urine analysis in family medicine

1. 7/29/2021
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2. Outline
 Introduction
 Indications
 Sample collection
 Macroscopic analysis
 Chemical analysis
 Dip stick procedure
 Macroscopic analysis
 Interpretations
 Sample cases
 Conclusion
 References
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3. INTRODUCTION
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 Urine is a solution of water and metabolic waste
products.
 A complex fluid whose examination and analysis can
produce useful information about milleu interior.
 A readily available specimen that can provide useful
information necessary for diagnosis and
management of several diseases.

4. INTRODUCTION
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 Urinalysis is a common non- invasive investigative procedure.
 It involves a lot of specific stepwise activities for optimal and reliable
results.
 It involves physical, biochemical and microbiological processes that check
the appearance, concentration and content of urine.
 It should and must always been seen as an adjunct to clinical diagnosis and
therapy.

5. Introduction
 Urinalysis
 A commonly ordered panel of tests on a urine sample which
can evaluate a wide range of clinical conditions
 Provides information about
 The state of the kidney and urinary tract
 Metabolic or systemic disorders
 Can be used for screening
 Can reveal diseases asymptomatic disease like
 Diabetes mellitus
 Various forms of kidney failure
 Chronic urinary tract infections
 Can also be used for diagnosis of some conditions
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6. Indications
 Renal conditions
 Renal failure
 Nephrotic syndrome
 Glomerulonephritis
 Urinary Tract Infection
 Diabetes
 Genitourinary malignancies
 Acid base disorders
 Rhabdomyolysis
 Volume status
 Response to alkalizations therapies
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7. Specimen Collection…
 Preparation
 No special preparations before collection are necessary
 Medications and treatments need not be stopped prior to
collection
 Analyzed within 1 hours of collection
 If testing cannot be done within an hour after voiding,
refrigerate the specimen immediately
 Let it return to room temperature before testing
 Prolonged exposure to room temperature may result in
microbial proliferation with the resultant changes in pH
 Urine containing glucose may decrease in pH as organisms
metabolize the glucose
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8. Macroscopic examination
 Gross inspection
 Colour
 Odour
 Turbidity
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9. Colour
 Normal colour is due to the presence of a pigment
called urochrome
 Varies based on the
 Concentration and
 Chemical composition
 Influence by
 Hydration status
 Food
 Drugs
 Medical conditions
 Normal colour is yellow (straw to amber)
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10. Colour…
 Pale light yellow
 Normal but diluted urine
 Over-hydration
 Diabetes insipidus due to impaired urine concentrating ability
 Dark amber color
 Normal but concentrated urine
 Dehydration
 Red urine
 Foods – Beets, blackberries, rhubarb
 Drugs – Propofol, chlorpromazine, thioridazine
 Medical conditions
 Urinary tract infections (UTIs)
 Nephrolithiasis
 Haemoglobineuria (rhabdomyolysis)
 Porphyrias (urine color, port win)
 Factitious disease
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11. Colour…
 Orange urine
 Medical condition- Hyper-bilirubineamia
 Foods – Carrot, vitamin C
 Drugs – Rifampin, phenazopyridine
 Green urine may indicate the following
 Food – Asparagus
 Drugs – Vitamin B, methylene blue, propofol, amitriptyline
 Medical condition – UTI with pseudomonas
 Blue urine may indicate the following
 Drugs – Methylene blue, indomethacin, amitriptyline,
triamterene, cimetidine (intravenous), promethazine
(intravenous)
 Medical condition – Blue diaper syndrome (also known as
tryptophan malabsorption)
 Purple urine may indicate the following
 Medical condition – Bacteriuria in patients with urinary catheters
(purple urine bag syndrome)
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12. Colour…
 Brown urine may indicate the following
 Food – Fava beans
 Drugs – Levodopa, metronidazole, nitrofurantoin,
primaquine, chloroquine, methocarbamol, senna
 Medical conditions – Gilbert syndrome , tyrosinemia
,hepatobiliary disease
 Black urine may indicate the following
 Medical conditions – Alkaptonuria, malignant melanoma
 Causes of red urine in high concentration
 White urine may indicate the following
 Drug – Propofol
 Medical conditions – Chyluria, pyuria, phosphate crystals
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13. Clarity or turbidity
 How clear the urine is
 Typically classified as clear, mildly cloudy, cloudy,
or turbid
 Determined by substances in urine, such as
amount of
 Cellular debris
 Casts
 Crystals
 Bacteria
 Significant proteinuria
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14. Clarity or turbidity…
 Turbid
 Urinary tract infection
 Precipitated crystal
 Contaminated urine: sperm, Vaginal discharge e.t.c.
