Theory Urinalysis

8/9/2019 Theory Urinalysis

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HUMAN ANATOMY AND PHYSIOLOGY

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Urinalysis

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THEORY

THE URINARY SYSTEM

Functions of the Kidneys

Metabolism constantly produces a variety of waste products that can poison the body if not

eliminated. The most fundamental role of the idneys is to eliminate these wastes and

homeostatically re!ulate the volume and compositionof the body fluids. "ll of the followin!

processes are aspects of idney function#

$ They filter blood plasma% separate wastes from the useful chemicals% and eliminate the

wastes while returnin! the rest to the bloodstream.

$ They re!ulate blood volume and pressure by eliminatin! or conservin! water as

necessary.

$ They re!ulate the osmolarity of the body fluids by controllin! the relative amounts of

water and solutes eliminated.

$ They secrete the en&yme renin% which activates hormonal mechanisms that controlblood pressure and electrolyte balance.

$ They secrete the hormone erythropoietin% which controls the red blood cell count and

o'y!en(carryin! capacity of the blood.

They function with the lun!s to re!ulate the )*O+ and acid(base balance of the body

fluids.

They contribute to calcium homeostasis throu!h their role in synthesi&in! calcitriol

,vitamin - ,see chapter /.

They deto'ify free radicals and dru!s with the use of pero'isomes.


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0n times of starvation% they carry out !luconeo!enesis1 they deaminate amino acids

,remove the 2H+ !roup% e'crete the amino !roup as ammonia ,2H3% and synthesi&e

!lucose from the rest of the molecule.

E'cretion

E'cretion is the process of separatin! wastes from the body fluids and eliminatin! them. 0t is

carried out by four or!an systems#

4. The respiratory system e'cretes carbon dio'ide% small amounts of other !ases% and

water.

+. The inte!umentary system e'cretes water% inor!anic salts% lactic acid% and urea in the

sweat.

3. The di!estive system not only eliminates food residue ,which is not a process of

e'cretion but also actively e'cretes water% salts% carbon dio'ide% lipids% bile pi!ments%

cholesterol% and other metabolic wastes.5. The urinary system e'cretes a broad variety of metabolic wastes% to'ins% dru!s%

hormones% salts% hydro!en ions% and water.

6ross "natomy

The idneys lie a!ainst the posterior abdominal wall at the level of vertebrae T4+ to 73. The

ri!ht idney is sli!htly lower than the left because of the space occupied by the liver above it.

Each idney wei!hs about 489 ! and measures about 4+ cm lon!% : cm wide% and +.: cm

thic;about the si&e of a bar of bath soap. The lateral surface is conve' while the medial

surface is concave and has a slit% the hilum% where it receives the renal nerves% blood vessels%lymphatic vessels% and ureter. The left adrenal !land rests on the superior pole of that idney%

while the ri!ht adrenal !land is more medial% between the hilum and pole. The idneys%

adrenal !lands% ureters% and urinary bladder are retroperitoneal;they lie between the

peritoneum and body wall.

The idney is protected by three layers of connective tissue# ,4 a fibrous renal+

fascia% immediately deep to the parietal peritoneum% which binds the idney and associated

or!ans to the abdominal wall1 ,+ the adipose capsule% a layer of fat that cushions the idney

and holds it in place1 and ,3 the renal capsule% a fibrous sac that is anchored at the hilum and

encloses the rest of the idney lie a cellophane wrapper% and protects the idney fromtrauma and infection. *olla!en fibers e'tend from the renal capsule% throu!h the fat% to the

renal fascia. The renal fascia is fused with the peritoneum on one side and the deep fascia of

the lumbar muscles on the other. Thus the idneys are suspended in place. 2evertheless% they

drop about 3 cm when you !o from a supine to a standin! position% and under some

circumstances they become detached and drift even lower% with patholo!ical results.

The ureter is a tubular continuation of the renal pelvis that drains the urine down to the

urinary bladder.

The 2ephron


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Each idney contains about 4.+ million functional units called nephrons ,2EF(rons "

nephron consists of two principal parts# a renal corpuscle where the blood plasma is filtered

and a lon! renal tubule that processes this filtrate into urine.

