This document provides information about routine urinalysis, including normal ranges, potential causes of abnormal findings, types of urine samples, macroscopic and microscopic examination, and dipstick test results. It describes the appearance and potential causes of abnormal urine colors. It also lists normal ranges and clinical significance for various findings on dipstick testing for specific gravity, pH, protein, glucose, ketones, blood, leukocyte esterase, nitrite, bilirubin, and urobilinogen. Details are given about cellular and non-cellular components that may be seen microscopically in urine sediment and their clinical relevance.

1. HUSSEIN REIAD ALMAYTAH & FATIMA ALMARAKSHI
Routine department & body fluids
((report))
 samples : urine , stool , Seminal fluid
Other fluid like (Synovial fluid, CSF, peritoneal fluid, pleural fluid)
 instrument and equipment : light microscope , centrifuge , fume hood
incubator , hemocytometer , slides and cover slide , conical tube
micropipettes 20-200 µl ,dipstick ,wooden stick , disposable dropper .
SECTION OF URINALYSIS :
NOTE : NORMAL VALUE RANGES MAY VARY SLIGHTLY AMONG DIFFERENT
LABORATORIES
NORMAL URINE OUTPUT (MINIMUM):0.5-1 ML/KG/HR DAILY
OLIGURIA LESS THAN 500ML/24 HOURS
ANURIA LESS THAN 100ML/24 HOURS
LOW URINE OUTPUT : POTENTIAL CAUSES
PRERENAL -HEART FAILURE
-SHOCK
-VOLUME DEPLETION
- RENAL ARTERY COMPROMISE
RENAL -ACUTE TUBULAR NECROSIS
-END-STAGE RENAL DISEASE
-GLOMERULAR DISEASE
POST-RENAL -NEUROGENIC BLADDER
-OBSTRUCTION OF URETER, BLADDER NECK
URINE SAMPLE TYPE :
-RANDOM
-FIRST MORNING
-24HR COLLECTION
-MIDSTREAM(CLEAN CATCH )

2.  URINALYSIS, MACROSCOPIC
APPEARANCE STRAW OR YELLOW COLORED CLEAR
ABNORMAL
URINE COLORS
DARK YELLOW -CONCENTRATED URINE
-DRUGS ; HEPARIN
WARFARIN
CHLORZOXAZONE
DARK BROWN -BILE PIGMENT
-HIGH BILIRUBIN CONCENTRATION
-RHABDOMYLOSIS(MYOGLOBINURIA)
-FAVA BEANS
- SULFONAMIDES,QUININ,CASCARA DRUGS
GREEN -HARTNUP DISEASE
-INDICANURIA
-PSEUDOMONAS INFECTION
-ASPARAGUS
-CLORETS
ORANGE -HYPERCAROTENEMIA
-DIABETES MELLITUS
-HYPERLIPIDEMIA
-HYPOTHYROIDISM
-PROPHYRIA
-BEETS
-BLACKBERRIES
RED -BLOOD
-HEMOGLOBIN
-MYOGLOBIN
-PROPHYRINS
-RHUBARB, BLACKBERRIES ,BEETS FOODS
- TRAUMA
-PRIMARY AND SECONDARY RENAL DISEASE
-TB
-SCHISTOSOMIASIS
-PROSTATITIS
-CYSTITIS
-UTI
-COAGULOPATHY

3. PINK OR PURPLE INFECTION
-KLEBSIELLA PNEUMONIAE
-P.AERUGINOSA
-E.COLI
-ENTEROCOCCUS SPP.
BLACK -ALKAPTONURIA
-MALIGNANT MELANOMA
-METHEMOGLOBINURIA
-ACUTE INTERMITTENT PORPHYRIA
MILKY -PYURIA
DIPSTICK CHART (CHEMICAL EXAMINATION )

4. TEST REMARKS
SPECIFIC GRAVITY AN INDEX OF WEIGHT PER UNIT VOLUME REFLECT URINE CONC.
NORMAL 1.001-1.035
 INCREASE IN :
-DEHYDRATION
-GLYCOSURIA
-PROTENURIA
 DECREASE IN :
-COMPULSIVE WATER DRINKING
-DIABETES INSIPIDUIS
PH NORMAL URINE IS ACIDIC BUT IN RANGE 4.8-8.0
 HIGH PH ( ALKALINE ) IN :
- INFECTION WITH UREA-SPLITTING
ORGANISMS EX.(PROTEUS)
- SYSTEMATIC ALKALOSIS
- RENAL TUBULAR ACIDOSIS
 LOW PH (ACID URINE) IN :
 METABOLIC ACIDOSIS
PROTEIN GLOMERULAR DISEASE PRODUCES PROTEINURIA BY ALLOWING FILTRATION
OF LARGER MOLECULES THAN NORMAL
 SLIGHTLY INCREASED PROTEIN IN :
-PYELEONEPHRITIS
-BENIGN ORTHOSTATIC PROTENURIA
-IDIOPATHIC FOCAL GLOMERULONEPHRITIS
 MARKED PROTEINURIA IN :
-DIABETES MELLITUS
-SLE
-RENAL VEIN THROMBOSIS
-AMYLOIDOSIS
 DEGREE OF PROTEINURIA CAN BE QUANTIFIED BY A 24-HOUR
URINE COLLECTION
GLUCOSE GLUCOSE IS FILTERED IN THE GLOMERULUS THEN REABSORBED IN THE
PROXIMAL TUBULE.
 IF SERUM GLUCOSE IS >180MG/DL THE FILTERED LOAD WILL
EXCEED THE CAPACITY FOR TUBULAR REABSORPTION AND GLUCOSE

