OS 214 [B]: Digestion and Excretion 1 Lab 01.2: Urinalysis December 4, 2013 Pathology Faculty TOPIC OUTLINE I. Urinalysis A. History B. Specimen Collection C. Types of Specimen D. Types of Analysis II. Physical Examination A. Volume B. Colour C. Odour D. Turbidity E. Specific Gravity III. Chemical Examination A. Glucose B. Bilirubin C. Ketones D. Specific Gravity E. Blood F. pH G. Protein H. Urobilinogen I. Nitrite J. Leukocyte Esterase IV. Microscopic Examination A. Cells B. Casts C. Crystals V. Flow Cytometry VI. Disease Diagnosis SUPRAPUBIC NEEDLE ASPIRATION Performed if the patient has spinal cord injury (cannot voluntarily urinate) Collected by the external introduction of a needle to through the abdomen into the bladder because the bladder is sterile under normal conditions. The sample is for bacterial culture and can also be used for cytologic examination. Figure 3. Suprapubic Needle Aspiration T/N: This is already the combined trans for the lecture from Dr. Lasap-Go and from the lab session, and is also based on 2016’s urinalysis lab trans. Dr. LasapGo said that we should know how to diagnose based on urinalysis results for the exam(s), so I suggest that you should read this trans in colour. URINALYSIS Is the physical, chemical, and microscopic examination of the urine. Can help find medical problems like renal disease, diabetes, liver disease and urinary infections. It involves tests to detect and measure various compounds that pass through the urine. Proper urine collection is very important HISTORY Start of Laboratory medicine – one of the earliest and simplest laboratory examinations Early physicians were seen examining urine in a bladder-shaped flask (even during the medieval era) They obtain information from basic observation of color, turbidity, odor, volume, viscosity, even sweetness (attracted ants) Though they may not know what is really wrong with the patient). Clinical microscopy would be essential test in a primary lab as mandated by law. SPECIMEN COLLECTION Should be the first morning voiding (most concentrated), midstream specimen Take note of: o Record collection time and the time the specimen was received in the laboratory o Type of specimen (e.g. “clean catch”) Should be analyzed within 2 hours of collection Free of debris or vaginal secretions TYPES OF SPECIMEN CLEAN CATCH Male patients should clean beginning at the urethra and withdrawing the skin, if necessary. Female patients should separate the labia and clean the urinary meatus and the surrounding area. Blood due to menstruation may contaminate the specimen Pediatric specimens are collected using clear plastic bags with adhesives attached to the genital area. (since some still cannot control their urination) Iodine scrub used to sterilized the area (see figure 1) TYPES OF ANALYSIS Macroscopic (Gross) Examination Chemical Analysis (Urine Dipstick) Microscopic Examination PHYSICAL EXAMINATION Evaluated by use of our senses. Parameters: volume, color, odor, turbidity & specific gravity Table 1. Summary of Physical Examination Findings of Urine Parameter Normal Abnormal Polyuria (>2L/day) 600mL – 1,600mL Volume Oliguria (<500mL/day) (adult) Anuria (<100mL/day) Hematuria… smoky urine Color Pale yellow or straw Hemoglobinuria, etc Odor Aromatic Fruity, rancid, etc Turbidity Clear Turbid… Cells, organisms, etc Specific High: Diabetes mellitus 1.003 – 1.035 Gravity Low: Diabetes insipidus VOLUME Depends on the state of hydration, activity level, environmental factors, weight, and individual’s health. Important to note especially in timed specimen collection (ex. 24h urine collection) o Low urine output – dehydration, renal failure o High urine output – diabetes mellitus, diabetes insipidus COLOUR Urine color is a transparent solution ranging from colorless to amber but it is usually pale yellow (however in diabetes mellitus, color is light (polyuria) but there is increase in specific gravity due to