The Renal *orpuscle

The renal corpuscle consists of a ball of capillaries called a !lomerulus: ,!lo(MERR(

you(lus% enclosed in a two(layered !lomerular ,uamous epithelium% while the visceral layer consists of

elaborate cells called podocytes/ wrapped around the capillaries.

URINE 0ORMATION I: GLOMERULAR 0ILTRATION

The idney converts blood plasma to urine in three sta!es# !lomerular filtration%

tubular reabsorption and secretion% and water conservation ,fi!. +3.?. "s we trace fluid

throu!h the nephron% we will refer to it by different names that reflect its chan!in!composition# ,4 The fluid in the capsular space% called !lomerular filtrate% is similar to blood

plasma e'cept that it has almost no protein. ,+ The fluid from the pro'imal convoluted

tubule throu!h the distal convoluted tubule will be called tubular fluid. 0t differs from the

!lomerular filtrate because of substances removed and added by the tubule cells. ,3 The fluid

will be called urine once it enters the collectin! duct.

6lomerular Filtration Rate

6lomerular filtration rate ,6FR is the amount of filtrate formed per minute by the

two idneys combined. For every 4 mmH! of net filtration pressure% the idneys produce

about 4+.: m7 of filtrate per minute. This value% called the filtration coefficient ,Kf% depends

on the permeability and surface area of the filtration barrier. Kf is about 49@ lower in women

than in men. For the reference male%


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6FRA 2F) ' Kf A 49 ' 4+.:A 4+: m7Bmin

0n the reference female% the 6FR is about 49: m7Bmin. This is a rate of 4?9 7Bday in

males and 4:9 7Bday in females;impressive numbers considerin! that this is about :9 to 89

times the amount of blood plasma in the body and e>ually e'ceeds the amount of filtrate

produced by all other capillaries combined. Obviously only a small portion of this is

eliminated as urine. "n avera!e adult reabsorbs CC@ of the filtrate and e'cretes 4 to + 7 of

urine per day.

Re!ulation of 6lomerular Filtration

6FR must be precisely controlled. 0f it is too hi!h% fluid flows throu!h the renal

tubules too rapidly for them to reabsorb the usual amount of water and solutes. Drine output

rises and creates a threat of dehydration and electrolyte depletion. 0f 6FR is too low% fluid

flows slu!!ishly throu!h the tubules% they reabsorb wastes that should be eliminated in the

urine% and a&otemia may occur. The only way to adust 6FR from moment to moment is to

chan!e !lomerular blood pressure. This is achieved by three homeostatic mechanisms# renal

autore!ulation% sympathetic control% and hormonal control.

URINE 0ORMATION II: TU1ULAR REA1SORPTION AND SE2RETION

The pro'imal convoluted tubule ,)*T reabsorbs about 8:@ of the !lomerular filtrate%

while it also removes some substances from the blood and secretes them into the tubule for

disposal in the urine. The importance of the )*T is reflected in its relatively !reat len!th and

prominent microvilli% which increase its absorptive surface area. 0ts cells also contain

abundant lar!e mitochondria that provide "T) for active transport. Your )*Ts alone accountfor about 8@ of your restin! "T) and calorie consumption.

Tubular reabsorption is the process of reclaimin! water and solutes from the tubular

fluid and returnin! them to the blood. The )*T reabsorbs a !reater variety of chemicals than

any other part of the nephron. There are two routes of reabsorption# ,4 the transcellular4:

route% in which substances pass throu!h the cytoplasm and out the base of the epithelial cells

and ,+ the paracellular48 route% in which substances pass between the epithelial cells. The

ti!htG unctions between tubule epithelial cells are >uite leay and allow si!nificant amounts

of water% minerals% urea% and other matter to pass between the cells. Either way% such

materials enter the e'tracellular fluid ,E*F at the base of the epithelium% and from there they

are taen up by the peritubular capillaries.

Tubular secretion in the distal convoluted tubule is discussed shortly. 0n the pro'imal

convoluted tubule and nephron loop% it serves two purposes#

4. aste removal. Drea% uric acid% bile acids% ammonia% catecholamines% and a little

creatinine are secreted into the tubule. Tubular secretion of uric acid compensates for

its reabsorption earlier in the )*T and accounts for all of the uric acid in the urine.

Tubular secretion also clears the blood of pollutants% morphine% penicillin% aspirin% and

other dru!s. One reason that so many dru!s must be taen three or four times a day is


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to eep pace with this rate of clearance and maintain a therapeutically effective dru!

concentration in the blood.

