This document discusses urine routine and microscopy, which involves tests performed on urine samples to diagnose urinary tract and systemic diseases. The tests include physical examination of the urine's appearance, biochemical analysis of properties like specific gravity and pH, and microscopic analysis of cells, casts, and microorganisms. Proper collection and handling of urine samples is important. Test results can provide information on conditions like infections, kidney function, diabetes, and more.

1. URINE ROUTINE AND
MICROSCOPY
DR KANISHK PATIL

2. WHY?
• Urine Routine and Microscopy is an array of tests performed on urine and is the
most fundamental urological test.
• Can help diagnose disorders of Urinary tract or systemic diseases affecting the
urinary tract.
• Screening/Monitoring patients of drug abuse or systemic diseases (Diabetes
Mellitus)
• Urine collected in sterile, wide mouthed and dry containers. Should be examined
within 2 hours of collection.
• A midstream urine sample is ideal for urinalysis.

3. COMPONENTS OF URINALYSIS
• Physical and Gross examination
• Color
• Turbidity
• Biochemical analysis
• Specific gravity
• Osmolality
• pH
• Hematuria/RBCs
• Proteinuria
• Glucose
• Bilirubin
• Leukocyte esterase activity
• Microscopic analysis : Cells, Cast, Microorganisms

4. PHYSICAL EXAMINATION
• Normal urine is pale yellow and non turbid.
• Colour may vary due to diet, medication or infection.
• Urine may be cloudy/turbid in cases of phosphaturia, pyuria, chyluria or presence
of crystals.
• Urine is normally odourless. May be foul or offensive in case of infection, fruity in
ketonuria, or strong ammoniacal on long standing.

5. CHEMICAL EXAMINATION
• pH
• pH of urine is reflective of the kidney’s ability to maintain normal hydrogen ion concentration in plasma and ECF.
• Urine pH may vary from 4.5 to 8, with average being 5.5 and 6.5. pH between 4.5 to 5.5 is considered acidic and
6.5 to 8 is considered alkaline.
• Urine tends to be acidic in ketosis, systemic acidosis and UTI; alkaline in cases of UTI caused by urea splitting
organisms.
• Specific gravity
• Reflective of the kidney’s ability to concentrate or dilute urine.
• Varies from 1.001 to 1.035. Considered dilute if <1.008 (diuretics, increased fluid intake, DI) and concentrated if
>1.020 (DM, increased ADH secretion or dehydration).
• Osmolality
• Measure of amount of material dissolved in urine & varies between 50 to 1200mOsm/L

6. CHEMICAL ANALYSIS CONTINUED
• Blood/Haematuria
• >=3 RBCs/hpf is defined as haematuria.
• Gross or microscopic.
• Detected using peroxidase like activity of hemoglobin.
• Should be differentiated from hemoglobinuria and myoglobinuria.
• Should be differentiated into nephrogenic or urologic and glomerular or non glomerular.
• Proteinuria
• Normal healthy adult excretes about 80-150mg of protein in a day.
• Seldom exceeds above 20mg/dl.
• Detected by heat coagulation or dipstick.

7. CHEMICAL ANALYSIS CONTINUED
• Glucose & Ketones
• Useful for screening patients with DM.
• Glucose is NOT present in urine normally.
• Glucose starts appearing in urine with serum glucose levels above 180mg/dl.
• Bilirubin & Urobilinogen