radiology urin analysis

1. • Urine is another fluid commonly used for testing in clinical chemistry
laboratories. It is especially suitable for tests that evaluate kidney
functions, tests that look at waste products that are excreted by the
kidneys, and for metabolites that are cleared quickly from the
bloodstream and accumulate in the urine, such as drugs of abuse.
• Different types of urine samples, representing collection at different
times of day and for different durations of time, are used for
laboratory analyses.
urine

2. Urine

3. urinalysis
A urinalysis is a laboratory test. It can help your doctor detect problems
that may be shown by your urine.
• Why Get Tested?
To screen for, help diagnose and/or monitor several diseases and
conditions, such as kidney disorders or urinary tract infections (UTIs).
When is it ordered?
When you have symptoms, such as abdominal pain, back pain,
frequent or painful urination; blood in urine , sometimes as part of a
health examination, pregnancy check-up, hospital admission, or pre-
surgical work-up.

4. What is being tested?
A complete urinalysis consists of three distinct testing phases:
• Visual examination, which evaluates the urine’s color and clarity
• Chemical examination, which tests chemically for about 9 substances
that provide valuable information about health and disease and
determines the concentration of the urine
• Microscopic examination, which identifies and counts the type of
cells, casts, crystals, and other components such as bacteria and
mucus that can be present in urine

5. How is the sample collected for testing?
• One to two ounces of urine is collected in a clean container. A sufficient
sample is required for accurate results.
• Urine for a urinalysis can be collected at any time. In some cases, a first
morning sample may be requested because it is more concentrated and
more likely to detect abnormalities.
• Sometimes, you may be asked to collect a “clean-catch” urine sample. For
this, it is important to clean the genital area before collecting the urine.
Bacteria and cells from the surrounding skin can contaminate the sample
and interfere with the interpretation of test results.
• A urine sample will only be useful for a urinalysis if taken to the healthcare
provider’s office or laboratory for processing within a short period of time.

6. Visual Exam
• During the visual examination of the urine, the laboratorian observes the
urine’s color and clarity. These can be signs of what substances may be
present in the urine.
• Urine color
Urine can be a variety of colors, most often shades of yellow, from very pale
or colorless to very dark or amber. Unusual or abnormal urine colors can be
the result of a disease process, several medications, or the result of eating
certain foods.
• Urine clarity
Urine clarity refers to how clear the urine is. “Normal” urine can be clear or
cloudy.

7. Chemical Exam
• To perform the chemical examination, most clinical laboratories use
commercially prepared test strips with test pads that have chemicals
impregnated into them. The laboratorian dips the strip into urine,
chemical reactions change the colors of the pads within seconds to
minutes, and the laboratorian determines the result for each test. To
reduce timing errors and eliminate variations in color interpretation,
automated instruments are frequently used to “read” the results of
the test strip.

10. A dipstick test checks for
Specific gravity
• Urine specific gravity is a measure of urine concentration. This test
show how concentrated particles are your in urine. If there were no
substances present, the specific gravity of the urine would be 1.000
(the same as pure water). Since all urine has some substances in it, a
urine SG of 1.000 is not possible. If a person drinks excessive
quantities of water in a short period of time or gets an intravenous
(IV) infusion of large volumes of fluid, then the urine specific gravity
may be very close to that of water. The upper limit of the test pad, a
specific gravity of 1.035, indicates concentrated urine, one with many
substances in a limited amount of water.

11. A dipstick test checks for
Acidity (pH)- The pH level indicates the amount of acid in urine. Abnormal pH levels may indicate a
kidney or urinary tract disorder.
The urine is usually slightly acidic, about pH 6, but can range from 4.5- 8. The kidneys play an
important role in maintaining the acid-base balance of the body.
Protein
• The protein test pad provides a rough estimate of the amount of albumin in the urine.
Normally, there will be no protein or a small amount of protein in the urine. When urine protein is
elevated, a person has a condition called proteinuria. ( Larger amounts may indicate
a kidney problem)
Proteinuria may occasionally be seen in healthy individuals. Healthy people can have temporary or
persistent proteinuria due to stress, exercise, fever, aspirin therapy, or exposure to cold. Repeat
testing may be done once these conditions have resolved to determine whether the proteinuria is
persistent.