+. "cid(base balance. Tubular secretion of hydro!en and bicarbonate ions serves to

re!ulate the pH of the body fluids

The 2ephron 7oop

The primary function of the nephron loop is to !enerate a salinity !radient that

enables the collectin! duct to concentrate the urine and conserve water.


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URINE 0ORMATION III: 5ATER 2ONSERVATION

The idney serves not ust to eliminate metabolic waste from the body but to prevent

e'cessive water loss in doin! so% and thus to support the body=s fluid balance. "s the idney

returns water to the tissue fluid and bloodstream% the fluid remainin! in the renal tubule

becomes more and more concentrated. 0n this section% we e'amine the idney=s mechanisms

for conservin! water and concentratin! the urine.

The -istal *onvoluted Tubule

hen the nephron loop returns to the corte'% it coils a!ain and forms the distal

convoluted tubule ,-*T. This is shorter and less convoluted than the )*T% so fewer sections

of it are seen in histolo!ical sections The -*T is the end of the nephron. The -*Ts of several

nephrons drain into a strai!ht tubule called the collectin! duct% which passes down into the

medulla. 2ear the papilla% several collectin! ducts mer!e to form a lar!er papillary duct1

about 39 of these drain from each papilla into its minor caly'.

The *ollectin! -uct

The collectin! duct ,*- be!ins in the corte'% where it receives tubular fluid from

numerous nephrons. "s it passes throu!h the medulla% it usually reabsorbs water and

concentrates the urine. hen urine enters the upper end of the *-% it has a concentration of

499 to 399 mOsmB7% but by the time it leaves the lower end% it can be up to four times as

concentrated. This ability to concentrate wastes and control water loss was crucial to the

evolution of terrestrial animals such as ourselves .

Two facts enable the collectin! duct to produce such hypertonic urine# ,4 the

osmolarity of the e'tracellular fluid is four times as hi!h deep in the medulla as it is in the

corte'% and ,+ the medullary portion of the *- is more permeable to water than to 2a*l.

Therefore% as urine passes down the *- throu!h the increasin!ly salty medulla% water leaves

the tubule by osmosis% most 2a*l and other wastes remain behind% and the urine becomes

more and more concentrated.

Drine Iolume

"n avera!e adult produces 4 to + 7 of urine per day. "n output in e'cess of + 7Bday is

called diuresis or polyuria4C ,)O7(ee(YOD(ree(uh. Fluid intae and some dru!s can

temporarily increase output to as much as +9 7Bday. *hronic diseases such as diabetes ,see

ne't can do so over a lon! term. Oli!uria+9 ,oll(ih(6DE(ree(uh is an output of less than :99

m7Bday% and anuria+4 is an output of 9 to 499 m7Bday. 7ow output can result from idney

disease% dehydration% circulatory shoc% prostate enlar!ement% and other causes. 0f urine

output drops to less than 599 m7Bday% the body cannot hi!h concentration of !lucose in the

blood. "bout 4@ to 3@ of pre!nant women e'perience !estational diabetes% in which

pre!nancy reduces the mother=s insulin sensitivity% resultin! in hyper!lycemia and !lycosuria.

0n renal diabetes% blood !lucose level is not elevated% but there is a hereditary deficiency of

!lucose transporters in the )*T% which causes !lucose to remain in the tubular fluid. -iabetes


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insipidus results from "-H hyposecretion. ithout "-H% the collectin! duct does not

reabsorb as much water as normal% so more water passes in the urine.

-iuretics are chemicals that increase urine volume. They are used for treatin!

hypertension and con!estive heart failure because they reduce the body=s fluid volume and

blood pressure. -iuretics wor by one of two mechanisms;increasin! !lomerular filtration

or reducin! tubular reabsorption. For e'ample% caffeine% in the former cate!ory% dilates the

afferent arteriole and increases 6FR. "lcohol% in the latter cate!ory% inhibits "-H secretion.

"lso in the latter cate!ory are many osmotic diuretics% which reduce water reabsorption by

increasin! the osmolarity of the tubular fluid. Many diuretic dru!s% such as furosemide

,7asi'% produce osmotic diuresis by inhibitin! sodium reabsorption.

