TOPIC: Urine & Other Body Fluids
LECTURER: Dr. Marlon A. Briones
DATE: January 04, 2017
URINE o Measured by: Urinometer
Take 2/3 of urinometer container with urine
Urine is formed in the kidneys, is a product of ultrafiltration of Allow the urinometer to float into the urine
plasma by the renal glomeruli. Read the graduation at the lowest level of
urinary meniscus
Collection of Urine
Correction of temperature & albumin is a must.
Early morning sample-qualitative Urinometer is calibrated at 15or 200c
Random sample- routine So for every 3oc increase/decrease add/subtract
24hrs sample- quantitative 0.001
Midstream sample-UTI For 1gm/dl of albumin add0.001
Post prandial sample-D.M High Specific Gravity
24-hour Urine Sample Normal-1.016-1.022
For quantitative estimation of proteins Causes:
o All causes of oliguria
For estimation of vanillyl mandelic acid, 5-hydroxyindole acetic acid,
metanephrines o Glycosuria
Low Specific Gravity/ Hyposthenuria
For detection of AFB in urine
All causes of polyuria except
For detection of microalbuminuria
glycosuria
Urine Examination Fixed specific gravity (isosthenuria) =
A. Macroscopic Examination 1.010
Volume Seen in chronic renal disease when
o Normal = 600-1550ml kidney has lost the ability to
o Polyuria = >2000ml concentrate or dilute
Diabetes mellitus o Refractometer
Diabetes insipidus o Dipsticks
Polycystic kidney B. Chemical Examination
Chronic renal failure Proteins
Diuretics o Heat & Acetic Acid Test
Intravenous saline/glucose Principle: proteins are denatured & coagulated
o Oliguria = <400ml on heating to give white cloud precipitate.
Dehydration-vomiting, diarrhea, excessive Method: take 2/3 of test tube with urine, heat
sweating only the upper part keeping lower part as
Renal ischemia control.
Acute tubular necrosis Presence of phosphates, carbonates, proteins
Obstruction to the urinary tract gives a white cloud formation. Add acetic acid
Acute renal failure 1-2 drops, if the cloud persists it indicates it is
o Anuria - complete cessation of urine (<200ml) protein (acetic acid dissolves the
o Nocturia - excretion of urine by an adult of >500ml with a carbonates/phosphates)
specific gravity of <1.018 at night (characteristic of o Other tests:
chronic glomerulonephritis) Sulphosalicylic acid test
Color Dipsticks
o Normal = clear & pale yellow Esbach’s albuminometer - for quantitative
o Colourless - dilution, diabetes mellitus, diabetes estimation of proteins
insipidus, diuretics o Causes of Proteinuria:
o Milky - purulent genitourinary tract infection, chyluria Prerenal causes: Heavy exercise, Fever,
o Orange - fever, excessive sweating Hypertension, Multiple myeloma, Eclampsia
o Red - beetroot ingestion,haematuria Renal: Acute and chronic glomerulonephritis,
o Brown/ black - alkaptunuria, melanin Renal tubular dysfunction, Polycystic kidney,
Odour Nephrotic syndrome
o Normal = aromatic due to the volatile fatty acids Post renal: Acute and chronic cystitis,
o Ammonical - bacterial action Tuberculosis cystitis
o Fruity- ketonuria o Types:
Selective proteinuria
Reaction or Urinary pH
Nonselective proteinuria
o Reaction reflects ability of kidney to maintain normal
o Microalbuminuria
hydrogen ion concentration in plasma & ECF
The level of albumin protein produced by
o Normal= 4.6-8
microalbuminuria cannot be detected by urine
o Tested by:
dipstick methods. In a properly functioning
Litmus paper
body, albumin is not normally present in urine
pH paper
because it is retained in the bloodstream by the
Dipsticks
kidneys. Microalbuminuria is diagnosed either
o Acidic Urine
from a 24-hour urine collection
Ketosis-diabetes, starvation, fever
Indicator of subclinical cardiovascular disease
Systemic acidosis
Important prognostic marker for kidney disease,
UTI- [Link]
in diabetes mellitus and in hypertension
Acidification therapy
increasing microalbuminuria during the first 48
o Alkaline Urine
hours after admission to an intensive care unit
Strict vegetarian
predicts elevated risk for acute respiratory
Systemic alkalosis
failure , multiple organ failure , and overall
UTI- Proteus
mortality
Alkalization therapy
o Bence Jones Proteins
Specific gravity
These are light chain globulins seen in multiple
o Depends on the concentration of various solutes in the
myeloma, macroglobulinemias and lymphoma.
urine.
