Urine and body fluids

analysis
(MeLS-M3253)

for MLS
undergraduate students
Rebuma Belete (MSc)
Lecturer, Haramaya University
Email: [email protected]
November 2022
 Learning objectives
At the end of this chapter, the students should be able to:

1. State urinary system organs and their functions

2. Discuss the segments of nephron and the processes of urine

formation

3. State the normal and abnormal composition of urine

4. Calculate creatinine clearance results using data provided

3
 Outline

 Anatomy of the kidney

 Physiology of the kidney & formation of urine

 Composition of urine

 Urinary system diseases

4
 Anatomy of urinary system
 Human urinary system

consists of:

• Two kidneys

• Two ureters

• One bladder

• One urethra

5
 1. Kidneys
• Bean shaped, lie behind the liver and the intestines.

• Weight: 150 g, length: 12.5 cm, width: 6 cm, and thickness: 2.5 cm.

• Kidney mainly divided into two regions:

– Cortex

– Medulla

o Divided into 7-18 renal pyramids.

• Interstitium, which comprises less than 10% of the renal volume,

lies b/n tubules and blood vessels.

– Contains fluid and scattered interstitial cells (fibroblasts and

6
others).
7
 Kidneys...
• Each kidney consists about 1.2 million
microscopic structures called nephrons.

– Functional units of kidneys.

• Segments of nephron:

Glomerulus (capillary network)

Bowman’s capsule

Proximal convoluted tubule (PCT)

Loop of Henle

Distal convoluted tubule (DCT)

Collecting duct (CD) 8

 2. Ureters
• Transport urine to urinary bladder.

• Gravity, hydrostatic pressure, and

muscular contractions push urine

through the ureters.

• Length: 25–30 cm, diameter: 1–10 mm.

• As the bladder fills with urine, it

compresses the openings to the ureters,

9
and prevents the backflow of urine.
 3. Urinary bladder
• Temporarily stores urine.

• Storage capacity: 700–800 mL.

– slightly smaller in females

due to uterus.

• Coordinated contraction of the

bladder muscles and relaxation of
the sphincters will result in the
passage of urine through the
urethra.
10
 4. Urethra
• The urethra carries urine out of the body.

• Two urinary sphincters control the flow of urine from the bladder
into the urethra.

• Length of urethra:

– In females, 4 cm

– In males, 20 cm

• Prostate gland surrounds the urethra.

• Most disorders of the prostate affect the male’s ability to urinate.

11
12
 Renal functions and urine formation
 Excretion of metabolic waste products and foreign materials

 Conservation of valuable nutrients

 Regulation of electrolytes

 Acid-base balance

 Secretion of hormones

 Regulation of blood volume and blood pressure

 Gluconeogenesis 13
 1. Excretion of wastes
• Our bodies continuously form end products of metabolic processes,

which are harmful at high concentrations.

– Urea (from proteins)

– Uric acid (from nucleic acids)

– Creatinine (from muscle creatine)

• Surplus substances (water, ions, etc.), drugs and hormones (or their

metabolites) in the blood are also removed by kidneys.

• Kidneys excrete these substances as urine.

14
 Urine formation
• Kidneys continuously form urine as an ultrafiltrate of plasma.

– ~1800 L of blood enters daily (1200 mL/min) into kidneys.

– ~ 180 L of plasma is filtered daily (120 mL/min) by kidneys.

– ~ 1.5 L of urine is formed daily (1 mL/min) by kidneys.

• The formation of urine is achieved by 3 processes:

I. Glomerular filtration

II. Tubular reabsorption

III. Tubular secretion 15

16
 I. Glomerular filtration
• Filtration: flow of fluid from the glomerular capillaries into
Bowman’s capsule.

• Takes place through the semi permeable walls of the glomerular

capillaries.

• Urine formation begins with glomerular filtration.

17
 Glomerular filtration...
Glomerular filtration depends on:

• Arterial blood pressure

• Glomerular filtration barriers:

– Endothelial cells of
glomerular capillaries

– Basement membrane

– Podocytes

• Properties of filtered molecules

18
 Glomerular filtration...
• Properties of filtered molecules:

– Size of solute:

• Large substances (m.wt >70,000, diameters > 8 nm) do not

pass through glomeruli.

– Large molecular weights proteins, cells

• Small solutes and water rapidly pass through glomeruli.

– Charge of solute:

• Filtration barriers contain shield of negativity that repels

macromolecules with a negative charge. 19
 Glomerular filtration rate (GFR)
 The rate of plasma cleared by the glomeruli per unit of time
(milliliters per minute).

 In healthy adults, about 120 mL of glomerular filtrate is

produced per minute.

 GFR is determined using clearance tests of substances that are

known to be removed exclusively by glomerular filtration, and that
are not reabsorbed or secreted by the nephrons (e.g., creatinine).

