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UrinalysisUrinalysis 1 Prepared by Hamad ALAssaf Prepared by Hamad ALAssaf

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Presentation on theme: "UrinalysisUrinalysis 1 Prepared by Hamad ALAssaf Prepared by Hamad ALAssaf"— Presentation transcript:

1 UrinalysisUrinalysis 1 Prepared by Hamad ALAssaf Prepared by Hamad ALAssaf

2 Urine Examination 1- Physical Examination 2- Chemical Examination 3- Microscopic Examination 2

3 3

4 Physical Examination URINE ANALYSIS Physical Examination 1- Volume 2- Specific Gravity 3- Apperance 4- Color 5- Odor 6- Deposit 7- Reaction (pH) 4

5 Physical Examination URINE ANALYSIS Physical Examination 1- Volume: 24 hours Normal urine volume in 24 hours is ml A- Urine volume increases (Polyuria) in the following conditions: Physiological:  Increased fluid intake  Diuretic Pathological:  Diabetes mellitus  Diabetes insipidus  Chronic renal failure B- Urine volume decreases (Oliguria or anuria) in the following conditions:  Dehydration  Acute renal failure  Obstruction 5

6 2- Specific gravity (SG): solute concentration Specific gravity measures solute concentration (urea and sodium). Normally Normally the specific gravity ranges between A- Increased in Dehydration (with oliguria) Diabetes Mellitus Diabetes Mellitus (with polyuria) Acute renal failure Acute renal failure (with oliguria) B- Decreased in Diabetes insipidus Diabetes insipidus (with polyuria) 6 Physical Examination URINE ANALYSIS Physical Examination

7 3- Appearance: - Normal fresh urine: clear (transparent) - Abnormal : Cloudy urine Indicates possible abnormal constituents such as: White blood cells Epithelial cells Crystals Bacteria N.B. N.B. Stored urine with no preservative & no cooling may turn clear urine samples into cloudy urine. 7 Physical Examination URINE ANALYSIS Physical Examination

8 4- Color: - Normal color: pale yellow (amber yellow) due to the presence of pigments of urobilin or urobilinogen - Abnormal colors of urine: Colorless Colorless Orange Orange Greenish yellow Greenish yellow Red Red Black Black Smoky Smoky 8

9 Left to right: (Straw, clear) (yellow, clear) (yellow, hazy) (yellow, clear) (red-orange, clear) (brown, hazy) Urine Colour 9

10 Physical Examination URINE ANALYSIS Physical Examination  Color  Color (cont.) 1- Colorless Urine:  Chronic renal failure  Diabetes insipidus  Diabetes 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 Jaundice Obstructive Jaundice Hepatic Jaundice Hepatic Jaundice 10

11 Physical Examination URINE ANALYSIS Physical Examination  Color  Color (cont.) 4- Red urine: 4- Red urine: blood,hemoglobinRBCs due to presence of blood, hemoglobin & RBCs. 5- Black urine:  Methemoglobi  Methemoglobin  Homogentisic acid in alkaptonuria  Malignant malaria  Malignant malaria (black water fever due to Malaria falciparum).  Melanin(melanoma)  Melanin (melanoma) 6- Smoky urine: RBCs acute glomerulonephritis presence RBCs. in the urine, in cases of acute glomerulonephritis 11

12 Physical Examination URINE ANALYSIS Physical Examination Odor: 5- Odor:  Normal Urineferous odor: normal The normal odor of fresh voided urine sample  Abnormal Odors: Fruity odor: 1- Fruity odor: acetone due to presence of acetone in the urine as in diabetic ketoacidosis 2- Ammonia odor: ammonia due to release of ammonia as result of: - the bacterial action on urea in the contaminated urine - or long standing exposed urine samples. 12

13 Physical Examination URINE ANALYSIS Physical Examination Deposits: 6- Deposits: NormallyNormally the urine is devoid of deposits. presence of depositsThe presence of deposits is mainly due to various types of crystals, salts and cells. 13

14 Physical Examination URINE ANALYSIS Physical Examination Reaction (pH): 7- Reaction (pH):  Normally  Normally: The pH of urine varies from Acidic urine: 1- Acidic urine: Large intake of meat & certain fruits (cranberries) Metabolic & respiratory acidosis Metabolic & respiratory acidosis Alkaline urine: 2- Alkaline urine: Vegetarians Metabolic & respiratory alkalosis Urinary tract infection by urea splitting bacteria which split urea to ammonia (alkaline) 14

15 Chemical Examination URINE 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. 15  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.

16 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) 16 Chemical Examination URINE ANALYSIS Chemical Examination

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18 18 Chemical Examination URINE ANALYSIS Chemical Examination GlucoseProtein Specific Gravity pH indicator of diabetes mellitus primarily detects glucose (sugar); important indicator of diabetes mellitus indicator in the detection of renal disease primarily detects protein called albumin; important indicator in the detection of renal disease state of kidney and hydration status of patient alkaline pH indicates old sample or urinary tract infection partial assessme nt of acid base status; alkaline pH indicates old sample or urinary tract infection

19 19 Chemical Examination URINE ANALYSIS Chemical Examination UrobilinogenBilirubinKetoneBlood hemolytic anemia and liver disease another by- product of red cell breakdown; increased amounts seen in fever, dehydration, hemolytic anemia and liver disease indicator of liver function detects bilirubin (a product of red cell breakdown) ; indicator of liver function diabetes normal product of fat metabolism; increased amounts seen in diabetes or starvation (extreme dieting) indicator of renal disease red blood cells, hemoglobin, or myoglobin (muscle hemoglobin); sensitive early indicator of renal disease