glucose) Urine color is directly proportional to concentration of solutes Urochrome/urobilin gives urine its color Table 2. Urine color and interpretation Color Interpretation Colorless Diluted urine Deep yellow Concentrated urine, riboflavin Yellow/light orange Removal of excess vitamin B Orange Rifampicin, phenazopyridine Yellow-green Bilirubin/Biliverdin Red Blood/Hemoglobin Dark orange-brown Jaundice, rhabdomyolysis, syndrome Brownish-red Acidified Blood (Acute GN) Brownish-black Homogentisic acid (Melanin) Gilber’s ODOUR Figure 1. Preparing for a clean catch specimen Marz, Micah, Kit Figure 2. Urine bag in a pediatric patient. Table 3. Urine odor and interpretation Odor Interpretation Aromatic Normal Ammonia-like Presence of urea-splitting bacteria Foul, offensive Old specimen, pus, or inflammation Sweet Presence of glucose Fruity Presence of ketones Page 1 / 10 OS 214 Lab 01.2: Urinalysis Maple syrup-like Maple Syrup Urine disease Mousy Phenylketonuria Rancid Tyrosinuria/tyrosinemia Rotting fish Trimethylenuria Sweaty feet Isovaleric acidemia, glutaric acidemia *Freshly voided urine has a faint aromatic odor as the specimen’s odor of ammonia becomes prominent. TURBIDITY Turbid urine is usually due to crystal formation in the bladder (maybe due to high concentration of solutes or unusual pH) or in the collection vessel due to reduction in temperature when the specimen stands. Can also indicate a symptom of bacterial infection but can also be due to crystallization of salts such as calcium phosphate Clarity of the urine should be visualized in a clear container. Cellular elements and bacteria (some causes of turbidity) will clear by centrifugation. Crystals dissolved by a variety of methods. Microscopic examination will determine which specific entities are present. SPECIFIC GRAVITY Important in measuring kidney’s concentrating ability CHEMICAL EXAMINATION URINE DIPSTICK can measure: 1. Glucose 2. Bilirubin 3. Ketones 5. Blood 6. pH 7. Protein 8. Urobilinogen 9. Nitrite 10. Leukocyte Esterase GLUCOSE URINOMETER Consists of a weighted float attached to a scale that has been calibrated in terms of urine specific gravity. Displaces a volume of liquid equal to its weight and has been designed to sink to a level of 1.000 in distilled water. Less accurate than other methods Not recommended Disadvantage: requires large volume of urine, affected by temperature (needs to be calibrated at 20 degrees Celsius), and affected by protein and glucose Chemical Principle Figure 4. Urinometer inside a test tube of urine REFRACTOMETER Determines the concentration of dissolved particles (specific gravity) by measuring the refractive index It is a comparison of the velocity of light in air with the velocity of light in a solution. The specific gravity scale is calibrated in terms of the angles at which the light passes through the specimen. It uses a small amount of urine (1-2 drops). Disadvantage: affected by glucose and protein, needs calibration (using distilled water: specific gravity = 1.00) Figure 5. Refractometer Directions of use: Simply dip the dipstick into the specimen and wait for 10 - 30 seconds. It should be read horizontally and universal precautions should be practiced. Don’t read it vertically since “run-off” will happen. 4. Specific Gravity Significance Limitations Other Tests Negative blue Trace 100 mg/dL + 250 mg/dL ++ 500 mg/dL +++ 1000 mg/dL ++++ 2000+ mg/dL Glucose Oxidase Glucose + 2 H2O + O2 Gluconic Acid + 2 H2O2 Horseradish Peroxidase 3 H2O2 + KI KIO3 + 3 H2O Read at 30 seconds RR: Negative Renal threshold: 160 mg/dL o Diabetes mellitus o Renal glycosuria o Interference: reducing agents, ketones. o Only measures glucose and not other sugars o Renal threshold must be passed in order for glucose to spill into the urine o CuSO4 test for reducing sugars. Table 4. Detection of Reducing Sugars by CuSO4 Type of Sugar Disease(s) Galactose Galactosemias Fructose