URINALYSIS

URINALYSIS LECTURE OUTLINE

SAMPLE COLLECTION AND PRESERVATIVES
PHYSIOCHEMICAL ANALYSIS
COLOUR
CLARITY
ODOUR
VOLUME
SPECIFIC GRAVITY
CHEMICAL ANALYSIS
PROTEINURIA
SUGAR IN URINE
KETONES
BILIRUBIN
UROBILINOGEN
PH
 CLINICAL UTILITY OF URINALYSIS
INDICATOR OF HEALTH/DISEASE IN
METABOLIC AND RENAL DISEASES

SCREENING ON ADMISSION

MONITORING DISEASE
 URINALYSIS CATEGORIES
PHYSIOCHEMICAL CHARACTERISTICS

CHEMICAL ANALYSIS

MICROSCOPIC EXAM

BACTERIAL SCREEN
 TYPES OF URINE SAMPLES
RANDOM/SPOT
CONVENIENT AND SUITABLE FOR CHEMICAL &
MICROSCOPIC EXAM

FIRST EARLY MORNING SAMPLE

BLADDER INCUBATED HENCE MORE CONC.
UNSUITABLE FOR GLUCOSE DETERMINATION
BEST FOR NITRITE & PROTEIN DETERMINATION

BOTH TYPES ONLY GOOD FOR QUALITATIVE

EVALUATION
 TIMED URINE SAMPLES
PATIENT GIVEN WRITTEN INSTRUCTIONS ON:

COLLECTION PROCEDURE

DIETARY RESTRICTIONS (IF ANY)

DRUG RESTRICTIONS (IF ANY)

TIMED URINE SAMPLES EXAMPLES
2-HR (EXOGENOUS GFR DETERMINATION)

5-HR (D-XYLOSE)

4-HR (ENDOGENOUS GFR DETERMINATION)

24HR (GFR, PROTEIN, VMA ETC)

GOOD FOR QUANTITATIVE ANALYSIS (URINE CONC. VARIES

THROUGHOUT THE DAY)

REMOVAL OF ALIQUOTS NOT PERMISSIBLE

CHANGES IN STORED URINE SAMPLES
LYSIS OF FORMED ELEMENTS

INCREASED BACTERIAL MULTIPLICATION

DEPLETION OF GLUCOSE

GENERATION OF AMMONIA FROM UREA (ALKALINE

PH)

CHEMICAL DECOMPOSTION OF URINARY CONSTITUEN

TS
 ACTION OF PRESERVATIVES
REDUCE BACTERIAL GROWTH

MINIMISE CHEMICAL DECOMPOSITION

SOLUBILISE PRECIPITATED COMPONENTS

REDUCE ATMOSPHERIC OXIDATION

COMMONLY USED PRESERVATIVES
CONC. HCL (5-HIAA, CALCIUM, VMA)

PETROLEUM ETHER (UROBILINOGEN)

SODIUM BICARBONATE (PORPHYRINS)

TOLUENE (URIC ACID, AMINO ACIDS)

BORIC ACID (HCG CORTISOL)

 PHYSIOCHEMICAL: COLOUR
NORMALLY AMBER DUE TO UROCHROME

RED BROWN: HB, MYG & BEETROOT

SMOKY RED: INTACT RBCS

DEEP YELLOW & FROTHY ON SHAKING: BILI

BROWNISH BLACK: HGA (ALKAPTONURIA)

 PHYSIOCHEMICAL: CLARITY

NORMALLY CLEAR

PINKISH TURBIDITY: INCREASED URIC ACID

CLOUDY: PHOSPHATES OR CARBONATES AT

ALKALINE PH OR DUE TO UTI
 PHYSIOCHEMICAL: ODOUR
NORMALLY AROMATIC DUE TO VOLATILE
ACIDS

AMMONIACAL DUE TO UREA

DECOMPOSITION

FOUL IN COLIFORM BACILLI INFECTION

 URINE VOLUME
750 2000ML/24HR

RELATED TO FLUID INTAKE, BODY SIZE AND

ENVIRONMENTAL TEMP.

PHYSIOLOGICAL POLYURIA
INCREASED WATER INTAKE
DIURETIC AGENTS
IV FLUID INFUSION
 URINE VOLUME
PATHOLOGICAL POLYURIA IN:
DIABETES MELLITUS
DIABETES INSIPIDUS

OLIGURIA (<200 ML/24HR)

ANURIA (COMPLETE SUPPRESSION)

BOTH ARE FEATURES OF RENAL INSUFFICIENCY OR
OBSTRUCTION
 SPECIFIC GRAVITY
REFLECTS KIDNEY CONCENTRATION ABILITY
ABOVE 1.025 REFLECTS ADEQUATE FUNCTION
DECREASED IN RENAL INSUFFICIENCY
INCREASED IN:
DM
ADRENAL INSUFFICIENCY
PROTEINURIA
DETECTED BY:
URINOMETER
FALLING DROP
REFRACTIVE INDEX
DIPSTIX
 CHEMICAL ANALYSIS OF URINE
EXAMINE WITHIN 1HR OR STORE IN FRIDGE

