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What do the kidneys do?
- Regulate Electrolytes
- remove toxins
- potentially contribute to high BP
- Activate Vitamin D into usable forms
- Generate Erythropoetin
What is the functional unit of the kidney?
Nephron and the main filtration occurs in the glomerulus
When is split times urine specimen used?
To check for orthostatic proteinuria
When do we check for overnight urine collection?
when we check for metabolic stone disease since the crystalloids are at their maximum concentration
How can we check for the patient's salt consumption?
we can use the 24 hour urine collection to check
What do we look for in a routine UA?
- Gross exam- color, odor and tubidity
- Dipstick- pH, specific gravity, protein, blood, glucose, ketones, leukocytes, nitrate and urobilinogen
- Microscopic- cells, casts, bacteria, yeast, parasites, and crystals
What can the color of the urine tell us?
- yellow - normal
- Amber/Reddish brown - RBC, Hgb, Myoglobin, Hemoderisin
- Bright red - Fresh blood, urates (infants) beets, pyridium, adrimyacin, food coloring, porphyrins
- Brown/black - homogentisic acid (alkaptonuria), melanin, methyldopa (BP med)
- Bright orange - Rifampin
- Dark Orange - carotene or bilirubin
- Bluegreen - methylene blue (marker for urinary tract during sx), biliverdin and indole
What does urinalysis turbidity tell us?
- clear- normal
- cloudy- bacteria, crystals alkaline urine amorphous PO4 or acidic urine with amorphous urates
- hazy- mucus
- milky- fat goblets
- smoky (red brown)- RBC
What is the normal range of urine pH?
urine pH >7.5
patient may be taking alkali supplements or bicarbonate
urine ph >8
urea spitting bacteria probably present which is important in kidney stone formation
urine pH >6 and metabolic acidosis (non-gap)
think RTA (renal tubular acidosis)
What is specific gravity, what does it tell us and what isn't it the same as?
it is a guide to concentration but it is not the same thing as osmolality.
When can the specific gravity be increased falsely?
if there is increased proteinuria
What is the dipstick sensitive to in protein?
albumin not LMW proteins
When can we have false positives in protein?
- chlorhexide, quartenary ammonium antiseptic
- vaginal secretions
- pH> 6.5
When we get a positive on the blood portion of the UA what do we need to do and when can we have false positives?
We need to confirm with a microscopic exam. Common false positives are:betadine- hypochlorite cleanser, bacterial peroxidases (UTI)- bacterial overgrowth, excess Vit C, and in menstruating women