PRINCIPLE OF URINALYSIS - Austin Community College - … · Objective • Can explain : the abnormalities detected in urine • Can perform : routine urinalysis • Can interprete

PRINCIPLE OF URINALYSIS PRINCIPLE OF URINALYSIS

Vanngarm Gonggetyai

ObjectiveObjective

• Can explain : the abnormalities detected in urine • Can perform : routine urinalysis• Can interprete : the results of urinalysis

Examination of urineExamination of urine

ScreeningDiagnosis and managementFollow up and prognosis

Collection of urineCollection of urineRoutine urinalysis Fresh

First morning or random specimenMidstreamClean, dry & detergent free container

Timed specimen RefrigeratorPreservative

Specimen for culture

Clean-voided/clean-catch midstreamSterile container

Routine urinalysisRoutine urinalysis

Physical examinationChemical examinationMicroscopic examination

Routine urinalysis : Physical examinationRoutine urinalysis : Physical examinationNormal Abnormal

Colour Pale yellow Hematuria .. smoky urine HemoglobinuriaEtc.

Clarity Clear Turbid .. Cells, Organisms, etc.

Volume 600-1,600 ml(adult)

Polyuria .. >2,000 ml/dayOliguria .. <500 ml/dayAnuria .. <100 ml/day

Specific gravity

1.003-1.035 High .. Diabetes mellitusLow .. Diabetes insipidus

Routine urinalysis : Chemical examinationRoutine urinalysis : Chemical examinationSpecific gravitypHProteinSugarBlood, hemoglobin & myoglobinBile (conjugated bilirubin)UrobilinogenKetoneNitriteLeukocyte esterase

Conventional methodvs

Reagent strip

Routine urinalysis : Chemical examinationRoutine urinalysis : Chemical examination

Specific gravity

o Indirect methodo Depends on ionic concentration of urineo Not affected by high amount of glucose

and protein


pH

Fresh urineNormal .. 4.6 - 8.0Acid urineAlkaline urine


ProteinUrine protein excretion > 150 mg/day = proteinuriaMost filtered protein = albuminReagent strip is sensitive to albumin

ProteinuriaFunctional proteinuria

Organic proteinuria Pre-renal proteinuriaRenal proteinuriaPost-renal proteinuria

Vaginal discharge contamination


GlucoseReagent strip is specific for glucoseRenal threshold = 160 mg/dl

GlucosuriaWithout hyperglycemiaWith hyperglycemia


KetoneKetone bodies .. .. Beta hydroxybutyric acid

acetoacetic acidacetone

Most reagent strips detect only acetoacetic acid

KetonuriaDiabetic ketonuriaNon-diabetic ketonuria


Bile (conjugated bilirubin)

Obstructive jaundiceHepatocellular jaundice


UrobilinogenFresh urineA small amount is excreted in urine

Increased urobilinogenHemolytic jaundiceHepatocellular disease


Blood, Hemoglobin, Myoglobin

Hematuria Intact erythrocyte

Hemoglobinuria Hemoglobin from hemolysis

Myoglobinuria Myoglobin from rhabdomyolysis


NitriteNitrite-forming bacteria

Leukocyte esteraseDetects both lysed and intact leukocyte equivalent to 5 - 15 cells/HPF

Routine urinalysis : Microscopic examinationRoutine urinalysis : Microscopic examination

Fresh urineNo preservativeMidstream collection


Preparation of urine sediments


Formed element of urine

CellsCastsCrystalsOrganismsContaminants and artifacts


Cells

ErythrocyteLeukocyteEpithelial cell

Tubular cell, Oval fat bodyTransitional cellSquamous cell


Erythrocyte (Red blood cell)Pale, biconcave disc, diameter ~ 7 micronNormal .. .. 0 - 2 cells/HPF

Increased erythrocyteRenal diseasesLower urinary tract diseaseExtrarenal diseasesToxic reactionPhysiologic


Dysmorphic erythrocyteRed blood cell with cellular protrusions or fragmentationReflect glomerular originDetected by phase contrast microscope


Increased leukocyteInfection, inflammation, fever, streneous exercise

Leukocyte (White blood cell)

Granular spheres, diameter ~ 12 micron, multilobated nucleiNormal .. .. 0 - 5 cells/HPF


