Urine analysis
MD SANA
BSC DIALYSIS TECHNOLOGY
School of Allied Health Science
Mohan Babu University
INTRODUCTION
IMPORTANCE OF EXAMINING URINE:
Urinalysis is one of the key tests to evaluate kidney and urinary tract
disease.
It enables detection of both physiological and pathological
functioning of the urinary system.
Various metabolic disorders and endocrine can also be detected on
urine examination.
Routine urine analysis consists of three important components:
1. Physical examination
2. Chemical determination
3. Microscopic analysis
COLLECTION OF URINE FOR URINE ANALYSIS
The first voided morning urine sample is the best for routine urine
analysis
The 24 hours urine collection for quantitative analysis (discard the first
urine of the morning).
For urine microscopy , a mid stream sample of the first morning urine
recommended.
Urine sample obtained by suprapubic bladder puncture.
In special situation, urine can also be collected through a bladder
catheter.
RECOMMENDATIONS
Strenuous physical exercise (running) should be avoided for at 24 hrs
before the urine sample delivery to avoid exercise induced proteinuria and
hematuria or urinary casts.
in women , urinalysis must be avoided during menstruation because of the
high probability of blood contamination.
PRESERVATION OF URINE
Urine is best examined within 4 hours of collection. If it is not possible refrigeration
of specimens also gives good preservation for upto 24 hours
In case 24 hrs urine analysis preservatives like thymol and formaldehyde can be
used.
PHYSICAL EXAMINATION
PHYSICAL PROPERTIES which includes (colour , clarity, odour, PH, volume,
specific gravity).
COLOUR
Colour:Normal urine is pale yellow colour.
Concentrated urine is high coloured and usually due to dehydration
Pale urine is usually due to overhydration
Pale Yellow/ Straw Coloured
ABNORMAL COLOURED URINE
Red Urine – Hematuria (presence of RBC)
Hemoglobinuria
myoglobinuria
Dark Yellow – Bilirubinuria(jaundice)
Pink urine – Massive uric acid crystalluria
CONT…..
Orange red - Drugs ( rifampicin)
Black - Alkaptonuria (On standing)
Melanin pigment
CLARITY
Normal urine is transparent (clear)
Cloudy urine indicates presence of WBC’s (pyuria) bacteria,
spermatozoa, mucin phosphates, carbonate, radiographic dyes.
Milky Urine - Pyuria ( pus cell in urine)
Lipiduria (lipid in urine)
Chyluria( lymphatic fluid in urine)
Clarity of urine
ODOUR
Normal urine has a faint aromatic odour
Ammoniacal fetid odour : bacterial overgrowth
Fruity odour : ketonuria
Mousy odour : phenyl ketonuria
Odourless urine : Acute tubular necrosis
URINE VOLUME
Normal -1.5-2.0 Litres
Polyuria - >2.5 litres/day
Oliguria - < 400 ml/day
Anuria - < 40 ml/day
Causes Of Polyuria
Physiological – increased intake of fluid, cold weather, diuretics .
Pathological – diabetics mellitus ,diabetics insipidus
Causes Of Oliguria
Physiological – Decreased intake of fluid , excess sweat, hot weather
Pathological – Shock, Renal failure, Acute tubular necrosis, Obstructive
uropathy
SPECIFIC GRAVITY
It measures the relative degree of concentration or dilution of urine
specimen.
It is the relative proportion of dissolved solid components to total
volume of the specimen.
NORMAL VALVE – 1.003-1.035 over a 24hr period
Causes of low specific gravity
<1.007 hyposthenuria
Diabetes insipidus
Chronic pyelonephritis
Chronic Glomerulonephritis
Over hydration
Causes of high specific gravity
Excess water loss/dehydration
Increased solutes in urine
sugar and protein in urine
Fixed specific gravity
Isothenuric specific gravity is fixed at 1.010, it is seen in chronic renal
failure which there is disruption of both concentrating and diluting abilities
of the kidney.
Method
Method for testing specific gravity
Urinometer
dipstick
URINE PH
Normal urine Ph varies from 4.0-6.5
Causes of acidic urine:
Intake of diet high protein
Respiratory acidosis
Metabolic acidosis
Causes of alkaline urine :
Intake of citrus fruits
Respiratory alkalosis
Metabolic alkalosis
Method
Dipstick method , Ph paper ,Ph meter and titration of urine
CHEMICAL DETERMINATION
Chemical characteristics of urine are most frequently evaluated by reagent
strips. These plastic strips bears several pads ( the most used are specific
gravity , PH, Glucose,, albumin ,blood/hemoglobulin, bilirubin, ketones ).
Each pad being impregnated with chemical reagents meant to be detect a
specific urine features
Reagent strips have the advantages of simplicity and low cost and supply a full
urinary profile within 2 to 3 minutes.
PROTEIN
Normal upto 150 mg of protein is excreted per day. it is usually composed
of tubular proteins, small immunoglobulins (IgA), albumin and β2
microglobulin in very small amounts.
ALBUMINURIA
Normal albumin excretion : 0- 30 mg/ 24 hrs
Microalbuminuria defined as urine albumin in the range of 30 to 300
mg/24 hrs. in patient with diabetes it indicates risk for developing overt
diabetic nephropathy.
In general population it indicates increased risk of CKD and
cardiovascular disease.
