<ul><li>The kidneys and bladder work together to make urine and remove it from our body.  </li></ul><ul><li>The kidneys fi...
TEST OVERVIEW <ul><li>Tests on urine provide information and clues to many diseases, and can also be indications of the co...
WHY IT IS DONE??? <ul><li>A urine test may be done: </li></ul><ul><li>To check for a disease or infection of the urinary t...
STANDARD OPERATION PROCEDURE FOR URINE FEME <ul><li>SAMPLE: Fresh Urine </li></ul><ul><li>MATERIAL REQUIRED: Urine Strip (...
<ul><ul><li>Microscopy Examination </li></ul></ul><ul><ul><li>1) Discard 9mL of urine and mix the remaining 1mL </li></ul>...
URINE FULL EXAMINATION <ul><li>A regular urinalysis often includes the following tests. </li></ul><ul><li>Color </li></ul>...
<ul><li>Odor </li></ul><ul><li>Normal odor :  Slightly &quot;nutty&quot; odor. </li></ul><ul><li>Some diseases cause a cha...
<ul><li>PH </li></ul><ul><li>To measure of how acidic or alkaline the urine is.  </li></ul><ul><li>Normal pH: 4.6 – 8.0 </...
<ul><li>Glucose </li></ul><ul><li>Glucose is the type of sugar usually found in blood. </li></ul><ul><li>Normally there is...
<ul><ul><li>Bilirubin </li></ul></ul><ul><ul><li>Normal : Negative </li></ul></ul><ul><ul><li>Substance formed by the brea...
<ul><li>Nitrites </li></ul><ul><li>Normal : Negative </li></ul><ul><li>Bacteria that cause a urinary tract infection (UTI)...
URINE MICROSCOPIC EXAMINATION <ul><li>It will typically be done when there are abnormal findings on the physical or chemic...
<ul><li>In healthy people, the urine contains small numbers of cells and other formed elements from the entire urinary tra...
<ul><li>Red Blood Cells (RBCs)   Normally, a few RBCs are present in urine sediment (0-5 per hpf). </li></ul><ul><li>Infla...
 
<ul><li>White Blood Cells (WBCs)   The number of WBCs in urine sediment is normally low (0-5 per hpf). </li></ul><ul><li>W...
<ul><li>Epithelial Cells   Normally, a few epithelial cells from the bladder (transitional epithelial cells) or from the e...
<ul><li>Microorganisms  The urinary tract is sterile, so there will be no microorganisms seen in the urine sediment.  </li...
<ul><li>2) Yeast and Fungal (Hyphae) </li></ul><ul><li>  They are most often present in women who have a vaginal infection...
<ul><li>3)Trichomonads   Trchomonas Vaginalis  are parasites that may be found in the urine of women or men (rarely). </li...
<ul><li>Casts   Casts are cylindrical particles sometimes found in urine that are formed from coagulated protein secreted ...
RBCs cast Granular cast <ul><li>Have a textured appearance which ranges from fine to coarse.  </li></ul><ul><li>Usually fo...
Hyaline cast <ul><li>Have a smooth texture. </li></ul><ul><li>Are not always indicative clinically significant disease. </...
Fatty cast <ul><li>Identified by the presence of refractile lipid droplets.  </li></ul><ul><li>Often, they are seen in uri...
<ul><li>Crystals  Urine contains many dissolved substances (solutes) – waste chemicals that body needs to eliminate.  </li...
Calcium Oxalate  Dihydrate Crystals Calcium Oxalate  Monohydrate Crystals <ul><li>In acid urine. </li></ul><ul><li>Have di...
Uric Acid Crystals Ammonium Urate (or Biurate) <ul><li>In acid urine. </li></ul><ul><li>Looked like leave shapes. </li></u...
Calcium Phosphate Triple Phosphate <ul><li>In alkaline urine. </li></ul><ul><li>Also called struvite crystals </li></ul><u...
Cystine Crystals Amorphous Phosphate <ul><li>In acid urine. </li></ul><ul><li>Is an amino acids </li></ul><ul><li>Seen as ...
Amorphous urate <ul><li>In acid urine. </li></ul><ul><li>Appear as fine pink or brownish granules. </li></ul><ul><li>Salts...
Leucine Crystals Tyrosine Crystals <ul><li>In acid urine. </li></ul><ul><li>Found as colorless to yellowish brown, needle ...
What Affects the Test <ul><li>foods that can color the urine, such as blackberries, beets, and rhubarb. </li></ul><ul><li>...
