p002 Urine Routine Examination

 Types of Urine samples
 Steps involved in analysis of urine samples
 Physical examination
 Chemical analysis
 Microscopic analysis
Urine a waste products of the body metabolism
produced by the Kidneys
It is examined to detect diseases of the kidney, the

Urinary tract (renal pelvis, ureters and bladder).
It is also tested to detected certain metabolic

diseases.
 http://www.aboutkidshealth.ca/en/howthebodyworks/kidneysandbladderoverview/thekidneysoverview/pag
es/urineformation.aspx
• Appropriate urine samples is required for
investigation of suspected disease condition.
• Patient should be provide appropriate urine
container.
Types of Urine samples
1. Random or Spot urine sample

It is useful for qualitative chemical testing
Approximately 10ml of urine samples voided at any time of day should

be collected into a clean and secured container (Universal bottle)
2. Mid-stream urine sample (MSU)
MSU is used for microscopy and culture to investigate
bacterial infections of the urinary tract.
Collecting MSU
 Provide the patient with a sterile bottle and tell the
patient to do the following

 Pass a small amount of urine into the toilet or latrine.
This will ensure that bacterial, cells or parasites that

have entered the urether from the vagina or perineal are
flushed away.
 Collect about 20 ml of urine into bottle
 Pass the remaining urine into the bladder into the toilet
or latrine
 Secure the lid immediately and bring it to the lab.
3. First morning urine sample
It is useful for the detection of Mycobacterium infection of
the urinary tract.
Collecting first morning urine

 Provide the patient with a clean container and tell the
patient
 To empty the bladder into the toilet or latrine before
retiring for the night

 On arising in the morning, collect all urine into the
container
 Secure the lid of the container immediately
4. Terminal urine samples
This type of urine sample is often requested when ova of
Schistosoma haematobium is suspected
Collecting Terminal urine samples

 After providing the patient with a clean container, tell the
patient to do the following:

 Void most of the urine in the bladder into the toilet or
latrine
 Collect the last portion of urine into the container
 Secure the lid of the container and bring the sample to
the laboratory.
5. Collecting of urine from Infants and babies
A random urine sample from an infant collected into a clean
contain from babies can be used for f urine investigations.
Collecting Sample
 Patients should be advised to do the following:
 Clean the perineal area of the child carefully with soap and
water and rinse thoroughly with clean water.

 Dry and leave the perineal area uncovered.
 Ask the mother to sit with the child, and feed if possible.
 With the provider container given to the mother, ask the
mother to catch a few drops of urine as soon as the child

urinates.
 Secure the lid and bring to the lab.
Method for Urinalysis
 Macroscopic - Observation of appearance
 Colour -
 Turbidity - clear, cloudy, bloody or whitish.
 Odour (smell)
 Urine chemistry
Specific gravity (SG), Protein, Glucose, ketones,
Bilirubin, Urobilinogen, Haemoglobin, Nitrite and
leulocytes.
 Microscopic analysis of urine sample
Epithelia cells, pus cells, yeast cells (candida), parasites
(Shistosoma spp.), casts or crystals.
 Colour
 Normal Urine
Clear, pale to dark yellow in colour ( Dilute – pale yellow,
concentrated – Dark yellow).
 Very Pale colour indicates high fluid intake
 Colour of urine can vary based on medications, medical condition,
or state of health of the patient.
 Odour
Presence of ketone bodies gives urine a sweet or

fruity smell
Bacteria contaminated urine may give a pungent

smell due to formation of ammonia.
 Turbidity (Appearance)
Normal urine is usually clear.
 Cloudy - pus cells and/ bacteria

 Bloody and cloudy - Urinary schistosomiasis
 Brownish & cloudy - intravascular haemolysis,
& blackwater fever
 Yellowish brown or green brown - Jaundice, bile pigments
 Milky white - Filariasis

