Let's go to the pH now,
another component that's important
determined by diet.
Remember if it's uric acid,
which is what, what does that
mean to you biochemically?
what uric acid means?
Good you've heard of
purine salvage pathway
and uric acid may then
accumulate in the urine
how often do cells break down?
cells break down all the time
Do cells contain DNA?
Of course they do
and what is DNA composed of?
Purines and Pyrimidines
You break down your purine,
what are you gonna release?
And if it ends up in your
urine, what's your pH?
Uric acid - decreased urine
pH, keep that in mind
Now, determined by diet and
acid-base status of the patient
I'll just give you one, for example
Pure vegan, who's
your patient here?
In the United States, maybe perhaps more
along the lines of Californians and such?
Doesn't have to be, but just saying
in terms of vegan communities
and these individuals are doing what?
Well they're not consuming any meat,
there's a difference between
vegetarians and vegans
vegans don't even
consume dairy products
Now, that becomes a big deal
for us pathologically,
because vegans in developed countries might
actually develop over a number of years,
known as B12 deficiency
There are certain things that
you want to keep in mind
But for now, pure vegan
usually have what kind of pH?
The citrate is converted into bicarbonate.
What does bicarbonate mean to you?
An increased pH - alkaline.
What about meat eaters, carnivores,
they usually have acid pH
because of organic
acids in the meat.
Simple example of diet and as to how
they will influence the pH of the urine
what if it was alkaline?
this would be ammonia perhaps?
So here if you're thinking
about urinary tract infection
and you have an alkaline
organism such as Proteus,
then please understand
that some of these urease
is then going to take your urea
and convert them to ammonia
what is that going
to do with your pH?
It will then alkalinize it
Let's move on to protein being
a component of your urinalysis
detects albumin, big time importance
in differentiation from globulins
now globulins perhaps may or may not get
through, let's not focus our time on that
let's focus on albumin.
let's say for example that you
have diabetic nephropathy
and we'll talk further about this later on
and one of the first signs that
you'll find with diabetic nephropathy
is going to be that you
and you'll use a specific dipstick
so that you can find this
and that to you should mean
automatic glomerular damage
now there's something called sulfosalicylic
acid and this is going to be
pay attention here, SSA, least
keep in mind "salicylic acid"
salicylic acid which is part of
SSA test specifically for protein
what kind of protein?
You've heard of BJ proteins (Bence
Jones proteins), have you not?
as soon as your Bence Jones proteins, what
are you thinking about immunoglobulins
What's that mean to you?
kappa, lambda, right?
What does that mean to you?
you know, you've done immunology.
if you haven't, you will and when you do
you've dissected the anatomy
of an immunoglobulin
and immunoglobulins are made up
of heavy chains and light chains
you've heard of constant
and variable regions
Now, forget about all that,
let's keep it simple pathology
the light chains are kappa lambda
If it's something like multiple
myeloma, what are you gonna release?
Pay attention; multiple myeloma
what are you gonna release?
IgG, IgA; no IgM.
IgG, IgA and then these then releases
your light chains into where?
maybe perhaps start accumulating on the
glomerulus and maybe passes through
my point is this, that's
a globulin, isn't it?
so therefore SSA would be
specific for detecting globulin.
that's very important
that you understand this
because you want to
order the correct test
for the correct component
that you're suspecting
based on the history
of your patient
what's your history of the
patient in multiple myeloma?
bone disease? sure, what
kind of bone disease?
lytic bone lesions, punched
out lesions, correct?
so that part of history will only help
you then supplement your information
Albuminuria, reagent strip
and SSA have the same results
so as far as SSA is concerned, that
will help you more so with the globulin
whereas the albumin disptick, you're
only going to look for albumin
examples, diabetic nephropathy and
then of course we're get into later on
Now if it is Bence Jones proteins, that's
what BJ stands for -Bence Jones Proteins
then your SSA is greater
than reagent strip test,
always confirm BJ protein with
is that clear?
so you're always going to confirm
your Bence Jones proteins
with imuunoelectrophoresis, and at that
point we use a particular stain
known as Congo Red stain, and
what are you gonna find?
apple green birefringence, won't you?
because this is amyloid.
are we clear?
we're putting in a lot of information but
you must be able to put things together
so that you'd come up
with the proper diagnosis
we've spend a little bit of time here
with protein component here of urine