20 20 Ascorbic Acid Leukocyte Esterase Nitrite Ascorbic acid (vitamin C) is known to interfere with the oxidation reaction of the blood and glucose pad on common urine test strips. indicator of urinary tract infection detects esterase enzyme present in certain white blood cells (e.g, neutrophils, monocytes); indicator of urinary tract infection indicator of urinary tract infection certain bacteria convert normal urine nitrate to nitrite; indicator of urinary tract infection Chemical Examination URINE ANALYSIS Chemical Examination

21 Abnormal Constituents of Urine 1- Proteins (proteinuria) 2- Sugars (glucosuria, fructosuria & galactosuria) 3- ketone Bodies (ketonuria) 4- Billirubin (billirubinuria) & Bile Salts 5- Nitrites 21

22 Chemical Examination URINE ANALYSIS Chemical Examination Proteins: (proteinuria ) 1 - Proteins: (proteinuria ) Proteinuria is divided into prerenal, renal and postrenal proteinuria. Proteinuria is divided into prerenal, renal and postrenal proteinuria. 1-Prerenal proteinuria: Bence-Jones protein: Bence-Jones protein: This abnormal gamma globulin (light chains only) is synthesized multiple myeloma by malignant plasma cells (multiple myeloma). It precipitates at 60 o C, redissolves at 100 o C and reprecipitates on cooling. 2-Renal proteinuria: Severe muscular exercise After prolonged standing Acute glomerulonephritis Acute glomerulonephritis Nephrotic syndrome Nephrotic syndrome 3- Postrenal proteinuria: Lower urinary tract inflammation, tumors or stones. Lower urinary tract inflammation, tumors or stones. 22

23 Chemical Examination URINE ANALYSIS Chemical Examination Glucose: (glycosuria) 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): - Galactose (Galactosuria): Presence of galactose in urine& may be due to: - Alimentary causes following the ingestion of large amount of galactose. - Galactossemia 23

24 Chemical Examination URINE ANALYSIS Chemical Examination Ketone Bodies (Ketonuria): 3- Ketone Bodies (Ketonuria): Presence of acetone, acetoacetic acid & β hydroxybutyric acid in urine due to: Presence of acetone, acetoacetic acid & β hydroxybutyric acid in urine due to: Diabetic ketoacidosis (uncontrolled DM) Diabetic ketoacidosis (uncontrolled DM) Starvation Starvation Unbalanced diet: high fat & low carbohydrates diet. Unbalanced diet: high fat & low carbohydrates diet. 24

25 Chemical Examination URINE ANALYSIS Chemical Examination 4- Bilirubin (bilirubinuria)  Billirubin appears in urine in cases of: Hepatocellular Jaundice: Hepatocellular Jaundice: as in viral hepatitis as in viral hepatitis Obstructive Jaundice Obstructive Jaundice as any cause of obstruction of bile duct as any cause of obstruction of bile duct 5- Nitrites: In bacteruria in urine (in cases of Urinary Tract Infection, UTI) In bacteruria in urine (in cases of Urinary Tract Infection, UTI) 25

26 The urine specimen is centrifuged and the liquid portion is poured off. 26 Microscopic Examination URINE ANALYSIS Microscopic Examination

27 The concentrated cellular sediment, is then placed on a microscope slide, covered with a coverslip and read under microscope. 27 Microscopic Examination URINE ANALYSIS Microscopic Examination

28 A variety of normal and abnormal cellular elements may be seen in urine sediment such as: Casts Crystals Amorphus Microorganisms Pus cells RBCs Epithelial cells Mucus 28 Microscopic Examination URINE ANALYSIS Microscopic Examination

29 RBCsRBCs - 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 40x objective 29 Microscopic Examination URINE ANALYSIS Microscopic Examination

30 Pus cells a few are normal (2 – 4 cells /HPF) high numbers indicate inflammation or infection somewhere along the urinary or genital tract. 40x objective 30 Microscopic Examination URINE ANALYSIS Microscopic Examination

31 MucusMucus –look like long, ribbon- like threads –common finding in urine sediment –secreted by glands in the lower urinary tract. –Become more with UTI, ulcerative colitis, kidney stones 40x objective 31 Microscopic Examination URINE ANALYSIS Microscopic Examination

32 Epithelial Cells –cells are large and flat –normal cells that line the urinary and genital tract or renal tubules 40x objective 32 Microscopic Examination URINE ANALYSIS Microscopic Examination

33 33 Microscopic Examination URINE ANALYSIS Microscopic Examination

34 Crystals of calcium oxalate Crystals of calcium oxalate colorless octahedron found in acid urine Crystals of triple phosphate Crystals of triple phosphate colorless, “coffin-lid” prism common finding; no clinically significant 34 Microscopic Examination URINE ANALYSIS Microscopic Examination

35 35 Microscopic Examination URINE ANALYSIS Microscopic Examination

36 36 Microscopic Examination (Casts) URINE ANALYSIS Microscopic Examination (Casts)

37 Amorphous urate (Acidic urine) Amorphous urate (Acidic urine) Amorphous phosphate (alkaline urine) Amorphous phosphate (alkaline urine) 37 Microscopic Examination URINE ANALYSIS Microscopic Examination

38 BacteriaBacteriaYeastYeast 38 Microscopic Examination URINE ANALYSIS Microscopic Examination

39 schistosoma haematobium Trichomonas vaginalis 39 Microscopic Examination (Parasites) URINE ANALYSIS Microscopic Examination (Parasites) Characterized by Central spin It is not Urinary system protozoa, it’s vagina protozoa

40 THANK YOU It’s not just water ! 40


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