DIPSTIX USED (PADS COATED WITH ANALYTE

SPECIFIC REAGENTS)
 URINARY PH
NORMALLY PH6 BUT RANGES FROM PH4
PH8

PAD IMPREGNATED WITH METHYL RED AND

BROMTHYMOL BLUE

INDICATORS GIVE SHADES OF ORANGE AND

GREEN
 PH
STRONGLY ACIDIC:
HIGH PROTEIN DIET
STARVATION
UNCONTROLLED DM

ALKALINE
RTA
UTI
AGED URINE SAMPLE
 URINARY PROTEIN

NORMAL RANGE <150 MG/24HR

1/3 ALBUMIN. REMAINDER LMW GLOBULINS

& TAMM HORSFALL MUCOPROTEIN.
 GLOMERULAR PROTEINURIA/NS
CHARACTERISED BY HMW PROTEINURIA

NEPHROTIC SYNDROME:
HEAVY PROTEINURIA (>3.5G/24HR)
HYPOALBUMINAEMIA (<25G/L)
OEDEMA
 TUBULAR PROTEINURIA
BETA-2-MICROGLOBULIN

RBP

ALPHA-1-MICROGLOBULIN

ALL NORMALLY FILTERED , REABSORBED AND

CATABOLISED IN PCT
 OVERFLOW PROTEINURIA
HIGH CONC OF LMW PROTEINS FILTERED THRU &
EXCEED REABSORPTION CAPACITY

Eg LIGHT CHAINS OF EXCRETED IN URINE AS

BENCE JONES PROTEINS IN MM

DETECTED BY :
HEAT TEST
BRADSHAWS TEST (CONC HCL)
ELECTROPHORESIS
 BENIGN PROTEINURIA
POSTURAL

FUNCTIONAL

PREGNANCY

EMOTIONAL STRESS
 DETECTION OF PROTEINURIA
DIPSTIX
PROTEIN ERROR OF INDICATORS CERTAIN PH
INDICATORS SHOW COLOUR CHANGE IN THE
PRESENCE OF PROTEIN (TETRABROMPHENOL
BLUE WITH CITRATE BUFFER.

SENSITIVE TOWARDS ALBUMIN

LOWER DETECTION LIMIT ABOUT 150MG/L

 DETECTION OF PROTEINURIA
PRECIPITATION & TURBIDOMETRY (SSA & TCA)

DYE BINDING (COOMASSIE BRILLIANT BLUE)

 EVALUATION OF PROTEINURIA
SCREEN BY DIPSTIX

IF 2/3 SAMPLES ARE POSITIVE SEND TO LAB

FOR QUANTIFICATION

PROTEINS IDENTIFIED BY ELECTROPHORESIS

 SUGAR IN URINE
MOSTLY GLUCOSE IN:
RENAL GLYCOSURIA
DM
..THIS MYSTERIOUS AFFECTIONBEING MELTING
DOWN OF FLESH & LIMBS INTO URINE. LIFE IS SHORT,
DISGUSTING AND DEATH PAINFUL. THIRSTY
UNQUENCHABLE AND DEATH INEVITABLE ARATEUS
AD 170
 OTHER SUGARS IN URINE
LACTOSE: NEONATES & LACTATING MOTHERS

GALACTOSE: GALACTOSAEMIA

FRUCTOSE: HEPATIC DISORDERS

PENTOSES: IBEM
 DETECTION OF URINE GLUCOSE
GLUCOSE OXIDASE & PEROXIDASE PRODUCE
H2O2 WHICH IS REDUCED WITH
CONCOMITANT OXIDATION OF KI TO RELEASE
IODINE..DIPSTIX

DETECTS 4 7MMOL/L
 DETECTION OF OTHER URINARY
SUGARS
CLINITEST:
GLUCOSE & OTHER REDUCING SUBSTANCES REDUCE
CUPRIC IONS IN HOT ALKALINE ENVIRONMENTS TO
CUPROUS IONS BRICK RED COLOUR
NOT SPECIFIC FOR GLUCOSE

POSITIVE CLINTEST SHOULD BE FOLLOWED BY

GLUCOSTIX TO RULE OUT PRESENCE OF GLUCOSE

-VE GLUCOSTIX INDICATE NON-GLUCOSE

REDUCING SUBSTANCES. IDENTIFY BY TLC
 KETONURIA
KETONES EXCRETED WITH BASIC IONS THUS EXACERBATES
SYSTEMIC ACIDOSIS AND OCCURS IN:
DKA
STARVATION
PROLONGED FASTING

ACETOACETATE 20% AND DERIVED FROM IT

ACETONE 2%
BETA HYDROXYBUTYRATE 78%

DETECTED BY KETOSTIX/ACETEST WHICH INCORPORATE

NITROPRUSSIDE (GVES SHADES OF PURPLE WHEN
POSITIVE)
 BILIRUBINURIA
EXCRETED IN BILE & REDUCED TO UROBILINOGEN IN GIT

BILIRUBINURIA PRECEDES ELEVATION OF OTHER HEPATIC MARKERS OF

LIVER DISEASE.

OCCURS IN INTRAHEPATIC OBSTRUCTION

INFECTIONS
HEPATOXIC AGENTS

EXTRAHEPATIC OBSTRUCTION
GALLSTONES
TUMOURS

DETECTED BY DIAZOTISED SULPHANILIC ACID IN AZOSTIX OR ICTOTEST

(PURPLE COLOUR)
 UROBILINOGEN
50% REABSORBED INTO PORTAL CIRCULATION AND RE-EXCRETED.

INCREASED WITH HIGH BILI PRODUCTION IN:

HAEMOLYTIC ANAEMIA
MALARIA
DISORDERS OF PORTAL CIRCULATION (HEPATITIS)

DECREASED IN ANTIBIOTIC THERAPY, NEONATES & CHOLESTASIS

USEFUL IN DIFFERENTIATION OF HAEMOLYTIC AND CHOLESTATIC

LIVER DISEASE

P-DIMETHYLAMINOBENZAYLDEHYDE ON AN EARLY AFTERNOON

SAMPLE (PINK COLOUR)