The document provides an overview of urinalysis, including definitions, indications for testing, and methods for collecting urine samples. It covers macroscopic, chemical, and microscopic examinations, detailing the significance of various findings such as color, odor, and specific gravity. The importance of urine analysis in diagnosing kidney diseases, monitoring diabetes, and screening for other health issues is emphasized.

1. URINALYSIS
Practical View
Hassaan Ali Gad
Assistant lecturer of urology
Aswan University, Egypt
hassaan.ali@aswu.edu.eg
2020

2. TOPICS
 What is Urine
 Indication of UA
 Methods of collection of urine sample
 Types of urine sample
 Macroscopic examination of urine
 Chemical examination of urine
 Microscopic examination of urine

3. What is Urinalysis
• The ultrafiltration product of the plasma by the renal glomeruli.
urine is formed through a three phase process of filtration, reabsorption
,and secretion
– 180 L/day of blood filtered >80% reabsorbed
– 1-2 L/day urinary output composed of 96% water and 4% dissolved

4. Indication of urine analysis
• Diagnosis of disease of the kidneys or urinary
tract
• Diagnosis of other systemic disease that affect
kidney function
• Monitoring of patients with diabetes
• Screening for drug abuse
• General evaluation of health

5. Methods of collection of urine sample
• Clean midstream voided sample
• via urethral catheter
• Suprapubic aspiration

6. Methods of collection of urine sample

7. Types of urine sample
• Random sample
• Early morning sample
• Fasting urine sample
• Post prandial sample-D.M
• 12 hour or 24 hour timed

8. Urine examination
• Macroscopic examination
• Chemical examination
• Microscopic examination

9. Macroscopic examination of urine
• Odor
• Color
• Aspect

10. Odor:
 Normal
aromatic due to the volatile fatty acids
 Abnormal
Ammonia-like: (Urea-splitting bacteria)
Foul, offensive: Old specimen, pus
Sweet: Glucose
Fruity: Ketones

11. Color
Normal:
pale yellow (amber)
Abnormal
Colorless Diluted urine/DM/DI
Deep Yellow Concentrated Urine,
Yellow-Green Bilirubin / Biliverdin
Red Blood / Hemoglobin
Brownish-red Acidified Blood (Actute GN)
Milky-purulent UTI, chyluria

12. Appearance /Aspect
Normal
clear transparent
Abnormal
Cloudy to turbid due to
White and red cells
Bacteria and yeast
Crystals

13. Chemical examination dipstick
Urine PH
Protein
Glucose
Ketones
blood
Bilirubin
Urobilinogen
Nitrites
Specific Gravity

14. Chemical examination dipstick

15.  Glucose
Significance
– Diabetes mellitus.
– Renal glycosuria.
 Bilirubin
Significance
- Increased direct bilirubin (correlates with urobilinogen and
serum bilirubin)
 Ketones
Significance
Diabetic ketoacidosis
Prolonged fasting
Hyperemesis of pregnancy
Patients accompanied by vomiting o diarrhea

16.  Specific Gravity 1015 to 1035 (urine volume↑ and SG ↓
Significance
Increase: Dehydration、fever, Vomiting, Diarrhea,DM
Decrease: diabetes insipidus
 Blood
Significance
- Hematuria (nephritis, trauma, etc)
- Hemoglobinuria (hemolysis, etc)
- Myoglobinuria (rhabdomyolysis, etc)
 pH 4.5-8.0
Significance
- Acidic (less than 4.5): metabolic acidosis, high-protein diet
- Alkaline (greater than 8.0): renal tubular acidosis (>5.5)

17.  Urobilinogen trace
Significance
High: increased hepatic processing of bilirubin
Low: bile obstruction
 Nitrite
Significance
- Gram negative bacteriuria
 Leukocyte Esterase
Significance
- Pyuria
- Acute inflammation
- Renal calculus

18. Protein
less than 150mg /24 hrs
• Protinuria
Functional
- Severe muscular exertion
- Pregnancy -
- Orthostatic proteinuria
Pre-Renal
- Fever -
- Renal hypoxia -
- Hypertension -
Renal
- Glomerulonephritis
Nephrotic syndrome
Renal tumor or infection
Post-Renal
Cystitis
Urethritis or prostatitis
Contamination with vaginal

19. Microscopic Examination
Urine sediment
Examination of The solid part which left in the bottom of the test tube
after centrifugation (the urine sediment)
– Erythrocytes RBC
– Leukocytes Pus cells
– Crystals
– Cast
– Renal Tubular Cells
– Bacteria
– Ova
– Parasite
– Fungi

20.  Red blood cells
Significant
hematuria is >3 RBCs/HPF
– presence of a few is normal
– higher numbers are indicator of renal disease
– result of bleeding at any point in urinary system

21. White blood cells
Pyuria is >5 WBCs/HPF
pyuria only is not diagnostic for UTI bacteria
should be present.
sterile pyuria :TB and, stones, foreign bodies
and tumors
Further assessment of UT is needed

22. Bacterurea
More than 10 per HPF
 Finding of even few number of bacteria in a well
collected urine sample indicated UTI
 Bacterial culture is necessary to confirm diagnosis
 Bacterial culture is specially important in recurrent
and persistent infection.

23. Epithelial cells:
More than 2cells
Squamous epithelium suggests contamination
from males urethra or vulva in females
Transitional epithelium may be normal in
urine
Abnormal transitional cells epithelium suggest
a urothelial tumor

24. Fungi
Candidiasis Most likely a contaminant
but should correlate with
clinical picture.
Viruses
CMV inclusions Probable viral cystitis.
Ova and Parasites

25. Casts
• A cylindrical aggregations of particles that formed in
the distal nephron, and pass into the urine.

26. Casts
Cellular
 Erythrocyte Casts: Glomerular diseases
 Leukocyte Casts: Pyuria, glomerular disease
 Epithelial cell cast ATN
Acellular
 Granular casts (Tamm-Horsfall protein) CRD
 Hyaline casts (Tamm-Horsfall protein)
 Waxy casts ESRD
 Fatty casts Nephrotic syndrome
 Crystal casts oxalates, urates
• Tamm-Horsfall mucoprotein which is secreted by renal tubule cells.

27. Crystals
Acidic urine
Uric acid
Calcium oxalate
Cystine
Leucine
Alkaline urine
Ammonium magnesium phosphates (triple phosphate )
Calcium carbonate
Calcium phosphate

30. Urinary volume
• Normal = 1ml/kg/hrs (500-1500ml)
• Polyuria- >2000ml
• Oliguria- <400ml
• Anuria- complete cessation of urine(<200ml

32. Any Questions ?

33. Thank you