Urine examination


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Urine examination

  1. 1. Urine Examination
  2. 2. Defination of urine • Urine (from Latin Urina, ae, f.) is a typically sterile liquid by-product of the body secreted by the kidneys through a process called urination and excreted through the urethra.
  3. 3. Possible pathogens • BACTERIA Gram positive Gram negative Staphylococcus saprophyticus Escherichia coli Hemolytic streptococci Pseudomonas aeruginosa Klebsiella strains Salmonella typhi Salmonella paratyphi Neisseria gonorrhoeae
  4. 4. Parasites (a) wuchereria bancrofti (b) schistosoma hematobium (c) trichomonas viginalis (d) enterobius vermicularis • Bladder and urinary tract are normally sterile. • Urethra and perineum has wide variety of gram positive and negative organisms. (a) (b) (c) (d)
  5. 5. Collection of urine specimen • The first voided morning urine (most concentrated) - qualitative • Random urine (routine) • 24hrs sample- quantitative • Mid-stream clean catch (most suitable for urine culture) • Post prandial sample. • Need to be examined within 1 hour.
  6. 6. Collection and transport • Give patient sterile,dry,wide necked leak proof container and request 10-20 ml specimen.(clean catch specimen) • Cleanse the area around urethral opening with clean water,dry the area and collect urine with labia held apart. • Wash hands before collecting specimen (middle of urine flow) • Label container with date & name. • Number of patient & time of collection. • As soon as possible, deliver specimen with request form to laboratory.
  7. 7. Collection and transport • Give patient a sterile,dry,leak proof container with instructions how to collect a clean catch MSU.(mid stream urine) • Add measured amount of boric acid powder (0.1g/10ml of urine) to preserve a specimen. • Label container and send urine with request form to reach microbiology laboratory within 48 hours.
  8. 8. Laboratory examination of urine • Appearance of specimen Appearance Possible cause Cloudy (urine has unpleasent smell and contains WBCs) Bacterial urinary infection Red &cloudy (due to red cells) Urinary schistosomiasis Bacterial infection Brown &cloudy (due to hemoglobin) Black water fever Intravascular hemolysis Yellow brown or green brown (due to bilirubin) Acute viral hepatitis Obstructive jaundice Yellow orange (due to urobillin) Haemolysis Hepatocellular jaundice Milky white (due to chyle) Bancroftian filariasis
  9. 9. Colour and turbidity in urine specimens
  10. 10. Microscopical examination of Urine • Round,10-15 um in diameter. • Report • Few upto 10 wbcs/HPF • Moderate:11-40/HPF • Many:more than 40 WBCs/HPF. • Definite outline and no granules. • Reported as few,moderate,many in number /HPF (high power field)
  11. 11. Microscopical examination of Urine (a) A hyaline cast with a 'fluffy' appearance due to the fibrillary substructure of Tamm–Horsfall glycoprotein . (b) A hyaline–granular cast. (c) A finely granular cast. (d) A waxy cast
  12. 12. Microscopical examination of Urine • Oval shape and some yeast • Show single budding • Yeast are reported as few,moderate or many / HPF(higher power field) (a) Uric acid crystals (b)calcium oxalate crystals. (c) calcium phosphate (d) Triple phosphate crystals.
  13. 13. Biochemical test for urine • Biochemical tests which are helpful in investigating UTI (Urinary tract infection ) include • Dipstick method is mostly used in chemistry labs.
  14. 14. CULTURE THE SPECIMEN: Culture is required when the urine contains bacteria(as indicated by Gram smear),cells,casts,proteins and nitrite. • Normal specimens may be contain small amount of organisms(less than 10,000/ml of urine) • In untreated acute infections the number of bacteria will be more than 100,000/ml.
  15. 15. METHODS OF ESTIMATING BACTERIAL NUMBERS 1. Using quarter plates of culture media 2. Inexpensive 3. Simple to perform 4. Provides individual colonies ( )
  16. 16. CYSTINE LACTOSE ELECTROLYTE DEFICIENT (CLED) • Allows the growth of both gram negative and gram positive pathogens • Electrolyte deficient to prevent swarming of Proteus species • Bromothymol blue indicator • Lactose fermenting colonies appears yellow
  17. 17. • Mix the urine by rotating the container • Using a sterile wire loop,inoculate a loopful of urine on plate of CLED ager • Incubate at 35-37°C overnight
  18. 18. CULTURE IDENTIFICATION : (CLED agar culture) • look for colonies that could be: • Escherichia coli • Proteus species • Pseudomonas aeruginosa • Klebsiella strains • Staphylococcus aureus • Staphylococcus saprophyticus • Enterococcus faecalis
  19. 19. E.coli: Klebsiella species: Proteus species: Pseudomonas aeruginosa: Enterococcus faecalis: Staphylococcus aureus: Coagulase negative staphylococci: CONTAMINATION SHOWS MIXED GROWTH
  20. 20. REPORTING BACTERIAL NUMBERS • Estimate the number of bacteria,i.e colony forming units(CFU) per ml of urine • Report the bacterial count as: Less than 10,000 organisms/ml 10,000-100,000/ml More than 100,000/ml
  21. 21. INTERPRETATION OF BACTERIAL COUNTS • Interpret culture count in relation to clinical conditions. => urinary infections => infection or contamination (repeat specimen) => contamination • UTIs with low counts in urinary obstruction.
  22. 22. ANTIMICROBIAL SUSCEPTIBILITY TESTING • On urines with significant bacteriuria, particularly in recurring UTI (Urinary tract infection).
  23. 23. TESTING URINE FOR HCG (PREGNANCY TESTING) • First morning specimen. • Based on detection of rapidly rising levels of hCG in urine or serum. • Investigation of suspected ectopic pregnancy, threatened abortion or trophoblastic tumor. • IC (immuno chromatographic) card and strip tests are able to detect 50mlU/ml of hCG.