Fundamentals of Urine and Body Fluid Analysis

Front Cover
Quick Guide To Urinalysis Figures
Fundamentals of Urine and Body Fluid Analysis
Copyright Page
Reviewers
Preface
Acknowledgments
Contents
1 Quality Assessment and Safety
	Key Terms
	Quality Assessment
		Quality Assessment: What Is It?
		Preanalytical Components of Quality Assessment
		Analytical Components of Quality Assessment
			Equipment
			Reagents
			Procedures
			Standardization of Technique
			Qualified Personnel
		Monitoring Analytical Components of Quality Assessment
		Postanalytical Components of Quality Assessment
	Safety in the Urinalysis Laboratory
		Biological Hazards
			Personal Protective Equipment
			Specimen Processing
			Disposal of Waste
			Decontamination
		Chemical Hazards
			Handling Chemical Spills
			Disposal of Chemical Waste
		Other Hazards
	References
	Bibliography
2 Urine Specimen Types, Collection, and Preservation
	Key Terms
	Why Study Urine?
	Specimen Types
		First Morning Specimen
		Random Urine Specimen
		Timed Collection
	Collection Techniques
		Routine Void
		Midstream “Clean Catch”
		Catheterized Specimen
		Suprapubic Aspiration
		Pediatric Collections
		Reasons for Urine Specimen Rejection
		Urine Volume Needed for Testing
	Urine Specimen Storage and Handling
		Containers
		Labeling
		Handling and Preservation
			Changes in Unpreserved Urine
			Preservatives
			Timed Collections
	Is this Fluid Urine?
	Study Questions
	References
	Bibliography
3 The Kidney
	Key Terms
	Renal Anatomy
	Renal Circulation
	Renal Physiology
		Urine Formation
		Glomerulus
		Tubules
		Tubular Function
			Transport
			Reabsorption
			Secretion
			Regulation of Acid-Base Equilibrium
			Tubular Transport Capacity
			Proximal Tubular Reabsorption
			Water Reabsorption
			Renal Concentrating Mechanism
	References
	Bibliography
4 Renal Function and Assessment
	Key Terms
	Urine Composition
	Urine Volume
	Solute Elimination
	Urine Concentration and Measurement
		Osmolality
		Osmolality Methods
			Freezing Point Osmometry
			Vapor Pressure Osmometry
		Specific Gravity
		Osmolality Versus Specific Gravity
	Assessment of Renal Concentrating Ability/Tubular Reabsorptive Function
		Osmolality and Specific Gravity
		Fluid Deprivation Tests
		Osmolar and Free-Water Clearance
	Assessment of Glomerular Filtration
		Renal Clearance
		Clearance Tests
			Inulin Clearance
			Creatinine Clearance
				Advantages and Disadvantages.
				Importance of Time Interval.
		Alternate Approaches to Assessing Glomerular Filtration Rate
			Estimated GFR (eGFR)
			Cystatin C and β2-Microglobulin
		Screening for Albuminuria
	Assessment of Renal Blood Flow and Tubular Secretory Function
		Determination of Renal Plasma Flow and Renal Blood Flow
		Assessment of Tubular Secretory Function for Acid Removal
			Measurement of Titratable Acid Versus Urinary Ammonia
			Oral Ammonium Chloride Test
	A Routine Urinalysis
	References
	Bibliography
5 Routine Urinalysis—the Physical Examination
	Key Terms
	Color
	Foam
	Clarity
	Odor
	Taste
	Volume
	Concentration
		Specific Gravity
			Refractometry
			Reagent Strip Method
			Specific Gravity Result Discrepancies Between Reagent Strip and Refractometry
	References
	Bibliography
6 Routine Urinalysis—the Chemical Examination
	Key Terms
	Reagent Strips
		Care and Storage
		Quality Control Testing
	Tablet and Chemical Tests
		Care and Storage
		Quality Control Testing
	Chemical Testing Technique
		Reagent Strips
		Tablet and Chemical Tests
	Chemical Tests
		Specific Gravity
			Principle
		pH
			Clinical Significance
			Methods
				Reagent strip tests.
				pH meter.
				pH test papers.