Transcribers: Janinejaturtles Page 1 of 4
CLINICAL PATHOLOGY: URINE & OTHER BODY FLUIDS
Test- Thermal method (water bath): TYPE PLASMA COLOR URINE COLOR
Proteins has unusual property of Hematuria Normal Smoky red
precipitating at 400 -600c & then m/s: plenty of RBC’s
dissolving when the urine is brought Hemoglobinuria Pink, hepatoglobin Red, occasional RBC’s
to boiling(1000c) & reappears when reduced
the urine is cooled.
Myoglobinuria Pink, normal Red, occasional RBC’s
Sugars
hepatoglobin
o Benedict’s Test (semi-quantitative)
o Principle: Benedict’s reagent contains [Link] the C. Microscopic Examination
presence of reducing sugars cupric ions are converted to Microscopic urinalysis is done simply pouring the urine sample into
cuprous oxide which is hastened by heating, to give the a test tube and centrifuging it (spinning it down in a machine) for a
color. few minutes. The top liquid part (the supernatant) is discarded. The
o Method: Take 5ml of benedict’s reagent in a test tube, add solid part left in the bottom of the test tube (the urine sediment) is
8drops of urine. Boil the mixture. mixed with the remaining drop of urine in the test tube and one drop
o Results: is analyzed under a microscope
Blue-green = Negative Contents of normal urine:
Yellow-green = + (<0.5%) o Few epithelial cells
Greenish yellow = ++ (0.5-1%) o Occasional RBC’s
Yellow = +++ (1-2%) o Few crystals
Brick red = ++++ (>2%) CRYSTALS IN URINE
o Detects all reducing substances like glucose, fructose, & Acidic Urine Alkaline Urine
other reducing substances.
Uric Acid Calcium carbonate
o To confirm it is glucose, dipsticks can be used (glucose
oxidase) Calcium Oxalate Ammonium magnesium
o Causes: Cystine phosphates (triple
Glycosuria with hyperglycaemia - diabetes, Leucine phosphate crystals)
acromegaly, cushing’s disease,
hyperthyroidism, drugs like corticosteroids. Urinary casts are cylindrical aggregations of particles that form in
Glycosuria without hyperglycaemia - renal the distal nephron, dislodge, and pass into the urine. In urinalysis
tubular dysfunction they indicate kidney disease. They form via precipitation of Tamm-
Ketone bodies Horsfall mucoprotein which is secreted by renal tubule cells.
o 3 types: ACELLULAR TYPES
Acetone
Hyaline Casts
Acetoacetic acid
β-hydroxy butyric acid The most common type of cast,
o They are products of fat metabolism hyaline casts are solidified Tamm-
o Principle: Acetone & acetoacetic acid react with sodium Horsfall mucoprotein secreted from
nitroprusside in the presence of alkali to produce purple the tubular epithelial cells
color. Seen in fever, strenuous exercise,
o Method: Take 5ml of urine in a test tube & saturate it with damage to the glomerular capillary
ammonium sulphate. Then add one crystal of sodium Granular Casts
nitroprusside. Then gently add 0.5ml of liquor ammonia Granular casts can result either from
along the sides of the test tube. the breakdown of cellular casts or
o Change in color indicates + test the inclusion of aggregates of
o Causes: plasma proteins (e.g., albumin) or
Diabetes immunoglobulin light chains
Non-diabetic causes- high fever, starvation, Indicative of chronic renal disease
severe vomiting/diarrhea
Bilirubin Waxy Casts
o Fouchet’s Test Suggest severe, longstanding
o Causes: kidney disease such as renal failure
Liver diseases - injury, hepatitis (end stage renal disease).
Obstruction to biliary tract
Bile salts
o Hay’s Test
o Cause: Obstruction to bile flow (obstructive jaundice)
Urobilinogen
o Ehrlich Test
o Cause: Hemolytic anemias
Blood
o Benzidine Test
o Principle: The peroxidase activity of hemoglobin
decomposes hydrogen peroxide releasing nascent
oxygen which in turn oxidizes benzidine to give blue color.
