5URINE ANALYSIS Physical Examination 1- Volume:Normal urine volume in 24 hours is mlA- Urine volume increases (Polyuria) in the following conditions:Physiological:Increased fluid intakeDiureticPathological:Diabetes mellitusDiabetes insipidusChronic renal failureB- Urine volume decreases (Oliguria or anuria) in the following conditions:DehydrationAcute renal failureObstruction
6URINE ANALYSIS Physical Examination 2- Specific gravity (SG):Specific gravity measures solute concentration (urea and sodium).Normally the specific gravity ranges betweenA- Increased inDehydration (with oliguria)Diabetes Mellitus (with polyuria)Acute renal failure (with oliguria)B- Decreased inDiabetes insipidus (with polyuria)
7URINE ANALYSIS Physical Examination 3- Appearance:- Normal fresh urine: clear (transparent)- Abnormal : Cloudy urineIndicates possible abnormal constituents such as:White blood cellsEpithelial cellsCrystalsBacteriaN.B. Stored urine with no preservative & no cooling may turn clear urine samples into cloudy urine.
8URINE ANALYSIS Physical Examination 4- Color:- Normal color: pale yellow (amber yellow)due to the presence of pigments of urobilin or urobilinogen- Abnormal colors of urine:ColorlessOrangeGreenish yellowRedBlackSmoky
10URINE ANALYSIS Physical Examination Color (cont.)1- Colorless Urine:Chronic renal failureDiabetes insipidus.2- Orange Urine:Ingestion of large amount of carotenoids (vitamin A)3- Yellowish - brown urine:due to presence of billirubin in cases of :Obstructive JaundiceHepatic Jaundice
11URINE ANALYSIS Physical Examination Color (cont.) 4- Red urine:due to presence of blood, hemoglobin & RBCs.5- Black urine:MethemoglobinHomogentisic acid in alkaptonuriaMalignant malaria (black water fever due to Malaria falciparum).Melanin (melanoma)6- Smoky urine:presence RBCs. in the urine, in cases of acute glomerulonephritis
12URINE ANALYSIS Physical Examination 5- Odor: Normal Urineferous odor:The normal odor of fresh voided urine sampleAbnormal Odors:1- Fruity odor:due to presence of acetone in the urine as in diabetic ketoacidosis2- Ammonia odor:due to release of ammonia as result of:- the bacterial action on urea in the contaminated urine- or long standing exposed urine samples.
13URINE ANALYSIS Physical Examination 6- Deposits:Normally the urine is devoid of deposits.The presence of deposits is mainly due to various types of crystals, salts and cells.
14URINE ANALYSIS Physical Examination 7- Reaction (pH):Normally: The pH of urine varies from 1- Acidic urine:Large intake of meat & certain fruits (cranberries)Metabolic & respiratory acidosis2- Alkaline urine:VegetariansMetabolic & respiratory alkalosisUrinary tract infection by urea splitting bacteria which split urea to ammonia (alkaline)
15URINE ANALYSIS Chemical Examination The presence of normal and abnormal chemical elements in the urine are detected using dry reagent strips.These plastic strips contain absorbent pads with various chemical reagents for determining a specific substance.When the test strip is put in urine the reagents are activated and a chemical reaction occurs.The chemical reaction results in a specific color change.
