AUBF- STRASINGER 7th ed.

PHYSICAL EXAMINATION

Importance of physical examination

 It provides a preliminary information  Other pigments responsible for

concerning disorders. the color of normal urine are:
 It aids in the evaluation of renal 1. Uroerythrin
tubular function. 2. Urobilin
 It is use to confirm or explain clinical
findings in the chemical and  Uroerythrin
microscopic analysis.  Pink pigment
 Indicator that the
Disorders
specimen was
 Glomerular bleeding refrigerated.
 Liver disease  Urobilin
 Inborn error of metabolism  Oxidation product of
 UTI urobilinogen
 Imparts Orange brown color
 Color of urine that is not fresh

Normal urine color ABNORMAL URINE COLOR

 Variation of urine color may be  Dark yellow

due to:  concentrated specimen
1. Normal metabolic functions  Amber
2. Physical activities  dehydration from fever and burns
3. Dietary intake
NOTES:
4. Pathologic disorders
 Normal urine produce small amount
 UROCHROME of foam and disappear rapidly
 Responsible for yellow color of  Presence of large amount of protein
urine. produce white foam
 Product of endogenous  Bilirubin – can be detected in
metabolism and is dependent in chemical analysis
body̕ s metabolic state.  Urobilinogen – no yellow foam is
seen when shaken.
NOTES:
 Pyridium- produce yellow foam when
 Thudichum named urochrome in shaken. Mistaken as bilirubin
1864
 urochrome is dependent on the  Yellow Orange
body’s metabolic state, with  Bilirubin
increased amounts produced in  yellow foam appears when
thyroid conditions and fasting. the specimen is shaken.
 Urochrome also increases in urine  Urobilinogen
that stands at room temperature  it is due to photo-oxidation of
urobilinogen to urobilin.
 Phenazopyridine (Pyridium)

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 AUBF- STRASINGER 7th ed.

 drug use for UTI NOTES:

 thick, orange pigment that
interferes in chemical tests  Methocarbamol (robaxin) – muscle
relaxant
that are based in color
 Amitriptyline ( Elavil ) –
reactions.
 Yellow green antidepressant
 Methylene blue – fistulas
 due to photo-oxidation of bilirubin
 purple staining may occur in catheter
to biliverdin.
bags and is caused by indican in the
urine or a bacterial infection,
 Brown / Black
frequently caused by Klebsiella or
 RBC remaining in an acidic urine
Providencia species
produce a brown color due to
oxidation of hemoglobin to
 Red
methemoglobin.
 Can be due to RBC, hemoglobin,
 Glomerular bleeding
myoglobin, menstrual contamination,
 Melanin
rifampin, phenolphthalein,
 Homogentinsic Acid phenindione, phenothiazines, beets
 Other causes: levodopa, and blackberries.
methyldopa, phenol derivatives & Rbc- Cloudy urine , positive in
metronidazole (Flagyl).
NOTES:

 Brown – oxidation of hemoglobin to

methemoglobin.
 Fresh brown urine containing blood –
glomerular bleeding.
 Melanin – oxidation product of the
colorless pigment melanogen,
produced in excess when a
malignant melanoma is present.
chemical test for blood, rbc observed
 Homogentinsic ACID – metabolite of
microscopically
phenylalanine , black color in alkaline
Hgb - clear urine w positive chem
urine from person with IEM called
test , intravascular hemolysis
alkaptonuria.
Mgb- clear urine w/ positive chemical
test , muscle damage
 Blue
Beets- red in alkaline urine
Medications like methocarbamol,
Blackberries - red in acidic urine
methylene blue, and amitriptyline
 Port wine
 Green
Due to oxidation of porphobilinogen
 Clorets phenol derivatives
to porphyrins.
found in IV medications
 Pseudomonas species
 Purple
 indicanuria
 bacterial infection

MJ SALVADOR 2
 AUBF- STRASINGER 7th ed.

CLARITY  Rbc , wbc and bacteria – cause by

 Clarity is the general term that refers infection or a systemic organ disorder
to transparency/turbidity of a urine.
SPECIFIC GRAVITY
 Precipitation of amorphous
phosphates and carbonates may Instruments use :
cause white cloudiness.
 Common terminology use:  Urinometer
 Clear  Harmonic Oscillation
 Hazy Densitometry (HOD)
 Cloudy  Refractometer
 Turbid  Chemical reagent strip
 Milky

 Clear- no visible particulates,

transparent
 Hazy – few particulates , print easily
seen
 Cloudy- many particulates , print
blurred
 Turbid – print cannot be seen
through urine
 Milky- may precipitate or be clotted
Pathologic Vs.Non-pathologic turbidity

NOTES:

 Urinometer and HOD are direct

method in determining the Specific
Gravity.
 Refractometer and Chemical rgt strip
are the indirect MTD.

 URINOMETER
CAUSES:  Consist of a weighted float that
displaces a volume of liquid equal to
NOTES:
its weight.
 Amorphous phosphate and
carbonates – white ppt in alkaline pH  Disadvantages :
 Amorphous urates – resembles as  Less accurate
pink brick dust due to uroerythyrin in  Large volume needed
acidic pH  Temperature correction needed

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 AUBF- STRASINGER 7th ed.

NOTES: Clinical significance

 Urinometer ( Hydrometer )  The specific gravity entering the

 CLSI – clinical and laboratory glomerulus is 1.010.
standards institute formerly NCCLS o Isosthenuric
 National committee for clinical o Hyposthenuric
laboratory standards o Hypersthenuric
 10-15mL  Normal random urine SG range is
1.003-1.035
 REFRACTOMETER o Below 1.003 is not a urine
 Principle use is refractive index. o Above 1.035 seen in * IV
 Advantages: pyelogram, dextran
 small volume of urine needed
NOTES:
 no temperature corrections
 Calibrators  Iso – 1.010
 distilled water  Hypo- <1.010
 5% NaCl  Hyper - > 1.010
 9% sucrose
 ODOR
 Harmonic Oscillation  It is not part of routine urinalysis.
densitometry
 It is based on the principle that the
frequency of sound wave entering a
solution changes in proportion to the
density of the solution.

Chemical Reagent strip

 Principle is based on the pKa

changes of a polyelectrolyte.

pKa ( dissociation constant)

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