 Clearance test measures the rate at which the kidneys are able to
remove (to clear) a filterable substance from the blood (e.g. CrCl).
 GFR...

Consider the following data:

– Serum creatinine: 1.8 mg/dL

– Urine creatinine: 63 mg/dL

– Total urine volume: 1680 ml/24hr (1680 ml/1440 min)

Calculate the CrCl (i.e. GFR)

21
 II. Tubular reabsorption
• Reabsorption: movement of substances from renal tubular lumen
into the peritubular capillary blood and interstitium.

• Nephron tubules reabsorb about 99% of the glomerular filtrate.

 Tubular reabsorption...
1. PCT:

– Water

– Reabsorbs 60% of all solutes: glucose, proteins, and amino acids

(100%), bicarbonate (90%), inorganic phosphate (80-90%)

2. Loop of Henle:

– Part of the tubule which dips or "loops" from the cortex into the
medulla.

• Descending limb: H2O permeable, salt impermeable

• Ascending limb: salt permeable, H2O impermeable

23
 Tubular reabsorption...
3. Distal tubule and collecting duct:

– Water moves out of the lumen of the duct to concentrate urine.

– Controlled by vasopressin/antidiuretic hormone (ADH).

– If ADH is present, the distal tubule and the collecting duct

become permeable to water.

– In the absence of ADH, the tubule is minimally permeable to

water so large quantities of dilute urine is formed.

24
25
 Tubular reabsorption...
Tubular reabsorptive capacity:

– Many solutes have maximum tubular reabsorption capacity.

– Plasma level at which the kidneys no longer reabsorb a

substance so that it is excreted into urine as waste is known as

renal threshold.

• Example:

– Glucose threshold level: 160-180 mg/dL

– Ketone threshold level: 70 mg/dL 26

 III. Tubular secretion
• Secretion: the passage of substances from the peritubular capillary
blood and interstitium into the renal tubular lumen.

• Tubular secretion serves two major functions:

– Elimination of waste products not filtered by the glomerulus.

– Regulation of the acid-base balance.

27
 2. Regulation electrolytes
• Kidneys regulate electrolytes (Na+, K+, Ca++, Mg++, PO4) under

the control of hormones.

a) Aldosterone:

– Stimulates Na+ reabsorption in exchange for K+ in DCT.

b) Parathyroid hormone (PTH):

– Increases renal reabsorption of Ca2+ and Mg2+ in exchange for

phosphorus.

28
 3. Acid-base balance
• Kidneys play an important role in acid-base balance along with

blood and lung.

• kidneys:

– Reabsorb all filtered HCO3- , blood pH buffer.

– Secrete the daily production of non-volatile acids into the urine.

• Renal tubular acidosis (RTA) is a tubular defect of acid-base

regulation.
29
 4. Endocrine function
• Kidneys synthesize renin, erythropoietin, 1,25-dihydroxy vitamin

D3, and the prostaglandins.

1. Renin:

• The initial component of the renin–angiotensin–aldosterone

system (RAAS).

• Renin is produced by the juxtaglomerular cells of the renal medulla

when extracellular fluid volume or blood pressure decreases.

30
 Endocrine function...

31
Renin-angiotensin-aldosterone system (RAAS)
 Endocrine function...
2. Erythropoietin:

– Acts on the erythroid progenitor cells in the bone marrow,

RBCs.

3. 1,25-Dihydroxy vitamin D3:

– The kidneys are the sites of formation of the active form of

vitamin D (1,25-(OH)2 vitamin D3).

– Important for phosphate and calcium balance and bone

calcification.

32
 Composition of urine
• The factors affecting the composition of urine:

– Diet and nutritional status

– Pathological conditions (renal, liver, endocrine, metabolic, etc.)

– Physiological conditions such as pregnancy

– Physical activity

– Climatic conditions

– Body metabolism
33
 Composition of urine...
Normal urine composition

34
 Composition of urine...
Abnormal urine composition

 Glucose  Cells

 WBCs
 Proteins
 RBCs
 Amino acids
 Casts

 Bilirubin  Parasites

 Ketone bodies  Yeasts

 Bacteria
35
 Urinary system diseases
• Renal diseases are often classified as:

– Glomerular diseases: affecting the glomeruli

• e.g., autoimmune diseases, systemic infections (hepatitis,

HIV), drugs, neoplasia

– Tubulointerstitial diseases: affecting the renal tubules and

interstitium

• e.g., urinary tract infection, stones, obstruction, drug toxicity

– Vascular: affecting the renal vasculature e.g. systemic vasculitis

36
 1. Glomerular disorders
1. Glomerulonephritis:

• Any condition associated with inflammation in the glomerular tuft.