" urine test checs different components of urine% a waste product made by the

idneys. " re!ular urine test may be done to help find the cause of symptoms. The test can

!ive information about your health and problems you may have.

Drinalysis can be part of a routine e'amination and is fre>uently performed upon

admission to the hospital and before sur!ery. The test can also follow a preliminary rapid

urine test that produced abnormal results% so that urinalysis can be used to chec those results.

*omplete urinalysis is done in a laboratory. 0t is usually made up of 3 parts#

$ "ssessment of the color% clarity and concentration of the urine

$ E'amination of the chemical composition of the urine with a test strip

$ E'amination of the urine usin! a microscope to identify bacteria% cells and cell parts

The idneys camera tae out waste material% minerals% fluids% and other substances

from the blood to be passed in the urine. Drine has hundreds of different body wastes. hat

you eat% drin% how much you e'ercise% and how well your idneys wor can affect what is in

your urine. More than 499 different tests can be done on urine. " re!ular urinalysis often

includes the followin! tests.

2!l!r. Many thin!s affect urine color% includin! fluid balance% diet% medicines% and diseases.

How dar or li!ht the color is tells you how much water is in it. Iitamin < supplements can

turn urine bri!ht yellow. Jome medicines% blacberries% beets% rhubarb% or blood in the urine

can turn urine red(brown.

2larity. Drine is normally clear.


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1a8teria% yeast cells% or parasites. There are no bacteria% yeast cells% or parasites in urine

normally. 0f these are present% it can mean you have an infection.

S-a"!-s 8ells6The presence of s>uamous cells may mean that the sample is not as pure as

it needs to be. These cells do not mean there is a medical problem% but your doctor may as

that you !ive another urine sample.

hy 0t 0s -one

" urine test may be done#

To chec for a disease or infection of the urinary tract. Jymptoms of a urine infection

may include colored or bad(smellin! urine% pain when urinatin!% hard to urinate% flan

pain% blood in the urine ,hematuria% or fever.

To chec the treatment of conditions such as diabetes% idney stones% a urinary tract

infection ,DT0% hi!h blood pressure ,hypertension% or some idney or liver diseases. "s part of a re!ular physical e'amination.

How To )repare

-o not eat foods that can color the urine% such as blacberries% beets% and rhubarb%

before the test. -o not e'ercise strenuously before the test.

Tell your doctor if you are menstruatin! or close to startin! your menstrual period.

Your doctor may want to wait to do the test.


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0f the collection cup has a lid% remove it carefully and set it down with the inner

surface up. -o not touch the inside of the cup with your fin!ers.

*lean the area around your !enitals.

o " man should retract the foresin% if present% and clean the head of his penis

with medicated towelettes or swabs.o " woman should spread open the !enital folds of sin with one hand. Then use

her other hand to clean the area around the urethra with medicated towelettes

or swabs. Jhe should wipe the area from front to bac so bacteria from the

anus is not wiped across the urethra.


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2larity 2ormal# *lear

"bnormal# *loudy urine can be caused by pus ,white blood cells% blood

,red blood cells% sperm% bacteria% yeast% crystals% mucus% or

aparasiteinfection% such as trichomoniasis.

Od!r 2ormal# Jli!htly nutty odor

"bnormal# Jome foods ,such as aspara!us% vitamins% and antibiotics ,such

aspenicillin can cause urine to have a different odor. " sweet%

fruity odor may be caused by uncontrolled diabetes. " urinary

tract infection ,DT0can cause a bad odor. Drine that smells lie

maple syrup can mean maple syrup urine disease% when the

body cannot brea down certain amino acids.

S7e8i9i8

)raity2ormal# 4.99:(4.939

"bnormal# " very hi!h specific !ravity means very concentrated urine%

which may be caused by not drinin! enou!h fluid% loss of too

much fluid ,e'cessive vomitin!% sweatin!% or diarrhea% or

substances ,such as su!ar or protein in the urine. Iery low

specific !ravity means dilute urine% which may be caused by

drinin! too much fluid% severe idney disease% or the use

of diuretics.

