BIO-202L-RS-Activity 3Urinalysis Lab- Onground Answers PDF

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This was a urine lab were we used urine and tested it to see what was in it and used it to decie what kind of disease it has....

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BIO-202L Urinalysis Lab

Name: _____________

Urine is produced by the kidneys and held in the bladder until micturition. The content, appearance, concentration, and amount of urine can be used to assess a wide range of disorders. Abnormal analysis may reveal the presence of diseases such as urinary tract infections, kidney disease, kidney stones, or diabetes mellitus. The first part of urinalysis is macroscopic analysis. Examination of the color and turbidity (cloudiness of a fluid) will give information about the sample. Normal, fresh urine is clear and should be pale to dark yellow in color. The presence of a red color or brownish color (cola colored) may indicate the presence of hemoglobin or myoglobin. Certain drugs, food dyes, and foods such as beets can also turn urine a red or red-brown color. Turbid urine can be milky or hazy looking and can be caused by the presence of pus, protein, white blood cells, or red blood cells. In the space below write down your visual observations for each of the four samples. It is important to note the color and consistency of the urine.

Sample 1: The color is clear. pH8.0 no glucose presents Protein’s present

Sample 3: The color is clear to light yellow. pH8.0 glucose present proteins present

The second part of urinalysis is done using urine test strips. The test strips contain up to ten different panels that contain chemicals or reagents and, when exposed to urine, change colors. It is a very fast analysis and only takes a minute or two for the reagents to completely react with the urine. The panels are then compared to a standard image provided by the strip manufacturer. The most common tests on a urinalysis test strip are: Glucose: When glucose is present in urine, this condition is known as glycosuria. When glucose is secreted into the primary filtrate, it is normally completely reabsorbed and there is almost no measurable glucose in the excreted urine. If there is excessive glucose in the filtrate, and the renal threshold is exceeded resulting in incomplete glucose reabsorption, glucose is present in the excreted urine. Excessive glucose in the primary filtrate occurs when there is excessive glucose circulating in the blood. A positive result on this panel indicates the presence of diabetes mellitus (type one or type two). Ketones: Ketone bodies are water soluble molecules that are the by-product of fat breakdown in the liver. Ketones circulating in the blood can cause decreased blood pH levels and condition known as ketoacidosis. Ketone bodies can appear in small amounts in the urine and their presence is known as ketonuria. A positive panel for ketones may indicate diabetes mellitus (normally type one), starvation, or diarrhea. Blood: The presence of blood in the urine can be detected by this panel, specifically it detects hemoglobin. There can be many causes of blood in the urine, not all of which are pathological. For example, menstruating females often exhibit blood on a urine dipstick test. The presence of just hemoglobin can be indicative of hemolytic anemia, transfusion reaction, burns, or renal disease among

others. When intact red blood cells are present (erythrocytes) the causes can include kidney stones, tumors, glomerulonephritis, physical trauma, urinary tract infection, or prostatitis. pH: Normal urine has, on average, a slightly acidic pH of 6. The pH can vary between 4.5 to 8 depending upon the condition. Diet can affect urine pH with high protein diets lowering the pH and vegetarian diets tending to increase the ph. Urinary tract infections caused by bacteria can increase urine pH to 7-8, and ketoacidosis can lower pH to 4-5. Protein: This panel tests for the presence of proteins and is most sensitive to albumin, which is made by the liver and is the most common blood plasma protein. Under normal conditions, albumin is too large to pass through glomerular filtration. Therefore, the presence of albumin indicates increased permeability of the filtration membrane. Like blood, testing positive for protein does not always indicate a pathological condition. For example: pregnancy, exercise, and increased dietary protein intake can all result in a positive test. Pathological conditions that can result in a positive test include diabetes mellitus, high blood pressure, glomerulonephritis bacterial toxins, and chemical poisons. Nitrate: The most common cause of urinary tract infections is the gram-negative bacteria E. coli. Certain gram-negative bacteria convert nitrate from the diet, now present in the urine, to nitrite. Abnormally high readings of nitrate indicate the presence of nitrate converting bacteria. Leukocytes: Leukocytes are white blood cells that are part of the immune system. When they are excreted in a high volume it creates pus, and the presence of pus in the urine is called pyuria. This panel indicates the presence of leukocytes, which is most often caused by a urinary tract infection or prostatitis. Urobilinogen: When red blood cells are removed from circulation the hemoglobin is broken apart into its iron containing heme group, and the protein globin. The heme group is further broken apart into the iron molecule and bilirubin which is secreted in bile. Further breakdown of bilirubin results in urobilinogen, with the majority of this substance excreted in the feces. Small amounts of urobilinogen are reabsorbed into the blood from the intestinal tract and then filtered out into urine. Increased levels of urobilinogen can be caused by liver diseases such as cirrhosis or viral hepatitis. Urobilinogen levels can also increase due to liver damage or hemolytic anemias. Bilirubin: See urobilinogen. Specific Gravity: The density of the urine, in other words how many solids are dissolved in the urine, is measured by specific gravity. Specific gravity indicates how dilute or concentrated a sample is. Water has a specific gravity of 1.00 and will always have a greater value depending upon the amount of dissolved substances such as salts. The lower the specific gravity, the more dilute the urine. The higher the specific gravity, the more concentrated the urine. Specific gravity indicates the kidney’s ability to concentrate urine. Normal urine has a specific gravity range between 1.010 - 1.025. Low specific gravity (i.e., dilute urine) is associated with conditions like diabetes insipidus, excessive water intake, or chronic renal failure. High specific gravity may indicate dehydration, glycosuria, or excess ADH.

