An abnormal urine analysis can indicate a variety of health conditions, as it evaluates the physical, chemical, and microscopic properties of urine. Abnormal results may include dark or cloudy urine, which can be signs of infection, liver disease, or kidney problems. A foul odor may suggest a urinary tract infection (UTI), while a sweet, fruity odor can indicate uncontrolled diabetes or diabetic ketosis. Chemical analysis can reveal abnormalities such as the presence of glucose, which may point to diabetes, pregnancy, or gestational diabetes. Ketones in the urine are abnormal and can indicate uncontrolled diabetes, starvation, a very low-carbohydrate diet, or alcohol use disorder. Protein in the urine (proteinuria) is a significant finding, often indicating kidney damage from conditions like high blood pressure, diabetes, or systemic lupus erythematosus (SLE). The presence of bilirubin in the urine is abnormal and may suggest liver disease, bile duct obstruction, or bleeding disorders. Microscopic examination can identify red blood cells (hematuria), which may be caused by kidney or bladder injury, kidney stones, UTIs, glomerulonephritis, or cancer. White blood cells (leukocyturia) suggest inflammation or infection in the urinary tract, such as a UTI or kidney infection. The presence of bacteria, yeast, or parasites can confirm an infection. Urine casts, especially red blood cell casts, are strong indicators of serious kidney involvement, such as lupus nephritis. Crystals, particularly in large amounts or of specific types, can be a sign of kidney stones or metabolic disorders. The specific gravity of urine, which measures concentration, can be high (indicating concentrated urine, possibly due to dehydration or kidney issues) or low (indicating dilute urine, which may result from drinking too much fluid, severe kidney disease, or diuretic use). The pH of urine, normally between 4.5 and 8.0, can be altered by diet, medications, or underlying conditions; a persistently high pH may suggest a UTI, while a low pH can be associated with uncontrolled diabetes or dehydration. Abnormal results from a rapid urine test should be confirmed with a more detailed laboratory analysis, as these tests can sometimes yield false positives or negatives.An abnormal urine analysis can indicate a variety of health conditions, as it evaluates the physical, chemical, and microscopic properties of urine. Abnormal results may include dark or cloudy urine, which can be signs of infection, liver disease, or kidney problems. A foul odor may suggest a urinary tract infection (UTI), while a sweet, fruity odor can indicate uncontrolled diabetes or diabetic ketosis. Chemical analysis can reveal abnormalities such as the presence of glucose, which may point to diabetes, pregnancy, or gestational diabetes. Ketones in the urine are abnormal and can indicate uncontrolled diabetes, starvation, a very low-carbohydrate diet, or alcohol use disorder. Protein in the urine

1. ANALYSIS OF ABNORMAL
CONSTITUENTS OF URINE

2.  The normal glomerulus filters plasma and retains most of
the large molecular weight and useful substances.
 Further, the small molecules filtered are also reabsorbed by
renal tubules.
INTRODUCTION : -

3. INTRODUCTION : -
 In many pathological conditions, the urine may contain
abnormal constituents which are not excreted normally-
 due to defective filtration by glomerulus
 or impaired reabsorption by renal tubules.
 Presence and analysis of these abnormal constituents in
urine will help in the diagnosis of pathological condition.

4. URINE EXAMINATION
 PHYSICAL EXAMINATION
 CHEMICAL EXAINATION
 MICROSCOPIC EXAINATION

5. PHYSICAL EXAMINATION
1. VOLUME
2. COLOUR
3. APPEARANCE
4. ODOUR
5. pH
6. SPECIFIC GRAVITY

6. PHYSICAL EXAMINATION
 VOLUME:
 Normal urine output is 800-2000 ml/day
 POLYURIA: Urine Output > 2.5 L / day; seen in -
 Diabetes Mellitus , Diabetes Insipidus
 Diuretics , later stages of renal failure
 OLIGURIA: Urine Output < 400 ml/day ; seen in -
 Acute Nephritis
 Excess fluid loss due to vomiting , diarrhea ,fever, haemorrhage , cardiac failure
 ANURIA: Complete cessation of urine. Urine Output < 50ml/day ; seen in -
 Shock , acute tubular necrosis , Bilateral renal stones , mismatched blood transfusion

7.  Ratio of urine output in day and night is 2:1 to 3:1
 The ratio is reversed or decreased in renal diseases
 High urine output at night (NOCTURIA) is one of the early
symptoms of chronic renal disease.