Fatty Casts
o Method: Mix 2ml of benzidine solution with 2ml of
hydrogen peroxide in a test tube. Take 2ml of urine & add Formed by the breakdown of lipid-
2ml of above mixture. A blue color indicates + reaction. rich epithelial cells, these are
o Causes: hyaline casts with fat globule
Pre-renal: Hemoglobinopathies, Bleeding inclusions
diathesis, Malignant hypertension They can be present in various
Renal: Trauma, Calculi, Acute and chronic disorders, including nephrotic
glomerulonephritis, Renal TB, Renal tumors syndrome, diabetic or lupus
Post renal: Severe UTI, Calculi, Trauma, nephropathy, and acute tubular
Tumors of urinary tract necrosis
Page 2 of 4
“Don’t worry about failures, worry about the chances you miss when you don’t even try.” –Jack Canfield
CLINICAL PATHOLOGY: URINE & OTHER BODY FLUIDS
Pigment Casts Disadvantages:
Formed by the adhesion of metabolic breakdown products or drug o Information may not be very accurate as the test is time-
pigments sensitive.
Pigments include those produced endogenously, such as hemoglobin in o It also provides limited information about the urine as it is
hemolytic anemia, myoglobin in rhabdomyolysis, and bilirubin in liver qualitative test and not a quantitative test (for example, it
disease. does not give a precise measure of the quantity of
Crystal Casts abnormality).
Though crystallized urinary solutes, such as oxalates, urates, or OTHER FLUIDS
sulfonamides, may become enmeshed within a hyaline cast during its
formation. CSF
The clinical significance of this occurrence is not felt to be great. Indications for lumbar puncture can be divided into four major
disease categories:
CELLULAR CASTS o meningeal infection
Red Blood Cell Casts o subarachnoid hemorrhage
o primary or metastatic malignancy
The presence of red blood cells within
o demyelinating diseases
the cast is always pathologic, and is
strongly indicative of glomerular
damage.
They are usually associated with
nephritic syndromes.
White Blood Cell Casts
Indicative of inflammation or infection,
pyelonephritis, acute allergic
interstitial nephritis, nephrotic
syndrome, or post-streptococcal
acute glomerulonephritis
Epithelial Casts
This cast is formed by inclusion or adhesion of desquamated epithelial
cells of the tubule lining.
These can be seen in acute tubular necrosis and toxic ingestion, such
as from mercury, diethylene glycol, or salicylate.
Urine Dipsticks
Urine dipstick is a narrow plastic
strip which has several squares of
different colors attached to it. Each
small square represents a
component of the test used to
interpret urinalysis. The entire strip
is dipped in the urine sample and
color changes in each square are
noted. The color change takes
place after several seconds to a
few minutes from dipping the strip.
If read too early or too long after the strip is dipped, the results may
not be accurate.
The squares on the dipstick represent the following components in
the urine:
o specific gravity (concentration of urine)
o acidity of the urine (pH)
o protein in the urine (mainly albumin)
o glucose (sugar)
o ketones
o blood
o bilirubin
o Urobilinogen
Advantages:
o convenient
o easy to interpret
o cost-effective
Page 3 of 4
“Don’t worry about failures, worry about the chances you miss when you don’t even try.” –Jack Canfield
CLINICAL PATHOLOGY: URINE & OTHER BODY FLUIDS
Synovial
Synovial fluid (synovia, SF) is an imperfect ultra-filtrate of blood
plasma combined with hyaluronic acid produced by the synovial
cells. Small ions and molecules
Peritoneal
Ascites is the pathologic accumulation of excess fluid in the
peritoneal cavity. Up to 50 mL of fluid is normally present in this
mesothelial-lined space. As with pleural and pericardial fluids, it is
produced as an ultra-filtrate of plasma dependent on vascular
permeability and on hydrostatic and oncotic Starling forces.
Pleural
An accumulation of fluid, called an effusion, results from an
imbalance of fluid production and reabsorption. This fluid
accumulation in the pleural, pericardial, and peritoneal cavities is
known as a serous effusion.
REFERENCE
Dr. Briones’ Powerpoint Presentation lifted from Henry’s Clinical Diagnosis
and Management by Laboratory Methods 22nd Edition Chapter 29
Pericardial
From 10–50 mL of fluid is normally present in the pericardial space,
produced by a transudative process similar to pleural fluid.
Pericardial effusions are most often caused by viral infection, and
enterovirus is the most common etiologic agent.
Page 4 of 4
“Don’t worry about failures, worry about the chances you miss when you don’t even try.” –Jack Canfield
