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Acidity

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Dehydration, Diabetes, Diarrhea, Fever, Gout, and High Protein Diets may have what effect on Urine?

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Alkalinity

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Acute and Chronic Renal Failure, Diuretics, and UTI's may have what effect of Urine?

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Small amounts of low-molecular weight protein are filtered at the glomerulus. Most of this protein is reabsorbed in the tubules.

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Urine Protein

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Exercise, Emotional Stress, Fever, Pregnancy

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Physiological causes for Protein in Urine

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Glomerulonephritis Pyelonephrites Malignant Hypertension

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Pathological Causes for Protein in Urine

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When the blood Glucose levels exceed 160-180md/dl

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When does Glucose become present in Urine

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Diabetes Mellitus. Fasting. Insufficient Carb intake, malnutrition, strenuous exercise, vomiting

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Ketones in Urine are caused by?

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1 Million

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How many Nephrons are present in each kidney?

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The Glomerulus

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What part of the Nephron filters blood?

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The Proximal Convoluted Tubule The Loop of Henle Distal Convoluted Tubule

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Reabsorption and Secretion occur where in the Nephron

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600 mL/min per kidney (1200mL min total)

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Blood passes through the kidneys at a rate of ...

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-- Endothelial Cells with Fenestra -- Glomerular Basement Membrane -- Visceral Epithelial Cells (podocytes)

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What are the three major componets accounting for the glomerular filtration (from inside to outside)

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90 - 120 mL/min (decreasing with age)

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Normal Glomerular Filtration Rate ranges are...

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--Estimates how much blood passes through each Glomeruli in a minute -- Measures Creatine levels in blood and then again to see how fast the kidneys are filtering in out.

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What is the Glomerular Filtration Rate?

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65%

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How much Potassium, Sodium Chloride, and Water are Reabsorbed in the proximal tubules

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-- Nearly Impermeable to Water -- Active Resorption of Sodium Chloride, Calcium, and Magnesium

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Ascending Limb of the Loop of Henle

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-- Permeable to Water -- No resorption of Solutes

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Descending Loop of Henle

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It lowers do to the loss of Sodium Chloride

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How does the osmolality of fluid leaving the Loop of Henle change?

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Proximal and Distal Tubules

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Hydrogen ions are exchanged for the sodium ions in sodium bicarbonate in the?

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90

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About ___% of the Glomerular Filtrate is reabsorbed by the time it reaches the distal tubule.

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-- Adjustment of the pH, Osmolality, and Electrolytes -- Secretion of potassium, ammonia, and hydrogen ions -- Reabsorption of Sodium and Bicarbonate

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Main function of the distal and collecting tubules

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Hormonal enzyme produced by the juxtaglomerular cells. Is secreted with and reacts with angiotensinogen in the blood to convert it to angiotensin I.

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Renin

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Passes through the lungs where the enzyme Angiotensin Converting Enzyme changes it to the active Angiotensin II

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Angiotensin I

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-- Causes Systemic Vasocontriction -- Triggers the release of Aldosterone and Antiduretic Hormone

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Angiotensin II

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-- Secreted by the Adrenal Cortex -- Enhances potassium / sodium exchange -- Increases blood sodium, which increase water retention, which increases Blood Pressure.

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Aldosterone

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Diabetes Insipidus

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Insufficient Antidiuretic Hormone results in?

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-- Released from the posterior pituitary gland -- makes the collecting ducts permeable to water -- production is dependent on the state of hydration in the body

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Antidiuretic Hormone (vasopressin)

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1200 - 1500 mL

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Average adult daily volume of Urine

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90-120 mL/min 1 mL/min

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Fluids filtered at the glomerulus at the rate of ________, excreted as urine at the rate of _____ on average.

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Dehydration reduces urine production to 0.3 mL/min

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Excessive Hydration increases urine production to 15mL/min

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Abnormal increase in the volume of urine (>2500 mL) as in Diabetes Insipidus and Diabetes Mellitus

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Polyuria

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Decrease in Urinary Volume (<500 mL per 24 hours). Occurs during shock or acute glomerulonephritis.

