URINE

EXAMINATION
FORMATION OF URINE
Nephron is functional unit of kidney
Glomerular filtrate
Renal tubules modify glomerular filtrate
Reabsorbtion of high threshold substances
Water, Glucose, Amino acids, Na
+
, K
+
, Ca
++
.

Diffusion of low threshold substances
Urea uric acid creatinine SO
4

PO
4

Secretion ammonia and creatinine
INDICATIONS OF URINE EXAMINATION
Routine investigation
Diagnosis
Urinary tract diseases
Jaundice
pregnancy
Endocrine disorders- DM,Hormonal problems
Genetic abnormalities- cystinuria,phenylketonuria
Parasitic infections-S.hematobium,T.vaginalis
Drug overdose
Carrier of enteric fever
Neoplastic diseases-multiple myeloma,neuroblastoma
Physical fitness


COLLECTION OF URINE

Container
Method of collection
Single specimen (routine examination )
24 hour urine collection (quantitative studies)
Method
Preservative
Formaldehyde 2-4 drops /30ml
Boric acid 0.5gm/60 ml
Thymol 0.1 gm/100ml
Conc. Hcl for estimation of ca
++
,nitrogen
Na fluoride 24 hr glucose

Bacteriological culture clean catch midstream ,
catheterization, suprapubic aspiration,
24 hr specimen
For pregnancy test
APPEARANCE
COLOUR
Pink,red - Blood, Hemoglobin, Myoglobin, Porphyrin, Beets
Orange - Conc. urine (fever,inadequate water intake,
excessive water loss)
Riboflavin
Carotene

PHYSICAL EXAMINATION
Black,gray,brown
- Alkaptonuria, bilirubin, inj.iron, melanin,
phenol poisoning, methemoglobinuria
Colorless - Chronic kidney disease
Diabetes insipidus
DM
High dilution
Severe iron def.anaemia

CLARITY
Cloudy - phosphates, urates, fecal contamination by fistula
Turbid pus cells, RBCs, bacteria, spermatozoa, chyluria
ODOUR
Ammoniacal odor
Fruity odor
Mousy odor
Rancid
Lack of odor
VOLUME
Normal = 1500 ml/24 hr
Polyuria - > 2000 ml/24 hr
causes- Polydipsia, HPD, cold, iv glucose/saline
DM, DI, chronic renal failure
Oliguria - <500 ml/24hr
causes PRE RENAL - Vomiting, Diarrhea, Excessive
sweating.
RENAL - AGN, ATN,vascular disorders
POST-RENAL- Obstruction
Anuria causes - Renal ischemia, Haemolytic transfusion reac
n

SPECIFIC GRAVITY
Definition Ratio of wt. of fixed volume of solution to
the wt.of same volume of water at a specified
temerature usually 20
0
C.
Normal S.G.= 1.016 - 1.022
I ncrease S.G - Decreased fluid intake, fever, vomiting, diarrhea
CCF, DM, proteinuria,
Decrease S.G - Diuretics, hypothermia, glomerulonephritis,
Diabetes insipidus
Fixed S.G - CRF 1.010
METHODS
Urinometer
Refractometer
falling drop method
reagent strip
CHEMICAL EXAMINATION

pH- Normal 6.0 (slightly acidic)
Causes of acidic urine
Metabolic acidosis
Respiratory acidosis
Diabetic ketoacidosis
Use of acidifiers in T/t of alkaline urine stones
Hypokalemic alkalosis

Causes of alkaline urine
Respiratory alkalosis
Metabolic alkalosis
Alkalinization of urine in T/t of acidic urine stones
T/t of UTI
T/t of salicylate poisoning
Proximal renal tubular acidosis
METHODS Litmus paper
pH electrode
Reagent strip
Titrable acidity of urine

PROTEINS IN URINE
Normal 50 mg/24 hr
Abnormal proteins in urine- Albumin
Globulins (B-J proteins)
Hemoglobins
Myoglobins
CAUSES OF PROTEINURIA
Pre-renal
Renal
Post-renal

