Urinalysis

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UrinalysisPrepared by

Hamad [email protected]

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Urine Examination1 -Physical Examination2 -Chemical Examination

3 -Microscopic Examination

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URINE ANALYSISPhysical Examination

1 -Volume2 -Specific Gravity

3 -Apperance4 -Color5 -Odor

6 -Deposit7 -Reaction (pH)

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1- Volume: Normal urine volume in 24 hours is 600-2000 ml

A- Urine volume increases (Polyuria) in the following conditions:

Physiological: Increased fluid intake Diuretic

Pathological: Diabetes mellitus Diabetes insipidus Chronic renal failure

B- Urine volume decreases (Oliguria or anuria) in the following conditions: Dehydration Acute renal failure Obstruction

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2- Specific gravity (SG): • Specific gravity measures solute concentration (urea and sodium). • Normally the specific gravity ranges between 1.015-1.025.

A- Increased in • Dehydration (with oliguria)• Diabetes Mellitus (with polyuria)• Acute renal failure (with oliguria)

B- Decreased in • Diabetes insipidus (with polyuria)


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3- Appearance:- Normal fresh urine: clear (transparent) - Abnormal : Cloudy urine

Indicates possible abnormal constituents such as:• White blood cells• Epithelial cells• Crystals• Bacteria

N.B. Stored urine with no preservative & no cooling may turn clear urine samples into cloudy urine.


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4- Color: - Normal color: pale yellow (amber yellow)

due to the presence of pigments of urobilin or urobilinogen

- Abnormal colors of urine:• Colorless• Orange• Greenish yellow• Red• Black• Smoky

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Left to right: (Straw, clear) (yellow, clear) (yellow, hazy) (yellow, clear) (red-orange, clear)

(brown, hazy)

Urine Colour

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Color (cont.)

1- Colorless Urine:

Chronic renal failure Diabetes insipidus. 2- Orange Urine:

Ingestion of large amount of carotenoids (vitamin A)

3- Yellowish - brown urine:

due to presence of billirubin in cases of :• Obstructive Jaundice • Hepatic Jaundice

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Color (cont.)

4- Red urine: due to presence of blood, hemoglobin & RBCs.

5- Black urine:

Methemoglobin Homogentisic acid in alkaptonuria Malignant malaria (black water fever due to Malaria falciparum). Melanin (melanoma)

6- Smoky urine:• presence RBCs. in the urine, in cases of acute glomerulonephritis

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5- Odor: Normal Urineferous odor:

The normal odor of fresh voided urine sample Abnormal Odors:

1- Fruity odor: due to presence of acetone in the urine as in

diabetic ketoacidosis2- Ammonia odor: due to release of ammonia as result of: - the bacterial action on urea in the contaminated

urine - or long standing exposed urine samples.

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6- Deposits:

• Normally the urine is devoid of deposits.

• The presence of deposits is mainly due to various types of crystals, salts and cells.

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7- Reaction (pH):

Normally: The pH of urine varies from 4.6 - 8.0

1- Acidic urine:• Large intake of meat & certain fruits (cranberries)• Metabolic & respiratory acidosis

2- Alkaline urine:• Vegetarians• Metabolic & respiratory alkalosis• Urinary tract infection by urea splitting bacteria which split urea to

ammonia (alkaline)

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URINE ANALYSISChemical Examination

The presence of normal and abnormal chemical elements in the urine are detected using dry reagent strips.

These plastic strips contain absorbent pads with various chemical reagents for determining a specific substance.

When the test strip is put in urine the reagents are activated and a chemical reaction occurs. The chemical reaction results in a specific color change.

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Used in the LAB for routine urine analysis (10 Chemical Tests)

Used in Emergency Room (ER) for diagnosis of Diabetic Ketoacidosis

(DKA) (3 chemical tests: Glucose, Ketones &

protein)


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Glucose

Protein

Specific

Gravity

pH

primarily detects glucose (sugar);

important indicator

of diabetes mellitus

primarily detects protein called

albumin; important indicator

in the detection of renal disease

state of kidney

and hydration status

of patient

partial assessment of acid

base status; alkaline

pH indicates

old sample or

urinary tract

infection

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Urobilinogen

Bilirubin Ketone Blood

another by-product of

red cell breakdown;

increased amounts seen in fever,

dehydration, hemolytic anemia

and liver disease

detects bilirubin

(a product of red cell breakdow

n); indicator of liver function

normal product of

fat metabolism; increased amounts seen in

diabetes or

starvation (extreme dieting)

red blood cells,

hemoglobin, or

myoglobin (muscle

hemoglobin); sensitive

early indicator of renal disease

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Ascorbic Acid

Leukocyte

EsteraseNitrite

Ascorbic acid (vitamin C) is

known to interfere with the oxidation

reaction of the blood and

glucose pad on common urine

test strips.

