Practical examination of urine

1. CASE -1
• 5 year old child having anasarca

2. PHYSICAL EXAMINATION
• Volume : ml
• Odour : odourless
• Color : colourless
• Specific gravity :
• Appearance : cloudy
• pH :

3. EXPERIMENT OBSERVATION INFERENCE
TEST FOR PROTEIN :
HEAT AND ACETIC
ACID TEST :
Take 5ml test tube , fill
2/3rd with urine ,
Add 10 % glacial acetic
acid
Boil the upper portion .
If precipitation occurs add
a few drops of 10% acetic
acid
Appearance of white
coagulum
Presence of protein

4. RESULT:
The given urine sample contains ---

5. CASE -2
• 18 year old male had sore throat 3 weeks back .

6. PHYSICAL EXAMINATION
• Volume : ml
• Odor : odourless
• Color : red
• Specific gravity :
• Appearance : clear
• pH :

7. EXPERIMENT OBSERVATION INFERENCE
TEST FOR BLOOD :
BENZIDINE TEST :
Take 2ml of urine in a
test tube
Add 2ml of saturated
soluion of benzidine
with glacial acetic
acid
Add 1ml of H2O2 to it
Appearance of
greenish blue color
Presence of blood

8. RESULT:
The given urine sample contains ---

9. CASE -3
• 27 year old female with dry mouth and altered sensorium .

10. PHYSICAL EXAMINATION
• Volume : ml
• Odor : Fruity odour
• Color : colourless
• Specific gravity :
• Appearance : clear
• pH:

11. EXPERIMENT OBSERVATION INFERENCE
TEST FOR KETONE
BODIES:
ROTHERA’S TEST :
Take a 5ml of urine in a test
tube
Saturate it with solid
ammonium sulphate salt
Add a few crystals of sodium
nitroprusside and shake
Add liquor ammonia from the
side of test tube
Appearance of purple ring Presence of ketone bodies

12. CASE -4
• 40 year old lady with weight loss and polyuria .

13. RESULT:
The given urine sample contains ---

14. PHYSICAL EXAMINATION
• Volume : ml
• Odor : odourless
• Color : colourless
• Specific gravity :
• Appearance : clear
• pH :

15. EXPERIMENT OBSERVATION INFERENCE
TEST FOR
GLUCOSE :
BENEDICT’S TEST :
Take 5ml of benedicts
reagent in a test tube
Add 0.5ml of sample
in it and heat it
Appearance of colour Presence of reducing
sugars

16. RESULT:
The given urine sample contains ---

17. 1) Normal urine output in an adult :
• 24 hour urine output in an adult is 600-2000ml
• The volume varies according to fluid intake , diet and climate

18. 2) POLYURIA :
Volume > 2000ml /24hrs
CAUSES :
• Excess fluid intake
• Seasonal
• Diabetic mellitus
• Diabetic insipidus
• Chronic renal failure

19. 3)OLIGURIA :
urinary volume < 400 ml/24 hours.
CAUSES :
• Febrile states
• Acute glomerulonephritis (decreased glomerular filtration),
• Congestive cardiac failure
• Dehydration (decreased renal blood flow).

20. 4) ANURIA :
urine output < 100 ml/24 hours or complete cessation of urine output.
CAUSES:
• Acute tubular necrosis (e.g. in shock, hemolytic transfusion reaction),
• Acute glomerulonephritis
• Complete urinary tract obstruction.

21. 5) Normal urine color is clear, pale ,straw coloured due to pigment
urochrome .
Depending on the state of hydration
• Colorless- over hydration
• Dark yellow – dehydration

23. • Freshly voided urine is clear in appearance.

24. • Freshly voided urine has a aromatic odour due to volatile organic
acids .
• After long standing , urine develops ammoniacal odor .
• Fruity: Ketoacidosis, starvation
• Mousy or musty: Phenylketonuria
• Fishy: Urinary tract infection with Proteus, tyrosinaemia.
• Rancid : Tyrosinemia

26. REACTION AND pH
• Freshly voided normal urine is slightly acidic
• Normal range 4.6-7.0
Acidic urine ( Ph < 7.0)
• Ketosis ( Diabetes mellitus ,starvation ,fever ) ,UTI by E.coli , high protein intake .
Alkaline urine : (Ph >7.0)
• UTI by proteus ,pseudomonas ,severe vomiting , metabolic alkalosis

27. SPECIFIC GRAVITY
• It is defined as density of a solution as compared to density of distilled
water .
• Normal specific gravity of urine is 1.003 to 1.030.
• SG of urine is a measure of concentrating ability of kidneys .
• Methods of measuring SG : urinometer method ,refractometer method
and reagent strip method

28. 1. Fill a measuring cylinder with 50 ml of urine.
2. Lower urinometer gently into the urine and let it float freely.
3. Let urinometer settle; it should not touch the sides or bottom of the
cylinder.
4. Take the reading of SG on the scale (lowest point of meniscus) at the
surface of the urine.
5. Take out the urinometer and immediately note the temperature of
urine with a thermometer.

