Biochemistry
Practical
URINALYSIS
To know what have we
changed check our
Editing file
Your body hears
everything your
mind says ..
Stay Positive
§ Important.
§ Doctors slides
Notes about the exam :
1. This work is not by any means a reference .
2. As the doctor said the exam will consist of a urinalysis case, and it
will be similar to the sample you did in the lab, but instead of finding
the features some of it will be given, and there will be a question on
the diagnosis of the case ..
3. Do your best and it will be so easy J
URINE :
vWhat is “urine”?
Urine is a fluid excreted by most of mammals including humans .
vIt is formed in :
the kidneys (renal glomeruli) .
vUrine Excretion :
-The fluid undergoes chemical changes before it is excreted as urine.
-Normal urine excretion by a healthy person is about 1.5 L per day .
v Physical Properties Of Urine
IMPORTANT
PARAMETER NORMAL ABNORMAL POSSIBLE CAUSES
Polyuria Diabetes , chronic renal failure
Volume 0.4-2.0 L/day
Oliguria Dehydration , Acute renal failure
Presence of pus cells , bacteria , salt or epithelial cells
Appearance Clear Cloudy
Excessive fluid intake , uncontrolled DM* , DI** , chronic
Colorless
renal failure
*Diabetes Mellitus
**Diabetes insipidus
Orange Dehydration , carotenoid ingestion
Yellow-Green Jaundice
Color Pale Yellow
Red Blood , drugs etc.
Methemoglobin , alkaptonuria , melanoma , black water
Dark brown-black
fever
smoky glomerulonephritis
Fruity Diabetic ketoacidosis
Odor Ammoniacal Contaminated and long standing exposed urine
Urineferous Phenylketonuria
(Smell) Mousy
Burnt sugar Maple syrup urine disease
Crystals, salts or
Deposits None
cells
Blood clots , necrotic tissues and urinary stones
ketosis (diabetes mellitus & starvation) , severe diarrhea ,
Acidic metabolic and respiratory acidosis , excessive ingestion of
Reaction meat and certain fruits
4.6 - 7.0
(pH)
Respiratory and metabolic alkalosis , Urinary tract infection ,
Alkaline
Vegetarians
v Chemical Properties of urine IMPORTANT
PARAMETER NORMAL ABNORMAL POSSIBLE CAUSES
Nephrotic syndrome , glomerulonephritis , multiple
Protein < 200mg/day Proteinuria
myeloma , lower UTI , tumors or stones
Uncontrolled DM , gestational diabetes , Fanconi’s
Glucose None Glucosuria
syndrome
Diabetic ketoacidosis , Glycogen storage disease,
Ketones None Ketonuria starvation , Prolonged vomiting , Unbalanced diet: high
fat & Low CHO diet
Nitrite None Detected UTI
Bilirubin None Detected Hepatic and post-hepatic jaundice
Normal Trace
Urobilinogen (1mg/dl)
> 2 mg/dl Jaundice
Acute & chronic glomerulonephritis , Trauma , cystitis ,
renal calculi and tumors , Bleeding disorders
Hematuria
(Hemophilia).
Blood None
Hemoglobinopathies , Malaria , Transfusion reaction
Hemoglobinuria (Blood Incompatibility)
Nephrotic
PROTEINS
syndrome
“ Normally less than 200 mg protein is
excreted in the urine daily “Large amounts of protein are lost in the
urine and hypoproteinemia develops.
“
More than this level leads to a “ Increase protein excretion in urine
condition called (Proteinuria). can be one of the following two types:
A: High Molecular Weight
Glomerular Filtration of high Protein Excretion:
Proteinuria glomerular molecular weight
It is due to permeability proteins ( e.g. • Glomerular proteinuria due to
glomerulonephritis) increase glomerular permeability
leading to filtration of high
molecular weight proteins
B: Low Molecular Weight
Tubular ¯ Tubular excretion of low Protein Excretion:
proteinuria reabsorption with molecular weight • Tubular proteinuria due to
normal glomerular proteins (e.g. decrease reabsorption with
It is due to
permeability chronic nephritis) normal glomerular permeability
v Urinalysis (using dipstick):
Principle:
Procedure:
§ Dipsticks are plastic strips impregnated
with chemical reagents which react
with specific substances in the urine to 1. Dip the strip in the urine sample
produce color-coded visual results. provided then remove it immediately.
