HUMAN ANATOMY AND PHYSIOLOGY

EXPERIMENT REPORT
Urinalysis

Made by:

Vita Istiqomah

3415110315

Anggi Dyah Aristi

3415111375

Ria Lestari

3415111382

Shelena Nugraha R Dewi

3415111389

Irma Fitriyani

3415111390

BIOLOGY EDUCATION PROGRAMS 2011

BIOLOGY MAYORS
FACULTY OF MATHEMATICS AND SCIENCE
JAKARTA STATE UNIVERSITY

2013

THEORY

THE URINARY SYSTEM

Functions of the Kidneys

Metabolism constantly produces a variety of waste products that can poison the body if not
eliminated. The most fundamental role of the kidneys is to eliminate these wastes and
homeostatically regulate the volume and compositionof the body fluids. All of the following
processes are aspects of kidney function:

They filter blood plasma, separate wastes from the useful chemicals, and eliminate the
wastes while returning the rest to the bloodstream.
They regulate blood volume and pressure by eliminating or conserving water as
necessary.
They regulate the osmolarity of the body fluids by controlling the relative amounts of
water and solutes eliminated.
They secrete the enzyme renin, which activates hormonal mechanisms that control
blood pressure and electrolyte balance.
They secrete the hormone erythropoietin, which controls the red blood cell count and
oxygen-carrying capacity of the blood.
They function with the lungs to regulate the PCO2 and acid-base balance of the body
fluids.
They contribute to calcium homeostasis through their role in synthesizing calcitriol
(vitamin D) (see chapter 7).
They detoxify free radicals and drugs with the use of peroxisomes.

In times of starvation, they carry out gluconeogenesis; they deaminate amino acids
(remove the NH2 group), excrete the amino group as ammonia (NH3), and synthesize
glucose from the rest of the molecule.

Excretion
Excretion is the process of separating wastes from the body fluids and eliminating them. It is
carried out by four organ systems:
1. The respiratory system excretes carbon dioxide, small amounts of other gases, and
water.
2. The integumentary system excretes water, inorganic salts, lactic acid, and urea in the
sweat.
3. The digestive system not only eliminates food residue (which is not a process of
excretion) but also actively excretes water, salts, carbon dioxide, lipids, bile pigments,
cholesterol, and other metabolic wastes.
4. The urinary system excretes a broad variety of metabolic wastes, toxins, drugs,
hormones, salts, hydrogen ions, and water.
Gross Anatomy
The kidneys lie against the posterior abdominal wall at the level of vertebrae T12 to L3. The
right kidney is slightly lower than the left because of the space occupied by the liver above it.
Each kidney weighs about 160 g and measures about 12 cm long, 5 cm wide, and 2.5 cm
thickabout the size of a bar of bath soap. The lateral surface is convex while the medial
surface is concave and has a slit, the hilum, where it receives the renal nerves, blood vessels,
lymphatic vessels, and ureter. The left adrenal gland rests on the superior pole of that kidney,
while the right adrenal gland is more medial, between the hilum and pole. The kidneys,
adrenal glands, ureters, and urinary bladder are retroperitonealthey lie between the
peritoneum and body wall.
The kidney is protected by three layers of connective tissue: (1) a fibrous renal2
fascia, immediately deep to the parietal peritoneum, which binds the kidney and associated
organs to the abdominal wall; (2) the adipose capsule, a layer of fat that cushions the kidney
and holds it in place; and (3) the renal capsule, a fibrous sac that is anchored at the hilum and
encloses the rest of the kidney like a cellophane wrapper, and protects the kidney from
trauma and infection. Collagen fibers extend from the renal capsule, through the fat, to the
renal fascia. The renal fascia is fused with the peritoneum on one side and the deep fascia of
the lumbar muscles on the other. Thus the kidneys are suspended in place. Nevertheless, they
drop about 3 cm when you go from a supine to a standing position, and under some
circumstances they become detached and drift even lower, with pathological results.
The ureter is a tubular continuation of the renal pelvis that drains the urine down to the
urinary bladder.
The Nephron

Each kidney contains about 1.2 million functional units called nephrons (NEF-rons) A
nephron consists of two principal parts: a renal corpuscle where the blood plasma is filtered
and a long renal tubule that processes this filtrate into urine.
The Renal Corpuscle
The renal corpuscle consists of a ball of capillaries called a glomerulus5 (glo-MERRyou-lus), enclosed in a two-layered glomerular (Bowmans6) capsule. The parietal (outer)
layer of the capsule is a simple squamous epithelium, while the visceral layer consists of
elaborate cells called podocytes7 wrapped around the capillaries.
URINE FORMATION I: GLOMERULAR FILTRATION
The kidney converts blood plasma to urine in three stages: glomerular filtration,
tubular reabsorption and secretion, and water conservation (fig. 23.8). As we trace fluid
through the nephron, we will refer to it by different names that reflect its changing
composition: (1) The fluid in the capsular space, called glomerular filtrate, is similar to blood
plasma except that it has almost no protein. (2) The fluid from the proximal convoluted
tubule through the distal convoluted tubule will be called tubular fluid. It differs from the
glomerular filtrate because of substances removed and added by the tubule cells. (3) The fluid
will be called urine once it enters the collecting duct.

