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Urine Analysis

Urine Analysis

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Urine Analysis

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  1. Urine Analysis 1- Physical Examination 2- Chemical Examination 3- Microscopic Examination 4- Microbiological Examination

  2. Urine Analysis 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.

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  4. URINE ANALYSISPhysical Examination 1- Volume 2- Specific Gravity 3- Aspect 4- Color 5- Odor 6- Deposit 7- Reaction (pH)

  5. 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

  6. URINE ANALYSISPhysical Examination 2- Specific gravity (SG): • 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)

  7. URINE ANALYSISPhysical Examination 3- Appearance: Normal fresh urine: clear (transparent) Abnormal : Cloudy urine may indicate possible abnormal constituents such as white cells, epithelial cells, crystals and bacteria. N.B. Stored urine with no preservative & no cooling may turn clear urine samples into cloudy.

  8. 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

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. 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)

  14. 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

  15. 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

  16. 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 proteinuria: >4 gm/24 hours moderate proteinuria: 1 - 4 gm/24 hours minimal proteinuria: < 1.0 gm/24 hours

  17. URINE ANALYSISChemical Examination 1- Proteins: (proteinuria) Proteinuria is divided into prerenal, renal and postrenalproteinuria. 1-Prerenal proteinuria: • Bence-Jones protein: This abnormal gamma globulin (light chains only) is synthesized by malignant plasma cells (multiple myeloma). It precipitates at 60oC, redidssolves at 100oC and reprecipitates on cooling. 2-Renal proteinuria: • Severe muscular exercise • After prolonged standing • Acute glomerulonephritis • Nephrotic syndrome 3-Postrenalproteinuria: • Lower urinary tract inflammation, tumors or stones.

  18. 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 glucosuriawith 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 & herditary 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. - Galactosemia

  19. URINE ANALYSISChemical Examination 3- Ketone Bodies (Ketonuria): Presence of acetone, acetoacetic acid and βhydroxybutyricacid in urine due to: • Diabetic ketoacidosis(uncontrolled DM) • Starvation • Unbalanced diet: high fat & low carbohydrates diet.

  20. 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

  21. URINE ANALYSISChemical Examination 5-Nitrites • In bacteruria in urine (in cases of Urinary Tract Infection, UTI)

  22. MICROSCOPIC URINE EXAMINATION Specimen of Choice: First morning , midstream, clean catch urine specimen. This specimen is preferred since it is most concentrated and thus small amounts of abnormal constituents are more likely to be detected Procedure: 1- By pouring the urine sample into a test tube & centrifuging it (spinning it down in a machine) for a few minutes. 2- The top liquid part (the supernatant) is discarded. 3- The solid part left in the bottom of the test tube (the urine sediment) is mixed with the remaining drop of urine in the test tube and one drop is analyzed under a microscope.

  23. MICROSCOPIC URINE EXAMINATION Urine is examined microscopically for: 1- Cells 2- Casts 3- Crystals 4- Parasitic ova .

  24. MICROSCOPIC URINE EXAMINATIONCellsRed Blood Cells (RBCs) Normally: < 3 RBCs / HPF Hematuria is the presence of abnormal numbers of red cells in urine Types of Hematuria: 1- Gross hematuria Means that the blood can be seen by the naked eye. The urine may look pink, brown or bright red. 2- Microscopic hematuria Means that the urine is clear, but blood cells can be seen when urine is examined under microscope. • Causes of hematuria: • Glomerulardamage : as in acute glomerulonephritis • Tumors • Urinary tract stones • Upper & lower urinary tract infections

  25. MICROSCOPIC URINE EXAMINATIONCellsWhite Blood Cells (WBCs) Normally: WBCs: < 5 cells / HPF Pyuria(Pus in Urine) Refers to the presence of abnormal numbers of WBCs that may appear with: - Urinary tract Infection : upper or lower - Acute glomerulonephritis - Acute pyelonephritis Repeated sterile cultures in presence of pyuria may indicate: -The patient is on antibiotic therapy -The presence of an organism that does not grow on ordinary media as T.B. -Non- bacterial urethritis or cystitis as viral infection

  26. MICROSCOPIC URINE EXAMINATIONCellsEpithelial Cells • Renal tubular epithelial cells contain a large round or oval nucleus & normally slough into the urine in small numbers. • The number sloughed renal epithelial cells is increased in: - Nephrotic syndrome (Glomerular) - Renal tubular degeneration (Tubular)

  27. MICROSCOPIC URINE EXAMINATIONCasts Acellularcasts Hyaline casts Granular casts Waxy casts Fatty casts Pigment casts Crystal casts Cellular casts Red cell casts White cell casts Epithelial cell cast Urinary casts are formed only in the distal convoluted tubule (DCT) or the collecting duct. Types of Casts

  28. MICROSCOPIC URINE EXAMINATIONCastsHyaline casts • Hyaline casts composed of a mucoprotein (Tamm- Horsfall protein) secreted by tubular cells.

  29. MICROSCOPIC URINE EXAMINATION Casts Hyaline casts cont. • Hyaline casts cont. • The factors which favor protein cast formation are: • Low flow rate • High salt concentration • Low pH • All of which favor protein denaturation and precipitation. • Protein casts with long thin tails formed at the junction of Henle's loop and the distal convoluted tubule are called cylindroids. • Hyaline casts are seen in • 1- Healthy persons • 2- Physiological (as in fever, strenuous exercise) • 3- Glomerular damage (as in nephrotic syndrome)

  30. Granular casts Granular casts can result either from the breakdown of cellular casts (if persist for long duration in tubules) resulting in appearance of aggregation of contents of cells without the cell membranes Or result from the inclusion of aggregates of plasma proteins (e.g. albumin) or immunoglobulin light chains to a hyaline cast indicative of chronic renal disease MICROSCOPIC URINE EXAMINATIONCastsGranular casts

  31. MICROSCOPIC URINE EXAMINATIONCastsWaxy casts Waxy casts Suggest severe longstanding kidney disease such as renal failure (end stage renal disease) They may appear as an advanced stages of granular casts

  32. MICROSCOPIC URINE EXAMINATIONCasts Fatty casts Formed by the breakdown of lipid-rich epithelial cells, these are hyaline casts with fat globule inclusions They can be present in: Nephrotic syndrome (due to cholesterol increase in urine) Diabetic or lupus nephropathy Acute tubular necrosis (damage of tubular cells with release of fat contents into hyaline casts)

  33. MICROSCOPIC URINE EXAMINATION Casts Red Blood Cells Casts Red Blood Cells Casts Red blood cells may stick together and form red blood cell casts. RBCs casts are indicative of: 1- Glomerulonephritiswith leakage of RBC's from glomeruli 2-Severe tubular damage

  34. MICROSCOPIC URINE EXAMINATION Casts White blood cell casts White blood cell casts Indicate inflammation of the kidney as such casts will not form except in the kidney 1- Acutepyelonephritis (most common cause) 2- Glomerulonephritis.

  35. MICROSCOPIC URINE EXAMINATIONCastsEpithelial casts Epithelial casts This cast is formed by inclusion or adhesion of desquamated epithelial cells of the tubule liningthe casts These can be seen in Acute tubular necrosis

  36. MICROSCOPIC URINE EXAMINATIONCrystals Crystals in acidic urine Uric acid Calcium oxalate Cystine Leucine Crystals in alkaline urine Ammonium magnesium phosphates (triple phosphate crystals) Calcium carbonate

  37. MICROSCOPIC URINE EXAMINATIONCrystals Calcium Oxalate Crystals Triple Phosphate Crystals Uric Acid Crystals Cystine Crystals

  38. crystals