Professor: SENG SEREYprepared by: NAM MENG LY

URINE ANALYSIS

• Urine Analysis: is an array of tests performed on urine and one of the most common method of medical diagnosis.

• Why we have to do urine analysis?

• - General evaluation of health • -Diagnosis of diseases or disorders of kidney and Urinary tract

• -Diagnosis of other systemic disease that affect kidney function

• -Monitoring of patients with diabetes• -Screening for drug abuse ( Sulfonamide and Aminoglycoside )

Collecting Specimens

• Type Urine examination

1.Macroscopic examinationVolume ColorOdorpHSpecific Gravity

A, Volume Normal: 600-1600ml

1.Polyuria: > 2000ml 2.Oliguria: < 400ml

-Causes: -Causes.DM .Dehydration.DI .Renal Ischemia.Polycystic .Acute Tubular Necrosis.Chronic renal failure .Obstruction to Urinary Tract.Diuretic .Acute Renal Failure.IV saline/Glucose

• B, Color Normal : clear and pale yellow

Colorless: dilution , DM, DI, DiureticMilky: Purulent GUT infection, ChyluriaOrange: Fever, excessive sweatingRed: Beetroot ingestion, hematuriaBrown: Melanin, Alkaptunuria.

• C, Odor

• D, pH (Normal: 4.6-8 ) Acidic Urine: Alkaline Urine:

-Ketosis Diabetes -Strict Vegetarian-Systemic acidosis -Systemic Alkalosis-UTI => E.Coli -UTI =>

Proteus-Acidification Therapy -Alkalization

TherapyE, Specific Gravity: ( Normal 1,016-1,022) depends on the concentration of various solutes in

urine. High SG: Hypersthenuria

causes by all causes of oliguria and Glycosuria Low SG: Hyposthenuria

caused by all causes of polyuria

• 2.Microscopic examination

A sample has been taken 10-15ml into a tube for 5-10min which produces a concentration of sediment at the bottom.

A drop of sediment is poured onto a glass slide with coverslip put onto observed under microscopes.

• A variety of normal and abnormal cellular elements in urine such as:

-RBC-WBC-Mucus-Various Epithelial Cells-Various Crystal -Bacteria-Casts

Abnormal Finding :.>3 RBC.>5 WBC.>2 Renal Tubular Cells.> 10 Bacteria.>3 Hyaline casts.>10 Squamous Cells ( Indicated of contaminated

specimen) .Fungal hyphae or Yeast , Parasite, Viral Inclusion .Pathological Crystal ( cystine, leucine, tyrosine.) .Large number of Uric acid or Ca oxalade.

• Presents of Casts:

Type of Casts:

Acellular casts Cellular casts

Hyaline Casts (fever, exercise) RBC casts( Glomerular damage)Granular casts (albumin) WBC casts(Infection)Waxy casts( Renal Failure) Epithelial casts(toxic ingestionFatty casts ( NS, DM, SLE,ATN) Hg,ATN)Pigment casts( Hemolytic anemia, Rhabdomyosis, Liver disease)Crystal casts( crystallized urinary solute: Oxalate urate,,,)

• 3.Chemical Examinaion

The chemical analysis of urine are undertaken to evaluate the level of the following components:1.Protein ( Heat and Acetic acid test)2.Glucose ( Benedict test) 3.Ketone4.Blood5.Bilirubin6.Urobilinogen7.Bile salts

The Dipstick method

1.Tests for proteins

•Test – HEAT & ACETIC ACID TEST•Principle-proteins are denatured & coagulated on heating to give white cloud precipitate.

•Method-take 2/3 of test tube with urine, heat only the upper part keeping lower part as control.