Fructosuria, Fructose Intolerance, etc. Lactose Lactase Deficiency Pentoses Essential Pentosuria Maltose Non-pathogenic *Sucrose is not included because it is not a reducing sugar. REAGENT STRIP Advantage: urine protein and glucose has no effect on reagent-strip specific gravity measurements Disadvantage: increments at 0.05; visual interpretation of color change on the reagent strip often difficult and very subjective; always recalibrated Figure 6. Urine vs. Blood Glucose If urine glucose is high, blood glucose is high as well. Marz, Micah, Kit Page 2 / 10 OS 214 Lab 01.2: Urinalysis BILIRUBIN Other Tests Negative Light yellow glucose) o Refractometry o Hydrometer o Osmolality measurement (typically used with water deprivation test) – not commonly used + (weak) BLOOD ++ (moderate) Peach +++ (strong) Pink Bilirubin + Diazo salt Azobilirubin Chemical Principle Significance o Limitations o o Other Tests o o Read at 30 seconds RR: Negative Increased direct bilirubin (correlates with urobilinogen and serum bilirubin) o Usually when the doctor prescribes urinalysis and blood chemistry to correlate bilirubin levels Interference: prolonged exposure of sample to light Only measures direct bilirubin--will not pick up indirect bilirubin Ictotest (more sensitive tablet version of same assay) Serum test for total and direct bilirubin is more informative Negative Yellow Trace (non-hemolyzed) Speckled appearance Moderate (nonhemolyzed) Speckled appearance Trace (hemolyzed) Yellow-green + (weak) ++ (moderate) Dark green +++ (strong) Darker green, almost black Chemical Principle KETONES Negative Light tan Trace (5 mg/dL) + (15 mg/dL) Significance ++ (40 mg/dL) Pink Limitations +++ (80 mg/dL) ++++ (160 mg/dL) o Dark violet o Chemical Principle Significance Limitations Other Tests o o o o Other Tests o Diabetic ketoacidosis o Prolonged fasting o Interference: expired reagents (degradation with exposure to moisture in air) o Only measures acetoacetate not other ketone bodies (such as in rebound ketosis). o Ketostix (more sensitive tablet version of same assay) o Serum glucose measurement to confirm DKA o o Hematuria (nephritis, trauma, etc) Hemoglobinuria (hemolysis, etc) Myoglobinuria (rhabdomyolysis, etc) Interference: reducing agents, microbial peroxidases Not diagnostic of any disease, will not tell you the cause of the hematuria Cannot distinguish between the above disease processes Urine microscopic examination Urine cytology (smear on the button after centrifugation then papanicolau stain) Myoglobin reacts as well. So how do we determine if myoglobin or hemoglobin? o Correlate with microscopic. If red cell is found: hemoglobin If no red cell, get clinical history of the patient o If no clinical history is obtained, centrifuge. Pink: hemoglobin Clear: myoglobin o Add ammonium sulfate: If the urine is still pink, it is hemoglobin SPECIFIC GRAVITY pH 1.000 Dark blue 5.0 Red 6.0 Orange 6.5 Yellow 7.0 Yellow-green 7.5 Green 8.0 Dark green 8.5 Darker green, almost black 1.005 1.010 1.015 Green 1.020 1.025 1.030 Yellow Chemical Principle Significance Limitations Chemical Principle o Diabetes Insipidus o Interference: alkaline urine o Does not measure non-ionized Marz, Micah, Kit solutes (e.g. Page 3 / 10 OS 214 Lab 01.2: Urinalysis o Acidic (less than 4.5): metabolic acidosis, highprotein diet o Alkaline (greater than 8.0): renal tubular acidosis (>5.5) o Interference: bacterial overgrowth (alkaline or acidic), “run over effect” effect of protein pad on pH indicator pad (false acidic reading) o Titrable acidity o Blood gases to determine acid-base status Significance Limitations Other Tests pH: RUN OVER EFFECT Glucose blue green Bilirubin light tan Ketones light brown Specific Gravity navy blue Blood yellow pH orange Protein yellow Buffers from the protein area of the strip (pH 3.0) spill over to the pH area of the strip and make the pH of the sample appear more acidic than it really is. keep strip