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 ANALYSISPhysical Examination 1- Volume 2- Specific Gravity 3- Aspect 4- Color 5- Odor 6- Deposit 7- Reaction (pH)
URINE ANALYSISPhysical 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 ANALYSISPhysical Examination 2- Specific gravity (SG): • Specific gravity measures solute concentration (urea and sodium). • Normallythe 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 ANALYSISPhysical 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 cloudyurine.
URINE ANALYSISPhysical Examination 4-Color: Normal color: pale yellow (amber yellow) due to the presence of pigments of urobilinor urobilinogen Abnormal colors of urine: • Colorless • Orange • Greenish yellow • Red • Black • Smoky
URINE ANALYSISPhysical 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 billirubinin cases of: • Obstructive Jaundice • Hepatic Jaundice
URINE ANALYSISPhysical 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 ANALYSISPhysical 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 ANALYSISPhysical 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 ANALYSISPhysical Examination 7- Reaction (pH): Normally: The pH of urine varies from 4.6 - 8.0 1- Acidic urine: • Large intake of meat & certain fruits (cranberries) • Metabolic & respiratory acidosis 2- Alkaline urine: • Vegetarians • Metabolic & respiratory alkalosis • Urinary tract infection by urea splitting bacteria which spliturea to ammonia (alkaline)
URINE ANALYSISChemical 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 • 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: • 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 . • Lactosuriaoccurs in infant and in women during the late months of pregnancy and during lactation
URINE ANALYSISChemical 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 ANALYSISChemical 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 : ＞4 gm/24 hours Moderate proteinuria: 1 - 4 gm/24 hours Mild (minimal) proteinuria: ＜ 1.0 gm/24 hours
URINE ANALYSISChemical Examination 1- Proteins: (proteinuria) Proteinuria is divided into prerenal, renal and postrenalproteinuria. 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, redissolvesat 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 ANALYSISChemical 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 ANALYSISChemical Examination 3- Ketone Bodies (Ketonuria): Presence of acetone, acetoacetic acid & βhydroxybutyricacid in urine due to: • Diabetic ketoacidosis(uncontrolled DM) • Starvation • Unbalanced diet: high fat & low carbohydrates diet.
URINE ANALYSISChemical 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 ANALYSISChemical Examination 5-Nitrites: • In bacteruria in urine (in cases of Urinary Tract Infection, UTI)