12. A dipstick test checks for
Glucose
Normally the amount of sugar (glucose) in urine is too low to be
detected. When glucose is present, the condition is called glucosuria.
Some other conditions that can cause glucosuria include hormonal disorders, liver disease,
medications, and pregnancy.
Bilirubin
• This test screens for bilirubin in the urine. Bilirubin is not present in the urine of normal,
healthy individuals. It is a waste product that is produced by the liver from the
hemoglobin of RBCs that are broken down and removed from circulation. It becomes a
component of bile, a fluid that is released into the intestines to aid in food digestion.
• In certain liver diseases, such as biliary obstruction or hepatitis, excess bilirubin can build
up in the blood and is eliminated in urine. The presence of bilirubin in urine is an early
indicator of liver disease and can occur before clinical symptoms such
as jaundice develop.

13. A dipstick test checks for
Ketones
As with sugar, any amount of ketones detected in your urine, could be a sign of
diabetes and requires follow-up testing. Exposure to cold, frequent, prolonged
vomiting, and several digestive system diseases can also increase fat metabolism,
resulting in ketonuria.
Urobilinogen
• This test screens for urobilinogen in the urine. Urobilinogen is normally present in
urine in low concentrations. It is formed in the intestine from bilirubin, and a
portion of it is absorbed back into the blood. Positive test results may indicate
liver diseases such as viral hepatitis, cirrhosis, liver damage due to drugs or toxic
substances, or conditions associated with increased RBC destruction (hemolytic
anemia). When urine urobilinogen is low or absent in a person with urine
bilirubin and/or signs of liver dysfunction, it can indicate the presence of hepatic
or biliary obstruction.

14. A dipstick test checks for
Blood (Hemoglobin) and Myoglobin
• This test is used to detect hemoglobin in the urine (hemoglobinuria)
• Its presence in the urine indicates blood in the urine (known
as hematuria).
• A small number of RBCs are normally present in urine and usually
result in a “negative” chemical test. An increased amount of
hemoglobin and/or increased number of RBCs are detected as a
“positive” chemical test result.

15. A dipstick test checks for
Leukocyte esterase is an enzyme present in most white blood cells
(WBCs). A few white blood cells are normally present in urine and
usually give a negative chemical test result. When the number of WBCs
in urine increases significantly, this screening test will become positive.
Results of this test will be considered along with a microscopic
examination for WBCs in the urine.
• When this test is positive and/or the WBC count in urine is high, it
may indicate that there is inflammation in the urinary tract or
kidneys. The most common cause for WBCs in urine (leukocyturia) is a
bacterial urinary tract infection (UTI)

16. A dipstick test checks for
Nitrite
This test detects nitrite and is based upon the fact, that many bacteria
can convert nitrate (a normal substance in urine) to nitrite. Normally,
the urinary tract and urine are free of bacteria and nitrite. When
bacteria enter the urinary tract, they can cause a urinary tract
infection. However, since not all bacteria are capable of converting
nitrate to nitrite, the results of this test will be considered along with
the leukocyte esterase (above) and a microscopic examination.
Ascorbic Acid (Vitamin C)
Occasionally, people taking vitamin C or multivitamins may have large
amounts of ascorbic acid in their urine

17. Microscopic Exam
The microscopic exam is performed on urine sediment – urine that has
been centrifuged to concentrate the substances in it at the bottom of a
tube. The fluid at the top of the tube is then discarded and the drops of
fluid remaining are examined under a microscope.
It will typically be done when there are abnormal findings on the
physical or chemical examination and the results from all will be taken
into account for interpretation

18. Microscopic Exam
• Red blood cells (RBCs)
• Normally, a few RBCs are present in urine sediment (0-5 RBCs per
high power field). Some causes of hematuria are benign, temporary
states that do no lasting harm and resolve with little or no specific
treatment, but may be a sign of kidney disease, a blood disorder
or another underlying medical condition, such as bladder cancer.