horizontal after dipping in urine NEPHROTIC SYNDROME (>3.5 g/dL in 24 hr) ↑ urine albumin levels Primary Lipoid nephrosis (severe) Membranous glomerulonephritis Membranoproliferative glomerulonephritis Secondary Diabetes mellitus (Kimmelsteil-Wilson lesions) Systemic lupus erythematosus Amyloidosis and other infiltrative diseases Renal vein thrombosis Table 5. Proteins in the “normal” urine Protein % of Total Daily Maximum Albumin 40% 60 mg Tamm-Horsfall 40% 60 mg Immunoglobulins 12% 24 mg Secretory IgA 3% 6 mg Other 5% 10 mg TOTAL 100% 150 mg UROBILINOGEN Urobilinogen light cream Negative Yellow Peach 2 mg/dL Light pink Trace Yellow green + (30 mg/dL) Light green ++ (100 mg/dL) Green +++ (300 mg/dL) Blue green ++++ (2000 mg/dL) Dark blue Dark pink Chemical Principle Significance Limitations Chemical Principle o High: increased hepatic processing of bilirubin o Low: bile obstruction o Interference: prolonged exposure of specimen to oxygen (urobilinogen ---> urobilin) Cannot detect low levels of urobilinogen still need blood chem o Serum total and direct bilirubin Table 6. Urobilirubinogen and/or bilirubin in the urine Urobilirubinogen Bilirubin Implication + Normal or hyperbilirubinemia (secondary to hemolytic anemia or malaria) Other Tests 1 mg/dL 8 mg/dL Esterase PROTEIN Other Tests Significance Limitations Light tan 4 mg/dL Nitrite Dirty white Leukocyte mustard 0.2 mg/dL o Proteinuria and the nephrotic syndrome. o Interference: highly alkaline urine. o Much more sensitive to albumin than other proteins (e.g., immunoglobulin light chains) o Can’t distinguish particular disease o Cannot detect microalbuminuria o Sulfosalicylic acid (SSA) turbidity test. o Urine protein electrophoresis (UPEP) o Bence Jones protein + + Liver pathology (hepatitis/viral) - + Obstructive Urobilirubinogen is a bile pigment that results from the degradation of hemoglobin Produced in the intestine from the reduction of bilirubin by intestinal bacteria Watson-Schwartz and Hoesch screening test is used for detection of porphobilinogen NITRITES Negative White Positive Pink CAUSES OF PROTEINURIA Functional o Severe muscular exertion o Pregnancy o Orthostatic proteinuria Renal o Glomerulonephritis o Nephrotic syndrome o Renal tumor or infection Pre-Renal o Fever o Renal hypoxia o Hypertension Post-Renal o Cystitis o Urethritis or prostatitis o Contamination with vaginal secretions Marz, Micah, Kit Chemical Principle Significance Limitations o Positive suggests presence of gram negative bacteriuria o Negative does not indicate absence of bacteria, must still correlate with microscopy o Interference: bacterial overgrowth o Only able to detect bacteria that reduce nitrate to nitrite Page 4 / 10 OS 214 Lab 01.2: Urinalysis Other Tests o Correlate with leukocyte esterase and o Urine microscopic examination (bacteria) o Urine culture LEUKOCYTE ESTERASE Negative Trace + (weak) ++ (moderate) Yellow Gray Lavender +++ (strong) Purple Chemical Principle “Dysmorphic” vs. “normal” (> 10 per HPF) o with cellular protrusions or fragmentation o reflect glomerular origin Crenated RBCs o Wrinkled o Due to difference in osmolality of the cytoplasm and the outside environment, or an artifact or (2016B) contamination of hypotonic solution Figure 7. Normal RBCs – biconcave in isotonic solution Figure 8. Dysmorphic RBCs with some normal RBCs LEUKOCYTES Significance Limitations Other Tests o o o o Pyuria Acute inflammation Renal calculus Interference: oxidizing agents, menstrual contamination o Urine microscopic examination (WBCs and bacteria) o Urine culture MICROSCOPIC EXAMINATION Preservation o Cells and casts begin to disintegrate in 1 - 3 hrs. at room temp o Refrigeration for up to 48 hours (to allow only a little loss of cells) Specimen concentration o Ten to twenty-fold concentration by centrifugation then get sample from the bottom Types of microscopy o Phase contrast microscopy o Polarized microscopy o Bright field