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Oliguria

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The complete suppression of urine formation or defined as < 100mL / 24hrs for 2-3 consecutive days.

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Anuria

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Water, Urea, uric acid, creatine, sodium, potassium, chloride, calcium, magnesium, phosphates, sulfates, and ammonia

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Urine consists of:

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60g

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In 24 hours, the body excretes roughly _____ of dissolved material, half of which is Urea.

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Bilirubin Blood Glucose Ketone Bodies Porphyrins Protein

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Abnormal Urine Compositions includes:

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Gives urine its color

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Urochrome

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Pathologic: Chyle, Lipids, and Pyuria (WBCs) Non-Pathologic: Phosphates and Vaginal Creams

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Causes of White urine:

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Pathologic: Bilirubin, Urobilin Non-Pathologic: Carrots, Vitamin B Complex, Food Color

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Causes of Yellow/Amber to Orange Urine

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Yellow/Amber to Orange

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Bilirubin, Urobilin, and a high amount of Vitamin B Complex will give the Urine what color?

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Bilirubin, Biliverdin (both Pathological)

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What gives Urine a Yellow to Green color

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Pathologic: Hemoglobin, Myoglobin. RBCs, Porphobilin, and Porphyrins Non-Pathologic: Beets (anthocyanin), Food Color, Senna, Cascara

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What gives Urine a pink to red color?

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Pathological: Bilirubin, Homogentistic Acid aka Alkapton, Meanin, Phenol Non-Pathological: Iron Compounds

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What gives Urine a Brown to Black color?

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Ratio of the weight of a volume of Urine to the weight of the same volume of distilled water. Used to measure the concentrating ability of the kidneys

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Specific Gravity

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--Formed by Hemoglobin Degradation -- Bound to albumin -- Unconjugated bilirubin is insoluble in water and can't be filtered through the glomerulus -- Conjugated Bilirubin is water soluble and is excreted by the liver into the duodenum via the bile duct

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Urine Bilirubin Formation

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-Small amounts of bilirubin regurgitate back from the bile duct into the blood system. -Filtered through the glomerulus and excreted as urine whenever the plasma levels are increased -Normally, No detectable amounts are present in urine

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Urine Bilirubin

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Present in Urine when: -When bile flow to duodenum is obstructed -A Liver pathology (hepatitis)

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Bilirubin in Urine

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-Formed from Bilirubin in the intestines, (most is lost in the feces) -10-15% is reabsorbed into the bloodstream. returned to the liver, and reexcreted into the intestines. Small amount is excreted by the kidneys

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Urine Urobilinogen Formation

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Peal Levels between 2-4pm Elevated in: - Liver Disease - Intestinal Obstruction - Hemolytic Anemia - Hemolysis

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Urine Urobilinogen

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Urinary Tract Infection

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A sudden compelling urge to urinate, accompanied by bladder pain, is a classic symptom of...

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Upper Motor Neuron Lesion

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Urgency to urinate without bladder pain may point to an

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ALS occasionally produces urinary urgency. More common findings include muscle weakness, cramping, atrophy, and coarse fasciculations in the forearms and hands. Brain stem involvement produces speech, chewing, swallowing, and breathing difficulty

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Amyotrophic lateral sclerosis (ALS)

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Bladder irritation can lead to urinary urgency and frequency, dysuria, hematuria, and suprapubic pain from bladder spasms.

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Bladder calculus

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Urinary urgency can occur with or without the frequent urinary tract infections that often accompany MS. Like MS's other variable effects, urinary urgency may wax and wane. Commonly, visual and sensory impairments are the earliest findings. Others include urinary frequency, incontinence, constipation, muscle weakness, paralysis, spasticity, intention tremor, hyperreflexia, ataxic gait, dysphagia, dysarthria, impotence, and emotional lability.