Increased renal tubular cellAcute tubular damage

Renal tubular cellLine the tubuleSlightly larger than leukocyteRound or polygonal shapeLarge nucleus


Oval fat bodyTubular cell that absorbed lipoprotein with cholesterol and triglyceride leaked from nephrotic glomeruliCharacteristic of the nephrotic syndrome


Transitional epithelialcell

Line the urinary tract from the renal pelvis to the proximal third of the urethraRound, oval, fusiformshapeRound centrally located nucleus

Increased : infection, CA


Squamous epithelial cell

Line the distal third of the urethraLarge and flat with abundant cytoplasm, fold marginSmall round central nucleus

Vaginal dischargecontamination


CastsTamm-Horsfall protein .. the glycoprotein secreted by the ascending loop of Henle .. forming the matrix of all casts

Hyaline castsRed blood cell castsWhite blood cell castsRenal tubular epithelial castsGranular castsFatty castsWaxy castsBroad casts


Increased inVarious renal diseasesTransiently in exercise, dehydration, fever, etc.

Hyaline castsTransparent, homogenous and colourlessCan be seen 0-2/LPF in normal


Erythrocyte (RBC) casts

Prolonged stasis leading to hemoglobin (blood) castIndication of bleeding in nephron : acute GN, lupus nephritis, nephrosclerosis, etc.

Hemoglobin castsErythrocyte (RBC) casts


Leukocyte (WBC) casts

Tubular and/or tubulo-interstitial diseases eg. acute & chronic pyelonephritis, interstitial nephritis, acute GN


Renal tubular epithelialcasts

Reflect tubular damage, e.g. acute tubular necrosis, acute allograft rejection, etc.


Granular castsGranules may originate from plasma protein aggregates as well as from cellular remnantsAppear with both pathologic and non-pathologic conditions


Fatty casts

Commonly seen with heavy proteinuriaFeature of nephroticsyndrome


Waxy casts

Homogeneously smooth with sharp margins, blunted ends and cracks along the lateral marginsExtreme stasis of urine flowAdvanced renal disease


Broad casts

Diameter 2-6 times that of normal castsIndicate tubular dilatation and/or stasis in the distal collecting ductFound in chronic renal failure / Poor prognosis


Telescoped sediment

Element of glomerulonephritis & nephrotic syndrome in the same urine specimenRbc, rbc casts, wbc, wbc casts, broad waxy casts, oval fat bodies, fatty castAdvanced renal disease eg. Lupus nephritis


CrystalsLess significant, except pathologic crystalsNormal acidic urine : Calcium oxalate, uric acid, etc.Normal alkaline urine : Calcium carbonate, triple phosphate, etc.

Abnormal crystalsCystine, acetyl sulfadiazine, cholesterol, bilirubin

Amorphous – granular precipitates : amorphous urate, amorphous phosphate


Normal crystals

Calcium oxalate Uric acid


Abnormal crystals

Cystine Acetyl sulfadiazine


Abnormal crystals

Cholesterol Bilirubin


Organisms

BacteriaFungusParasiteEtc.

Routine urinalysis : Microscopic examination Routine urinalysis : Microscopic examination

Bacteria


Fungus

Yeast Hyphae

Trichomonas vaginalisTrichomonas vaginalis


Contaminants and artifacts

Starch granuleSpermatozoa

REPORTREPORT

• CELL (10-15 high power field)0-1, 1-2, 2-3, 3-5, 5-10, 10-20,…/ HPFor numerous

• CAST (10-15 low power field)0-1, 1-2, 2-3,…/ LPF

• BACTERIA & CRYSTAL1+, 2+, 3+ or few, moderate, numerous

Reference Values for Urine SedimentReference Values for Urine Sediment

• Red blood cells 0-2/ HPF• White blood cells 0-5 / HPF• Renal epithelial cells few/HPF• Transitional epithelial cells few/HPF• Squamous epithelial cells few/HPF

Reference Values for Urine SedimentReference Values for Urine Sediment

• Casts 0-2 hyaline cast /LPF• Abnormal crystals Negative• Bacteria Negative• Yeast Negative

THANK YOU FOR YOUR ATTENTION

Documents

PRINCIPLE OF URINALYSIS - Austin Community College - … · Objective • Can explain : the abnormalities detected in urine • Can perform : routine urinalysis • Can interprete