Definition

Urinalysis is a diagnostic physical, chemical, and microscopic examination of a urine sample (specimen).
Specimens can be obtained by normal emptying of the bladder (voiding) or by a hospital procedure called
catheterization.

Purpose
urinalysis is performed for several reasons:

• general evaluation of health

• diagnosis of metabolic or systemic diseases that affect kidney function
• diagnosis of endocrine disorders. Twenty-four-hour urine studies are often ordered for these tests
• diagnosis of diseases or disorders of the kidneys or urinary tract.
• monitoring of patients with diabetes
• testing for pregnancy
• screening for drug abuse

Precautions
Voided specimens
Urinalysis should not be performed while a woman is menstruating or having a vaginal discharge. A woman
who must have a urinalysis while she has a vaginal discharge or is having her period should insert a fresh
tampon before beginning the test. She should also hold a piece of clean material over the entrance to
her vagina to avoid contaminating the specimen.
Patients do not have to fast or change their food intake before a urine test. They should, however, avoid
intense athletic training or heavy physical work before the test because it may result in small amounts of
blood in the urine.
The following drugs can affect urinalysis results. The patient may be asked to stop taking them until after the
test:

• nitrofurantoin (Macrodantin, Furadantin). Nitrofurantoin is prescribed for infections of the urinary

tract and other bacterial infections.
• phenazopyridine (Pyridium). This medication is used to relieve burning and paincaused by urinary-
tract infections.
• rifampin (Rifadin). This medication is prescribed to treat tuberculosis, prevent the spread
of meningitis, and treat other infections.

Bladder catheterization
Bladder catheterization is sometimes used to collect urine samples from hospitalized patients. It should not,
however, be used to collect specimens from males with acute inflammation of the prostate or from a patient
of either sex with a fractured pelvis.

Laboratory procedures

STORAGE
Urine specimens should not remain unrefrigerated for longer than two hours. A urine specimen that cannot
be delivered to a laboratory within two hours should be stored in a refrigerator. The reason for this
precaution is that urine samples undergo chemical changes at room temperature. Blood cells begin to
dissolve and the urine loses its acidity.
VISUAL EXAMINATION
A doctor, nurse, or laboratory technician will look at the specimen to see if the urine is red, cloudy, or looks
unusual in any way. He or she will also note any unusual odor.
TESTING TECHNIQUES
Urine samples are tested with a variety of different instruments and techniques. Some tests use dipsticks,
which are thin strips of plastic that change color in the presence of specific substances. Dipsticks can be
used to measure the acidity of the urine (its pH) or the presence of blood, protein, sugar, or substances
produced during the breakdown of fatty acids (ketones). A urinometer is used to compare the density of the
urine specimen with the density of plain water. This measurement is called specific gravity.
The urine specimen is also examined under a microscope to determine whether it contains blood cells,
crystals, or small pieces of fibrous material (casts).

Preparation
Voided specimens
Most urine specimens from adults or older children are collected by the patient's voiding into a suitable
container. Soaps and disinfectants may contaminate urine specimens and should not be used. The doctor or
laboratory may supply a special antiseptic solution that won't irritate the skin. The method for collection
varies somewhat according to age and sex.
WOMEN AND GIRLS
Before collecting a urine sample, a woman or girl should use a clean cotton ball moistened with lukewarm
water to cleanse the external genital area. Gently separating the folded skin (labia) on either side of her
vagina, she should move the cotton ball from the front of the area to the back. After repeating this process
several times, using a fresh piece of cotton each time, she should dry the area with a clean towel.
To prevent menstrual blood, vaginal discharge, or germs from the external genitalia from contaminating the
specimen, a woman or girl should release some urine before she begins to collect her sample. A urine
specimen obtained this way is called a midstream clean catch.
MEN AND BOYS
A man or boy should use a piece of clean cotton, moistened with antiseptic, to cleanse the head of his penis
and the passage through which urine leaves his body (the urethral meatus). He should draw back his
foreskin if he has not been circumcised. He should move the cotton in a circular motion away from the
urinary opening, using a fresh piece of cotton each time. After repeating this process several times, he
should use a fresh piece of cotton to remove the antiseptic. After the area has been thoroughly cleansed, he
should begin urinating and collect a small sample in a container without interrupting the stream of urine.
INFANTS
A parent, nurse, or doctor should cleanse the child's genitals and as much of the surrounding area as will fit
into the sterile urine-collection bag provided by the hospital. When the area has been thoroughly cleansed,
the bag should be attached to the child's genital area and left in place until the child has urinated. It is
important to remember not to touch the inside of the bag and to remove it as soon as a specimen has been
obtained.

Bladder catheterization
Bladder catheterization is a hospital procedure used to collect uncontaminated urine when the patient
cannot void. A catheter is a thin flexible tube that the doctor inserts through the urethra into the bladder to
allow urine to flow out. To minimize the risk of infecting the patient's bladder with bacteria, many doctors use
a so-called Robinson catheter, which is a plain rubber or latex tube that is removed as soon as the specimen
is collected.
Suprapubic bladder aspiration is a technique that is sometimes used to collect urine from infants younger
than six months. The doctor withdraws urine from the bladder into a syringe through a needle inserted
through the skin over the bladder. This technique is used only when the child cannot void because of an
abnormal urethra or if he or she has a urinary tract infection that has not responded to treatment.

Aftercare
The patient may return to normal activities after collecting the sample and may start taking medications that
were discontinued before the test.

Risks
There are no risks associated with voided specimens. The risk of bladder infection from catheterization with
a Robinson catheter is about 3%.