5. WILL APPEAR IN THE URINE
 GLUCOSURIA IN :
- D.M
- ACUTE TUBULAR DAMAGE
- FANCONI SYNDROME
KETONES KETONURIA INDICATES THAT CELLULAR METABOLISM IS DEPENDENT
UPON FATTY ACIDS RATHER THAN GLUCOSE FOR ENERGY
 KETONURIA IN :
-DIABETIC KETO-ACIDOSIS
-FASTING/STARVATION
-ALCOHOLIC KETOACIDOSIS
BLOOD  THE DIPSTICK TEST FOR HEME, WHICH IS FOUND IN BOTH
HEMOGLOBULIN AND MYOGLOBIN.
 A DIPSTICK POSITIVE FOR BLOOD SHOULD BE FOLLOWED UP WITH
A MICROSCOPIC ANALYSIS.
 HEMATURIA IN :
-INFECTION/INFLAMMATION OF BLADDER OR PROSTATE
-NEPHROLITHIASIS
-MALIGNANCY ( BLADDER , RENAL )
LEUKOCYTE
ESTERASE ( LE )
 INDICATE THE PRESENCE OF LEUKOCYTE WHICH HAVE LIBERATED
ESTERASE
 INFECTION OR INFLAMMATION WITHIN THE URINARY TRACT
NITRITE  INDICATE THE PRESENCE OF BACTERIA WHICH HAVE REDUCED
NITRATE  NITRITE
BILIRUBIN  BILIRUBINURIA IN :
- HEPATIC DISEASE
- OBSTRUCTIVE BILIARY DISEASE
UROBILINOGEN NORMAL IN URINE <1MG/DL
 INCREASED IN :
-HEMOLYTIC DISEASE
-HEPATIC DISEASE
BENCE-JONES
PROTEIN
NORMAL ( NOT FOUND)
IF PRESENT INDICATE OF MULTIPLE MYELOMA

6. MICROSCOPIC EXAMINATION
RED BLOOD
CELLS
LESS THAN 5/HPF
IFMORE, SUGGESTS INFECTION
OR INFLAMMATION OF BLADDER
OR PROSTATE
NEPHROLITHIASIS
WHITE BLOOD
CELLS
LESS THAN 5HPF
IF MORE, SUGGESTS INFECTION
OR UTI
*IN WOMEN THE UA MAY BE
CONTAMINATED BY VAGINAL
LEUKOCYTE
RENAL CELLS NONE SEEN
INCREASED NO. INDICATE
NECROSIS OF THE TUBULES
TRANSITIONAL
CELLS
NONE SEEN
SPINDLE OVAL SHAPE ,INCREASE
NO. INDICATE UTI
SQUAMOUS
CELLS
RARE. USUALLY NO CLINICAL
SIGNIFICANCE
LARGE , FLAT SHAPE
IN FEMALE SUGGEST
CONTAMINATION.

7. BACTERIA RODS OR COCCI , MOTLE IN
FRESH URINE .WITH WBC
INDICATES UTI .
YEAST OVAL ,SHOWING BUDDING
DUE TO : UTI BY YEAST OR
CONTAMINATION FROM
VAGINAL SECRETION .
HAYLINE CAST COLORLESS AND HOMOGENOUS
RBC CAST ORANGE RED TO BROWN
WBC CAST INDICATE INFLAMMATION
WITH RBC CAST INDICATE
GLOMERULONEPHRITIS

8. RENAL
TUBULAR CAST
LARGE SIZE , CELL ARRANGED IN
PARALLEL ROWS
GRANULAR
CAST
INCREASE IN URINE AFTER
STRENUOUS EXERCISE
WAXY CAST SMOOTH LOOKING WITH BLUNT
END AND SERRATED MARGINS
SHOW IN RENAL FAILURE
CRYSTALS IN ACID URINE :
URIC ACID ,CA++ OXALATE
AMORPHOUS URATES
IN ALKALINE URINE :
TRIPLE PHOSPHATE
CA++ PHOSPHATE
AMMONIUM BIURATE

9. PARASITE - T .VAGINALIS
-S. HAEMATOBIUM
- E .VERMICULARIS
PROCEDURE FOR EXAMINING THE URINARY SEDIMENT :
- CENTRIFUGE 10ML OF URINE IN A CONICAL TUBE FOR 5 MIN
- DECANT THE SUPERNATANT
- PLACE THE FORMED ELEMENT ON A SLIDE UNDER A COVER SLIP TO BE EXAMINED WITH HPF