§ They provide quick determination of 2. Remove the excess urine and keep the
strip in a horizontal position.
pH, protein, glucose, ketones,
urobilinogen, bilirubin, blood,
hemoglobin, nitrite, and specific 3. Read the color produced within 30-60
seconds (Color changes after more
gravity. The depth of color produced
relates to the concentration of the than 2 minutes are of no significance).
substance in urine.
4. Match the color changes to the color
§ Color controls are provided against scale provided.
which the actual color produced by the
urine sample can be compared .The 5. Give a full report about:
- Physical examination
reaction times of the impregnated
chemicals are standardized. - Chemical examination
CASE I Usually under 25 years patient
with type I diabetes When there
is no enough Insulin, the
A 12-year-old girl, a known patient with T1DM, presented to Emergency drowsy with short patient
history of vomiting and abdominal pain. On examination: can not use the glucose as a fuel
- Tachycardia so the body breaks down fat
instead, lead to acid (ketones) build up.
- Tachypnea with a fruity smell of breath.
- BP: 85/50 mmHg (Ref range: 100/66-135/85 mmHg) Diagnosis is very important
- Blood sugar: 26.7 mmol/L (Ref range: 3.9-5.6 mmol/L) Diabetic with ketonuria
- HbA1C: 9.9% (Ref range: 5.7-6.4%)
(diabetic ketoacidosis)
- Blood pH: 7.1 (Ref range: 7.35–7.45)
- Circulating Ketone bodies: positive
A mid stream Urine sample was collected for complete urinalysis.
Important characteristics:
v What are the Physical Properties of Urine.?
Polyuria, Fruity Odor, Acidic PH, colorless
(usually the rest are normal)
v What are the Chemical Properties of urine?
Ketonuria, Glucosuria
elevated amount of keton and glucose in urine .
(usually the rest are normal)
CASE II UTI patients usually have:
1- Pain or burning feeling during urination.
2- feeling of urgency.
●A 49-old woman with history of DM came to hospital 3- feeling the need to urinate frequently.
with fever, weakness and dysuria (pain during urination) 4- altered appearance of the urine,either
for the last three days. bloody (red) or cloudy.
● The results of her laboratory tests were as the table below. 5- pain or pressure inthe rectum.
● A mid stream Urine sample was collected for complete urinalysis.
● Microscopic examination of urine showed:-
－ WBCs: over 100/HPF (Ref range: 2-3/HPF) Diagnosis is very important
－ RBCs: 10 /HPF (Ref range: 0-2/HPF) Urinary tract infection
Test Result Reference range
Fasting blood glucose 7.5 3.9-5.8 mmol/L
Creatinine 75 55-120 mmol/L
Urea 3.7 2.5-6.4 mmol/L
Sodium 140 135-145 mmol/L
Potassium 3.9 3.5-5.1 mmol/L
Important characteristics:
v What are the Physical Properties of Urine?
(Alklaine, cloudy) (usually the rest are normal)
v What are the Chemical Properties of urine?
(Proteinuria, Hematuria, Nitrite detected)
(usually the rest are normal)
CASE III Nephrotic Syndrome Is A
Kidney Disease With:
§ Proteinuria
A 6-year-old boy, developed marked edema over a period of few days. His mother had noted puffiness § Hypoalbuminemia
around the eyes, characteristically in the morning. She also noted that his urine had become frothy § Edema
His general practitioner ordered the following investigations (in the table below): § Hyperlipidemia
§ Hypercholesterolemia
• A BLOOD sample was collected to show the following
Test Result Reference range Diagnosis is very important
creatinine 58 55-120 mmol/L
Nephrotic Syndrome
Urea 3.4 2.5-6.4 mmol/L
Sodium 136 135-145 mmol/L
Potassium 4.0 3.5-5.1 mmol/L
Total Protein 34 60-80 g/L
Albumin 14 35-50 gmL
Cholesterol 11 3.2-5.2 mmol/L
Triglycerides 1.5 0.5-2.27 mmol/L
The blood sample shows
hypoalbuminemia and
hyperlipidemia = Nephrotic Important characteristics:
Urine dipstick must
v What are the physical properties ofurine?
show proteinuria
SYMPTOMS: Frothy urine.
(usually the rest are normal)
1. Frothy urine v What are the Chemical Properties of urine?
2. Puffiness around the eye Heavy proteinuria.
3. Edema (usually the rest are normal)
THANK YOU
FOR CHECKING OUR WORK
Done By:
MUHANNED ALZAHRANI
