URYNALISIS

RINI MAYA PUSPITA

 INTRODUCTION

URINALYSIS is a simple non-invasive

diagnostic test which can provide a
glimpse into a person’s health
 OBJECTIVES

 Give an overview of the anatomy and

physiology of the urinary system
 Explain how urine is produced and its
components
 Describe the types of urine samples and
tests
 Describe the requirements and procedure
for dipstick urinalysis using the manual
method
 IMPORTANCE OF URINE ANALYSIS

• It can detect diseases which pass unnoticed.

For example, D.M, chronic UTI.

• Diagnosis of many renal diseases.

As nephrotic, nephritic syndrome, acute renal

failure, multiple myeloma

 URINE COMPOSITION

• Urine, a very complex fluid, is composed of 95% water

and 5% solids .It is the end product of the metabolism
carried out by billions of cells and results in an average
urinary out put of 1-1.5 L per day.

• Almost all substances found in urine are also find in the

blood although in different concentration.

• Urine may also contain formed elements such as cells,

casts, crystals, mucus and bacteria.
THE URINARY SYSTEM

Organs of the urinary

system

 Kidneys
 Ureters
 Urinary bladder
 Urethra
THE FUNCTION OF THE URINARY
SYSTEM

 The kidneys regulate: acid-base balance;

electrolyte concentration; extracellular fluid
volume (homeostasis).
 The kidneys remove waste & water from the
blood stream and reabsorb vital nutrients.
 The kidneys regulate the blood pressure.
 The urinary bladder stores urine.
KIDNEY NEPHRON
FORMATION OF URINE

HCO 3 – bicarbonate
NaCl – sodium chloride
K – potassium
H2O – water
H – hydrogen
NH3 - amonia
COMPONENTS OF URINE
COMPONENTS OF URINE
 COLLECTION REQUIREMENTS
 Containers – white/red/green topped Discuss.
 Mid stream
 Early morning
 Sample storage < 2hrs or kept at 4c out of direct
sunlight - DISCUSS
 TYPES OF SAMPLE
 Random – most common for infection.
 Early morning urine (EMU) – has greater
concentration of substances (micro-albumInuria).
 Clean catch midstream (MSU) – genitalia
should be cleaned, urine is tested for micro-
organisms for presence of infection (culture &
sensitivity).
 Timed – specific time of day, always discard the
1st specimen before testing.
 24 hour – used for quantitative and qualitative
analysis of substances.
 TYPES OF TESTING

 Physical
 Chemical
 Microscopic
 PHYSICAL EXAMINATION OF
URINE

Done with the naked eye, a very important

part of the test. Findings should be
documented.

 Colour (affected by drugs, food, general

condition).
 Turbidity (clear; cloudy, particles).
 Volume.
 Odour (affected by infection, diet)
Normal Urine Abnormal Urine
color:
* Normal urine color has a wide range of variation
ranging from pale yellow, straw, yellow, dark
yellow, amber due to urobillin ,trace of
urobilinogen appears in urine

The color is affected by: -

• Concentration of urine.
• pH.
• Metabolic activity.
• Diet intake (Beet).
• Drugs may change urine color (Rifampicine)
 COLOR ABNORMALITIES :
• Colorless or pale yellow:
• High fluid intake
• Reduction in perspiration.
• Using of diuretic.
• Diabetes Mellitus.
• Diabetes Insipidus.
• Alcohol ingestion
• Dark yellow:
• Low fluid intake.
• Excessive sweating
• Dehydration (burns, fever).
• Carrots or vitamin (A) orange urine
• Pyridium(local analgesic effects on the urinary tract. It is
typically used in conjunction with an antibiotic when
treating a urinary tract infection)cause a distinct color
change in the urine, typically to a dark orange to reddish
color .
• Nitrofurantoin(antibiotic used against E. coli in urinary
tract infection ).
Hepatitis and obstructive jaundice, with excessive
bilirubin in urine
Bilirubin on shaking yellow foam will appear.
Urobilin on shaking the foam has no color.
• Yellow – green
• Biliverdin (greenish) just in abnormal cases when there is liver
cirrhosis
• Which give a yellow foam & (- ve) test for bilirubin

• Blue – Green:
• Pseudomonas Infection

o Brownish yellow:
• Hepatitis and obstructive jaundice, with excessive bilirubin in
urine
• Bilirubin on shaking yellow foam will appear.
• Urobilin on shaking the foam has no color.
• Pink – Red:
• Due to the presence of fresh blood (hematuria) or Hb
(hemoglobinuria)
• Fresh blood will give smoky color while Hb gives clear reddish urine,
which may be due to: -
• Urinary tract infection, Calculi, Trauma
• Menstrual contamination.
• Cancer kidney or cancer bladder

• Dark brown:
• Malignant Melanoma:

.Melanogen (Colorless) ──light─ Melanin (Brown).