Glomerular Filtration Rate

Glomerular filtration rate (GFR) is the amount of filtrate formed per minute by the
two kidneys combined. For every 1 mmHg of net filtration pressure, the kidneys produce
about 12.5 mL of filtrate per minute. This value, called the filtration coefficient (Kf), depends
on the permeability and surface area of the filtration barrier. Kf is about 10% lower in women
than in men. For the reference male,

GFR= NFP x Kf = 10 x 12.5= 125 mL/min

In the reference female, the GFR is about 105 mL/min. This is a rate of 180 L/day in
males and 150 L/day in femalesimpressive numbers considering that this is about 50 to 60
times the amount of blood plasma in the body and equally exceeds the amount of filtrate
produced by all other capillaries combined. Obviously only a small portion of this is
eliminated as urine. An average adult reabsorbs 99% of the filtrate and excretes 1 to 2 L of
urine per day.
Regulation of Glomerular Filtration
GFR must be precisely controlled. If it is too high, fluid flows through the renal
tubules too rapidly for them to reabsorb the usual amount of water and solutes. Urine output
rises and creates a threat of dehydration and electrolyte depletion. If GFR is too low, fluid
flows sluggishly through the tubules, they reabsorb wastes that should be eliminated in the
urine, and azotemia may occur. The only way to adjust GFR from moment to moment is to
change glomerular blood pressure. This is achieved by three homeostatic mechanisms: renal
autoregulation, sympathetic control, and hormonal control.
URINE FORMATION II: TUBULAR REABSORPTION AND SECRETION
The proximal convoluted tubule (PCT) reabsorbs about 65% of the glomerular filtrate,
while it also removes some substances from the blood and secretes them into the tubule for
disposal in the urine. The importance of the PCT is reflected in its relatively great length and
prominent microvilli, which increase its absorptive surface area. Its cells also contain
abundant large mitochondria that provide ATP for active transport. Your PCTs alone account
for about 6% of your resting ATP and calorie consumption.
Tubular reabsorption is the process of reclaiming water and solutes from the tubular
fluid and returning them to the blood. The PCT reabsorbs a greater variety of chemicals than
any other part of the nephron. There are two routes of reabsorption: (1) the transcellular15
route, in which substances pass through the cytoplasm and out the base of the epithelial cells
and (2) the paracellular16 route, in which substances pass between the epithelial cells. The
tight junctions between tubule epithelial cells are quite leaky and allow significant amounts
of water, minerals, urea, and other matter to pass between the cells. Either way, such
materials enter the extracellular fluid (ECF) at the base of the epithelium, and from there they
are taken up by the peritubular capillaries.
Tubular secretion in the distal convoluted tubule is discussed shortly. In the proximal
convoluted tubule and nephron loop, it serves two purposes:
1. Waste removal. Urea, uric acid, bile acids, ammonia, catecholamines, and a little
creatinine are secreted into the tubule. Tubular secretion of uric acid compensates for
its reabsorption earlier in the PCT and accounts for all of the uric acid in the urine.
Tubular secretion also clears the blood of pollutants, morphine, penicillin, aspirin, and
other drugs. One reason that so many drugs must be taken three or four times a day is

to keep pace with this rate of clearance and maintain a therapeutically effective drug
concentration in the blood.
2. Acid-base balance. Tubular secretion of hydrogen and bicarbonate ions serves to
regulate the pH of the body fluids
The Nephron Loop
The primary function of the nephron loop is to generate a salinity gradient that
enables the collecting duct to concentrate the urine and conserve water. But in addition, the
loop reabsorbs about 25% of the Na, K, and Cl and 15% of the water in the glomerular
filtrate.

The Distal Convoluted Tubule and Collecting Duct

Fluid arriving in the DCT still contains about 20% of the water and 7% of the salts
from the glomerular filtrate. If this were all passed as urine, it would amount to 36 L/day, so
obviously a great deal of fluid reabsorption is still to come. A distinguishing feature of these
parts of the renal tubule is that unlike the PCT and nephron loop, they are subject to hormonal
controlparticularly by aldosterone, atrial natriuretic peptide, antidiuretic hormone, and
parathyroid hormone. There are two kinds of cells in the DCT and collecting duct. The
principal cells are the more abundant; they have receptors for these hormones and are
involved chiefly in salt and water balance. The intercalated cells are fewer in number. They
have a high density of mitochondria, reabsorb K, secrete H into the tubule lumen, and are
involved mainly in acid-base balance.