 Prostatic secretions
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15. 7/29/2021
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16. Odour
 Not so accurate
 Brief changes in odor are usually merely interesting and not
medically significant. Normal odor varies
 Odorless: when very light colored and dilute
 Much stronger odor: During dehydrated
 Ammonia-like
 Urea-splitting bacteria
 Foul, offensive
 Old specimen, pus or inflammation
 Sweet
 Glucose
 Fruity
 Ketones
 Maple syrup-like
 Maple Syrup Urine 7/29/2021
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17. Chemical Examination/ Urine Dipstick
 Determination chemical elements in the urine using dry reagent
strips
 A semi-quantitative test
 Dip stick
 A series of pad embedded on a reagent strip that provide quick semi-
quantitative assessment of various content of urine
 These plastic strips contain
 Absorbent pads with
 Various chemical reagents for determining a specific substance
 When the test strip is dipped in urine
 Reagents are activated and a chemical reaction occurs
 Chemical reaction then results in a specific color change
 After a specific amount of time has elapsed
 Color change is compared against a reference color chart provided by the
manufacturer of the strips
 Intensity of the color formed is generally proportional to the amount of
substance present
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18. Components Tested
 pH
 Specific Gravity
 Protein
 Blood: hemoglobin, or myoglobin
 Ketone
 Bilirubin
 Urobilinogen
 Glucose
 Nitrite
 Leucocyte esterase
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19. Procedure
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20. Procedure
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21. Procedure
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22. Reagent Storage and Stability
 Store at room temperature between 15-30oC
 Do not use product after expiration date
 Do not store the bottle in direct sunlight
 All unused strips must remain in the original bottle
 Do not remove desiccant from bottle
 Do not touch reagent areas of the reagent strips
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23. Specific gravity
 Measurement of urine concentration
 Representative of kidney’s ability to concentrate urine
 A comparison of the amount of solutes in urine as
compared with pure water
 May also be used as a rough estimate of urine osmolality
 Often specific gravity is reflective of hydration status
 However, it can be inaccurate
 Varies from 1.001 to 1.035
 Principle
 X+ + Polymethyl vinyl ether/maleic anhydride -------> X+-Polymethyl
vinyl ether / maleic anhydride + H+
 H+ interacts with a Bromthymol Blue indicator to form a colored
complex
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24. Specific gravity…
 Low specific gravity is seen in patients with
 Impaired urinary concentrating ability eg,
 Diabetes insipidus
 Sickle cell nephropathy
 Acute tubular necrosis
 A specific gravity of 1.003 or less is indicative of maximally
dilute urine
 Excessive hydration
 High values may be due to
 Dehydration
 Significant amounts of protein or ketoacids
 SIADH
 Cirrhosis
 Congestive heart failure
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25. pH
 Urine pH ranges from 4.5 to 8.0
 Depending on physiologic state
 Principle
 Based on the double indicator principle that gives a broad range of colors
 H+ interacts with
 Methyl Red (at high concentration; low pH) and
 Bromthymol Blue (at low concentration; high pH), to form a colored complexes
(dual indicator system)
 Uses
 To diagnose renal tubular acidosis
 To monitor alkalization of urine
 To prevent precipitation of myoglobin in Rhabdomyolysis
 To aid excretion of some drugs like aspirin and methotrexate
 To differentiate different types of kidney stone
 Alkaline urine: Calcium oxalate/calcium phosphate, magnesium- ammonium
phosphate, staghorn calculi
 Acidic urine: Uric acid and Cysteine calculi 7/29/2021
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26. pH…
 Acidic (less than 4.5)
 Metabolic acidosis
 High-protein diet
 Alkaline (greater than 8.0)
 Renal tubular acidosis (>5.5)
 Distal RTA
 Old sample
 Urinary tract infection caused by urease producing organisms
(protease and Klebsiella)
 Limitations
 Interference: bacterial overgrowth (alkaline or acidic),