• Nephritic syndrome (cola color of urine)

o Black Urine: -
• Alkaptonurea (ochronosis), a disease of tyrosine metabolism.
 CLARITY (TRANSPARENCY).

Normal urine clear or transparent, any turbidity will

indicate.
• WBCs (pus).
• RBCs
• Epithelial cells
• Bacteria
• Casts
• Crystals
• Lymph
• Semen.
 ODOR
• Fresh normal urine has a faint aromatic odor due
to the presence of some volatile acids.

• In some pathological conditions, certain

metabolites may be produced to give a specific
odor such as:
• Fruity odor is due to acetone.(Diabetic urine)
• Ammoniac odor urine standing long time
• Offensive odor Bacterial action of pus (UTI).
• Mousy odor Phenylalanine (phenylketonurea
“PKU” ).
 VOLUME

• Adult urine volume = 600 – 2500 ml /24hr.

0.5-1ml /kg/hr, Average 1.5 litres
• Children urine volume =200–400ml /24hr
(4ml/kg/ hr).
• Which depends on:
• Water intake
• External temperature.
• Mental and physical state.
• Intake of fluid and diuretics (Drugs, alcohol ,tea).
 ABNORMALITIES
• Oligouria: marked decrease in urine flow < 400 ml.
• Polyuria: Marked increase in urine flow > 2500 ml.
• Anuria: <100ml/day
• Nocturia: excessive urination during night.

• Causes of polyuria:
• Increased fluid in take (polydipsia ──>polyuria).
• Increased salt intake ad protein diet, which need
more water to excrete.
• Diuretics intake (certain drugs, drinks , caffeine)
• Intravenous saline or glucose.
 • Diabetes Mellitus.

• Diabetes Insipidus.

• End stages of chronic renal failure

• Hypoaldasteronism.

• Hypercalcaemia

• Hyperthyroidism

• Pregnancy

• Removal of urinary obstruction

• Psychogenic polydepsia
• Causes of Oliguria:
• Water deprivation
• Dehydration
• Prolonged vomiting.
• Diarrhea
• Excessive sweating
• Renal Ischemia
• Heart failure
• Hypotension
• Acute renal failure
• Obstruction by :Calculi,Tumor,Prostatic
hypertrophy.
• Causes of anuria:
• Sever Renal Defect and loss of urine formation
mechanism.
• Due to the presence of stone or tumor.
• Post transfusion hemolytic reaction.
 PH
• One of the important functions of the kidneys is
pH regulation, the glomerular filtrate of blood
plasma is usually acidified by renal tubules and
collecting ducts from a pH of 7.4 to about 6 in the
final urine to keep blood pH about 7.4.

• Hence, urine pH must vary to compensate for

diet and products of metabolism, this function
takes place in the distal convoluted tubule with
the secretion of both H+ and reabsorbtion of
bicarbonate.

• Normal urine pH is (4.6 – 8.0) as average (6.0)

• Even in abnormal conditions, urine pH mustn’t
reach 9, if so or more this will indicate that urine
is stand for along time & must be rejected
Renal physiology has several powerful mechanisms
to control pH by the excretion of excess acid or
base. In responses to acidosis, tubular cells
reabsorb more bicarbonate from the tubular fluid,
collecting duct cells secrete more hydrogen and
generate more bicarbonate. In responses to
alkalosis, the kidney may excrete more bicarbonate
and decrease hydrogen ion secretion from the
tubular epithelial cells.
CLINICAL SIGNIFICANCE OF PH
• Determine the existence of metabolic acid base
disorder
• Precipitation of crystals to from stone requires
specific pH for each type. Hence, pH control may
inhibit the formation of these stones by control
diet.
Crystals found in alkaline urine : Ca carbonate,
Ca phosphate, Mg Phosphate
Crystals found in acidic urine:Ca oxalate,uric
acid.
Acidic urine in : acidosis , DKA, starvation
dehydration, diarrhea
Alkaline urine in : alkalosis, congenital hypertrophic
pyloric stenosis, renal tubular acidosis, UTI .
CHEMICAL TESTING OF URINE
 Usually done with reagent strips.

 Used to determine body processes such as

carbohydrate metabolism, liver or kidney
function.

 Used to determine infection.

 Can be used to determine presence of drug or

toxic environmental substances.
 SOME CHEMICALS THAT CAN BE FOUND IN
URINE (NOT NORMAL COMPONENTS)
 Ketones .
 pH – acid/alkaline balance.
 Blood
 Bilirubin (urobilinogen)
 Glucose
 Protein
 Nitrates
 Leukocytes
 drugs
 Phenylketones – indicates PKU – a rare genetic disorder of one of the liver
enzymes. If left, can cause a build up of the chemical in the blood and brain
which can cause mental development issues and epilepsy – screened for in
babies 1st week of life with heel prick test.
MICROSCOPIC EXAMINATION OF
URINE
 Used to examine the elements not
visible without a microscope.
 Centrifuge spins the urine to
separate substances.

