Urinalysis

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Urinalysis

• Dr. A. Basu MD

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Topic

• Definition and normal urine
• Indication
• Collection
• Examination
• Physical
• Chemical
• Microscopical

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Urinalysis Definition

• Qualitative and semi quantitative evaluation of
  renal products.

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Normal Urine At a glance

• a. Physical - color - normally pale yellow
• transparency - clear
• specific gravity - 1.020 - 1.030
• b. Chemical - pH
• 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)

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Indication

1. Glomerulonephritis
2. Diabetes mellitus
3. Urinary tract infection
4. Tumors

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Collection

• Random collection
• Early morning chemical are present in higher
  concentration
• 24 hours urine collection
• Nephrotic syndrome
• Suprapubic Trans- abdominal needle aspiration of
  the bladder (purest sample)

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Urine preservatives

• Boric acid
• HCl
• Sulfuric acid

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Collection

• Maintain patient privacy
• Do not clean the area with antiseptic
• Collect mid stream urine

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When you should examine

• Immediate
• Or, within One hour after collection of urine.

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• 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.

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URINALYSISThree phases

• A. Physical Examination
• B. Chemical Examination
• C. Microscopical Examination

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URINALYSIS A. Physical Examination

• 1.Volume
• 2. Color
• Odor
• 3.Appearance(e.g. transparent or Turbidity
  present)
• 4.pH
• 5. Specific Gravity

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Colour

• Red Hematuria, hemoglobinuria, certain drugs,
  myoglobinuria .
• White chyluria
• Red colour on standing Porphyria
• urine darkens on standing - Alkaptonuria

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Odor

• Normal ammonia
• In infection fishy smell
• If Ketone is high sweet smell.

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Appearance

• Normal transparent
• Turbid
• High WBC
• High epithelial cells.

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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.

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Specific Gravity

• Low (1.007 to 1.010) End stage kidney disease.
• High (1.035) SIADH, contamination , presence of
  glucose.

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Chemical test

• Protein
• Sugar (Glucose)
• Ketone
• Blood
• Nitrite
• Leukocyte Esterase

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Protenuria

• More than 150 mg/day is defined as proteinuria

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Ketone

1. Diabetic ketosis or
2. Some other form of calorie deprivation
   (starvation).

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Nitrite

• Positive nitrite test Bacteria may be present

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Leukocyte Esterase

• Positive WBC are present

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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

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In protenuria 4
Leucocyte esterase
Colors' are before examination
Nitrite
pH

• A sample Strip
• For Chemical
• Analysis Of
• Urine

Protein
Blood
Specific Gravity
Ketone
Glucose
Bilirubin
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Interpretation of the result
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Microscopical examination

• RBC
• WBC
• Yeast
• Casts
• Crystals

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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.

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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.

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The presence of dysmorphic RBC's in urine
suggests a glomerular disease such as a
glomerulonephritis.
Normal RBC
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White Blood Cells When we see this cell?

• Infection (pyuria)
• Acute glomerulonephritis

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These white blood cells in urine have lobed
nuclei and refractile cytoplasmic granules.
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A white blood cell is seen at the left and a red
blood cell at the right for size and morphologic
comparison
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Important

• Tuberculosis may be a cause for a 'sterile
  pyuria' in which routine cultures fail to grow
  bacterial organisms, but inflammation is present.

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Epithelial Cells

• Acute tubular necrosis
• UTI

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Oval Fat Bodies

• When lipiduria occurs, these cells contain
  endogenous fats. When filled with numerous fat
  droplets, such cells are called oval fat bodies

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Oval fat bodies consist of degenerated tubular
cells containing abundant lipid, which appears
refractile
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Casts

• Hyaline casts are composed primarily of a
  mucoprotein (Tamm-Horsfall protein) secreted by
  tubule cells.

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Hyaline casts can be seen even in healthy
patients.
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The presence of this red blood cell cast in on
urine microscopic analysis suggests a glomerular
or renal tubular injury.
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This white blood cell cast suggests an acute
pyelonephritis.
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This renal tubular cell cast suggests injury to
the tubular epithelium(ATN).
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Presence of Granular cast suggest Chronic
disease chronic GN
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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.
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Yeast

• Yeast cells may be contaminants or represent a
  true yeast infection.
• Most often they are Candida, distinguished by
  their tendency to bud

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• Crystals
• MAY BE ASSOCIATE WITH STONE IN THE Urinary system.

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These are oxalate crystals, which look like
little envelopes (or tetrahedrons, depending upon
your point of view).
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These "triple phosphate" crystals look like
rectangles, or coffin lids.
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One Bag For Urine Collection And Testing
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Thanks