 “Run over effect” effect of protein pad on pH indicator pad
 Highly dependent on diet (require ABG or metabolic panel)
 Other Tests
 Titrable acidity
 Blood gases to determine acid-base status 7/29/2021
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27. Glucose
 Glucose is freely filtered by glomerulus but also
reabsorbed by the tubules
 Presence in urine is called glycosuria
 Glycosuria can causes diuresis and then
dehydration
 Principles
 Based on a double sequential enzyme reaction
 First, glucose oxidase, catalyzes the formation of gluconic acid
and hydrogen peroxide from the oxidation of glucose
 Glucose + 2 H2O + O2 ---> Gluconic Acid + 2 H2O2
 Then , peroxidase, catalyzes the reaction of hydrogen peroxide
with a potassium iodide chromogen to oxidize the chromogen to
colors ranging from green to brown
 3 H2O2 + KI ---> KIO3 + 3 H2O
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28. Glucose…
 Causes of detectable glucose
 Hyperglycaemia
 Fanconi syndrome
 Pregnancy
 Limitations
 Interference: reducing agents, ketones
 Only measures glucose and not other sugars
 Renal threshold must be passed in order for glucose to spill into the
urine
 Other Tests
 Clinitest
 CuSO4 test for reducing sugars
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29. Ketones
 Include acetoacetate, acetone and β-hydroxybutyrate
 Accumulate when carbohydrates are insufficient and
the body must get its energy from fat metabolism
 Ketones in the urine are abnormal
 Principle
 Based reaction of acetoacetic acid reacts with nitroprusside
 Then colors ranging from buff-pink (negative reading) to purple
(positive) result
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30. Ketones…
 Ketonuria may be seen with
 Uncontrolled diabetes
 Diabetic ketoacidosis
 Severe exercise
 Starvation
 Prolonged fasting
 Ketogenic diet
 Vomiting
 Alcohol
 Pregnancy
 Limitations
 Interference: expired reagents
 Degradation with exposure to moisture in air
 Only measures acetoacetate and acetone not other ketone bodies
 Even though β-hydroxybutyrate is most abundant ketone in diabetes, thus not
sensitive in detecting DKA
 Other Tests
 Ketostix (more sensitive tablet version of same assay)
 Serum glucose measurement to confirm DKA
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31. Protein
 Normally urine protein is not detectable using
dipstick because
 Specific but not sensitive
 Does not detect globulin
 Principle
 Based on the protein-error-of-indicators principle
 At a constant pH, the development of any green color is due to
the presence of protein
 Colors range from yellow for "Negative" through yellow-green
and green to green-blue for "Positive" reactions
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32. Protein…
 Transient proteinuria due to transient changes in
glomerular hemodynamics
 Increased excretion of urinary protein
 May have the following etiologies:
 Congestive heart failure
 Fever
 Strenuous exercise
 Seizure disorders
 Stress
 Orthostatic proteinuria
 Pregnancy
 Glomerular proteinuria
 Due to disruption of filtration barrier
 Increased filtration of albumin across the glomerular capillary wall
 May have the following etiologies:
 Nephrotic syndrome
 Diabetic nephropathy
 Glomerulonephritis
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33. Protein…
 Tubular proteinuria
 Due to defective re-absorptive capacities in the proximal
tubules
 May be caused by tubulointerstitial diseases
 ATN
 Acute interstitial nephritis
 Fanconi syndrome
 Overflow proteinuria
 Due to overproduction
 amount produced exceeds maximum amount for reabsorption in
the tubules
 Example immunoglobulin light chains in multiple myeloma
 May have the following etiologies
 Multiple myeloma
 Myoglobinuria 7/29/2021
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34. Protein…
 Others
 Lower UTI
 Renal tumor or infection
 Limitations
 Interference: highly alkaline urine
 Much more sensitive to albumin than other proteins
 e.g., immunoglobulin light chains
 Depends on the urine concentration
 Insensitive for microalbuminuria (DM patient)
 Contrast can cause false positive result
 Other Tests
 Sulfosalicylic acid (SSA) turbidity test
 Urine protein electrophoresis (UPEP)
 Bence Jones protein
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35. Blood/Heme