• Cells • Bacteria
• Crystal • Yeasts
• Casts • Parasites
 MICROSCOPIC URINALYSIS

Microscopic examination used to view elements that are

not visible without microscope. e.g cells

1. Red Blood Cells:

Hematuria is the presence of abnormal numbers
of red cells in urine due to:
a. Glomerular damage
b. Tumors
c. Urinary tract stones
d. Upper and lower urinary tract infections
 HEMATURIA

Two Types of Hematuria

• Gross hematuria means that the blood can be seen by

the naked eye. The urine may look pinkish, brownish, or
bright red.

• Microscopic hematuria means that the urine is clear, but

blood cells can be seen under a microscope.
RBC's may appear normally shaped, swollen by
diluted urine.
 2.WHITE BLOOD CELLS

Pyuria refers to the presence of abnormal numbers of

leukocytes that may appear with infection in either the
upper or lower urinary tract or with acute
glomerulonephritis.

Usually, the WBC's are granulocytes

WBCs - ≤2-5 WBCs/hpf
 3. Epithelial Cells

• Renal tubular epithelial cells, contain a large round or

oval nucleus and normally slough into the urine in small
numbers. However, with nephrotic syndrome and in
conditions leading to tubular degeneration, the number
sloughed is increased.

• ≤15-20 squamous epithelial cells/hpf

 4. CASTS

• Urinary casts are cylindrical structures produced by the

kidney and present in the urine in certain disease states.
• They are formed in the distal convoluted tubule (DCT) and
collecting ducts of nephrons, then dislodge and pass into
the urine, where they can detected by microscopy.
-Urinary casts may be made up of cells (such as white
blood cells, red blood cells, kidney cells) or substances
such as protein.
 OTHER TESTS

 Pregnancy tests – EIA (enzyme immunoassay test)

used to detect human chorionic gonadotrophin
(hCG), secreted by the placenta.

 STIs - chlamydia
 THE SQUARES ON THE DIPSTICK
REPRESENT THE FOLLOWING
COMPONENTS IN THE URINE

Nitrite (suggestive of bacteria in urine)

Bilirubin ( possible liver disease or red blood cell break down)
Urobilinogen ( possible liver disease)
 VISUAL SIGNIFICANCE OF
URINALYSIS
 Colour: The colour and clarity of the urine has significant
implications and should always be noted. The colour of
normal urine varies with its concentration, from deep
yellow to almost clear. In disease, the colour may be
abnormal due to excretion of the endogenous pigments
as well as drugs and their metabolites.

 Odour: Odour in the urine of patients who have a urinary

tract infection, is often due to the urea-splitting
organisms. This makes it smell ammonia. The presence of
urinary ketones, as in diabetic ketoacidosis, leads to an
acetone smell. The presence of malodorous urine does
not indicate the presence of infection and does not
negate the need for testing.
 CLINICAL SIGNIFICANCE OF TEST
RESULTS
 Glucose - is found when its concentration in
plasma exceed the renal threshold (may
indicate diabetes)
 Bilirubin/urobilinogen – indicates an excess in
the plasma. Commonest cause of positive
results is liver cell injury e.g. hepatitis,
paracetamol overdose, late-stage cirrhosis.
 Ketones – due to excessive breakdown of body
fat. Common in fasting, may indicate low
carbohydrate diet, vomiting & fever, present in
starvation
 CLINICAL SIGNIFICANCE OF TEST
RESULTS (CONT.)
 Specific gravity – a measure of solute concentration.
High values can be found in dehydration. Low
values found in high fluid intake. Diabetes insipidus;
chronic renal failure; hypercalcaemia;
hypokalaemia.
 Blood – menstruation, kidney disorders; urinary tract
disorders (e.g. tumours, prostatic enlargement).
 pH – high values - commonest cause of high vales is
stale urine; large intake of antacids;UTI with
ammonia forming organisms. Low values – acidosis
(diabetic & lactic); starvation; potassium depletion.
 CLINICAL SIGNIFICANCE OF TEST
RESULTS (CONT.)

 Protein – excess albumen in the urine is unusually due

increased permeability in the glomeruli. Positive results
in acute and chronic kidney disease, pre-eclampsia.
 Nitrite – UTI – most of the organisms which infect the
urinary tract contains an enzyme that convers nitrate
(normally found in urine) to nitrite which is not found in
urine in the absence of infection. Some organisms do
not convert nitrate to nitrite (false negative).
 Leucocytes – leucocytes enter inflamed tissue from
the blood and are shed into the urine. UTI is
commonest cause of positive results.
 UTI TESTING PATHWAY

If all Negative-
nitrite, leucocytes,
blood, protein -
discard
Test with reagent
clear
strip
If any Positive –
nitrates,
Urine sample Visual appearance
leucocytes, blood,
protein = UTI
Send for C&S /
Obviously infected
treat