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Urine FEME

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  1. 2. <ul><li>The kidneys and bladder work together to make urine and remove it from our body. </li></ul><ul><li>The kidneys filter waste products and water from the blood to form urine. </li></ul><ul><li>The urine moves from the kidneys through tubes called ureters to the bladder, which stores the urine until it is full. </li></ul><ul><li>From the bladder, urine leaves the body through another thin tube, the urethra. </li></ul><ul><li>After the bladder starts to empty, it normally empties all of the urine. </li></ul>URINARY TRACT
  2. 3. TEST OVERVIEW <ul><li>Tests on urine provide information and clues to many diseases, and can also be indications of the condition of a patient's health. </li></ul><ul><li>A routine urine-screening test may be done to help find the cause for a number of different symptoms. </li></ul><ul><li>The kidneys remove waste material, minerals, fluids, and other substances from the blood for elimination through urine. </li></ul><ul><li>Therefore, urine can contain hundreds of different bodily waste products. </li></ul><ul><li>Many factors (such as diet, fluid intake, exercise, and kidney function) affect the constituents of urine. </li></ul>
  3. 4. WHY IT IS DONE??? <ul><li>A urine test may be done: </li></ul><ul><li>To check for a disease or infection of the urinary tract. Symptoms of a urine infection may include colored or bad-smelling urine, pain when urinating, hard to urinate, flank pain, blood in the urine (hematuria), or fever. </li></ul><ul><li>To check the treatment of conditions such as diabetes, kidney stones, a urinary tract infection (UTI), or some kidney or liver diseases. </li></ul><ul><li>As part of a regular physical examination. </li></ul>
  4. 5. STANDARD OPERATION PROCEDURE FOR URINE FEME <ul><li>SAMPLE: Fresh Urine </li></ul><ul><li>MATERIAL REQUIRED: Urine Strip (10 parameters), 10mL sample tube, pasteur pipette, microscope slide, cover slip, microscope and urine analyzer (Urisys 1100 or Urisys 1800). </li></ul><ul><li>PROCEDURE: </li></ul><ul><ul><li>Full Examination </li></ul></ul><ul><ul><li>1) Put 10mL urine in urine tube </li></ul></ul><ul><ul><li>2) Dip 1 urine strip in urine </li></ul></ul><ul><ul><li>3) Wipe and put it in the reader and press start </li></ul></ul><ul><ul><li>4) Analyzer will read the strip and result will be printed out </li></ul></ul><ul><ul><li>5) Record result and proceed to spin urine at 1500rpm for 5 minutes. </li></ul></ul>
  5. 6. <ul><ul><li>Microscopy Examination </li></ul></ul><ul><ul><li>1) Discard 9mL of urine and mix the remaining 1mL </li></ul></ul><ul><ul><li>2) Put 1 drop of urine on a microscope slide using a pasteur pipette and put a cover slip on it. </li></ul></ul><ul><ul><li>3) Examine urine slide with microscope at 40x magnification and report the observation per high power field. </li></ul></ul>
  6. 7. URINE FULL EXAMINATION <ul><li>A regular urinalysis often includes the following tests. </li></ul><ul><li>Color </li></ul><ul><li>Many factors affect the color of urine, including fluid balance, diet, medications and disease. </li></ul><ul><li>Normal color – pale to dark yellow </li></ul><ul><li>The intensity of the color generally indicates the concentration of the urine; pale or colorless urine indicates that the urine is dilute, and deep yellow urine indicates that it is concentrated. </li></ul><ul><li>Vitamin B supplements can turn urine bright yellow. Reddish brown urine is usually caused by certain medications, eating blackberries or beets or by the presence of blood in urine. </li></ul><ul><li>Clarity </li></ul><ul><li>Also called opacity or turbidity - determines the cloudiness of the urine. </li></ul><ul><li>Urine is normally clear, but bacteria, blood, sperm, crystals, or mucus can make urine appear cloudy. </li></ul>
  7. 8. <ul><li>Odor </li></ul><ul><li>Normal odor : Slightly &quot;nutty&quot; odor. </li></ul><ul><li>Some diseases cause a change in the normal odor of urine. </li></ul><ul><li>For example, an infection with E. coli bacteria can cause a foul odor while diabetes or starvation can cause a sweet, fruity odor. </li></ul><ul><li>Specific gravity </li></ul><ul><li>Measures the amount of substances dissolved in the urine. </li></ul><ul><li>It also indicates how well the kidneys are able to adjust the amount of water in urine. </li></ul><ul><li>The higher the specific gravity, the more the solid material dissolved in the urine. </li></ul><ul><li>Normal SG : 1.005 – 1.025 </li></ul><ul><li>When a person drinks a lot of liquids, the kidneys generally produce greater than normal amounts of dilute urine. </li></ul><ul><li> When a person drinks very little liquid, the kidneys generally make only small amounts of concentrated urine. </li></ul>
  8. 9. <ul><li>PH </li></ul><ul><li>To measure of how acidic or alkaline the urine is. </li></ul><ul><li>Normal pH: 4.6 – 8.0 </li></ul><ul><li>A high (alkaline) pH can be caused by severe vomiting, a kidney </li></ul><ul><li>disease, some UTIs, and asthma. A low (acidic) </li></ul><ul><li>pH may be caused by severe lung disease (emphysema), </li></ul><ul><li>uncontrolled diabetes, aspirin overdose, severe diarrhea, </li></ul><ul><li>dehydration, starvation or drinking too much alcohol. </li></ul><ul><li>Protein </li></ul><ul><li>Normally there is no protein in the urine (negative). </li></ul><ul><li>Sometimes a small amount of protein is released into the urine when a person stands up (this condition is called postural proteinuria). </li></ul><ul><li>Fever, strenuous exercise, normal pregnancy, and some diseases (especially kidney disease) may also cause protein in the urine. </li></ul>
  9. 10. <ul><li>Glucose </li></ul><ul><li>Glucose is the type of sugar usually found in blood. </li></ul><ul><li>Normally there is very little or no glucose in urine. </li></ul><ul><li>However, when the blood sugar level is very high, as in uncontrolled diabetes, it spills over into the urine. </li></ul><ul><li>Glucose can also be present in urine when the kidneys are damaged or diseased, adrenal gland problem, liver damage, brain injury or certain types of poisoning. </li></ul><ul><li>Ketones </li></ul><ul><li>Normal : no ketones (negative). </li></ul><ul><li>When fat is broken down for energy, the body produces by-products called ketones (or ketone bodies) and releases them into the urine. </li></ul><ul><li>Large amounts of ketones in the urine may signal a dangerous condition known as Diabetic Ketoacidosis. </li></ul><ul><li>A diet low in sugars and starches (carbohydrates), starvation, or prolonged vomiting may also cause ketones in the urine. </li></ul>
  10. 11. <ul><ul><li>Bilirubin </li></ul></ul><ul><ul><li>Normal : Negative </li></ul></ul><ul><ul><li>Substance formed by the breakdown of RBCs. </li></ul></ul><ul><ul><li>It is passed from the body in stool and should not found in urine. </li></ul></ul><ul><ul><li>If it is present, it often means the liver is damaged or that the flow of bile from the gallbladder is blocked. </li></ul></ul><ul><ul><li>Urobilinogen </li></ul></ul><ul><ul><li>Normal : Negative </li></ul></ul><ul><ul><li>Substance formed by the breakdown of bilirubin. </li></ul></ul><ul><ul><li>It is also passed from the body in stool and only small amounts of urobilinogen are found in urine. </li></ul></ul><ul><ul><li>Urobilinogen in urine can be a sign of liver disease (cirrhosis, hepatitis) that the flow of bile from the gallbladder is blocked. </li></ul></ul>
  11. 12. <ul><li>Nitrites </li></ul><ul><li>Normal : Negative </li></ul><ul><li>Bacteria that cause a urinary tract infection (UTI) make an enzyme that changes urinary nitrates to nitrites. </li></ul><ul><li>Nitrites in urine show a UTI is present. </li></ul><ul><li>Leukocyte esterase (WBC esterase) </li></ul><ul><li>Normal : Negative </li></ul><ul><li>Leukocyte esterase shows leukocytes (WBCs) in the urine. WBCs in the urine may mean a UTI is present. </li></ul>
  12. 13. URINE MICROSCOPIC EXAMINATION <ul><li>It will typically be done when there are abnormal findings on the physical or chemical examination and also to verify the results produced from the urine analyzers. </li></ul><ul><li>It is performed on urine sediment – urine that has been centrifuged to concentrate the substances in it at the bottom of a tube. </li></ul><ul><li>The fluid at the top of the tube is then discarded and the drops of fluid remaining are examined under a microscope. </li></ul>
  13. 14. <ul><li>In healthy people, the urine contains small numbers of cells and other formed elements from the entire urinary tract, and epithelial cells from the kidney, ureter , bladder, and urethra. </li></ul><ul><li>A microscopic examination of urine sediment detects the presence and amounts of red blood cells, white bloods cells, crystals, casts and bacteria or yeast. </li></ul>
  14. 15. <ul><li>Red Blood Cells (RBCs) Normally, a few RBCs are present in urine sediment (0-5 per hpf). </li></ul><ul><li>Inflammation, injury, or disease in the kidneys or elsewhere in the urinary tract can cause RBCs to leak out of the blood vessels into the urine. </li></ul><ul><li>RBCs can also be a contaminant due to an improper sample collection and blood from hemorrhoids or menstruation. </li></ul><ul><li> RBCs may appear normally shaped, swollen by dilute urine or crenated by concentrated urine. </li></ul><ul><li> Hematuria is the presence of abnormal numbers of red cells in urine due to: .... glomerular damage .... tumors which erode the urinary tract .... kidney trauma, .... urinary tract stones, .... upper and lower urinary tract infections, .... nephrotoxins, and physical stress </li></ul>
  15. 17. <ul><li>White Blood Cells (WBCs) The number of WBCs in urine sediment is normally low (0-5 per hpf). </li></ul><ul><li>When the number is high, it indicates an infection or inflammation somewhere in the urinary tract. </li></ul><ul><li>WBCs can also be a contaminant, such as those from vaginal secretions. </li></ul>WBCs
  16. 18. <ul><li>Epithelial Cells Normally, a few epithelial cells from the bladder (transitional epithelial cells) or from the external urethra (squamous epithelial cells) can be found in the urine sediment. </li></ul><ul><li>Cells from the kidney (kidney cells) are less common. </li></ul><ul><li>In urinary tract conditions such as infections, inflammation, and malignancies, more epithelial cells are present. </li></ul>Squamous epithelial cells Transitional epithelial cells
  17. 19. <ul><li>Microorganisms The urinary tract is sterile, so there will be no microorganisms seen in the urine sediment. </li></ul><ul><li>1) Bacteria from the surrounding skin can enter the urinary tract at the urethra and move up to the bladder, causing a UTI. </li></ul><ul><li>If the infection is not treated, it can eventually move to the kidneys and cause pyelonephritis. </li></ul><ul><li>Less frequently, bacteria from a blood infection (septicemia) may move into the urinary tract and also can cause UTI. </li></ul><ul><li> A urine culture and sensitivity may be performed if a UTI is suspected. </li></ul>Bacteria : Cocci Bacteria : Rods
  18. 20. <ul><li>2) Yeast and Fungal (Hyphae) </li></ul><ul><li> They are most often present in women who have a vaginal infection, because the urine has been contaminated with vaginal secretions during collection. </li></ul>Hyphae Yeast : Candida
  19. 21. <ul><li>3)Trichomonads Trchomonas Vaginalis are parasites that may be found in the urine of women or men (rarely). </li></ul><ul><li>These actually infecting the vaginal canal and their presence in urine is due to contamination. </li></ul><ul><li>When alive, T. vaginalis can readily be identified due to the motility of the flagella and the rapid and irregular movements of the body across the microscopic field. </li></ul>Trichomonas Vaginalis
  20. 22. <ul><li>Casts Casts are cylindrical particles sometimes found in urine that are formed from coagulated protein secreted by kidney cells. </li></ul><ul><li> When a disease process is present in the kidney, other things such as RBCs or WBCs can become trapped in the protein as the cast is formed. </li></ul><ul><li>When this happens, the cast is identified by the substances inside it, for example, as a RBCs cast or WBCs cast. </li></ul>WBCs cast <ul><li>Most typical for acute pyelonephritis, but they may also be present with glomerulonephritis. </li></ul><ul><li>Their presence indicates inflammation of the kidney. </li></ul>
  21. 23. RBCs cast Granular cast <ul><li>Have a textured appearance which ranges from fine to coarse. </li></ul><ul><li>Usually form as a stage in the degeneration of cellular casts . </li></ul><ul><li>Red blood cells may stick together and form red blood cell casts. </li></ul><ul><li>Indicative of glomerulonephritis, with leakage of RBC's from glomeruli, or severe tubular damage. </li></ul>
  22. 24. Hyaline cast <ul><li>Have a smooth texture. </li></ul><ul><li>Are not always indicative clinically significant disease. </li></ul><ul><li>Greater numbers may be seen associated with proteinuria of renal (such as glomerular disease). </li></ul>Waxy cast <ul><li>Have a smooth consistency, squared off ends, as if brittle and easily broken. </li></ul><ul><li>Found especially in chronic renal disease, diabetic nephropathy, malignant hypertension and glomerulonephritis. </li></ul>