 Detect heme which is a marker of blood urine
 Heme is equally elevated in myoglobinemia
 Detect heme which is a marker of blood urine
 Principle
 Based on the peroxidase-like activity of hemoglobin
 Lysing agent lyse red blood cells to release heme
 Catalyzes the reaction of diisopropylbenzene
dihydroperoxide and 3,3',5,5'-tetra methylbenzidine
 Diisopropylbenzene dihydroperoxide + Tetramethylbenzidine --
----------> Colored Complex
 Resulting color ranges from orange through green; very high
levels of blood may cause the color development to continue
to blue.
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36. Blood/Heme …
 Heme is positive in urine in
 Hematuria (nephritis, trauma, etc)
 Heamoglobinuria (hemolysis, etc)
 Myoglobineuria (rhabdomyolysis, etc)
 Limitations
 Interference: reducing agents, microbial peroxidases
 Cannot distinguish between the above disease processes
 Other Tests
 Urine microscopic examination
 Urine cytology
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37. Bilirubin and Urobilinogen
 Principle
 Bilirubin
 Based on the coupling of bilirubin with diazotized dichloraniline in
a strongly acid medium
 Color ranges through various shades of tan
 Urobilinogen
 Based on a modified ehrlich reaction
 Reaction of urobilinogen with P-diethylaminobenzaldehyde and
color enhancer in a strongly acid medium to produce a pink-red
color
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38. Bilirubin and Urobilinogen…
 Bilirubin should not be present in the urine
 However conjugated (water-soluble) bilirubin is excreted in
the urine in
 obstructive hepatobiliary conditions
 certain liver diseases like hepatitis
 Often, this may occur prior to the development of clinical
symptoms (ie. Jaundice)
 Increased urobilirubin levels are associated with
 Excessive hemolysis
 Liver parenchymal diseases
 Constipation
 Intestinal bacterial overgrowth
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39. Bilirubin and Urobilinogen…
 Decreased urobilirubin levels are associated with
 Obstructive biliary disease
 Severe cholestasis
 Limitations
 Interference: prolonged exposure of specimen to oxygen and
light (urobilinogen ---> urobilin)
 Cannot detect low levels of urobilinogen
 Other Tests
 Serum total and direct bilirubin
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40. Bilirubin and Urobilinogen…
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41. Nitrite
 Normally no nitrites are detected in the urine
 Urinary nitrates are converted to nitrites by bacteria in urine
 Positive nitrite result signifies presence of bacteria with this
capability like
 Escherichia coli
 Klebsiella
 Proteus
 Enterobacter
 Citrobacter
 Pseudomonas
 Nitrite testing is sensitive, but not specific, in detecting UTIs
 Bacteria incapable of converting nitrates to nitrites are not
detected even if present
 Staphylococcus, Streptococcus , Haemophilus
 Therefore negative test result does not rule out a UTI
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42. Nitrite…
 Principle
 Based on conversion of nitrate (derived from the diet) to nitrite by
bacteria
 At the acid pH of the reagent area
 Nitrite in the urine reacts with p-arsanilic acid to form a
diazonium compound in turn couples with 1,2,3,4-
tetrahydrobenzo(h)quinolin-3-ol to produce a pink color
 Significance
 Detect gram negative bacteriuria
 Limitations
 Interference: bacterial overgrowth
 Only able to detect bacteria that reduce nitrate to nitrite
 Other Tests
 Correlate with leukocyte esterase and
 Urine microscopic examination (bacteria)
 Urine culture
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43. Leucocyte esterase
 WBCs contain an enzyme known as leukocyte
esterase
 This is released when WBCs undergo lysis
 Normally are not detectable in urine
 It become positive when WBC in urine increase
 Principle
 Granulocytic leukocytes contain esterase
 This catalyze the hydrolysis of
 Derivatized pyrrole amino acid ester to liberate 3-hydroxy-5-
phenyl pyrrole
 This pyrrole then reacts with a diazonium salt to produce a
purple product
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44. Leucocyte esterase…
 Positive leukocyte esterase test result indicates pyuria
 Pyuria typically implies a UTI
 Sterile pyuria is seen in
 Analgesic nephropathy
 UTIs of organisms not grow by standard culture
 Chlamydia