8. 
Appearance :
 Normal urine is clear and does not contain any
sediments.
 Turbid urine is seen in
 1. urinary tract infections (excretion of pus cells) and
 2. protein in urine.
 3. On long standing ,urine turns turbid due to
precipitation of phosphates present in urine.

9.  COLOUR :
 Normal colour is pale yellow / amber yellow due to excretion of urochrome or
urobilinogen.
 Dark coloured urine is -due to increased concentration of urine , as in acute
glomerulo nephritis.
 Red colour- seen in Haematuria , due to stones in urinary tract, carcinoma of
bladder, injury to urinary passage , acute glomerulo nephritis)
Reddish brown – Haemoglobinuria ( incompatible blood transfusion)
Myoglobinuria ( road traffic accidents, crush injury)
 Yellow colour- seen in Jaundice due to excretion of bile pigments.
 Milky white urine or Chyluria is seen in –– Filariasis
 Black to brown – seen in Porphyrias, PKU, Alkaptonuria.

10.  ODOUR :
 Normal odour is Faint Aromatic odour ( due to volatile
organic acids )
 Sweety / fruity odour – seen in Diabetic keto acidosis
 Mousy odour - seen in Phenyl ketonuria
 Cabbage odour - seen in Tyrosinemia
 putrid or ammonical odour / Foul smell – is due to bacterial
decomposition, if urine is kept outside for a long time.
 Burnt sugar odour- seen in Maple syrup urine disease

11.  Specific gravity
 Indicates concentrating ability of kidneys
 Ranges from 1.015 – 1.025 for normal urine
 Measured by Urinometer
 S.G α Solutes
Volume
 Increased - in Diabetes mellitus (glucose in urine ) low water
intake, albuminuria ( albumin in urine) , Chronic renal failure
 Decreased - in diabetes insipidus , high fluid intake
 Isosthenuria - fixed specific gravity (1.010 )– seen in later stages of
renal disease. (chronic and acute kidney failure ) , sickle cell trait .

12. MEASUREMENT OF SPECIFIC GRAVITY
Urinometer

13. CORRECTED SPECIFIC GRAVITY
 Specific gravity = observed specific gravity + temperature correction
 Temperature correction = Room temperature – calibrator temperature X 0.001
3
 Ex- Specific gravity = 1.016 +{ 36 – 27 / 3 X 0.001}
 = 1.016 + 0.003
 = 1.019

14.  pH :
 Freshly voided urine has a pH 4.6-8 (mean pH 6.0 )
 On long standing becomes - alkaline due to bacterial action of
conversion of urea to ammonia and increases the pH
 Urine excreted after meals is alkaline and is known as alkaline
tide.
 Fruits and veggies – alkaline urine
 High protein diet – acidic urine
 In D.K.A – acidic urine ( due to Ketone bodies - acetoacetic acid &
beta hydroxy butyric acid )

15. MEASUREMENT OF URINARY PH
Urinary pH is measured by-
 pH papers
 Litmus papers

16. ABNORMAL CONSTITUENTS OF URINE
1. Reducing sugars
2. Ketone bodies
3. Proteins
4. Blood
5. Bile salt
6. Bile pigments.

17. TEST FOR REDUCING SUGARS –
BENEDICT’S TEST
EXPERIMENT OBSERVATION INFERENCE
Take 5ml of
Benedicts reagent
in a test tube, add 8
drops of urine
sample & boil for 2
minutes.
Brick red color
precipitate is
observed.
Indicates the
presence of
reducing sugars in
the given urine
sample.

