Urinalysis

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---BIOCHEMISTRY BIOCHEMISTRY

---Biochemistry Laboratory – CH600 (2008-2009) Experiment 9 Biochemistry Laboratory – CH600 (2008-2009) Experiment 9

Urinalysis

*Michelle Dy Sim, Gellina Ann Ram Suderio, Jonnah Kristina Chua Teope *Michelle Dy Sim, Gellina Ann Ram Suderio, Jonnah Kristina Chua Teope

Department of Biology, 3Biology-6, Group # 7, College of Science Department of Biology, 3Biology-6, Group # 7, College of Science

University of Santo Tomas, España Street, Manila 1008 University of Santo Tomas, España Street, Manila 1008

March 2, 2009 March 2, 2009 Abstract: Abstract:

Urine is a liquid waste product of the body secreted by the

Urine is a liquid waste product of the body secreted by the kidneyskidneys by a process of by a process of filtration fromfiltration from blood blood calledcalled urinationurination andand excreted

excreted through thethrough the urethraurethra. Urinalysis is an array of tests performed on. Urinalysis is an array of tests performed on urineurine and one of the most common methods of and one of the most common methods of medical

medical diagnosis.diagnosis. The objectThe objectives of ives of this experthis experimeniment t are to are to subjesubject the ct the urine samplurine sample e acquacquired to ired to seveseveral tests and ral tests and toto quali

qualitatitatively examine the vely examine the prespresence ence of of some normal some normal orgaorganic nic constconstitueituents nts and and pathopathologic organic logic organic constconstituenituents. ts. InitInitialial examination includes the notation of the collection time, color, turbidity, acidity and pH of the urine sample. For the examination includes the notation of the collection time, color, turbidity, acidity and pH of the urine sample. For the qualitative exam of normal organic constituents, the test for urea, uric acid, indican and creatinine were conducted. In these qualitative exam of normal organic constituents, the test for urea, uric acid, indican and creatinine were conducted. In these tests, the patient’s results were all normal. For the qualitative examination for pathologic organic constituents, Gunnings’s tests, the patient’s results were all normal. For the qualitative examination for pathologic organic constituents, Gunnings’s test, Bene

test, Benedict’dict’s s testtest, Exton’s test, Smi, Exton’s test, Smith’s test and Occult blood test were perforth’s test and Occult blood test were performed. med. The result obtaThe result obtained for the ined for the urineurine sample was that the patient was healthy except for

sample was that the patient was healthy except for the fact that the patient might have the fact that the patient might have diabetes.diabetes.

Keywords: Keywords: • • UrineUrine • • UrinalysisUrinalysis •

• Laboratory TestsLaboratory Tests

I. Introduction I. Introduction

Urine is a transparent solution that can range from colorless to amber but is usually pale yellow. Urine is a transparent solution that can range from colorless to amber but is usually pale yellow. Urine is an aqueous solution of metabolic wastes such as

Urine is an aqueous solution of metabolic wastes such as ureaurea, dissolved salts, and organic compounds, dissolved salts, and organic compounds produced by the kidneys. It plays a vital role in maintaining homeostasis. The production of urine is produced by the kidneys. It plays a vital role in maintaining homeostasis. The production of urine is

called diuresis. called diuresis.[1][1]

Urine ranges from pale yellow to amber because of the pigment urochrome. The color indicates Urine ranges from pale yellow to amber because of the pigment urochrome. The color indicates the concentration of the urine and varies with specific gravity. Dilute urine is straw colored, while the concentration of the urine and varies with specific gravity. Dilute urine is straw colored, while concentrated urine is deep amber.

