BODY FLUIDS: URINE and BLOOD

I. INTRODUCTION Urine is a typically sterile (in the absence of a disease condition) liquid by-product of the body that is secreted by the kidneys through a process called urination andexcreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream. These by-products are eventually expelled from the body in a process known as micturition, the primary method for excreting water-soluble chemicals from the body. These chemicals can be detected and analyzed by urinalysis. II. BODY OF THE RESEARCH

Urine Composition In general, urine consists of urea and other organic and inorganic chemicals dissolved in water. Urine is normally 95% water and 5% solutes, although considerable variations in the concentrations of these solutes can occur owing to the influence of factors such as dietary intake, physical activity, body metabolism, endocrine functions, and even body position. Urea, a metabolic waste product produced in the liver from the breakdown of protein and amino acids, accounts for nearly half of the total dissolved solids in urine. Other organic substances include primarily creatinine and uric acid. The major inorganic solid dissolved in urine is chloride, followed by sodium and potassium. Small or trace amounts of many additional inorganic chemicals are also present in urine. Dietary intake greatly influences the concentrations of these inorganic compounds, making it difficult to establish normal levels. Other substances found in urine include hormones, vitamins, and medications. Although not a part of the original plasma filtrate, the urine also may contain formed elements, such as cells, casts, crystals, mucus, and bacteria. Increased amounts of these formed elements are often indicative of disease. PHYSICAL EXAMINATION OF URINE Color The color of urine varies from almost colorless to black. These variations may be due to normal metabolic functions, physical activity, ingested materials, or pathologic conditions. A noticeable change in urine color is often the reason a patient seeks medical advice; it then becomes the responsibility of the laboratory to determine whether this color change is normal or pathologic.

Clarity Clarity refers to the transparency/turbidity of a urine specimen. In routine urinalysis, clarity is determined in the same manner that ancient physicians used: by visually examining the mixed specimen while holding it in front of a light source. The specimen should, of course, be in a clear container. Color and clarity are routinely determined at the same time. Common terminology used to report clarity includes clear, hazy, cloudy, turbid, and milky. As discussed under the section on urine color, terminology should be consistent within a laboratory. Freshly voided normal urine is usually clear, particularly if it is a midstream clean-catch specimen. Precipitation of amorphous phosphates and carbonates may cause a white cloudiness. The presence of squamous epithelial cells and mucus, particularly in specimens from women, can result in a hazy but normal urine. Blood Blood may be present in the urine either in the form of intactred blood cells (hematuria) or as the product of red blood cell destruction, hemoglobin (hemoglobinuria). Hematuria produces a cloudy red urine, and hemoglobinuria appears as a clear red specimen. Because any amount of blood greater than five cells per microliter of urine is considered clinically significant, visual examination can- not be relied upon to detect the presence of blood. Microscopic examination of the urinary sediment shows intact red blood cells, but free hemoglobin produced either by hemolytic disorders or lysis of red blood cells is not detected. MICROSCOPIC EXAMINATION OF URINE SEDIMENT CONSTITUENTS Red Blood Cells In the urine, RBCs appear as smooth, non-nucleated, biconcave disks measuring approximately 7 mm in diameter. They must be identified using high-power (40X) objective (X400 magnification). RBCs are routinely reported as the average number seen in 10 hpfs.Of all the sediment elements, RBCs are the most difficult for students to recognize. The reasons for this include RBCs lack of characteristic structures, variations in size,and close resemblance to other sediment constituents. RBCs are frequently confused with yeast cells, oil droplets, and air bubbles. The rough appearance of crenated RBCs may resemble the granules seen in WBCs; however, they are much smaller than WBCs. White Blood Cells WBCs are larger than RBCs, measuring an average of about 12 mm in diameter. The predominant WBC found in the urine sediment is the neutrophil. Neutrophils are much easier to identify than RBCs because they contain granules and multilobed nuclei.They are reported as the average number seen in 10 hpfs. Neutrophils lyse rapidly in dilute alkaline urine and begin to lose nuclear detail. Epithelial Cells It is not unusual to find epithelial cells in the urine, because they are derived from the linings of the genitourinary system. Unless they are present in large numbers or in abnormal forms, they represent normal sloughing of old cells. Three types of epithelial cells are seen in urine: squamous, transitional (urothelial), and renal tubular (Fig. 6-19). They are classified according to their site of origin within the genitourinary system.