• Characterized by:

– Hematuria with dysmorphic RBCs and RBCs casts

– variable degree of proteinuria usually in the non‐nephrotic range

– Hypertension (HTN)

– Edema (secondary to sodium retention)

• A variety of types of glomerulonephritis exist, and the condition also

may progress from one form to another.
37
 Glomerular disorders...
2. Nephrotic syndrome:

• Increased permeability of the glomeruli to plasma proteins.

• Causes: primary defect of the kidney, or secondary to diabetes,

carcinomas, systemic lupus erythematosus, or drug therapies.

• Characterized by:

Massive proteinuria (>3.5 g/day)

Hypoproteinemia (albumin less than 3 g/dL)

Generalized edema

• Hyperlipidemia, lipiduria, and casts (fatty, waxy, and RTE) 38

 2. Tubulointerstitial disorders
1. Acute tubular necrosis (ATN)

• Destruction of renal tubular epithelial cells

• Causes: hypotensive event, nephrotoxic agents

• Nephrotoxic agents:

– Aminoglycoside antibiotics

– Ethylene glycol

– Heavy metals

– Toxic mushrooms

• Urinalysis findings: mild proteinuria, microscopic hematuria, RTE

cells and RTE casts, others. 39
 Tubulointerstitial disorders...
2. Fanconi’s syndrome

• Generalized failure of tubular reabsorption in the PCT.

• Substances most noticeably affected include glucose, amino acids,

phosphorous, sodium, potassium, bicarbonate, and water.

• Causes: inherited, toxic agents, complication of multiple myeloma

and renal transplant.

• Urinalysis findings: glycosuria with a normal blood glucose, mild

proteinuria, very low urine pH 40

 Tubulointerstitial disorders...
3. Renal glucosuria

• Inherited condition that results in excretion of glucose in the urine

despite normal blood glucose levels.

• Glucosuria can result from a lowered maximal tubular reabsorptive

capacity (Tm) for glucose.

4. Renal Tubular Acidosis (RTA):

• Characterized by the inability of the tubules to secrete adequate H+.

41
 3. Urinary tract infection (UTI)
• Normally, urine and urinary tract are sterile, except distal urethra.

• UTIs are caused most often by bacteria from the GI tract.

• 85% of UTIs are caused by the gram -ve rods.

– E. coli
– Proteus spps
– Klebsiella spps
– Enterobacter spps
– Pseudomonas spps

• S. fecalis and S. aureus are gram +ve bacteria that cause UTI. 42
 UTI...
UTI affect :

• Lower urinary tract:

– Urethra (urethritis)

– Bladder (cystitis)

• Upper urinary tract:

– Renal pelvis (pyelitis)

– Renal tubules

– Interstitium
43
 4. Diabetic nephropathy
• In diabetes, there is damage to the glomerular membrane due to:

– Thickening

– Increased cellular proliferation

– Accumulation of solid substances around the vascular tuft

• This causes vascular sclerosis and can lead to end-stage renal

disease.

• Microalbuminuria is important to detect the onset of diabetic

nephropathy.
44
 5. Renal calculi
• Renal calculi (stones) may form in the calyces and pelvis of the
kidney, ureters, and bladder.

• Conditions favoring the formation of renal calculi are low fluid

intake, pH, high solute concentration, and urinary stasis.

• Analysis of the chemical composition of renal calculi plays an

important role in patient management.

• Calculi constituents: calcium oxalate or calcium phosphate (75%),

magnesium ammonium phosphate (struvite), uric acid, and cystine.
4
5
 6. Renal failure
• Inability of the kidneys to perform excretory function leading to
retention of nitrogenous waste products from the blood.

• Renal failure exists in both acute and chronic forms (CKD).

• Acute kidney injury (AKI) exhibits a sudden loss of renal function

and is frequently reversible.

• Primary causes of AKI include:

– Sudden decrease in blood flow to the kidney

– Acute glomerular and tubular disease

– Renal calculi 46
 Test your knowledge #1

Which of these is the major functional unit of the kidney?

A. Renal interstitium

B. Efferent arteriole

C. Renal pelvis

D. Nephron

47
 Test your knowledge #2

The glucose renal threshold is 160 - 180 mg/dL. This represents the:

A. Concentration of glucose in the vasa recta

B. Maximum rate of glucose reabsorption in the renal tubule

C. Plasma concentration above w/c glucose is excreted in urine

D. Plasma level at the commencement of glucose reabsorption in

the nephron

48
 Test your knowledge #3

Which of the following components is/are present in plasma but not

present in the glomerular filtrate?

A. Glucose

B. Amino acids

C. Urea

D. Large molecular weight proteins

49
 Test your knowledge #4

The primary organic substance found in normal urine is:

A. Chloride

B. Glucose

C. Urea

D. Uric acid

50
 Reference

• Brunzel, Nancy A. (2018).

Fundamentals of Urine and

Body Fluid Analysis (4th ed.).

Elsevier Inc.

 NB: you can download this book and

others from ‘LIBRARY GENESIS

51
(https://libgen.is)’