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URINE Urine Physical properties

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a) Crystals : urates and oxalates (acid urine), tripple phosphate (ammonium magnesium phosphate [NH2MgPO4]) (alkaline urine) b) Casts : albuminoid ... – PowerPoint PPT presentation

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Title: URINE Urine Physical properties


1
URINEUrine Physical properties
2
  • The kidney is an organ which does not simply
    remove the metabolic waste products, but actually
    performs an important homeostatic function.

3
  • It regulates
  • the internal environment
  • of the body cells by
  • 3 mechanisms

4
  • 1) Glomerular filtration.
  • 2) Selective tubular reabsorption of substances
    that are necessary to maintain the internal
    environment and
  • 3) Tubular secretion of substances from the blood
    into the tubular lumen for excretion into the
    urine.
  • These 3 mechanisms result in
  • urine formation.

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PHYSICAL PROPERTIESOFURINE
8
  • 7 ITEMS
  • Volume
  • Colour
  • Aspect
  • Deposits
  • Odour
  • Reaction
  • Specific Gravity

9
  • Volume
  • It ranges between 1 and 1.5 L/day.
  • The volume depends on
  • water intake,
  • external temperature,
  • diet,
  • mental and physical state of the individual.

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Volume
more than 2 L/day
  • Physiological increase
  • In winter
  • After excessive fluid intake- Coffee
  • Nervousness or excitement

N.B. Normally, more urine is excreted during
the day than at night.
13
  • Abnormal increase (polyuria )
  • More than 3 L/day
  • diabetes mellitus (may reach 5 L/day)
  • diabetes insipidus (10-15 L/day)
  • hyperparathyroidism.
  • Hypercalcemia ? -- Action of ADH

14
Volume
  • Physiological decrease
  • in summer due to increased sweating
  • during fasting or restricted fluids in diet.

15
Volume
  • Abnormal decrease (Oliguria)
  • Less than 200 ml/day
  • acute nephritis,
  • heart failure,
  • shock, burns
  • haemorrhage.
  • vomiting and diarrhoea.

16
Volume
  • Anuria
  • No urine at all (or lt 50 ml /day)
  • late stages of renal failure
  • and heart failure.

17
  • Colour
  • Normal colour is amber yellow.
  • due to pigments called urochromes , urobilin or
    urobilinogen peptide.
  • There are also other pigments (coproporphyrin,
    uroerythrin), but occur in small amounts.

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  • The colour is changed
  • in the following conditions

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  • Diabetes insipidus colourless or pale yellow.
  • Fever, deep orange.
  • Obstructive jaundice Greenish brown due to
    presence of cholebilirubin.
  • Haemorrhage in urinary tract, reddish brown
    colour.
  • Alkaptonuria Black (homogentisic acid is
    oxidized to give black colour when exposed to air.

21
  • Ingestion of
  • food coloured with dyes or
  • coloured drugs result in discolouration of urine.

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  • Odour
  • Fresh urine is normally aromatic (urineferous).
  • This odour is changed by
  • Different types of food Cabbage, garlic, onion.
  • Severe uncontrolled diabetes mellitus Fruity
    odour due to presence of acetone/acetoacetoacetic
    acid.
  • Contaminated urine Ammoniacal odour. In stagnant
    urine, this odour is due to bacterial action,
    e.g. on urea which is converted into ammonia.
  • Putrefaction Putrid odour due to bacterial
    growth in urinary infection.

24
Normally aromatic (urineferous)
Odour
Fruity odour
Severe uncontrolled DM
Ammoniacal odour
Putrid odour
Growth
Urease
Bacteria
25
  • Reaction
  • On mixed diet, it is acidic (pH is 6). It may be
    slightly acidic or slightly alkaline.
  • The urine pH depends on
  • the ratio of acid phosphate (NaH2PO4) to alkaline
    phosphate (Na2HPO4). The kidney mainly excretes
    acid phosphate to preserve the alkali.

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  • Reaction
  • High protein diet gives acidic urine
  • due to excretion of excess phosphate and
    sulphate.

28
Reaction
  • Vegetables and fruits give alkaline urine
  • due to their high sodium and potassium content
    with excretion of sodium and potassium
    bicarbonate in urine

29
Reaction
  • Alkaline urine
  • is passed
  • an hour after a meal,
  • this is the so called
  • alkaline tide.

30
  • Aspect
  • Normal urine is clear (transparent).
  • On standing, it turns cloudy due to precipitation
    of muco- and nucleoproteins and epithelial cells
    (present in traces in normal urine).

31
  • It becomes turbid and opaque due to presence of
    albumin.
  • Exposed urine is a good medium for bacterial
    growth as its pH becomes alkaline, resulting in
    precipitation of phosphates.

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  • Deposits
  • Normal urine is
  • devoid from deposits.
  • In case of its presence, it depends on the colour
    and shape of deposit.
  • In order to examine the deposit, we make
    centrifugation to urine then microscopic
    examination.

34
  • a) Crystals urates and oxalates (acid
    urine),
  • tripple phosphate (ammonium magnesium phosphate
    NH2MgPO4) (alkaline urine)
  • b) Casts albuminoid substances released from
    epithelial
  • c) Parasitic ova and
  • d) Cells Pus cells or RBCs.

35
Microscopic examination of the solid parts of
urine the picture shows red blood cells (above),
white blood cells (middle) and a cast of
clumped-together white blood cells (below).
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  • A urinary cast is a protein or cellular debris,
    that forms within a renal tubule.
  • The material or cells that form a cast may have 
  • come through a damaged glomerulus, 
  • been part of an interstitial inflammatory
    infiltrate, 
  • have been dead tubular cells.
  • The cast is expelled into the urine, and
    maintains the shape of the tubule in which it
    formed.
  • Casts reflect conditions of the kidney proper and
    not the lower urinary tract.
  • In most cases they are significant and must be
    explained.

38
  • Specific gravity
  • Normally, it ranges between 1.015 to
    1.025
  • It varies inversely with the volume of urine,
    e.g. ? In diabetes insipidus, it is low (1.004).
  • In fever, it is high (more than 1.030) due to
    small amount of urine.
  • In diabetes mellitus, the specific gravity is
    1.40 due to the presence of glucose.

39
  • A diseased kidney loses its ability to dilute or
    concentrate urine

40
Water diuresis test
  • Evacuate The Bladder
  • Then, Drink 1.5 L of water.
  • Urine will be collected every half an hour for 5
    hours
  • For each sample, ? determine volume specific
    Gravity.
  • Normally, after 5 hours, ? shold void at least
    800 ml Sp. Gravity lt 1.010
  • If the distal tubules function is impaired ?
    Diuresis doesnot occur Sp. Gravity doesnot drop
    below 1.010

41
Water Concentration test
  • Evacuate The Bladder
  • Then, No Drinking for 10-12 hours to produce
    dehydration.
  • At the end of the 12 hours Urine will be
    collected
  • determine volume specific Gravity.
  • Normally, Sp. Gravity shold rise to 1.025
  • If with dehydration, the Sp. Gravity remains
    below 1.020 ? it indicates that the function of
    Loop of Henle distal Tubules is inhibited
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