Urinalysis
Prepared by:
محمد سعد جاد
Definition
It is the physical, chemical and microscopic
.examination or testing of urine
. It’s simple, cheap and useful
Methods of urine collection:
.Clean-Catch midstream urine sample -1
.From urinary catheter -2
.Suprapubic needle aspiration of the bladder -3
The timing:
Urine samples collected from the first void or “morning urine” are
considered the best representative for testing. The urine accumulated
overnight in the bladder is more concentrated, thus provides an insight
into the kidneys’ concentrating capacities and allows for the detection of
trace amounts of substances that may not be present in more diluted
samples.
Components of urinalysis
Physical Examination -1
Chemical Examination -2
Microscopic Examination -3
4
Physical Examination
Volume -1
Specific Gravity -2
Apperance -3
Color -4
Odor -5
Physical Examination
1- Volume:
Normal urine volume in 24 hours is 600-2000 ml
A- Urine volume increases (Polyuria = > 2.5 L / day) in the following conditions:
Physiological:
Increased fluid intake
Diuretics
Pathological:
Diabetes mellitus
Diabetes insipidus
B- Urine volume decreases (Oliguria = < 400 ml / day , or Anuria = < 100 ml /
day) in the following conditions:
Nephritic syndrome
Dehydration
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Obstruction
Physical Examination
2- Specific gravity (SG):
• Specific gravity measures solute concentration.
concentration
• Normally the specific gravity ranges between 1.003-1.030.
A- Increased in
• Dehydration (with oliguria)
• Diabetes Mellitus (with polyuria)
• Acute kidney injury (with oliguria, in oliguric phase)
B- Decreased in
• Diabetes insipidus (with polyuria)
B- Fixed = 1.010 (isostheneuria) in
• CKD … due to loss of the ability to either dilute or concentrate
urine.
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Physical Examination
3- Appearance:
- Normal fresh urine: clear
- Abnormal : Cloudy or turbid urine:
• Pus cells (pyuria)
• Epithelial cells
• Crystals (e.g amorphous phosphates)
• Bacteria
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Physical Examination
4- Color:
- Normal color: pale to dark yellow
→ due to the presence of urobilin pigment
- Abnormal colors of urine:
1- Colorless Urine:
Diabetes mellitus.
Diabetes insipidus.
insipidus
2- cola-like or tea-like urine:
due to presence of conjugated billirubin in cases of :
• Obstructive Jaundice
• 9 Hepatocellular Jaundice
Physical Examination
3- Red urine:
- Hematuria.
- Hemoglobinuria.
- Myoglobinuria.
- Drugs as rifampicin & phenytoin.
- Foods as beets & blueberries.
4- Orange Urine:
- Ingestion of large amount of carotenoids (vitamin A).
5- Green urine:
- UTI caused by pseudomonas.
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Physical Examination
5- Odor:
Normal Urinoid odor
Abnormal Odors:
1- Fruity odor:
due to presence of acetone in the urine as in DKA.
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.
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URINE ANALYSIS
Chemical Examination
Chemical elements in the urine
are detected using dry reagent
strips (dipsticks).
These plastic strips contain
absorbent pads with various When the test strip is put in
chemical reagents for determining urine the reagents are activated
a specific substance. and a chemical reaction occurs.
The chemical reaction results in
a specific color change.
URINE ANALYSIS
Chemical Examination
1- pH
2- Proteins (proteinuria)
3- Glucose
4- ketone Bodies (ketonuria)
5- Billirubin (billirubinuria) & Bile Salts
6- Nitrites
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URINE ANALYSIS
Chemical Examination
1- pH:
Normally:
Normally The pH of urine varies from 4.5 - 8.0
1- Acidic urine:
• High protein diet.
• Metabolic & respiratory acidosis.
2- Alkaline urine:
• Vegetarian diet.
• Metabolic & respiratory alkalosis.
• Urinary tract infection by urea splitting bacteria which convert urea
to ammonia (alkaline).
URINE ANALYSIS
Chemical Examination
:Proteins: (proteinuria) -2
Normally: Proteinuria less than or equal to 150 mg/day
URINE ANALYSIS
Chemical Examination
Glucose: (glucosuria) -3
[1] with hyperglycemia:
- DM.
- Cushing’s syndrome.
- Corticosteroids.
[2] without hyperglycemia:
- Renal glucosuria (inherited disorder).
URINE ANALYSIS
Chemical Examination
3- Ketone Bodies (Ketonuria):
• Diabetic ketoacidosis.
• Starvation.
• Ketogenic diet: high fat & low carbohydrates diet.
URINE ANALYSIS
Chemical Examination
4- Bilirubin (bilirubinuria)
Billirubin (Conjugated) appears in urine in cases of:
• Hepatocellular Jaundice:
as in viral hepatitis .
• Obstructive Jaundice
as in gall stones.
:Nitrites -5
• In cases of UTI with gram –ve bacteria
URINE ANALYSIS
Microscopic Examination
A variety of normal and abnormal cellular elements
may be seen in urine microscopy such as:
• Casts
• Crystals
• Mucus
• Microorganisms
• Pus cells
• RBCs
• Epithelial cells
URINE ANALYSIS
Microscopic Examination
RBCs 40x objective
- presence of a few is
normal (2 – 5
cells/HPF)
- higher numbers are
indicator of renal
disease
- result of bleeding at
any point in the
urinary tract
URINE ANALYSIS
Microscopic Examination
Pus cells 40x objective
a few are normal (2 – 4
cells /HPF)
high numbers indicate
inflammation or infection
somewhere along the
urinary or genital tract.
URINE ANALYSIS
Microscopic Examination
Mucus 40x objective
– look like long, ribbon-
like threads
– secreted by glands in the
lower urinary tract.
– Increases with UTI,
ulcerative colitis, kidney
stones
URINE ANALYSIS
Microscopic Examination
40x objective
Epithelial Cells
– normal cells that line
the urinary and
genital tract or renal
tubules
– Increase in UTI and
certain cancers
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Casts
27
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URINE ANALYSIS
Microscopic Examination (Casts)
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URINE ANALYSIS
Microscopic Examination (Organisms)
Bacteria Yeast
URINE ANALYSIS
Microscopic Examination (Organisms)
schistosoma haematobium Trichomonas vaginalis
It is not Urinary system protozoa, it’s
vagina protozoa
Thank you