Causes of proteinuria:
Functional proteinuria: less than 0.5 gm/day
seen in : Exercise, exposure to cold, fever
Mild proteinuria( <1.0 gm /day)
causes: Chronic pyelonephritis
Renal tubular disease
Urinary Tract infection
Moderate proteinuria ( 1.0 – 3.5 gm /day)
causes : Acute glomerulonephritis
Renal stone disease
Severe urinary tract infection
Renal failure
Heavy proteinuria ( > 4.0 gm/day)
causes : Nephrotic syndrome
Chronic glomerulonephritis
Systemic lupus erythromatous
Diabetic nephropathy
GLUCOSE AND OTHER SUGARS
Various sugars found in urine include glucose, fructose, maltose ,
lactose, pentose and sucrose
GLUCOSE:
Presence of glucose in urine is termed as glycosuria . Glycosuria
occur when blood glucose level is more than 180-200 mg/dl( Renal
threshold)
CAUSES OF GLYCOSURIA
Diabetics mellitus
Cushing syndrome( increased level of corticosteroids)
Acromegaly( increased level of growth hormone
pheochromocytoma( tumor of adrenal medulla)
pregnancy (gestational diabetics mellitus)
OTHER SUGARS IN URINE
Galactose – Galactosemia
pentose – with ingestion of large quantities of fruits
Lactose – late pregnancy & lactation.
METHODS FOR TESTING SUGARS
SPECIFIC TEST
DIPSTICK – it involves glucose oxidase and peroxidase method which is
double sequential enzyme reaction . The dipstick impregnated with the
enzymes. This is specific only for GLUCOSE.
KETONES
Ketones are breakdown products of fatty acids and their presence in urine is
indicative of excessive fatty acid metabolism .This leads to formation of ketones
bodies
In ketonuria three types of ketones are found in urine:
Acetoacetic acid (20%)
Acetone (2%)
β hydroxy butyric acid (78%)
CAUSES OF KETONURIA
Diabetes mellitus
Starvation
Vomiting / dehydration
Pregnancy with hyperemesis
Acute febrile illness
DETECTION OF KETONURIA IN URINE
Most methods detect acetoacetic predominantely or acetoacetic acid and acetone
. β hydroxybutyric is rarely detected
DIPSTICK-based on nitroprusside reaction. Dipstick is coated with nitroprusside.
Positive result is indicated by colour change to varying shades of violet.
ROTHER’S TEST – (Classic nitroprusside test)acetoacetic acid and acetone reacts
with nitroprusside in alkaline solution to form “purple ring” complex
BLOOD
The presence of abnormal number of RBCs in urine called hematuria.
The presence of free hemoglobin in urine called Hemoglobinuria.
CAUSES OF HEMATURIA
Acute glomerulonephritis ( AGN)
IgA nephropathy
Membranous nephropathy
Focal segmental Glomerulosclerosis
Urinary calculi
Tumors of urinary tract
Bleeding disorders
Hematuria can be grossly or microscopically
CAUSES OF HEMOGLOBINURIA
Severe intravascular hemolysis
Mechanical trauma to RBCs – prosthetic valves
Incompatible blood transfusion
Hemolytic uremic syndrome
METHODS
BENZIDINE TEST:
Mix equal volume of benzidine solution and hydrogen peroxide (reagent). Add few ml
of urine with above reagent . A blue colour indicates presence of blood and hemoglobin.
DIPSTICK – Based on H2O2 reaction . The dipstick is coated with orthotoluidine.
BILIRUBIN
Presence of bilirubin indicates jaundice
TEST FOR BILIRUBIN
FOUCHET’S TEST:
DIPSTICK :
Uses diazo reaction to detect bilirubin. Bilirubin couples with a diazonium salt in a
week acid to give a tan colour.
MICROSCOPIC EXAMINATION
Urine sediments are composed of
Cells
Urinary Casts
Urinary Crystals
CELLS
RBCs CELL
Red blood cells (RBCs) may find their way into the urine from any
source between the glomerulus and the urethral meatus.
The presence of more than two to three erythrocytes per HPF is
considered pathologic.
WBC
Normal – < 5 neutrophil/HPF
Increased WBCs seen in pyuria due to
Urinary Tract Infection
Pyelonephritis
Cystitis
SLE
CASTS
Casts are cylindrical structures that form in the lumen of the distal
renal tubules and collecting ducts . Their matrix is made up of
Tammhorsfall glycoprotein(uromodulin).
URINARY CASTS
Hyaline casts- normally present in urine especially ( concentrated
&acidic)
Hyaline – granular casts- seen commonly in glomerulonephritis and acute
interstitial nephritis.
Granular casts – seen in renal disease, acute tubular necrosis
Waxy casts- Seen in Chronic renal disease usually ESRD
CONT…
Fatty casts- seen in glomerular disease with marked proteinuria or
nephrotic syndrome.
RBCs Casts- Acute glomerulonephritis, acute interstitial nephritis
WBCs Casts- Acute pyelonephritis
CRYSTAL
Examination of urine for crystal is a key test in the assessment of
patients with stone disease , with some rare inherited metabolic
disorders (eg cystinuria) and with suspected drug nephrotoxicity.
Urinary crystals
Crystals found in acidic urine
Amorphous urates- reddish granules
uric acid – Rhombic/ prism shaped
calcium oxalate- envelop/ dumbbell shape
Crystals found in alkaline urine
triple phosphate – coffin lid shape
calcium carbonate- dumbbell/spherical shape
ammonium biurate- thorn apple shape
Crystals found in abnormal urine
Cysteine – colourless hexagonal plates seen in cysteinuria
Leucine – yellow oily needles seen in leucinuria
Tyrosine – fine silky needles seen in tyrosinemia
Bilirubin crystal
Cholesterol crystal
Large crystal of indinavir
THANK YOU