 Mycobacterium tuberculosis
 Ureaplasma urealyticum
 Other cause of positivity include
 Acute inflammation
 Renal calculus
 Pregnancy
 Sexual intercourse
 Delayed urination
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45. Leucocyte esterase…
 Limitations
 Interference: oxidizing agents
 Menstrual contamination
 Other Tests
 Urine microscopic examination (WBCs and bacteria)
 Urine culture
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46. Microscopy
 Following are examined
 Crystals
 Cast
 Cells
 Red blood cells
 White blood test
 Epithelia cells
 Others: parasites, sperm, yeast, malignant cells
 Types of microscopy
 Phase contrast microscopy
 Polarized microscopy
 Bright field microscopy with special staining
 e.g., Sternheimer-Malbin stain
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47. Microscopy…
 Preparation
 Urine is centrifuge for 5 minutes
 Most of the supernatant is poured off and the remaining
pellet is re-suspended by gently shaking the tube
 Small sample is the apply to microscope slide covered with a
coverslip
 Suspended material is referred to as urine sediment
 The slide is then observed under microscope
 Unaided slide usually suffice for examination, however
staining may be required occasionally
 Old sample is not encouraged because cells and cast might
have been degraded
 Crystals may equally precipitate (false positive)
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48. Crystals
 Highly organized microscopic solids usually composed
of small number of different ion and or molecules
 Crystals formation is dependent on
 Concentration of ions and molecules
 pH
 Small numbers of most crystals are usually normal
 Especially if urine is kept at low temperature for a while because
low temperature favour crystal precipitation
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49. Crystals
 However certain urinary crystals can diagnostically
significant in large number
 Calcium oxalate crystals
 Envelope-shaped
 In acute kidney injury
 Seen with ethylene glycol ingestion
 Uric acid crystals
 ("diamond" or "barrel" shaped
 Presence of large amounts and acute kidney injury
 Seen in tumor lysis syndrome
 May also be seen in hyperuricosuria (gout)
 Cystine crystals
 "Hexagonal“ in shape
 Seen with cystinuria
 Magnesium ammonium phosphate and triple phosphate crystals
(struvite)
 "Coffin-lid" shaped
 Seen with UTIs caused by urea-splitting organisms (ie Proteus,
Klebsiella )
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50. Crystals
 Certain urinary crystals can be of diagnostic significant
 Calcium oxalate crystals
 Envelope-shaped
 In acute kidney injury
 Seen with ethylene glycol ingestion
 Uric acid crystals
 "Diamond" or "barrel" shaped
 Presence of large amounts and acute kidney injury
 Seen in tumor lysis syndrome
 May also be seen in hyperuricosuria (gout)
 Cystine crystals
 "Hexagonal“ in shape
 Seen with cystinuria
 Magnesium ammonium phosphate and triple phosphate crystals
(struvite)
 "Coffin-lid" shaped
 Seen with UTIs caused by urea-splitting organisms (ie Proteus,
Klebsiella )
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51. Casts
 Cylindrical structures formed in renal tubule due to
precipitation of Tamm-Horsfall muco-protein
 Formation promoted by concentrated or acidic urine
 Described by element embedded in his muco-protein
 Acellular
 Cellular
 Provide insight to aetiology of AKI
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52. Casts…
 Types
 Acellular
 Hyaline cast
 Consist of Tamm-Horsfall protein without other constituent
 Generally not clinically significant
 However seen in dehydration
 Muddy brown cast
 Seen acute tubular necrosis
 Waxy cast
 Not specific
 Seen in various acute and chronic renal disease
 Fatty cast
 Contain yellow fat globules
 Strongly suggestive of nephrotic syndrome
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53. Casts…
 Types
 Acellular
 Hyaline cast
 Consist of Tamm-Horsfall protein without other constituent
 Generally not clinically significant
 However seen in dehydration
 Muddy brown cast
 Seen acute tubular necrosis
 Waxy cast
 Not specific
 Seen in various acute and chronic renal disease
 Fatty cast
 Contain yellow fat globules
 Strongly suggestive of nephrotic syndrome
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54. Casts…
 Types..