URINE FORMATION III: WATER CONSERVATION

The kidney serves not just to eliminate metabolic waste from the body but to prevent
excessive water loss in doing so, and thus to support the bodys fluid balance. As the kidney
returns water to the tissue fluid and bloodstream, the fluid remaining in the renal tubule
becomes more and more concentrated. In this section, we examine the kidneys mechanisms
for conserving water and concentrating the urine.
The Distal Convoluted Tubule
When the nephron loop returns to the cortex, it coils again and forms the distal
convoluted tubule (DCT). This is shorter and less convoluted than the PCT, so fewer sections
of it are seen in histological sections The DCT is the end of the nephron. The DCTs of several
nephrons drain into a straight tubule called the collecting duct, which passes down into the
medulla. Near the papilla, several collecting ducts merge to form a larger papillary duct;
about 30 of these drain from each papilla into its minor calyx.
The Collecting Duct
The collecting duct (CD) begins in the cortex, where it receives tubular fluid from
numerous nephrons. As it passes through the medulla, it usually reabsorbs water and
concentrates the urine. When urine enters the upper end of the CD, it has a concentration of
100 to 300 mOsm/L, but by the time it leaves the lower end, it can be up to four times as
concentrated. This ability to concentrate wastes and control water loss was crucial to the
evolution of terrestrial animals such as ourselves .
Two facts enable the collecting duct to produce such hypertonic urine: (1) the
osmolarity of the extracellular fluid is four times as high deep in the medulla as it is in the
cortex, and (2) the medullary portion of the CD is more permeable to water than to NaCl.
Therefore, as urine passes down the CD through the increasingly salty medulla, water leaves
the tubule by osmosis, most NaCl and other wastes remain behind, and the urine becomes
more and more concentrated.
Urine Volume
An average adult produces 1 to 2 L of urine per day. An output in excess of 2 L/day is
called diuresis or polyuria19 (POL-ee-YOU-ree-uh). Fluid intake and some drugs can
temporarily increase output to as much as 20 L/day. Chronic diseases such as diabetes (see
next) can do so over a long term. Oliguria20 (oll-ih-GUE-ree-uh) is an output of less than 500
mL/day, and anuria21 is an output of 0 to 100 mL/day. Low output can result from kidney
disease, dehydration, circulatory shock, prostate enlargement, and other causes. If urine
output drops to less than 400 mL/day, the body cannot high concentration of glucose in the
blood. About 1% to 3% of pregnant women experience gestational diabetes, in which
pregnancy reduces the mothers insulin sensitivity, resulting in hyperglycemia and glycosuria.
In renal diabetes, blood glucose level is not elevated, but there is a hereditary deficiency of
glucose transporters in the PCT, which causes glucose to remain in the tubular fluid. Diabetes

insipidus results from ADH hyposecretion. Without ADH, the collecting duct does not
reabsorb as much water as normal, so more water passes in the urine.
Diuretics are chemicals that increase urine volume. They are used for treating
hypertension and congestive heart failure because they reduce the bodys fluid volume and
blood pressure. Diuretics work by one of two mechanismsincreasing glomerular filtration
or reducing tubular reabsorption. For example, caffeine, in the former category, dilates the
afferent arteriole and increases GFR. Alcohol, in the latter category, inhibits ADH secretion.
Also in the latter category are many osmotic diuretics, which reduce water reabsorption by
increasing the osmolarity of the tubular fluid. Many diuretic drugs, such as furosemide
(Lasix), produce osmotic diuresis by inhibiting sodium reabsorption.
A urine test checks different components of urine, a waste product made by the
kidneys. A regular urine test may be done to help find the cause of symptoms. The test can
give information about your health and problems you may have.
Urinalysis can be part of a routine examination and is frequently performed upon
admission to the hospital and before surgery. The test can also follow a preliminary rapid
urine test that produced abnormal results, so that urinalysis can be used to check those results.
Complete urinalysis is done in a laboratory. It is usually made up of 3 parts:

Assessment of the color, clarity and concentration of the urine

Examination of the chemical composition of the urine with a test strip

Examination of the urine using a microscope to identify bacteria, cells and cell parts

The kidneys camera take out waste material, minerals, fluids, and other substances
from the blood to be passed in the urine. Urine has hundreds of different body wastes. What
you eat, drink, how much you exercise, and how well your kidneys work can affect what is in
your urine. More than 100 different tests can be done on urine. A regular urinalysis often
includes the following tests.
Color. Many things affect urine color, including fluid balance, diet, medicines, and diseases.
How dark or light the color is tells you how much water is in it. Vitamin B supplements can
turn urine bright yellow. Some medicines, blackberries, beets, rhubarb, or blood in the urine
can turn urine red-brown.
Clarity. Urine is normally clear. Bacteria, blood, sperm, crystals, or mucus can make urine
look cloudy.
Odor. Urine does not smell very strong, but has a slightly "nutty" odor. Some diseases cause
a change in the odor of urine. For example, an infection with E. coli bacteria can cause a bad
odor, while diabetes or starvation can cause a sweet, fruity odor.
Specific gravity. This checks the amount of substances in the urine. It also shows how well
the kidneys balance the amount of water in urine. The higher the specific gravity, the more
solid material is in the urine. When you drink a lot of fluid, your kidneys make urine with a

