INTRODUCTION TO URINALYSIS

PMLS - LABORATORY
LEGEND
o Readily available and can be
MAIN TOPIC easily collected
SUBTOPIC o Urine contains information which
SUB-SUBTOPIC can be contained by inexpensive
laboratory tests about the body’
HISTORY AND IMPORTANCEO OF URINALYSIS major metabolic function
• Analysis of urine was the beginning of • IMPORTANCE: used to detect and
laboratory medicine manage a wide range of disorders.
• Pictures of early physicians commonly URINE FORMATION
showed them examining a bladder- • Kidneys continuously form urine as an
shaped flask of urine ultrafiltrate of plasma
• Ff. diagnostic observations of urine: • Reabsorption of water and filtered
o Color substances essential to body function
o Turbidity converts approx. 170,000 mL or filtered
o Odor plasma to average daily urine output of
o Volume 1200-1500 mL
o Viscosity
o Sweetness URINE COMPOSITION
• Uroscopy – water casting • Consists of urea and other inorganic and
• Hippocrates wrote the book Uroscopy organic chemicals
• During the middle ages, physicians • 95% water and 5% solute
concentrated their efforts in intensively • Concentration of solutes in the urine
on the art of uroscopy depends on the ff:
• Fedrick Dekkers – discovered o Dietary uptake
albuminuria in 1694 by boiling urine o Physical activity
• Invention of the Microscope (17th o Body metabolism
century) – led t the examination of o Endocrine functions
urinary sediment PRIMARY OF NORMAL COMPONENTS OF
• Thomas Addis – pioneered the methods URINE
for quantifying microscopic sediments UREA Primary organic component.
• Richard Bright – introduced the concept Product of protein and amino
of urinalysis as a part of routing patient acid metabolism
examination in 1827 CREATININE Product of creatinine
• 1930s – the complexity of the tests metabolism by muscles
performed has reached a point of URIC ACID Product of nucleic acid
impracticality and urinalysis began to breakdown in food and cells
CHLORIDE Primary inorganic component.
disappear from routine examinations.
Found in combination with
o UTI
sodium and others
o Metabolic disorder
SODIUM Primary from salt, varies by
o Liver disorder intake
o Kidney problems POTASSIUM Combined with chloride and
• Unique characteristics of urine specimen other salts
for continued popularity analysis: AMMONIUM Regulates blood and tissue fluid
INTRODUCTION TO URINALYSIS
PMLS - LABORATORY

CALCIUM Combines chloride, sulfate, and o A requisition form must

phosphate accompany specimens delivered
URINE VOLUME to the laboratory
• Depends on the amount of water that the o Information on the form must
kidney excretes match the information on the
• Factors that influence urine volume: specimen label
o Fluid intake or fluid loss from o Other information can include,
nonrenal sources interfering medications and
o Variations in the secretion of patient’s clinical information
anti-diuretic hormone SPECIMEN REJECTION
o Need to excrete the amount of • Improper labeled and collected
glucose and salts specimens should be rejected by the
COMMON TERMINOLOGY laboratory
OLIGURIA • Decreased urine output • The following situations called for
• <400 mL/day In adults rejection:
• Commonly seen when o Unlabeled containers
body enters a state of o Non-matching labels and
dehydration requisition forms
ANURIA • Cessation of urine flow o Specimens contaminated with
• May result from any feces or toilet paper
serious damage to the o Containers with contaminated
kidneys from a decrease exteriors
in the flow of blood to o Specimens of insufficient
kidney quantity
POLYURIA • Increased in daily urine o Specimens that have been
volume improperly transported
• >2.5 L/day in adults
NOCTURIA • Increased urine output SPECIMEN INTEGRITY AND PRESERVATAION
in the evening • Specimen should be delivered to the
laboratory and promptly tested within 2
MATERIALS
• CONTAINERS hours
o Dry, leak-proof containers • Temperature for preservation = 2C to 8C
o Wide mouth, flat bottom must be • When a specimen must be transported
to prevent overturning over a long distance and refrigeration is
o Made of clear material impossible, chemical preservatives can
o Recommended container be added.
capacity = 50mL; allows 12mL of CHANGES IN UNPRESERVED URINE
specimen ANALYTE CHANGE CAUSE
• LABELS Color Modified/ Oxidation or
o Patient’s name and ID number Darkened reduction of
o Date and Time of Collection metabolites
o Patient’s age and requesting Clarity Decreased Bacterial growth
physician and precipitation
• REQUISITION of amorphous
material
 INTRODUCTION TO URINALYSIS
PMLS - LABORATORY

