PATHOLOGICAL COMPONENTS OF URINE

PHYSICAL CHARACTERISTICS OF URINE VOLUME DENSITY and OSMOLARITY COLOR   PHYSICAL CHARACTERISTICS OF URINE VOLUME DENSITY and OSMOLARITY COLOR ODOR FOAM CHEMICAL COMPOSITION OF URINE pH PROTEINS HEMOGLOBIN GLUCOSE KETONE BODIES BILIRUBIN UROBILINOGEN MORPHOLOGY OF URINE URINE SEDIMENT - ORGAN - NONORGAN

pH NORMAL RANGE: pH 5 - 6 MAXIMAL RANGE: pH 4,5 - 8   ACIDURIA - pH permanently < 5,4 - Metabolic or respiration acidosis - Diabetes - Starving ALKALIURIA - pH permanently > 6,5 - Metabolic or respiratory alkalosis - Vegetable diet - Bacterial infection

PROTEINS PROTEINURIA < 0,15 – 0,2 g/day - PHYSIOLOGICAL   PROTEINURIA < 0,15 – 0,2 g/day - PHYSIOLOGICAL < 0,5 g/day - MILD DEGREE 0,5 - 1,5 g/day - MIDDLE DEGREE 1,5 - 4 g/day - EXPRESSIVE > 4 g/day - HEAVY    A) PHYSIOLOGIC PROTEINURIA (LESS THAN 500 mg/d) - SEVERE EXERCISE - A HIGH PROTEIN MEAL - SOME TEMPORARY IMPAIRMENT IN RENAL CIRCULATION - PREGNANCY (30 – 40%) B) PATHOLOGIC PROTEINURIAS   - PRERENAL, WHEN THE PRIMARY CAUSES ARE FACTORS OPERATING BEFORE KIDNEY IS REACHED - RENAL, WHEN THE LEASON IS INTRINSIC TO THE KIDNEY - POSTRENAL, WHEN PROTEINURIA IS DUE TO INFLAMMATION IN THE LOWER URINARY TRACT TESTS: SULFOSALICYLIC ACID, HELLER´S QUANTITY: BIURET REACTION

URINE HEMOGLOBIN BLOOD MAY APPEAR IN THE URINE AS INTACT RED CELLS OR AS A FREE HEMOGLOBIN HEMOGLOBINURIA IS USUALLY REALATED TO A CONDITION OUTSIDE THE URINARY TRACT AND OCCURES WHEN THERE IS SUCH EXTENSIVE OR RAPID DESTRUCTION OF RED BLOOD CELLS (HEMOLYSIS). HEMOGLOBINURIA IS FOUND IN - EXTENSIVE BURNS - CRUSHING INJURIES - MALARIA - TRANSFUSION REACTION WITH INCOMPATIBLE BLOOD PRODUCTS… ERYTHROCYTURIA – WHEN INTACT RED CELLS ARE PRESENT IN THE URINE. THE TERM IS USED TO INDICATE BLEEDING IN THE URINARY TRACT. ERYTHROCYTURIA IS FOUND IN: LOWER URINARY TRACT INFECTION URINARY TRACT OR RENAL CANCER HEMOPHYLIA … ERYTROCYTURIA (HEMATURIA) > 5 Ery/l ( 2 - 3 mil./day) HEMOGLOBINURIA - 0,15 - 0,45 mg Hb/l

GLUCOSE NORMAL RANGE: 0.06 – 0.83 mmol/L (0.01 – 0.15 g/L) PATHOLOGICAL GLUCOSURIA: > 1.67 mmol/L (0.3 g/L) GLUCOSURIA IS INDICATED, WHEN MORE THAN 1.67 mmol/L IS FOUND TRANSIENT GLUCOSURIA MAY BE NOTED AFTER - EMOTIONAL STRESS - EXCITING ATHLETIC CONTEST 15 % OF CASES ARE NOT DUE TO DIABETES OTHER SUGARS: GALACTOSURIA AND LACTOSURIA MAY OCCURE OCCASIONALLY IN INFANTS AND IN THE MOTHER DURING PREGNANCY LACTATION AND WEANIG PERIOD. PENTOSURIA MAY OCCURE TRANSIENTLY AFTER INGESTION OF FOODS CONTAINING LARGE QUANTITIES OF PENTOSES (PLUMS, CHERRIES, GRAPES). TESTS: FEHLING’S (FROM 11 mmol/L ~ 2 g/L) BENEDICT’S (FROM 5.5 mmol/L ~ 1g/L)

KETONE BODIES 3 – HYDROXYBUTYRATE 60 - 70% ACETACETATE 30 - 35% ACETONE 3 - 4% NORMALLY, ONLY 3 TO 15 mg/d THE QUANTITY IS INCREASED IN - STARVATION - IMPAIRED CARBOHYDRATE METABOLISM (e.g. DIABETES) - PREGNANCY EXCESS FAT METABOLISM WILL ALSO INDUCE A KETONURIA. ACIDOSIS IS ACCOMPANIED WITH KETONURIA. TESTS: LEGAL’S LESTRADET’S

TRANSFORMATION AND TRANSPORT OF BILE PIGMENTS

URINE BILIRUBIN NORMAL RANGE: 0 - 0,5 mol/l IN SERUM:   IN SERUM: BILIRUBIN + ALBUMIN = INDIRECTLY REACTING BILIRUBIN BILIRUBIN IS NOT CONJUGATED BILIRUBINDIGLUKOSIDURONATE = DIRECLY REACTING BILIRUBIN CONJUGATED BILIRUBIN URINE BILIRUBIN IS AN EARLY SIGN OF HEPATOCELLULAR DISEASE OR BILIARY OBSTRUCTION. INCREASED LEVEL OCCURES IN - HEPATITIS - LIVER DISEASE CAUSED BY INFECTION OR EXPOSURE TO TOXIC AGENTS - OBSTRUCTIVE BILIARY TRACT DISEASE TESTS: ROSIN'S GMELIN'S

UROBILINOGEN (UROBILINOIDS) NORMAL: < 4 mol/day (2,5 mg); max. 17 mol/l   URINE UROBILINOGEN IS ONE OF THE MOST SENSITIVE TEST AVAILABLE TO DETECT LIVER DISFUNCTION URINARY UROBILINOGEN IS INCREASED BY - ANY CONDITION THAT CAUSES AN INCREASE IN THE PRODUCTION OF BILIRUBIN - ANY CONDITION THAT PREVENTS THE LIVER FROM REMOVING THE NORMALLY REABSORBED UROBILINOGEN FROM THE PORTAL CIRCULATION TESTS: EHRLICH'S EHRLICH POSITIVE SUBSTANCES: Urobilinogen, sterkobilinogen SCHLESINGER'S SCHLESINGER POSITIVE SUBSTANCES: Urobilin, sterkobilin

HYPRBILIRUBINEMIA BILIRUBIN UROBILINOGEN IN URINE IN URINE HEMOLYTIC NEG. + (prehepatal) HEPATAL + +   OBSTRUCTIVE + NEG. (posthepatal)

URINARY SEDIMENT

THE MOST FREQUENT NONORGAN SEDIMENT

Organ sediment - 1

Organ sediment - 2

Organ sediment - 3

Organ sediment - 4