18.  COMPOSITION
1 liter of Benedicts reagent contain
1)100 g of Na2co3
– provides alkaline medium
2) 173g of sodium citrate
– keep copper in ionic state
3) 17.3 g of cuso4 – provides cu ions

19.  PRINCIPLE :
In alkaline medium, (sugars behave as weak acids &)
tautomerise to form enediols which are powerful reducing
agents , these enediols reduce the cupric (Cu2+
)ions to red
color cuprous (Cu+
) oxide.

20.  Benedicts test is a semi quantitative test:
 The colour of the precipitate
indicates the approximate
concentration of
the reducing sugars.
Blue color Negative test absence of sugar
Green precipitate Positive test 0.5g% (+)
Yellow precipitate Positive test 1.0g% (++)
Orange precipitate Positive test 1.5g% (+++)
Red precipitate Positive test 2.0 g% (++++)
Brick red precipitate Positive test > 2.0 g%(++++)

21. TESTS FOR REDUCING SUGARS
Clinical Interpretation:
 Glycosuria – is excretion of reducing sugars in urine.
 Glycosuria is a non-specific term.
 Any reducing sugar found in urine is denoted by glycosuria
( mostly glucose)
 Galactosuria - in galactosemia
 Fructosuria - in hereditary fructose intolerance
 Pentosuria - in essential Pentosuria
21

22.  1.Determination of Glucose.
Benedicts test
Fehling's test
 2. Determination of Lactose
Yeast fermentation test
Osazone test.
Rubners test.
 3. Seliwanoffs Test for Fructose
 4. Bial’s Test For Pentoses

23. GLYCOSURIA - CAUSES
a. Hyperglycemic glycosuria - Diabetes mellitus ,
Hyperthyroidism, hyperpituitarism and hyperadrenalism
b. Non- Hyperglycemic glycosuria or Renal glycosuria
- Pregnancy, hereditary diseases of renal tubules(Fanconi
syndrome ) , heavy metal poisoning , glomerulosclerosis .
c. Alimentary glycosuria - transient glycosuria
d. Stress, severe infections, increased intracranial pressure

24. GLYCOSURIA
Examples of non-carbohydrate substances which give a
positive Benedict's reaction are:
a) Creatinine
b) Ascorbic acid
c) Glucuronates
d) Drugs: Salicylates, PAS and Isoniazid

25. TEST FOR KETONE BODIES-
ROTHERA’S TEST
EXPERIMENT OBSERVATION INFERENCE
Take 5ml of urine,
saturate with
Ammonium sulphate
crystals. Add 2-3drops
of freshly prepared 5%
Sodium nitroprusside
& mix well. Then add
2ml of strong liquour
Ammonia slowly
along the sides of the
test tube
Permangate or
purple colour ring
is observed at the
junction of two
layers
Indicates the
presence of
ketone bodies
( Acetone ,
acetoacetate) in
the given urine
sample.

26. Rothera’s Test
Principle:
Nitroprusside in alkaline medium reacts
with a ketone group to form a purple ring.
 It is given by acetone and acetoacetate,
but not by Beta hydroxy butyric acid.
26

27. Acetone, acetoacetate and beta hydroxy butyrate are the ketone bodies.
They serve as energy source for tissues like brain , muscle during
starvation .
Normal blood level < 1 mg/dl ; Normal urine conc. < 1 mg/day
 Ketonemia and hence ketonuria occurs mostly in conditions of glucose
deprivation.
Ketosis = ketonemia + ketonuria
Causes of Ketonuria:
1) Pathological - Uncontrolled diabetes mellitus , Toxemia of pregnancy
2) Physiological - Starvation , High fat feeding , Heavy exercise

28. OTHER TESTS FOR K.B
 Rothera's test for acetone.
 Gerhard's test for acetoacetic acid
 Tablet test

29. TEST FOR BLOOD – O-TOLIDINE TEST
EXPERIMENT OBSERVATION INFERENCE
Take 1ml of
O-tolidine in a T.T
and add 1ml of 1 in 10
H2O2 . Mix well.
Make it into 2 parts
into another TT.
To 1 part add 1ml of
given urine solution.
To the other TT, add 1
ml of D.H2O ,as
control.
Development of
blue color
indicates presence
of blood pigment.
The second tube
serves as control.
Indicates the
presence of Blood in
urine

30. PRINCIPLE:
 Hemoglobin of blood decomposes Hydrogen peroxide
in presence of the enzyme catalase – liberating water and
nascent oxygen.
 Nascent Oxygen oxidizes O-Tolidine to a blue or green
colored Tolidine blue. This color changes to brown with
in a few minutes on exposure to air.

