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URINALYSIS AND THE HCA

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Each kidney is composed of about one million 'filtering packets' called glomeruli ... Kidney stones. Injury to urinary tract or kidneys. Malignancy ... – PowerPoint PPT presentation

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Title: URINALYSIS AND THE HCA


1
URINALYSIS AND THE HCA
  • Tanis Hand RGN OHND
  • HealthTrain
  • www.healthtrain.co.uk

2
More to urine than meets the eye?
3
  • Ancient Romans used urine to bleach clothes
  • Koryak people of Siberia are said to drink urine
    of a person who has ingested fly agaric (magic
    mushroom) to communicate with the spirits
  • In Scotland wool was soaked in urine to prevent
    it from shrinking

4
  • Urine has been used as antiseptic in war times
  • Some Spanish people use urine as a teeth whitener
  • Aztec physicians administered urine as drink to
    relieve stomach problems
  • Urine from postmenopausal women is rich in
    gonadotrophins which give FSH for fertility
    therapy

5
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6
Aims for today
  • Review the anatomy and physiology of the urinary
    tract
  • Consider why we test urine and what the results
    tell us
  • Discuss the role of the HCA in performing
    urinalysis and reporting on the findings

7
The urinary tract
8
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9
Most people have two kidneys but it is possible
to live with only one
Each kidney weighs about 160 grams and is 10-15
cm long
Their main job is to cleanse the blood of toxins
and transform the waste into urine for excretion
10
How is urine formed (1)?
  • Renal arteries channel blood to the kidneys
  • The kidneys filter out waste products from the
    blood and excrete them in a solution - urine
  • Renal veins carry filtered blood to the major
    vein of the lower trunk (inferior vena cava).

11
How is urine formed (2)?
  • Each kidney is composed of about one million
    filtering packets called glomeruli
  • The glomeruli remove waste products from the
    blood
  • Each glomerulus connects to a long tube, the
    tubule
  • Urine made by the glomerulus moves down the
    tubule
  • The glomerulus and the tubule form a unit called
    a nephron

12
There are about 1 million nephrons per kidney
  • Approx. 200 litres of blood flow to the kidneys
    daily and 2 litres of waste are filtered out

13
Each nephron connects to progressively larger
tubular branches, on to the ureter, a large tube
connecting the kidney to the bladder
14
The bladder serves as a reservoir that holds
urine until it contracts and expels the urine out
of the body via the urethra
15
The kidneys
  • Filter the blood and rid the body of toxic waste
    products e.g. urea creatinine
  • Keep the electrolytes (e.g.sodium potassium)
    and water content of the body constant
  • Return vital substances to the blood e.g.
    vitamins, amino acids, glucose
  • Secrete some essential hormones

16
Contents of
17
Hormones secreted by the kidney
  • RENIN keeps blood pressure normal. In kidney
    disease too much renin can lead to hypertension
  • ERYTHROPOEITIN acts on the bone marrow to
    increase red blood cell production. Too little
    will lead to anaemia

18
What do we test urine for?
(Cards)
19
PROTEIN
  • Morning specimen best
  • Greater than trace could be significant
  • May indicate hypertension
  • kidney disease
  • infection
  • diabetes
  • Very important in pregnancy (pre-eclampsia)

20
MICROALBUMIN
  • Albumin is a very small molecule and one of first
    proteins to be detected in urine if the kidney is
    damaged
  • Persistent microalbuminuria is a risk factor for
    progressive kidney disease
  • Most often seen in diabetes and hypertension

21
BLOOD
  • Not normally present, may indicate
  • Infection
  • Kidney stones
  • Injury to urinary tract or kidneys
  • Malignancy
  • n.b can be caused by vigorous exercise, toxic
    chemical exposure, menstruation

22
KETONES
  • Produced by the breakdown of fatty acids.
  • Can indicate uncontrolled diabetes so doctor /
    nurse must be informed
  • May indicate anorexia
  • Sometimes present following vomiting or diarrhoea

23
NITRITE
  • Pink colour must be uniform to indicate a
    positive result
  • Most accurate when urine has been in bladder 4
    hours or more
  • Indicative of infection

24
GLUCOSE
May be present if renal absorption is abnormal
Should be followed up by fasting blood glucose
test if patient is not a known diabetic
25
SPECIFIC GRAVITY (SG)
  • Used in the evaluation of kidney function
  • Relates to the concentration of excreted
    substances in urine, expressed in grams per ml
    (g/ml)
  • High SG dehydration, renal artery stenosis
  • Low SG renal failure, pyelonephritis, diabetes
    insipidus
  • Normal SG 1.0002 1.028 g/ml

26
pH
  • pH potential of Hydrogen
  • Measure of acidity of any solution i.e.
    concentration of hydrogen ions)
  • pH of distilled water is 7 (neutral)
  • lt 7 acidic, gt 7 alkaline
  • pH of urine can range between 4.5 and 8, but is
    usually around 7
  • Alkaline urine may indicate hyperkalaemia or
    vegetarian diet for example
  • Acidic urine may be due to acute starvation,
    diabetic ketoacidosis or hypokalaemia e.g.

27
SOME MORE TESTS
  • Bence-Jones protein specific test which may
    demonstrate malignant disease of bone marrow e.g.
    multiple myeloma
  • Urobilinogen and bilirubin - may indicate hepatic
    abnormalities
  • Chemical exposure tests e.g. lead, cadmium,
    arsenic, nickel

28
Pregnancy tests
29
Drug tests
30
GOOD PRACTICE
  • Always wear gloves
  • Check expiry date on strips
  • After dipping in urine, remove
  • excess urine by tapping
  • Lie dipstick flat on a dry surface
  • Always check time be accurate
  • Do not discard urine until sure it will not be
    needed again
  • Follow infection control procedures and wash
    hands thoroughly afterwards
  • Document results accurately

31
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