Urine Samples Type, and Composition

Urine samples Types

What are the indications of urine examination?

1. This is part of the routine workup of a patient.
2. It can diagnose urinary tract infections.
3. It can diagnose diabetes.
4. Diagnose any abnormality of metabolism.

What are the types of Urine samples?

1.  Random sample:
   1. This is a diluted urine sample and may give an inaccurate interpretation of patient health. However, it is best to do microscopy to evaluate WBC or RBC.
2. First Morning sample:
   1. This is the best sample for microscopy and urine analysis. It is concentrated urine because urine remains in the urinary bladder throughout the night.
   2. This will contain an increased concentration of analytes and cellular elements.
   3. Urine must have remained in the bladder for 8 hours and is considered the first-morning sample.
3.  Urine for sugar (Postprandial 2 hours):
   1. The postprandial 2-hour sample was collected after 2 hours of a high carbohydrate diet.
4. Midstream clean catch urine:
5. This sample is needed for the culture and sensitivity of urinary infections.
6. The patient is advised to clean the urethra and discard the first few mL of urine.
7. Now, the midstream of the urine is collected in the sterile container.
8. 24-Hour of a urine sample
9. In this case, discard the first urine and note the time.
10. Urine will be collected in the container for 24 hours, and the last sample will be put in the container.
11. Refrigerate the sample.
12. These 24 hours of samples are needed to measure urea, creatinine, sodium, potassium, glucose, and catecholamines.
13. Supra-pubic collection of the urine sample:
    1. It is done in patients who cannot be catheterized; the sample is needed for culture.
    2. With the help of a needle, a urine sample is collected.

Urine samples: Urine suprapubic aspiration

14.  Catheter collection of urine:
    1. This is done in patients who are bedridden and can not urinate.
15. Pediatric urine sample:
    1. In infants, special collection bags are made adherent around the urethra.
    2. Then, urine is transferred to a container.

Urine storage and preservation (Precautions):

1. Preserving urine is essential to keeping its constituents intact. Without preservation, the number of bacteria and chemicals in urine will change.
2. To prevent bacterial growth, immediately refrigerate the urine.
3. Light-sensitive chemicals are protected by keeping the urine in a colored bottle like an amber plastic bottle.
4. Precipitation of calcium and phosphate can be prevented by acidifying the urine.
5. Freshly voided and concentrated urine is needed to see the crystals, casts, RBCs, and white cells.
6. Ideally, urine should be examined within one hour of collection.
7. Sodium fluoride can be added to estimate 24 hours of glucose. It inhibits the growth of bacteria.
8. 10 ml of HCl (6N) is added to the containers to estimate VMA.

 What is the Pathophysiology of urine?

1. The kidneys continuously form urine.
2. This process is basically the ultrafiltration of plasma or blood, where glucose, amino acids, water, and important metabolically active substances needed for the body are absorbed.
   1. Ultrafiltrate has constituents like plasma, so this is called ultrafiltrate.
   2. Each nephron (one glomerulus unit) can filter 100 µL ultrafiltrate daily.
   3. The total ultrafiltrate formed is 170 to 200 L/day.

Urine Samples: Urine formation and renal threshold

3. After absorption, the urine formation is 0.4 to 2 L/day.

Urine samples: Urine formation and excretion

How will you summarize the urine formation?

1. Ultrafiltrate by the glomerulus and nephron.
   1. It does not contain large molecular structures like blood cells and large proteins.
2. Tubular resorption occurs in the proximal tubule, loop of Henle, and distal consulted tubules.
   1. It also occurs in the collecting ducts.
   2. Most necessary chemicals like glucose, amino acids, water, and electrolytes are reabsorbed.
   3. The loop of Henle concentrates the urine by absorbing the water.
3. Tubular secretion leads to waste products such as Hydrogen, Ammonia, Potassium, urea, creatinine, and drugs.

Urine formation stages

What is the urine composition?

1. Urine is a mixture of water, which is about 96% and 4% dissolved substances.
   1. Urea is about one-half of the dissolved substances.
   2. The main substances are sodium, potassium, urea, creatinine, calcium, magnesium, phosphate, sulfates, and ammonia.
2. An average of 170,000 ml/day of plasma passes from the kidney, and an average of 1200 ml of urine is formed/per day.

What is the composition of the Urine?

1. Water 95%.
2. Organic substances are 5%:
   1. Urea. It is 2% of the total.
   2. Creatinine.
   3. Uric acid.
   4. Ammonia.
   5. Hippuric acid.
3. Inorganic substances are:
   1. Chloride.
   2. Sodium.
   3. Potassium.
   4. Bicarbonate.
   5. Traces of Ammonia.
   6. Calcium.
   7. Phosphate.
   8. Magnesium.
4. Other substances are:
   1. Hormone.
   2. Vitamins.
   3. Medications (Drugs metabolites).
   4. Cells.
   5. Casts.
   6. Crystals.
   7. Mucous.
   8. Bacteria.
5. Abnormal contents are:
   1. Pus cells.
   2. Red blood cells.
   3. Glucose.
   4. Ketone bodies.
   5. Bilirubin.
   6. Urobilinogen.

Urine water reabsorption

What is the role of Kidneys?

1. Clear the body waste products.
2. Maintain the water and electrolyte balance.
3. This selective function in the nephron is controlled by:
   1. Renal blood flow.
   2. Glomerular filtration.
   3. Tubular reabsorption and secretion.
4. Urine concentration and dilution occur in the renal medulla.

What are the functions of the kidneys?

1. To concentrate or dilute the urine.
2. Regulate sodium excretion.
3. Regulate Blood chemistry.
4. Regulate Fluid balance.
5. Regulate nutrient intake.
6. Regulate blood pressure.

Questions and answers: