PHYSICAL EXAMINATION OF URINE, SUCH AS COLOR, VOLUME, ODOR, TRANSPARENCY

1. PHYSICAL EXAMINATION
OF URINE
WEEK 3
AUBF
PREPARED BY:
PRINCESS ALEN I. AGUILAR,RMT

2. List of References
Lillian Mundt & Kristy Shanahan, Graff’s Textbook of
Urinalysis and Body Fluids, 2nd Ed.
Susan Strassinger & Marjorie Di Lorenzo, Urinalysis and
Body Fluids, 5th & 6th Ed.
Erol Coderres,RMT-AUBF notes
Roderick Balce, RMT-CEU Professor AUBF Notes
Ridley,J. et al, Essentials of Clinical Laboratory Science,
©2011

3. • Following collection, urine specimens should be delivered
to the laboratory promptly and tested within 2HOURS.
INCREASED (pBaON)
1. pH Urea - - - - - - (Urease) - - - - - >
Ammonia
2. Bacteria Multiplication
3. Odor Urea - - - --(Urease) - - - -- > Ammonia
4. Nitrite Due to bacterial multiplication
DARKENED/MODIFIED
5. Color Oxidation or reduction of metabolites

4. DECREASED
6. Clarity Due to bacterial multiplication
Precipitation of amorphous urates (pink) or PO4s
(white)
7. Glucose Due to glycolysis
8. Ketones Due to volatilization/evaporation (left uncapped)
9. Bilirubin Due to light exposure (B2-water soluble)
10. Urobilinogen Oxidized to urobilin
11. RBC/WBC/Cast Disintegrate in alkaline urine
12. Protein Least unaffected parameter in unpreserved urine

5. 1. Colorless/pale yellow – recent fluid consumption, polyuria, DM,
DI, diluted
2. Yellow – Mepacrine (Atabrin) – antimalarial Tx: intestinal worms,
Giardiasis)
3. Dark Yellow – Concentrated specimen; Streneous exercise,
First morning specimen
4. Bright yellow- Riboflavin/ Multivitamins
5. Amber- Dehydration; fever, burns
6. Orange – Bilirubin (tea-colored urine; Tietz), Phenazopyridine
(Pyridium; Tx for UTI; Orange and viscous urine with orange
foam)Nitrofurantoin, Phenindione, Acriflavin
7. Yellow-green – oxidation of bilirubin to biliverdin
8. Blue/green – Indican, Pseudomonas Infection, Amitriptyline,
Methocarbamol, Clorets, Methylene Blue, Phenol

6. 9. Pink/Red
1. Intact RBCs (Cloudy/Smoky red) Hematuria,
2. Hemoglobin (Clear Red); Intravascular hemolysis,
3. Myoglobin (Clear red or reddish-brown); muscle damage
4. Rifampin –Tx for TB
5. Beets -Alkaline urine of genetically susceptible persons
6. Menstrual contamination
10. Brown/black
1. Methemoglobin (acidic)
2. Homogentisic Acid (alkaline urine); Alkaptonuria
3. Melanin (Upon exposure)
4. Phenol derivatives, Argyrol,
5. Metronidazole (Flagyl)- Tx: Trichomoniasis
11. Burgundy/Purplish Red, Portwine – Porphyrins
12. Green-Brown - Methyldopa/Levodopa (Aldomet); anti-
hypertensive

8. • View the urine against a white background using adequate room
lighting
• View through a newspaper print

10. • 1. Normal – faint aromatic due to volatile acids; becomes
ammoniacal as the specimen stands
• 2. Variations
1) Ammoniacal (freshly voided) – UTI (ex. Proteus vulgaris)
2) Mousy – PKU
3) Fruity/ sweet – Diabetes Ketoacidosis (Ketones), Starvation,
vomitting
4) Rancid – Tyrosinuria
5) Sweaty feet – Isovaleric Acidemia, glutaric acidemia
6) Maple syrup/ caramelized sugar/curry – MSUD
7) Rotting fish (galunggong)– Trimethyl Aminuria
8) Sulfur odor – Cystine Disorders
9) Fecaloid – Recto-vesicular Fistula
10) Cabbage/ hops – Methionine Malabsorption M
11) Pungent/Asparagus- methylMercaptan, Garlic, Onion, And Eggs
12) Bleach – Contamination