20. Microscopic Exam
White blood cells (WBCs)
The number of WBCs in urine sediment is normally low (0-5 WBCs per high
power field). WBCs can be a contaminant, such as those from vaginal
secretions. An increased number of WBCs seen in the urine under a
microscope and/or positive test for leukocyte esterase may indicate
an infection or inflammation somewhere in the urinary tract.
Epithelial cells
Epithelial cells are usually reported as “few,” “moderate,” or “many” present
per low power field (LPF). Normally, in men and women, a few epithelial cells
can be found in the urine sediment. In urinary tract conditions such as
infections, inflammation, and malignancies, an increased number of
epithelial cells are present.

21. Epithelial Cells

22. Microscopic Exam
Bacteria, yeast
in healthy people, the urinary tract is sterile and, if the urine sample is
collected as a “clean-catch” sample, there will be no microbes seen in the
urine sediment under the microscope.
Urinary tract infections are caused by microorganisms — usually bacteria
— that enter the urethra and bladder, causing inflammation and infection.
Though a UTI most commonly happens in the urethra and bladder, bacteria
can also travel up the ureters and infect your kidneys.
In women (and rarely in men), yeast can also be present in urine. They are
most often present in women who have a vaginal yeast infection because the
urine has been contaminated with vaginal secretions during collection.

24. Microscopic Exam
Casts
• Casts are cylindrical particles sometimes found in urine that are formed
from coagulated protein released by kidney cells. They are formed in the
long, thin, hollow tubes of the kidneys known as tubules and usually take
the shape of the tubule. Under the microscope, they often look like the
shape of a “hot dog” and in healthy people they appear nearly clear. This
type of cast is called a “hyaline” cast. Normally, healthy people may have a
few (0–5) hyaline casts per low power field.
• Other types of casts are associated with different kidney diseases, and the
type of casts found in the urine may give clues as to which disorder is
affecting the kidney.

25. Microscopic Exam
• Fatty casts are seen in people who have lipids in urine. This is most often a complication
of nephrotic syndrome.
Granular casts are a sign of many types of kidney diseases.
• Red blood cell casts mean there is a microscopic amount of bleeding from the kidney.
• Renal tubular epithelial cell casts reflect damage to tubule cells in the kidney. These casts are
seen in conditions such as renal tubular necrosis, viral disease such as cytomegalovirus nephritis
and kidney transplant rejection.
• Waxy casts can be found in people with advanced kidney disease and long term (chronic) kidney
and long-term (chronic) kidney failure.
• White blood cell (WBC) casts are common with acute kidney infections and interstitial nephritis.

27. Microscopic Exam
Crystals
• Urine contains a large number of different chemicals. Under some
circumstances, these chemicals may solidify into salt crystals. This is called
crystaluria.
Crystals are considered “normal” if they are from solutes that are typically
found in the urine:
• Amorphous urates
• Crystalline uric acid
• Calcium oxalates
• Amorphous phosphates

28. Microscopic Exam
• If the crystals are from substances that are not normally in the urine, they
are considered “abnormal.” Abnormal crystals may indicate an abnormal
metabolic process. Some of these include:
• Calcium carbonate
• Cystine
• Tyrosine
• Leucine
Normal or abnormal crystals can form within the kidneys as urine is being
made and may group together to form kidney “stones” or calculi. These
stones can become lodged in the kidney itself or in the ureters, tubes that
pass the urine from kidney to the bladder, causing extreme pain.

29. Urine crystals