Urine analysis
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URINE ANALYSIS
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Urine dipstick
• Screening for disease • Fresh urine is collected into clean dry
container• Reagent strip immersed in the urine specimen,
ensure all the reagent blocks are covered.• Errors in results
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• Three urine samples are shown. The one at the left shows a red, cloudy appearance. The one in the center is red but clear. The one on the right is yellow, but cloudy.
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Parameters in urine dipstick test• Glucose• Bilirubin• Urobilinogen• Ketones• Specific gravity• pH • Protein• Blood• Nitrite• Leucocytes
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Physical examination of urine
• Volumea) physiological factor-increase intake of water-temperature-physical activity
-others due to diuretic drugs, coffee and alcohol-normal adult urine volume : 600-1200ml/hour-difference in urine volume due to: polyuria, oliguria, anuria and nocturia
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• Colour- normal : pale yellowish- urochrom pigment- abnormal : due to food intake and drugs
Red : beets, rhubarb (alkaline urine)Orange-yellowish : carrot, antibioticGreen, blue-green : drugs eg: amitryplineDark brown : drugs eg: methyldopa, metronidazole
- abnormal : due to pathologicalRed/maroon : rbc, hemoglobin, myoglobin‘wine-red’ : porphyrinDark brown : melanin, homogentisic acidYellowish-brown or greenish-brown : bilirubin, bile pigment
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• Odour normal: aromatic odour - Food and drugs causes characteristic odour
e.g: methyl salicylic, asparagus- Ketosis : fruity/sweet- Congenital metabolism disorder : e.g:
phenylketonuria ‘mousy’
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• Appearance/ transparencyNormal: -Slight turbidity: mucus (in women), squamous epithelial cell-Turbidity: calcium oxalate, uric acid, amorphous phosphate, amorphous urates
Abnormal:-turbid-red : rbc-turbid : bacterial or yeast infection -milky: lipid
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Normal urine composition
• Urea- End product of protein metabolism- 50% from urine composition- 25-30 g/24hr• Uric acid- End product of purine metabolism- 0.5-1 g/24hr• Creatinine- Skeletal muscle tissue
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• Creatine- Can be found in muscle tissues in form of
phosphocreatin• Sulphur- Protein intake• Indican- Triptophan katabolism in intestine• Ammonia- Final product of protein metabolism
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• Chloride- Second largest composition found in urine- Excreted in form of NaCl : 10-15g/24hr urine• Phosphate- Protein intake- 1.1g/24hr urine
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Pathological urine composition• Glucose• Protein• Ketones• Pus cells• Red blood cells• Lipid• Amino acid• Bile pigment• Calculi
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Microscopic sediment of urine• Cells -rbc, wbc, squamous epithelial cells, urethral epithelial cells• Casts- Represent a collection of protein and cellular debris in a
kidney tubule- Eg: hyaline : occasionally found in normal urine but their
number is increased in renal diseases. - Cellular cast: one or more type of cells are trapped during
their formation. Eg; pus cell casts, red cell casts, epithelial casts, and mixed cellular casts.
- Granular casts : fine granules appear in glomerular and tubular renal disease.
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Cyrstals• Uric asid• Amorphous urates• Amourphous phosphate• Calcium oxalate• Triple phosphate• Calcium carbonate• Tyrosine• Leucine• Cystine• Cholesterol
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• Red blood cells in urine appear as refractile disks. With hypertonicity of the urine, the RBC's begin to have a crenated appearance
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• These white blood cells in urine have lobed nuclei and refractile cytoplasmic granules.
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• Large polygonal squamous epithelial cells with small nuclei are seen here.
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• Oval fat bodies consist of degenerated tubular cells containing abundant lipid, which appears refractile.
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broad (Figure 3).
Urinary casts. (A) Hyaline cast (200 X); (B) erythrocyte cast (100 X); (C) leukocyte cast (100 X); (D) granular cast (100 X).
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Urinary crystals. (A) Calcium oxalate crystals (arrows; 100 X); (B) uric acid crystals (100 X); (C) triple phosphate crystals with amorphous phosphates (400 X); (D) cystine crystals (100 X).
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Type of Urine Sample & CollectionSample Sampling Purpose
Morning sample First urine in the morning
Pregnancy test, microscopic test
Random sample No specific time Routine screening, chemical & FEME
Postprandial 2 hours after meal Determine glucose in diabetic monitoring
Midstream/clean match
Discard first few ml, collect the rest
Culture
2 hours Within 2 hours period Determine urobilinogen
24 hours Within 24 hours period Determine renal function
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