Urinalysis
Dr. A. Basu MD
Topic
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Definition and normal urine
Indication
Collection
Examination
– Physical
– Chemical
– Microscopical
Urinalysis : Definition
• Qualitative and semi quantitative
evaluation of renal products.
Normal Urine = At a glance
• a. Physical - color - normally pale yellow
– transparency - clear
– specific gravity - 1.020 - 1.030
• b. Chemical - pH
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acid in carnivores
alkaline in herbivores
protein - normally 0 mg/dl
glucose - normally none
blood - normally none
• c. Sediment - urine solids stained after
centrifugation( no finding, except scanty
epithelial cell)
Indication
1.
2.
3.
4.
Glomerulonephritis
Diabetes mellitus
Urinary tract infection
Tumors
Collection
1. Random collection:
Early morning: chemical are present in
higher concentration
2. 24 hours urine collection
Nephrotic syndrome
3. Suprapubic Trans- abdominal needle
aspiration of the bladder (purest sample)
Urine preservatives
• Boric acid
• HCl
• Sulfuric acid
Collection
• Maintain patient privacy
• Do not clean the area with antiseptic
• Collect mid stream urine
When you should examine
• Immediate
• Or, within One hour after collection of
urine.
• The interval of time which elapses from
collection to examination in the laboratory
is important.
• Changes which occur with time after
collection include:
– loss of ketone bodies,
– loss of bilirubin,
– overgrowth of contaminating microorganisms.
URINALYSIS
Three phases
• A. Physical Examination
• B. Chemical Examination
• C. Microscopical Examination
URINALYSIS
A. Physical Examination
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1.Volume
2. Color
Odor
3.Appearance(e.g. transparent or
Turbidity present)
• 4.pH
• 5. Specific Gravity
Colour
• Red: Hematuria, hemoglobinuria, certain
drugs, myoglobinuria .
• White: chyluria
• Red colour on standing : Porphyria
• urine darkens on standing - Alkaptonuria
Odor
• Normal: ammonia
• In infection: fishy smell
• If Ketone is high: sweet smell.
Appearance
• Normal: transparent
• Turbid:
– High WBC
– High epithelial cells.
ph
• The glomerular filtrate of blood plasma is
usually acidified by renal tubules and
collecting ducts and from a pH of 7.4 to
about 6 in the final urine.
Specific Gravity
• Low (1.007 to 1.010) : End stage kidney
disease.
• High (1.035) : SIADH, contamination ,
presence of glucose.
Chemical test
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Protein
Sugar (Glucose)
Ketone
Blood
Nitrite
Leukocyte Esterase
Protenuria
• More than 150 mg/day is defined as
proteinuria
Ketone
1. Diabetic ketosis or
2. Some other form of calorie deprivation
(starvation).
Nitrite
• Positive nitrite test ; Bacteria may be
present
Leukocyte Esterase
• Positive: WBC are present
URINE DIPSTICK CHEMICAL ANALYSIS
• A dipstick is a paper strip with patches
impregnated with chemicals that undergo a
color change when certain constituents of the
urine are present or in a certain concentration.
• The strip is dipped into the urine sample,
and after the appropriate number of
seconds, the color change is compared
to a standard chart to determine the
findings
In protenuria
4+
• A sample
Strip
• For Chemical
• Analysis Of
• Urine
Leucocyte esterase
Nitrite
pH
Colors' are
before
examination
Protein
Blood
Specific Gravity
Ketone
Glucose
Bilirubin
Interpretation of the result
Microscopical examination
1.
2.
3.
4.
5.
RBC
WBC
Yeast
Casts
Crystals
Examination(Microscopy)
RBC
• Red blood cells in
urine appear as
refractile disks.
• With hypertonicity of
the urine, the RBC's
begin to have a
crenated
appearance.
Examination(Microscopy)
RBC
1. Glomerular damage
2. Tumors which erode the urinary tract
anywhere along its length,
3. Kidney trauma, urinary tract stones,
4. Renal infarcts, acute tubular necrosis,
5. Upper and lower urinary tract infections,
nephrotoxins, and physical stress.
6. Red cells may also contaminate the urine
from the vagina in menstruating women or
7. From trauma produced by bladder
catherization.
The presence of dysmorphic RBC's in urine suggests a
glomerular disease such as a glomerulonephritis.
Normal
RBC
White Blood Cells : When we see
this cell?
• Infection (pyuria)
• Acute glomerulonephritis
These white blood cells in urine have lobed
nuclei and refractile cytoplasmic granules.
A white blood cell is seen at the left and a red blood cell at the
right for size and morphologic comparison
Important
• Tuberculosis may be a cause for a 'sterile
pyuria' in which routine cultures fail to
grow bacterial organisms, but
inflammation is present.
Epithelial Cells
• Acute tubular
necrosis
• UTI
Oval Fat Bodies
• When lipiduria occurs, these cells contain
endogenous fats. When filled with
numerous fat droplets, such cells are
called oval fat bodies
Oval fat bodies consist of degenerated tubular cells
containing abundant lipid, which appears refractile
Casts
• Hyaline casts are composed primarily of a
mucoprotein (Tamm-Horsfall protein)
secreted by tubule cells.
Hyaline casts can be seen even in healthy
patients.
The presence of this red blood cell cast in on
urine microscopic analysis suggests a
glomerular or renal tubular injury.
This white blood cell cast suggests an acute
pyelonephritis.
This renal tubular cell cast suggests injury to
the tubular epithelium(ATN).
Presence of Granular cast
suggest Chronic disease:
chronic GN
Granular cast later form a finely granular cast,
and ultimately, a waxy cast.
Waxy cast. Note that the edges are
sharp and there are "cracks" in this
cast.
Yeast
• Yeast cells may be contaminants or
represent a true yeast infection.
• Most often they are Candida, distinguished
by their tendency to bud
Crystals
MAY BE ASSOCIATE WITH STONE IN THE Urinary
system.
These are oxalate crystals, which look like little
envelopes (or tetrahedrons, depending upon
your point of view).
These "triple phosphate" crystals
look like rectangles, or coffin lids.
One Bag For Urine Collection
And Testing
Thanks