1. Discuss the normal and abnormal constituents of urine and list the changes th
ID: 3522651 • Letter: 1
Question
1. Discuss the normal and abnormal constituents of urine and list the changes that would be seen. When could there be a change in the appearance or smell in the absence of illness? Urinalysis is one way to look at how the kidneys are working how would blood tests be useful in diseases of the kidney?
2. List the signs/symptoms and etiology of renal cell carcinoma and bladder tumors. Would you expect to see frank or occult blood in the urine with these diseases? What is the treatment for these conditions and what is the prognosis?
Explanation / Answer
1.
Urine is used in diagnosis of many diseases.
Normal Constituents of Urine
Water - In normal urine water makes up about 95% of the total volume of urine.
Urea - Urea makes up about 3% of the total volume of urine.
Uric Acid - Uric Acid makes up about 0.5% of the total volume of urine.
Salts - Salts make up about 1.5% of the total volume of urine.
Normal Urine also constitutes waste products like Creatinine and Ammonia.
In addition to this normal Urine also contains inorganic substances like Sodium, Potassium, Magnesium, Sulphate, Calcium, Phosphate and Chloride.
Due to some pathological or physiological changes in our body the color of Urine changes and this depicts that the Urine is abnormal, that is the urine contains abnormal constituents.
Abnormal Urine contains all the substances present in normal urine but it has some additional substances which are absent in normal urine.
These substances include
Bile Salts and Bile Pigments which is present in case of Jaundice.
Ketone bodies and Glucose which is present in case of Diabetes. Ketone bodies are present due to the incomplete digestion of fatty acids. In case of diabetes the urine has a different smell.
Proteins most commonly Albumins which is in case of Nephropathy.
Hemoglobin or Red Blood Cells which occurs in case of Renal Cell Carcinoma, Renal Tuberculosis or Kidney Stone.
White Blood Cells in case of Urinary Tract Infection.
Fats in case of Chyluria.
There could be a change in the appearance or smell of Urine in absence of illness during Dehydration. Dehydration increases the ammonia levels in urine which makes the urine yellow in color and leaves a bad odor of ammonia.
Blood Tests are also useful to find Kidney diseases. Doctors prescribe certain blood tests to find out
(a) The amount of Red Blood Cells in Urine which may indicate Kidney diseases like Renal Cell Carcinoma.
(b) Detect the levels of protein by calculating the Glomerular Filtration Rate(GFR).
(c) Blood Urea Nitrogen test is performed to find out if there is an excess of urea in your blood but this may or may not be the root cause of kidney damage.
2.
Signs/Symptoms of Renal Cell Carcinoma include
(a) Presence of Red Blood Cells in Urine. Blood passing along with urine may also be due to Urinary Tract Infection or Stone.
(b) Loss of appetite not caused by any other disease.
(c) Presence of Fever not caused by anything else.
(d) Inflation in the lower back leading to the formation of a hump.
(e) Rapid Weight loss not caused by anything else.
Etiology of this disease consists of various factors but it cannot be told exactly what causes it.
(a) Smoking - Smokers have higher probability of developing Renal Cell carcinoma than Non smokers
(b) Obesity - People who are obese or overweight have higher chance of developing Renal Cell carcinoma.
(c) Old Age - Older people are more likely to have Renal Cell Carcinoma.
(d) Males have higher chance of developing Renal Cell carcinoma than Females.
(e) High blood pressure may also be a reason for developing Renal Cell carcinoma but it cannot be guaranteed.
(f) Hereditary - Someone in the family with Renal Cell Carcinoma may be a factor in developing Renal Cell carcinoma in the patient.
We would expect to see Frank blood in the urine due to this disease. Frank blood is true red blood which shows the presence of higher quantity of Red Blood Cells as compared to Occult blood which is dark brown or black in color.
Treatment for Stage 1 and Stage 2 Renal Cell Carcinoma include Surgery and after that Radiotherapy. Surgeries are extremely effective in case of Stage 1 and Stage 2.
In case of Stage 3 surgery may or may not help but it depends on how much the tumor has metastasized. Radiotherapy can help.
In Stage 4 Surgery is highly unlikely. Other methods like cuuting the blood flow to cancerous cells(Embolization) may be done.
The Prognosis or survival rates of Renal Cell Carcinoma accordin to different stages are
Stage 1 - Highly effective. Over 80% of cases have shown positive results.
Stage 2 - Again Surgery and Radiotherapy has ensured a high survival rate of over 75%
Stage 3 - Survival rates drop down to almost 55% in case of Stage 3
Stage 4- Very low survival rate below 10%
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