URINALYSIS AND THE HCA

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URINALYSIS AND THE HCA

• Tanis Hand RGN OHND
• HealthTrain
• www.healthtrain.co.uk

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More to urine than meets the eye?
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• 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

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• 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

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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

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The urinary tract
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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
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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).

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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

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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

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Each nephron connects to progressively larger
tubular branches, on to the ureter, a large tube
connecting the kidney to the bladder
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The bladder serves as a reservoir that holds
urine until it contracts and expels the urine out
of the body via the urethra
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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

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Contents of
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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

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What do we test urine for?
(Cards)
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PROTEIN

• Morning specimen best
• Greater than trace could be significant
• May indicate hypertension
• kidney disease
• infection
• diabetes
• Very important in pregnancy (pre-eclampsia)

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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

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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

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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

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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

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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
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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

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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.

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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

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Pregnancy tests
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Drug tests
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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

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