  23. 25. Fatty cast <ul><li>Identified by the presence of refractile lipid droplets. </li></ul><ul><li>Often, they are seen in urines in which free lipid droplets are present as well. </li></ul>
  24. 26. <ul><li>Crystals Urine contains many dissolved substances (solutes) – waste chemicals that body needs to eliminate. </li></ul><ul><li>These solutes can form crystals, solid forms of a particular substance, in the urine if: </li></ul><ul><li>urine pH is increasingly acidic or basic </li></ul><ul><li>the concentration of dissolved substances is increased </li></ul><ul><li>the urine temperature promotes their formation. </li></ul><ul><li>Crystals are identified by their shape, color, and by the urine pH </li></ul><ul><li>When crystals form as urine is being made in the kidney, they may group together to form kidney &quot;stones&quot; or calculi. </li></ul><ul><li>These stones can become lodged in the kidney itself or in the ureters, tubes that pass the urine from kidney to the bladder, causing extreme pain. </li></ul>
  25. 27. Calcium Oxalate Dihydrate Crystals Calcium Oxalate Monohydrate Crystals <ul><li>In acid urine. </li></ul><ul><li>Have different shapes like colorless squares whose corner are connected by intersecting lines, spindle, oval or dumbbell shape. </li></ul><ul><li>Most common constituent of kidney stones. </li></ul>
  26. 28. Uric Acid Crystals Ammonium Urate (or Biurate) <ul><li>In acid urine. </li></ul><ul><li>Looked like leave shapes. </li></ul><ul><li>Often yellow to orange-brown in color </li></ul><ul><li>In alkaline urine. </li></ul><ul><li>Golden brown color with thorn apple shape. </li></ul><ul><li>The only urate crystals appear in alkaline urine </li></ul>
  27. 29. Calcium Phosphate Triple Phosphate <ul><li>In alkaline urine. </li></ul><ul><li>Also called struvite crystals </li></ul><ul><li>Appear as colorless, prism-like crystal or coffin lids </li></ul><ul><li>UTI with urease producing bacteria can promote struvite crystalluria by raising urine pH and increasing free ammonia. </li></ul><ul><li>In alkaline urine. </li></ul><ul><li>Usually found as rosette and pointed finger forms. </li></ul>
  28. 30. Cystine Crystals Amorphous Phosphate <ul><li>In acid urine. </li></ul><ul><li>Is an amino acids </li></ul><ul><li>Seen as flat colorless hexagonal plates. </li></ul><ul><li>Often aggregate in layers. </li></ul><ul><li>In alkaline or neutral urine </li></ul><ul><li>Looked very scattered and bright around the field. </li></ul><ul><li>As fine, colorless or slightly brown granules. </li></ul><ul><li>White precipitate is observed on centrifugation. </li></ul>
  29. 31. Amorphous urate <ul><li>In acid urine. </li></ul><ul><li>Appear as fine pink or brownish granules. </li></ul><ul><li>Salts of uric acid. </li></ul><ul><li>Pink precipitate is observed on centrifugation. </li></ul>Cholesterol Crystal <ul><li>Found as transparent plates. </li></ul><ul><li>Usually one or more corners are cut off or notched </li></ul><ul><li>Also called ‘stair step crystals’. </li></ul><ul><li>Usually accompanied by proteinuria, but they are only rarely seen. </li></ul>
  30. 32. Leucine Crystals Tyrosine Crystals <ul><li>In acid urine. </li></ul><ul><li>Found as colorless to yellowish brown, needle shaped crystals </li></ul><ul><li>Usually appear together with leucine crystals. </li></ul><ul><li>Products of protein metabolism and appear in urine people with tissue degeneration or necrosis (such as severe liver disease). </li></ul><ul><li>In acid urine. </li></ul><ul><li>Same clinical conditions like tyrosine. </li></ul><ul><li>Found in form of spheroids and appear as yellowish brown bodies. </li></ul>
  31. 33. What Affects the Test <ul><li>foods that can color the urine, such as blackberries, beets, and rhubarb. </li></ul><ul><li>exercise strenuously before the test. </li></ul><ul><li>menstruating or close to starting menstrual period. </li></ul><ul><li>taking certain medicines that color the urine include vitamin B, phenazopyridine (Pyridium), rifampin, and phenytoin (Dilantin). </li></ul><ul><li>Having an X-ray test with contrast material in the past 3 days. </li></ul>
  32. 34. THANK YOU

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