high amount of water in it which has a low specific gravity. When you do not drink fluids,
your kidneys make urine with a small amount of water in it which has a high specific gravity.
pH. The pH is a measure of how acidic or alkaline (basic) the urine is. A urine pH of 4 is
strongly acidic, 7 is neutral (neither acidic nor alkaline), and 9 is strongly alkaline.
Sometimes the pH of urine is affected by certain treatments. For example, your doctor may
instruct you how to keep your urine either acidic or alkaline to prevent some types of kidney
stones from forming.
Protein. Protein is normally not found in the urine. Fever, hard exercise, pregnancy, and
some diseases, especially kidney disease, may cause protein to be in the urine.
Glucose. Glucose is the type of sugar found in blood. Normally there is very little or no
glucose in urine. When the blood sugar level is very high, as in uncontrolled diabetes, the
sugar spills over into the urine. Glucose can also be found in urine when the kidneys are
damaged or diseased.
Nitrites. Bacteria that cause a urinary tract infection (UTI) make an enzyme that changes
urinary nitrates to nitrites. Nitrites in urine show a UTI is present.
Leukocyte esterase (WBC esterase). Leukocyte esterase shows leukocytes (white blood
cells [WBCs]) in the urine. WBCs in the urine may mean a UTI is present.
Ketones. When fat is broken down for energy, the body makes substances called ketones (or
ketone bodies). These are passed in the urine. Large amounts of ketones in the urine may
mean a very serious condition, diabetic ketoacidosis, is present. A diet low in sugars and
starches (carbohydrates), starvation, or severe vomiting may also cause ketones to be in the
urine.
Microscopic analysis. In this test, urine is spun in a special machine (centrifuge) so the solid
materials (sediment) settle at the bottom. The sediment is spread on a slide and looked at
under a microscope. Things that may be seen on the slide include:
Red or white blood cells. Blood cells are not found in urine normally. Inflammation, disease,
or injury to the kidneys, ureters, bladder, or urethra can cause blood in urine. Strenuous
exercise, such as running a marathon, can also cause blood in the urine. White blood cells
may be a sign of infection or kidney disease.
Casts. Some types of kidney disease can cause plugs of material (called casts) to form in tiny
tubes in the kidneys. The casts then get flushed out in the urine. Casts can be made of red or
white blood cells, waxy or fatty substances, or protein. The type of cast in the urine can help
show what type of kidney disease may be present.
Crystals. Healthy people often have only a few crystals in their urine. A large number of
crystals, or certain types of crystals, may mean kidney stones are present or there is a problem
with how the body is using food (metabolism).

Bacteria, yeast cells, or parasites. There are no bacteria, yeast cells, or parasites in urine
normally. If these are present, it can mean you have an infection.
Squamous cells. The presence of squamous cells may mean that the sample is not as pure as
it needs to be. These cells do not mean there is a medical problem, but your doctor may ask
that you give another urine sample.
Why It Is Done
A urine test may be done:

To check for a disease or infection of the urinary tract. Symptoms of a urine infection
may include colored or bad-smelling urine, pain when urinating, hard to urinate, flank
pain, blood in the urine (hematuria), or fever.
To check the treatment of conditions such as diabetes, kidney stones, a urinary tract
infection (UTI), high blood pressure (hypertension), or some kidney or liver diseases.
As part of a regular physical examination.

How To Prepare

Do not eat foods that can color the urine, such as blackberries, beets, and rhubarb,
before the test. Do not exercise strenuously before the test.
Tell your doctor if you are menstruating or close to starting your menstrual period.
Your doctor may want to wait to do the test.
Because urine can easily be contaminated with bacteria, cells and other substances it
is a good idea to clean the genital area with water before the test but without soap.
To get a good result and avoid contamination with external bacteria, clean
midstream urine is used for a urine test: urine is considered to be midstream when the
first portion of the urine stream is not used, and only the middle part of the urine is
caught in a cup. If there is anything else to be careful about for your specific test your
doctor will tell you.
Your doctor may ask you to stop taking certain medicines that color the urine. These
include vitamin B, phenazopyridine (Pyridium), rifampin, and phenytoin (Dilantin).
Be sure to tell your doctor if you are taking diuretics, which may affect the test
results.
Talk to your doctor any concerns you have regarding the need for the test, its risks,
how it will be done, or what the results will mean. To help you understand the
importance of this test, fill out the medical test information form.

How It Is Done
A routine urine test can be done in your doctor's office, clinic, or lab. You may also be asked
to collect a urine sample at home and bring it with you to the office or lab for testing.

Clean-catch midstream one-time urine collection

Wash your hands to make sure they are clean before collecting the urine.

If the collection cup has a lid, remove it carefully and set it down with the inner
surface up. Do not touch the inside of the cup with your fingers.
Clean the area around your genitals.
o A man should retract the foreskin, if present, and clean the head of his penis
with medicated towelettes or swabs.
o A woman should spread open the genital folds of skin with one hand. Then use
her other hand to clean the area around the urethra with medicated towelettes
or swabs. She should wipe the area from front to back so bacteria from the
anus is not wiped across the urethra.
Begin urinating into the toilet or urinal. A woman should hold apart the genital folds
of skin while she urinates.
After the urine has flowed for several seconds, place the collection cup into the urine
stream and collect about 2 fl oz (60 mL) of this "midstream" urine without stopping
your flow of urine.
Do not touch the rim of the cup to your genital area. Do not get toilet paper, pubic
hair, stool (feces), menstrual blood, or anything else in the urine sample.
Finish urinating into the toilet or urinal.
Carefully replace and tighten the lid on the cup then return it to the lab. If you are
collecting the urine at home and cannot get it to the lab in an hour, refrigerate it.

Double-voided urine sample collection

This method collects the urine your body is making right now.

Urinate into the toilet or urinal. Do not collect any of this urine.
Drink a large glass of water and wait about 30 to 40 minutes.
Then get a urine sample. Follow the instructions above for collecting a clean-catch
urine sample.

