Urinalysis provides important information about overall health and diseases affecting the kidneys, urinary tract, and other body systems. It can detect disorders like diabetes, kidney disease, urinary tract infections, and drug abuse. Abnormalities in urine color, odor, volume, pH, specific gravity, protein, glucose, bilirubin, blood, and casts can indicate various underlying health issues. A urinalysis is a generally safe and noninvasive test that provides clinicians with valuable clues for diagnosis, monitoring disease progression, and screening for certain conditions.

1. The significant of urinalysis:
Why urinalysis?
-General evaluation of health
-Diagnosis of disease or disorder of the kidney or
urinary tract
-Diagnosis of systemic disease that affect the
kidney function
-Monitoring of patient with diabetes
-
-Screening for inborn error of metabolism
-
-Screening for drug abuse(sulfonamide,
aminoglycoside)
-
- To diagnose pregnancy
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2. 2
Color abnormalities:
 colorless urine:
• High fluid intake
• Using of diuretic.
• Diabetes Mellitus.
• Diabetes Insipidus.
• Alcohol ingestion
Dark yellow:
• Low fluid intake.
• Excessive sweating
• Dehydration (burns, fever).
• Carrots or vitamin (A) orange urine
• Some drugs

3. 3
• Yellow – green
• Biliverdin (greenish) in abnormal cases like liver cirrhosis
• Which give a yellow foam & (- ve) test for bilirubin
o Brownish yellow:
– Hepatitis and obstructive jaundice, with excessive
bilirubin in urine
– Bilirubin on shaking yellow foam will appear.
– Urobilin on shaking the foam has no color.

4. 4
• Pink – Red:
• Due to the presence of fresh blood (hematuria) or
Hb (hemoglobinuria)
• Urinary tract infection, Calculi, Trauma
• Menstrual contamination.
• Cancer kidney or cancer bladder
• Dark brown:
• Malignant Melanoma:
• Nephritic syndrome ( color of urine)
o Black Urine: -
• Alkaptonurea (ochronosis), a disease of tyrosine metabolism.

5. 5
 Odor:
 In some pathological conditions, certain metabolites may
be produced to give a specific odor such as:
• Fruity odor is due to acetone.(Diabetic urine)
• Ammoniac odor urine standing long time
• Offensive odor Bacterial action of pus (UTI).
• Mousy odor Phenylalanine (phenylketonurea “PKU” ).

6. 6
Abnormal urine Volume
Oligouria: marked decrease in urine flow < 400 ml.
Polyuria: Marked increase in urine flow > 2500 ml.
Anuria: <100ml/day
Nocturia: excessive urination during night.
Causes of polyuria:
• Increased fluid in take (polydipsia ──>polyuria).
• Increased salt intake and protein diet, which need more
water to excrete.
• Diuretics intake (certain drugs, drinks , caffeine)
• Intravenous saline or glucose.

7. 7
• Diabetes Mellitus.
• Diabetes Insipidus.
• End stages of chronic renal failure
• Hypoaldasteronism.
• Hypercalcaemia
• Hyperthyroidism
• Pregnancy
• Removal of urinary obstruction

8. 8
Causes of Oliguria:
• Water deprivation
• Dehydration
• Prolonged vomiting.
• Diarrhea
• Excessive sweating
• Renal Ischemia
• Heart failure
• Hypotension
• Acute renal failure
• Obstruction by :Calculi,Tumor,Prostatic hypertrophy.
Causes of anuria:
• Sever Renal Defect and loss of urine formation mechanism.
• Due to the presence of stone or tumor.
• Post transfusion hemolytic reaction.

