Urine Examination
(Urine Analysis or Urine Report)
Urine Examination
(Urine Analysis or Urine Report)
Collection of Urine
for Analysis
• Urine is collected over a period of 24 hours.
• A preservative (as toluene, chloroform, thymol & formalin) is
added to prevent contamination of the urine
• keeping urine in refrigerator is greatly advisable especially in
hot weather.
Urine Examination
(Urine Analysis or Urine Report)
1- Physical Examination
2- Chemical Examination
3- Microscopic Examination
4- Microbiological Examination
URINE ANALYSIS
Physical Examination
1- Volume
2- Specific Gravity
3- Aspect
4- Color
5- Odor
6- Deposit
7- Reaction (pH)
URINE ANALYSIS
Physical Examination
1- Volume:
Normal urine volume in 24 hours is 600-2000 ml
1- Urine volume increases (Polyuria) in the following conditions:
Physiological:

Increased fluid intake

Diuretic
Pathological:

Diabetes mellitus (type-1 & type-2)

Diabetes insipidus (due to decrease of ADH)

Chronic renal failure
2- Urine volume decreases (Oliguria or anuria) in the following conditions:

Dehydration

Acute renal failure

Obstruction
URINE ANALYSIS
Physical Examination
2- Specific gravity (SG):
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Specific gravity measures solute concentration (urea and sodium).
Normally the specific gravity ranges between 1.015-1.025.
1- Increased in
• Dehydration (with oliguria)
• Diabetes Mellitus (with polyuria)
• Acute renal failure (with oliguria)
2- Decreased in
• Diabetes insipidus (with polyuria)
URINE ANALYSIS
Physical Examination
3- Appearance:
Normal fresh urine: clear (transparent)
Abnormal : Cloudy urine
Indicates possible abnormal constituents such as:
• White blood cells
• Epithelial cells
• Crystals
• Bacteria
N.B. Stored urine with no preservative & no cooling may turn clear urine samples
into cloudy urine.
URINE ANALYSIS
Physical Examination
4- Color:
Normal color: pale yellow (amber yellow)
due to the presence of pigments of urobilin or
urobilinogen
Abnormal colors of urine:
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•
•
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Colorless
Orange
Greenish yellow
Red
Black
Smoky
URINE ANALYSIS
Physical Examination
Color (cont.)
1- Colorless Urine:


Chronic renal failure
Diabetes insipidus.
2- Orange Urine:

Ingestion of large amount of carotenoids (vitamin A)
3- Yellowish brown urine:
due to presence of billirubin in cases of:
•
•
Obstructive Jaundice
Hepatic Jaundice
URINE ANALYSIS
Physical Examination
Color (cont.)
4- Red urine:
due to presence of blood, hemoglobin & RBCs.
5- Black urine:




Methemoglobin
Homogentisic acid in alkaptonuria
Malignant malaria (black water fever due to Malaria falciparum).
Melanin (melanoma)
6- Smoky urine:
• presence RBCs. in the urine, in cases of
acute glomerulonephritis
URINE ANALYSIS
Physical Examination
5- Odor:
Normal Urineferous odor:
The normal odor of fresh voided urine sample
Abnormal Odors
1- Fruity odor
due to presence of acetone in the urine as in diabetic ketoacidosis
2- Ammonia odor
due to release of ammonia as result of:
the bacterial action on urea in the contaminated urine
or long standing exposed urine samples.
URINE ANALYSIS
Physical Examination
6- Deposits:
• Normally the urine is devoid of deposits.
• The presence of deposits is mainly due to various types of
crystals, salts and cells.
URINE ANALYSIS
Physical Examination
7- Reaction (pH):
Normally: The pH of urine varies from 4.6 - 8.0
1- Acidic urine:
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•
Large intake of meat & certain fruits (cranberries)
Metabolic & respiratory acidosis
2- Alkaline urine:
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Vegetarians
Metabolic & respiratory alkalosis
Urinary tract infection by urea splitting bacteria which split urea to ammonia
(alkaline)
URINE ANALYSIS
Chemical Examination
Normal Constituents of Urine
Normal urine contains about 50g of solids dissolved in about 1.5 liters of water per day.
Urine contains organic and inorganic solids.
A) Chief Inorganic Solids
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Sodium, potassium & chlorides
Smaller amounts of calcium, magnesium, sulfate & phosphates
Traces of iron, copper, zinc and iodine.
B) Chief Organic Solids:
1- Non-protein nitrogen:
•
amino acids, ammonia, urea, uric acid , creatine & creatinine
2- Organic acids:
•
•
lactic acid, citric acid & oxalic acid
ketone bodies (few amounts)
3- Sugars:
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•
•
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Normally not more than 1g of sugars is excreted in the urine per day.
Sugars cannot be detected by ordinary tests.
Very small amounts of glucose not exceeding 150 mg of glucose are normally excreted per day.
Other sugars present in urine are: pentose and lactose .
Lactosuria occurs in infant and in women during the late months of pregnancy and during lactation
URINE ANALYSIS
Chemical Examination
Abnormal Constituents of Urine
1- Proteins (proteinuria)
2- Sugars (glucosuria, fructosuria & galactosuria)
3- ketone Bodies (ketonuria)
4- Billirubin (billirubinuria) & Bile Salts
5- Nitrites
URINE ANALYSIS
Chemical Examination
1- Proteins: (proteinuria)
Proteinuria
Presence of more than 150 mg proteins in urine in 24 hours
detected by ordinary laboratory means
Heavy (marked) proteinuria :
Moderate proteinuria:
Mild (minimal) proteinuria:
＞4 gm/24 hours
1 - 4 gm/24 hours
＜ 1.0 gm/24 hours
URINE ANALYSIS
Chemical Examination
1- Proteins: (proteinuria)
Proteinuria is divided into prerenal, renal and postrenal proteinuria.
1-Prerenal proteinuria:
Example:
Bence-Jones protein: This abnormal gamma globulin (light chains only) is synthesized
by malignant plasma cells (multiple myeloma).
It precipitates at 60oC, redissolves at 100oC and reprecipitates on cooling.
2-Renal proteinuria:
• Severe muscular exercise
• After prolonged standing
• Acute glomerulonephritis
• Nephrotic syndrome
3- Postrenal proteinuria:
• Lower urinary tract inflammation, tumors or stones.
URINE ANALYSIS
Chemical Examination
2- Sugars: (glycosuria)
Glucose (Glucosuria);
Presence of detectable amount of glucose in urine which occurs in the following conditions:
- Uncontrolled Diabetes Mellitus (DM)
- Renal glucosuria with lowering of renal threshold : e.g. during pregnancy (gestational diabetes).
Fructose (Fructosuria)
Presence of fructose in urine & may be due to:
- Alimentary causes following the ingestion of large amounts of fructose
Fructosemia & hereditary fructose intolerance (Metabolic disorders of fructose).
Galactose (Galactosuria):
Presence of galactose in urine& may be due to:
- Alimentary causes following the ingestion of large amount of galactose.
- Galactossemia
URINE ANALYSIS
Chemical Examination
3- Ketone Bodies (Ketonuria):
Presence of acetone, acetoacetic acid & β hydroxybutyric acid in urine due to:
• Diabetic ketoacidosis (uncontrolled DM)
• Starvation
• Unbalanced diet: high fat & low carbohydrates diet.
URINE ANALYSIS
Chemical Examination
4- Bilirubin (bilirubinuria)
Billirubin appears in urine in cases of:
• Hepatocellular Jaundice:
as in viral hepatitis
• Obstructive Jaundice
as any cause of obstruction of bile duct
URINE ANALYSIS
Chemical Examination
5- Nitrites:
• In bacteruria in urine (in cases of Urinary Tract Infection, UTI)