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The aromatic odor of fresh, normal urine is caused by the presence of volatile acids. Analysis of The aromatic odor of fresh, normal urine is caused by the presence of volatile acids. Analysis of the pH of a freshly voided urine specimen indicates the acid – base balance. The urine reflects the work the pH of a freshly voided urine specimen indicates the acid – base balance. The urine reflects the work of the kidneys to maintain normal pH homeostasis.

of the kidneys to maintain normal pH homeostasis.[2][2]_{The kidneys mainta}_{The kidneys maintain normal acid}_{in normal acid –}_{– base balance}_{base balance}

primarily through reabsorption of sodium and tubular secretion of hydrogen

primarily through reabsorption of sodium and tubular secretion of hydrogen and ammonium ions.and ammonium ions.[3][3]

Urinalysis is part of routine diagnostic and screening evaluati

Urinalysis is part of routine diagnostic and screening evaluati ons performed on urine that provideons performed on urine that provide a general overview of a person’s health.

a general overview of a person’s health.[4][4] _{Urinalysis is used as a diagnostic tool because it can help}_{Urinalysis is used as a diagnostic tool because it can help}

det

detect ect subsubstastancences s or or celcellullular ar matmaterierial al in in the the uriurine ne assassociociateated d witwith h difdifferferent ent metmetabolabolic ic and and kidkidneyney disor

disorders. It ders. It is routinelis routinely y done in done in all patients admittall patients admitted ed to to the hospitalthe hospital, , pregnapregnant nt women and women and presurpresurgicalgical patients. It is done diagnostically in patients with abdominal or back pain, dysuria, hematuria, or urinary patients. It is done diagnostically in patients with abdominal or back pain, dysuria, hematuria, or urinary frequency. It is part of routine monitoring in patients with chronic renal disease and some metabolic frequency. It is part of routine monitoring in patients with chronic renal disease and some metabolic diseases.

diseases.[2][2]

Most urine tests are performed for one

Most urine tests are performed for one of the following reasons: to diagnose of the following reasons: to diagnose renal or urinary tractrenal or urinary tract disease; to monitor renal or urinary tract disease; to detect metabolic or systematic diseases not directly disease; to monitor renal or urinary tract disease; to detect metabolic or systematic diseases not directly related to the kidneys.

related to the kidneys.[2][2]

The process of urinalysis determines the following properties of urine: color, odor, turbidity, The process of urinalysis determines the following properties of urine: color, odor, turbidity, spe

specifcific ic gragravitvity, y, pH, pH, gluglucoscose, e, ketketonesones, , bloblood, od, proproteitein, n, bilbilirirubiubin, n, urourobilbilinoinogengen, , nitnitririte, te, leuleukocykocytete estaerase, and other abnormal constituents revealed

estaerase, and other abnormal constituents revealed by microscopic examination of the urine sediment.by microscopic examination of the urine sediment.[3][3]

This experiment aims to subject the urine sample acquired to several tests and to qualitatively This experiment aims to subject the urine sample acquired to several tests and to qualitatively examine the presence of some

examine the presence of some normal organic constituents and pathologic organic normal organic constituents and pathologic organic constituents.constituents.

II. Methodology II. Methodology

A. Initial Examination of Urine A. Initial Examination of Urine

The color, turbidity, acidity and the time when

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B. Qualitative Examination for Normal Organic Constituents B. Qualitative Examination for Normal Organic Constituents 1.) Test for Urea

1.) Test for Urea

A 0.5mL of 70% NaOH and 4 drops of bromine water was added to 1mL urine sample. After, A 0.5mL of 70% NaOH and 4 drops of bromine water was added to 1mL urine sample. After, the evolution of N

the evolution of N22 gas was observed.gas was observed.

2.) Test for Uric Acid 2.) Test for Uric Acid

A 1mL of urine sample was added with 5mL of 20% Na2CO3. Then, 5 drops of phosphotungstic A 1mL of urine sample was added with 5mL of 20% Na2CO3. Then, 5 drops of phosphotungstic acid reagent was also added then mixed. The formation of a blue color was observed.

acid reagent was also added then mixed. The formation of a blue color was observed.

