Physical Examination of Urine

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1

urochrome

lipid-soluble pigment in plasma excreted at a constant rate in urine; gives urine the characteristic yellow color

2

urobilin

orange-brown pigment

3

uroerythrin

pink pigment; evident when deposited on rate crystals producing a precipitate often described as brick dust

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amount of substance present, urine pH, and structural form of substance

factors of substances that can change the color of urine

5

brown urine

can indicate presence of blood, hemoglobin, or myoglobin in a fresh specimen

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brown or black urine

as red blood cells disintegrate, hemoglobin is released and oxidizes to methemoglobin

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bilirubin

by-product of hemoglobin catabolism and has characteristic yellow color

8

amber

indicates presence of significant bilirubin

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greenish color

indicates improperly stored urine where bilirubin has oxidized to biliverdin

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orange-brown

indicates urobilinogen oxidized to urobilin

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phenazopyridine

drug used to treat UTI's that gives distinct yellow-orange (orange soda) color and may interfere with color interpretation on chemical reagent strip

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white foam

indicates large amounts of albumin in urine

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yellow foam

caused by increased bilirubin

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clarity or turbidity

Describes cloudiness of urine caused by suspended particulate matter that scatters light

15

clear

no or rare visible particles; transparent; all solutes present are soluble

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hazy or slightly cloudy

visible particles present; newsprint can be read when viewed through urine tube; indicates presence of blood cells or contaminants

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cloudy

significant particulate matter; newsprint is blurred or difficult to read when viewed through urine tube; indicates crystals, epithelial cells, fats, microbes, or contaminants

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turbid

newsprint cannot be seen when viewed through urine tube; indicates mucus, contrast media, semen, or contaminants

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amorphous phosphates

alkaline urine that produces a white or beige precipitate

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amorphous urates and uric acid crystals

acidic urine producing a pinkish precipitate (brick dust)

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ammonia

converted from urea due to bacteria from standing urine

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ketones

produce sweet or fruity smell of urine

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amino acid disorders

often produce odd odors

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concentration

refers to the quantity of solutes present in volume of water excreted

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94%

percentage of water in urine

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6%

percentage of solutes in urine

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diet, physical activity and health

factors that cause variety in solute types

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specific gravity

rapid assessment of urine concentration in terms of density; mass solutes present per volume of solution; considers both number of solute particles and their molecular size

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osmolality

used for more accurate assessment of urine concentration; considers only solutes present

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1.002

lowest possible specific gravity

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1.040

highest possible specific gravity

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refractometry and reagent strips

the two indirect methods of specific gravity measurement

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refractive index

the ratio of light refraction in two differing media

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refractometry

indirect method of measuring specific gravity based on refractive index of light

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wavelength of light, temperature of solution, and concentration of solution

the three factors that affect the refractive index of a solution

36

1.022

specific gravity of NaCl

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protein and glucose

two solutes also included in specific gravity

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glucose, urea, protein, and radiographic media

nonionic solutes not measured in reagent strip method

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reagent strip method

indirect colorimetric estimation of urine density based on amount of ionic or charged solutes present

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protons

Release changes pH of test pad, resulting in a color change of reagent strip pad

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radiographic contrast media

suspected if refractometer reads >1.040, but reagent strip reads normal

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275-300 mOsm/kg

normal serum osmo reference range

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275-900 mOsm/kg

normal urine osmo reference range

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milliosmoles (mOsm/kg)

units of measurement for osmolality

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evaluate renal system, monitor renal disease, monitor fluid and electrolyte balance, and diagnose polyuria cuases

the four principal uses of osmolality

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600-1800 mL/day

normal urinary output per day

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isothenuria

inability of kidneys to change specific gravity of plasma ultra filtrate (1.010) whether hydrated or dehydrated

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polyuria

excretion of greater than 3L/day

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oliguria

excretion of less than 400 mL/day

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anuria

complete lack of urine excretion