Tubular Reabsorption Test 2.

Titratable Acidity and Ammonia

1. Osmometry Significance: the inability to produce as acid urine in the
2. Fishberg Test presence of metabolic acidosis (renal tubular acidosis)
3. Mosenthal Test Due to:
a. Impaired Hydrogen ion secretion in the PCT
1. Osmolarity Test b. Defects of ammonia secretion in DCT
Specific gravity and urine osmolality - measures total
solute concentration How would you know?
Specific gravity - depends on the number and weight MEASURE
of the solute - Urine pH
Osmolarity - depends on the number of particles - Titratable acidity - quantitate hydrogen ions in
present in the solution the urine
Osmolality - better; unaffected by density of solutes - Alkaline urine: 2 hr PP
- Acid Urine: Night time
Why OSMOLALITY not included in Routine Urine Test?
1. More time Factors Affecting Urine Production:
2. More expensive 1. Amount of H2O excreted - average daily is 1200 ml
3. More equipment 2. Bodys state of hydration

Osmolality of normal adult (Graffs) Variation in Urine Production and Volume:

Normal diet: 500-850 mOsm/kg water
Excessive hydration: 40-80 mOsm/kg Children 1-6 y/o 300-1000
During dehydration: 800-1400 mOsm/kg water ml/day
Terminal Renal Failure: Around 285 mOsm/kg Children 6-12 y/o 500-1500
BLOOD normal osmolality: 275-300 mOsm/kg; ml/day
average 300 mOsm/kg Adult 13 - above 800-1600
ml/day
Plasma and Glomerular Filtrate Osmolality Urine production per hour = 40-50 ml

2 Ways to Measure: Factors Affecting Volume of Urine:

a. Freezing Point Osmometer - a solution that contains 1. Fluid intake
1000 mOsm/kg water lowers the freezing point 2. Kidney and other diseases (DM)
1.86oC below that of water (OoC). The lower the - Kidneys do not reabsorb excess glucose
freezing point, the higher the osmolality (NaCl) - Excrete more water to remove dissolved glucose
b. Vapor Pressure Osmometer - Dew point 3. Diabetes Insipidus - decrease secretion / function of ADH
(temperature at which water vapor condenses to a 4. Food and drugs - SIADH - syndrome of inappropriate ADH
liquid). 5. Temperature (cold temp)
- the depression of dew point temperature 6. Metabolism
parallels the decrease in vapor pressure 7. Emotions
8. Age
2. Fishberg Concentration Test - patient deprived of fluid per
24 hours then measure specific gravity Urinary Bladder
Volume of 300-400 ml = (to feel a conscious) desire
3.Mosenthal Concentration Test - comprises of the volume to urinate
and specific gravity of day and night urine sample. Volume of 600-800 ml - (a feeling of urgent) need to
urinate
Tubular Secretion Test and Renal Blood Flow Test Amount of urine secreted/day = 3x greater than
during night
1. PAH (Para-aminohippuric Acid Test) Residual - amount of urine that remains in the bladder after a
Principle: Clearance test for GFR voluntary urination
Most common exogenous method
Radioactive hippurate DIFFERENT TERMS:
Principle:
1. It measures the exact amount of blood flowing 1. Oliguria - decrease; less than 400 ml/24hr
through the kidneys Clinical Significance:
2. Uses substances that is completely removed from Dehydration (vomiting, diarrhea, excessive
the blood primarily in the peritubular capillaries perspriration)
(excreted in the PCT) Obstruction
 Severe burn
Shock
Acute nephritis
2. Anuria - complete cessation in the urine output; less than
100 ml/24hr
Clinical Significance:
Acute glomerulonephritis
Renal obstruction
Decreased blood flow (heart failure)
3. Nocturia - an excessive urination during night
4. Polyuria - more than 3000ml/day; excessive daily urine
output
Clinical Significance:
Caffeine and alcohol
Diabetes Insipidus and Diabetes mellitus
Specimen Collection and Handling
Urine - a biohazardous substance
- uses disposable container
- reject improperly labeled specimen
- reject if specimen is more than 2 hours
Specimen Integrity
- urine specimen should be examined within 2
hours after
BOOK:
TABLE 3-2 Changes in Unpreserved Urine (memorize)
TABLE 3-3 Urine Preservatives (memorize)
Types of Specimen Collection:
1. Random Urine
2. First Morning Specimen - preferred specimen for pregnancy
test (pH) to prevent false (-) results
- more concentrated
- ideal for screening of urinary tract infection
- evaluation of orthostatic (prolonged standing)
proteinuria
- 12-15 ml in a clean container
* Standard Urine Container - 50ml
* Analysis should be done within 2 hours
3. Fasting Specimen - Second specimen voided after a period
of fasting
-recommended for glucose monitoring
4. 2-hour Postprandial Specimen - first specimen collected
before meal (for comparison)
-2nd specimen will be collected 2 hours after meal
-monitoring of insulin therapy
5. Glucose Tolerance Specimen - measures the ability of an
individual to metabolize
6. 24 hours specimen - collection of specimen will begin and
end with an empty bladder (ex: from 6PM to 6PM the
following day)
Diagnostic Purposes:
To determine exact amount of urine chemical substance (ex.
Creatinine Total Protein and other metabolites)
specimen must be thoroughly mixed
exact volume must the measured
specimen should be refrigerated
7. Catheterized Specimen - urine collection under sterile
condition through a hollow tube from urethra into the
bladder
- measures individual functions of the kidney (left and right)
- used for bacterial culture
8. Midstream Clean-catch Specimen
- same as midstream collection
- patient only instructed to collect specimen from a clean
genitalia with the use of mild antiseptic towelletes
- an alternative to catheterized specimen for bacterial culture
(use sterile conical tube)
9. Suprapubic Aspiration - it is a direct puncturing of the
urinary bladder at the suprapubic region
- it is applied commonly in infants
- for bacterial culture and cytologic examination
10. (Prostatitis Specimen) Three Glass Specimen
- collection of urine into 3 sterile containers
- for quantitative culture
- determines prostatic infection
a.) First urine (passed into urethra) - microscopic examination
b.) Midstream Urine Collection - used as con___???
c.) Urine collected during prostatic massage - microscopic
examination
Stamey-Mears Four Glass Method
Initial voided urine = for bacterial culture (VB1)
Clinical correlation: Urethral infection or
inflammation
Midstream urine (VB2) = bladder infection
Expressed prostatic secretions
11. Pediatric Specimens - urine collected by the use of an
adhesive pediatric bag for infants
- for routine analysis
12. Drug Specimen Collection - collection must follow the
correct protocol with documentations
- specimen should be kept between 32.5oC to 37oC and
examined immediately