3.) Indican Test 3.) Indican Test

To begin with, 5mL of Obemayer’s reagent was added to 5mL urine sample then mixed. Then, To begin with, 5mL of Obemayer’s reagent was added to 5mL urine sample then mixed. Then, 3mL of chloroform was added to

3mL of chloroform was added to it before shaking and allowed to it before shaking and allowed to settle. The formation of a blue color settle. The formation of a blue color inin the lower chloroform layer was observed.

the lower chloroform layer was observed.

4.) Test for Creatinine 4.) Test for Creatinine

A 1mL

A 1mL alkalalkaline picrate solutiine picrate solution was on was added to 2mL added to 2mL urine samplurine sample. The e. The formformation of an ation of an orange – orange – colored solution was noted.

colored solution was noted.

C. Qualitative Examination for Pathogenic Organic Constituents C. Qualitative Examination for Pathogenic Organic Constituents 1.) Gunning’s Test

1.) Gunning’s Test

The 5mL of urine sample was basified with 5 drops of concentrated ammonium hydroxide using The 5mL of urine sample was basified with 5 drops of concentrated ammonium hydroxide using a red litmus paper. Then, Lugol’s solution was added to the basic urine, enough to produce a black cloud a red litmus paper. Then, Lugol’s solution was added to the basic urine, enough to produce a black cloud which does not disappear immediately. It was let stood for 5 minutes. Similar procedure was done for which does not disappear immediately. It was let stood for 5 minutes. Similar procedure was done for the positive control. The results obtained were

the positive control. The results obtained were compared.compared.

2.) Benedict’s Test 2.) Benedict’s Test

To start with, 5mL Benedict’s reagent was added to 8 – 10 drops of urine sample in a test tube To start with, 5mL Benedict’s reagent was added to 8 – 10 drops of urine sample in a test tube then mixed. It was then heated in a boiling water bath for 2 – 3 minutes then let stood and allowed to then mixed. It was then heated in a boiling water bath for 2 – 3 minutes then let stood and allowed to cool. The formation of a precipitate was observed. Similar procedure was done for the positive control. cool. The formation of a precipitate was observed. Similar procedure was done for the positive control. The results obtained were compared.

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3.) Exton’s Test 3.) Exton’s Test

Firs

First, 3mL of t, 3mL of urine samplurine sample and e and 3mL of Exton’s reagent were mixed in a 3mL of Exton’s reagent were mixed in a test tube. The solutiontest tube. The solution was warmed until cloudiness appeared. Similar procedure was done for the positive control. The results was warmed until cloudiness appeared. Similar procedure was done for the positive control. The results obtained were compared.

obtained were compared.

4.) Smith’s Test 4.) Smith’s Test

The 5mL urine sample was placed in a test tube. The test tube was inclined and overlayed with The 5mL urine sample was placed in a test tube. The test tube was inclined and overlayed with 3mL tincture of alcoholic iodine mixture. Similar procedure was done for the positive control. The 3mL tincture of alcoholic iodine mixture. Similar procedure was done for the positive control. The results obtained were compared.

results obtained were compared.

5.) Test for Occult Blood 5.) Test for Occult Blood

A half spatula guaiac powder was added with 5mL of 95% ethanol in a test tube then mixed. To A half spatula guaiac powder was added with 5mL of 95% ethanol in a test tube then mixed. To this mixture, 5mL hydrogen peroxide was added

this mixture, 5mL hydrogen peroxide was added. Then, 5mL of this solution was . Then, 5mL of this solution was added to 3mL acidifiedadded to 3mL acidified urine. Similar procedure was done for the po

urine. Similar procedure was done for the positive control. The results obtained were compared.sitive control. The results obtained were compared.

