Chemical Dipsticks: pH & Protein

by Carlo Raj, MD

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    00:00 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? Breakdown of? Purines 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? Uric Acid And if it ends up in your urine, what's your pH? decreased. Correct? 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? alkaline.

    01:28 The citrate is converted into bicarbonate. What does bicarbonate mean to you? An increased pH - alkaline.

    01:33 What about meat eaters, carnivores, they usually have acid pH because of organic acids in the meat.

    01:39 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.

    02:24 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 find microalbuminuria 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 light chains 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.

    03:43 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.

    04:01 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 our glomerulonephritides 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 urine immunoelectrophoresis 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.

    05:17 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

    About the Lecture

    The lecture Chemical Dipsticks: pH & Protein by Carlo Raj, MD is from the course Urinalysis.

    Included Quiz Questions

    1. Hypertonic loss of sodium
    2. Water deprivation
    3. Increased urobilinogen
    4. Vitamin B ingestion
    5. Excessive sweating
    1. It is associated with respiratory acidosis
    2. On exposure to oxygen, urine turns black
    3. It presents with an elevated level of homogentisic acid in the urine
    4. It is inherited in an autosomal recessive pattern
    5. It is a deficiency of the enzyme, homogentisic oxidase
    1. Acidity of urine pH converts hemoglobin to hematin
    2. Presence of homogentisic acid in the urine
    3. Intravascular destruction of red blood cells
    4. Bacterial metabolism of bicarbonate
    5. Excessive protein concentration in the urine
    1. It is caused by inappropriate complement activation
    2. It is a form of extravascular hemolysis
    3. It may be managed by increased vitamin consumption
    4. It presents with smoky colored urine
    5. It is the result of nocturnal respiratory alkalosis
    1. Hypotonic loss of sodium
    2. Nephrotic syndrome
    3. Paroxysmal Nocturnal Hemoglobinuria
    4. Crush injury
    5. Acute intermittent porphyria
    1. Phosphates
    2. White blood cells
    3. Myoglobin
    4. Bacteria
    5. Uric acid
    1. 1.008
    2. None of the answers are correct
    3. 1.020
    4. 1.018
    5. 1.023
    1. Renal concentrating ability is defective
    2. Urine osmolality is > 900 mOsm/kg
    3. Plasma osmolality is low.
    4. ADH concentrations are high
    5. Extrinsic renal disease is excluded
    1. Urinary tract infection with Proteus mirabilis
    2. Urinary tract infection with Escherichia coli
    3. Diabetes mellitus
    4. Diet high in meat
    5. Strict vegan diet
    1. Microalbuminuria
    2. Glucosuria
    3. Renal papillary necrosis
    4. Dehydration
    5. Elevated serum glucose
    1. In order to detect protein
    2. In order to detect albumin
    3. In order to detect ketones
    4. In order to detect glucose
    5. In order to detect fructose.

    Author of lecture Chemical Dipsticks: pH & Protein

     Carlo Raj, MD

    Carlo Raj, MD

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    Short and Sweet.
    By Ricardo N. on 11. February 2020 for Chemical Dipsticks: pH & Protein

    This lecture is quick, has good examples and is straight to the point.

    By Rodrigo C. on 23. November 2019 for Chemical Dipsticks: pH & Protein

    B12 is produced by bacteria. Almost all vegans know we have to consume it with supplements, I heard it a thousand times already. We don't need any animal products to have enough B12, stop spreading misconceptions. How about telling about how eating too much purine (daily meat) may causes gout? It's much more common.

    By Sharon M. on 20. February 2018 for Chemical Dipsticks: pH & Protein

    clear teaching and repetition, thanks. Learnt a lot. Clinically useful. thanks