Physical examination of urine


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Physical examination of urine by Mostafa Sabry TEACHING ASSISTANT at AZHAR UNIVERSITY

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Physical examination of urine

  1. 1. URINE REPORT Section No.1 Mostafa Sabry Abdullah, B. Pharm. Sci. TeachingAssistant, College of Pharmacy,Al-Azhar University,Assiut, Egypt.
  2. 2. The Urinary System  Paired kidneys  Ureter for each kidney  Urinary bladder  Urethra 3
  3. 3. Introduction:  The kidneys are the organs responsible for excretion of large number of substances produced by I. metabolic pathways II. food contaminants III. Drugs,naturallyorartificial.
  4. 4. 5
  5. 5.  Every 45 min the entire blood plasma volume is filtered by the kidneys.  Kidneys filter ~ 180 L of fluid/day  Urine production ~ 1.8 L/day
  6. 6.  Practically, a normal person can handle a daily  water intake ranging from one liter to 20 liters, a sodium intake of 5 - 500 mmoI, a potassium intake of20 - 200 mmol and a protein intake of 30 - 150 gram
  7. 7. In this chapter complete urine report will be discussed. It includes the following topics: 1- Physical examination of the urine. 2- Chemical examination of the urine including: a) Normal constituents of the urine. b) Abnormal (pathological) constituents of the urine. c) Stone analysis. 3- Microscopical examination of the urine.
  9. 9.  Examination of the physical properties of urine including; 1. Volume. 2. Odour, 3. Colour. 4. Aspect, 5. Sp. gravity, 6. PH and 7. Deposits.
  10. 10. 1-VOLUME Normal urine volume: 800-2000 ml/day. N.B:- Increased volume of urine over 2000 ml/day called; Decreased volume of urine less than 500 ml/day called When urine volume become less than 125 ml/day - Polyurea Oligourea Anurea.
  11. 11. Factors affecting urine volume: A. Dietetic factors :- 1- High protein diets increase urine volume. 2-The rate of water intake as free water or in the other forms as milk or watermelon. 3-The amounts of salts in diet. B- Environmental factors:- e.gWeather. C- Pathological factors: -e.g. Diabetes mellitus
  12. 12. Clinical significance: A. Polyurea B.OLIGOUREA C. ANUREA
  13. 13. A-Polyurea  Itisanincreased volumeofurineover2000ml/day CAUSES; 1- Physiological:- as in the following: a- High fluids intake e.g tea,water. b- High protein diets; protein metabolism UREA osmotic diuretic effect. c- During cold weather "winter" due to the low activity of sweat glands. d- During the day urine volume is two time as urine volume during night.
  14. 14. 2- Pathological:- as in thefollowing: a- Diabetes mellitus: this because glucose cause osmotic diuresis. b- Diabetes insipidus: It is the lack of anti-diuretic hormone (A.D.H.). In this case urine volume is about 4-6 liters per day. c- Diabetes Innocence ;decrease of renal threshold lead to osmotic diuresis. d- Hypertension: due to increased glomerular filtration rate.
  15. 15. B-Oligourea It is the decreased volume of urine less than500ml/day Causes; 1-Physiological:- as in the following:- a- Low fluids intake. b- During summer due to high activity of sweat glands. c- During exercises due to much sweating. 2- Pathological:- as in the following:- a-Urinary obstruction by stones & tumors. b- Inflammatory kidney diseases. c- Heart failure. d- Sever vomiting and diarrhea. e- Oedema. f- Severe Hemorrhage and shock.
  16. 16. C- ANUREA Anuria is the total absence of urine production. Due to UT obstruction, which may be; - lower (bladder neck or urethral obstruction causing acute urinary retention) -or upper, e.g. a ureteric stone in a patient with a single functioning kidney.
  17. 17. 2- Odour Normal odour of the urine: faint aromatic odour. Why??? presence of volatile aromatic acids. Clinical significance: a) Ammonia odour: as in case of  urinary tract infection or  leaving of urine sample for long time Due to ;- bacterial decomposition of urea that normally present in the urine. b) Acetone odour: as in case of ketonurea. c) Mercaptan (CH3 - SH) odour: as some diets and medicines that change the odour of urine which exaggerated by heating in acid solution e.g Onion and Garlic.
  18. 18. 3-Colour Normal urine colour: is paleor umberyellow. Why??? due to presence of two pigments "urochromeand urobilin" {a breakdown products of hemoglobin related to the bile pigments} N.B:- Dilute urine has paleyellow colour, while concentrated urine has deeporangeyellowcolour
  19. 19. Factors affecting urine colours
