URINALYSIS Power Point Presentation

8/12/2019 URINALYSIS Power Point Presentation

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URINALYSIS

Dr. Samuel Adegoke

WGH, Ilesa.


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Introduction

The Human urine is the effluent fluid

that is disposed from the kidney.

Thus, It is highly reflective in its

properties, of the state of health of

each individual.


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Urinalysis

A routine/ basic investigation.

Involves: Physical & chemical examination of urine.

Complete urinalysis: Includes microscopic exam.

Cheap, Fast & Simple.

Evaluation, diagnoses & monitoring health status.


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Indications:

To:1. Evaluate the general health status (Routine test)

2. Diagnose & monitor renal disorders.

3. Monitor for hyperglycemia/ Diabetes Mellitus.

4. Screen for drug abuse (e.g. steroids in athletes).

5. Pregnancy test


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Analysis

Can be performed:

Bedside.

Side laboratory.

Chemical pathology laboratory.


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How is urinalysis done?

1. Obtain Consent & Cooperat ion o f Pat ient & Parent.

2. Urine co l lect ion :

a) Freshly voided urine

b) Timing: Any time of the day.

Early morning is most valuable: Being most concentrated, it is more

reliably measures kidney function.

c) Clean the genitalia: cotton wool, water.

i. *Soap & disinfectant may contaminate urine.

ii. *Methylated spirit is astringent & kills germs in urine.


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Procedure:a) Collect mid-stream (clean

catch) or terminal urinesamples.

b) Other methods of collection:

i. Catheterisation.ii. Supra-pubic aspiration.

Collect sample in a clean,

transparent containers:

i. Urinalysis

ii. MCS

Precautions:

Read immediately (Max: 15

min) as Chemistry changes.

Otherwise refrigerate urine.

Put the dipstick into the urine

May use Urinometer to

measure S.G


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The Normal Urine Vs Abnormality:

Colour & Clarity Normal Appearance:

Colour: Colourless

Amber

Straw-coloured.

Clarity: Clear (i.e. not turbid).

Abnormalities: Dark-coloured:

Dehydration.

Haematuria:

Schistosomiasis, Hb SS.

Haemoglobinuria: G6PD Def

Bilirubinuria: Hepatitis

Foods & drugs: Rifampicin.

Amino-acidurias. In-born errors of

Metabolism.

Cloudy/ Turbid : Suggest UTI.


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Normal Urine Vs. Coca-Cola Urine


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The Normal Urine Vs Abnormality

Odour & Sediments

Normal Appearance:

Odour: Slight ammonical odour.

Sediments: Nil.

Abnormalities:

Odour: Has fishy odour in UTIparticularly in Proteus Sp.

Sediments:


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The Normal Urine Vs Abnormality

Volume, S.Gravity & pH Vol: 1 - 2mls/ Kg/ hour.

S. Gravity: a simplemeasure of concentrating

ability of kidneys = 1.0151.025.

pH: 4.58.0 (i.e. Slightlyacidic)

Oliguria: < 0.5 -1.0 mL/ kg. ARF, Dehydration, Shock

Persistently 1.010 CRF.

DI.

> 1.035: Shock, Severe dehydration

pH: If Alkaline = UTI


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Urinometer (Hygrometer)


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Urine Chemistry: Proteinuria

Proteinuria:

About 150mg/ 24hours,

(usually Albumin).

This amount is usuallynot dipstix detectable.

Trace, 1+, 2+

ARF, CRF, UTI,

Exercise

3+/ 4+

Nephrotic Syn.

Trace: 1029 mg/ dL

1+: 3099 mg/ dL

2+: 100299 mg/ dL

3+: 300999 mg/ dL

4+: 1 g/ dL


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Dipsticks (Combi-9 Dipstix)


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Urine Chemistry: Sugar

Glucose: Nil.

Glycosuria reflects

hyperglycemia:

DM

Monitor Patients on IVglucose infusion

Other Reducing

Substances:

Usually absent. E.g. Galactosuria.

Clinitest: ROYGBIV

Normal (0%): Blue

Glycosuria:

Green: %

Yellow: %

Orange: 1%

Red: 2% suggestive of

(RBS 15 mmol/ L)


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Urine Chemistry: Normal Vs AbN

Bilirubin:

Nil.

Conjugatedhyperbilirubinaemia.

Urobilinogen:

Trace.

Unconjugated hyperbil.

Haemoglobin: Nil.

Haemoglobinuria: intra-vascular haemolysis.

Ketones:

Nil.

Ketonuria: Starvation, DKA.

Nitrite:

Not usually detectable.

Presence indicative of UTI(Proteussp).


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Urine Microscopy Cells:

RBC: 02/ hpf

WBC: 05/ hpf but > 5/ hpf: Pyuria.

Epithelial Cells: Few, more in newborn

Organisms: Nil.

Casts: Small fibrous objects formed when protein &

other materials deposit in the kidney tubules & coll. ducts. Hyaline cast: 0-1/ hpf; found in Nephrotic Syn.

Red cell/ granular: Nil; found in AGN.


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Limitation

A limitless test, Simple, Cheap, Easil

reproducible.

Protein + Glucose: N50

Protein + Glucose + pH: N75

Combi-9: N150

Microscopy: N225

Full Urinalysis: N375.

Limitation: We often forget to do it.


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Conclusion

Must be done on all patients.

The findings must be followed with

appropriate investigations.

Best combined with other tests .e.g. E/ U + Cr &

24Hour urinalysis.


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Thank

you!

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