This document discusses the physical examination of urine, including collection, preservation, and analysis methods. It describes examining the urine's volume, color, odor, appearance, pH, and specific gravity. Specific gravity is measured using a urinometer, refractometer, or dipstick. Abnormal readings may indicate conditions like diabetes, kidney disease, or urinary tract infections. The document provides details on testing urine and interpreting the results of the physical examination.

1. PHYSICAL EXAMINATION OF
URINE
SUNIL KUMAR.P
DEPARTMENT OF CLINICAL PATHOLOGY
ST.JOHN’S MEDICAL COLLEGE
BANGALORE
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2. urine analysis
• Physical examination
• Chemical examination
• Microscopy examination
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3. Collection of urine
• Done in clean container
• Should be examined freshly
• Best sample early morning
• Culture-sterile containers are used
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4. Types of sample
• Random sample-ordinary qualitative test
• Early morning sample –nephritis
• 2hr post prandial sample-DM
• Mid stream urine collection-culture
• 24hrurine sample-quantitative analysis
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5. Collection method
• 24hr urine –void & discard urine at particular
time. Collect all urine for next 24hr.
• Mid stream urine-initial portion of urine
should be discard. only the mid stream urine
should be collected.
• Catheterized specimen-insertion of tube or
catheter through the ureter into the bladder
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6. Preservation of urinePreservative Concentration limitation
toluene 2ml/100ml Floats on the surface of the
urine. good for constituent
formalin 3drops /100ml
urine
Good for sediment.
Precipitate protein.
thymol 1crystal/100ml Interfere with acid
precipitation test for protein
chloroform 5ml/100ml Forms upper layer. changes
cellular sediment
charactrestics.
Boric acid 0.3gm/120ml of
urine
Yeast can still grow .uric acid
crystal get precipitated.
Conc.HCL 10ml/24hr urine Best preservative for all
chemical examination,
especially for ca,uric acid
,crea,urea.
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7. Physical examination of urine
• volume
• Colour
• Odour
• Apperance
• pH
• Specific gravity
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8. volume
●VOLUME-24hr
neonates-30-60ml
children -600-700ml
adult -600-2500ml
• Oliguria-urinary excretion less than 500ml
• Polyuria-urinary excreation greater than 2500ml.
• Anuria-complete cessation of urine.
• Disuria- painful in voiding time.
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9. polyuria
-DM/Insipidus
-diuretics
-intravenous saline /glucose
-chronic renal failure
-addison’s disease, decrease of
adreno cortical hormone.
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10. Oliguria
-dehydration
vomiting
diarrhea
exessive sweating
-renal ischemia
-acute renal tubular necrosis
-acute glomerulonephritis
-obstruction to urinary outflow
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11. • Anuria -complete suppression of urine
formation .
-renal collapse
-severe case of acute nephritis
-burns
-transfusion reaction
-traumatic shock
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12. colour
• Normal –straw colour
• Colourless- dilution DM
• Milky-chyluria due to filariasis ,ABD Lymphodenopathy
• Yellow to Brown -jaundice
• Brownish yellow or green-bile pigment
• Orange red or orange brown-urobilinogen
• Bright red-fresh blood
• Brownish black-poisoning
• Black-alkaptnuria
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13. odor
• Fresh urine-aromatic odour
• Urine allow to stand-strong ammonic smell
because of decomposition of urea with
liberation of ammonia.
• Ketone bodies-fruity odor
• Infants with phenylketouria-musty odour
• Putrid odor-UTI
• Fecal odor –E.coli cystitis
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14. Appearance
• Normal-clear
• Cloudy due to
-amorphous phosphate(neutral or alkaline
condition)
-amorphous urates(acidic urine)
• Which disappear on heating.
• In disease – urine cloudy due to
-presents of WBC
-presents of bacteria or fungi
-colloidal suspension of fat or chyle
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15. pH
• Average - 4.6-8.0
• Average pH -6.0-presents of sulphates,
phoshate,chloride.
• Alkaline urine-vegetarian &urine on standing
• Measurements of pH-
1.litmus paper
2.pH paper or nitrazine paper
3.Dip stick method
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16. Dip stick method
• Reagent
 0.2% w/w methyl red
 2.8%w/w bromo thymol blue
 97.0%w/w non reactive ingradiant
• Principle:-
- Based on double indicator principle.