31. Clinical Interpretation:
Hematuria : Presence of blood in urine.
a. Gross hematuria:
b. Microscopic hematuria:

32. 32
a. Gross hematuria:
Urine appears reddish in
gross hematuria.
observed in :
Trauma,
Renal stones,
Malignancies,
Tuberculosis
acute glomerulonephritis.
b. Microscopic hematuria:
Blood is not visible to naked
eyes.
It is observed in:
Malignant hypertension,
Sickle cell anemia,
Coagulation disorders,
Polycystic kidney disease,
Hemoglobinuria - free Hb. in urine imparts smoky red color –seen in
Incompatible blood transfusion , malaria, Auto immune hemolytic
anemia.

33. OTHER TESTS
 Guaiac test

34. TEST FOR PROTEIN-
HEAT COAGULATION TEST
EXPERIMENT OBSERVATION INFERENCE
Take urine solution
up to 3/4th
of TT,
&heat the upper
part.
Add 2-3 drops of
10% Acetic acid
and again heat the
upper part of the test
tube.
White coagulum
is observed at the
top of the test
tube.
Indicates presence
of protein in the
given urine sample.

35.  Principle:
 Albumin is denatured and coagulated on
heating at the iso-electric point( acetic
acid )
 Acidification is necessary because-
- In alkaline medium, heating may
precipitate carbonates and phosphates.
Acetic acid dissolves this precipitate.
The heated upper half shows
turbidity due to the precipitation
of proteins, the lower half serves
as a control for comparison.

36. TEST FOR PROTEIN-
SULPHOSALICYLIC ACID TEST
EXPERIMENT OBSERVATION INFERENCE
Take 3ml of urine
solution in a test
tube,
Add 3 drops of 20
% sulphosalicylic
acid .
White precipitate
is observed.
Indicates presence
of protein in urine

37. Principle
 In acidic medium, proteins carry positive charges which is
neutralized by negatively charged alkaloidal reagents, like
sulphosalicylic acid and the proteins get precipitated.

38. TEST FOR PROTEIN-
HELLERS NITRIC ACID TEST
EXPERIMENT OBSERVATION INFERENCE
Take 3ml of urine
solution in a test
tube ,
add1ml of
Conc.HNO3 along
the walls of the test
tube.
A white ring is
formed at
junction of two
layers.
Indicates presence
of protein in urine

39.  Principle:
 Concentrated HNO3 causes denaturation and hence
precipitation of proteins.

40. Clinical Interpretation-
Normally protein excretion in urine is in insignificant
amount ( < 20-80 mg/day) .
This small amount is not detectable by routine methods.
Proteinuria : presence of protein in urine.(in detectable
quantities)
The most common type of proteinuria is albuminuria;
hence proteinuria and albuminuria are used synonymously

41. Proteinuria.
It can be caused by-
a) Increased glomerular permeability
b) Reduced tubular reabsorption
c) Increased secretion of proteins
d) Increased concentration of low molecular weight
proteins in the plasma

42. Proteinuria may be- Physiological or Pathological
Physiological Proteinuria
Severe exercise , Pregnancy , Postural , After high protein
diet , Exposure to cold
Pathological proteinuria
I. Pre Renal:
 Severe dehydration , Heart disease , Ascites (due to
increased intra-abdominal pressure) , Severe anemia,
and Fever