Return the urine sample to the lab. If you are collecting the urine at home and cannot get
it to the lab in an hour, refrigerate it.
The normal values listed here-called a reference range-are just a guide. These ranges
vary from lab to lab, and your lab may have a different range for whats normal. Your lab
report should contain the range your lab uses. Also, your doctor will evaluate your results
based on your health and other factors. This means that a value that falls outside the normal
values listed here may still be normal for you or your lab.
Urine test results
Color

Normal:

Pale to dark yellow

Abnormal: Many foods and medicines can affect the color of the urine.
Urine with no color may be caused by long-term kidney disease
or uncontrolled diabetes. Dark yellow urine can be caused
by dehydration. Red urine can be caused by blood in the urine.

Clarity

Normal:

Clear

Abnormal: Cloudy urine can be caused by pus (white blood cells), blood
(red blood cells), sperm, bacteria, yeast, crystals, mucus, or
a parasite infection, such as trichomoniasis.
Odor

Normal:

Slightly "nutty" odor

Abnormal: Some foods (such as asparagus), vitamins, and antibiotics (such

as penicillin) can cause urine to have a different odor. A sweet,
fruity odor may be caused by uncontrolled diabetes. A urinary
tract infection (UTI) can cause a bad odor. Urine that smells like
maple syrup can mean maple syrup urine disease, when the
body cannot break down certain amino acids.
Specific
gravity

Normal:

1.005-1.030

Abnormal: A very high specific gravity means very concentrated urine,

which may be caused by not drinking enough fluid, loss of too
much fluid (excessive vomiting, sweating, or diarrhea), or
substances (such as sugar or protein) in the urine. Very low
specific gravity means dilute urine, which may be caused by
drinking too much fluid, severe kidney disease, or the use
of diuretics.
pH

Normal:

4.6-8.0

Abnormal: Some foods (such as citrus fruit and dairy products) and
medicines (such as antacids) can affect urinepH. A high
(alkaline) pH can be caused by severe vomiting, a kidney
disease, some urinary tract infections, and asthma. A low
(acidic) pH may be caused by severe lung disease
(emphysema), uncontrolled diabetes, aspirin overdose, severe
diarrhea, dehydration, starvation, drinking too much alcohol, or
drinking antifreeze (ethylene glycol).
Protein

Normal:

None

Abnormal: Protein in the urine may mean kidney damage, an

infection, cancer, high blood pressure, diabetes,systemic lupus
erythematosus (SLE), orglomerulonephritis is present.
Protein in the urine may also mean that heart failure, leukemia,
poison (lead or mercury poisoning), or preeclampsia (if you are
pregnant) is present.

Glucose

Normal:

None

Abnormal: Intravenous (IV) fluids can cause glucose to be in the urine. Too
much glucose in the urine may be caused by uncontrolled
diabetes, an adrenal glandproblem, liver damage, brain injury,
certain types of poisoning, and some types of kidney diseases.
Healthy pregnant women can have glucose in their urine, which
is normal during pregnancy.
Ketones

Normal:

None

Abnormal: Ketones in the urine can mean uncontrolled diabetes, a very

low-carbohydrate diet, starvation or eating disorders (such
as anorexia nervosa orbulimia), alcoholism, or poisoning from
drinking rubbing alcohol (isopropanol). Ketones are often found
in the urine when a person does not eat (fasts) for 18 hours or
longer. This may occur when a person is sick and cannot eat or
vomits for several days. Low levels of ketones are sometimes
found in the urine of healthy pregnant women.
Microscopi
c analysis

Normal:

Very few or no red or white blood cells or casts are seen. No

bacteria, yeast cells, parasites, or squamous cells are present. A
few crystals are normally seen.

Abnormal: Red blood cells in the urine may be caused by kidney or bladder
injury, kidney stones, a urinary tract infection (UTI),
inflammation of the kidneys (glomerulonephritis), a kidney or
bladder tumor, or systemic lupus erythematosus (SLE). White
blood cells (pus) in the urine may be caused by a urinary tract
infection, bladder tumor, inflammation of the kidneys, systemic
lupus erythematosus (SLE), or inflammation in the vagina or
under the foreskin of the penis.
Depending on the type, casts can mean inflammation or damage
to the tiny tubes in the kidneys, poor blood supply to the
kidneys, metal poisoning (such as lead or mercury), heart
failure, or a bacterial infection.
Large amounts of crystals, or certain types of crystals, can mean
kidney stones, damaged kidneys, or problems with metabolism.
Some medicines and some types of urinary tract infections can
also increase the number of crystals in urine.
Bacteria in the urine mean a urinary tract infection (UTI). Yeast
cells
or
parasites
(such
as
the
parasite
that
causes trichomoniasis) can mean an infection of the urinary
tract.

The presence of squamous cells may mean that the sample is

not as pure as it needs to be. These cells do not mean there is a
medical problem, but your doctor may ask that you give another
urine sample.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

If you are having your menstrual period.

Taking medicines, such as diuretics, erythromycin, trimethoprim (Trimpex), or high
doses of vitamin C (ascorbic acid) taken with an antibiotic, such as tetracycline.
Having an X-ray test with contrast material in the past 3 days.
Not getting the urine sample to the lab in 1 hour.

