LESSON 4 Physical Examination of Urine

PHYSICAL
EXAMINATION OF
URINE
LECTURE #4 IN AUBF
PHYSICAL EXAMINATION OF URINE
• The physical examination of urine includes the determination of the urine color, clarity, and
specific gravity.
A. Color :
➢ The color of urine varies from almost colorless to black.
➢ These variations may be due to normal metabolic functions, physical activity, ingested
materials, or pathologic conditions.
➢ A noticeable change in urine color is often the reason that a patient seeks medical advice; it
then becomes the responsibility of the laboratory to determine whether this color change is
normal or pathologic.
NORMAL URINE COLOR :

• Common descriptions include pale yellow, yellow, and dark yellow.
• Care should be taken to examine the specimen under a good light source, looking down through the container
against a white background.
• The yellow color of urine is caused by the presence of a pigment, which Thudichum named urochrome in 1864.
• Urochrome is a product of endogenous metabolism, and under normal conditions the body produces it at a constant
rate.
• The actual amount of urochrome produced is dependent on the body’s metabolic state, with increased amounts
produced in thyroid conditions and fasting states.
• Urochrome also increases in urine that stands at room temperature
NORMAL URINE COLOR :

• Two additional pigments, uroerythrin and urobilin, are also present in the urine in much
smaller quantities, and contribute little to the color of normal, fresh urine.
• The presence of uroerythrin, a pink pigment, is most evident in specimens that have
been refrigerated, resulting in the precipitation of amorphous urates. Uroerythrin
attaches to the urates, producing a pink color to the sediment.
• Urobilin, an oxidation product of the normal urinary constituent urobilinogen, imparts an
orange-brown color to urine that is not fresh.
URINE CLARITY :
Clarity” is a general term that refers to the transparency or turbidity of a urine specimen. In
routine urinalysis, clarity is determined in the same manner that ancient physicians used:
• by visually examining the mixed specimen while holding it in front of a light source. The
specimen should, of course, be in a clear container.
• Color and clarity are routinely determined at the same time.
• Common terminology used to report clarity includes clear, hazy, cloudy, turbid, and
milky.
NORMAL URINE CLARITY

• Freshly voided normal urine is usually clear, particularly if it is a midstream clean-catch
specimen.
• Precipitation of amorphous phosphates and carbonates may cause a white cloudiness.
NON PATHOLOGIC TURBIDITY :

