Learn how to accurately analyze urine and body fluids with Fundamentals of Urine and Body Fluid Analysis, 5th Edition. Known for its clear writing style, logical organization, and vivid full-color illustrations, this renowned textoffers the perfect level and depth of information for understanding the fundamental principles of urine and body fluids frequently encountered in the clinical laboratory.This includes the collection and analysis of urine, fecal specimens, vaginal secretions, and other body fluids such as cerebrospinal, synovial, seminal, amniotic, pleural, pericardial, and peritoneal fluids. Author Nancy Brunzel also shares her extensive knowledge and expertise in the field as she highlights key information and walks you through essential techniques and procedures ― showing you how to correlate data with your knowledge of basic anatomy and physiology in order to understand pathologic processes.
- Study questions and case studies in each chapter reinforce comprehension and application, with an answer key located in the back of the book.
- UNIQUE! Table of crystal images based on shape serves as a single, comprehensive guide to the identification of crystals in urine sediment.
- UNIQUE! Image Gallery of Urine Sedimentprovides alternate views of sediment components to augment the numerous classic photomicrographs already present in the Microscopic Examination of Urine chapter.
- UNIQUE! Quick Guides to urine and body fluid photomicrographs make it fast and easy to find a photo of a specific cell type or component of interest.
- UNIQUE! Tables with high quality polarizing microscopy photomicrographs demonstrate the differences in birefringent intensity of substances with and without a red compensator.
- The most complete collection of high-quality, full-color images enables optimal identification of microscopic components in urine and other body fluids.
- NEW! Fully updated content provides valuable information on the latest techniques and advances in the field.
- NEW! Enhanced content, new tables, and new images facilitate the microscopic differentiation of monocytes, macrophages, and mesothelial cells in pleural, peritoneal, and pericardial fluids.
- NEW! More than 250 photomicrographs of cells and other components in body fluid and urine sediment serve as a visual quick reference for identification during analysis.
- NEW! Thumbprint images embedded in numerous tables enhance learning and serve as an invaluable resource when performing fluid analysis at the bench.
Author(s): Nancy A. Brunzel
Edition: 5
Publisher: Elsevier
Year: 2022
Language: English
Pages: 459
City: St. Louis
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