Normal results
Contents and appearance
Normal urine is a clear straw-colored liquid. It has a slight odor. It contains some crystals, a small number of
cells from the tissues that line the bladder, and transparent (hyaline) casts. Normal urine does not contain
sugars, yeast cells, protein, ketones, bacteria, or parasitic organisms.
The time of day a urine sample is collected can make a difference in the appearance of the specimen. Some
foods and medicines, including red beets, asparagus, and penicillin, can affect the color or smell of urine.
Although most color variations are harmless, they sometimes indicate the presence of serious disease. A
doctor, nurse, or laboratory technician should be notified if the urine is red or cloudy or looks unusual in any
way.

Acidity
The pH of normal urine is 4.5–8.0. Its specific gravity is 1.0005–1.035.

Abnormal results

Cloudiness
Urine may be cloudy (turbid) because it contains red or white blood cells, bacteria, fat, mucus, digestive fluid
(chyle), or pus from a bladder or kidney infection.

Odor
Foul-smelling urine is a common symptom of urinary-tract infection. A fruity odor is associated with diabetes
mellitus, starvation and dehydration, or ketone formation. Other distinctive odors are present in the urine of
patients with maple syrup urine disease or phenylketonuria (PKU).

Specific gravity
The specific gravity of urine can be affected by a range of diseases and disorders. Low specific gravity
(below 1.005) is associated with diabetes insipidus, nephrogenic diabetes insipidus, acute tubular necrosis,
and inflammation of the upper urinary tract (pyelonephritis). In fixed specific gravity, the specific gravity of
the urine remains at 1.010 no matter how much fluid the person drinks. This condition occurs in patients who
have chronic inflammation of the small blood vessels in the kidneys (glomerulonephritis) and serious kidney
damage. High specific gravity (above 1.035) occurs in patients who are in shock or who suffer
from nephrotic syndrome, dehydration, acute glomerulonephritis, congestive heart failure, or liver failure.

pH
A pH factor greater than 7 (more alkaline) may result from Fanconi's syndrome, urinary tract infections, or
metabolic or respiratory alkalosis. A pH factor below 7 (more acid) may be due to fever, PKU, the secretion
of homogentisic acid in the urine (alkaptonuria), and acidosis.

Blood and tissue cells

Red blood cells in the urine can be due to vigorous exercise or exposure to toxic chemicals. Bloody urine
can also be a sign of bleeding in the genitourinary tract as a result of systemic bleeding disorders, various
kidney diseases, bacterial infections, parasitic infections including malaria, obstructions in the urinary
tract, scurvy, subacute bacterial endocarditis, traumatic injuries, and tumors.
A high number of white blood cells in the urine is usually a symptom of urinary tract infection. A large
number of cells from tissue lining (epithelial cells) can indicate damage to the small tubes that carry material
into and out of the kidneys.

Casts
Casts are small fibrous objects that are formed when protein and other materials settle in the kidney tubules
and collecting ducts. Casts are dislodged by normal urine flow. A large number of them in a urine specimen
is a sign of kidney disease.
Crystals
There are several different chemicals in body fluids that can form crystals that appear in urine. Some of
these appear in normal urine, such as calcium oxalate or uric acid crystals. A large number of calcium
oxalate crystals, however, may be a sign of abnormally high levels of calcium in the blood (hypercalcemia).
Other crystals, including tyrosine, leucine, and cholesterol, are abnormal. The presence of cystine crystals is
a symptom of excessive urinary secretion of cystine (cystinuria). Cystine is an acid found in many proteins
and normally reabsorbed by the kidney tubules.

Protein
Protein in the urine can be a symptom of kidney stones, inflammation of the kidneys, degenerative kidney
disease, or multiple tumors.

Sugars
A high level of glucose and other sugars in the urine (glycosuria) is often a symptom of diabetes mellitus.
Glycosuria can also be caused by advanced kidney disease,Cushing's syndrome, impaired tubular
reabsorption, shock, a rare tumor of the adrenal gland (pheochromocytoma), or cancer of the pancreas.
Milk in the urine is normal if a woman is pregnant, has just given birth, or is breastfeeding. On the other
hand, rare hereditary metabolic disorders are indicated when urine contains fruit sugar (fructose), milk sugar
(galactose), or a simple sugar called pentose.

Ketones
The presence of abnormally high numbers of ketones in the urine (ketonuria) usually results from
uncontrolled diabetes mellitus. Ketonuria can also be caused by prolonged diarrhea or vomiting that results
in starvation.

Bilirubin
Bilirubin is an orange-yellow pigment found in bile, a fluid secreted by the liver. When it is found in urine,
bilirubin may be a symptom of liver disease caused by the formation of fibrous tissue, medications that
damage the liver, or obstructive jaundice.

Urobilinogen
Bacteria in the small intestine can convert bilirubin to urobilinogen, which is excreted in the feces, in bile, or
in urine. An accumulation of urobilinogen in the urine may be a sign of severe infection, liver damage, or
diseases that destroy red blood cells. Low levels of urobilinogen in the urine may be a result of antimicrobial
therapy, inflammatory diseases, kidney disease, severe diarrhea, or blocked bile ducts.

Other findings
The presence of bacteria, parasites, or yeast cells in the urine may be a symptom of urinary tract infection or
contamination of the external genitalia. Other factors that may affect urinalysis results include failure to
collect a specimen during the day's first voiding; frequent urination; large dietary intake of vitamin C; and
urine with a pH value lower than 6.