		Protein
			Clinical Significance
			Methods
				Sulfosalicylic acid precipitation test.
				Reagent strip tests.
				Sensitive albumin tests.
		Blood
			Clinical Significance
				Hematuria and hemoglobinuria.
				Myoglobinuria.
				Differentiation of hemoglobinuria and myoglobinuria.
			Method
		Leukocyte Esterase
			Clinical Significance
			Methods
		Nitrite
			Clinical Significance
			Methods
		Glucose
			Clinical Significance
			Methods
				Reagent strip tests.
				Copper reduction tests.
				Comparison of the Clinitest method and glucose reagent strip tests.
		Ketones
			Formation
			Clinical Significance
			Methods
				Reagent strip tests.
				Nitroprusside tablet test for ketones (Acetest).
		Bilirubin and Urobilinogen
			Formation
			Clinical Significance
			Bilirubin Methods
				Physical examination.
				Reagent strip tests for bilirubin.
				Diazo tablet test for bilirubin (Ictotest method).
			Urobilinogen Methods
				Classic Ehrlich’s reaction (historical).
				Reagent strip tests for urobilinogen
					Multistix reagent strips.
					Chemstrip reagent strips.
		Ascorbic Acid
			Clinical Significance
			Mechanisms of Interference
			Method
	Reflex Testing and Result Correlation
	References
7 Routine Urinalysis–the Microscopic Exam of Urine Sediment
	Key Terms
	Standardization of Sediment Preparation
		Commercial Systems
		Specimen Volume
		Centrifugation
		Sediment Concentration
		Volume of Sediment Viewed
		Reporting Formats
	Enhancing Urine Sediment Visualization
		Staining Techniques
			Supravital Stains
			Acetic Acid
			Fat or Lipid Stains
			Gram Stain
			Prussian Blue Reaction
			Hansel Stain
		Microscopy Techniques
			Phase Contrast Microscopy
			Polarizing Microscopy
			Interference Contrast Microscopy
	Cytocentrifugation and Cytodiagnostic Urinalysis
		Cytocentrifugation
		Cytodiagnostic Urinalysis
	Formed Elements in Urine Sediment
		Blood Cells
			Red Blood Cells (Erythrocytes)
			Microscopic Appearance.
			Correlation With Physical and Chemical Examinations.
			Look-Alikes.
			Clinical Significance.
			White Blood Cells (Leukocytes)
			Neutrophils
				Microscopic Appearance.
				Correlation with Physical and Chemical Examinations.
			Look-Alikes.
			Clinical Significance.
			Eosinophils.
			Lymphocytes.
			Monocytes and Macrophages (Histiocytes).
		Epithelial Cells
			Squamous Epithelial Cells
			Transitional (Urothelial) Epithelial Cells
			Decoy Cells
			Renal Tubular Epithelial Cells
				Convoluted Renal Tubular Cells.
					Proximal Convoluted Tubular Cells.
					Distal Convoluted Tubular Cells.
				Collecting Duct Cells.
				Renal Tubular Cells with Absorbed Fat.
			Other Epithelial Cells
				Bladder Diversion.
		Casts
			Formation and General Characteristics
			Clinical Significance
			Classification of Casts
				Homogeneous Matrix Composition.
					Hyaline Casts.
					Waxy Casts.
				Cellular Inclusion Casts.
					Red Blood Cell Casts.
					White Blood Cell Casts.
					Renal Tubular Cell Casts.
					Mixed Cell Casts.
					Bacterial Casts.
				Casts with Inclusions.
					Granular Casts.
					Fatty Casts.
					Other Inclusion Casts.
				Pigmented Casts.
				Size.