-gives broad range of colors covering entire urinary PH.
-color change from
orange-yellow-green-blue
(Acidic) (alkaline)
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17. Acidic urine
High protein intake and ingestion of acidic
fruits.
Respiratory acidosis
Metabolic acidosis-uremia, diabetes mellitus,
starvation .
E.coli infection
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18. Alkaline urine
• Respiratory alkalosis
• Metabolic alkalosis(excessive vomiting)
• UTI due to proteus and pseudomonas
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19. SPECIFIC GRAVITY
• Normal specific gravity-1.015-1.025
• Urines of low specific gravity are called
hyposthenuric (<1.007) while urines of fixed
sp.gravity of about 1.010 are known as
isothenuric.
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20. Specific gravity measurement
• Urinometer
• Refractometer
• Dip stick method
• Osmometer
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21. urinometer
• This is a bulb shaped instrument that has a
cylindrical stem ,which contains a scale
calibrated in sp.gravity reading. This instrument
is floated in a cylinder containing urine.
• The depth to which it sinks in the urine indicates
the sp.gravi
of urine
• Stem reading-1.000 to
1.060.
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22. Urinometer method
• Principle:-The method of measuring
sp.gravity of urine is based on the principle of
buoyancy. An increased solute concentration or
increased sp.gravity increases the upthrust of
the solution correspondingly.
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23. procedure
• Mix the urine & pour into the cylinder of 25ml capacity.
• Carefully float the urinometer by grasping the stem of
urinometer at the top and inserting slowly into the urine.
• Swirl the urinometer slightly as it is inserted.make sure the
instrument floats freely away from the sides of container.
• Take the reading from the graduation gives on the stem at
lower meniscus formed at eye level.
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25. Correction for temperature
• To correct the sp.gravity reading for
temp, place the thermometer in the urine &
note the exact temp.
• Then add 0.001 to the reading for each 3ºC
above the temperature for which the
urinometer is caliberated.
• Subtract 0.001 from the reading for each 3ºC
which the urine is below the temp of
caliberation.
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26. • Eg:-
Temp of urine is 32ºC
caliberation temp is20ºC
sp.gravity of the urine is measure at 1 .011
corrected sp.gravity =
[(32-20)×0.001] +1.011=1.015
3
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27. Correction for abnormal solute
concentration
• Albumin :- for each gram of albumin/100ml,
sp.gravity rises by 0.003 and this is subtracted
.
• Glucose :- for each gram of glucose /100ml,
sp.gravity raises by 0.004 and this must be
subtracted.
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28. Correction for dilution
• If the volume of urine is insufficient for
measuring sp.gravity, urine can be diluted
with distilled water.
• Multiply the last two numbers of the
recorded sp.gravity by the dilution factor.
• Eg:- urine dilution is1:5 , record
sp.gravity is 1.003
corrected sp.gravity is 1.003×5=1.015
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29. Disadvantages of urinometer
• Large amount of urine is required.
• Turbid urine may make reading of the scale
difficult.
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30. refractometer
• To determine the sp.gravity of urine by this
method require only few drops of urine.
• PRINCIPLE:-
 The refractive index of a solution is related to
the content of dissolved solids present in
solution.
 µ=Va/Vs
This ratio varies directly with
the number of dissolved parti-
cles in the solution .
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31. Conti……….
Although the instrument measures the
refractive index of a solution , scale reading is
generally calibrated in terms of sp.gravity.
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32. Dipstick method
• Reagent
2.8% w/w bromothymol blue
28.4% w/w NaOH
• Principle
PH change of pretreated polyelectrolyte in
relation to ionic strength, the released hydrogen
ion is indicated by PH indicator.
• Colour changes from a dark blue at a low
sp.gravity to yellow green at high sp.gravity
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33. • High sp.gravity
excessive sweating
glycosuria
acute nephritis
albuminuria
all causes of oliguria
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34. • Low specific gravity(less than 1.010)
-excessive water intake
-chronic nephritis
-dibetic incipidus
-all causes of polyuria except DM
• Low or fixed sp.gravity(1.010-1.012)
-chronic nephritis
-ADH deficiency
-arteroscerotic kidney
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35. Thank you
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