III. Results and Discussion III. Results and Discussion

Ur

Urea ea iis s tthe he mamajjor or enend d prprododucuct t of of prprototeiein n ninitrtrogogenen met

metaboabolislism m in in humhumansans. . HepHepatiatic c enzenzymeymes s conconververt t ammammonioniaa from amino acids to urea.

from amino acids to urea.[5][5] _{Urea is produced in the liver and}_{Urea is produced in the liver and}

exc

excretreted ed thrthrough ough the the kidkidneyneys s in in the the uriurine. ne. The The circirculculatiatingng levels of urea depend upon protein intake, protein catabolism levels of urea depend upon protein intake, protein catabolism and

and kidkidney ney funfunctiction. on. EleElevatvated ed ureurea a levlevels els can can occoccur ur witwithh dietary changes, diseases which impair kidney function, liver dietary changes, diseases which impair kidney function, liver diseases, congestive heart failure, diabetes and infections. A diseases, congestive heart failure, diabetes and infections. A positive result shows the formation of N

positive result shows the formation of N22 gas or moistening of gas or moistening of

the sides of the test tubes used. The urea cycle (also known as the sides of the test tubes used. The urea cycle (also known as tthe he ororninitthihine ne cycyclcle) e) iis s a a cycyclcle e of of biochemical biochemical reactionsreactions occurring in many animals that produces

occurring in many animals that produces ureaurea (( N NHH22))22CCOO fromfrom

ammonia

ammonia (NH(NH33). ). ThThis is cycyclcle e wawas s ththe e fifirsrst t memetatabobolilic c cycyclclee

discovered. In mammals, the urea cycle takes place only in the

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Uric acid is an organic compound of carbon, nitrogen, oxygen and hydrogen with the formula Uric acid is an organic compound of carbon, nitrogen, oxygen and hydrogen with the formula C

C55HH44 N N44OO33. . XanthiXanthine ne oxidasoxidase e oxidizoxidizes oxypurines such as es oxypurines such as xanthixanthine ne and hypoxanthiand hypoxanthine ne to uric to uric acid. Uricacid. Uric

acid is the final breakdown product of purine catabolism.

acid is the final breakdown product of purine catabolism.[2][2]_{In most other mammals, the enzyme uricase}_{In most other mammals, the enzyme uricase}

further oxidizes uric acid to allantoin. Uric acid is a strong reducing agent and a potent antioxidant. In further oxidizes uric acid to allantoin. Uric acid is a strong reducing agent and a potent antioxidant. In hum

humansans, , aboabout ut halhalf f the oxidanthe oxidant t capacapacitcity y of of plaplasma comes sma comes frofrom m uriuric c aciacid. d. HumHumans producans produce e larlargege quantities of uric acid. In human blood, uric acid concentrations between 3.6mg/dL and 8.3mg/dL are quantities of uric acid. In human blood, uric acid concentrations between 3.6mg/dL and 8.3mg/dL are cons

consideidered red nornormal mal by by the the AmeAmericrican an MedMedicaical l AssAssociociatiation, on, altalthoughough h sigsignifnificaicantlntly y lowlower er levlevels els areare common in vegetarians due to a decreased intake of purine – rich meat.

common in vegetarians due to a decreased intake of purine – rich meat.[2][2] _{Diseases related to elevated}_{Diseases related to elevated}

uric acid levels are kidney stones, Lesch – Nyhan syndrome, CVDs and diabetes. Uric acid reacts with uric acid levels are kidney stones, Lesch – Nyhan syndrome, CVDs and diabetes. Uric acid reacts with phosphotungstic acid to produce allantoin and tungsten blue.

phosphotungstic acid to produce allantoin and tungsten blue.

+

H

33

P

P W

W

1212

O

4040



+

Tungsten Blue

Indican is an indole produced by bacterial action on an amino acid, tryptophan, in the intestine. Indican is an indole produced by bacterial action on an amino acid, tryptophan, in the intestine. Most of the indole is excreted in the feces. The remainder is absorbed, metabolized and excreted as Most of the indole is excreted in the feces. The remainder is absorbed, metabolized and excreted as indicant in the urine. In normal urine, the amount of indican excreted is small. It is increased with high indicant in the urine. In normal urine, the amount of indican excreted is small. It is increased with high protein diets or inefficient protein digestion. If not digested properly, or if the wrong types of proteins protein diets or inefficient protein digestion. If not digested properly, or if the wrong types of proteins