15. PRINCIPLE =
REFLECTANCE PHOTOMETRY
 Light reflection from the test pads
decrease in proportion to the intensity
of color produced by the concentration
of the test substance

16. • Density of solution compared with density of
similar volume of distilled water at a similar
temperature
• Influenced by number and size of particles in a
solution
Normal SG
(random)
1.003-1.035 Isosthenuria SG: 1.010
When SG
<1.003
Not a urine (except
in DI)
Hyposthenuria SG: <1.010
When SG
>1.040
Due to radiographic
dye
(Refractometer)
Hypersthenuria SG: >1.010

17. • Calibration temperature : 20oC
• Requires temperature correction:
• (-)0.001 for every 3oC that the specimen temp
is below the calibration temperature
• (+) 0.001 for every 3oC that the specimen temp
is above the calibration temperature
• Requires correction for glucose and
protein
• 1g/dL glucose = (-)0.004
• 1g/dL protein = (-)0.003
• Urine volume required = 10-15mL
• Calibration: Potassium sulfate (K2SO4)
• 20.29 g K2SO4 to 1 L H2O
• SG = 1.015

18. • Sample problem:
• Urine SG BY urinometer is 1.025
• Urine temp is 260C
• With 2g/dL glucose
• With 2g/dL protein
What is the corrected SG?

19. • Indirect method based on refractive
index (RI)
• RI = ligh velocity in air___
Light velocity in solution
• Compensated to temperature (15-38oC)
• Requires correction for glucose and
protein (same as urinometer)
• CALIBRATION:
• DISTILLED WATER = 1.000
• 5% NaCl = 1.022 + 0.001
• 9% Sucrose = 1.034 + 0.001
• Adjust the set crew to zero

21. NOTES TO REMEMBER!
• Both refractometer and urinometer require correction for
glucose and protein
• Refractometry reading is lower than the urinometer
reading by 0.002
SPECIFIC GRAVITY DILUTION:
Specimens with very high SG readings can be diluted and retested
To obtain the actual SG, multiply the decimal portion of SG by the dilution
factor
EX: 1:4 dilution has a reading of 1.014

22. PRINCIPLE: Change in pKa (dissociation constant) of a polyelectrolyte
BLUE -------- GREEN ---------- YELLOW
(dec. H+) (inc. H+) (markedly inc. H+)
Reagent is sensitive to the no. of ions in the urine specimen; indicator
changes color in relation to ionic concentration
REAGENTS:
Multistix =poly (methyl vinyl ehter/ maleic anhydride) bromthymol blue
Chemstrip= Ethyleneglycoldiaminoethylether tetraacetic acid bromthymol blue
Blue (SG 1.000) to yellow (SG 1.030)
NOTES: Add 0.005 to SG reading when pH is > 6.5 due to interference with the
bromthymol blue indicator
Not affected by glucose, protein and radiographic dye (NO CORRECTION!)

23. • Sound waves of specific frequency are generated at one
end of the tube and as the sound waves oscillate through
urine, their frequency is altered by the density of the
specimen.
• Mass gravity meter- used by YELLOW IRIS (International
Remote Imaging System)
IRIS DIAGNOSTICS
*Models 300 and 500 workstations:
*6mL = required urine volume
* 4mL (of 6mL) = for IRIS slideless microscope
*2mL (of 6mL) = for IRIS Mass Gravity Meter ( for SG
determination- by using harmonic oscillation)
OBSOLETE  on year 2011, changed principle into Refractometry

24. THANK YOU FOR
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