16URINE ANALYSIS Chemical Examination Used in the LAB for routine urine analysis (10 Chemical Tests)Used in Emergency Room (ER) for diagnosis of Diabetic Ketoacidosis (DKA) (3 chemical tests: Glucose, Ketones & protein)
18URINE ANALYSIS Chemical Examination GlucoseProteinSpecific GravitypHprimarily detects glucose (sugar); important indicator of diabetes mellitusprimarily detects protein called albumin; important indicator in the detection of renal diseasestate of kidney and hydration status of patientpartial assessment of acid base status; alkaline pH indicates old sample or urinary tract infection
19URINE ANALYSIS Chemical Examination UrobilinogenBilirubinKetoneBloodanother by-product of red cell breakdown; increased amounts seen in fever, dehydration, hemolytic anemia and liver diseasedetects bilirubin (a product of red cell breakdown); indicator of liver functionnormal product of fat metabolism; increased amounts seen in diabetes or starvation (extreme dieting)red blood cells, hemoglobin, or myoglobin (muscle hemoglobin); sensitive early indicator of renal disease
20URINE ANALYSIS Chemical Examination Ascorbic AcidLeukocyte EsteraseNitriteAscorbic acid (vitamin C) is known to interfere with the oxidation reaction of the blood and glucose pad on common urine test strips.detects esterase enzyme present in certain white blood cells (e.g, neutrophils, monocytes); indicator of urinary tract infectioncertain bacteria convert normal urine nitrate to nitrite; indicator of urinary tract infection
21URINE ANALYSIS Chemical Examination Abnormal Constituents of Urine1- Proteins (proteinuria)2- Sugars (glucosuria, fructosuria & galactosuria)3- ketone Bodies (ketonuria)4- Billirubin (billirubinuria) & Bile Salts5- Nitrites
22URINE ANALYSIS Chemical Examination 1- Proteins: (proteinuria)Proteinuria is divided into prerenal, renal and postrenal proteinuria. 1-Prerenal proteinuria:Bence-Jones protein: This abnormal gamma globulin (light chains only) is synthesizedby malignant plasma cells (multiple myeloma).It precipitates at 60oC, redissolves at 100oC and reprecipitates on cooling.2-Renal proteinuria:Severe muscular exerciseAfter prolonged standingAcute glomerulonephritisNephrotic syndrome3- Postrenal proteinuria:Lower urinary tract inflammation, tumors or stones.
23URINE ANALYSIS Chemical Examination 2- Glucose: (glycosuria)Presence of detectable amount of glucose in urine which occurs in the following conditions:Uncontrolled Diabetes Mellitus (DM)Renal glucosuria with lowering of renal threshold : e.g. during pregnancy (gestational diabetes).- Fructose (Fructosuria)Presence of fructose in urine & may be due to:- Alimentary causes following the ingestion of large amounts of fructose- Fructosemia & hereditary fructose intolerance (Metabolic disorders of fructose).- Galactose (Galactosuria):Presence of galactose in urine& may be due to:- Alimentary causes following the ingestion of large amount of galactose.- Galactossemia
24URINE ANALYSIS Chemical Examination 3- Ketone Bodies (Ketonuria):Presence of acetone, acetoacetic acid & β hydroxybutyric acid in urine due to:Diabetic ketoacidosis (uncontrolled DM)StarvationUnbalanced diet: high fat & low carbohydrates diet.
25URINE ANALYSIS Chemical Examination 4- Bilirubin (bilirubinuria)Billirubin appears in urine in cases of:Hepatocellular Jaundice:as in viral hepatitisObstructive Jaundiceas any cause of obstruction of bile duct5- Nitrites:In bacteruria in urine (in cases of Urinary Tract Infection, UTI)
26URINE ANALYSIS Microscopic Examination The urine specimen is centrifuged and the liquid portion is poured off.
27URINE ANALYSIS Microscopic Examination The concentrated cellular sediment, is then placed on a microscope slide, covered with a coverslip and read under microscope.
28URINE ANALYSIS Microscopic Examination A variety of normal and abnormal cellular elements may be seen in urine sediment such as:CastsCrystalsAmorphusMicroorganismsPus cellsRBCsEpithelial cellsMucus
29URINE ANALYSIS Microscopic Examination RBCs40x objective- presence of a few is normal (2 – 5 cells/HPF)- higher numbers are indicator of renal disease- result of bleeding at any point in urinary system
30URINE ANALYSIS Microscopic Examination Pus cells40x objectivea few are normal (2 – 4 cells /HPF)high numbers indicate inflammation or infection somewhere along the urinary or genital tract.
31URINE ANALYSIS Microscopic Examination Mucus40x objectivelook like long, ribbon-like threadscommon finding in urine sedimentsecreted by glands in the lower urinary tract.Become more with UTI, ulcerative colitis, kidney stones
32URINE ANALYSIS Microscopic Examination Epithelial Cells40x objectivecells are large and flatnormal cells that line the urinary and genital tract or renal tubules