Urinalysis

Betsy Ripley, MD, MS

Office: 828-1955

Email eripley@mcvh-vcu.edu

Urine Related Terms

Anuria Dysuria Glycosuria Hematuria Hypersthenuria Hyposthenuria Isosthenuria

Ketonuria Nocturia Polyuria Pyuria

Urine Collections

Random Urine Specimen First morning specimen Midstream Clean-Catch Catheterized Suprapubic Aspiration

Urine Preservation

The Urinalysis

Inspection Chemical Testing Microscopic exam

Inspection

Color Urochrome pigment Color is concentration dependent

Appearance Specific Gravity

Color

Cause Laboratory Correlation

ColorlessStrawPale

Yellow

Recent fluid consumption

Polyuria or Diabetes insipidus

or diabetes mellitus

Commonly observed with random specimen Increased 24-hour volume Elevated specific gravity and positive

dip test for glucose

Dark yellow

Amber Orange

Concentrated specimen

DehydrationBilirubinCarrots or vitamin

APyridiumNitrofurantoin

May be normal after exercise or in a first morning specimen

Yellow foam when shaken and positive test for bilirubin

Drug given for urinary tract infectionsDrug given for urinary tract infection

Yellow-green

Yellow-brown

Bilirubin oxidized to biliverdin

Rhubarb

Colored foam in acidic urine false negative tests for bilirubin

Seen in acidic urine

Green Blue-green

Pseudomonas infection

Amitriptyline

CloretsMethylene Blue

Positive urine culture Antidepressant Used in tube feedings in ICU to look for

aspiration

Color

Cause Laboratory Correlation

PinkRed

Red Blood Cells

HemoglobinMyoglobinBeetsRhubarb

Cloudy urine with positive dip test for blood and RBC's microscopically Clear urine positive dip test for blood and no RBC's microscopically Clear urine with positive dip test for blood and no RBC's microscopically

Brown Red Blood cells oxidized to methemoglobin

Myoglobin

Methyldopa

Metronidazole

Positive test for blood Seen in acidic urine Positive test for blood

Antihypertensive

Antibiotic

Inspection

Color Urochrome pigment Color is concentration dependent

Appearance Specific Gravity

Chemical Testing

Chemical Testing

pH Protein Glucose Ketones Blood- Red blood cells, myoglobin and hemoglobin Bilirubin (Conjugated) Urobilinogen Nitrite Specific Gravity Leukocytes

Microscopic Examination

Epithelial Cells Squamous Cells-lining of the vaginal and lower portion

of the male and female urethras Transitional cells- lining of the bladder, renal pelvis,

and upper urethra Renal Tubular Cells

Red Blood Cells White Blood Cells Crystals Bacteria, Fungus and Protozoa Casts

CastsType Origin Clinical Significance

Hyaline Tubular secretion of Tamm Horsfall protein that aggregates into fibrils

GlomerulonephritisPyelonephritisChronic Renal DiseaseCongestive heart failureStress and ExerciseNormal

Red Blood Cell Red blood cells in Tamm Horsfall proteins

GlomerulonephritisStrenuous Exercise

White blood Cell WBC in Tamm Horsfall protein PyelonephritisAllergic Interstitial nephritis

Epithelial Cell Tubular cells attatched to Tamm Horsfall protein

Renal Tubular nephritis

Granular Disintegration of white cells, bacteria, urates, tubular cells

Stasis of urineUrinary tract infectionStress and exercise

Waxy Hyaline casts Stasis of urine

Fatty Renal tubular cellsOval fat bodies

Nephrotic syndrome

Broad Casts Formed in collecting ducts Extreme stasis of urine flow

Common Crystals

Crystal pH Color Appearance

Uric Acid Acid Yellow-brown

Rosettes

Amorphous Urates

Acid Brick dust or yellow brown

Crud

Calcium Oxalate

Acid/neutral

(alkaline)

Colorless Envelopes

Amorphous phosphates

Alkaline

Neutral

Colorless

Crystal pH Color Appearance

Triple Phosphate

Alkaline Colorless Coffin lids

Calcium Carbonate

Alkaline Colorless Dumbbells

Cystine Acid Colorless 6 sided

Cholesterol Acid Colorless Notched Plates

Microscopic Examination

The Loch Ness Monster

You’ve Got to Look to See It!

Squamous Epithelial Cells

Red Blood Cells

Red Blood Cells

Red Blood Cells

Transitional Cells

White Blood Cells

White Blood Cells

Budding Yeast

Yeast with Hyphae

Cystine Crystal

Cystine Crystals

Calcium Oxalate Crystals

Calcium Oxalate and Calcium Carbonate Crystals

Triple Phosphate Crystals

Triple Phosphate Crystals

Uric Acid Rosette

Birefringent Uric Acid Crystals

Amorphous Urates

Contrast Crystals

Casts

White Blood Cell Clump

White Blood Cell Cast

White Blood Cell Cast

Red Blood Cell Cast

Red Blood Cell Cast

Hyaline Cast with Red Cells Around

Brown Muddy Granular Casts

Lipid Droplets

Maltese Crosses of Lipid Droplets

A 24 year old female presents with dysuria and a low grade temperature. What would you expect to see on the dip stick?

A. pH 6, 3+ protein, Leukocytes +2

B. pH 8.0, Leukocytes +3, Nitrite +

C. pH 6, +3 Blood

D. pH 6, glucose +3, ketones +2

Cystitis- Urinary Tract Infection

35 year old female with Temp 102, BP 98/63 mmHg, ill appearing, CVA tendernessDip pH 5.5, Leukocytes +3,

What treatment would you start?

A.Lithotripsy for a stone

B.Steroids following a renal biopsy

C.An IV antibiotic

D.A statin for hyperlipidemia

24 year old male presents with severe flank pain radiating to the scrotumUA: blood +1, What would you expect to see on microscopy?

A.

B.

C.

12 year old male presents with leg swelling and feeling bad. Mom notes he had a sore throat one week ago.BP 148/98mmHg, Tonsils are mildly erythematous, legs have trace edemaUA: blood+3Microscopic

Which diagnosis is most likely?

A. Diabetes B. Fibromuscular Dysplasia with hypertension C. Post Streptococcal Glomerulonephritis

34 year old admitted yesterday following a motorcycle accident. Due to multiple injuries he had significant blood loss, required a prolonged surgery and had systolic blood pressures of 60-70 mmHg for more than 8 hours.

You are consulted because his initial creatinine on admission was 0.8 mg/dl it has risen to 1.9mg/dl today.

UA dip stick large blood micro 0-1 RBC

What is the most likely diagnosis?

A.Interstitial Nephritis B.Focal Segmental GlomeruloscerosisC.Acute Tubular Necrosis- RhabdomyolysisD.Contrast Nephropathy