9. PH; Clinical Significance
1. Respiratory or metabolic acidosis/ketosis
2. Defects in renal tubular secretion and reabsorption of
acids and bases—renal tubular acidosis
3. Renal calculi formation
Clinical Significance of Urine Specific Gravity
1. Monitoring patient hydration and dehydration
2. Loss of tubular concentrating ability
3.Diabetes insipidus
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10. Protein:
Clinical proteinuria is indicated at ≥30 mg/dL (300 mg/L).
causes prerenal, renal, and Postrenal Proteinuria
Microalbuminuria:
•Is the presence of excess amounts of albumin in urine.
•It is very important in detection of early stage of
nephronpathy and in diagnosis of DM complication
(nephropathy).
Interpretation of 24 hour Urine Protein : Proteinuria
-Glomerular Causes
-Primary Glomerulonephropathy
Minimal Change Disease
-
-Secondary Glomerulonephropathy
Diabetes Mellitus (Diabetic Nephropathy)
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11. 11
-Drug-induced Glomerulonephropathy
Lithium Heavy metals
-
-Tubular Causes : (Decreased tubular reabsorption )
Orthostatic (Postural) Proteinuria
A persistent benign proteinuria occurs frequently in young
adults and is termed orthostatic, or postural, proteinuria. It
occurs following periods spent in a vertical posture and disappears
when a horizontal position is assumed. Increased pressure
on the renal vein when in the vertical position is believed
Postrenal Proteinuria
Protein can be added to a urine specimen as it passes through
the structures of the lower urinary tract (ureters, bladder,
urethra, prostate, and vagina). Bacterial and fungal infections
and inflammations produce exudates containing protein from
the interstitial fluid.
- Overflow Causes : Hemoglobinuria,Myoglobinuria ,
Multiple Myeloma

12. Urine Glucose:
Hyperglycemia-Associated:
Diabetes mellitus,Pancreatitis,Acromegaly,Cushing syndrome,
Hyperthyroidism
Pheochromocytoma,
Gestational diabetes
Renal-Associated
Fanconi syndrome,
Advanced renal disease,
Osteomalacia,
Pregnancy
-
Ketone Bodies: normally are absent from the urine if
present in the urine can be caused by:
-DM
- Starvation
– Prolong vomiting
,
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13. Bilirubin :
may indicate bile duct obstruction or liver
disease
Clinical Significance of Urine Urobilinogen
1. Early detection of liver disease
2. Hemolytic disorders
3. Liver disorders:
hepatitis
cirrhosis
carcinoma
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14. Clinical Significance of a Positive Reaction for Blood
Excess RBCs in urine
:
Hematuria
1. Renal calculi 2. Glomerulonephritis 3. Pyelonephritis
4.Tumors 5.Trauma 6. Exposure to toxic chemicals
7. Anticoagulants 8. Strenuous exercise
Hemoglobinuria 1.Transfusion reactions 2. Hemolytic
anemias
3. Severe burns 4. Infections/malaria 5. Strenuous exercise/red
blood cell trauma 6. Brown recluse spider bites
Myoglobinuria
1. Muscular trauma/crush syndromes 2. Prolonged coma 3.
Convulsions
4. Muscle-wasting diseases 5. Alcoholism/overdose 6. Drug
abuse
7. Extensive exertion 8. Cholesterol-lowering statin
medications
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15. -
White Blood Cells:
-
Pyuria abnormal numbers of leukocytes that appear
with infection in UT, acute glomerulonephritis,
Inflammation of the urinary tract
-
Epithelial Cells:
-
Transitional epithelial cells from the renal pelvis, ureter,
or bladder have more regular cell borders, Squamous
epithelial cells from the skin surface from the outer
urethra can appear in urine .
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16. Mucus
produced by the glands and epithelial cells of lower
genitourinary tract cells. Tamm-Horsfall protein is a major
constituent of mucus
Clinical significance of cast:
The major constituent of casts is Tamm-Horsfall protein
Hyaline cast: Glomerulonephritis,Pyelonephritis,Chronic renal
disease,Congestive heart failure,Stress and exercise
RBC: Strenuous exercise, Glomerulonephritis
WBC: Pyelonephritis,Acute interstitial nephritis
Waxy : Stasis of urine flow,Chronic renal failure
Granular :Glomerulonephritis,Pyelonephritis,Stress and
exercise
Epethelial: Renal tubular damage
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