Urinary tract infection
Bladder cancer
Kidney problems
Inflammation or infection of the prostate gland
Sexually transmitted diseases
Cardiovascular diseases, including hypertension and
heart failure
Certain autoimmune diseases
Heat exposure or dehydration
Diabetes
Sickle cell anemia
Leukemia
Lymphoma
Method for Urine examination
1. Urine Chemistry
 Urinalysis test strips
• Easily available
• Cheap and easy to perform
Principle
• The reagent pads react with the sample urine to
provide a standardized visible colour reaction within 30
seconds to one minute.
• The colour is then visually compared to the included
colour chart to determine the level of each chemical
factor.
Procedure
 Pour about 10 ml of the urine sample into a centrifuge
tube. (Sample-First void urine (morning) collected into a clean urine container. First morning
samples contain the highest concentration of target markers.)
 Label the centrifuge tube with patients Lab. No.
 Remove one reagent strip from the bottle and
immediately replace the container cap.
 Completely immerse the reagent pads of the strip in the
urine sample and then remove immediately to avoid
dissolving out the reagent pads.
 While removing the reagent strip, run the edge of the
strip against the rim of the specimen container to remove
excess urine.
Method for urine examination (cont.)
• Hold the strip in a horizontal position to prevent
possible cross contamination of chemicals located
in adjacent
• Compare the colour change of reagent pads to the
corresponding colour chart on the bottle label.
• Read results according to the chart's time frame for
each panel tested.
• Record the results
 Specific gravity (SG) - Normal 1.002 – 1.024
(SG is proportional to the urea and sodium concentration of the person)
Higher SG - presence of glucose, protein, heavy metals.

 pH - Normal and abnormal urinary pH may range from
5 to 9. First morning urine from healthy individuals will

usually range from 5 to 6.
 Protein -Protein is usually not detectable in normal

urine. A colour matching any block greater than
"Trace" indicates significant proteinuria.
• Glucose - Glucose should not be detected in normal
urine. Positive (indicative of Diabetes millitus).
• Ketones - The presence of elevated levels of ketones

in human urine is a primary indicator that the body is
in ketosis.
Ketosis means the body's stored fat cells are being
utilized as a primary fuel source to produce energy.
 Bilirubin - Elevated is indicative of the following:
hepatocellular jaundice - Yellow brown colour urine
Obstructive jaundice - Yellow green colour urine
 Haemoglobin - Elevated is indicative of intravascular

haemolysis
 Nitrate – Healthy people are negative for nitrate. Positive

for UTIs’ associated with nitrogen-reducing bacteria.
 Leukocytes – indicative of inflammation of the urinary

tract.
3. Microscopy
 After performing the chemical analysis
 Spin the Centrifuge tubes at medium speed for 2
mins in an electric centrifuge.

 Decant the supernatant into a bucket with disinfect
marked “ body fluids’.

 Resuspend the sediments by tapping the bottom of
the centrifuge tube.

 Transfer a small quantity of the deposit onto a clean
glass slide.
 Put on a cover slip, label the slide with patients Pat.
No.
 Place the slide on the microscope stage and
examine with 10X objective of the microscope.

Swing the objective to 40 X and open the iris
diaphragm very slightly to allow just enough to
enable good contrast for cells and background.
 Count the number of cells and casts in high power
fields.
 Find an average no. of cells and cast per field.
 Note crystals and amorphous salts and record.

Expected Results
 Cellular Elements
• Cell Types Observed in Urine Sediment
• Squamous Epithelial Cells , Transitional Epithelial Cells ,
Epithelial Cell Groups
• White Blood Cells, Red Cell (Crenated Red Cells,
Swollen RBCs) Ghost Cells, Yeast
• Bacteria
• Candida (Yeast cells)
Crystals
• Normal Crystals
• Uric Acid Crystal Morphology, Calcium Oxalate
Crystals,Amorphous Urates, Crystals in Normal Alkaline
Urine, Calcium Carbonate Crystals , Ammonium Biurate
Crystals
 Abnormal Crystals
 Leucine Crystals
 Tyrosine Crystals
 Cystine Crystals
 Cholesterol Crystals
Formation and Significance of Casts
 Recognition and Identification
 Hyaline Casts, Cellular Casts (White Cell Casts, Red Cell
Casts, Renal Tubular Epithelial Cell Casts & Squamous
Epithelial Cell cast )
 Granular Casts, Waxy Casts, &Fatty Cast
 Artifacts
Fibers, hair, oil droplets, Air bubbles
Urine Red Blood cells
Round, slightly red-tinged, smooth