microscopy with special staining (e.g., SternheimerMalbin stain) Formed elements of urine: o Cells (erythrocytes, leukocytes, epithelial cells) o Casts (hyaline, RBC, WBC, renal tubular epithelial, granular, fatty, waxy, broad casts) o Crystals Normal (calcium oxalate, uric acid) Abnormal (cysteine, acetyl sulfadiazine, cholesterol, bilirubin) o Organisms (bacteria, fungus, parasite, yeast etc) o Contaminants (starch granule, spermatozoa) ABNORMAL FINDINGS Per High Power Field (HPF) (400x) o > 3 erythrocytes o > 5 leukocytes o > 2 renal tubular cells o > 10 bacteria Per Low Power Field (LPF) (200x) o > 3 hyaline casts or > 1 granular cast o > 10 squamous cells (↑ sq cell count indicates not clean catch collection ≈ contamination ) o Any other cast (RBCs, WBCs) Presence of: o Fungal hyphae or yeast, parasite, viral inclusions o Pathological crystals (leucine, tyrosine, cystine) o Large number of uric acid or calcium oxalate crystals Neutrophils (glitter cells): More than 1 per 3 HPF Eosinophils: Hansel test (special stain) Increased: o Infection o Inflammation o Strenuous exercise Figure 9. Arrows pointing to PMNs EPITHELIAL CELLS 1. Renal tubular epithelial cells (RTE) Few are normal From renal tubules (proximal, distal, collecting) Must be enumerated using HPF The presence of > 2 RTE/HPF indicates tubular injury and specimens should be referred for cytologic urine testing. Difficult to identify due to variability in appearance With small, dense, eccentrically placed nucleus Figure 10. Benign tubular epithelial cells 2. Transitional epithelial cells (TC) Few are normal Smaller than squamous epithelial cells An increase in TC number exhibiting abnormal morphology such as vacuoles and irregular nuclei may be indicative of malignancy or viral infection CELLS ERYTHROCYTES Normal: 0-2 RBC/HPF Pathologic: >3 RBC/HPF Increased RBC: o Renal diseases o Lower urinary tract diseases o Extrarenal diseases o Toxic reaction o Physiologic Marz, Micah, Kit Figure 11. Benign Transitional Epithelial Cells from Bladder L – w/o stain; R – w/ stain 3. Oval fat bodies (oil-like droplets) Abnormal Page 5 / 10 Lab 01.2: Urinalysis OS 214 Indicate nephrosis A type of RTE that absorbs lipids Seen in free floating fat droplets Stained by Sudan III or Oil Red O fat stains Examined in a Polarized microscope Produces Maltese cross appearance on Polarized light Figure 17. LEFT: Casts forming in the cortical collecting duct. RIGHT: Casts forming in the thick ascending limb Figure 12. LEFT: oval fat body with Maltese cross appearance. RIGHT: regular oval fat body 4. Squamous cells Indicates level of contamination Table 7. Types of casts and disease associated Type of Cast Disease Associated Erythrocyte cast Glomerular diseases Leukocyte cast Pyuria, glomerular disease Degenerating casts Granular cast Non-specific (Tamm-Horsfall protein) Hyaline cast Non-specific (Tamm-Horsfall protein) Waxy cast Non-specific Fatty cast (oval fat body cast) Nephrotic syndrome RBC CASTS (formed inside a tubule) Figure 13. Transitional epithelial cells BACTERIA AND YEASTS 1. Bacteria (Bacteriuria: more than 10 per HPF) Figure 18. L - RBC Cast in urine; R - RBC Cast embedded within renal tubule WBC CASTS Figure 14. Bacteria around the cast 2. Yeasts (Candidiasis) Most likely a contaminant but should correlate with the clinical picture. Figure 19. WBC cast stuck together by Tamm Horsfall protein; also known as Glitter Cells (but don’t expect them to look glittery under the microscope) TUBULAR EPITHELIAL CASTS Figure 15. Yeast (Candida) in branched, mycelial form Figure 20. Epithelial cast with cuboidal to low columnar morphology GRANULAR CAST (non-specific) Non-pathologic if it came from the lysosomes excreted by RTE during normal metabolism (e.g. in extreme physical work) Pathologic if it represents disintegration of cellular casts and tubule cells or protein aggregates filtered by the glomerulus. Figure 16. Yeast exhibiting