Test each of the four samples provided for you with the test strips provided by your instructor. Be sure to note the panel (i.e., glucose, pH, ketones) and how each sample reacted.

Test Panel Color

Sample 1 clear

Sample 2 brown

Sample 3 Clear to light yellow

Sample 4 Yellow to amber

Ph Glucose present? Protein present diagnosis

8.0 -

8.0 +

-

+

-

-

+

Diabetes mellitus, ketoacidosis.

High blood pressure, urinary infection

ketoacidosis

healthy

Diabetes mellitus, high blood pressure, urinary tract infection

For each case study identify the sample that belongs to the patient profiled in the case study then explain why the sample matches the case study.

Case Study 1 65-year-old Ryan M. has come to you, his general practitioner, complaining of blurred vision, constant thirst (polydipsia), and constantly needing to urinate (polyuria). He mentions that he is also constantly hungry and this has resulted in a 20 lb. weight gain over the last few months. In his glory days about 40 years ago he was a Mr. Universe contestant, but now he is a professional video poker player who spends most of his days on his computer. He is obese and admits to having a diet of primarily fast food and alcohol. After examination of his urine strip and a blood test, you diagnose Ryan with Type 2 diabetes mellitus and advise him on lifestyle changes and medication.

Which sample belongs to Ryan M.? Clearly explain which panels are relevant and what their readings are. Also describe the macroscopic examination of Ryan’s urine. Ryan M. urine is sample one’s urine. You can see this through the glucose that is in the urine and that the urine’s pH is greater than 4.0. The urine will have glucose in it because the body had too much glucose in it. This mean more that there was not enough insulin produced by the body to store the glucose so it is exerted during urination. Even though you can have ketones in your urine for Type 1 diabetes mellitus, this patient has Type 2 diabetes mellitus, which means that he will not have ketones present in the urine. At a micropig level, it should look like pretty normal pee, except for the fact that there will be glucose in the urine and there can also possible be ketones as well.

Case Study 2 Stephanie S. is a 45-year-old trapeze artist who has stopped by your urgent care while performing in your town. She is concerned because she has sapropelic pain and pressure, increased frequency and urge to urinate, and chronic pelvic pain. She has had these symptoms on and off for several months, but this her first visit to a physician due to her travelling schedule. These symptoms are interfering with her ability to perform and she is concerned about her career. You immediately suspect a chronic urinary tract infection, but her urine dipstick and a urine culture that come back negative for bacteria. You advise Stephanie that with diet and a medication she can control her symptoms, and you diagnose her with a chronic inflammatory condition known as interstitial cystitis. Which sample belongs to Stephanie S.? Clearly explain which panels are relevant and what their readings are. Also describe the macroscopic examination of Stephanie’s urine. Sample 4 probably belongs to her. This is because there are no bacteria in her urine, there is no glucose in her urine, and there are not proteins. She seems to have some uncomfortable inflammation, but does not really seem to have anything serous, and probably is healthy. At a macroscopic examination of her pee, we really would not find anything in her urine, except for what would be expected: water, urea, inorganic salts, creatinine, ammonia, and pigmented products of blood breakdown.

