Complete Urinalysis: A. Physical Characteristics of Urine

COMPLETE URINALYSIS
A. PHYSICAL CHARACTERISTICS OF URINE

The physical characteristics of urine include observations and measurements of
color, turbidity, odor, specific gravity, pH and volume. Visual observation of a urine
sample can give important clues as to evidence of pathology.
1. COLOR
The color of normal urine is usually light yellow to amber. Generally the greater the
solute volume the deeper the color. The yellow color of urine is due to the presence
of a yellow pigment, urochrome. Deviations from normal color can be caused by
certain drugs and various vegetables such as carrots, beets, and rhubarb.
2. ODOR
Slightly aromatic, characteristic of freshly voided urine. Urine becomes more
ammonia-like upon standing due to bacterial activity.
3. TURBIDITY
Normal urine is transparent or clear; becomes cloudy upon standing. Cloudy urine
may be evidence of phosphates, urates, mucus, bacteria, epithelial cells, or
leukocytes.
4. pH
Ranges from 4.5 - 8.0. Average is 6.0, slightly acidic. High protein diets increase
acidity. Vegetarian diets increase alkalinity. Bacterial infections also increase
alkalinity.
5. SPECIFIC GRAVITY
The specific gravity of urine is a measurement of the density of urine - the relative
proportions of dissolved solids in relationship to the total volume of the specimen. It
reflects how concentrated or dilute a sample may be. Water has a specific gravity of
1.000. Urine will always have a value greater than 1.000 depending upon the
amount of dissolved substances (salts, minerals, etc.) that may be present. Very
dilute urine has a low specific gravity value and very concentrated urine has a high
value. Specific gravity measures the ability of the kidneys to concentrate or dilute
urine depending on fluctuating conditions. Normal range 1.005 - 1.035, average
range 1.010 - 1.025.
Low specific gravity is associated with conditions like diabetes insipidus,
excessive water intake, diuretic use or chronic renal failure.
High specific gravity levels are associated with diabetes mellitus, adrenal
abnormalities or excessive water loss due to vomiting, diarrhea or kidney
inflammation. A specific gravity that never varies is indicative of severe renal
failure.
Specific gravity can be determined by either of two methods using a refractometer

or a urinometer.
a.
Refractometer - measures the refractive index of urine which parallels the
specific gravity.
1.
Collect mid-stream sample of urine in collection cup.
2.
Pipette 1-2 drops of urine into the plastic chamber located on the top of the
refractometer. Be sure that the plastic is pressed firmly down in place on the
refractometer.
3.
Determine the specific gravity of the urine by looking through the
refractometer and determining the value on the scale on the left hand side. The
specific gravity value is where the light and dark intersect on the scale.
4.
Clean the refractometer with kimwipes.
b.
Urinometer - Is a weighted, bulb shaped device that has a specific gravity
scale on the stem end.
1.
Fill the cylinder with enough urine so that the urinometer will float in the urine
and not touch the bottom.
2.
Be careful not to drop the urinometer in the cylinder! Gently release it in order
not to break or burst the cylinder. It should NOT touch the sides or bottom of
cylinder.
3.
The specific gravity can be read on the scale on the stern of the urinometer at
the meniscus.
4.
The specific gravity of water is 1.000 with respect to temperature. The
urinometer can be checked periodically against this standard to ensure quality
control at that temperature.
(* For very precise and exacting measurements of specific gravity, corrections
should be made +/- .001 for each 3 C above or below 25 C. Add .001 if above
25 C, subtract .001 if below 25C.
B. CHEMICAL ANALYSIS
For routine chemical analysis of urine there are several brands of chemical test
strips (dip sticks) that are commercially available. These urinalysis test strips have
small test patches impregnated with various chemicals in order to detect the
presence or absence of certain substances. Qualitative and/or quantitative results
can be obtained depending on the particular test.
1. Take a specimen cup from the lab to the bathroom; void into the cup and
return to the lab.
2. Briefly (one second or less) dip the test strip into the urine. Make sure that all
test
squares are immersed.
3. Draw the edge of the strip along the rim of the specimen cup to remove
excess urine.
4. After the appropriate times (as indicated on the vial of strips) read the tests
by
comparing to the color chart on the edge of the vial.
PLEASE DO NOT TOUCH THE TEST STRIP TO THE COLOR CHART. IF
YOU DO SO
ACCIDENTALLY, IMMEDIATELY WIPE THE VIAL WITH DISINFECTANT.
5. NOTE: For convenience, all values on the strip may be read between 1 and 2
minutes after immersion. The colors are stable for up to 120 seconds after
immersion. Color changes that occur after 2 minutes from immersion are not
of diagnostic value. Color changes that occur only along the edge of the test
area should be ignored.
6. Results are obtained by direct visual comparison with the color scale printed
on the vial
label. No calculations are necessary. Record your results.
7. NOTE: For such a test to be considered clinically acceptable for a valid
diagnosis, careful quality control should be maintained, i. e. expiration dates
respected, environmental conditions stabilized, etc. In a teaching lab these
conditions are not met. You can learn the procedure and see some variable
results among the class members, but do not base any clinical assumptions
on the results obtained in this lab. If you have any
reason to suspect a clinical problem, go to a licensed medical laboratory for
a urinalysis.
ABNORMAL
CONSTITUENT ASSOCIATED CAUSES:
:
Protein
(albumin)
Glucose
Albumin is normally too large to pass through