7H 2ormal# 5.8(?.9

"bnormal# Jome foods ,such as citrus fruit and dairy products and

medicines ,such as antacids can affect urinepH. " hi!h

,alaline pH can be caused by severe vomitin!% a idney

disease% some urinary tract infections% andasthma. " low

,acidic pH may be caused by severe lun!disease

,emphysema% uncontrolled diabetes% aspirinoverdose% severe

diarrhea% dehydration% starvation% drinin! too much alcohol% ordrinin! antifree&e ,ethylene !lycol.

Pr!tein 2ormal# 2one

"bnormal# )rotein in the urine may mean idney dama!e% an

infection%cancer% hi!h blood pressure% diabetes%systemic lupus

erythematosus ,J7E% or!lomerulonephritisis present.

)rotein in the urine may also mean that heart failure%leuemia%

poison ,lead or mercury poisonin!% orpreeclampsia,if you are

pre!nant is present.
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Gl-8!se 2ormal# 2one

"bnormal# 0ntravenous ,0Ifluids can cause !lucose to be in the urine. Too

much !lucose in the urine may be caused by uncontrolled

diabetes% anadrenal !landproblem% liver dama!e%braininury%certain types of poisonin!% and some types of idney diseases.

Healthy pre!nant women can have !lucose in their urine% which

is normal durin! pre!nancy.

4et!nes 2ormal# 2one

"bnormal# Ketones in the urine can mean uncontrolled diabetes% a very

low(carbohydrate diet% starvation or eatin! disorders ,such

as anore'ia nervosaorbulimia%alcoholism%or poisonin! from

drinin! rubbin! alcohol ,isopropanol. Ketones are often foundin the urine when a person does not eat ,fasts for 4? hours or

lon!er. This may occur when a person is sic and cannot eat or

vomits for several days. 7ow levels of etones are sometimes

found in the urine of healthy pre!nant women.

Mi8r!s8!7i

8 analysis2ormal# Iery few or no red or white blood cells or casts are seen. 2o

bacteria% yeast cells% parasites% or s>uamous cells are present. "

few crystals are normally seen.

"bnormal# Red blood cells in the urine may be caused by idney or bladder

inury% idney stones% a urinary tract infection ,DT0%

inflammation of the idneys ,!lomerulonephritis% a idney or

bladder tumor% or systemiclupuserythematosus ,J7E. hite

blood cells ,pus in the urine may be caused by a urinary tract

infection% bladder tumor% inflammation of the idneys% systemic

lupus erythematosus ,J7E% or inflammation in the va!inaor

under the foresin of the penis.

-ependin! on the type% casts can mean inflammation or dama!e

to the tiny tubes in the idneys% poor blood supply to the

idneys% metal poisonin! ,such as lead or mercury% heartfailure%or abacterial infection.

7ar!e amounts of crystals% or certain types of crystals% can mean

idney stones% dama!ed idneys% or problems withmetabolism.

Jome medicines and some types of urinary tract infections can

also increase the number of crystals in urine.


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The presence of s>uamous cellsmay mean that the sample is

not as pure as it needs to be. These cells do not mean there is a

medical problem% but your doctor may as that you !ive another

urine sample.

hat "ffects the Test

Reasons you may not be able to have the test or why the results may not be helpful include#

0f you are havin! your menstrual period.

Tain! medicines% such as diuretics% erythromycin% trimethoprim ,Trimpe'% or hi!h

doses of vitamin * ,ascorbic acid taen with an antibiotic% such as tetracycline.

Havin! an P(ray test with contrast material in the past 3 days.

2ot !ettin! the urine sample to the lab in 4 hour.

hat To Thin "bout

Jome urine tests can be done usin! a home test it. For more information% see the

topic Ketones or Home Test for Drinary Tract 0nfections.

0n some cases% the amount of urine you mae in +5 hours may be measured. Most

adults mae about 4 >t ,4 7 to + >t ,+ 7 per day. *hildren mae about 9.3 >t ,9.3 7

to 4.8 >t ,4.: 7 per day.

Other substances that may be checed durin! a urine test include#

o


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0f an abnormal result is found durin! a urine test% more tests may be done% such as a

urine culture% P(ray of the idneys ,intravenous pyelo!ram L0I)% or cystoscopy. For

more information% see the topics Drine *ulture% 0ntravenous )yelo!ram ,0I)% and

*ystoscopy.