textured cells, which may be biconcave
in fresh urine.
They do not contain nucleus.
They are about 7um in diameter
May be spiky (crenated) in stored urine
May lyse in very alkaline or dilute
(USG < 1.008) urine
????
Compared to fat droplets: RBC are more uniform and

red-tinged versus
fat droplets are more variable in shape, slightly greenish-
tinged (or refractile), have a darker edge, are more
globular shape (this can be visualized when you focus up
and down) and usually float to the top of the coverslip
(thus when fat droplets are in focus, the other urine
constituents are out of focus - see lower panel on left)
– Cellular Elements of Urine
• Urine white blood cells
Normal
<2/hpf in men and <5/hpf in women
• Round, colourless cells with a grainy texture (see upper panel on left -
bacterial rods are also visible in the background), may see nuclei of
cells. May lyse in very alkaline or dilute (USG < 1.008) urine
Variable size and shape (depends on origin).
 Round or polygonal, pear-shaped, caudate (pelvis), tailed, spindle, fatty
inclusions with storage.
Transitional epithelia cell

Squemous epithelia cells
flat cells, large, irregular shaped, From renal pelvis, ureters, urinary
bladder and/or urethra
contain a nuclear or small central Transitional cells are smaller with
nuclues, present as single cells (shown
rounder (not as angular) borders
on left) or in variably-sized clusters . Can be seen in normal urine (few
Represent contamination (from skin, in samples collected by mid-stream
catch or cystocentesis, more in
genital tract)in voided urine
catheterized specimens.
Uncommon Crystals
Uric acid crystals (Acidic: pH < 7)
Yellow, red-brown or brown, rarely colorless
hexagonal plates or needles (rare)
Variable: Rhomboid to diamond crystals, often
with pointed ends, hexagonal flat crystals, rosettes,
barrel shapes
Cystein crystals (neutral to acidic: pH ≤ 7)

Flat colorless hexagonal plates, which often
aggregate
Indicative of cystinuria, a rare inborn error of
amino acid metabolism.
Tylosine crystal (Acidic: pH < 7)

Fine colourless to brownish needles
Indicate severe liver disease or conditions
causing aminoaciduria in humans
Cholesterol crystallizes
They are thin rectangular plates with
one of the corners (sometimes two or
more) having a square notch.
These crystals are seen in degenerative
kidney diseases.
The presence of these crystals is
normally accompanied by a heavy
proteinuria.
Bilirubin Crystals (Acidic: pH < 7)
Small needle-like to granular yellow or yellow-
brown crystals
Indicates bilirubinuria due to conjugated (direct)
bilirubin
Calcium Oxalate (neutral to acidic: pH ≤ 7)

Is an indication of a pathological massive
precipitation
The classic crystal shape is the eight-face bi-
pyramid
Colorless octahedrons, "envelopes
Uric acid crystals
Rhombus shaped, hexagonal plate, the needle
and the rosette.
Yellow colour or brownish colour, intensity of
the colour depends on the thickness of the
crystal
Amorphous Crystals Phosphates: pH ≥ 7
Under the microscope, amorphous urates

appear as yellow-brown mass of small
rounded particles.
Amorphous urates are of little clinical
value.
Mimic bacterial cocci - perform a gram
stain to differentiate.
Magnesium ammonium phosphate,

neutral to alkaline: pH ≥ 7
common in bacterial-induced infection
 Urinary castes are formed in the lumen of the tubule
of the kidney.
 The tubules secrete a protein called Tamm-Horsefall
mucoprotein secreted by epithelial cells lining the

loops of Henle, the distal tubules and the collecting
ducts.
The factors responsible for the precipitation of this
mucoprotein are not fully understood, but may relate to the
concentration and pH of urine in these areas.
Casts have a parallel sides and are rounded or blunted at
both ends.
• Casts may form in the presence or absence of cells
in the tubular lumen.
• If cells (epithelial cells, WBC) are present as a cast
forms, they may adhere to, and subsequently be
surrounded by, the fibrillar protein network.
Examples
• Gradula cast
• Hyaline cast
• Cellular cast (Red cell casts, White cell cast,
epithelial cell cast)

