Urinalysis PDF

• At the end of the session students will be able to:
• define urinalysis
LEARNING • discuss different process in urine analysis
• describe physical characteristics of urine
OBJECTIVES: • explain importance of urinalysis as diagnostic tool
• predict the outcomes of urinalysis results
Urine Sample Cup or container
Collection • The laboratory needs at least 10 ml of urine. The
perineal area in women or the end of the penis in
of
men should be cleaned before the urine is
collected. For a female, collecting midstream
specimens:
urine lessens the contamination from vaginal
secretions or menstrual flow. Urine specimens
need to be examined within 2 hours. Urine that is
left to standing too long becomes alkaline because
bacteria begins to split the urea contained in urine
into ammonia. Visualization of urine and other
tests are inaccurate if the pH of the urine
specimen has become highly alkaline. A urine
specimen should be refrigerated if it cannot be
sent to the laboratory within 2 hours.
Urine analysis, also called Urinalysis-
What is one of the oldest laboratory
procedures in the practice of medicine
Urine
Analysis? Also known as Urine –R&M(routine &
microscopy)
Is an array of tests performed on

urine, and one of the most common
General evaluation of health
Diagnosis of disease or disorders of the kidneys or

urinary tract
Why Diagnosis of other systematic disease that affect
urinalysis? kidney function
Monitoring of patients with diabetes
Screening for drug abuse (e.g. Sulfonamide or

aminoglycosides)
Improper collection----may invalidate
the results
Collection of
urine Containers for collection of urine should
be wide mouthed, clean and dry.
specimens
Analyzed within 2 hours of collection
else requires refrigeration.
Urinalysis; What to look for?
Urinalysis consists of the
following measurements:
Macroscopic or physical
examination
Chemical examination
Microscopic examination
od the sediment
Physical examination of urine
Examination of physical characteristics:
Volume
Color
Odor
pH
Specific gravity (the refractometer or reagent strip is used to measure specific gravity)
 Normal- 1-2.5 L/day
V  Oliguria- urine output < 400mL/day
Seen in:
O -- Dehydration
-- Shock
L --Acute glomerulonephritis
--Renal Failure
 Polyuria-Urine output >2.5L/day
U Seen in:
-- Increased water ingestion
M --Diabetes mellitus and insipidus
 Anuria- urine output<100mL/day
E Seen in:
-- Renal shut down
C Normal pale yellow in color due to
pigments urochrome, urobilin and
O uroerythrin.
Cloudiness may be caused by excessive
L cellular material or protein,
crystallization or precipitation of non
O pathological salts upon standing at room
temperature or in the refrigerator.
R Color of urine depending upon its
constituents.
Color
O Normal aromatic due to the volatile fatty acids
On long standing ammonical (decomposition of
D urea forming ammonia which gives a strong

ammonical smell)
Foul, offensive pus or inflammation
O Sweet diabetes
Fruity Ketonuria
R Maple syrup like maple syrup urine disease
Rancid Tyrosinaemia
pH • Reflects ability of kidney to maintain normal
hydrogen ion concentration in plasma & ECF
• Urine pH ranges from 4.5 to 8
• Normally it is slightly acidic lying between 6-6.5
• Tested by:
Litmus paper
pH paper
Dipsticks
• Acidic Urine Ketosis (diabetes, starvation, fever),
systematic acidosis, UTI-E.coli
S
P
E • It is measurement of urine
C density which reflects the
I
F ability of the kidney to
I concentrate or dilute the
C
urine relative to the plasma
G from which it is filtered.
R • Measured by:
A
V Urinometer
I Refractometer
T
Y dipsticks
A sample of well-mixed urine (usually 10-
15mL) is centrifuged in a test tube @ relatively
low speed (about 2000-3000 rpm) for 5-10
minutes which produces a concentration of
Microscopic sediments at the bottom of the test tube.
examination
of Urine A drop of sediment is poured onto a glass slide,
a thin slice of glass (coverslip) is placed over it
and observed under microscope.
• A variety of normal and abnormal
cellular elements may be seen in urine
sediment such as:
 RBC
 WBC
 Mucus
 Various epithelial cells
 Various crystal
 Bacteria
 Casts
Per High Power Field (HPF) (400x)
-- >3 erythrocytes
-- >5 leukocytes
Abnormal -- > 2 renal tubular cells
Finding: • -- > 10 bacteria
Per Low Power Field (LPF) (200x)

• -- >3 hyaline casts or >1 granular casts
• -- > 10 squamous cells ( indicative of contaminated
specimen)
• -- > any other casts (RBC, WBC)
Presence of :
Fungal hyphae or yeast, parasite, viral

inclusion
Continuation……..
Pathological crystals (cystine, leucine,
tyrosine)
Large number of uric acid or calcium

oxalate crystal
is the presence of abnormal numbers of red
cells in urine due to any of several possible
causes.
Glomerular damage,
Tumor which erode the urinary tract
anywhere along its length,
Hematuria Kidney trauma,
Urinary tract stones,
Acute tubular necrosis,
Upper and lower urinary tract infections,
nephrotoxins
Microscopic
examination of
urine
• Urinary casts are cylindrical
aggregations of particles that
form in the distal nephron,
dislodge, and pass into the urine.
In urinalysis they indicate kidney
disease.
Casts • They form via precipitation of
Tamm-Horsfall mucoprotein
which is secreted by renal tubule
cells.
Chemical Analysis of Urine
The chemical analysis of urine us undertaken to evaluate the levels of the following
components:
Protein Glucose Ketones Occult blood
Bilirubin Urobilinogen Bile salts

The presence of normal and abnormal
chemical elements in the urine are detected
using dry reagent strips called dipsticks.
Chemical When the test strip is dipped in urine the
analysis of reagents are activated and a chemical
reaction occurs.
urine The chemical reaction results in a specific
color change.
Microscopic
view with
UTI
Resources
• Urinalysis: Part 1. 2006 The University of Iowa (accessed 17 Aug 2007)
Available from:
http://www.medicine.uiowa.edu/cme/clia/modules.asp?testID=19
• http://www.utmem.edu/nephrology/documents/powerpoint-urinalysis-
files/frame.htm
• http://www.texascollaborative.org/spencer_urinalysis/ds_overview.htm
• http://www.nlm.nih.gov/medlineplus/ency/article/003583.htm

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• At the end of the session students will be able to:

Is an array of tests performed on

Diagnosis of disease or disorders of the kidneys or

Monitoring of patients with diabetes

Screening for drug abuse (e.g. Sulfonamide or

D urea forming ammonia which gives a strong

Per Low Power Field (LPF) (200x)

Fungal hyphae or yeast, parasite, viral

Large number of uric acid or calcium

Protein Glucose Ketones Occult blood

Bilirubin Urobilinogen Bile salts

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