Other urine tests

-ru!s can also be detected in urine for a certain time after they are used. *annabis

can be detected% dependin! on the type of test used% up to several wees after it has been

taen# dru!s lie cocaine% ecstasy or heroin for up to : days. -ifferent tests are also used in

detectin! dru! use# rapid tests% which can help !ive police fast results in the field% and other

tests% that need to be done in laboratories. Drine samples are also used when !ivin! athletes

dru! tests to chec whether someone has used banned substances.

-0"uate% or because the bodys cells do not respond properly to

insulin% or both. )atients with hi!h blood su!ar will typically e'perience polyuria ,fre>uent

urination% they will become increasin!ly thirsty ,polydipsia and hun!ry ,polypha!ia.

There are three types of diabetes#

4 Type 4 -iabetes

The body does not produce insulin. Jome people may refer to this type as insulin(dependent diabetes% uvenile diabetes% or early(onset diabetes. )eople usually develop type 4

diabetes before their 59th year% often in early adulthood or teena!e years.

4 Type 4 diabetes is nowhere near as common as type + diabetes. "ppro'imately 49@ of all

diabetes cases are type 4.

)atients with type 4 diabetes will need to tae insulin inections for the rest of their

life. They must also ensure proper blood(!lucose levels by carryin! out re!ular blood tests

and followin! a special diet.


16/23

Overwei!ht and obese people have a much hi!her ris of developin! type + diabetes

compared to those with a healthy body wei!ht. )eople with a lot of visceral fat% also nown

as central obesity% belly fat% or abdominal obesity% are especially at ris.


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and !rowth. Most of what we eat is broen down into !lucose. 6lucose is a form of su!ar in

the blood ( it is the principal source of fuel for our bodies.

hen our food is di!ested% the !lucose maes its way into our bloodstream. Our cells

use the !lucose for ener!y and !rowth. However% !lucose cannot enter our cells without

insulin bein! present ( insulin maes it possible for our cells to tae in the !lucose. 0nsulin is

a hormone that is produced by the pancreas. "fter eatin!% the pancreas automatically releases

an ade>uate >uantity of insulin to move the !lucose present in our blood into the cells% as

soon as !lucose enters the cells blood(!lucose levels drop.

" person with diabetes has a condition in which the >uantity of !lucose in the blood is

too elevated ,hyper!lycemia. This is because the body either does not produce enou!h

insulin% produces no insulin% or has cells that do not respond properly to the insulin the

pancreas produces. This results in too much !lucose buildin! up in the blood. This e'cess

blood !lucose eventually passes out of the body in urine. Jo% even thou!h the blood has

plenty of !lucose% the cells are not !ettin! it for their essential ener!y and !rowth

re>uirements.

How To -etermine hether You Have -iabetes% )rediabetes or 2either -octors can

determine whether a patient has a normal metabolism% prediabetes or diabetes in one of three

different ways ( there are three possible tests#

The "4* test

at least 8.:@ means diabetes

between :./@ and :.CC@ means prediabetes less than :./@ means normal

The F)6 ,fastin! plasma !lucose test

at least 4+8 m!Bdl means diabetes

between 499 m!Bdl and 4+:.CC m!Bdl means prediabetes

less than 499 m!Bdl means normal

"n abnormal readin! followin! the F)6 means the patient has impaired fastin! !lucose

,0F6

The O6TT ,oral !lucose tolerance test

at least +99 m!Bdl means diabetes

between 459 and 4CC.C m!Bdl means prediabetes

less than 459 m!Bdl means normal

"n abnormal readin! followin! the O6TT means the patient has impaired !lucose tolerance

,06T

Researchers from the Mayo *linic "ri&ona in Jcottsdale showed that !astric bypasssur!ery can reverse type + diabetes in a hi!h proportion of patients. They added that within


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three to five years the disease recurs in appro'imately +4@ of them. Yessica Ramos% M-.%

said The recurrence rate was mainly influenced by a lon!standin! history of Type + diabetes

before the sur!ery. This su!!ests that early sur!ical intervention in the obese% diabetic

population will improve the durability of remission of Type + diabetes. ,7in to article

)atients with type 4 are treated with re!ular insulin inections% as well as a special diet

and e'ercise. )atients with Type + diabetes are usually treated with tablets% e'ercise and a

special diet% but sometimes insulin inections are also re>uired. *omplications lined to badly

controlled diabetes#

Eye complications ( !laucoma% cataracts% diabetic retinopathy% and some others.

