This document provides an overview of urine analysis including physical, chemical, and microscopic examination. Physical examination assesses volume, color, odor, pH, and specific gravity. Chemical examination tests for proteins, sugars, ketone bodies, bilirubin, and blood. Microscopic examination identifies epithelial cells, red blood cells, crystals, and casts which can indicate various conditions. Urine dipsticks provide a convenient qualitative analysis of various urine components. A comprehensive urine analysis evaluates kidney and bladder function and detects underlying diseases.
Urine is the body's liquid waste composed of water, salt urea and uric acid. Urine can be evaluated by its physical appearance (color, cloudiness, odor, clarity), also referred to as a macroscopic analysis. It can be also analyzed based on its chemical and molecular properties, including microscopic assessment.
It gives basic things regarding urinalysis and will be very useful for medical students, house surgeons, laboratory technicians and postgraduates in medicine.
Urine is the body's liquid waste composed of water, salt urea and uric acid. Urine can be evaluated by its physical appearance (color, cloudiness, odor, clarity), also referred to as a macroscopic analysis. It can be also analyzed based on its chemical and molecular properties, including microscopic assessment.
It gives basic things regarding urinalysis and will be very useful for medical students, house surgeons, laboratory technicians and postgraduates in medicine.
WHAT IS URINE ANALYSIS?
Urine analysis, also called Urinalysis – one of the oldest laboratory procedures in the practice of medicine.
Also knows as Urine- R&M (routine & microscopy)
Is an array of tests performed on urine
WHY URINALYSIS?
General evaluation of health
Diagnosis of disease or disorders of the kidneys or urinary tract
Diagnosis of other systemic disease that affect kidney function
Monitoring of patients with diabetes
Screening for drug abuse (eg. Sulfonamide or aminoglycosides)
COLLECTION OF URINE SPECIMENS
Improper collection---- may invalidate the results
Containers for collection of urine should be wide mouthed, clean and dry.
Analyzed within 2 hours of collection else requires refrigeration.
URINE CULTURE
Culture within 1 hour after collection or stored in a refrigerator at 4oC for no more than 18 hours.
Culture is performed when Polynephritis or Cystitis is suspected.
UTI is most frequent caused by E.Coli.
Other common agents are Enterobacter, Proteus, and Enterococcus faecalis.
URINALYSIS; WHAT TO LOOK FOR?
• Urinalysis consists of the following measurements:
Macroscopic or physical examination
Chemical examination
Microscopic examination of the sediment
Urine culture
PHYSICAL EXAMINATION OF URINE
Examination of physical characteristics:
Volume
Color
Odor
pH
Specific gravity
The refractometer or a reagent strip is used to measure specific gravity
PHYSICAL EXAMINATION
Normal- 1-2.5 L/day
Oliguria- Urine Output < 400ml/day
Dehydration
Shock
Acute glomerulonephritis
Renal Failure
Polyuria- Urine Output > 2.5 L/day
Increased water ingestion
Diabetes mellitus and insipidus.
Anuria- Urine output < 100ml/day
Seen in renal shut down Volume
PHYSICAL EXAMINATION
Normal
pale yellow in color due to pigments urochrome (different colour pigments in urine), urobilin (When urobilinogen- degraded product of bilirubin, is exposed to air, it is oxidized to urobilin, giving urine its yellow color) and uroerythrin (red pigment in urine).
Cloudiness
may be caused by excessive cellular material or protein, crystallization or precipitation of non pathological salts upon standing at room temperature or in the refrigerator.
Color
Colour of urine depending upon it’s constituents.
PHYSICAL EXAMINATION
Abnormal Colors:
Colorless – diabetes, diuretics.