			Correlation With Physical and Chemical Examinations
			Look-Alikes
		Microorganisms in Urine Sediment
			Bacteria
			Yeast
			Trichomonas vaginalis
			Clue Cells and Gardnerella vaginalis
			Parasites
		Miscellaneous Formed Elements
			Mucus
			Fat
			Hemosiderin
			Sperm
		Crystals
			Contributing Factors
			Acidic Urine
				Amorphous Urates.
				Monosodium Urate.
				Uric Acid.
				Calcium Oxalate.
				Hippuric Acid.
			Alkaline Urine
				Amorphous Phosphate.
				Triple Phosphate.
				Calcium Phosphate.
				Ammonium Biurate.
				Calcium Carbonate.
			Crystals of Metabolic Origin
				Bilirubin.
				Cystine.
				Tyrosine and Leucine.
				Cholesterol.
			Crystals of Iatrogenic Origin
				Radiographic Contrast Media.
				Drug Crystals.
					Acyclovir.
					Ampicillin and Amoxicillin.
					Indinavir.
					Sulfonamides.
					Primidone and Triamterene.
					Crystal Summary
		Contaminants
			From the Laboratory
			From the Patient
			Starch and Talc.
			Fibers.
			Creams and Lotions.
			Fecal Matter.
			From the Environment
			Pollen Grains and Fungal Spores.
	Correlation of Urine Sediment Findings With Disease
	Study Questions
	References
Urine Sediment Image Gallery
	Artifacts/contaminants
	Blood Cells
		Red Blood Cells
		White Blood Cells
	Casts
		Cellular Casts
		Granular Casts
		Hyaline Casts
		Waxy Casts
	Crystals
		Ammonium Biurate Crystals
		Bilirubin Crystals
		Calcium Carbonate Crystals
		Calcium Oxalate Crystals
		Cholesterol Crystals
		Cystine Crystals
		Drug Crystals
		Phosphate Crystals
		Urate Crystals
		Uric Acid Crystals
	Epithelial Cells
	Fat Droplets and Oval Fat Bodies
	Microorganisms
		Bacteria
		Trichomonads
		Yeast
	Miscellaneous Formed Elements
		Hemosiderin
		Mucus
		Sperm
8 Renal and Metabolic Disease
	Key Terms
	Renal Diseases
		Glomerular Disease
			Morphologic Changes in the Glomerulus
			Pathogenesis of Glomerular Damage
			Clinical Features of Glomerular Diseases
			Nephrotic Syndrome
			Types of Glomerulonephritides
				Acute glomerulonephritis.
				Rapidly progressive glomerulonephritis.
				Membranous glomerulonephritis.
				Minimal change disease.
				Focal segmental glomerulosclerosis.
				Membranoproliferative glomerulonephritis.
				IgA nephropathy.
				Chronic glomerulonephritis.
			Systemic Diseases and Glomerular Damage
		Tubular Disease
			Acute Tubular Necrosis
			Tubular Dysfunction
				Fanconi’s syndrome.
				Cystinosis and cystinuria.
				Renal glucosuria.
				Renal phosphaturia.
				Renal tubular acidosis.
		Tubulointerstitial Disease and Urinary Tract Infections
			Urinary Tract Infections
			Acute Pyelonephritis
			Chronic Pyelonephritis
			Acute Interstitial Nephritis
			Yeast Infections
		Vascular Disease
		Acute Kidney Injury
			Chronic Kidney Disease
		Calculi
			Pathogenesis
			Factors Influencing Calculus Formation
			Prevention and Treatment
	Screening for Metabolic Diseases
		Amino Acid Disorders
			Cystinosis
			Cystinuria
			Maple Syrup Urine Disease
			Phenylketonuria
			Alkaptonuria
			Tyrosinuria
			Melanuria
		Carbohydrate Disorders
			Glucose and Diabetes Mellitus
			Galactosemia
		Diabetes Insipidus
		Porphyrias
	References
9 Cerebrospinal Fluid Analysis
	References
10 Pleural, Pericardial, and Peritoneal Fluid Analysis
	Key Terms
	Physiology and Composition
	Specimen Collection
	Transudates and Exudates
	Physical Examination
	Microscopic Examination
		Total Cell Counts
		Differential Cell Count
			Microscope Slide Preparation
			Low-Power Examination
			Nucleated Cell Differential
				Monocytes, macrophages, and mesothelial cells.
