Urinalysis

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• Urinalysis
• By
• Dr. Jay Shahed

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URINALYSIS OUTLINE

• AN OVERVIEW OF THE KIDNEY
• FUNCTION S STRUCTURES
• URINE FORMATION.
• TERMS RELATED TO THE URINARY SYSTEM.

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URINALYSIS OUTLINE cont.

• URINE SPECIMEN COLLECTION.
• TYPES OF URINE SPECIMEN
• DEFINITION OF URINALYSIS.
• PHYSICAL CHARACTERISTICS
• CHEMICAL CHARACTERISTICS

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URINALYSIS OUTLINE cont.

• URINALYSIS PROCEDURES
• REAGENT MULTI-STRIPS.
• SPECIFIC GRAVITY MEASUREMENTS
• 1. URINOMETER.
• 2. REFRACTOMETER.

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URINALYSIS OUTLINE cont.

• PROCEDURES cont.
• CLINITEST.
• HCG ONE STEP TEST.
• MICROSCOPIC CELLS IDENTIFICATION

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THE STRUCTURE FUNCTIONS OF THE KIDNEY.

• STRUCTURE
• BEAN- SHAPED ORGAN.
• LOCATION
• RETROPERITONEAL LEFT RIGHT LUMBAR REGIONS.
• FUNCTION
• FILTRATION
• REABSORBTION
• EXCRETION

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URINE FORMATION

• THE BLOOD PASS THROUGH THE KIDNEYS TO BE FILTERED
  REABSORBED TO FORM URINE.
• URINE IS COMPOSED OF 95 WATER AND 5 ORGANIC AND
  INORGANIC WASTE PRODUCT.
• MATERIAL.
• ORGANIC UREA, URIC ACID, AMMONIA AND
  CREATININE.
• INORGANIC MINERALS( K, Cl, Na, Ca, Mg, S, P )
• NORMAL DAILY OUTPUT 750 - 2000 Ml

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TERMS RELATED TO THE URINARY SYSTEM

• ANURIA
• NO URINE FORMATION
• DIURESIS
• INCREASE URINE VOLUME SECRETION.
• DYSURIA
• PAINFUL OR DIFFICULT URINATION
• ENURESIS
• NIGHT BED WETTING.
• FREQUENCY
• URINATION OFTEN.

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U.A. SYSTEM TERMS cont.

• HEMATURIA
• BLOOD IN URINE.
• MICTURATION
• VOIDING
• NOCTURIA
• FREQUENT NIGHT URINATION.
• OLIGURIA
• SCANTY URINATION.
• POLYURIA
• INCREASE URINE OUTPUT

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• PYURIA
• PUS IN THE URINE
• RETENTION
• INABILITY TO VOID.
• URGENCY
• IMMEDIATE NEED TO URINATE.
• INCONTINENCE
• INABILITY TO RETAIN URINE.

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TYPES OF URINE SPECIMEN cont.

• 24 HOUR SPECIMEN
• collected If a large urine volume is needed.
• (kidney failure).
• CLEAN CATCH (MID - STREAM)
• used to test for microorganisms .
• ( urinary tract infection ).

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URINE SPECIMEN COLLECTION PROCEDURE.

• RANDOM SPECIMEN
• USED FOR ROUTINE URINALYSIS.
• SHOULD BE EXAMINED WITHIN ONE HOUR AFTER VOIDING.
• SHOULD BE REFRIGERATED IF NEEDED.

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MID - STREAM SPECIMEN (CLEAN - CATCH) COLLECTION

• ASSEMBLE SUPPLIES ( STERILE URINE CUP,
  ANTISEPTIC SWAP,STERILE WATER).
• PROCEDURE
• PT. TO CLEANSE THE MEATUS WITH AN ANTISEPTIC
  SWAP.
• PT. THEN VOIDS THE INITIAL STREAM IN TO THE
  TOILET.
• PT. THEN CATCH THE SUBSEQUENT MIDSTREAM IN A
  STERILE CONTAINER.

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URINALYSIS

• THE ANALYZING OF URINE COMPONENTS USING DIFFERENT
  LABORATORY PROCEDURES .

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• PHYSICAL CHEMICAL CHARACTERISTICS

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Physical Characteristics

• Color
• Normal Yellow
• Abnormal
• Straw ( Glucose) Diabetes
• Brown ( Bilirubin ) Liver
• Red ( RBC ) Trauma to the renal system

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• Odor
• Normal
• Aromatic
• Abnormal
• Fruity
• Diabetes
• Ammonia
• Infection

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• Turbidity
• Normal
• Clear
• Abnormal
• Cloudy
• Bacteria
• Yeast
• Cells
• Crystals

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Daily Volume Output

• Normal volume
• 750 ml - 2000 ml

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Foam

• White
• Protein
• Yellow
• Bilirubin

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Specific Gravity

• Normal Range
• 1.005 - 1.030

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Chemical Characteristics

• PH
• Normal Value
• 5.5 - 8.0
• Abnormalities
• Early in the morning
• Pregnancy
• Menstruation