Deep Yellow – concentrated urine, excess bile pigments, jaundice Color
Blue-Green – Methylene Blue, Pseudomonas (Bactrium), Riboflavin (Vitamin B2, in FAD give Yellow Orange Color)
Pink-Orange-Red – Hemoglobin, Myoglobin, Phenolphthalein, Porphyrins, Rifampicin (antibiotic against TB give orange color to urine)
Red-Brown-Black - Hemoglobin, Myoglobin, Red Blood Cells, Homogentisic acid (Homogentisic acid present in Blood and its oxidized form alkapton are excreted in the urine, giving it an unusually dark color), L-DOPA (Levodopa, is the most effective drug for Parkinson’s disease), Melanin (brown Pigment)
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7. Urinary volume
• Normal = 700-2500ml passed in 24 hrs
• Polyuria >2500ml passed in 24 hrs
• Oliguria <500ml passed in 24 hrs
• Anuria complete suppression of urine
production (<150ml in 24 hrs)
• Nocturia excretion of >500ml of urine at
night (a sign of early renal failure)
9. 1. Colourless - diabetes mellitus, diabetes insipidus, diuretics,
excessive intake of water.
2. Milky – pus, chyluria(fat)
3. Orange – urobilinogen, conc. Urine, ATT
4. Deep amber colour – high grade fever, muscular exercise
5. Smoky – Vit B12 therapy, aniline dye
6. Red – hematuria, haemoglobinuria
7. Brown – Bile
8. Green – phenol poisoning, putrified sample.
10. Urinary pH/ reaction
• Reaction reflects ability of kidney to maintain normal
hydrogen ion concentration in plasma & ECF
• Normal= 4.6-7
• Tested by- 1.litmus paper
2. pH paper strips
3. dipsticks
4. Electronic pH meter
11. Acidic urine
• High protein intake (meat)
• Ingestion of acidic fruits
• Respiratory and metabolic acidosis
• UTI by E.coli
13. Odour
• Normal – faintly aromatic due to the volatile fatty
acids
1.Pungent – ammonia produced by bacterial
contamination
2.Putrid – UTI
3.Fruity – ketoacidosis
14. Specific gravity
• Ratio of weight of 1ml of urine to 1ml of distilled water.
• Depends on the concentration of various solutes in the urine.
• Purpose – to measure the concentrating and diluting power of
kidneys.
• Measured by-urinometer
- refractometer
- dipsticks
15. Urinometer
• Take 3/4th of urinometer container with urine
• Allow the urinometer to float in the urine without
touching the walls or bottom of the container.
• Read the graduation at the lowest level of urinary
meniscus
• Urinometer is calibrated at 15 or 200
c
• Correction of temperature is necessary
So for every 3o
c increase/decrease add/subtract 0.001
Normal-1.016-1.022
18. Low specific gravity
(hypo-osthenuria)
• Diabetes insipidus
• Excess water intake
• Fixed specific gravity
(iso-osthenuria)=1.010
Seen in chronic renal disease when kidney has lost the ability to
concentrate or dilute
21. Tests for proteins
• Test – HEAT & ACETIC ACID TEST
• Principle-proteins are denatured & coagulated on
heating giving a white cloudy precipitate.
• Method-take 2/3 of test tube with urine, heat only
the upper part keeping lower part as control.
• Presence of phosphates, carbonates, proteins gives a
white cloud formation. Add acetic acid 1-2 drops, if
the cloud persists it indicates it is protein(acetic acid
dissolves the carbonates/phosphates)
22. • Method-
take 2/3 of test tube with urine,
heat only the upper part keeping lower part as control.
when precipitate of turbidiy occurs, add few drops of
10% acetic acid
(acetic acid dissolves the carbonates/phosphates)
23.
24. • Grading:
Negative – no cloudiness
Traces – cloudiness against dark background
+ - cloudiness without granularity
++ - cloudiness with granularity
+++ - precipitation and flocculation
++++ - thick solid precipitation
25. Other tests
• Sulphosalicylic acid test
• Heller’s test
• Reagent strip method
• Esbach’s albuminometer- for quantitative estimation
of proteins
• Turbidimetric method
28. microalbuminuria
• The level of albumin protein produced by
microalbuminuria cannot be detected by urine
dipstick methods. In a properly functioning body,
albumin is not normally present in urine because it is
retained in the bloodstream by the kidneys.