• waxy cast
• fatty cast.
Red cell cast
 It is indicative of a glomerular disease
found in acute glomerulonephritis and

in renal infarction
White cell cast

Compared to RBC casts, the WBC's
are larger, have nuclei and contain
cytoplasmic granules.
The cast takes the shape of the renal
tubule.
Epithelial cell cast (rarely seen in urine)

It presense is indicative of tubular
degeneration and necrosis
Present in severe chronic renal disease
Epithelial cell may be arranged
hephazardly.
Gradular Cast
This indicates significant renal diseases.
It occurs when there is massive
degeration of cellular cast or aggregation
of serum protein.
Hyaline casts
They are colourless, homogeneous,
trasparent with round ends.
They are seen in increased numbers in the
mildest kind of renal disease.
Various forms of presentation of casts
Parasites in Urine
Schistosoma haematobium -
(note terminal spine of egg)
(400X)
Candidal albicans (Fungi)
Yeasts in unstained urine sediments
are round to oval in shape, colorless,
and may have obvious budding (upper
panel).
They can represent contaminants,
however, their are significant.
 The lower photo shows
pseudohyphae formation by the yeasts
(Candida albicans).
 What organism is this ?
 What are its’morphological
features?
Wuchereria bancrofti
 Discussion

p002 Urine Routine Examination

Uploaded by

Copyright:

Available Formats

p002 Urine Routine Examination

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

p002 Urine Routine Examination

Uploaded by

Copyright:

Available Formats

 Types of Urine samples

 Steps involved in analysis of urine samples

It is examined to detect diseases of the kidney, the

It is also tested to detected certain metabolic

Types of Urine samples

1. Random or Spot urine sample

Approximately 10ml of urine samples voided at any time of day should

patient to do the following

This will ensure that bacterial, cells or parasites that

Collecting first morning urine

retiring for the night

Collecting Terminal urine samples

patient to do the following:

 Secure the lid of the container and bring the sample to

water and rinse thoroughly with clean water.

 With the provider container given to the mother, ask the

mother to catch a few drops of urine as soon as the child

Presence of ketone bodies gives urine a sweet or

Bacteria contaminated urine may give a pungent

 Cloudy - pus cells and/ bacteria

 Milky white - Filariasis

Inflammation or infection of the prostate gland

Sexually transmitted diseases

Cardiovascular diseases, including hypertension and

Heat exposure or dehydration

Sickle cell anemia

Higher SG - presence of glucose, protein, heavy metals.

5 to 9. First morning urine from healthy individuals will

 Protein -Protein is usually not detectable in normal

• Ketones - The presence of elevated levels of ketones

 Haemoglobin - Elevated is indicative of intravascular

 Nitrate – Healthy people are negative for nitrate. Positive

 Leukocytes – indicative of inflammation of the urinary

 Spin the Centrifuge tubes at medium speed for 2

mins in an electric centrifuge.

marked “ body fluids’.

the centrifuge tube.

examine with 10X objective of the microscope.

 Note crystals and amorphous salts and record.

Round, slightly red-tinged, smooth

Compared to fat droplets: RBC are more uniform and

Transitional epithelia cell

Cystein crystals (neutral to acidic: pH ≤ 7)

Tylosine crystal (Acidic: pH < 7)

Calcium Oxalate (neutral to acidic: pH ≤ 7)

Under the microscope, amorphous urates

Magnesium ammonium phosphate,

mucoprotein secreted by epithelial cells lining the

• Cellular cast (Red cell casts, White cell cast,

epithelial cell cast)

found in acute glomerulonephritis and

White cell cast

Epithelial cell cast (rarely seen in urine)

You might also like