilinogen is
reabsorbed from the intestine into the blood,recirculates to the liver, and is secreted back intothe intestine through the bile duct.
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UROBILINOGEN
- The urobilinogen remaining in the intestine is excreted inthe feces, where it is oxidized to urobilin, the pigmentresponsible for the characteristic brown color of thefeces.
- Urobilinogen appears in the urine because, as itcirculates in the blood en route to the liver, it passesthrough the kidney and is filtered by the glomerulus.
-A small amount of urobilinogen less than 1 mg/dl or 1Ehrlich unit is normally found in the urine.
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UROBILINOGEN
EHRLICH'S TUBE TEST
- The reagent used in all tests was
p-dimethylaminobenzaldehyde (Ehrlich'sreagent), addition of Ehrlich's reagent to urinecontaining urobilinogen produces a cherry redcolor.
- Positive results in dilutions greater than 1 to 20were considered significant.
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UROBILINOGEN
EHRLICH'S TUBE TEST
- An Ehrlich unit is essentially equal to 1 mg ofurobilinogen.
- Normal values for females are 0.1 to 1.1 Ehrlichunits; and for males, 0.3 to 2.1 Ehrlich units,
these values are based on the recommended 2-hour specimen collected after the noon mealbetween 2 and 4 PM, which is the time ofgreatest urobilinogen excretion.
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UROBILINOGEN
CLINICAL SIGNIFICANCE OF URINE UROBILINOGEN
1.Early detection ofliver disease
2.Hemolytic disorders
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NITRITE
- The reagent strip test for nitrite provides a rapid
screening test for the presence of urinary tractinfection.
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NITRITE
REAGENT STRIP REACTIONS
- Nitrite is detected by the Greiss reaction:
- nitrite at an acidic pH reacts with an aromatic
amine to form a diazonium compound that react
with quinolin compound to produce a pink color.
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NITRITE
CLINICAL SIGNIFICANCE OF URNE NITRITE
1. Cystitis (initial bladder infection)
2.Pyelonephritis (an inflammatory process of thekidney and adjacent renal pelvis)
3.Evaluation of antibiotic therapy
4.Monitoring of patients at high risk for urinarytract infection
5.Screening of urine culture specimens (detectionof bacteruria)
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SPICIFIC GRAVIIY
- The addition of a specific gravity testing area toMultistix has eliminated:
time-consuming step in routine urinalysis
provided a convenient method for routinescreening.
- It is not recommended to replace osmometry orrefractometry for critical fluid monitoring.
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SPICIFIC GRAVIIY
REAGENT STRIP REACTION
- The test is based on the change in pK-
(dissociation constant) of poly methyl vinyl-
ethermaleic anhydride.
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SPICIFIC GRAVIIY
CLINICAL SIGNIFICANCE OF URINE SPECIFIC CRAVITY
1.Patient hydration and dehydration
2. Loss of renal tubular concentrating ability
3.Diabetes insipidus
4.Determination of unsatisfactory specimens due
to low concentration
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LUKOCYTES
- One of the most frequent findings in the routine
urinalysis is the presence ofleukocytes,
indicating a possible infection of the urinary tract.
- Detection ofleukocytes was previously made
only by microscopic examination of the urinarysediment.
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LUKOCYTES
REAGENT STRIP REACTION
- The chemical reaction is enzymatic, utilizing esterases present in granulocyticwhite blood cells to hydrolyze indoxylcarbonic acid ester to produce indoxyl,which reacts with a diazonium salt to create a purple color.
leukocyte
indoxylcarbonic acid ester indoxyl + diazonium salt (purple color)
esterases
- It is recommended that trace reactions be repeated on a fresh specimen and thatmicroscopic examinations be performed on all positive specimens.
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LUKOCYTES
CLINICAL SIGNIFICANCE OF URINE LEUKOCYTES
1.Urinary tract infection
2.Screening of urine culture specimens