This document provides an overview of urinalysis, including the types of urine specimens that can be collected, sources of errors, and the different types of urine analyses that are performed. It discusses macroscopic examination of urine including odor, color, and chemical analysis using urine dipsticks. Microscopic examination is explained in detail with images showing abnormal findings like red blood cells, white blood cells, casts, crystals, and parasites that can be seen under the microscope.

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2. MUHAMMAD ABDULLAH KHOSAMUHAMMAD ABDULLAH KHOSA
MSc MLTMSc MLT
TRAINEE TECHNOLOGISTTRAINEE TECHNOLOGIST
STAT LAB LAHORE
UrinalysisUrinalysis
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3. CONTENTSCONTENTS
IntroductionIntroduction
Types of SpecimenTypes of Specimen
Sources of errorsSources of errors
Types of AnalysisTypes of Analysis
Microscopic ImagesMicroscopic Images 33

4. INTRODUCTIONINTRODUCTION
First laboratory test performedFirst laboratory test performed
Used for more than 6000 yearsUsed for more than 6000 years
Powerful diagnostic toolPowerful diagnostic tool
An index to many normal and pathological mechanisms.An index to many normal and pathological mechanisms.
By composition:By composition:
95% water
Remaining 5% is composed of mainly urea
Trace amounts of vitamins, minerals,
enzymes, hormones, proteins and antibodies 44

5. Types of SpecimenTypes of Specimen
First morningFirst morning ((most concentratedmost concentrated))
Second voidedSecond voided
Random specimenRandom specimen (( most convenientmost convenient))
Post-prandial specimenPost-prandial specimen ( usually after 2 hour)( usually after 2 hour)
24 hour urine24 hour urine
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6. SOURCES OF ERRORSOURCES OF ERROR
 Contamination with:Contamination with:
Bacteria or chemicalsBacteria or chemicals
menstrual bloodmenstrual blood
vaginal or urethral dischargevaginal or urethral discharge
 Inadequate mixing before examinationInadequate mixing before examination
 Wrong/inadequate preservativeWrong/inadequate preservative
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7. − MacroscopicMacroscopic
− ChemicalChemical
− MicroscopicMicroscopic
Types of AnalysisTypes of Analysis
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8. Macroscopic ExaminationMacroscopic Examination
Odor:Odor:
− Ammonia-like:Ammonia-like: (Urea-splitting bacteria)(Urea-splitting bacteria)
− Offensive:Offensive: Old specimen, pus or inflammationOld specimen, pus or inflammation
− Sweet:Sweet: GlucoseGlucose
− Fruity:Fruity: KetonesKetones
Color:Color:
− ColorlessColorless Diluted urineDiluted urine
− Deep YellowDeep Yellow Concentrated UrineConcentrated Urine
− Turbid cells or crystalsTurbid cells or crystals
− Yellow-GreenYellow-Green Bilirubin / BiliverdinBilirubin / Biliverdin
− RedRed Blood / HemoglobinBlood / Hemoglobin
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9. Chemical AnalysisChemical Analysis Urine DipstickUrine Dipstick
Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protein
Urobilinogen
Nitrite
Leukocyte
30 sec RR: Negative30 sec RR: Negative D. mellitus. Renal glycosuria.
30 sec RR: Negative30 sec RR: Negative -increased bilirubin (correlate urobilinogen, S.bilirubin)
40 sec RR: Negative40 sec RR: Negative Diabetic ketoacidosis Prolonged fasting
2 min RR: 1.003-1.0352 min RR: 1.003-1.035 - Diabetes insipidus
60 sec RR: Negative60 sec RR: Negative Hematuria - Hemoglobinuria
2 min R.R.: 4.5-8.02 min R.R.: 4.5-8.0 <4.5): high-protein diet, >8.0): renal tubular acidosis
60 sec RR: Negative60 sec RR: Negative - Proteinuria and the nephrotic syndrome.
60 sec RR: 0.02-1.0 mg/dL60 sec RR: 0.02-1.0 mg/dL High: increased hepatic processing of bilirubin
- Low: bile obstruction
60 sec RR: Negative60 sec RR: Negative
Gram negative bacteriuria
2 min RR: Negative - Pyuria - Acute inflammation Renal calculus
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SIGNIFICANCEPARAMETER
S
TIME OF
READING

10. Microscopic ExaminationMicroscopic Examination
Per High Power Field (HPF) (400x)Per High Power Field (HPF) (400x)
– > 3 erythrocytes> 3 erythrocytes
– > 5 leukocytes> 5 leukocytes
– > 2 renal tubular cells> 2 renal tubular cells
– > 10 bacteria> 10 bacteria
Per Low Power Field (LPF) (200x)Per Low Power Field (LPF) (200x)
– > 3 hyaline casts or > 1 granular cast> 3 hyaline casts or > 1 granular cast
– > 10 squamous cells> 10 squamous cells
– Any other cast (RBCs, WBCs)Any other cast (RBCs, WBCs)
Presence of:Presence of:
– Fungal hyphae or yeast, parasite,Fungal hyphae or yeast, parasite,
– Pathological crystals (cystine, leucine, tyrosine)Pathological crystals (cystine, leucine, tyrosine)
– Large number of uric acid or calcium oxalate crystalsLarge number of uric acid or calcium oxalate crystals
Abnormal FindingsAbnormal Findings
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11. Microscopic ExaminationMicroscopic Examination
RBCsRBCs
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12. Microscopic ExaminationMicroscopic Examination
WBCsWBCs
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13. Microscopic ExaminationMicroscopic Examination
Tubular EpithelialTubular Epithelial
CellsCells
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14. Microscopic ExaminationMicroscopic Examination
YeastsYeasts
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15. Microscopic ExaminationMicroscopic Examination
RBCs CastRBCs Cast
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16. Microscopic ExaminationMicroscopic Examination
WBCs CastWBCs Cast
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17. Microscopic ExaminationMicroscopic Examination
Tubular Epith. CastTubular Epith. Cast
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18. Microscopic ExaminationMicroscopic Examination
Granular CastGranular Cast
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19. Microscopic ExaminationMicroscopic Examination
Hyaline CastHyaline Cast
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20. Microscopic ExaminationMicroscopic Examination
Waxy CastWaxy Cast
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21. Microscopic ExaminationMicroscopic Examination
Calcium Oxalate CrystalsCalcium Oxalate Crystals
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22. Microscopic ExaminationMicroscopic Examination
Calcium Oxalate CrystalsCalcium Oxalate Crystals
DumbbellDumbbell
ShapeShape
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23. Microscopic ExaminationMicroscopic Examination
Triple Phosphate CrystalsTriple Phosphate Crystals
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24. Microscopic ExaminationMicroscopic Examination
Urate CrystalsUrate Crystals
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25. Microscopic ExaminationMicroscopic Examination
Cholesterol CrystalsCholesterol Crystals
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26. Microscopic ExaminationMicroscopic Examination
Leucine CrystalsLeucine Crystals
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27. Microscopic ExaminationMicroscopic Examination
Cystine CrystalsCystine Crystals
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28. Thank youThank you
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