•Presence of phosphates, carbonates, proteins gives a white cloud formation. Add acetic acid 1-2 drops, if the cloud persists it indicates it is protein(acetic acid dissolves the carbonates/phosphates)

Other tests

• Sulphosalicylic acid test• Dipsticks• Esbach’s albuminometer- for quantitative estimation of proteins

Causes of proteinuria

•Prerenal causes-Heavy exercise,Fever,hypertension, multiple myeloma, eclumpsia

•Renal –acute & chronic glomerulonephritis,Renal tubular dysfunction,Polycystic kidney, nephrotic syndrome

•Post renal- acute & chronic cystitis, tuberculosis cystitis

• Selective proteinuria• Nonselective proteinuria

microalbuminuria

• The level of albumin protein produced by microalbuminuria cannot be detected by urine dipstick methods. In a properly functioning body, albumin is not normally present in urine because it is retained in the bloodstream by the kidneys. Microalbuminuria is diagnosed either from a 24-hour urine collection

Significance of microalbuminuria•an indicator of subclinical cardiovascular disease

•an important prognostic marker for kidney disease

• in diabetes mellitus • in hypertension • increasing microalbuminuria during the first 48 hours after admission to an intensive care unit predicts elevated risk for acute respiratory failure , multiple organ failure , and overall mortality

Bence Jones proteins

•These are light chain globulins seen in multiple myeloma, macroglobulimias, lymphoma.

•Test- Thermal method(waterbath): Proteins has unusual property of precipitating at 400 -600c & then dissolving when the urine is brought to boiling(1000c) & reappears when the urine is cooled.

2.Test for sugar• Test-BENEDICT’S TEST(semiquantitative)• Principle-benedict’s reagent contains CuSO4.In the presence of reducing sugars cupric ions are converted to cuprous oxide which is hastened by heating, to give the color.

• Method- take 5ml of benedict’s reagent in a test tube, add 8drops of urine. Boil the mixture.

Blue-green= negativeYellow-green=+(<0.5%)Greenish yellow=++(0.5-1%)Yellow=+++(1-2%)Brick red=++++(>2%)

Benedict’s test

• Detects all reducing substances like glucose, fructose, & other reducing sustances.

• To confirm it is glucose, dipsticks can be used (glucose oxidase)

Causes of glycosuria

• Glycosuria with hyperglycaemia- diabetes,acromegaly, cushing’s disease, hyperthyroidism, drugs like corticosteroids.

• Glycosuria without hyperglycaemia- renal tubular dysfunction

3.Ketone bodies

• 3 typesAcetoneAcetoacetic acidβ-hydroxy butyric acid

They are products of fat metabolism

Rothera’s test

• Principle-acetone & acetoacetic acid react with sodium nitroprusside in the presence of alkali to produce purple colour.

• Method- take 5ml of urine in a test tube & saturate it with ammonium sulphate. Then add one crystal of sodium nitroprusside. Then gently add 0.5ml of liquor ammonia along the sides of the test tube.

• Change in colour indicates + test

Causes of ketonuria

• Diabetes• Non-diabetic causes- high fever, starvation, severe vomiting/diarrhoea

4.Bilirubin •Test- fouchet’s test.•CausesLiver diseases-injury,hepatitisObstruction to biliary tract

5.Urobilinogen

• Test- ehrlich test• Causes-hemolytic anemia's

6.Bile saltsHay’s testCause- obstruction to bile flow (obstructive jaundice)

7.Blood in urine

•Test- BENZIDINE TEST

•Method- mix 2ml of benzidine solution with 2ml of hydrogen peroxide in a test tube. Take 2ml of urine & add 2ml of above mixture. A blue color indicates + reaction.

Causes of hematuria• Pre renal- bleeding diathesis, hemoglobinopathies, malignant hypertension.

• Renal- trauma, calculi, acute & chronic glomerulonephritis, renal TB, renal tumors

• Post renal – severe UTI, calculi, trauma, tumors of urinary tract

Type Plasma color Urine color

Hematuria normal Smoky redm/s-plenty of RBC’s

hemoglobunuria Pink,hepatoglobin reduced

Red , occasional RBC’s

Myoglobunuria Pink, normal hepatoglobin

Red, occasional RBC’s

Thanks for pay attention !!!