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Multiple sclerosis (MS)

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In this self-limiting syndrome that primarily affects males, urgency occurs with other symptoms of acute urethritis 1 to 2 weeks after sexual contact. Arthritic and ocular symptoms and skin lesions usually develop within several weeks.

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Reiter's syndrome

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Urinary urgency can result from incomplete cord transection when voluntary control of sphincter function weakens. Urinary frequency, difficulty initiating and inhibiting a urinary stream, and bladder distention and discomfort may also occur. Neuromuscular effects distal to the lesion may include weakness, paralysis, hyperreflexia, sensory disturbances, and impotence.

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Spinal cord lesion

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Urinary urgency is commonly associated with this infection. Other characteristic urinary changes include frequency, hematuria, dysuria, nocturia, and cloudy urine. Urinary hesitancy may also occur. Associated findings may include bladder spasms; costovertebral angle tenderness; suprapubic, low back, or flank pain; urethral discharge in males; and constitutional effects, such as fever, chills, malaise, nausea, and vomiting.

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Urinary tract infection

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Morbid anxiety produces urinary frequency and other types of genitourinary dysfunction, such as dysuria, impotence, and frigidity. Other findings include headache, diaphoresis, hyperventilation, palpitations, muscle spasm, polyphagia, constipation, and other GI complaints. Chest pain, tachycardia, and transient hypertension may also occur.

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Anxiety neurosis

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Prostatic enlargement causes urinary frequency, along with nocturia and possibly incontinence and hematuria. Initial effects are those of prostatism: reduced caliber and force of the urinary stream, urinary hesitancy and tenesmus, a feeling of incomplete voiding, and occasionally urinary retention. Assessment reveals bladder distention.

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Benign prostatic hypertrophy

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Acute prostatitis commonly produces urinary frequency, along with urgency, dysuria, nocturia, and purulent urethral discharge. Other findings include fever, chills, low back pain, myalgia, arthralgia, and perineal fullness. Rectal palpation reveals a markedly tender, indurated, swollen prostate. Clinical features of chronic prostatitis are usually the same as those of the acute form, but to a lesser degree. Other effects may include painful ejaculation, persistent urethral discharge, and sexual dysfunction.

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Prostatitis

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The pressure exerted by this tumor on the bladder may cause urinary frequency. Early findings include a change in bowel habits, often beginning with an urgent need to defecate on arising, or constipation alternating with diarrhea; blood or mucus in the stool; and a sense of incomplete evacuation. Later, the patient may feel a dull ache in the rectum or sacral region.

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Rectal tumor

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painful or difficult urination

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Dysuria

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Appendicitis, Bladdar Tumor, Cystitis, Diverticulitis, Urinary Obstruction, drugs

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Possible causes of Dysuria

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cardinal sign of renal and urinary tract disorders.

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Oliguria is a____.

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prerenal (decreased renal blood flow) intrarenal (intrinsic renal damage) postrenal (urinary tract obstruction)

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What are the 3 classifications of Oliguria?

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Acute tubular necrosis (ATN), Benign prostatic hypertrophy, Congestive Heart Failure, Glomerulonephritis (acute), Renal artery occlusion (bilateral), Renal vein occlusion(bilateral), sepsis, drugs

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Causes of Oliguria

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This disorder occasionally causes oliguria accompanied by acute low back and flank pain, CVA tenderness, fever, pallor, hematuria, enlarged, palpable kidneys, and possibly signs of uremia.

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Renal vein occlusion(bilateral)

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This disorder is characterized by a sudden change from oliguria to anuria, along with gross hematuria, flank pain and fever.

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Cortical necrosis (bilateral)

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Cortical Necrosis, Hemolytic-Uremic Syndrome, Renal Artery/Vein Occulsion

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Caues of Anuria

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Anuria often occurs in the initial stages of this disorder and may last from 1 to 10 days. The patient may have vomiting, diarrhea, abdominal pain, hematemesis, melena, purpura, fever, elevated blood pressure, hepatomegaly, ecchymoses, edema, hematuria and pallor. He may also show signs of upper respiratory tract infection.

