DIAG 2735 4 - Chemical Analysis - Chemical Analysis of the Urine Specimen Chemical Analysis Chemical reagent strip Enzymes Hormones Metabolites Protein

Chemical Analysis of the Urine Specimen

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Chemical Analysis • Chemical reagent strip • Enzymes • Hormones • Metabolites • Protein and protein metabolites • Pigments • Sugars, ketones, and mucopolysaccarides • Minerals

Leukocytes (page 6) • Present with bacterial invasion or inflammation • May be seen without RBCs • Mostly neutrophils • Increased – Fever – Exercise • In casts indicates renal disease

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Leukocytes (continued) • Gross pyuria – Greater than 30 per hpf = acute infection – May indicate abscess • Causes – Acute and chronic pyelonephritis – Acute and chronic GMN – Infection of tract – Obstruction • Tumors and stones

Nitrites (page 4) • Indicates bacteria present (abnormal) • With WBCs indicates UTI • Without WBCs indicates contamination • Best specimen is morning • Requires culture • E. Coli most common

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pH (page 3) • Acid pH < 7.0 – Happens due to protein metabolism – May be due to glucosuria of diabetes – Clinically significant crystals form – Most urine averages pH 6.8

pH (continued) • Alkaline pH > 7.0 – From eating green leafies – Alkali earth metals (Ca, K, Na, Mg etc.) – E. Coli thrives in alkaline urine – Casts dissolve in alkaline urine

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Protein (page 3) • Most important indicator of renal disease • Normal amount is 150 mg/day • Happens when basement membrane swells – Loses (-) electric charge which repels protein • 1/3 albumin, 1/3 Tamm-Horsfall, 1/3 others • Tamm-Horsfall is secreted by ascending Loop of Henli (always

Protein (continued) • Benign causes – Rarely exceeds 1 g/day – Exercise – Postural (hyperlordosis, poorly supported liver present during day not at night – Dehydration – Sunburn

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Protein (continued) • Minimal proteinuria < 1 g/day – Chronic or intermittent pyelonephritis – Obstructive nephropathy • Tumors • Stones – Inactive GMN – Polycystics disease

Protein (continued) • Moderate Proteinuria = 1-3 g/day – Seen with diseases of heavy proteinuria – Toxic nephropathy – Radiation nephritis – Multiple myeloma • Bence Jones proteins

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Protein (continued) • Bence Jones proteins – Multiple myeloma (plasmacytoma) – Acute lymphocytic leukemia – Lymphoma – Mets of lung, colon, prostate, breast • Dissolve and precipitate varying temperatures

Protein (continued) • Heavy proteinuria > 3 g/day • Renal causes – Acute and chronic GMN • Systemic causes – Toxemia of pregnancy – Diabetes – Lupus – Sickle cell disease – Malignant hypertension – Congestive heart failure

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Protein (continued) • Persistent proteinuria – 1-2 g/day – Consistent – Follows healing of renal disease

Glucose (page 4) • Hallmark of diabetes mellitus – Polyuria and polydipsia • Renal threshold is 180 mg/dl • Should not be in urine specimen • May appear with endocrine disorders • May be due to drugs • Other pathologies • Eating after a fast