glomerulus. Indicates abnormal increased
permeability of the glomerulus membrane. Nonpathological causes are: pregnancy, physical
exertion, increased protein consumption.
Pathological causes are: glomerulonephritis
bacterial toxins, chemical poisons.
Glycosuria is the condition of glucose in urine.
Normally the filtered glucose is reabsorbed by the
renal tubules and returned to the blood by carrier
molecules. If blood glucose levels exceed renal
threshold levels, the untransported glucose will spill

over into the urine. Main cause: diabetes mellitus
Ketones
Ketone bodies such as acetoacetic acid, betahydroxybutyric acid, and acetone can appear in
urine in small amounts. These intermediate byproducts are associated with the breakdown of
fat. Causes: diabetes mellitus, starvation, diarrhea
Bilirubin
Bilirubin comes from the breakdown of hemoglobin

in red blood cells. The globin portion of hemoglobin
is split off and the heme groups of hemoglobin is
converted into the pigment bilirubin. Bilirubin is
secreted in blood and carried to the liver where it is
conjugated with glucuronic acid. Some is secreted
in blood and some is excreted in the bile as bile
pigments into the small intestines. Causes: liver
disorders, cirrhosis, hepatitis, obstruction of bile
duct
Bile pigment derived from breakdown of

hemoglobin. The majority of this substance is
Urobilinoge excreted in the stool, but small amounts are
n
reabsorbed into the blood from the intestines and
then excreted into the urine. Causes: hemolytic
anemias, liver diseases
Hemoglobinuria is the presence of hemoglobin in
Hemoglobin
the urine. Causes: hemolytic anemia, blood
transfusion reactions, massive bums, renal disease

Red blood
cells
Hematuria is the presence of intact erythrocytes.

Almost always pathological. Causes: kidney stones,
tumors, glomerulonephritis, physical trauma
The presence of leukocytes in urine is referred to as

White blood
pyuria (pus in the urine). Causes: urinary tract
cells
infection
Nitrite
Presence of bacteria. Causes: urinary tract

infection
C. MICROSCOPIC EXAMINATION
Examination of urine sediment may reveal the presence of different types of cells
such as epithelial cells, leukocytes, erythrocytes, or renal cells. Different types of
crystals, yeast, bacteria, or casts may also be present. Casts are cylindrical
structures created by protein precipitation in the renal tubules.
Procedure:
1. Transfer urine sample to a conical centrifuge tube.
2. Centrifuge your sample at a moderate speed for 5 minutes. BE SURE
TO
BALANCE CENTRIFUGE.
3. Discard the supernatant (fluid off the top) by quickly pouring off fluid.
4. Tap tube with index finger to mix sediment with remaining fluid.
5. Make a wet mount of sample by transferring 1 drop of material to a slide
and
covering with a coverslip.
6. Examine the sample under the microscope under low and high power.
7. Identify what you see by comparing to charts. Draw a few of your
observations.
Urine Analysis
Urinanalysis
Parameter
Normal Values
Aspect
Clear
Colour
Pale yellow-yellow
Atypical
Odour
Acid (5,5-6)
Reaction (pH)
No
Acid
1010-1030
Specific gravity
Negative
Leukocyte esterase
Negative
Nitrites
Negative or traces (< 30 mg/dl)

Protein
Negative
Glucose
Negative
Ketones
Negative
Hemoglobin
Negative
Bilirubin
Urobilinogen
Negative or traces (< 0,2 EU/dl <1

mg/dl)
0-4 p.v.f.
Epithelial cells
0-4 p.v.f.
Erythrocytes
0-4 p.v.f.
Pus cells
0-2 hyaline
Casts
Germs- fungi
None
No abnormal crystals present
Crystals
A few
Amorphous salts
No, some
Mucus
None
Lipid droplets
Return to Table of Contents
24-hour Urine Collection

Urinalysis parameter
Normal values
pH
4,6-8,0
Specific gravity
1003-1030
Sodium
3-6 g/24h
Potassium
2-3,5 g/24h
Chlorine
6-9 g/24h
Calcium
0,01-0,30 g/24h
Phosphorus
0,8-2,0 g/24h
Urea
20-25 g/24h
Uric acid
400-800 mg/24h
Creatinine
1-1,6 g/24h
Bilirubin
70 g/kg BW
Urobilinogen
0,05-3,5 mg/24h

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COMPLETE URINALYSIS

A. PHYSICAL CHARACTERISTICS OF URINE

Specific gravity can be determined by either of two methods using a refractometer

Collect mid-stream sample of urine in collection cup.

Clean the refractometer with kimwipes.

Albumin is normally too large to pass through

threshold levels, the untransported glucose will spill

Bilirubin comes from the breakdown of hemoglobin

Bile pigment derived from breakdown of

transfusion reactions, massive bums, renal disease

Hematuria is the presence of intact erythrocytes.

The presence of leukocytes in urine is referred to as

Presence of bacteria. Causes: urinary tract

Negative or traces (< 30 mg/dl)

Negative or traces (< 0,2 EU/dl <1

24-hour Urine Collection

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