Case Study 3 It is Monday morning and 8-year-old Polly’s mother brought her to you, a pediatrician. She says that her daughter has suddenly been short of breath, suffering from weakness, nausea and vomiting, polydipsia, and polyuria. When examining her daughter, you notice her breath has a fruity scent to it. Polly has Type 1 diabetes which is normally well controlled through diet and medication, but this weekend she stayed overnight at a friend’s house and may have forgotten to take her medication. The sleepover was part of a birthday party and Polly whispers in your ear that she had two pieces of frosted cake that her mom doesn’t know about. You diagnose Polly with diabetic ketoacidosis. Which sample belongs to Polly? Clearly explain which panels are relevant and what their readings are. Also describe the macroscopic examination of Polly’s urine.

Polly’s urine is probably sample 1. This is because she would expel glucose in her urine since she is a diabetic who had something that is really sugary without taking her insulin. She also has ketoacidosis which is seen through how the pH of the urine is lower than it should be. This is something that is more typical of diabetics who either are not taking their insulin like Polly or they do not know that they have diabetes. At a microscopic level, would expect to find all the normal things like water, urea, inorganic salts, creatinine, ammonia, and pigmented products of blood breakdown, but we should also expect to see glucose and ketones in her urine as well.

Case Study 4 Tom has brought his 89-year-old mother, Amanda, in to see you. She lives in an assisted care facility but this morning one of her regular caregivers called Tom to let him know that Amanda was having difficulties. Tom arrived to find Amanda disoriented and confused. She refused to let the caregiver in to help her, and asked repeatedly to go home. Tom had dinner with Amanda only three days before and he states that she had been completely lucid and exhibited no signs of confusion. Amanda is in the assisted care facility due to a recent hip replacement that required long-term rehabilitation. You take her vital signs and find that her blood pressure and heart rate are normal, but she has a fever of 102 Fahrenheit. You tell Tom you want a urine sample from Amanda, but Tom says that is unnecessary and insists she get checked for Alzheimer’s disease. You explain to Tom that since Amanda has been unable to move around easily due to her hip replacement, it is likely that she has been holding in her urine. Retaining urine has likely resulted in a urinary tract infection. In elderly people UTIs sometime manifest as cognitive dysfunction due to the fever and pain. This results in diminished cognitive capacity, confusion, and agitation. Tom consents to a urinalysis and urine culture, which confirms the presence of a UTI and you prescribe the appropriate antibiotics. In a few days Amanda should return to her normal self. Which sample belongs to Amanda? Clearly explain which panels are relevant and what their readings are. Also describe the macroscopic examination of Amanda’s urine. Amanda’s sample of pee is probably sample 2. This is because she has a urinary tract infection, which means that there should be some blood in her urine. In blood there is proteins, which is why her urine tested positive for having proteins in it and the brown color is a result of having blood combined with urine. In addition, we can see that patient 2 is Amanda because if someone were to have a UTI, the pH of the urine would be between 8.5-9.0, which is expedited in sample 2’s urine. Also, at a microscopic level, we would find all of the normal things like water, urea, inorganic salts, creatinine, ammonia, and pigmented products of blood breakdown, but we would also find blood and all the things that are in blood like proteins. Also, it makes sense that Amanda could also have high blood pressure because she is elderly. High blood pressure could cause the blood into urine if Amanda were to have a microscopic hematuria.

Blood Pressure and Urine Chronic high blood pressure can cause kidney damage and result in changes to urine. Macroscopic analysis may reveal decreased urine volume and possible blood in the urine. Strip analysis may reveal

the presence of excessive albumin due to destruction of the glomerulus. Regulation of blood pressure involves the renin-angiotensin-aldosterone hormone system. In the space below please draw and label a nephron including the glomerulus, juxtaglomerular apparatus, afferent arteriole, efferent arteriole, Bowman’s capsule, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting duct. Also indicate: a. Where renin is released from: It is released from the kidneys. Juxtaglomerular cells are what sore and release the renin in the kidney. b. Where most salts and nutrients are reabsorbed from the tubules Proximal convoluted tubule. c. Where most drugs are secreted into the tubules. Proximal convoluted tubule d. Where water conservation takes place Distal convoluted tubule Distal convoluted tubules

a. b. c. d. e. f.

Glomerulus (only outside line) Bowman’s capsule Proximal convoluted tubule Distal convoluted tubule Collecting duct Excite from collecting duct

g-I Loop of Henle (they all just pointing to subgroups) j. afferent arterioles k. efferent arterials Please draw a diagram of the renin-angiotensin-aldosterone system beginning with the liver and angiotensinogen. To do this, please indicate the organ that produces each hormone and indicate the effect each hormone has....