1. Urinalysis
Prepared by
Hamad ALAssaf

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

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

5. URINE ANALYSIS Physical Examination
1- Volume:
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

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

7. URINE ANALYSIS Physical Examination
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. Stored urine with no preservative & no cooling may turn clear urine samples into cloudy urine.

8. URINE 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:
Colorless
Orange
Greenish yellow
Red
Black
Smoky

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

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

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

12. URINE ANALYSIS Physical Examination
5- Odor: 
Normal Urineferous odor:
The normal odor of fresh voided urine sample
Abnormal Odors:
1- Fruity odor:
due to presence of acetone in the urine as in diabetic ketoacidosis
2- 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.

13. URINE 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.

14. URINE 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 acidosis
2- Alkaline urine:
Vegetarians
Metabolic & respiratory alkalosis
Urinary tract infection by urea splitting bacteria which split urea to ammonia (alkaline)

15. 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.
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. URINE 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)

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

19. URINE ANALYSIS Chemical Examination
Urobilinogen
Bilirubin
Ketone
Blood
another by-product of red cell breakdown; increased amounts seen in fever, dehydration, hemolytic anemia and liver disease
detects bilirubin (a product of red cell breakdown); indicator of liver function
normal 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

20. URINE ANALYSIS Chemical Examination
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.
detects esterase enzyme present in certain white blood cells (e.g, neutrophils, monocytes); indicator of urinary tract infection
certain bacteria convert normal urine nitrate to nitrite; indicator of urinary tract infection

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

22. URINE 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 synthesized
by malignant plasma cells (multiple myeloma).
It precipitates at 60oC, redissolves at 100oC and reprecipitates on cooling.
2-Renal proteinuria:
Severe muscular exercise
After prolonged standing
Acute glomerulonephritis
Nephrotic syndrome
3- Postrenal proteinuria:
Lower urinary tract inflammation, tumors or stones.

23. URINE 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

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

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

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

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

28. URINE ANALYSIS Microscopic Examination
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

29. URINE ANALYSIS Microscopic Examination
RBCs
40x 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

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

31. URINE ANALYSIS Microscopic Examination
Mucus
40x objective
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

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

33. URINE ANALYSIS Microscopic Examination

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

35. URINE ANALYSIS Microscopic Examination

36. URINE ANALYSIS Microscopic Examination (Casts)

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

38. URINE ANALYSIS Microscopic Examination
Bacteria
Yeast

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

40. It’s not just water !
Thank you