What To Think About

Some urine tests can be done using a home test kit. For more information, see the
topic Ketones or Home Test for Urinary Tract Infections.
In some cases, the amount of urine you make in 24 hours may be measured. Most
adults make about 1 qt (1 L) to 2 qt (2 L) per day. Children make about 0.3 qt (0.3 L)
to 1.6 qt (1.5 L) per day.
Other substances that may be checked during a urine test include:
o Bilirubin. This is a substance formed by the breakdown of red blood cells. It is
passed from the body in stool. Bilirubin is not found in urine. If it is present, it
often means the liver is damaged or that the flow of bile from the gallbladder
is blocked. For more information, see the topic Bilirubin.
o Urobilinogen. This is a substance formed by the breakdown of bilirubin. It is
also passed from the body in stool. Only small amounts of urobilinogen are
found in urine. Urobilinogen in urine can be a sign of liver disease (cirrhosis,
hepatitis) that the flow of bile from the gallbladder is blocked.
o Bence Jones protein. This is an abnormal protein found in the urine of about
50% of people with a rare type of cancer called multiple myeloma. A urine test
is often done when multiple myeloma is suspected. The protein test done
during a regular urine test does not check for Bence Jones protein.
Collecting a urine sample from a small child or baby is done by using a special plastic
bag with tape around its opening. The bag is placed around the child's genitals until he
or she urinates. Then you carefully removed the bag. To collect a urine sample from a
very sick baby, a doctor may use a urinary catheter through the urethra or a needle
through the baby's belly directly into the bladder (suprapubic tap).
To lower the chance of contaminating the urine sample with bacteria, a health
professional may collect a urine sample by using a urinary catheter. A catheter may be
used to collect urine from a person in the hospital who is very ill or who cannot give a
clean-catch sample. Using a catheter allows a clean sample to be collected.

If an abnormal result is found during a urine test, more tests may be done, such as a
urine culture, X-ray of the kidneys (intravenous pyelogram [IVP]), or cystoscopy. For
more information, see the topics Urine Culture, Intravenous Pyelogram (IVP), and
Cystoscopy.

Other urine tests

Drugs can also be detected in urine for a certain time after they are used. Cannabis
can be detected, depending on the type of test used, up to several weeks after it has been
taken: drugs like cocaine, ecstasy or heroin for up to 5 days. Different tests are also used in
detecting drug use: rapid tests, which can help give police fast results in the field, and other
tests, that need to be done in laboratories. Urine samples are also used when giving athletes
drug tests to check whether someone has used banned substances.
DIABETES
Diabetes, often referred to by doctors as diabetes mellitus, describes a group of
metabolic diseases in which the person has high blood glucose (blood sugar), either because
insulin production is inadequate, or because the body's cells do not respond properly to
insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent
urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).
There are three types of diabetes:
1) Type 1 Diabetes
The body does not produce insulin. Some people may refer to this type as insulindependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop type 1
diabetes before their 40th year, often in early adulthood or teenage years.
1) Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all
diabetes cases are type 1.
Patients with type 1 diabetes will need to take insulin injections for the rest of their
life. They must also ensure proper blood-glucose levels by carrying out regular blood tests
and following a special diet. Between 2001 and 2009, the prevalence of type 1 diabetes
among the under 20s in the USA rose 23%, according to SEARCH for Diabetes in Youth data
issued by the CDC (Centers for Disease Control and Prevention). (Link to article)
2) Type 2 Diabetes
The body does not produce enough insulin for proper function, or the cells in the body
do not react to insulin (insulin resistance). Approximately 90% of all cases of diabetes
worldwide are of this type.
Some people may be able to control their type 2 diabetes symptoms by losing weight,
following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels.
However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and the
patient will probably end up have to take insulin, usually in tablet form.

Overweight and obese people have a much higher risk of developing type 2 diabetes
compared to those with a healthy body weight. People with a lot of visceral fat, also known
as central obesity, belly fat, or abdominal obesity, are especially at risk. Being
overweight/obese causes the body to release chemicals that can destabilize the body's
cardiovascular and metabolic systems.
Being overweight, physically inactive and eating the wrong foods all contribute to our
risk of developing type 2 diabetes. Drinking just one can of (non-diet) soda per day can raise
our risk of developing type 2 diabetes by 22%, researchers from Imperial College London
reported in the journal Diabetologia. The scientists believe that the impact of sugary soft
drinks on diabetes risk may be a direct one, rather than simply an influence on body weight.
The risk of developing type 2 diabetes is also greater as we get older. Experts are not
completely sure why, but say that as we age we tend to put on weight and become less
physically active. Those with a close relative who had/had type 2 diabetes, people of Middle
Eastern, African, or South Asian descent also have a higher risk of developing the disease.
Men whose testosterone levels are low have been found to have a higher risk of
developing type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say that
low testosterone levels are linked to insulin resistance. (Link to article)
3) Gestational Diabetes
This type affects females during pregnancy. Some women have very high levels of glucose in
their blood, and their bodies are unable to produce enough insulin to transport all of the
glucose into their cells, resulting in progressively rising levels of glucose.
Diagnosis of gestational diabetes is made during pregnancy.
The majority of gestational diabetes patients can control their diabetes with exercise
and diet. Between 10% to 20% of them will need to take some kind of blood-glucosecontrolling medications. Undiagnosed or uncontrolled gestational diabetes can raise the risk
of complications during childbirth. The baby may be bigger than he/she should be.
Scientists from the National Institutes of Health and Harvard University found that
women whose diets before becoming pregnant were high in animal fat and cholesterol had a
higher risk for gestational diabetes, compared to their counterparts whose diets were low in
cholesterol and animal fats.
What Is Prediabetes? The vast majority of patients with type 2 diabetes initially had
prediabetes. Their blood glucose levels where higher than normal, but not high enough to
merit a diabetes diagnosis. The cells in the body are becoming resistant to insulin.Studies
have indicated that even at the prediabetes stage, some damage to the circulatory system and
the heart may already have occurred.
Diabetes Is A Metabolism Disorder Diabetes (diabetes mellitus) is classed as a
metabolism disorder. Metabolism refers to the way our bodies use digested food for energy