  20. 20. A- Physioiogical factors; as; 1- During fasting and excessive exercises. Theurinecolourbecomedeeporangecolour. 2- In winter urine colour become pale yellowbut in summer the colour usually is orange. 3- In females; urine colour may become red during menstrual cycle; due to Contamination by blood of the cycle.
  21. 21. B- Pathological factors:- Urine colour changes in some diseases to give: 1- Red colour "Haemoturea" as in cases of: a- Urinary tract Bilharziasis. b- Some urinary tract infection. c- Some urinary tract tumors. d- In some cases of U.T stones that has sharp ends. 2- Greenish yellow colour: as in case of jaundice. 3- Deep orange colour: as in case of high fever due to conc. of urine by excessive sweating.
  22. 22. 4- Dark brown colour:- Tea like colour as in Alkaptonurea: is a benign disease result from defect in Homogentesate oxidaseenzyme in tyrosine degradation which lead to homogentesate level then oxidized in air to give dark urine. 5- Cola like colour: as in case of nephrotic syndrome(nephrosis) C-Other factors: - Some drugs may change the urine colour e.g; Remectazid which give the red colour .
  23. 23. 4. Aspect "appearance' Normal fresh urine aspect: is transparent. Leavingofurinesampleleading to their turbidity why???? Due to the following causes: 1- Cloudy layer that consists of; nucleoproteins, mucoid or epithelial cells. 2. Ammonia as a result of; Urea bacterial decompositn. Ammonia Alkaline PH ppt of some salts e.g. phosphates.
  24. 24. Clinical significance A permanent turbidity indicate pathogenesis as the following cases ;- 1-Turbidity due to pus ~ pyuria 2-Turbidity due to RBCs ~ haematouria 3- Turbidity due to crystals e.g. oxalate, phosphates and urates ~ Crystalourea. 4- Turbidity due to chyle ~ Chyluria. a milky body fluid consisting of lymph and emulsified fats,formed in the small intestine , and taken up by lymph vessels and secreted in urine
  25. 25. 5. Specific gravity: Definition: It is the density of , any liquid compared to the density of distilled water at 25 C0. Also it is called urine relative mass density. Normal SP.G of the urine:The relative SP.G of urine collected over 24 hr is 1015-1025. why??? ~ due to presence of the dissolved solids e.g urea, sugar and uric acid.
  26. 26. Factors affecting specific gravity of the urine 1- Physiological factors:- After high fluids intake especiallywater SP.G reach1000 or lower. in case of excessive dehydration SP.G reach 1040 or higher. 2- Pathological factors:- a- SP-G increase in conc. urine as in :- -Acute nephritis( blood flow urine retention R. of waste product) - Diabetes mellitus. b- SP-G decrease in diluted urine as in : - Chronic nephritis. - Diabetes insipidus.
  27. 27. Measurement: by using of Urinometer the following figure;
  28. 28. 6-PH Normal pH of the urine: is acidic about "6" with pH rang of"5-6.5". Why??? ~ due to ;the acidity of urine results from conversion of basic phosphates Na2HP03 into acidic phosphates NaH2P03 in the distal convoluted tubules of the kidneys. N.B.: Generally, some pathological diseases are associated with further acidity of the urine.
  29. 29. Factors affecting the PH of the urine: A-Dietetic factors :- The composition of food can affects the pH as the following;- 1- After meals: urine pH become less acidic due to gastric HCl the absorption of bicarbonates. Then the HC03 is excreted in urine and PH. This process is called Alkaline tide. 2- High protein in diet cause low urine PH.???? 3- Citrus fruits and vegetables inlargeamountscause highpHwhy????
  30. 30. B-Pathological factors 1- PH of urine is incr. in potassium depletion that lead to alkalosis. 2- Urine PH is decr. bellow 6 in:-  Metabolic and respiratory acidosis.  Urinary tract infection with E-coli.
  31. 31. 7. Deposits "sediments" The normal urine contains no visible deposits, But in some pathological cases upon centrifugation byusing microscope 1- Pus cells normally 0-3 cm/l Pus cells are the deadW.B.Cs =pyurea 2-RBCs :-This called haemoturea
  32. 32. 3- Epithelial cells :- _ Squamous epithelial cells normally present in the urine of females due to ; the Passage of urine through the Female gental tract _ columnar and transitional epithelial cells are derived from kidneys ,ureters or bladder due to urinary tract infection.
  33. 33. 4- Parasites and ova :- as in bilharziasis 5- Castes: - Caste is a cylindrical structure formed basically from mucoprotein in the distal convoluted tubule . because it’s loose structure go down from the tubules into the urine. 6- Crystals :- as oxalates & urates or phosphates