Prof. Dr. Zeliha Büyükbingöl Urine analysis Prof. Dr. Zeliha Büyükbingöl

How the Tests Are Obtained Kidney function tests usually require a 24-hour urine sample and a blood test. 24-Hour Urine Sample A 24-hour urine sample is a creatinine clearance test. It gives an idea of how much creatinine the body expels over a single day. Spot urine The sampling of a single, untimed urine specimen, voided spontaneously by the patient. The sample is analyzed to determine its protein, creatinine, or electrolyte content. This type of specimen differs from a timed urinary specimen, which represents all the urine a patient produces over a 12- or 24-hr period. Both types of specimen are used in the diagnosis and treatment of renal disease.

Routine Urinalysis A urinalysis is important in accessing the chemical constituents in the urine and the relationship to various disease states. Macro and Microscopic Analyzes The urine sample's color Appearance Specific gravity pH Protein levels Glucose Ketones Blood Leukocyte esterase Nitrite Bilirubin Urobilinogen

Macroscopic urinalysis Macroscopic urinalysis is the direct visual observation of the urine, noting its quantity, color, clarity or cloudiness, etc. Normal urine is typically light yellow and clear without any cloudiness. Obvious abnormalities in the color, clarity, and cloudiness may suggest possibility of an infection (cloudy urine), Dehydration (dark urine color),stains urine a tea or cola color), blood in the urine (visible to the eye may indicate urinary tract infection, stones, tumors, or injuries), or breakdown of muscle (orange- or tea-colored urine).

Microscopic urine analysis This test looks at a sample of urine under a microscope. It can see cells from your urinary tract, blood cells, crystals, bacteria, parasites, and cells from tumors. This test is often used to confirm the findings of other tests or add information to a diagnosis.

Laboratory Reference Ranges in Healthy Adults Each laboratory has specific reference ranges. Reference range values are for apparently healthy people and often overlap significantly with values for those who are sick. Actual values may vary significantly due to differences in assay methodologies and standardization. Institutions may also set up their ownreference ranges based on the particular populations that they serve, thus regional differences may occur.

Protein and Glucose Test The protein test provides a rough estimate of the amount of albumin in the urine. When urine protein is elevated, a person has a condition called proteinuria. Glucose is normally not present in urine. When glucose is present, the condition is called glucosuria. It results from: An excessively high glucose level in the blood, such as person who have uncontrolled diabetes Some other conditions: hormonal disorders, liver disease, medications, and pregnancy. When glucosuria occurs, other tests such as a fasting blood glucose are usually performed to further identify the specific cause.

Leukocytes and nitrites Both of which are potential indicators of infection. The presence of nitrite in the urine is highly specific of a bacterial infection. If there is no leukocyte esterase in the urine, this means an infection is unlikely.

Bilirubin Bilirubin is primarily derived from metabolism of hemoglobin. Only conjugated bilirubin is excreted into the urine and normally only trace amounts can be detected in urine. Elevated urinary bilirubin occurs in patients with obstructive jaundice or jaundice due to hepatocellular disease or injury. Hyperbilirubinemia due to hemolysis is principally due to unconjugated bilirubin, and therefore does not result in increased urinary bilirubin.

Normal Urine Characteristics Normal values Color Pale yellow to deep amber Odor Odorless Volume 750–2000 mL/24 hour pH 4.5–8.0 Specific gravity 1.003–1.032 Osmolarity 40–1350 mOsmol/kg Urobilinogen 0.2–1.0 mg/100 mL White blood cells 0–2 HPF (per high-power field of microscope) Leukocyte esterase None Protein None or trace Bilirubin <0.3 mg/100 mL Ketones Nitrites Blood Glucose

Excessive Urination Volume (Polyuria) Excessive urination volume (or polyuria) occurs when the patient urinate more than normal. Urine volume is considered excessive if it equals more than 2.5 liters per day. A normal urine volume depends on the age and gender. However, less than 2 liters per day is usually considered normal. Excreting excessive volumes of urine is a common condition but should not last more than several days. Many people notice the symptom at night. In this case, it is called nocturnal polyuria (or nocturia).

Anuria Anuria or anuresis occurs when the kidneys are not producing urine. A person may first experience oliguria, or low output of urine, and then progress to anuria. Anuria is primarily linked to acute (sudden or short-term) or chronic (long- term) kidney disease. It may also be associated with other health conditions that cause kidney disease.