43. II. Renal: All inflammatory, degenerative or destructive diseases of
kidney; the most common ones are:
 Nephrotic syndrome, Pyelonephritis , Acute and Chronic
glomerulonephritis , Nephrosclerosis , Tuberculosis of kidney
 Renal failure.
III. Post Renal – due to inflammation of lower urinary tract
 Severe urinary tract infections
 Inflammatory, degenerative or traumatic lesions of pelvis, ureters,
bladder, prostate or urethra
 Bleeding in genito urinary tract
 Pus in urine
 Contamination of urine by semen or vaginal secretions

44. BENCE JONES PROTEINS
 Bence Jones proteins are light chain immunoglobulins
 Excreted in urine of a patient suffering from multiple
myeloma.
 These proteins are detected in urine by classical heat test :
 These proteins precipitate between 40-60 degree centigrade
 Upon further heating, turbidity disappears to reappear on
cooling
 These proteins redissolve on boiling unlike albumin

45. TEST FOR BILE SALTS-
HAY’S SULPHUR TEST
EXPERIMENT OBSERVATION INFERENCE
Take Two test tubes
label as Test
(T) ,Control (C).
Take 5ml of urine in
a test and 5ml of
Distilled water in
control.
Sprinkle little
Sulphur powder in
both test tubes
Sulphur powder
sinks in TEST
Floats in
CONTROL
Indicates the
presence of Bile
salts in the given
urine sample.
Control
test

46.  Principle:
 Bile salts lower the surface tension allowing the sulphur
powder to sink
 Clinical Interpretation:
 Bile salts – Na and K salts of Glyocholic and
Taurocholic acids.
 Excreted in urine –in obstructive jaundice due to
regurgitation of bile into blood . ( causes are - due to gall
stones, cancer of head of pancreas ) –
 Other tests- Peten koffer`s test.

47. TEST FOR BILE PIGMENTS-
FOUCHET’S TEST
EXPERIMENT OBSERVATION INFERENCE
Take 5 ml of urine in
a test tube.
Add 1ml of 10 %
Bacl2 & 1 ml of
Mgso4 . mix well,
wait for 5 minutes
and filter it.
Dry the precipitate on
the filter paper.
Add to the
precipitate, few drops
of fouchets reagent.
Green color is
observed on the
filter paper.
Indicates the
presence of
Bile pigments in
the given urine
sample.

48.  Principle:
 BaCl2 reacts with Mg.sulphate in urine to form
precipitate of barium sulphate, which adsorbs bile
pigments in urine .
( if present )
- Composition of Fouchets reagent – FeCl3 in TCA
 The adsorbed bile pigments are released by
TriChloroAceticacid (TCA) of Fouchets Reagent and
FeCl3 oxidizes bilirubin to biliverdin (green color).

49. Clinical Interpretation
Bilirubin in urine means increased amount of conjugated
bilirubin because unconjugated bilirubin is water insoluble
and is also bound to albumin, hence cannot cross the
glomerular membrane.
Causes of bilirubinuria are: hepatic and obstructive jaundice
1) Moderate to severe hepatocellular damage
2) Obstruction of bile duct- Intra or extra hepatic
In prehepatic jaundice, bilirubin is absent in urine.
(unconjugated bilirubin– seen in hemolytic jaundice)

50. OTHER TESTS
 Foam test
 Gmelin's test , SMITH`S TEST
 Ehrlich's aldehyde test – urobilinogen
 Schlesingers test

51. ABNORMAL URINE REPORT
 1. PHYSICAL CHARACTERS
 VOLUME
 APPEARNCE
 COLOR
 ODOUR
 pH
 SPECIFIC GRAVITY

52. 2. CHEMICAL CHARACTERS
Procedure Observation Inference
1. Test For Reducing Sugars – Benedicts
2. Test For Ketone bodies – Rotheras
3. Test For Proteins– Heat Coagulation
test +2
4. Test For blood – benzidine / O-toluidine
test
5.Test For Bile salts – Hays sulphur test
6. Test For Bile pigments– Fouchets test
Report :- The Given Urine Sample Contains --------------------------- And
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