ar

are e iningegeststeded, , bobowel wel putputrerefafactctioion n can can occoccurur. . PrProboblelems ms wiwith th prprototeiein n didigegeststioion n cacan n be be cacausused ed byby overgrowth of anaerobic bacteria, intestinal obstruction, stomach cancer, low stomach acid, parasitic overgrowth of anaerobic bacteria, intestinal obstruction, stomach cancer, low stomach acid, parasitic infections, malabsorptive syndromes, fungal infections, lack of digestive enzymes, or liver problems. infections, malabsorptive syndromes, fungal infections, lack of digestive enzymes, or liver problems. Following absorption, indole is converted to 3-hydroxy indole in the liver. Detection of indican in the Following absorption, indole is converted to 3-hydroxy indole in the liver. Detection of indican in the urine depends upon its decomposition and subsequent oxidation of indoxyl to indigo blue and its urine depends upon its decomposition and subsequent oxidation of indoxyl to indigo blue and its absorption into a chloroform layer.

absorption into a chloroform layer.



+

H

22

O

22



+

Indoxyl Sulfuric Acid K

Creatinine test measures the level of the waste product creatinine in the urine. This test indicates Creatinine test measures the level of the waste product creatinine in the urine. This test indicates whether the kidneys are working properly. Creatine is formed when food is changed into energy through whether the kidneys are working properly. Creatine is formed when food is changed into energy through a process called metabolism. Creatine is broken down into another substance called creatinine by the a process called metabolism. Creatine is broken down into another substance called creatinine by the

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addition of strong acid or by alkali or by using enzyme, creatine hydroxylase.

addition of strong acid or by alkali or by using enzyme, creatine hydroxylase.[7][7] _{If the kidneys are}_{If the kidneys are}

damage

damaged d and cannot work normallyand cannot work normally, , the amount of the amount of creatcreatinine in the inine in the urine goes down while its urine goes down while its level inlevel in the blood goes up. Alkaline picrate solution is composed of saturated picric acid and 10% NaOH. Most the blood goes up. Alkaline picrate solution is composed of saturated picric acid and 10% NaOH. Most methods used for creatinine determination are based upon the Jaffe reaction. The Jaffe reaction uses methods used for creatinine determination are based upon the Jaffe reaction. The Jaffe reaction uses saturated picric acid which oxidizes creatinine in alkali forming creatinine picrate, in which creatinine saturated picric acid which oxidizes creatinine in alkali forming creatinine picrate, in which creatinine forms a characteristic orange color when treated with

forms a characteristic orange color when treated with alkaline picrate.alkaline picrate.[7][7]



Gunning’s test checks for ketone bodies in the blood or urine. Ketone bodies are three water – Gunning’s test checks for ketone bodies in the blood or urine. Ketone bodies are three water – solubl

soluble compounds that are e compounds that are producproduced as ed as by – by – productproducts when s when fatty acids are broken down for fatty acids are broken down for energy inenergy in the body. The excess presence of ketones in urine is associated with diabetes or altered carbohydrate the body. The excess presence of ketones in urine is associated with diabetes or altered carbohydrate metabolism.

metabolism.[3][3]_{Lugol’s solution consists of 5% iodine and 10% potassium iodide in 85% distilled water}_{Lugol’s solution consists of 5% iodine and 10% potassium iodide in 85% distilled water}

with a total iodine content of 1

with a total iodine content of 130mg/mL. A positive result shows a formation of iodoform crystals.30mg/mL. A positive result shows a formation of iodoform crystals.