Foot complications ( neuropathy% ulcers% and sometimes !an!rene which may re>uire

that the foot be amputated

Jin complications ( people with diabetes are more susceptible to sin infections and

sin disorders Heart problems ( such as ischemic heart disease% when the blood supply to the heart

muscle is diminished

Hypertension ( common in people with diabetes% which can raise the ris of idney

disease% eye problems% heart attac and stroe

Mental health ( uncontrolled diabetes raises the ris of sufferin! from depression%

an'iety and some other mental disorders

Hearin! loss ( diabetes patients have a hi!her ris of developin! hearin! problems

6um disease ( there is a much hi!her prevalence of !um disease amon! diabetes

patients

6astroparesis ( the muscles of the stomach stop worin! properly Ketoacidosis ( a combination of etosis and acidosis1 accumulation of etone bodies

and acidity in the blood.

2europathy ( diabetic neuropathy is a type of nerve dama!e which can lead to several

different problems.

HH2J ,Hyperosmolar Hyper!lycemic 2onetotic Jyndrome ( blood !lucose levels

shoot up too hi!h% and there are no etones present in the blood or urine. 0t is an

emer!ency condition.

2ephropathy ( uncontrolled blood pressure can lead to idney disease

)"- ,peripheral arterial disease ( symptoms may include pain in the le!% tin!lin! andsometimes problems walin! properly

Jtroe ( if blood pressure% cholesterol levels% and blood !lucose levels are not

controlled% the ris of stroe increases si!nificantly

Erectile dysfunction ( male impotence.

0nfections ( people with badly controlled diabetes are much more susceptible to

infections

Healin! of wounds ( cuts and lesions tae much lon!er to heal

Met#!d!l!)y

E=a"inati!n !9 t#e a"!-nt !9 -rine


19/23

E>uipment#

measurin! cup

urine container

Materials#

Drine +5 hours

How it ors#

4. *ollect of urine for +5 hours. note the amount of urine durin! the 4+(hour and 4+(hour

urine ni!ht and the amount of urine now. Record the measurements.

E=a"inati!n !9 -rine !d!r

E>uipment#

closed container

Materials#

Fresh urine without preservative

How it wors#

4. 0nsert fresh urine into the container and immediately identify the smell comin! out of

the urine.+. Record the results of the e'amination.

E=a"inati!n !9 -rine 8!l!r

E>uipment#

Test tube

Flashli!ht

Materials#

Fresh urine

How it wors#

4. )our the urine into a test tube filled up 3B5 of the tube. then tilt the tube

+. )rovide e'posure to the tube

3. Jpecify the color of the urine with the statement# colorless% pale yellow% dar yellow%

yellow% yellow red mi'ed% etc.

5. Record the results of the e'amination

Deter"ine t#e 8larity !9 t#e -rine


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E>uipment#

Test tube

Flashli!ht

Materials#

Fresh urine

How it wors#

4. )our the urine into a test tube filled up 3B5 of the tube. then tilt the tube

+. )rovide e'posure to the tube

3. -etermine the clarity of the urine with the statement# clear% somewhat clear% cloudy%

and very turbid

5. Record the results of the e'amination

Deter"ine t#e s7e8i9i8 )raity !9 -rine

E>uipment#

Drinometer

Drinometer !lass

Materials#

Drine

How it wors#

4. )our into a !lass urinometer urine. foam may be formed with a piece of paper thrown

away or drop ether

+. Enter urine into the urinometer !lass. to be free floatin! urinometer then there must be

>uite a lot of urine in a cup. if the amount is too little urine dilute urine with distilled

water a number of urine. to calculate its density% the second last number of readin!s

must be multiplied by two anyway.

3. uipment#

Dniversal indicator

Drine container


21/23

Materials#

Fresh urine

How it wors#

4. Dniversal indicator of wet urine checed . wait for a few minutes .

+. 2ote the color chan!e occurs .

3. *ompare with the list of colors available on the acidity of universal indicator. Jpecify

a value correspondin! to the color.

5. Record the measurement results.

Pr!tein test .it# a8eti8 a8id

E>uipment#

test tube

burner ,uipment#

test tube

burner ,


22/23

flashli!ht

blac cardboard

Materials#

Drine


23/23

Documents

Theory Urinalysis