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Tubular Reabsorption
Substance Location
Active transport Glucose, amino acids, salts Proximal convoluted tubule
Chloride Ascending loop of Henle
Sodium Proximal and distal convoluted tubules
Passive transport Water Proximal convoluted tubule
Descending loop of Henle
Collecting duct
Urea Proximal convoluted tubule
Ascending loop of Henle
Sodium Ascending loop of Henle
Chapter III: Introduction to Urinalysis
Urine Clarity
Clarity Clarity
Clear No visible particulates, transparent.
Hazy Few particulates, print easily seen through urine.
Cloudy Many particulates, print blurred through urine.
Turbid Print cannot be seen through urine.
Milky May precipitate or be clotted.
Laboratory Correlations
Acidic Urine Amorphous urates
Radiographic contrast media
Alkaline Urine Amorphous phosphates
Carbonates
Soluble With Heat Amorphous urates
Uric acid crystals
Soluble in Dilute Acetic Acid RBCs
Amorphous phosphates
Carbonates
Insoluble in Dilute Acetic Acid WBCs
Bacteria, yeast
Spermatozoa
Soluble in Ether Lipids
Lymphatic fluid
Chyle
Tablet Procedures
Clinitest (Glucose) Place a glass test tube in a rack, add 5 drops of urine.
Add 10 drops of distilled water to the urine in the test tube.
Drop one Clinitest tablet into the test tube and observe the reaction until completion (cessation of
boiling).
CAUTION: The reaction mixture gets very hot. Do not touch the bottom area of the test tube. Use glass
test tube only.
Wait 15 seconds after boiling has stopped and gently shake the contents of the tube.
Compare the color of the mixture to the Clinitest color chart and record the result in mg/dL or percent.
Observe for the possibility of the “pass-through” phenomenon.
Repeat using the 2-drop procedure.
Acetest (Ketone) Remove the Acetest tablet from the bottle and place on a clean dry piece of white paper.
Place one drop of urine on top of the tablet.
Wait 30 seconds.
Compare the tablet color with the manufacturer supplied color chart.
Report as negative, small, moderate, or large.
Ictotest (Bilirubin) Place 10 drops of urine onto one square of the absorbent test mat.
Using forceps, remove one Ictotest reagent tablet, recap the bottle promptly, and place the tablet in
the center of the moistened area.
Place one drop of water onto the tablet and wait 5 seconds.
Place a second drop of water onto the tablet so that the water runs off the tablet onto the mat.
Observe the color of the mat around the tablet at the end of 60 seconds. The presence of a blue-to-
purple color on the mat indicates that bilirubin is present. A slight pink or red color should be ignored.
Report as positive or negative.
Jaundice
Urine Bilirubin Urine Urobilinogen
Bile duct obstruction +++ Normal
Liver damage + or - ++
Hemolytic disease Negative +++
Collection
CSF Tube Test Preservation/Storage
1 Chemical and serologic tests Freezing (-15° to -30°C)
2 Microbiology study Room temperature
3 Hematology (cell count) reftigeration
4 Optional; for additional tests
Composition of Semen
Spermatozoa 5%
Seminal fluid 60%–70%
Prostate fluid 20%–30%
Bulbourethral glands 5%
Joint Disorders
Group Classification Pathologic Significance Laboratory Findings
1. Noninflammatory Degenerative joint disorders, osteoarthritis Clear, yellow fluid
Good viscosity
WBCs <1000 uL
Neutrophils <30%
Normal glucose (similar to blood glucose)
2. Inflammatory Immunologic disorders, rheumatoid arthritis, lupus Immunologic Origin:
erythematosus, scleroderma, polymyositis, anklylosing Cloudy, yellow fluid
spondylitis, rheumatic fever, and Lyme arthritis Poor viscosity
Crystal-induced gout and pseudogout WBCs 2000–75,000 uL
Neutrophils <50%
Decreased glucose level
Possible autoantibodies present
Crystal-induced origin:
Cloudy or milky fluid
Low viscosity
WBCs up to 100,000 uL
Neutrophils <70%
Decreased glucose level
Crystals present
3. Septic Microbial infection Cloudy, yellow-green fluid
Variable viscosity
WBCs 50,000–100,000 uL
Neutrophils <75%
Decreased glucose level
Positive culture and Gram stain
4. Hemorrhagic Traumatic injury, tumors, hemophilia, other Cloudy, red fluid
coagulation disorders Low viscosity
Anticoagulant overdose WBCs equal to blood
Neutrophils equal to blood
Normal glucose level
Significant colors
Transparent Normal
Yellow green TB, Bronchiectasis
Green P. aeruginosa
Red TB
Rusty red Lobar pneumonia
Brown Congestive heart failure
Black Heavy smokers
Olive/grass green Carcinoma of the lungs
Significant odors
Normal Odorless
Foul/putrid Cavitary TB, Lung abscess. Gangrene
Fruity/Sweet odor P. aeruginosa, bronchiectasis and bronchomoniliasis, pulmonary TB
Cheesy odor Necrosis or malignant tumors and perforating empyemas
Fecal odor Ruptured subphrenic or liver abscess and in enteric gram-negative products
Causes of Blood-Stained Sputum
Cause Appearance
Pneumococcal pneumonia Uniform, rusty color, pus present
CHF/Mitral valve disease Uniform, rusty color, no pus
Klebsiella pneumonia Bright streaks in viscid sputum
Bronchogenic carcinoma Scant but persistent streaks in mucoid sputum
Tuberculosis Episodic occurrences of small hemorrhages
Cavitary TB, Pulmonary Infarction, Fungal Pneumonia Episodes of large hemorrhages
Bleeding in nose/nasopharynx Spurious hemoptysis
Chemical Examination
Qualitative tests (Free HCl) Reagent: Positive result
Topfer’s test Dimethylaminoazobenzol Cherry red color
Boas’ test Resublimed resorcinol, cane sugar, 95% alcohol Rose-red color
Gunzberg’s test Phloroglucin, vanillin & 95% alcohol Purplish-red color
Diagnex blue test Caffeine stimulation Azure blue in urine
Quantitative tests (Free HCl)
Topfer’s method Dimethylaminoazobenzol; 0.1N NaOH Canary yellow color
Total acidity Phenolphthalein; 0.1N NaOH Faint pink
Combined HCl Sodium alizarin sulfonate; 0.1N NaOH Violet color
Quantitative tests (Lactic acid)
Modified Uffelman’s test Phenol and FeCl3 (Amethyst blue) Canary yellow
Strauss test 20% FeCl3 and ether Yellowish-green or slight green color
Kelling’s test FeCl3 Faint to deep yellow
Microscopic examination
Pus cells Stomach abscess; chronic gastritis; gastric carcinoma
RBC Bleeding
Columnar epithelial cells Gall bladder disease
Yeast; bacteria; parasites Boas-Oppler bacilli
Boas-Oppler bacilli Increased in gastric fluid which is devoid of or with little HCl
Food residues Pyloric obstruction
Murexide Test
Uric acid Deep yellow to orange-red or crimson purplish (ammonium molybdate), bluish violet (NaOH)
Xanthine Greenish yellow to orange (NH4OH) reddish (warming), deep orange-red (NaOH)
Protein Pale yellow orange
Sulfonamides Yellow mahogany brown