Glucose levels are measured to diagnose diabetes. The normal glucose level in the urine is Glucose levels are measured to diagnose diabetes. The normal glucose level in the urine is 180m

180mg/dg/dL. L. UriUrine ne gluglucoscose e levlevels els of of 300 300 – – 500m500mg/dg/dL L are are comcommon mon witwith h sevsevere untreaere untreated ted diadiabetbetes.es. Diabetes results from deficient insulin or decreased sensitivity to insulin. The results of a urine glucose Diabetes results from deficient insulin or decreased sensitivity to insulin. The results of a urine glucose test are abnormal in cases of renal

test are abnormal in cases of renal glycosuria and diabetes mellitus.glycosuria and diabetes mellitus.[2][2]

+

2Cu

2+2+

_{+ 4OH}

--



_Cu

2

O

(solid)(solid)

+ 2H

22

O

Normally, protein is not found in urine. This is because the kidney is supposed to keep large Normally, protein is not found in urine. This is because the kidney is supposed to keep large molecules in the blood and only filter out smaller impurities. If the kidney is diseased, protein will molecules in the blood and only filter out smaller impurities. If the kidney is diseased, protein will appear in the urine. Exton’s reagent is 5% sul

appear in the urine. Exton’s reagent is 5% sulfosalicylic acid in a solutifosalicylic acid in a solution of sodium sulfate. on of sodium sulfate. A cloudyA cloudy solution shows the presence of albumin.

solution shows the presence of albumin.

Hemoglobin breakdown results in bilirubin production. In the liver, bilirubin is conjugated to an Hemoglobin breakdown results in bilirubin production. In the liver, bilirubin is conjugated to an acid to make conjugated bilirubin. Unconjugated bilirubin is water soluble and can be excreted in the acid to make conjugated bilirubin. Unconjugated bilirubin is water soluble and can be excreted in the

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uri

urine. ne. AbnoAbnormarmal l bilbiliruirubin bin valvalues ues may may indindicaicate te aneanemiamia, , exceexcessissive ve brebreakdoakdown wn of of RBCRBC, , hepahepatititistis,, cirrhosis, obstruction of biliary duct, toxic liver damage and biliary tree obstruction.

cirrhosis, obstruction of biliary duct, toxic liver damage and biliary tree obstruction.[3][3] _{Tincture of}_{Tincture of}

alcoholic iodine is usually 10% elemental iodine in ethanol. Addtion od a solution of alcoholic iodine to alcoholic iodine is usually 10% elemental iodine in ethanol. Addtion od a solution of alcoholic iodine to urine produces a green color. The green color indicates the presence of bile. The addition of hydrogen urine produces a green color. The green color indicates the presence of bile. The addition of hydrogen peroxide to 5mL 95% ethanol and guaiac powder oxidizes the guaiac causing a color change. Heme, a peroxide to 5mL 95% ethanol and guaiac powder oxidizes the guaiac causing a color change. Heme, a component of hemoglobin found in blood, catalyzes this reaction giving a result in about two seconds. A component of hemoglobin found in blood, catalyzes this reaction giving a result in about two seconds. A blue ring indicates a positive result.

blue ring indicates a positive result.[8][8]

A. Initial Examination of Urine Sample A. Initial Examination of Urine Sample

Time collected

Time collected Early morningEarly morning

Color

Color LightLight

Turbidity

Turbidity Clear Clear

Acidity

Acidity Neutral Neutral

pH

pH 77

B. Qualitative Exam of Normal Organic Constituents B. Qualitative Exam of Normal Organic Constituents

T

Teesstt RReessuulltt

UREA

UREA With little evolution of white fumes; red litmus paper With little evolution of white fumes; red litmus paper

URIC ACID

URIC ACID Formation of blue – colored solutionFormation of blue – colored solution

INDICAN

INDICAN Formation of blue – colored interface in Formation of blue – colored interface in the lower chloroform layer the lower chloroform layer

CREATININE

CREATININE Yellow to orange – colored solutionYellow to orange – colored solution

C. Qualitative Exam for Pathologic Constituents C. Qualitative Exam for Pathologic Constituents

T

Teesstt PPoossiittiivve e ((++) ) CCoonnttrrooll UUrriinne e SSaammppllee GUNNING’S TEST

GUNNING’S TEST (ketone bodies) (ketone bodies)

Cl

Clououdy dy ininttererffacace we wiith th crcrysystatallss LighLight ot orarangnge se sololututioion wn wiith th rreded precipitate precipitate BENEDICT’S TEST BENEDICT’S TEST (glucose) (glucose)