 Acellular…
 Pigment cast
 Contain one of several pigments such as heme, bilirubin e.t.c.
 Granular cast
 Result from degeneration of cellular cast
 Cellular
 Red blood cell cast
 Contain red blood cells
 Strongly suggestive of glomerulonephritis
 White blood cell cast
 Contain white blood cells
 Strongly suggestive of
 Infectious or non infectious interstitial inflamation
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55. Casts…
 Types..
 Acellular…
 Pigment cast
 Contain one of several pigments such as heme, bilirubin e.t.c.
 Granular cast
 Result from degeneration of cellular cast
 Cellular
 Red blood cell cast
 Contain red blood cells
 Strongly suggestive of glomerulonephritis
 White blood cell cast
 Contain white blood cells
 Strongly suggestive of
 Infectious or non infectious interstitial inflammation
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56. Cells
 Cells assessed
 White and red blood cells
 Bacteria
 Renal tubular cells
 Per High Power Field (HPF) (400x)
 > 3 erythrocytes
 > 5 leukocytes
 > 2 renal tubular cells
 > 10 bacteria
 Dys-morphic red blood cells indicate
glomerulonephritis
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57. Cell…
 Increased red blood cells
 UTI
 Renal stone
 Heamaturia
 Malignancies
 Recent instrumentation
 Coagulopathy
 Glomerulonephritis
 Sickle cell aneamia
 Renal tuberculosis
 Contamination with menstrual blood
 Vigorous exercise
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58. Cell…
 Increased white blood cell
 Urinary tract infection
 Malignancies
 Recent instrumentation
 Interstitial nephritis
 Interstitial cystitis
 Intraabdominal inflammatory process adjacent to bladder
 Contamination from vaginal secretions
 Indwelling urethral catheter
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59. A 35-year old man undergoing routine pre
employment drug screening.
Physical characteristics: Clear.
Microscopic: Not performed.
Drugs Identified: None.
Questions:
- What is your differential diagnosis?
- What would you do next to confirm your
suspicion?
- Would you order a microscopic analysis
on this sample?
Negative
Negative
Negative
1.001
Negative
5.5
Negative
0.2 mg/dL
Negative
Negative
Glucose
Bilirubin
Ketones
S.G.
Blood
pH
Protein
Urobilinogen
Nitrite
L.E.
Diluted urine, request a voided urine in the morning
If persisting low SG, possible diabetes insipida
A microscopic may give negative results
Case 1
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60

60. A 42-year old woman presents with “dark urine”
Physical characteristics: Red-brown.
Microscopic: Not performed.
Questions:
- What is your differential diagnosis?
- Could this be a case of hemolytic anemia?
- How would you rule it out?
- What tests would you order next? Why?
- Would you order a microscopic analysis?
Negative
+++
Negative
1.020
Negative
5.5
Negative
0.2 mg/dL
Negative
Negative
Glucose
Bilirubin
Ketones
S.G.
Blood
pH
Protein
Urobilinogen
Nitrite
L.E.
Possible gallbladder or hepatic disease.
