Urine Analysis

Sbmitted to:Dr.Jayganeesh
Asst.Professor
Dept.of Modern Diagnosis
Submitted by:Manisha Nandan
3rd year BNYS
 Introduction
• Urine analysis, also called Urinalysis – one of
the oldest laboratory procedures in the
practice of medicine.
• Also knows as Urine- R&M (routine &
microscopy)
• Is an array of tests performed on urine.
 Collection of Urine sample
• 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
a: clean catch urine collection method
in children
b: Suprapubic aspiration of urine.
c: Urine storage and transportation kit
 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.
 Volume
• Normal- 1-2.5 L/day
• 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
 Color
• Normal- pale yellow in color due to pigments
urochrome, urobilin and uroerythrin.
• 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.
Abnormal colors:
• Colorless – diabetes, diuretics.
• Deep Yellow – concentrated urine, excess bile
pigments, jaundice
 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
• Characteristic "rotten egg" odor -
 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
 Specific Gravity
It is measurement of urine density which
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
• Normal :- 1.001- 1.040.
 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 2000-3,000rpm) 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.
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
 Abnormal Findings
Per High Power Field (HPF) (400x)
– > 3 erythrocytes
– > 5 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 contaminated
specimen)
– Any other cast (RBCs, WBCs)
• Presence of:
– Fungal hyphae or yeast, parasite, viral inclusions
– Pathological crystals (cystine, leucine, tyrosine)
– Large number of uric acid or calcium oxalate cr
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 or genital tract
RBC in urine appears as refeactile disk White blood cells in 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 Tamm-Horsfall
mucoprotein which is secreted by renal tubule
cells.
Types of cast seen :
– Acellular cast: Hyaline casts, Granular casts, Waxy
casts, Fatty casts, Pigment casts, Crystal casts.
– Cellular cast: Red cell casts, White cell casts,
Epithelial cell cast
• The most common type of cast- hyaline casts are solidified Tamm-Horsfall
mucoprotein secreted from the tubular epithelial cells and
seen in fever, strenuous exercise, damage to the glomerular capillary.
• Red blood cells may stick together and form red blood cell casts. Such casts
are indicative of glomerulonephritis, with leakage of RBC's from glomeruli, or
severe tubular damage
• White blood cell casts are most typical for acute pyelonephritis, but they
may also be present
A variety of normal or 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 componen:
– Protein
– Glucose
– Ketones
– Occult blood
– Bilirubin
– Urobilinogen
– Bile salts
• 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
provided by the
Dipstick method of 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. The
lightchains produced from these disorders are filtered by
the glomerulus and overwhelm
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