Basic Examination of the

Urine Specimen

MR. ZUMBENG SOLOMON

ATEBUBU MUNICIPAL HOSPITAL LABORATORY
 Outline/objectives

 Give an overview of the anatomy and physiology of the

urinary system
 Explain how urine is produced and its components
 Indication for urine analysis
 Specimen collection and types of examinations
 Describe the requirements and procedure for dipstick
urinalysis using the manual method
 Results interpretation
 conclusion
 Introduction

• URINALYSIS is a simple non-invasive(most times)

diagnostic test which can provide a glimpse into a
person’s health

• It is a physical, chemical and microscopic examination of

urine via procedures performed in an expeditious,
reliable, accurate and safe manner

• Qualitative and semi quantitative evaluation of renal

products
Introduction cont.
KIDNEY nephron
Components of urine
 Function of the kidneys

• The kidneys regulate: acid-base balance;

electrolyte concentration; extracellular fluid
volume (homeostasis).
• The kidneys remove waste & water from
the blood stream and reabsorb vital
nutrients.
• The kidneys regulate the blood pressure.
• The urinary bladder stores urine.
 Indication

• Glomeralonephritis
• Diabetes mellitus
• UTI
• Tumours
• Pregnancy (not a disease)
 Specimen Collection
• Maintain patient privacy

• Do not clean the area with antiseptic

• Collect mid stream urine

 Patient instruction
‘How should I collect and store a urine sample

To collect a clean urine sample:

label the container with patient name, lab number, date of birth and
the date
wash your hands
men should wash their penis 
women should wash their genitals, including between the labia
(lips around the entrance to the vagina)
start to urinate but don’t collect the first part of urine that comes out
collect a sample of urine ‘mid-stream’ in a sterile screw-top
container
screw the lid of the container shut
wash your hands thoroughly

http://www.nhs.uk/chq/pages/how-should-i-collect-and-store-a-urine-sample.aspx?CategoryID=69&SubCategor
yID=692
 The Urine Sample(types)
 Random – most common for infection.
 Early morning urine (EMU) – has greater
concentration of substances
 Clean catch midstream (MSU) – genitalia
should be cleaned, urine is tested for micro-organisms
for presence of infection (culture & sensitivity).
 Timed – specific time of day, always discard the 1st
specimen before testing.
 24 hour – used for quantitative and qualitative
analysis of substances (nephrotic syndrome)
 Suprapubic Trans- abdominal needle aspiration of
the bladder (purest sample)
 Specimen collection
• All specimens must be properly labeled
– The laboratory request slip must accompany
the specimen
• The patient’s name
• The patient’s identification number
• The date
• The time of collection
• The type of specimen
• The attending physician’s name
• The label should be affixed on the
container, not the lid.
 The Urine Sample
• Collection and Preservation of Urine
– Types of Specimens & Containers
 Urine collected anytime of the day or night can be used for
routine urinalysis testing, BUT the sample collected the first
thing in the morning is preferred as it is the most
concentrated.
 Containers must be clean and single use
 If urine is to be cultured for bacteria, the container must be
sterile.

Sample cup for routine testing

 preservatives
 HCL, BORIC ACID, SULPHURIC
 ACID
 Normal Urine = At a glance
• a. Physical - color - normally pale yellow
– transparency - clear
– specific gravity - 1.020 - 1.030
• b. Chemical - pH
– acid in carnivores
– alkaline in herbivores
– protein - normally 0 mg/dl
– glucose - normally none
– blood - normally none
• c. Sediment - urine solids stained after
centrifugation( no finding, except scanty
epithelial cell)
• The interval of time which elapses from
collection to examination in the laboratory
is important.

• Changes which occur with time after

collection include:
– loss of ketone bodies,
– loss of bilirubin,
– overgrowth of contaminating microorganisms.
 Testing of Urine Sample (3
phases)
• Physical Examination

• Chemical Examination

• Microscopical Examination
Physical examination of urine
Done with the naked eye, a very important part of the test.
Findings should be documented.
•Volume ,not measured routinely
•Colour (Red-hematuria, drugs, White-chyluria).
Appearance-Normal –transparent (clear)
Turbidity (high wbc/high EC).
pH (slightly acid 6.0 (4.6-8.0)

Odour (normal-ammonia, infection,(fishy), high

ketones-sweet smell
Examples of Urine Color
 Visual significance of
urinalysis
 Colour: The colour and clarity of the urine has significant
implications and should always be noted. The colour of normal
urine varies with its concentration, from deep yellow to almost
clear. In disease, the colour may be abnormal due to excretion
of the endogenous pigments as well as drugs and their
metabolites.