Microalbuminuria is diagnosed from a 24-hour urine
collection
32. Test for sugar
• Test- BENEDICT’S TEST(semiquantitative)
• Principle
Benedict’s reagent contains CuSO4.
In the presence of reducing sugars cupric ions are converted
to cuprous oxide which is hastened by heating, to give the
color.
REDUCING SUBSTANCES PRESENT IN URINE: glucose,
fructose, maltose, lactose (not sucrose)
33. • Method-
take 5ml of benedict’s reagent in a test tube
add 8 drops of urine.
Boil the mixture.
No change in blue colour = negative
Greenish= Traces (<0.5gm%)
Green/Cloudy green=+(1gm%)
Yellow=++(1-1.5gm%)
Orange=+++(1.5-2gm%)
Brick red=++++(>2gm%)
34. Benedict’s test
• Detects all reducing substances like glucose, fructose,
& other reducing sustances.
• To confirm it is glucose, dipsticks can be used
(glucose oxidase)
35.
36. Causes of glycosuria
• Diabetes mellitus
• Renal glucosuria
• Sever burns
• Administration of corticosteroids
• Severe sepsis
• Pregnancy
37. Ketone bodies
• 3 types
Acetone
Acetoacetic acid
β-hydroxy butyric acid
They are products of fat metabolism
39. • Method-
take 5ml of urine in a test tube & saturate it with ammonium
sulphate.
Then add few crystals of sodium nitroprusside and shake.
Then gently add 0.5ml of liquor ammonia along the sides of the
test tube.
• Appearance of purple coloured ring at the junction indicates +
test
42. Other tests for ketone bodies
• Gerhardt’s test
• Reagent strip test
43. Bilirubin
• Test- fouchet’s test.
• Principle:
ferric chloride oxidises bilirubin to green biliverdin
Procedure:
• 10ml of urine in test tube
• 3-5 ml of 10% barium chloride is added
• Filter through filter paper
• to the precipitate, add few drops of fouchet’s reagent
(ferric chloride + trichloroacetic acid)
Green colour indicates bilirubin
46. BILE SALTS
Hay’s test
Principle: bile salts lowers the surface tension
Fill 2/3rd
of beaker with urine
Sprinkle finely powdered Sulphur powder over it
Sinks - presence of bile salts
47.
48. Blood in urine
• Test- BENZIDINE TEST
• Principle-The peroxidase activity of
hemoglobin decomposes hydrogen peroxide
releasing nascent oxygen which in turn
oxidizes benzidine to give blue color.
49.
50. Blood in urine
• Method-
mix 2ml of benzidine solution with 2ml of
hydrogen peroxide in a test tube.
Take 2ml of urine & add 2ml of above
mixture.
A blue color indicates + reaction.
53. Microscopic examination
• Microscopic urinalysis is done by pouring the urine
sample into a test tube and centrifuging it for a few
minutes.
• The top liquid part (the supernatant) is discarded.
• The solid part left in the bottom of the test tube (the
urine sediment) is mixed with the remaining drop of
urine in the test tube
• one drop of this is analyzed under a microscope
54. Contents of normal urine m/s
• Contains few epithelial cells, occasional RBC’s, few
crystals.
56. casts
• Urinary casts are cylindrical aggregations of
particles that form in the distal nephron
57. Red cell casts
• The presence of red blood cells within the cast is
always pathologic, and is strongly indicative of
glomerular damage.
• They are usually associated with nephritic syndromes.
62. Urine dipsticks
• 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.
• The entire strip is dipped in the urine sample and
color changes in each square are noted.
• The color change takes place after several seconds
to a few minutes from dipping the strip.
• If read too early or too long after the strip is
dipped, the results may not be accurate.
63. Urine dipsticks
• The color change takes place after several seconds
to a few minutes from dipping the strip.
• If read too early or too long after the strip is
dipped, the results may not be accurate.
65. • The main advantage of dipsticks is that they are
1. convenient,
2. easy to interpret,
3. and cost-effective
66. The main disadvantage is that the
1. Information may not be very accurate as the test is
time-sensitive.
2. It also provides limited information about the urine
as it is qualitative test and not a quantitative test