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• Glucose
• Normal Value
• Negative
• Abnormalities
• Diabetes
• Hyperglycemia
• After heavy meals

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• Ketones
• Normal Value
• Negative
• Abnormalities
• Intracellular fat break down
• Diabetes ketoacidosis
• Starvation

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• Blood
• Normal Value
• 0 - 4 cells
• Abnormalities
• Menstruation
• Renal disorders
• Calculi
• Infections
• Trauma

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• Bilirubin
• Normal Value
• Negative
• Abnormalities
• Jaundice
• Liver disorders
• Gall Bladder Disorders
• Hemolysis

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• Nitrite
• Normal Value
• Negative
• Abnormalities
• Infections

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• Phenylketone
• Normal Value
• Negative
• Abnormalities
• PKU
• Increase Alanine that leads to increase
  Phenylalanine and Ketones in the urine
• Mental retardation

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Microscopic Identification

• Cells
• Epithelial
• Transitional
• Single scale like cells
• Normal Value 0- 3 cells
• Abnormalities
• Bladder disorders
• Squamous
• Clue cells
• Folded cells
• Normal Value few
• Abnormalities
• Vaginal disorders

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• Red Blood Cells
• Normal Value 0- 5 cells
• Abnormalities
• Inflammation
• renal trauma
• Stones
• Tumors
• Anticoagulant

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• White blood cells
• Normal Value 0- 8 cells
• Abnormalities
• Renal Infection
• Transplant
• Injury
• Immune Disorders
• Tubular
• Normal Value few cells
• Abnormalities
• Nephrons ducts
• Viral

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Casts

• Hyaline
• Abnormalities Exercise
• RBC
• Abnormalities Bleeding
• WBC
• Abnormalities Infections
• Epithelial
• Abnormalities Tubular damage

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• Granular
• Abnormalities Proteinuria
• waxy
• Abnormalities Hypertension
• Fatty
• Abnormalities Diabetes

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Crystals

• Calcium
• Abnormalities Kidney stones
• Uric Acid
• Abnormalities Gout
• Tyrosine
• Abnormalities Liver
• Cystine
• Abnormalities Non-pathologic
• Amorphous Urate
• Abnormalities Non-pathologic

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URINALYSIS PROCEDURES

• REAGENT MULTI-STRIPS.
• PAD STICKS THAT TESTS FOR THE FOLLOWING URINE
  PRODUCTS ( pH, PROTEINS, GLUCOSE, KETONES,
  BLOOD, BILIRUBIN, URIBILINOGEN, NITRITE, SPECIFIC
  GRAVITY, LEUKOCYTES.

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MULTI - STRIP PROCEDURE

• DIP THE STRIP INTO THE URINE SPECIMEN.
• IMMEDIATELY LAY THE STRIP NEXT AND AWAY FROM
  THE COLOR CHART .
• START COMPARING COLORS STARTING FROM THE BOTTOM
  OF THE CHART .
• ALL COMPONENTS SHOULD BE READ WITHIN A MINUTE.
• RECORD THE RESULTS ON TO THE CHART.

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SPECIFIC GRAVITY MEASUREMENT

• URINOMETER METHOD
• FILL 3/4 OF URINE INTO THE URINOMETER.
• INSERT THE STEM INTO THE URINOMETER SLOWLY.
• READ AT THE LEVEL OF MENISCUS.
• RECORD RESULTS.

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REFRACTOMETER(SPECIFIC GRAVITY TEST).

• OPEN THE COVER PLACE ONE DROP OF URINE ON THE
  PRISM LENS.
• CLOSE THE COVER, POINT THE REFRACTOMETER TOWARD A
  LIGHT SOURCE.
• READ THE NUMBER AT THE MID LINE BETWEEN THE DARK
  AND LIGHT AREAS.

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CLINITEST(GLUCOSE TEST)

• POUR 5 DROPS OF URINE INTO A TEST TUBE USING A
  PLASTIC PIPETTE.
• PLACE THE CLINITEST TABLET INTO THE SPECIMEN.
• ALLOW TO REACT, THEN COMPARE COLORS.
• RECORD THE RESULT.

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HUMAN CHORIONIC GONADOTROPIN HORMONE( HCG)
PREGNANCY TEST.

• ONE STEP METHOD
• SEE THE MANUFACTURING INSTRUCTION.

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MICROSCOPIC CELLS IDENTIFICATION.

• POUR 10 ML OF FRESH URINE SPECIMEN INTO A TEST
  TUBE.
• CENTRIFUGE FOR 5 MINUTES.
• DISCARD THE TOP THIN LAYER OF URINE INTO THE SINK
  AND KEEP THE SEDIMENT PART.
• DROP ONE DROP OF SEDI-STAIN INTO THE SAMPLE
  SHAKE GENTLY.
• USING A PLASTIC DROPPER APPLY ONE DROP OF THE
  MIXTURE ON TO A SLIDE COVER IT WITH A GLASS
  SLIP.
• IDENTIFY THE CASTS UNDER LOW POWER AND THE REST
  OF THE CELLS UNDER HIGHER POWER.
• RECORD THE AVERAGE NUMBER SEEN.