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Urine Analysis

This document provides details on performing a physical and chemical examination of urine. Key steps include assessing the urine's appearance, color, volume, odor, and specific gravity. Under microscopic examination, the urine is analyzed for the presence of red blood cells, white blood cells, epithelial cells, casts, crystals, and other findings. Chemical tests evaluate the urine for proteins, glucose, ketones, bile, urobilinogen, and other constituents. Taking these examination steps allows for analyzing the urine and providing impressions to identify any abnormalities.

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ajaysom
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112 views

Urine Analysis

This document provides details on performing a physical and chemical examination of urine. Key steps include assessing the urine's appearance, color, volume, odor, and specific gravity. Under microscopic examination, the urine is analyzed for the presence of red blood cells, white blood cells, epithelial cells, casts, crystals, and other findings. Chemical tests evaluate the urine for proteins, glucose, ketones, bile, urobilinogen, and other constituents. Taking these examination steps allows for analyzing the urine and providing impressions to identify any abnormalities.

Uploaded by

ajaysom
Copyright
© © All Rights Reserved
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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PHYSICAL EXAMINATION

• Appearance
• Colour
• Volume
• Odour
• Specific gravity
PHYSICAL EXAMINATION

1. Appearance
• Clear – Normal

• Cloudy – ppt of amorphous phosphates


(alkaline urine), urate ppts on cooling urine
(acidic urine)

• Fecal contamination – fistula

• Turbid – pus cells, RBC, bacteria, spermatozoa


2. Colour

• Normal pale yellow : urochromes

• Yellow/ yellowish green: bile pigments, vit B complex, carotene

• Red/ brown: Hb, beet, aniline dyes, hematuria, menstrual blood

• Smoky red/ brown: blood, senna

• Milky: large amounts of pus, bacteria, fat or chyle

• Black: melanin, homogentesic acid


3. Volume

• Adult -Normal average 24 hrs volume of urine is about 1500ml

(a) Polyuria - > 2,500 ml/24 hrs

• Increased salt, water & protein intake, Caffeine, thiazides,


diuretics
• Cold weather, rainy season
• DM, DI, Chronic Pyelonephritis, renal failure

(b) Oliguria - < 500 ml/24 hrs

• Acute & chronic glomerulonephritis, CCF, Shock


• Dehydration – water deprivation, hot weather, vomiting,
diarrhea, febrile states
(c) Anuria - Renal ischemia (CCF, HTN), Crush injuries, surgical
shock, mismatched transfusion
PHYSICAL EXAMINATION

4. Odour

Normal - aromatic/uriniferous d/t volatile aromatic acids

Sweet or fruity - ketone bodies

Ammonical - decomposition from stasis in bladder

Musty - phenylketonuria

Putrid - infection
PHYSICAL EXAMINATION
5. Reaction & pH

• Freshly voided normal urine is slightly acidic with a pH of 6.


• On standing pH becomes alkaline d/t release of NH3 from urea
• Acidic urine: high protein intake, Diabetic ketoacidosis,
respiratory & metabolic acidosis, UTI by Escherichia Coli

Alkaline urine: alkalinization of urine, high citrus fruits intake,


respiratory & metabolic alkalosis, UTI by Proteus &
pseudomonas

• Method- Litmus paper


pH electrode
Reagent strip
6. Specific gravity

• Ratio of the weight of a volume of urine to the weight of


same volume of distilled water.
• Sp.gr. depends on – Amount of solute, volume of solution
• Normal range for a 24 hr urine specimen is 1.016 to 1.022

• Increase S.G (hypersthenuria) - Decreased fluid intake,


fever, vomiting, diarrhea, CCF, DM,proteinuria

• Decrease S.G (hyposthenuria) - Diuretics, hypothermia,


glomerulonephritis, Diabetes insipidus

• Fixed S.G (isosthenuria)- CRF 1.010


Specific gravity

METHODS
• Urinometer
• Refractometer
• Falling drop method
• Reagent strip
CHEMICAL EXAMINATION

• Protein
• Glucose
• Ketone bodies
• Blood
• Bile pigments
• Bile salts
• Urobilinogen
PROTEIN

I. Qualitative estimation – ppt of proteins by


heat/chemical agents
• Heat coagulation test
• Sulfosalycilic acid test
• Heller’s nitric acid test
• Reagent strips- detects only albumin

II. Quantitative estimation –


• Esbach’s albuminometer

III. Test for Bence jones proteins


Glycosuria
• I. Diabetic : in DM
• II. Non-diabetic:

– Alimentary glycosuria – partial gastrectomy,


excessive sugar ingestion

– Renal glycosuria - low renal threshold,


pregnancy, after anaesthesia

– Endocrine- hyperthyroidism, pancreatitis,


acromegaly, Cushing syndrome

– Liver disease

– Intracranial injury

– Starvation
C. KETONE bodies

• Ketone bodies are intermediate products of fat


metabolism & include acetone, acetoacetic acid
& β hydroxyl butyric acid
• Ketonuria - diabetic ketoacidosis, starvation,
glycogen storage diseases, eclampsia, severe
dehydration states, febrile states & after general
anaesthesia.
• Tests: 1. Rothera’s- acetone, acetoacetic acid
2. Gerhardt’s – acetoacetic acid
D. BILE SALTS

Hay’s test:

Principle: Bile acid lowers the surface tension


of fluids in which they are contained.
E. BILE PIGMENTS

• Principle: Bile pigments are oxidized by acids


forming a series of coloured derivatives of
bilirubin. eg biliverdin (green), bilicyanin (blue),
& choletelin (yellow).