				Granulocytes.
				Lymphocytes and plasma cells.
				Malignant cells.
			Clinical Value of the Nucleated Cell Differential
		Cytologic Examination
	Chemical Examination
		Total Protein and Lactate Dehydrogenase Ratios
		Glucose
		Amylase
		Lipids (Triglyceride and Cholesterol)
		pH
		Carcinoembryonic Antigen
	Microbiological Examination
		Staining Techniques
		Culture
	References
	Bibliography
11 Synovial Fluid Analysis
	Key Terms1
	Physiology and Composition
	Classification of Joint Disorders
	Specimen Collection
	Physical Examination
		Color
		Clarity
		Viscosity
		Clot Formation
	Microscopic Examination
		Total Cell Count
		Differential Cell Count
		Crystal Identification
			Microscope Slide Preparations
			Monosodium Urate Crystals
			Calcium Pyrophosphate Dihydrate Crystals
			Cholesterol Crystals
			Hydroxyapatite Crystals
			Corticosteroid Crystals
			Calcium Oxalate Crystals
			Hematin Crystals
			Artifacts
	Chemical Examination
		Glucose
		Total Protein
		Uric Acid
		Lactate
	Microbiological Examination
		Gram Stain
		Culture and Molecular Methods
	Study Questions
	References
	Bibliography
12 Seminal Fluid Analysis
	Key Terms1
	Physiology
	Specimen Collection
	Physical Examination
		Appearance
		Volume
		Viscosity
	Microscopic Examination
		Motility
		Concentration and Sperm Count
		Postvasectomy Sperm Counts
		Morphology
		Automated Semen Analysis Systems
		Vitality
		Cells Other Than Spermatozoa
		Agglutination
	Chemical Examination
		pH
		Fructose
		Other Biochemical Markers
	Study Questions
	REFERENCES
	Bibliography
13 Analysis of Vaginal Secretions
	Key Terms
	Specimen Collection and Handling
		pH
	Microscopic Examinations
		Wet Mount Examinations
			Blood Cells
			Bacterial Flora
			Yeast
			Epithelial Cells
			Trichomonads
		KOH Preparation and Amine Test
	Clinical Correlations
		Bacterial Vaginosis
		Candidiasis
		Trichomoniasis
		Atrophic Vaginitis
	Pregnancy-Associated Tests
		Fetal Fibronectin
			Specimen Collection
			fFN Test
		Placental Alpha Microglobulin-1
			Specimen Collection
			PAMG-1 Test
	References
14 Amniotic Fluid Analysis
	Key Terms
	Physiology and Composition
		Function
		Formation
		Volume
	Specimen Collection
		Timing of and Indications for Amniocentesis
		Collection and Specimen Containers
		Specimen Transport, Storage, and Handling
		Differentiation From Urine
	Physical Examination
		Color
		Turbidity
	Chemical Examination
		Tests to Determine Fetal Lung Maturity
			Lecithin/Sphingomyelin Ratio
			Phosphatidylglycerol
			Lamellar Body Counts
			Foam Stability Index
		Test to Detect Blood Type Incompatibility
			Amniotic Fluid Bilirubin (or ΔA450 Determination)
	References
15 Fecal Analysis
	Key Terms
	Fecal Formation
	Diarrhea
		Acute Diarrhea
		Chronic Diarrhea
		Steatorrhea
	Specimen Collection
		Patient Education
		Specimen Containers
		Type and Amount Collected
		Contaminants to Avoid
		Gas Formation
	Macroscopic Examination
		Color