TESTS FOR PROTEIN
Heat coagulation test
Sulpho salicylic acid test
Hellers nitric acid test
Reagent strip
MICROALBUMINURIA - 20-200 mg/L
B-J proteins causes Multiple myeloma, Leukemia, malignant
lymphoma, primary amyloidosis, mets of breast ca
Method
SUGARS IN URINE
Normal 0.01-0.03 gm %
GLUCOSURIA
DIABETIC
NON DIABETIC
Alimentary
Renal glucosuria
Starvation
Endocrinal
Liver diseases
Intracranial lesions of 4
th
ventrical

METHODS
Reagent strip
Copper reduction test (Benedicts test)
Interpretation
green Colour - trace - 0.25 gm%
green ppt. - 1+ - 0.50 gm%
yellow ppt. - 2+ - 0.75 gm%
orange ppt. - 3+ - 1.00 gm%
brick red. - 4+ - 2.00 gm%

KETONE BODIES
Causes DKA, starvation, glycogen storage disease, eclampsia,
severe dehydration,febrile states,after GA
TESTS
Rotheras test
Gerhardts test
Reagent strip

BILE SALTS AND BILE PIGMENTS

TEST FOR BILE PIGMENT TEST FOR UROBILINOGEN

OBSTRUCTIVE
JAUNDICE +

HEPATOCELULLAR
JAUNDICE + +

HEMOLYTIC
JAUNDICE +

Gmelins Test for bile pigment
Harrison Fouchet test for bile pigment
Hay sulphur test for bile salts
BLOOD IN URINE

HEMATURIA Acute nephritis, PN, Urinary calculi, renal TB,
embolic nephritis, leukemias, blood dyscrasias, benign and malignant
tumor of kidney, drugs.

HEMOGLOBINURIA Intravascular hemolysis, severe burns,
hemolytic transfusion reaction, black water fever, AIHA, G6PD
deficiency, PNH, drugs.

MICROSCOPIC EXAMINATION OF URINE
CELLS
RBCS Wet preperation, Hemolysed with 2 % acetic acid,
Benzidine test is confirmatory.
Causes- Renal diseases
Lower urinary tract diseases
Extra renal causes
Drugs
Physiologic causes
PUS CELLS - Normal 2-5 per hpf
Pyogenic infection of urinary tract and genital tract
Glomerulonephritis
Kidney infarct
EPTHELIAL CELLS
Sqamous cells
Renal tubular epithelial cells
Transitional epithelial cells
CAST
Types Hyaline Cast
Causes Fever, Glomerulonephritis, Nephrosclerosis,
Anaesthesia and exercise
Epithelial cast
Causes AGN, Kidney infarct
Granular cast
Causes CGN, Nephritic syndrome , nephrotic
syndrome
Waxy cast
Causes chronic nephritis, Nephrotic

Broad cast
Causes Formed in collecting duct, uremia
Pigmented cast
Causes hemosiderine, melanin, Blood , Billirubin
RBC cast

Pus cell cast

CRYSTALS IN URINE
Normal 1-3 per lph
Crystals in acid urine
Uric acid crystals
Urate crystals
Calcium oxalate
Cystine

Crystals in alkaline urine
Ammonium magnesium phosphates
Calcium carbonate
Ammonium biurate
CRYSTALS IN URINE (Cont.)
PARASITE IN URINE
Trichomonas vaginalis
Microfilaria in chylous urine
Ova of schistosoma hematobium
Hooklets or Scolices of E.granulosus
BACERIOLOGICAL EXAMINATION
For pyogenic organism
For M. tuberculosis


SPECIAL TESTS
CYTOLOGICAL EXAMINATION FOR CANCER
HORMONES IN URINE
Diseases of ovary, adrenals and pituitary
Diagnosis of pregnancy (HCG level )
Hydatiform mole and choriocarcinoma (HCG level )

Name: Regd no:

Age: Sex: Time of collection:

Chief complaints:

PHYSICAL EXAMINATION
Appearance-Colour,clarity :
Odor :
Volume :
Specific gravity :

URINE REPORT
CHEMICAL EXAMINATION
Reaction :
Proteins :
Sugar :
Ketone bodies :
Bile salts and pigments :
Urobilinogen :

MICROSCOPY
RBCS :
PUS CELLS :
EPITHELIAL CELL :
CASTS :
CRYSTALS :
OTHER FINDINGS :

IMPRESSION