Urinalysis is a test to determine urine content and can detect diseases, especially kidney-related issues, and drug abuse. Kidney function is assessed through various methods including analysis of urine characteristics, chemical composition, and microscopic examination, with abnormalities indicating potential health problems. Key indicators include the presence of red blood cells, white blood cells, proteins, and specific gravity, alongside tests for substances like glucose and ketones.

1. Urine analysis

2. What is a Urinalysis?
• A test that determines the content of the
urine.
– Because urine removes toxins and excess liquids from the body, its
contents can provide vital health information.
– Urinalysis can be used to detect some types of disease, particularly
in the case of kidney disease.
– Urinalysis can also be used to uncover evidence of drug abuse.

3. Kidney Function
• The role of the kidneys is to maintain
homeostasis by controlling the chemical
composition of the blood. The kidneys do
this by:
– Removing waste products from the blood
– Leaving nutrients such as proteins and glucose in the
blood
– Regulating water and electrolyte balance

4. Proper Kidney Function
• Therefore, if the kidneys are functioning properly
and person is in good over-all health, urine will
be normal.
• If urine shows abnormalities, this can indicate
problem with kidneys. The following conditions
can cause kidney problems:
– Heart failure
– Injury to glomerulus or tubules from drugs, heavy
metals, and viral infections.
– Diabetes, hypertension, and kidney stones

6. Collection of urine specimens
• Improper collection---- may invalidate the results
• Containers for collection of urine should be wide mouthed, clean and dry.
• Analysed within 2 hours of collection else requires refrigeration.

7. Urinalysis Basics
• Urinalysis is carried out by following steps:
– Physical Examination
– Chemical Analysis
– Microscopic Examination

10. Physical analysis
Is the direct visual observation of the urine, noting
its volume, color, clarity or cloudiness, etc
Normal urine is typically pale yellow and clear .
Obvious abnormalities in the color, clarity, and
cloudiness may suggest different diseases.

11. Normal Urine Abnormal Urine

16. Dipstick chemical analysis
• Urine dipstick is a narrow plastic strip which
has several squares of different colors
attached to it.
• Each small square represents a component
of the test used to interpret urinalysis.
• Colors generated by each pad are visually
compared against a range of colors on
brand-specific color charts
• The entire strip is dipped in the urine sample
and color changes in each square are noted.

17. The squares on the dipstick represent the
following components in the urine
Nitrite (suggestive of bacteria in urine)
Bilirubin ( possible liver disease or red blood cell break down)
Urobilinogen ( possible liver disease)

19. Parts of Chemical Analysis
• pH
– Test measures if urine is acidic, basic or neutral
– Normal urine ranges from 4.6 to 8.0
• Specific Gravity:
– Test measures the concentration of particles in the urine and evaluates
the body’s water balance.
– The more concentrated the urine, the higher the urine specific gravity.
– The most common increase in urine specific gravity is the result of
dehydration.
– Normal urine ranges between 1.002 to 1.028

20. Parts of Chemical Analysis
• Ketones:
– Test measures the presence or absence of ketones or excessive
fat breakdown, in the urine.
– Normal urine does not contain ketones
• Protein:
– Normal urine levels of proteins (called albumin) are very small

22. Parts of Chemical Analysis
• Glucose:
– The test measures the amount of sugar in a
urine sample.
– Normal urine does not contain glucose.

23. Microscopic Examination
• A variety of normal and abnormal cellular
elements may be seen in urine when
looked at under a microscope, including:
– Red blood cells
– White blood cells
– Epithelial cells
– Crystals
– Bacteria

24. Microscopic Examination
• Red blood cells are not found in normal urine.
• White blood cells and bacteria, signs of infections, are not found in
normal urine.
• Epithelial cells are found in urine as they are the cells that line the
urinary tract.
• Common crystals seen even in healthy patients include calcium
oxalate, triple phosphate crystals and amorphous phosphates.
– A large number of crystals, or certain types of crystals, may mean
kidney stones are present or there is a problem with how the body
is using food.

25. MICROSCOPIC URINALYSIS
Microscopic examination used to view elements that are not visible
without microscope. e.g cells
Red Blood Cells:
Hematuria is the presence of abnormal numbers of
red cells in urine due to:
a. Glomerular damage
b. Tumors
c. Urinary tract stones
d. Upper and lower urinary tract infections

26. 1.Hematuria
Two Types of Hematuria
• Gross hematuria means that the blood can be
seen by the naked eye. The urine may look
pinkish, brownish, or bright red.
• Microscopic hematuria means that the urine is
clear, but blood cells can be seen under a
microscope.

28. RBC's may appear normally shaped, swollen by
diluted urine.

29. 2.White Blood Cells
Pyuria refers to the presence of abnormal
numbers of leukocytes that may appear
with infection in either the upper or lower
urinary tract or with acute
glomerulonephritis.
Usually, the WBC's are granulocytes
WBCs - ≤2-5 WBCs/hpf

31. 3. Epithelial Cells
• Renal tubular epithelial cells, contain a
large round or oval nucleus and normally
slough into the urine in small numbers.
However, with nephrotic syndrome the
number sloughed is increased.

33. 4. Casts
• Urinary casts are cylindrical structures produced by the
kidney and present in the urine in certain disease states.
• They are formed in the distal convoluted tubule (DCT)
and collecting ducts of nephrons, then dislodge and pass
into the urine, where they can detected by microscopy.
-Urinary casts may be made up of cells (such as white
blood cells, red blood cells, kidney cells) or substances
such as protein.

35. Red blood cells may stick together and form
red blood cell casts. Such casts are indicative
of glomerulonephritis, with leakage of RBC's
from glomeruli
White blood cell casts may also be present
with glomerulonephritis. Their presence
indicates inflammation of the kidney,
because such casts will not form except in
the kidney.

37. Crenated RBC
RBCs

38. WBCs

39. Hyaline Casts appear Transparent

40. 40
Red Cell Casts

41. 41
White Cell Casts

42. Bence Jones proteins are small proteins found in the
urine. Testing for these proteins is done to diagnose and
monitor multiple myeloma and other similar diseases.
Bence Jones proteins are considered the first tumor
marker.
A tumor marker is a substance, made by the body, that
is linked to a certain cancer, or malignancy. Bence
Jones proteins are made by plasma cells, a type of white
blood cell. The presence of these proteins in a person's
urine is associated with a malignancy of plasma cells.
Bence Jones proteins