		Consistency and Form
		Mucus
		Odor
	Microscopic Examination
		Fecal White Blood Cells
		Qualitative Fecal Fat
		Meat Fibers
	Chemical Examination
		Fecal Blood
			Guaiac-Based Fecal Occult Blood Tests
			Immunochemical Fecal Occult Blood Tests
			Porphyrin-Based Fecal Occult Blood Test
		Fetal Hemoglobin in Feces (Apt Test)
		Quantitative Fecal Fat
		Fecal Carbohydrates
	References
16 Automation of Urine and Body Fluid Analysis
	Key Terms
	Automation of Urinalysis
		Urine Chemistry Analyzers
			Principle of Reflectance Photometry
			Semiautomated Chemistry Analyzers
			Fully Automated Chemistry Analyzers
		Automated Microscopy Analyzers
			Digital Flow Morphology
			Flow Cytometry
			Digital Microscopy
		Fully Automated Urinalysis Systems
	Automation of Body Fluid Analysis
		Body Fluid Cell Counts Using Hematology Analyzers
		Body Fluid Cell Counts Using iQ200
	References
17 Body Fluid Analysis: Manual Hemacytometer Counts and Differential Slide Preparation
	Using A Hemacytometer
		Diluents and Dilutions
			Pretreatment and Dilution of Synovial Fluid Specimens
			Semen Dilution and Pretreatment of Specimens
		Hemacytometer Cell Counts
		Calculations
		Hemacytometer Calculation Examples
			Example A: Using Undiluted Body Fluid
			Example B: Using Diluted Body Fluid
			Example C: Sperm Count Using Diluted Semen
	Preparation of Slides for Differential
		Cytocentrifugation
		Slide Preparation and Review
	References
18 Microscopy
	Key Terms
	Brightfield Microscope
		Eyepiece
		Mechanical Stage
		Condenser
		Illumination System
		Objectives
	Ocular Field Number
	Microscope Adjustment Procedure
	Care and Preventive Maintenance
	Types of Microscopy
		Brightfield Microscopy
		Phase-Contrast Microscopy
		Polarizing Microscopy
		Interference Contrast Microscopy
			Modulation Contrast Microscopy (Hoffman)
			Differential Interference Contrast Microscopy (Nomarski)
		Darkfield Microscopy
		Fluorescence Microscopy
	References
	Bibliography
Appendix A: Reagent Strip Color Charts
Appendix B: Comparison of Reagent Strip Principles, Sensitivity, and Specificity
	References
Appendix C: Reference Intervals
Appendix D: Body Fluid Diluents and Pretreatment Solutions
	Commercial Isotonic Diluents
	References
Appendix E: Manual and Historic Methods of Interest
	References
Answer Key
	Chapter 1
	Case 1.1
	Chapter 2
	Chapter 3
	Chapter 4
	Case 4.1
	Case 4.2
	Chapter 5
	Case 5.1
	Case 5.2
	Chapter 6
	Case 6.1
	Case 6.2
	Case 6.3
	Case 6.4
	Case 6.5
	Chapter 7
	Case 7.1
	Case 7.2
	Case 7.3
	Case 7.4
	Case 7.5
	Case 7.6
	Case 7.7
	Chapter 8
	Case 8.1
	Case 8.2
	Case 8.3
	Case 8.4
	Case 8.5
	Case 8.6
	Case 8.7
	Chapter 9
	Case 9.1
	Case 9.2
	Chapter 10
	Case 10.1
	Case 10.2
	Chapter 11
	Case 11.1
	Case 11.2
	Case 11.3
	Chapter 12
	Case 12.1
	Case 12.2
	Chapter 13
	Case 13.1
	Chapter 14
	Case 14.1
	Chapter 15
	Case 15.1
	Case 15.2
	Case 15.3
	Chapter 16
	Chapter 17
	Chapter 18
Glossary
Index
Quick Guide To Body Fluid Figures