• Gmelin’s Test
• Harrison Fouchet test
BILE SALTS AND BILE PIGMENTS

BILE PIGMENT UROBILINOGEN

OBSTRUCTIVE
JAUNDICE + –
HEPATOCELULLAR
JAUNDICE + +

HEMOLYTIC
JAUNDICE – +
F. BLOOD

• Presence of blood may be in the form of intact


RBC’s (hematuria) or hemoglobin
(hemoglobinuria).
• Benzedine test:
Urine is centrifuged . The sediment is mixed
with equal volumes of the reagent (saturated
solution of benzedine in glacial acetic acid to
which equal quantitiy of hydrogen peroxide is
added)
Result: Blue color indicates a positive test
Hematuria:

• Pyelonephritis
• Urinary calculi
• Renal tuberculosis
• Tumours of kidney & urinary tract
• Sulfonamides & salicylates

Bleeding can occur high in the kidney & renal pelvis


( urine appears smoky brown due to hematin) or in lower
urinary tract (bright red urine).
Hemoglobinuria:

Disintegration of RBC’s within the circulation with


excessive liberation of Hb
When free hemoglobin d/t hemolysis is >150mg% in
plasma, it is excreted by the kidneys
(i) black water fever , clostridial infection
(ii) severe burns
(iii) hemolytic transfusion reaction
(iv) autoimmune hemolytic anemia
(v) PNH
(vi) sulfonamide & phenacetin administration
MICROSCOPIC EXAMINATION

1. Cells
(a). Pus cells
• Normal range is 2-5/HPF
• Pyogenic infection of
urinary tract and genital
tract
• Glomerulonephritis
• Kidney infarct
MICROSCOPIC EXAMINATION

(b). Red cells:


Pale yellow refractile
discs, & disintegrate on
addition of 2% acetic acid
Normally an occasional
red cell may be present.
Significant numbers
indicate hematuria.
MICROSCOPIC EXAMINATION

(c). Epithelial cells:

Originate from any site in


the genitourinary tract
Normally 3 – 5/ H.P.F.

(a) tubular
(b) transitional
(c) squamous cells
CASTS
• Cylindrical structures with parallel edges, formed by
precipitation of proteins (Tamm Honsefall protein) within
DCT & collecting tubules
• Associated with pathological change in kidney

a) Hyaline - fever, anaesthesia, GN, nephrosclerosis,


exercise
b) Epithelial – acute GN, kidney infarct
c) Granular – chronic GN, nephrosclerosis
d) Waxy - chronic nephritis, NS, Anuria, prolonged oliguria
e) RBC & WBC cast – pus cell cast
f) Pigment – blood, hemosiderin, bile, melanin
CRYSTALS IN URINE
Normal 1-3 per lph

Crystals in acid urine


Uric acid crystals
Urate crystals
Calcium oxalate
CRYSTALS IN URINE (Cont.)

Crystals in alkaline urine


Ammonium magnesium phosphates
Calcium carbonate
Ammonium biurate
CRYSTALS IN URINE (Cont.)

3. Abnormal crystals
(a) cysteine
(b) leucine
(c) Tyrosine
PARASITES IN URINE

Trichomonas vaginalis

Microfilaria in chylous urine

Ova of schistosoma hematobium

Hooklets or Scolices of E.granulosus

BACERIOLOGICAL EXAMINATION

For pyogenic organisms

For M. tuberculosis
SPECIAL TESTS

CYTOLOGICAL EXAMINATION FOR CANCER

HORMONES IN URINE

 Diseases of ovary, adrenals and pituitary

 Diagnosis of pregnancy (HCG level )

 Hydatiform mole and choriocarcinoma (HCG level)


DIP STICKS/ REAGENT
STRIPS

Commercially available
strips impregnated with
various reagents, for
easy & rapid testing of
various abnormal
constituents of urine.
URINE REPORT

Name: Regd no:

Age: Sex: Time of collection:

Chief complaints:

PHYSICAL EXAMINATION
Appearance-Colour,clarity :
Odor :
Volume :
Specific gravity :
CHEMICAL EXAMINATION
Reaction :
Proteins :
Sugar :
Ketone bodies :
Bile salts and pigments :
Urobilinogen :

MICROSCOPY
RBCS :
PUS CELLS :
EPITHELIAL CELL :
CASTS :
CRYSTALS :
OTHER FINDINGS :

IMPRESSION

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