Nursing Foundation
Mrs. Neha Babru
Asst.Professor
What is urine analysis?
• Urine analysis, also called
Urinalysis – one of the oldest
laboratory procedures in the
practice of medicine.
• Also knows as Urine-
R&M (routine &
microscopy) Courtesy of the National Library of Medicine
• Is an array of tests
performed on urine, and
one of the most common
Why urinalysis?
• General evaluation of health
• Diagnosis of disease or disorders of the
kidneys or urinary tract
• Diagnosis of other systemic disease that
affect kidney function
• Monitoring of patients with diabetes
• Screening for drug abuse (eg.
Sulfonamide or aminoglycosides)
Collection of urine specimens
• Improper collection---- may
invalidate the results
• Containers for collection of urine
should be wide mouthed, clean and
dry.
• Analysed within 2 hours of
collection else requires
refrigeration.
Types of urine sample
Sample type Sampling Purpose
Random specimen No specific time Routine screening, chemical
most common, taken & FEME
anytime of day
Morning sample First urine in the morning, Pregnancy test, microscopic
most concentrated test
Clean catch midstream Discard first few ml, collect Culture
the rest
24 hours All the urine passed during used for quantitative and
the day and night and next qualitative analysis of
day Ist sample is collected. substances
Postprandial 2 hours after meal Determine glucose in
diabetic monitoring
Supra-pubic aspired Needle aspiration Obtaining sterile urine
a
b
a: clean catch urine collection method
in children
b: Suprapubic aspiration of urine.
c: Urine storage and transportation kit
c
Urinalysis ;What to look for?
• Urinalysis consists of the following
measurements:
– Macroscopic or physical examination
– Chemical examination
– Microscopic examination of the sediment
– Urine culture
Physical examination of urine
Examination of physical
characteristics:
• Volume
• Color
• Odor
• pH and
• Specific gravity
▪ The refractometer or a reagent strip is used to
measure specific gravity
Physical examination continued…
▪ Normal- 1-2.5 L/day
Volume ▪ Oliguria- Urine Output < 400ml/day
Seen in
– Dehydration
– Shock
– Acute glomerulonephritis
– Renal Failure
▪ Polyuria- Urine Output > 2.5 L/day
Seen in
– Increased water ingestion
– Diabetes mellitus and insipidus.
▪ Anuria- Urine output < 100ml/day
Seen in renal shut down
Physical examination continued…
Color ▪ Normal- pale yellow in color due to pigments
urochrome-urobilin(yellow)and uroerythrin
(Red)
▪ Cloudiness may be caused by excessive
cellular material or protein, crystallization or
precipitation of non pathological salts upon
standing at room temperature or in the
refrigerator.
▪ Colour of urine depending upon it’s
constituents.
Physical examination continued…
Color • Abnormal colors:
• Colorless – diabetes, diuretics.
• Deep Yellow – concentrated urine,
excess bile pigments, jaundice
Physical examination continued…
Odour• Normal - aromatic due to the volatile fatty
acids
• On long standing – ammonical
(decomposition of urea forming ammonia
which gives a strong ammonical smell)
• Foul, offensive - pus or inflammation
• Sweet - Diabetes
• Fruity - Ketonuria
• Maple syrup-like - Maple Syrup Urine
Disease
• Rancid - Tyrosinaemia
Physical examination continued…
pH • Reflects ability of kidney to maintain
normal hydrogen ion concentration in
plasma & ECF
• Urine pH ranges from 4.5 to 8
• Normally it is slightly acidic lying between
6 – 6.5.
• Tested by:
– litmus paper
– pH paper
– dipsticks
• Acidic Urine –Ketosis (diabetes, starvation,
fever),systemic acidosis, UTI- E.coli,
acidification therapy
Physical examination continued…
Specific •It is measurement of urine density which
gravity reflects the ability of the kidney to
concentrate or dilute the urine relative to
the plasma from which it is filtered.