 Odour: Odour in the urine of patients who have a urinary tract

infection, is often due to the urea-splitting organisms. This
makes it smell ammonia. The presence of urinary ketones, as
in diabetic ketoacidosis, leads to an acetone smell. The
presence of malodorous urine does not indicate the presence
of infection and does not negate the need for testing.
Chemical examination of urine
• Usually done with reagent strips
• Used to determine body processes such as
carbohydrate metabolism, liver or kidney
function.
• Used to determine infection
• Can be used to determine presence of drug or
toxic environmental substances
 URINE DIPSTICK CHEMICAL ANALYSIS

• A dipstick is a paper strip with patches

impregnated with chemicals that undergo a color
change when certain constituents of the urine
are present or in a certain concentration.

• The strip is dipped into the urine sample,

and after the appropriate number of
seconds, the color change is compared
to a standard chart to determine the
findings
Chemical Examination of Urine
• Chemical Examination of Urine
– Reagent strips
 Test pads are for pH, protein, glucose, ketone,
bilirubin, blood, urobilinogen, specific gravity,
leukocytes and bacteria
 Used only once and discarded
 Performing the chemical tests by reagent strip
• Perform within 1 hour after collection OR
• Allow refrigerated specimens to return to room
temperature
• Dip strip in fresh urine and compare color of pads to the
color chart after appropriate time period
• Instruments are available which detect color changes
electronically
 Testing the Urine Sample

• Urine Multistix
– This product made by Siemans Bayer corp.
 Normal dipstick procedure
• wear gloves
• Ensure the sample is in the correct container
• Check the appearance of sample and records result
• Ensure the strips have been stored properly & are in-date
• Remove the cap, take out strip & replace the cap on the bottle
• Using the appropriate reagent strip completely immerse all reagent areas into the
sample. Dip briefly and remove immediately to avoid dissolving out the reagents
• While removing the strip, run the edge against the rim of the urine container to
remove excess urine.
• Hold the strip in a horizontal position to prevent possible mixing of chemicals from the
adjacent areas.
• After the appropriate time, compare test areas closely with the corresponding colour
chart on the bottle label at the specified time. Hold the strip close to the colour blocks
and match carefully.
• Always record results.
 Do’s and don’ts
DO
Follow manufacturers instruction.
Ensure the sample is in the correct container for the test required (red/white top).
Ensure correct reagent strips are selected for the required test. Discuss.
Always check and record the appearance of the urine sample.
Return the top on the reagent strip bottle.
TIMING IS ESSENTIAL for reliable results.
DON’T
Remove the desiccant from the reagent strip bottle.
Touch the test areas of the strip.
Take out more strips than are required for immediate use.
 Chemical Exam of Urine
Sources of error (& preventions)
– Failure to observe color changes at appropriate time

– Failure to observe color changes under good lighting

– Testing cold specimens

 would result in a slowing down of reactions; test specimens
when fresh or bring them to RT before testing
– Inadequate mixing of specimen
 could result in false reduced or negative reactions to blood
and leukocyte tests; mix specimens well before dipping
– Over-dipping of reagent strip
 will result in leaching of reagents out of pads; briefly, but
completely dip the reagent strip into the urine
 Chemical Exam of Urine

• Handling and Storage

– Keep strips in original container, stored at RT
– Protect from moisture and volatile fumes
– Use before expiration date
– Do not touch reagent pad areas
Thoughts about urine chemical tests

– Glucose
 Presence of glucose (glycosuria) indicates that the blood glucose
level has exceeded the renal threshold
 This test result is useful to screen for diabetes
Thoughts about urine chemical tests

– Bilirubin
 Bilirubin is a byproduct of the breakdown of hemoglobin.
 Not normally found in the urine.
 Its presence may be an indication of liver disease, bile
duct obstruction or hepatitis
 Bilirubin quickly breaks down in light, resulting in false
negative results if the sample is exposed to light for a long
period of time.
Thoughts about urine chemical tests

– Ketones
 are excreted when the body metabolizes fats incompletely
(ketonuria) present in DM
 Ketones evaporate easily and the sample must be kept
tightly capped and tested within an hour of collection for
best results.
Thoughts about urine chemical tests

– Specific gravity
 reflects kidney's ability to concentrate the urine
 High specific gravity indicates a concentrated sample.
The first morning collection specimen usually has a high specific
gravity and provides the most useful urinalysis results.
 Low specific(1.007 -1.010) gravity indicates end stage
kidney disease and the urine is more ‘water-like’.