budding (High power view) + Crenated RBC 3. Viruses CMV inclusions: probable viral cystitis CASTS Casts are the only urine sediment unique to the kidney. Dissolve quickly in dilute alkaline urine. Major constituent of a Cast is Tamm-Horsfall protein, a glycoprotein excreted by the RTE of the DCT (distal convoluted tubule) and CD (collecting duct). Formed within the lumens of the distal convoluted tubules and collecting ducts. Marz, Micah, Kit Figure 21. Granular Cast Page 6 / 10 OS 214 Lab 01.2: Urinalysis HYALINE CAST (non-specific) Frequently seen cast, consists almost entirely of Tamm Horsfall protein Normal 0-2/LPF Can be seen in Acute Glomerulonephritis, pyelonephritis, CRD and CHF. Or dumbbell shaped. TRIPLE PHOSPHATE Figure 22. Hyaline Cast WAXY CAST (non-specific) Normal crystal Alkaline pH Colorless Coffin lid appearance Represent Extreme Urine Stasis, Indicating CRF Derived From The Degenerating Hyaline And Cellular Cast. URATE Figure 23. Waxy Cast FATTY CAST Seen in conjunction with oval fat bodies and free fat droplets in disorders causing lipiduria. Frequently associated with nephrotic syndrome, toxic tubular necrosis, DM, and crash injuries May consist of numerous Maltese crosses Normal crystals Most commonly seen as amorphous urates, uric acid, acid urates and sodium urates. Appear reddish to brown and are the only normal crystals found in acidic urine that appear colored. TYROSINE Abnormal crystal needles Acidic/neutral urine Fine colorless to yellow needles that frequently form clumps or rosettes Associated with liver disorders. Figure 24. Fatty Cast CYSTINE Abnormal crystal Acid urine Colorless, hexagonal plates may be thick or thin. Associated with hereditary cystinuria. SIGNIFICANCE OF CELLULAR CASTS Erythrocyte Casts Leukocyte Casts Endothelial Casts Individual Erythrocytes Individual Leukocytes Individual Bacteria AMMONIUM BIURATE Normal Crystal Alkaline Urine Yellow brown crystals (“thorny apple”) CRYSTALS 1. Urate (Ammonium biurate, uric acid) 2. Triple Phosphate 3. Calcium Oxalate 4. Amino Acids (Leucine, Cysteine, Tyrosine) 5. Sulfonamide CALCIUM OXALATE Normal crystal Present in Acid/neutral pH They are colorless, folded envelope shape Marz, Micah, Kit CHOLESTEROL Abnormal crystal Acid urine Colorless rectangular with notched edges/plates Disorders producing lipiduria-like nephrotic syndrome Crystals are very delicate so be very careful with handling the specimen Page 7 / 10 Lab 01.2: Urinalysis FLOW CYTOMETRY OS 214 URINALYSIS: DISEASE DIAGNOSIS ACUTE TUBULAR NECROSIS Urine Dipstick Microscopic Renal tubular epithelial cells Glucose (blue-green) Pathological casts Bilirubin (light yellow) Ketones (tan) S.G.: Decreased (dark blue) Blood: +/- (yellow) pH (orange) Figure 25. Fluorescence Flow Cytometry Providing accurate and precise information in minimum turnaround time Better workflow with UF: no special pre-analytical handling for sample turbidity or volume, and no image review or sub classification necessary Precise and selective testing of bacteria, saving time and unnecessary testing Comprehensive data management and work areas, with an initiative user interface clearly presenting the required information for clinicians Easy to use and learn Added flexibility: interfaces with ‘best of breed’ workstations, all printers and added systemization, automation, or network support capabilities via Sysmex Network Communication System (SNCS) Unmatched support with SYSMEX, with the SNCS enabling the network-ready UF-1000 to easily integrate into lab networks and providing remote access diagnostic support, daily online QC management & scientific web information services. Protein: +/- (neon green) Urobilinogen (tan) Nitrite (cream) L.E. ACUTE GLOMERULONEPHRITIS Urine Dipstick Microscopic Erythrocytes Glucose (blue-green) (dysmorphic) Erythrocyte casts Bilirubin (light yellow) Mixed cellular casts Ketones (tan) S.G.