and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in
the blood - it is the principal source of fuel for our bodies.
When our food is digested, the glucose makes its way into our bloodstream. Our cells
use the glucose for energy and growth. However, glucose cannot enter our cells without
insulin being present - insulin makes it possible for our cells to take in the glucose. Insulin is
a hormone that is produced by the pancreas. After eating, the pancreas automatically releases
an adequate quantity of insulin to move the glucose present in our blood into the cells, as
soon as glucose enters the cells blood-glucose levels drop.
A person with diabetes has a condition in which the quantity of glucose in the blood is
too elevated (hyperglycemia). This is because the body either does not produce enough
insulin, produces no insulin, or has cells that do not respond properly to the insulin the
pancreas produces. This results in too much glucose building up in the blood. This excess
blood glucose eventually passes out of the body in urine. So, even though the blood has
plenty of glucose, the cells are not getting it for their essential energy and growth
requirements.
How To Determine Whether You Have Diabetes, Prediabetes or Neither Doctors can
determine whether a patient has a normal metabolism, prediabetes or diabetes in one of three
different ways - there are three possible tests:
The A1C test

at least 6.5% means diabetes

between 5.7% and 5.99% means prediabetes
less than 5.7% means normal

The FPG (fasting plasma glucose) test

at least 126 mg/dl means diabetes

between 100 mg/dl and 125.99 mg/dl means prediabetes
less than 100 mg/dl means normal

An abnormal reading following the FPG means the patient has impaired fasting glucose
(IFG)
The OGTT (oral glucose tolerance test)

at least 200 mg/dl means diabetes

between 140 and 199.9 mg/dl means prediabetes
less than 140 mg/dl means normal

An abnormal reading following the OGTT means the patient has impaired glucose tolerance
(IGT)
Researchers from the Mayo Clinic Arizona in Scottsdale showed that gastric bypass
surgery can reverse type 2 diabetes in a high proportion of patients. They added that within

three to five years the disease recurs in approximately 21% of them. Yessica Ramos, MD.,
said "The recurrence rate was mainly influenced by a longstanding history of Type 2 diabetes
before the surgery. This suggests that early surgical intervention in the obese, diabetic
population will improve the durability of remission of Type 2 diabetes." (Link to article)
Patients with type 1 are treated with regular insulin injections, as well as a special diet
and exercise. Patients with Type 2 diabetes are usually treated with tablets, exercise and a
special diet, but sometimes insulin injections are also required. Complications linked to badly
controlled diabetes:

Eye complications - glaucoma, cataracts, diabetic retinopathy, and some others.

Foot complications - neuropathy, ulcers, and sometimes gangrene which may require
that the foot be amputated
Skin complications - people with diabetes are more susceptible to skin infections and
skin disorders
Heart problems - such as ischemic heart disease, when the blood supply to the heart
muscle is diminished
Hypertension - common in people with diabetes, which can raise the risk of kidney
disease, eye problems, heart attack and stroke
Mental health - uncontrolled diabetes raises the risk of suffering from depression,
anxiety and some other mental disorders
Hearing loss - diabetes patients have a higher risk of developing hearing problems
Gum disease - there is a much higher prevalence of gum disease among diabetes
patients
Gastroparesis - the muscles of the stomach stop working properly
Ketoacidosis - a combination of ketosis and acidosis; accumulation of ketone bodies
and acidity in the blood.
Neuropathy - diabetic neuropathy is a type of nerve damage which can lead to several
different problems.
HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) - blood glucose levels
shoot up too high, and there are no ketones present in the blood or urine. It is an
emergency condition.
Nephropathy - uncontrolled blood pressure can lead to kidney disease
PAD (peripheral arterial disease) - symptoms may include pain in the leg, tingling and
sometimes problems walking properly
Stroke - if blood pressure, cholesterol levels, and blood glucose levels are not
controlled, the risk of stroke increases significantly
Erectile dysfunction - male impotence.
Infections - people with badly controlled diabetes are much more susceptible to
infections
Healing of wounds - cuts and lesions take much longer to heal

Methodology
Examination of the amount of urine

Equipment:

measuring cup
urine container

Materials:

Urine 24 hours

How it Works:
1. Collect of urine for 24 hours. note the amount of urine during the 12-hour and 12-hour
urine night and the amount of urine now. Record the measurements.
Examination of urine odor
Equipment:

closed container

Materials:

Fresh urine without preservative

How it works:
1. Insert fresh urine into the container and immediately identify the smell coming out of
the urine.
2. Record the results of the examination.
Examination of urine color
Equipment:

Test tube
Flashlight

Materials:

Fresh urine

How it works:
1. Pour the urine into a test tube filled up 3/4 of the tube. then tilt the tube
2. Provide exposure to the tube
3. Specify the color of the urine with the statement: colorless, pale yellow, dark yellow,
yellow, yellow red mixed, etc.
4. Record the results of the examination
Determine the clarity of the urine

Equipment:

Test tube
Flashlight

Materials:

Fresh urine

How it works:
1. Pour the urine into a test tube filled up 3/4 of the tube. then tilt the tube
2. Provide exposure to the tube
3. Determine the clarity of the urine with the statement: clear, somewhat clear, cloudy,
and very turbid
4. Record the results of the examination
Determine the specific gravity of urine
Equipment:

Urinometer
Urinometer glass

Materials:

Urine

How it works:
1. Pour into a glass urinometer urine. foam may be formed with a piece of paper thrown
away or drop ether
2. Enter urine into the urinometer glass. to be free floating urinometer then there must be
quite a lot of urine in a cup. if the amount is too little urine dilute urine with distilled
water a number of urine. to calculate its density, the second last number of readings
must be multiplied by two anyway.
3. Before determining the specific gravity of the stalk urinometer, the tool must be
detached from the glass wall. To take it off, turn the urinometer with thumb and
forefinger.
4. The rotation causes urinometer floating in the middle of the glass. Now read without
paralax density below the meniscus height.
5. Record the results of the examination
Determine urine pH: determination with universal indicator .
Equipment:

Universal indicator
Urine container

Materials:

Fresh urine

How it works:
1. Universal indicator of wet urine checked . wait for a few minutes .
2. Note the color change occurs .
3. Compare with the list of colors available on the acidity of universal indicator. Specify
a value corresponding to the color.
4. Record the measurement results.
Protein test with acetic acid
Equipment:

test tube
burner (Bunsen)
tube clamp
pipette
flashlight
black cardboard

How it works:
1. Enter urine into a test tube filled up 3/4 of the tube.
2. Clamp on the bottom of the tube, the tube tilt about 45 degrees to the top of the tube
can be heated over a fire to boil for 30 seconds.
3. Tube to give exposure to incident light from the cardboard background
4. Note the occurrence of turbidity layer of the upper urinary. compare with the clarity of
urine that is not heated at the bottom of the tube. in case of turbidity, may be caused
by the protein, but may also be due to calcium phosphate or calcium carbonate.
5. To determine whether the turbidity caused by the calcium phosphate then when the
urine is still hot dropped 3-5 drops of 3-6% acetic acid then the turbidity will
disappear. If turbidity is due to calcium carbonate, with hatching acetic acid turbidity
will also be lost, but is accompanied by the formation of gas. If cloudiness persists or
turbid added, meaning there is protein.
6. Heat once again the top of the tube to boiling and consider the examination of the
urine.
7. Record observations.
Urine glucose test: test benedict
Equipment:

test tube
burner (Bunsen)
tube clamp
pipette

flashlight
black cardboard

Materials:

Urine
Benedict 5 ml
Paraffine

How it works:
1.
2.
3.
4.

Enter 5 ml reagent benedict into a test tube.

Drops as much as 5-8 drops (no more) into the tube.
Heat tube to boil slowly for 2 minutes.
Lift tube, shake, and read the results in a way to give exposure reduction on the tube
until the incident light from the cardboard background.
5. Note the turbidity that occurs.
6. Record observations.
Literature:
Centers for Disease Control and Prevention, NHS Direct, University of California (San
Diego).
Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St.
Louis: Saunders.
Healthwise staff. 2010. Urology.
Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th
ed. Philadelphia: Lippincott Williams and Wilkins.
Pagana KD, Pagana TJ (2010). Mosbys Manual of Diagnostic and Laboratory Tests, 4th ed.
St. Louis: Mosby Elsevier.
German Institute for Quality and Efficiency in Health Care (IQWiG). Urine and blood
glucose self-measurement in diabetes mellitus type 2. Final report A05-08. Version 1.0.
Cologne: IQWiG. October 2009. [Executive summary in English] [Full text in German]
National Institute for Health and Clinical Excellence (NICE). NICE clinical guideline 62:
Antenatal care Routine care for the healthy pregnant woman. London: NICE. March 2008.
[Full text]
Tate, Philips. 2009. Seeleys Principles of Anatomy and Physiology, 2nd Edition. New York:
Mc Graw-Hill Companies.
Rogers M, Nixon J, Hempel S, Aho T et al. Diagnostic tests and algorithms used in the
investigation of haematuria: systematic reviews and economic evaluation. Health Technol
Assess 2006; 10 (18). [Full text] [PubMed]

Saladin. 2003. Anatomy and Physiology: The Unity of Form and Function, 3rd Edition. New
York: Mc Graw-Hill Companies
Thomas L. Labor und Diagnose. Marburg: Die Medizinische Verlagsgesellschaft. 7th edition,
2007.
Williams GJ, Macaskill P, Chan SF, Turner RM et al. Absolute and relative accuracy of rapid
urine tests for urinary tract infection in children: a meta-analysis. Lancet Infect Dis 2010; 10:
240-50. [PubMed]