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1. Analysis of
Urine

2. Urine should be analyzed as rapidly as possible.
ideally within 30 minutes.
If not possible:
◦ it should be refrigerated immediately and stored for preferably no more than
6–12 hours after collection.
◦ Refrigerated urine should be brought to room temperature and thoroughly
mixed before analysis
◦ Urine should not be frozen if sediment analysis is to be performed.

3. COLLECTION OF URINE SPECIMENS
First morning sample –concentrated urine --- biochemical
analysis, casts and crystals.
Random specimen - chemical screening, microscopic
examinations.
24 sample urine sample - quantitative estimation of
proteins, sugars, electrolytes, and hormones

5. PHYSICAL EXAMINATION
Volume –
Normal -- 1.2-2 L /day.
The day is 3-4 times > night.
Night is < 400 ml.
Polyuria >3000ml / day.
Oliguria <400ml / day.
Anuria <100 ml per day.

6. Polyuria when urine amount exceeds 2000 mL/ 24 hours.
◦ This is seen in diabetes mellitus.
◦ Drugs like diuretic therapy.
Oliguria when urine volume is less than 500 mL/ 24 hours. This is
seen in the following conditions.
◦ Renal tubular dysfunction.
◦ Edema..
◦ Dehydration.
◦ Vomiting.
◦ Shock.
◦ Diarrhea.
Anuria when there is no urine output. This is seen in the following
conditions.
◦ Acute renal failure.
◦ Heart failure.
◦ Shock.

7. APPEARANCE
COLOUR
Normal - amber yellow (due to the presence of urobilin, uroerythrin
and urochromes ).
Colorless - Very dilute urine (Diabetes, Polyuria).
Yellow orange (high colored) - Concentrated urine, Excess urobilin, Bile
pigments.

8. Red/ smoky - RBC, Myoglobin, Menstrual contamination.
Cloudy - Phosphates and Carbonates, Uric acid, Bacteria, Yeast.
Milky - Pyuria, Fat.
Brown black-Methemoglobin,Homogenestic acid( alkaptonuria ),Melanin.
Orange- Bile pigments, Drugs like:
Rifampicin- orange red
Nitrofurantoin-dark yellow to brown
Levodopa -brown to black;

9. TURBIDITY (muddy urine)
Freshly voided: Clear and transparent
Bacteria growth : gives uniform cloudiness.
Mucus : it forms bulky deposits
Red cells : gives turbid smoky urine
Chyluria : gives turbid milky urine (when you have lympha in
urine)

10. ODOUR OF URINE
Normal odour
Fresh urine has aromatic odor
Abnormal odors
Ammonia smell: after prolonged standing
Fecal smell: due to urinary infection.
Fruity smell: ketosis
Mousy order : phenylketonuria.

11. pH
1. Normal pH = 4.6 – 8.0.
2. The average person has a pH of 5 to 6.
3. pH is helpful for the identification of crystals.
4. pH is helpful for the acid-base status

12. A pH < 7 indicates acid urine and a pH > 7 alkaline urine.
Some foods (such as citrus fruits and dairy products) and medications
(such as antacids) can affect urine pH.
In a diet high in protein the urine is more acidic, while a diet high in
vegetable material yields a urine that is more alkaline.

13. A high alkaline pH can be caused by:
Severe vomiting.
Kidney disease.
Some urinary tract infections.
Asthma.

14. A low acidic pH may be caused by :
Severe lung disease like emphysema.
Uncontrolled diabetes.
Aspirin overdose.
Severe diarrhea.
Dehydration.
Starvation.

15. SPECIFIC GRAVITY
The specific gravity (SG) of urine is a useful indicator of
renal concentrating ability.
This can be readily obtained by measuring the
refractive index (RI) in specially calibrated
refractometer.

16. For urine, the specific gravity is a function of the number and weight of the
dissolved solute particles.
Specific gravity measures the concentrating and diluting abilities of the
kidney.

17. Normal = 1.005 – 1.030
Abnormal Sp.Gravity
A very high specific gravity urine means very concentrated urine, which
may be caused by:
1. Lake of drinking enough fluid.
2. Loss of too much fluid like excessive vomiting, sweating, or diarrhea.
3. Substances (such as sugar or protein) in the urine.
Very low specific gravity means dilute urine, which may be caused by:
1. Drinking too much fluid.
2. Severe kidney disease.
3. Use of diuretics.

18. GLUCOSURIA
Under normal circumstances glucose in not excreted in
urine.
Glucose is freely filtered then reabsorbed in the proximal
tubule, but resorptive capacity is limited.
Glucosuria occurs when : blood glucose exceeds this renal
threshold, for example Diabetes mellitus
Glucosuria in the absence of hyperglycaemia reflects:
- a tubular resorption defect eg: Fanconi syndrome

20. GLUCOSE

21. KETONURIA
Ketonuria is usually associated with diabetic ketoacidosis and
starvation.
Dipsticks detect acetoacetate and to a lesser extent,acetone but
do not detect betahydroxybutyrate (BHB).
TESTS
1.Dipstick test
2.Rothera’s test

22. KETONES
Ketones are excreted when the body metabolizes fats
incompletely (ketonuria).

23. Normally urine is negative.
Abnormal Ketonuria
◦ uncontrolled diabetes.
◦ Very low-carbohydrate diet.
◦ Starvation.
◦ Eating disorders e.g. anorexia nervosa or bulimia.
◦ Alcoholism.
◦ Poisoning from drinking rubbing alcohol (isopropanol).
◦ Ketones are often found in the urine during fasting for 18 hours or longer.

24. BILE IN URINE
The constituents are :
1. Bilirubin (bile pigments),
2. Bile salts,
3. Urobilin and Urobilinogen.
•Bilirubin appears IN JAUNDICE.
•Increased bilirubinuria may be caused by liver diseses, cholestasis or
haemolytic anaemia.
•Bilirubin in urine is in the form of conjugated bilirubin

26. The appearance of the bilirubin in the urine indicates liver disease.
It is detected long before jaundice clinically appears.
It is negative in normal urine.
Increased in hepatic and obstructive jaundice in urine.

28. Significance of urobilinogen:
It helps in the early detection of liver diseases.
It is increased in hemolytic disorder.
In hepatic jaundice, in liver disorder, hepatitis, cirrhosis, and cancers.
It is absent in obstructive jaundice.

29. BLOOD IN URINE
Red blood cells or Haemoglobin in urine.
When hemolysis occurs in circulation or urine.
Normally an occasional red cell may be found on microscopic examination
of the urine sediment.
In women during menstruation, the urine may get contaminated with
menstrual blood

30. HAEMATURIA: Denotes the presence of red blood cells in urine.
- Renal disorders, Infections or Neoplasm or Trauma related to any part
of urinary tract.
HEMOGLOBINURIA: is the presence of blood pigments in the urine without
the presence of red blood cells.
- Hemolytic anemia, Transfusion reactions, Malaria, Paroxysmal
Nocturnal Hemoglobinuria.