29. CAUSES OF INCREASE IN SG URINE :
• Diabetes mellitus (glycosuria)
• Nephrotic syndrome (proteinuria )
• Fever
• Dehydration
CAUSES OF DECREASE IN SG URINE :
• Diabetes insipidus
• Chronic renal failure

30. FIXED SPECIFIC GRAVITY : (1.010)
• ADH deficiency
• Chronic kidney disease

31. PROTEIN
• Normally kidney excrete scant amount of protein in urine ( upto 150mg /24
hrs )
• Normal proteins in urine :
Proteins from plasma (albumin) , Proteins derived from urinary tract (Tamm-
Horsfall protein ,secretory IgA ,proteins derived from tubular epithelial cells
,leucocytes
• Proteinuria refers to protein excretion in urine greater than 150 mg/24 hours
in adults

32. CAUSES OF PROTEINURIA
CAUSES OF PROTEINURIA :
1)PRE RENAL PROTEINURIA: ( over flow proteinuria )
Intravascular hemolysis , muscle injury, inflammations ,infections,
multiple myeloma
2)RENAL PROTEINURIA :
GLOMERULAR : Glomerulonephritis ,minimal change disease, diabetes
mellitus ,pre eclampsia , strenuous exercise ,fever,orthostastic or postural
proteinuria

33. • Tubular proteinuria : pyelonephritis ,interstitial nephritis ,Fanconi
anemia
3)POST RENAL PROTEINURIA :
Inflammation or neoplasms of lower urinary tract

34. TESTS OF PROTEINURIA
QUALITATIVE TESTS:
1. Heat and acetic acid test
2. Sulfosalicyclic acid test
3. Reagent strip method
QUANTITATIVE TESTS
1. Esbach’s albuminometer method
2. Turbidimetric method

35. HEAT AND ACETIC ACID TEST – PRINCIPLE
• This test is based on the principle
that proteins get precipitated when
boiled in acidic solution

36. INTERPRETATION
• No cloudiness = Negative
• Faint cloudiness = Traces ( < 0.1g /dl )
• Cloudiness without granularity = +1(0.1g/dl )
• Granular cloudiness = +2(0.1-0.2g/dl)
• Precipitation and flocculation = +3 (0.2-0.4 g/dl )
• Thick solid precipitation = + 4 (0.5g/dl)

37. GLUCOSE
• Normally a very small amount of glucose (130mg/24 hrs ) is excreted
in urine .
• TESTS FOR GLUCOSE :
1. Benedict’s test
2. Reagent strip method

38. REDUCING SUGARS
• GLUCOSE
• FRUCTOSE
• MALTOSE
• LACTOSE
Other reducing substances :
• Ascorbic acid
• Salicylates
• Antitubercular drugs
NON REDUCING SUGARS
• Sucrose
• Trehalose

40. • COMPOSITION OF BENEDICT’S REAGENT :
Copper sulphate 17.3 g
Sodium citrate 173 g
Sodium carbonate 100g
Distilled water 1000ml

41. CAUSES OF GLYCOSURIA
• Diabetes mellitus
• Acromegaly
• Hyperthyroidism
• Cushing’s syndrome
• Corticosteroid administration
• Severe burns and sepsis

42. KETONES
• Excretion of ketone bodies (acetoacetic acid, β-hydroxybutyric acid,
and acetone) in urine is called as ketonuria.
• Ketones are breakdown products of fatty acids and their presence in
urine is indicative of excessive fatty acid metabolism to provide
energy.
CAUSES :
1. Decreased utilization of carbohydrates
Uncontrolled diabetes mellitus with ketoacidosis
Glycogen storage disease (von Gierke’s disease)

43. Ketonuria
2. Decreased availability of carbohydrates in the diet:
• Starvation
• Persistent vomiting in children
• Weight reduction program (severe carbohydrate restriction with normal
fat intake)
3. Increased metabolic needs:
• a. Fever in children
• b. Severe thyrotoxicosis
• c. Pregnancy
• d. Protein calorie malnutrition

44. • Methods for detection of ketone bodies in urine
Rothera’s test, Acetest tablet method, ferric chloride test, and reagent
strip test
• 1. Rothera’s’ test (Classic nitroprusside reaction)
Acetoacetic acid or acetone reacts with nitroprusside in alkaline
solution to form a purple-colored complex

46. BLOOD
• The presence of abnormal number of intact red blood cells in urine is
called as hematuria.
• It implies presence of a bleeding lesion in the urinary tract.
Causes of Hematuria:
1. Diseases of urinary tract :
• Glomerular diseases: Glomerulonephritis, Berger’s disease, lupus
nephritis, Henoch-Schnolein purpura

47. • Non glomerular diseases: Calculus, tumor, infection, tuberculosis,
pyelonephritis, hydronephrosis, polycystic kidney disease, trauma, after
strenuous physical exercise, diseases of prostate (benign hyperplasia of
prostate, carcinoma of prostate).
2. Hematological conditions: Coagulation disorders, sickle cell disease
Presence of red cell casts and proteinuria along with hematuria suggests
glomerular cause of hematuria.

48. Hemoglobinuria : Presence of free hemoglobin in urine .

49. MICROSCOPIC HEMATURIA
• Presence of 3 or more number of red blood cells per high power field
on microscopic examination in two out of three properly collected
samples