No hemolytic anemia. Perform bilirubins in serum
Microscopic unlikely to provide additional info
Case 2
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61

61. A 42-year old man presents painful urination
Physical characteristics: dark red, turbid
Microscopic: leukocytes = 30 per HPF
RBCs = >100 per HPF
Bacteria = >100 per HPF
Questions:
- What is your suspected diagnosis?
- What would you do next?
- What do you make of the nitrite test?
- How would the microscopic exam differ if
the S.G. were 1.003?
- Is this a common diagnosis for this type of
patient?
Negative
Negative
Negative
1.030
+++
6.5
Trace
1.0 mg/dL
Negative
+++
Glucose
Bilirubin
Ketones
S.G.
Blood
pH
Protein
Urobilinogen
Nitrite
L.E.
Possible UTI, request culture and antibiotic sensitivity
Negative Nitrite test: Gram positive bacteria
Lower SG may show less number of cells and bacteria
Un-common diagnosis in this type of patient
Case 3
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62

62. A 27-year old woman presents with severe
abdominal pain.
Physical characteristics: clear-yellow.
Microscopic: Not performed.
Questions:
- What is the most likely diagnosis?
- What do you make of the ketone result?
- What do you expect to happen to the ketone
measurement when treatment begins?
++
Negative
Trace
1.015
Negative
6.0
Negative
1.0 mg/dL
Negative
Negative
Glucose
Bilirubin
Ketones
S.G.
Blood
pH
Protein
Nitrite
L.E.
Urobilinogen
Diabetes
May be decompensated and with ketoacidosis
Ketones should become negative after treatment
Case 4
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63

63. Negative
Negative
Negative
1.015
+++
6.5
+
1.0 mg/dL
Negative
Negative
8-year old boy presents with discolored urine
Physical characteristics: Red, turbid.
Microscopic: erythrocytes = >100 per HPF
(almost all dysmorphic)
Red cell casts present.
Questions:
- What is the most likely diagnosis in this
case?
- Does the presence of red cell casts help you
in any way?
- If the erythrocytes were not dysmorphic
would that change your diagnosis?
Glucose
Bilirubin
Ketones
S.G.
Blood
pH
Protein
Nitrite
L.E.
Urobilinogen
Case 5
Glomerulonephritis
RBC casts reveals renal cortex involvement
RBC cast are not always present in GN
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64

64. Negative
Negative
Negative
1.010
Negative
5.0
+
0.2 mg/dL
Negative
Negative
22-year old man presenting for a routine
physical required for admission to medical
school
Physical characteristics: Yellow
Microscopic: Not performed
Questions:
- What is your differential diagnosis?
- Would you order a microscopic analysis on
this sample?
- What would you do next to confirm the
diagnosis?
Glucose
Bilirubin
Ketones
S.G.
Blood
pH
Protein
Nitrite
L.E.
Urobilinogen
Case 6
“Functional” proteinuria?
Microscopic may reveal a few leukocytes
Request protein concentration in 24 h urine
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65

65. Increased
Increased
Microscopic:
• Erythrocytes (dysmorphic)
• Erythrocyte casts
• Mixed cellular casts
Common Findings in:
Acute
Glomerulonephritis
Glucose
Bilirubin
Ketones
S.G.
Blood
pH
Protein
Nitrite
L.E.
Urobilinogen
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66

66. Conclusion
 The “watery fluid”
 Readily made most people is just fluid but a window through
which all the interior of the house (body) can be view
 Can be readily analyse to aid diagnosis of vast array of
conditions
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67

67. References
 Urinalysis. (n.d.). In Wikipedia. Retrieve July 25,
2018, from
https;//em.m.Wikipedia.org/wiki/urinalysis
 Geeky medicis, May 2, 2015, Urinalysis OSCE guide
(online video), retrieve from http://you
tu.be/uxBCLBb5cQpc
 Strong medicine, Sep; 27, 2015, Interpretation of
urinalysis, retrieve from
http://youtu.be/xUPoJPm4V4
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