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Urine Examination (Urine Analysis or Urine Report)

Urine Examination (Urine Analysis or Urine Report)

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Page 1: Urine Examination (Urine Analysis or Urine Report)

Urine Examination(Urine Analysis or Urine Report)

Page 2: Urine Examination (Urine Analysis or Urine Report)

Collection of Urine for Analysis

• Urine is collected over a period of 24 hours.

• A preservative (as toluene, chloroform, thymol & formalin) is added to prevent contamination of the urine

• keeping urine in refrigerator is greatly advisable especially in hot

weather.

Urine Examination(Urine Analysis or Urine Report)

Page 3: Urine Examination (Urine Analysis or Urine Report)

Urine Examination(Urine Analysis or Urine Report)

1 -Physical Examination2 -Chemical Examination

3 -Microscopic Examination4 -Microbiological Examination

Page 4: Urine Examination (Urine Analysis or Urine Report)

1 -Volume2 -Specific Gravity

3 -Aspect4 -Color5 -Odor

6 -Deposit7 -Reaction (pH)

URINE ANALYSISPhysical Examination

Page 5: Urine Examination (Urine Analysis or Urine Report)

URINE ANALYSISPhysical Examination

 

1- Volume: Normal urine volume in 24 hours is 600-2000 ml 1- Urine volume increases (Polyuria) in the following conditions:

Physiological: Increased fluid intake Diuretic

Pathological: Diabetes mellitus (type-1 & type-2) Diabetes insipidus (due to decrease of ADH) Chronic renal failure 2- Urine volume decreases (Oliguria or anuria) in the following conditions: Dehydration Acute renal failure Obstruction

Page 6: Urine Examination (Urine Analysis or Urine Report)

2- Specific gravity (SG): • Specific gravity measures solute concentration (urea and sodium). • Normally the specific gravity ranges between 1.015-1.025. 1- Increased in • Dehydration (with oliguria)• Diabetes Mellitus (with polyuria)• Acute renal failure (with oliguria) 2- Decreased in • Diabetes insipidus (with polyuria)

URINE ANALYSISPhysical Examination

Page 7: Urine Examination (Urine Analysis or Urine Report)

3- Appearance:

Normal fresh urine: clear (transparent) Abnormal : Cloudy urineIndicates possible abnormal constituents such as:• White blood cells• Epithelial cells• Crystals• Bacteria

N.B. Stored urine with no preservative & no cooling may turn clear urine samples into cloudy urine.

URINE ANALYSISPhysical Examination

Page 8: Urine Examination (Urine Analysis or Urine Report)

4- Color: Normal color: pale yellow (amber yellow)due to the presence of pigments of urobilin or urobilinogen

Abnormal colors of urine:• Colorless• Orange• Greenish yellow• Red• Black• Smoky

URINE ANALYSISPhysical Examination

Page 9: Urine Examination (Urine Analysis or Urine Report)

Color (cont.)

1- Colorless Urine:

Chronic renal failure Diabetes insipidus. 2- Orange Urine:

Ingestion of large amount of carotenoids (vitamin A)

3- Yellowish brown urine: due to presence of billirubin in cases of:

• Obstructive Jaundice • Hepatic Jaundice

URINE ANALYSISPhysical Examination

Page 10: Urine Examination (Urine Analysis or Urine Report)

Color (cont.)

4- Red urine: due to presence of blood, hemoglobin & RBCs. 5- Black urine:

Methemoglobin Homogentisic acid in alkaptonuria Malignant malaria (black water fever due to Malaria falciparum). Melanin (melanoma) 6- Smoky urine:• presence RBCs. in the urine, in cases of acute glomerulonephritis

URINE ANALYSISPhysical Examination

Page 11: Urine Examination (Urine Analysis or Urine Report)

5- Odor: Normal Urineferous odor: The normal odor of fresh voided urine sample

Abnormal Odors

1- Fruity odor due to presence of acetone in the urine as in diabetic ketoacidosis 2- Ammonia odor due to release of ammonia as result of: the bacterial action on urea in the contaminated urine or long standing exposed urine samples.

URINE ANALYSISPhysical Examination

Page 12: Urine Examination (Urine Analysis or Urine Report)

6- Deposits: • Normally the urine is devoid of deposits. • The presence of deposits is mainly due to various types of

crystals, salts and cells.