Squamous Epithelial Cells Squamous cells are the largest cells found in the urine sediment. They contain abundant, irregular cytoplasm and a prominent nucleus about the size of an RBC. They are often the first structures observed when the sediment is examined under low-power magnification. Usually at least a few squamous epithelial cells are present in the sediment and can serve as a good reference for focusing of the microscope Transitional Epithelial (Urothelial) Cells Transitional epithelial cells are smaller than squamous cells and appear in several forms, including spherical, polyhedral, and caudate. These differences are caused by the ability of transitional epithelial cells to absorb large amounts of water. Cells in direct contact with the urine absorb water, becoming spherical in form and much larger than the polyhedral and caudate cells. Renal Tubular Epithelial Cells Renal tubular epithelial (RTE) cells vary in size and shape depending on the area of the renal tubules from which they originate. The cells from the proximal convoluted tubule (PCT) are larger than other RTE cells. They tend to have a rectangular shape and arereferred to as columnar or convoluted cells. The cytoplasm is coarsely granular, and the RTE cells often resemble casts. They should be closely examined for the presence of a nucleus, as a nucleus would not be present in a cast. Bacteria Bacteria are not normally present in urine. However, unless specimens are collected under sterile conditions (catheterization), a few bacteria are usually present as a result of vaginal, urethral, external genitalia, or collection-container contamination. These contaminant bacteria multiply rapidly in specimens that remain at room temperature for extended periods, but are of no clinical significance. They may produce a positive nitrite test result and also frequently result in a pH above 8, indicating an unacceptable specimen. Yeast Yeast cells appear in the urine as small, refractile oval structures that may or may not contain a bud. In severe infections, they may appear as branched, mycelial forms. Parasites The most frequent parasite encountered in the urine is Trichomonasvaginalis. The Trichomonastrophozoite is a pear- shaped flagellate with an undulating membrane. It is easily identified in wet preparations of the urine sediment by its rapid darting movement in the microscopic field. Mucus Mucus is a protein material produced by the glands and epithelial cells of the lower genitourinary tract and the RTE cells. Immunologic analysis has shown that Tamm-Horsfall protein is a major constituent of mucus. Casts Casts are the only elements found in the urinary sediment that are unique to the kidney. They are formed within the lumens of the distal convoluted tubules and collecting ducts, providing a microscopic view of conditions within the nephron. Their shape is representative of the tubular lumen, with parallel

sides and somewhat rounded ends, and they may contain additional elements present in the filtrate.

III. CONCLUSION I therefore conclude that urine is consists of urea and other organic and inorganic chemicals dissolved in water. Urine is normally 95% water and 5% solutes. . Other substances found in urine include hormones, vitamins, and medications. The presence of blood in urine is called hematuria, sometimes blood in the urine is a sign of a serious problem in the urinary tract.

IV. INSIGHTS Urine is a liquid solution of metabolic wastes and other, often toxic, substances filtered from plasma. The fluid in the Bowman capsule at the start of each nephron is essentially plasma without the large molecules (e.g., proteins). The concentrated fluid (final urine) that exits the kidney consists of water, urea, inorganic salts, uric acid, creatinine, ammonia, and broken-down blood pigments, including urochrome, which makes urine yellow, plus any unusual substances not reabsorbed into the blood. This is then excreted. V. REFERENCES Brunzel N.A. , (2004). Fundamentals of Urine and Body Fluid Analysis. Minneapolis,

Minnesota, MN. Saunder

Health & Leisure Shangri-Las Boracay Resort and Spa offers a variety of activities to suit both adults and children. CHI, The Spa at Shangri-La is a haven for wellness within in the Resort. Recreational facilities such as outdoor tennis courts, a freeform swimming pool, a health club and a marine centre with diving facilities are also available. Chi, The Spa Massage has been taught from generation to generation, and this therapeutic method of care remains an important and viable means of restoring and maintaining vitality. The spectrum of Asian massage therapies share at their core, an understanding of the body as an energy system, from meridians lines to energy pressure points, many cultures recognise various points and pathways lying within the body that hold the key to health and vitality. Spa Menu *Mystical Flowing River Created to ease the tension and stress derived from a fast-paced lifestyle, this massage balances the mind to create a deep inner calm. The use of Flowing River Massage oil stimulates the lymph systems to help restore stamina and improve overall health. *Chi, Healing Stone Massage CHI healing stones combine all the benefits of thermotherapy, with gliding massage strokes to create a deeply relaxing and healing treatment. The use of therapeutic oils with the warm stones eases the muscles and restores the bodys energy and vitality. *Philippine Hilot An authentic local massage that focuses on ancient diagnostic methods passed down through generations of Philippine culture. Warm coconut oil and banana leaves are placed over the body to let the healing hands of the therapist, also known as the Hilot, detect areas of energy imbalance and blockages in the body for your emotional, physical, and spiritual well-being. *Thai Massage This Wat Pho style Thai massage will help improve your flexibility and stimulate blood circulation. The combination of gentle rocking, deep stretching movements and compression makes for a truly invigorating massage performed on a traditional Thai mattress. A comfortable top and drawstring pants are provided for you to wear *Foot Reflex Therapy Based on the belief that the body contains constant flowing energy or chi that unites the body with specific reflex points on the feet, this specialized treatment helps in the relief of stress and tension and improves circulation, restoring the bodys natural balance. Plan an Event *Meetings Complete with several well-appointed function rooms each outfitted with state-of-the-art audio-visual equipment which are expertly managed by an experienced events team, Shangri-Las Boracay Resort and Spa provides the ideal meeting venue in Boracay to carry out important business conferences, client meetings and corporate events, all within a setting of great natural beauty. *Weddings Discerning couples seeking a unique wedding experience that combines a romantic natural setting with cosmopolitan flair will find all this and much more at Shangri-La's Boracay Resort and Spa.