Thoughts about urine chemical tests

– Presence of blood
 may indicate infection, trauma to the urinary tract or
bleeding in the kidneys
 Positive results are also seen due to contamination with
menstrual blood


Thoughts about urine chemical tests

– pH
 measures degree of acidity or alkalinity of urine
 Normal range 4.6 -8 (avg-6)
 High-bacteriuria, diet, RF, drugs (antibiotics,
 Low-Acidosis, (metabolic, respiratory), drugs (NhCl), DM,
starvation diarrhoea
Thoughts about urine chemical tests

– Protein
 Presence of protein (proteinuria) is an important indicator of
renal disease
 False negatives can occur in alkaline or dilute urines or when the
primary protein is not albumin.
Thoughts about urine chemical tests

– Urobilinogen
 is a degradation product of bilirubin formed by intestinal
bacteria.
 It may be increased in hepatic disease or hemolytic disease
Thoughts about urine chemical tests

– Nitrite
 formed by gram negative bacteria converting urinary nitrate
to nitrite
 Any shade of pink color on this pad is considered a positive
result.
 Request for urine C/S
Thoughts about urine chemical tests

– Leukocytes (white blood cells)

 A positive leukocyte usually indicate infection, especially
when the nitrite pad is also positive.
 Thoughts about urine chemical tests

• Normal values
– Negative results for glucose, ketones, bilirubin,
nitrites, leukocyte esterase and blood
– Protein negative or trace
– pH 5.5-8.0
– Urobilinogen 0.2-1.0 Ehrlich units
 Do’s and don’ts

DO
 Follow manufacturers instruction.
 Ensure the sample is in the correct container for
the test required (red/white top).
 Ensure correct reagent strips are selected for the
required test. Discuss.
 Always check and record the appearance of the
urine sample.
 Return the top on the reagent strip bottle.
 TIMING IS ESSENTIAL for reliable results.
 Do’s and don’ts

DON’T
 Remove the desiccant from the
reagant strip bottle.
 Touch the test areas of the strip.
 Take out more strips than are required
for immediate use.
 Microscopical examination

• Used to examine the elements not visible

without a microscope
• Centrifuge spins the urine to separate
substances
• Cells (RBC & WBC) Bacteria
• Crystals Yeasts
• Casts Parasites
 Examination(Microscopy)
RBC
• Red blood cells in
urine appear as
refractile disks.
• With hypertonicity of
the urine, the RBC's
begin to have a
crenated
appearance.
 Examination(Microscopy)
RBC

1. Glomerular damage
2. Tumors which erode the urinary tract
anywhere along its length,
3. Kidney trauma, urinary tract stones,
4. Renal infarcts, acute tubular necrosis,
5. Upper and lower urinary tract infections,
nephrotoxins, and physical stress.
6. Red cells may also contaminate the urine
from the vagina in menstruating women or
7. From trauma produced by bladder
catherization.
The presence of dysmorphic RBC's in urine suggests a
glomerular disease such as a glomerulonephritis.

Normal
RBC
White Blood Cells : When we see
this cell?

• Infection (pyuria)
• Acute glomerulonephritis
These white blood cells in urine have lobed
nuclei and refractile cytoplasmic granules.
A white blood cell is seen at the left and a red blood cell at the right for

size and morphologic comparison

 Important

• Tuberculosis may be a cause for a 'sterile

pyuria' in which routine cultures fail to
grow bacterial organisms, but
inflammation is present.
 Epithelial Cells

• Acute tubular
necrosis
• UTI
 Oval Fat Bodies

• When lipiduria occurs, these cells contain

endogenous fats. When filled with
numerous fat droplets, such cells are
called oval fat bodies
Oval fat bodies consist of degenerated tubular cells
containing abundant lipid, which appears refractile
 Casts

• Hyaline casts are composed primarily of a

mucoprotein (Tamm-Horsfall protein)
secreted by tubule cells.
Hyaline casts can be seen even in healthy
patients.
The presence of this red blood cell cast in on urine
microscopic analysis suggests a glomerular or renal
tubular injury.
This white blood cell cast suggests an acute
pyelonephritis.
This renal tubular cell cast suggests injury to the
tubular epithelium(ATN).
Presence of Granular cast
suggest Chronic disease:
chronic GN
Granular cast later form a finely granular cast,
and ultimately, a waxy cast.

Waxy cast. Note that the edges are

sharp and there are "cracks" in this
cast.
 Yeast
• Yeast cells may be contaminants or
represent a true yeast infection.
• Most often they are Candida, distinguished
by their tendency to bud
 Crystals

MAY BE ASSOCIATE WITH STONE IN THE Urinary

system.
These are oxalate crystals, which look like little
envelopes (or tetrahedrons, depending upon
your point of view).
These "triple phosphate" crystals
look like rectangles, or coffin lids.
Thank you