URINE ANALYSISPhysical Examination

Page 13: Urine Examination (Urine Analysis or Urine Report)

7- Reaction (pH):

Normally: The pH of urine varies from 4.6 - 8.0

1- Acidic urine:

• Large intake of meat & certain fruits (cranberries)• Metabolic & respiratory acidosis

2- Alkaline urine: • Vegetarians• Metabolic & respiratory alkalosis• Urinary tract infection by urea splitting bacteria which split urea to ammonia (alkaline)

URINE ANALYSISPhysical Examination

Page 14: Urine Examination (Urine Analysis or Urine Report)

Normal Constituents of UrineNormal urine contains about 50g of solids dissolved in about 1.5 liters of water per day. Urine contains organic and inorganic solids.

A) Chief Inorganic Solids

• Sodium, potassium & chlorides • Smaller amounts of calcium, magnesium, sulfate & phosphates• Traces of iron, copper, zinc and iodine.•

B) Chief Organic Solids:

1- Non-protein nitrogen: • amino acids, ammonia, urea, uric acid , creatine & creatinine

2- Organic acids: • lactic acid, citric acid & oxalic acid• ketone bodies (few amounts)

3- Sugars: • Normally not more than 1g of sugars is excreted in the urine per day. • Sugars cannot be detected by ordinary tests. • Very small amounts of glucose not exceeding 150 mg of glucose are normally excreted per day. • Other sugars present in urine are: pentose and lactose .• Lactosuria occurs in infant and in women during the late months of pregnancy and during lactation

URINE ANALYSISChemical Examination

Page 15: Urine Examination (Urine Analysis or Urine Report)

Abnormal Constituents of Urine

1- Proteins (proteinuria)2- Sugars (glucosuria, fructosuria & galactosuria) 3- ketone Bodies (ketonuria)4- Billirubin (billirubinuria) & Bile Salts5- Nitrites

 

 

URINE ANALYSISChemical Examination

Page 16: Urine Examination (Urine Analysis or Urine Report)

1- Proteins: (proteinuria) Proteinuria Presence of more than 150 mg proteins in urine in 24 hours

detected by ordinary laboratory means Heavy (marked) proteinuria : > 4 gm/24 hours Moderate proteinuria: 1 - 4 gm/24 hours Mild (minimal) proteinuria: < 1.0 gm/24 hours

URINE ANALYSISChemical Examination

Page 17: Urine Examination (Urine Analysis or Urine Report)

1 -Proteins: (proteinuria)

Proteinuria is divided into prerenal, renal and postrenal proteinuria.  1-Prerenal proteinuria:

Example: Bence-Jones protein: This abnormal gamma globulin (light chains only) is synthesized by malignant plasma cells (multiple myeloma). It precipitates at 60oC, redissolves at 100oC and reprecipitates on cooling.

2-Renal proteinuria: • Severe muscular exercise • After prolonged standing• Acute glomerulonephritis • Nephrotic syndrome

3- Postrenal proteinuria:• Lower urinary tract inflammation, tumors or stones.

URINE ANALYSISChemical Examination

Page 18: Urine Examination (Urine Analysis or Urine Report)

 

2 -Sugars: (glycosuria) Glucose (Glucosuria);

Presence of detectable amount of glucose in urine which occurs in the following conditions:

- Uncontrolled Diabetes Mellitus (DM) - Renal glucosuria with lowering of renal threshold : e.g. during pregnancy (gestational diabetes).

Fructose (Fructosuria)

Presence of fructose in urine & may be due to :- -Alimentary causes following the ingestion of large amounts of fructose

Fructosemia & hereditary fructose intolerance (Metabolic disorders of fructose). 

Galactose (Galactosuria):

Presence of galactose in urine& may be due to :- Alimentary causes following the ingestion of large amount of galactose. - Galactossemia

URINE ANALYSISChemical Examination

Page 19: Urine Examination (Urine Analysis or Urine Report)

3- Ketone Bodies (Ketonuria): Presence of acetone, acetoacetic acid & β hydroxybutyric acid in urine due

to:

• Diabetic ketoacidosis (uncontrolled DM)• Starvation• Unbalanced diet: high fat & low carbohydrates diet.

URINE ANALYSISChemical Examination

Page 20: Urine Examination (Urine Analysis or Urine Report)

4- Bilirubin (bilirubinuria) Billirubin appears in urine in cases of:

• Hepatocellular Jaundice: as in viral hepatitis • Obstructive Jaundice as any cause of obstruction of bile duct

URINE ANALYSISChemical Examination

Page 21: Urine Examination (Urine Analysis or Urine Report)

5- Nitrites:• In bacteruria in urine (in cases of Urinary Tract Infection, UTI)

URINE ANALYSISChemical Examination

Page 22: Urine Examination (Urine Analysis or Urine Report)