• Refrigerated specimens frequently develop a thick turbidity caused by the precipitation
of amorphous phosphates, carbonates, and urates.
• Amorphous phosphates and carbonates produce a white precipitate in urine with an
alkaline pH, whereas amorphous urates produce a precipitate in acidic urine that
resembles pink brick dust due to the presence of uroerythrin.
( PATHOLOGIC CAUSES OF TURBIDITY)
• The most commonly encountered pathologic causes of turbidity in a fresh specimen are
RBCs, white blood cells (WBCs), and bacteria caused by infection or a systemic organ
disorder.
• Other, less frequently encountered causes of pathologic turbidity include abnormal
amounts of nonsquamous epithelial cells, yeast, abnormal crystals, lymph fluid, and
lipids.
• Current criteria used to determine the necessity of performing a microscopic
examination on all urine specimens include both clarity and chemical tests for RBCs,
WBCs, bacteria, and protein.
SPECIFIC GRAVITY
• Specific gravity is defined as the density of a solution compared with the density of a
similar volume of distilled water (SG 1.000) at a similar temperature.
• Because urine is actually water that contains dissolved chemicals, the specific gravity of
urine is a measure of the density of the dissolved chemicals in the specimen.
• As a measure of specimen density, specific gravity is influenced not only by the number of
particles present but also by their size.
• The specific gravity of the plasma filtrate entering the glomerulus is 1.010.
• The term isosthenuric is used to describe urine with a specific gravity of 1.010. Specimens below 1.010
• are hyposthenuric, and those above 1.010 are hypersthenuric.
• One would expect urine that has been concentrated by the kidneys to be hypersthenuric, but this is not
always true.
• Normal random specimens may range from approximately 1.002 to 1.035, depending on the patient’s
amount of hydration.
• Specimens measuring lower than 1.002 probably are not urine.
• Most random specimens fall between 1.015 and 1.030.
A. Refractometer :
➢ Refractometry determines the concentration of dissolved particles in a specimen by
measuring refractive index.
➢ Refractive index is a comparison of the velocity of light in air with the velocity of light in
a solution.
➢ The concentration of dissolved particles present in the solution determines the velocity
an angle at which light passes through a solution.
REFRACTOMETER:
• the specific gravity scale is calibrated in terms of the angles at which light passes through
the specimen.
• Temperature corrections are not necessary because the light beam passes through a
temperature compensating liquid prior to being directed at the specific gravity scale.
• Temperature is compensated between 15°C and 38°C.
• Corrections for glucose and protein must be calculated by subtracting 0.003 for each
gram of protein present and 0.004 for each gram of glucose present
( COMPUTATION OF CORRECTION )
Ex: A specimen containing 1 g/dL protein and 1 g/dL glucose
has a specific gravity reading of 1.030. Calculate the corrected reading.
REFRACTOMETER CALIBRATION :
• The refractometer is calibrated using distilled water that should read 1.000.
• If necessary, the instrument contains a zero setscrew to adjust the distilled water reading .
• The calibration is further checked using 5% NaCl, which as shown in the refractometer
conversion tables should read 1.022 ± 0.001, or 9% sucrose that should read 1.034 ± 0.001.
Urine control samples representing low, medium, and high concentrations should also be run
at the beginning of each shift.
▪ Calibration and control results are always recorded in the appropriate quality control records.
Abnormally high
results—above
1.040—are seen in
patients
who have recently
undergone an
intravenous
pyelogram.
This is caused by the
excretion of the
injected radiographic
contrast media
B. OSMOLALITY :
• As stated previously, specific gravity depends on the number of particles present in a
solution and the density of these particles;
• osmolality is affected only by the number of particles present.
• When evaluating renal concentration ability, the substances of interest are small
molecules, primarily sodium (molecular weight 23) and chloride (molecular weight 35.5).
• However, urea (molecular weight 60), which is of no importance to this evaluation, will
contribute more to the specific gravity than will the sodium and chloride molecules.
• An osmole is defined as 1 g molecular weight of a substance divided by the number of

particles into which it dissociates.
• A nonionizing substance such as glucose (molecular weight, 180) contains 180 g per osmole,
whereas sodium chloride (NaCl) (molecular weight 58.5), if completely dissociated, contains
29.25 g per osmole. Just like molality and molarity, there are osmolality and osmolarity.
• An osmolal solution of glucose has 180 g of glucose dissolved in 1 kg of solvent. An osmolar
solution of glucose has 180 g of glucose dissolved in 1 L of solvent.
• The unit of measure used in the clinical laboratory is the milliosmole (mOsm), because it is
not practical when dealing with body fluids to use a measurement as large as the osmole (23
g of sodium per kilogram).
c. Reagent Strip ( specific gravity )

➢ The reagent strip reaction is based on the change in pKa (dissociation constant) of a polyelectrolyte in an
alkaline medium.
➢ The polyelectrolyte ionizes, releasing hydrogen ions in proportion to the number of ions in the solution.
➢ The higher the concentration of urine, the more hydrogen ion are released, thereby lowering the pH.
➢ Incorporation of the indicator bromthymol blue on the reagent pad measure the change in pH.As the
specific gravity increases, the indicator changes from blue (1.000 [alkaline]), through shades of green, to
yellow (1.030 [acid]).
➢ Readings can be made in 0.005 intervals by careful comparison with the color chart.
Urine Odor :
• Although it is seldom of clinical significance and is not a part of the routine urinalysis,
urine odor is a noticeable physical property.
• Freshly voided urine has a faint aromatic odor.

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PHYSICAL

NORMAL URINE COLOR :

NORMAL URINE COLOR :

NORMAL URINE CLARITY

NON PATHOLOGIC TURBIDITY :

• An osmole is defined as 1 g molecular weight of a substance divided by the number of

c. Reagent Strip ( specific gravity )

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