detects esterase enzyme

present in certain white blood cells

(e.g, neutrophils, monocytes); indicator of urinary tract

infection

certain bacteria convert normal urine

nitrate to nitrite;

indicator of urinary tract

infection


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Abnormal Constituents of Urine

1- Proteins (proteinuria)2- Sugars (glucosuria, fructosuria & galactosuria) 3- ketone Bodies (ketonuria)4- Billirubin (billirubinuria) & Bile Salts5- Nitrites

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1 -Proteins: (proteinuria)

Proteinuria is divided into prerenal, renal and postrenal proteinuria.

1-Prerenal proteinuria : Bence-Jones protein: This abnormal gamma globulin (light chains only) is synthesized by malignant plasma cells (multiple myeloma). It precipitates at 60oC, redissolves at 100oC and reprecipitates on cooling.

2-Renal proteinuria: • Severe muscular exercise • After prolonged standing• Acute glomerulonephritis • Nephrotic syndrome

3- Postrenal proteinuria:• Lower urinary tract inflammation, tumors or stones.

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2 -Glucose: (glycosuria)Presence of detectable amount of glucose in urine which occurs in the following conditions:

Uncontrolled Diabetes Mellitus (DM) Renal glucosuria with lowering of renal threshold : e.g. during pregnancy (gestational

diabetes).

-Fructose (Fructosuria)Presence of fructose in urine & may be due to :

- Alimentary causes following the ingestion of large amounts of fructose - Fructosemia & hereditary fructose intolerance (Metabolic disorders of fructose).

-Galactose (Galactosuria):

Presence of galactose in urine& may be due to: - Alimentary causes following the ingestion of large amount of galactose. - Galactossemia

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3- Ketone Bodies (Ketonuria): Presence of acetone, acetoacetic acid & β hydroxybutyric acid in

urine due to:

• Diabetic ketoacidosis (uncontrolled DM)• Starvation• Unbalanced diet: high fat & low carbohydrates diet.

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4- Bilirubin (bilirubinuria) Billirubin appears in urine in cases of:• Hepatocellular Jaundice: as in viral hepatitis • Obstructive Jaundice as any cause of obstruction of bile duct

5 -Nitrites:• In bacteruria in urine (in cases of Urinary Tract Infection, UTI)

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• The urine specimen is centrifuged and the liquid portion is poured off.

URINE ANALYSISMicroscopic Examination

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• The concentrated cellular sediment, is then placed on a microscope slide, covered with a coverslip and read under microscope.


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A variety of normal and abnormal cellular elements may be seen in urine sediment such as:

• Casts• Crystals • Amorphus• Microorganisms• Pus cells• RBCs• Epithelial cells• Mucus


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RBCs -presence of a few

is normal (2 – 5 cells/HPF)

-higher numbers are indicator of renal disease

-result of bleeding at any point in urinary system

40x objective


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Pus cellsa few are normal

(2 – 4 cells /HPF)high numbers

indicate inflammation or infection somewhere along the urinary or genital tract.

40x objective


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Mucus– look like long,

ribbon-like threads– common finding in

urine sediment– secreted by glands

in the lower urinary tract.

– Become more with UTI, ulcerative colitis, kidney stones

40x objective


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Epithelial Cells

–cells are large and flat

–normal cells that line the urinary and genital tract or renal tubules

40x objective


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Crystals of calcium oxalatecolorless octahedronfound in acid urine

Crystals of triple phosphatecolorless, “coffin-lid”

prism common finding; no

clinically significant


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URINE ANALYSISMicroscopic Examination (Casts)

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Amorphous urate(Acidic urine)

Amorphous phosphate (alkaline urine)


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Bacteria Yeast


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schistosoma haematobium Trichomonas vaginalis

URINE ANALYSISMicroscopic Examination (Parasites)

Characterized by Central spin

It is not Urinary system protozoa, it’s vagina

protozoa

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Urinalysis

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