Olive green cloudy solution with Olive green cloudy solution with precipitate

precipitate

Clear green solution with some Clear green solution with some cloudy precipitate cloudy precipitate EXTON’S TEST EXTON’S TEST (albumin) (albumin) C

Clloouuddy y ssoolluuttiioonn NNo o cclloouuddiinneessss

SMITH’S TEST SMITH’S TEST (bile pigments) (bile pigments)

Emerald green – colored solution Emerald green – colored solution with no precipitates

with no precipitates

Yellow orange interface; no Yellow orange interface; no emerald green color

emerald green color

OCCULT BLOOD TEST

OCCULT BLOOD TEST XX XX

A normal urine specimen should be clear. Cloudy urine may be caused by the appearance of pus, A normal urine specimen should be clear. Cloudy urine may be caused by the appearance of pus, RBCs or bacterias; however, normal urine also may be cloudy because of ingestion of certain foods. RBCs or bacterias; however, normal urine also may be cloudy because of ingestion of certain foods. Abnormally colored urine may also result from a pathologic condition or the ingestion of certain Abnormally colored urine may also result from a pathologic condition or the ingestion of certain medicines. Dark yellow urine may indicate the presence of urobilinogen or bilirubin.

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The kidneys assist in acid – base balance by reabsorbing sodium and excreting hydrogen. An The kidneys assist in acid – base balance by reabsorbing sodium and excreting hydrogen. An alkaline pH is observed in a patient with alkalemia. Bacteria, urinary tract infection, or a diet in citrus alkaline pH is observed in a patient with alkalemia. Bacteria, urinary tract infection, or a diet in citrus fruits or vegetables may cause increased urine pH. Alkaline urine is associated with calcium carbonate, fruits or vegetables may cause increased urine pH. Alkaline urine is associated with calcium carbonate, calcium phosphate and magnesium phosphate stones. Acidic urine is generally obtained from patients calcium phosphate and magnesium phosphate stones. Acidic urine is generally obtained from patients with academia, which can result from metabolic or respiratory acidosis, starvation, dehydration, or a diet with academia, which can result from metabolic or respiratory acidosis, starvation, dehydration, or a diet high in meat products or cranberries. Acidic urine is associated with xanthine, cystine, uric acid and high in meat products or cranberries. Acidic urine is associated with xanthine, cystine, uric acid and calcium oxalate stones.

calcium oxalate stones.[2][2]

Urine pH becomes alkaline on standing, because of the action of urea – splitting bacteria, which Urine pH becomes alkaline on standing, because of the action of urea – splitting bacteria, which produce ammonia. The urine pH of an uncovered specimen will become alkaline because carbon dioxide produce ammonia. The urine pH of an uncovered specimen will become alkaline because carbon dioxide vaporizes from the urine. Dietary factors affect urine pH. Ingestion of large quantities of citrus fruits, vaporizes from the urine. Dietary factors affect urine pH. Ingestion of large quantities of citrus fruits, dairy products, and vegetables produces alkaline urine, whereas a diet high in meat and certain foods dairy products, and vegetables produces alkaline urine, whereas a diet high in meat and certain foods produces acidic urine.

produces acidic urine.[2][2]

Protein is a sensitive indicator of kidney function. Normally, protein is not present in the urine Protein is a sensitive indicator of kidney function. Normally, protein is not present in the urine because the spaces in the normal glomerular filtrate membrane are too small to allow its passage. If because the spaces in the normal glomerular filtrate membrane are too small to allow its passage. If glomerular membrane is injured, the spaces in the filtrate become larger, and the protein seeps into the glomerular membrane is injured, the spaces in the filtrate become larger, and the protein seeps into the filtrate, then into the urine. If this persists at a significant rate, hypoproteinemia can develop as a result filtrate, then into the urine. If this persists at a significant rate, hypoproteinemia can develop as a result of severe protein loss through the kidneys. This decreases the normal capillary oncotic pressure that of severe protein loss through the kidneys. This decreases the normal capillary oncotic pressure that holds fluid within the vasculature and cau

holds fluid within the vasculature and causes severe interstitial edema.ses severe interstitial edema.[2][2]

Specific gravity is a measurement of the kidney’s ability to concentrate urine.

