Problematic Substances in Urine (Nursing)

by Rhonda Lawes

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    00:00 Okay now let's look at the next part of your results.

    00:04 So look at this some of these may be present.

    00:06 So there might be some glucose, some your urobilinogen, some blood, some protein, you've got the whole list there.

    00:13 And we've got a cheat sheet for you at the end that puts this all together, but some of these may be present in your urine and it's okay.

    00:22 We're not worried about it.

    00:23 Let's look at glucose in your urine.

    00:25 Normal levels of glucose would be less than or equal to a 130.

    00:30 See glucose is normally filtered by the glomerulus.

    00:33 What is the glomerulus? Yeah. It's that tangle of capillaries that's right inside of Bowman's capsule and it's all connected up to the tubules in your kidneys.

    00:43 So glucose is normally filtered by the glomerulus, but almost completely reabsorbed in the proximal tubule.

    00:51 So when we say that that's great to have the definition, but I want you to picture it.

    00:55 So you have that picture in your mind of what a glomerulus looks like.

    00:58 It's a tangle of capillaries inside of Bowman's capsule, right? And that is connected to the tubules.

    01:06 So when it says that glucose is almost completely reabsorbed in the tubule, that means it comes out of the filtrate back into the body circulation.

    01:15 It should not be leaving the body in the urine.

    01:19 So it's okay to have less than or equal to a 130 but if you've got more of that we've got a problem.

    01:27 Now glycosuria means you've got glucose, use your round 180 to 200.

    01:33 Normal is less than 130 once you hit 180 you get a diagnosis.

    01:38 So there's that word again uria, that means urine whatever comes in front of that means what's in the urine.

    01:45 Oh glucose, so that's why glycosuria means a too high of a level of glucose in your urine.

    01:52 That means the filtered load of glucose exceed your kidneys ability to reabsorb it.

    01:59 I wonder I would have too much glucose in their blood to the point where the kidneys couldn't reabsorb it.

    02:07 Yeah, you're right.

    02:09 Let's look at the possible causes.

    02:11 Number 1, diabetes mellitus or if you prefer mellitus.

    02:16 However, you want to say it.

    02:18 That's who's going to have too much blood sugar, right? People with diabetes that is the that's the risk and the cause of diabetes is an elevated blood glucose level.

    02:30 So when that blood is heading on into the kidney, it is oversaturated with glucose.

    02:36 It is more than the kidneys can or should reabsorb which is why it tries to get rid of some of it in the urine.

    02:45 So if someone has glycosuria, we would expect they have diabetes.

    02:49 Now cushing syndrome.

    02:51 We're back to that endocrine system.

    02:53 If a patient has cushing's syndrome this happens with someone who's received high dose corticosteroids.

    02:59 So now somebody who usually has an inhaler talking about somebody who's been pretty high dose glucocorticoid therapy either taking it by a pill or IV.

    03:10 They tend to have more systemic results.

    03:14 But remember the end up with those weird side effects, like moon face, facial hair, mood swings, all kinds of weird stuff, but cushing's syndrome looks like cushing's disease because they have excess glucocorticoids.

    03:29 So remember glucocorticoids come from my adrenal glands, right? They come from the adrenal cortex, but when I give them to you as a medication I can cause cushing syndrome.

    03:41 It's like your adrenal gland said, hey party and it just starts shooting out way too much.

    03:47 Well in c ushing syndrome, we did that to you, You're welcome. No charge.

    03:53 Cushing syndrome happens when a patient receives excess high doses of glucocorticoids because we're trying suppress inflammation somewhere in their body.

    04:03 That messes with their protein fat and sugar metabolism.

    04:06 So that's why you end up with excess levels of glucose in their urine.

    04:12 If someone's on glucocorticoid therapy their blood sugar is usually elevated if you got a diabetic on glucocorticoid therapy, their blood sugars can go crazy.

    04:23 Now, we also have issues with liver and pancreatic diseases and something we call fanconi syndrome.

    04:30 Now you can file that away as fun trivia the most important points I want you to take away are diabetes, Cushings, and then your liver and pancreatic diseases.

    04:42 Fanconi's we put on there but we're not even going to delve into it.

    04:45 It's just something interesting for you to know.

    04:48 But number one takeaway diabetes, second one cushing syndrome, and make sure you add a note that that's caused by glucocorticoid medications, and then liver and pancreatic disease.

    05:00 These because those are key players with endocrine and hormone.

    About the Lecture

    The lecture Problematic Substances in Urine (Nursing) by Rhonda Lawes is from the course Introduction to Urinalysis – Renal Assessment (Nursing).

    Author of lecture Problematic Substances in Urine (Nursing)

     Rhonda Lawes

    Rhonda Lawes

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