• Measured by:
– urinometer
– refractometer
– dipsticks
Physical examination continued…
Specific •Normal :- 1.001- 1.040.
gravity
▪ Increase in Specific Gravity - Low water intake,
Diabetes mellitus, Albuminuruia, Acute nephritis.
▪ Decrease in Specific Gravity - Absence of ADH,
Renal Tubular damage.
▪ Fixed specific gravity (isosthenuria)=1.010
Microscopic examination of urine
• A sample of well-mixed urine (usually 10-
15 ml) is centrifuged in a test tube at
relatively low speed (about 2000-3,000
rpm) for 5-10 minutes which produces a
concentration of sediment (cellular matter)
at the bottom of the tube.
• A drop of sediment is poured onto a glass
slide, a thin slice of glass (a coverslip) is
place over it ond observed under
microscope.
Microscopic examination of urine
• A variety of normal and abnormal
cellular elements may be seen in urine
sediment such as:
• Red blood cells
• White blood cells
• Mucus
• Various epithelial cells
• Various crystals
• Bacteria
• Casts
Microscopic examination of urine
Abnormal• Per High Power Field (HPF) (400x)
findings –– >>35 erythrocytes
leukocytes
– > 2 renal tubular cells
– > 10 bacteria
• Per Low Power Field (LPF) (200x)
– > 3 hyaline casts or > 1 granular cast
– > 10 squamous cells (indicative of contaminate
specimen)
– Any other cast (RBCs, WBCs)
• Presence of:
– Fungal hyphae or yeast, parasite, viral inclusion
– Pathological crystals (cystine, leucine, tyrosine)
– Large number of uric acid or calcium oxalate .
Microscopic examination of urine
• Hematuria is the presence of abnormal numbers
of red cells in urine due to any of several
possible causes.
– glomerular damage,
– tumors which erode the urinary tract anywhere along
its length,
– kidney trauma,
– urinary tract stones,
– acute tubular necrosis,
– upper and lower urinary tract infections,
– nephrotoxins
• WBC in high numbers indicate inflammation
or infection somewhere along the urinary
tract.
Microscopic examination of urine
Red blood cells in urine appear as refractile White blood cells in urine
disks
Microscopic examination of urine
Casts
• Urinary casts are cylindrical
aggregations of particles that form in the
distal nephron, dislodge, and pass into
the urine. In urinalysis they indicate
kidney disease.
• They form via precipitation of
mucoprotein which is secreted by renal
tubule cells.
Microscopic examination of urine
Hyaline Cast Granular Cast
Microscopic examination of urine
A variety
of normal
and
abnormal
crystals
may be
present in
the urine
sediment
Chemical analysis of urine
• The chemical analysis of urine us
undertaken to evaluate the levels of the
following component:
– Protein
– Glucose
– Ketones
– Occult blood
– Bilirubin
– Urobilinogen
– Bile salts
Chemical analysis of urine
• The presence of normal and abnormal chemical
elements in the urine are detected using dry reagent
strips called dipsticks.
• When the test strip is dipped in urine the reagents
are activated and a chemical reaction occurs.
• The chemical reaction results in a specific color
change.
• After a specific amount of time has elapse, this color
change is compared against a reference color chart.
Chemical analysis of urine
The dipstick method of chemical analysis
of urine
Chemical analysis of urine
Proteins in urine:
• Detected by heat coagulation or dipstick
method.
• Urine proteins come from plasma protein
and Tomm-Horsfall (T-H) glycoprotein.
• healthy individuals excrete <150 mg/d of
total protein and <30 mg/d of albumin.
• Plasma cell dyscrasias (multiple myeloma)
can be associated with large amounts of
excreted light chains in the urine, which
may not be detected by dipstick.
Chemical analysis of urine
Proteins in urine:
• Detected by heat coagulation or dipstick
method.
• Urine proteins come from plasma protein
and Tomm-Horsfall (T-H) glycoprotein.
• healthy individuals excrete <150 mg/d of
total protein and <30 mg/d of albumin.
• Plasma cell dyscrasias (multiple myeloma)
can be associated with large amounts of
excreted light chains in the urine, which
may not be detected by dipstick.