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Hemolytic-Uremic Syndrome

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Diabetes Mellitus, Hypercalcemia, Hypokalemia, Sheehan's Syndrome, Sickle Cell Anemia

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Causes of Polyuria

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Elevated plasma calcium levels may lead to nephropathy, usually producing polyuria of less than 5 liters/day with a specific gravity of about 1.010. Accompanying signs and symptoms include polydipsia, nocturia, constipation, paresthesias and, occasionally, hematuria and pyuria. In severe hypercalcemia, the patient's condition worsens rapidly and he experiences anorexia, vomiting, stupor progressing to coma and renal failure.

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Hypercalcemia

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Prolonged potassium depletion may lead to nephropathy, producing polyuria - usually less than 5 liters/day with a specific gravity of about 1.010. Associated findings include polydipsia, muscle weakness or paralysis, hypoactive deep tendon reflexes, fatigue, hypoactive bowel sounds, nocturia and dysrhythmias.

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Hypokalemia

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By Strict Definition, the presence of 3 or more Red Blood Cells in a High-Powered Microscopic Field

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Hematuria

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Appendictitis, Bladder Neoplasm, Bladdar Trauma, Renal Trauma, Sickle Cell Anemia, Vaginitis, etc...

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Causes of Hematuria

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This elicited symptom indicates sudden distention of the renal capsule. It almost always accompanies unelicited, dull, constant flank pain in the costovertebral angle (CVA) just lateral to the sacrospinalis muscle and below the 12th rib. This associated pain typically travels anteriorly in the subcostal region toward the umbilicus. Percussing the costovertebral angle elicits CVA tenderness.

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Costovertebral Angle Tenderness

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the abnormal enlargement of the bladder - results from an inability to excrete urine, causing its accumulation. Distention can result from mechanical and anatomic obstructions, neuromuscular disorders and drugs. Relatively common in all ages and both sexes, it occurs most frequently in older men with prostate disorders leading to urine retention

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Bladder distention

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excessive urination at night - may result from disruption of the normal diurnal pattern of urine concentration or from overstimulation of the nerves and muscles that control urination. Normally, more urine is concentrated during the night than during the day. As a result, most people excrete three to four times more urine during the day, and can sleep for 6 to 8 hours during the night without being awakened. In nocturia, the patient may awaken one or more times during the night to empty his bladder and excrete 700 ml or more of urine. Although nocturia usually results from renal and lower urinary tract disorders, it may result from certain cardiovascular, endocrine, and metabolic disorders.

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Nocturia

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refers to nighttime urinary incontinence in a girl over age 5 or a boy over age 6. Rarely, this sign may continue into adulthood. It is most common in boys and may be classified as primary or secondary. Primary enuresis describes the child who has never achieved bladder control; Secondary enuresis describes the child who achieved bladder control for at least 3 months but has lost it. Among factors that may contribute to enuresis are delayed development of detrusor muscle control, unusually deep or sound sleep, failure to produce ADH at night, organic disorders such as urinary tract infection or obstruction, and psychological stress. Probably the most important factor, psychological stress commonly results from the birth of a sibling, the death of a parent or loved one, or premature, rigorous toilet training. The child may be too embarrassed or ashamed to discuss his enuresis, which intensifies psychological stress and makes enuresis more likely - thus creating a vicious cycle.

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Enuresis

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Detrusor Muscle Hyperactivity, UTI, Urinary Tract Obstruction

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Causes of Enuresis

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a fine white powder, believed to be urate crystals, that covers the skin - is a characteristic sign of end-stage renal failure, or uremia. Urea compounds and other waste substances that can't be excreted by the kidneys in urine are excreted in sweat, and remain as powdery deposits on the skin when the sweat evaporates. The frost typically appears on the face, neck, axillae, groin and genitalia. Because of advances in managing renal failure, uremic frost is now relatively rare

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Uremic frost

Urine Analysis: Life University College of Chiropractic

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