Specific gravity is a measurement of the kidney’s ability to concentrate urine.[3][3]_{Specific gravity}_{Specific gravity}

is used to evaluate the concentrating and excretory power of the kidneys. High specific gravity indicates is used to evaluate the concentrating and excretory power of the kidneys. High specific gravity indicates concentrated urine. Low specific gravity indicates dilute urine. Specific gravity refers to the weight of concentrated urine. Low specific gravity indicates dilute urine. Specific gravity refers to the weight of the urine compared with that o

the urine compared with that of distilled water. Particles in the urine give it weight or specific gravity.f distilled water. Particles in the urine give it weight or specific gravity.[4][4]

Leukocyte (WBC) esterase is a screening test used to detect leukocytes in the urine. Positive Leukocyte (WBC) esterase is a screening test used to detect leukocytes in the urine. Positive results indicate urinary tract infection. Leukocyte esterase is nearly 90% accurate in detecting WBC in results indicate urinary tract infection. Leukocyte esterase is nearly 90% accurate in detecting WBC in urine.

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Like the leukocyte esterase screen, the nitrite test is a screening test for identification of urinary Like the leukocyte esterase screen, the nitrite test is a screening test for identification of urinary tract infection. Nitrite screening enhances the sensitivity of the leukocyte esterase test to detect urinary tract infection. Nitrite screening enhances the sensitivity of the leukocyte esterase test to detect urinary tract infection. Nitrite testing is only about 50% accurate in detecting WBCs in the urine.

tract infection. Nitrite testing is only about 50% accurate in detecting WBCs in the urine.[2][2]

Normally, no ketones are present in the urine; however, a patient with poorly controlled diabetes Normally, no ketones are present in the urine; however, a patient with poorly controlled diabetes and hyperglycemia may have a massive fatty acid catabolism. The purpose of this catabolism is to and hyperglycemia may have a massive fatty acid catabolism. The purpose of this catabolism is to p

prorovivide de an an enenerergy gy sosoururce ce whwhen en glglucucosose e cacannnnot ot be be trtranansfsfererrered d ininto to ththe e cecell ll bebecacaususe e of of ininsusulilinn insufficiency. Ketones are the end products of this

insufficiency. Ketones are the end products of this fatty acid breakdown.fatty acid breakdown.[2][2]

Bi

Bililirurubibin n is is a a mamajojor r coconsnstititutuenent t of of bibilele. . If If bibililirurubibin n exexcrcretetioion n is is ininhihibibiteted, d, coconjnjugugatateded hyperbilirubinemia will result. Bilirubin in urine suggests disease affecting bilirubin metabolism after hyperbilirubinemia will result. Bilirubin in urine suggests disease affecting bilirubin metabolism after conjugation or defects in excretion. For screening, elevated urine bilirubin concentration can indicate conjugation or defects in excretion. For screening, elevated urine bilirubin concentration can indicate previously unsuspected liver injury due to disease, gallstones or drug toxicity. Bilirubin in the urine will previously unsuspected liver injury due to disease, gallstones or drug toxicity. Bilirubin in the urine will

color the urine dark yellow or orange. color the urine dark yellow or orange.[2][2]

IV. Conclusion IV. Conclusion

It comes to the conclusion that the patient is therefore free form any sickness aside from the fact It comes to the conclusion that the patient is therefore free form any sickness aside from the fact that the patient is already close to having

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V. References V. References

[1] Urinalysis – Retrieved February 27, 2009 [1] Urinalysis – Retrieved February 27, 2009 http://en.wikipedia.org/wiki/Urinalysis

http://en.wikipedia.org/wiki/Urinalysis

[2] Pagana, K. D.

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