Odor Increased Bacterial changes with diurnal variations

multiplication with daily activities
causing o Solutes analyzed:
breakdown of ▪ 17-hydroxysteroids
urea to ammonia ▪ Catecholamine
pH Decreased Breakdown of ▪ Electrolytes
urea to ammonia
• Catheterized specimens
by urease-
o Collected under sterile
producing
bacteria/loss of conditions by passing a hollow-
CO2 tube (catheter) through the
Glucose Decreased Glycolysis and urethra into the bladder
bacterial use o Mostly used in bacterial culture
Ketones Decreased Volatilization and • Midstream clear-catch specimen
bacterial o Provides a sager, less traumatic
metabolism method for obtaining urine for
Bilirubin Decreased Exposure to bacterial culture and urinalysis
light/photo- o Specimen is less contaminated
oxidation to with epithelial cells and bacteria
biliverdin
• Suprapubic Aspiration
Urobilinogen Decreased Oxidation to
o Provides sample for bacterial
urobilin
culture that is free from
RBC, WBC, Decreased Disintegration in
and Casts dilute alkaline extraneous contamination
urine o Also used for cytologic
Bacteria Increased Multiplication exmaination
Trichomonas Decreased Loss of motility,
Type of Specimen Purpose
death
Random Routine screening
First Morning Routine screening,
TYPES OF URINE SPECIMENS PTs, Orthostatic
• Random specimen protein
o Most commonly received 24-hour (or timed) Quantitative chemical
specimen tests
o Useful for routine screening test Catheterized Bacterial culture
to detect obvious abnormalities Midstream clean- Routing screening,
catch bacterial culture
• First Morning Specimen
Suprapubic Bladder urine for
o The ideal screening specimen
aspiration bacterial culture,
o Essential for preventing false- Cytology
negative pregnancy test and for Three-glass collection Prostatic infection
evaluating orthostatic, THREE PHASES OF URINE ANALYSIS
proteinuria • Physical Appearance
o Concentrated specimen o Color
• 24-hour or timed specimen o Clarity
o Collected when concentration of o Specific Gravity
substance to be measured • Chemical Examination
• Microscopic Examination
INTRODUCTION TO URINALYSIS
PMLS - LABORATORY
INTRODUCTION TO URINALYSIS
PMLS - LABORATORY

PHYSICAL EXAMINATION o Defined as the density of a

• Color (prev. table) solution compared with the
o Varies from almost colorless to density of a similar volume of
black distilled water at a similar
o Variations may be due to temperature
metabolic functions, physical o the SG of plasma filtrate entering
activity, ingested material or the glomerulus is 1.010
pathologic conditions o Isosthenuric SG = 1.010
o Urochrome – pigment that gives o Hyposthenuric SG = <1.010
urine a yellow color o Hypersthenuric SG = >1.010
• Clarity o Normal Random Specimen SG =
o General term that refers to 1.002 to 1.035
transparency or turbidity of a o Random Specimen = 1.015 to
urine specimen 1.030
o Visually examined in front of a
CHEMICAL EXAMINATION
light source, and specimen must
• Reagent test strip – used to confirm the
be in a clear container
presence of certain chemicals in the urine
o Routinely determined with color
that yields a color based on the intensity
at the specific same time
of the reaction.
• Parameters measures in the Chemical
Examination:
o pH
o Protein
o Glucose
o Ketone
o Blood
o Bilirubin
o Urobilinogen
o Nitrite
o Specific gravity
o Leukocyte esterase

MICROSCOPIC EXAMINATION
• To detect and to identify insoluble
materials present in the urine
• Microscopic analysis of urine and other
body fluids is the most important and
most utilized process used to determine
the presence of renal and urinary tract
diseases
• Sediments that settle at the bottom of
the tube is then analyzed under the
microscope
• Specific Gravity
INTRODUCTION TO URINALYSIS
PMLS - LABORATORY

• Blood, kidney, and lower genitourinary o Semi-quantitative terms (rare,

tract contributed to the formed elements few, moderate, many) (1+, 2+,
in the urine 3+, 4+ respectively)
• Formed elements: ▪ Squamous epithelial cells
o RBCs and mucus
o WBCs ▪ Transitional epithelial
o Epithelial cells cells
o Hyaline casts ▪ Bacteria, yeast,
o Bacteria Trichomonas
o Yeast ▪ Urinary crystals
o Parasites
o Mucus
o Spermatozoa
o Crystials
o Artifacts

IMPORTANT NOTES
• SPECIMEN VOLUME
o Standard amt of urine = 10-15 mL
o 12 mL is frequently used
• CENTRIFUGATION
o 5 mins @ 400 RCF
• SEDIMENT PREPARATION AND
SEDIMENT VOLUME
o Volume of sediment placed on
glass slide = 20 uL (0.02 mL)
covered by 22 x 22 mm glass
cover slip

EXAMINING SEDIMENT
• Minimum of 10 fields should be read
• 10x (LPO) and 40x (HPO) objectives are
used

REPORTING OF MICROSCOPIC EXAMINATION

• SEDIMENTS/FORMED ELEMENTS
o Average # per HPF
▪ RBCs
▪ WBCs
▪ Renal tubular epithelial
cells
▪ Oval fat bodies
o Average # per LPF
▪ Urinary Casts