(dark blue) CRITERION URINE ANALYZER Blood: Increased (dark blue) pH (orange) Protein: Increased (neon green) Urobilinogen (tan) Nitrite (cream) L.E. (yellow-tan) Figure 26. Criterion Standardizes measurements via selective light emitting diodes (LEDs) at wavelengths designated to coordinate closely with the chemical reaction occurring in the reagent test area of the test strip LEDs illuminate the test area at a 60° angle from the longitudinal axis of the test strip. The LED flashes light of a defined wavelength at an optimal angle onto the surface of the test area. The light that reaches the surface of the test area is reflected at an intensity dependent upon the test area color. This reflected light is received by a photodiode detector directly above the test area. The detector sends an electrical measurement signal to an analog/digital converter to convert the signal into a digital reading. A microprocessor converts the digital reading into a concentration value. The reflected light is, therefore, an indirect measurement of the color change reaction. Results can be printed out, stored, or transferred to a laboratory. CHRONIC GLOMERULONEPHRITIS Urine Dipstick Microscopic Pathological casts Glucose (blue-green) (broad waxy casts, RBCs Bilirubin (light yellow) Ketones (tan) S.G.: decreased (dark blue) Blood: Increased (dark blue) pH (orange) Protein: Increased (neon green) Urobilinogen (tan) Nitrite (cream) L.E. (yellow-tan) Marz, Micah, Kit Page 8 / 10 Lab 01.2: Urinalysis OS 214 ACUTE PYELONEPHRITIS Urine Dipstick Microscopic Bacteria Glucose (blue-green) Leukocytes Leukocyte, granular, Bilirubin (light yellow) and waxy casts Renal tubular epithelial Ketones (tan) cell casts UROTHELIAL CARCINOMA Urine Dipstick Microscopic Malignant cells on urine Glucose (blue-green) cytology (urine sample should be submitted Bilirubin (light yellow) separately to cytology, void or 24 hours Ketones (tan) S.G. (dark blue) S.G. (dark blue) Blood (yellow) Blood: + (yellow) pH (orange) pH (orange) Protein: Trace (neon green) Protein: (yellow) Urobilinogen (tan) Urobilinogen (tan) Nitrite: Positive (pink) Nitrite (cream) L.E.: Positive (yellow-tan) L.E. (yellow-tan) NEPHRITIC SYNDROME Urine Dipstick Microscopic Oval fat bodies Glucose (blue-green) Fatty casts Waxy casts Bilirubin (light yellow) Ketones (tan) S.G. (dark blue) Blood (yellow) pH (orange) END OF TRANSCRIPTION Marz: YEHEY. NATAPOS RIN. Nakakaloka pala ang lab trans. HI MICAH AND KIT woooo =)) Hi Geoff onti na lang estudyante ka na ulit hahaha! Hi Jeff and MSK :)) Hi researchmates, alam nyo na gagawin sa susunod na birthday HAHAHAHAHA. iMed! Tuloy natin yung Christmas thing please haha :D Lean and Angeli, alam nyo na kung anong gusto ko for Christmas hahahaha =)))) TRP na sa Friday! Push natin to 2017! Go chorale! Alto-mates! Abutin natin yung notes kahit wala na tayong boses harhar =)) Go dancers kaya nyo yan! :D And dahil baka last trans na namin ito before Christmas…. Merry Christmas! :D Protein: ++++ (yellow) Urobilinogen (tan) Nitrite (cream) L.E. (yellow-tan) EOSINOPHILIC CYSTITIS Urine Dipstick Microscopic Numerous eosinophils Glucose (blue-green) (Hansel’s stain) NO significant casts. Bilirubin (light yellow) Ketones (tan) S.G. (dark blue) Blood: + (yellow) pH (orange) Protein: (yellow) Urobilinogen (tan) Nitrite (cream) L.E. (yellow-tan) Marz, Micah, Kit Page 9 / 10 SUMMARY OF URINALYSIS INDICATORS Disease Sp. Gravity Blood Acute TN ↓ +/- Acute GN ↑ + + Dysmorphic RBC Erythrocyte casts Mixed cellular casts Chronic GN ↓ + + Broad waxy casts, RBC Acute Pyelonephritis Blood Pro. Trace Protein +1 Protein +2 Protein +4 L.E. Mircoscopy Notes Renal Tubular epithelial cells Pathological casts +/- + Nephrotic Syndrome Nitrite + + + Bacteria Leukocytes Leukocyte, granular, waxy casts Renal tubular epithelial cell casts Oval fat bodies Fatty casts Waxy casts Eosinophilic Cystitis + No significant casts Numerous eosinophils Urothelial CA + Malignant cells on urine cytology