Normal Urine Analysis PDF

12/24/2024 Urine: Is an ultrafiltrate of plasma from which glucose, amino acids, water and other substances essential to body metabolism have been reabsorbed. Urine carries waste products and excess water out of the body. Urine consists of: (96%)...

12/24/2024 Urine: Is an ultrafiltrate of plasma from which glucose, amino acids, water and other substances essential to body metabolism have been reabsorbed. Urine carries waste products and excess water out of the body. Urine consists of: (96%) (4%) water dissolved solids: (2%) (2%) Urea Other compounds Inorganic: Organic: Cl-, Na, K. creatinine uric acid trace amounts of: sulfate, HCO3 etc.) 1  12/24/2024 A urine test checks different components of urine, a waste product made by the kidneys. A regular urine test may be done to help find the cause of symptoms. The test can give information about your health and problems you may have. The kidneys take out waste material, minerals, fluids, and other substances from the blood to be passed in the urine. Urine has hundreds of different body wastes. What you eat, drink, how much you exercise, and how well your kidneys work can affect what is in your urine. 2  12/24/2024 Factors affect on urine constituents: Dietary intake, Physical activity, Body metabolism, Endocrine function Others. 3  12/24/2024 Urine Analysis: Routine Urinalysis (Routine-UA): It consists of a group of tests performed as part of physical examination. It involves macroscopic and microscopic analysis. Type of analysis: physical characteristics macroscopic analysis: chemical analysis microscopic examination: urine sediment is examined under microscope to identify the components of the urinary sediments. Steps in basic urine analysis Three steps analysis: First: physical characteristics of urine are noted and recorded. Second: series of chemical tests is run. Third: urine sediment is examined under microscope to identify the components of sediments. 4  12/24/2024 Urine Collection: Types of urine specimens: type of specimen and collection procedure are determined by physician and depend on the tests to be performed. There are basically four types of urine specimens: 1. First morning specimen 2. Random urine specimen 3. Fractional collection 4. Timed collection Composition and concentration of urine changes during 24hr Urine conc. vary according: to water intake and physical activities. Sampling: It is necessary to regulate: time of collection, length of collection period, patient's dietary, medical intake and method of collection. Initial morning sample is preferred (particularly for protein analysis) because they are more concentrated from overnight retention in bladder. 5  12/24/2024 Time of analysis: - Must analyzed within 1h at room temp. or within 8hr at 2oC- 8oC - If not assayed within these time limits, several changes will occur. Sample should collected in a clean container. Urine container must be sterile if the urine is to be cultured. For microscopic examination, the urine must be fresh. Direct visual observation. Normal fresh urine: Color: pale or dark yellow-amber, clear. Vol:750 - 2000 ml/24hr. Physical examination involves: 1. Color 2. Transparency 3. Odour 4. Volume 5. pH 6. Specific gravity 6  12/24/2024 Click on the glasses in PowerPoint view – DELETE THIS 7  12/24/2024 Transparency Urine is normally clear. Bacteria, blood, sperm, crystals, or mucus can make urine look cloudy. Is classified as clear or turbid. In normal urine: the main cause of cloudiness is crystals and epithelial cells. In pathological urine: it is due to pus, blood and bacteria. Degree of cloudiness depends on: pH and dissolved solids  Turbidity: may be due to gross bacteriuria,  Smoky appearance: is seen in hematouria.  Thread-like cloudiness: is seen in sample full of mucus. Odour Odour has little diagnostic significance. 1. Aromatic odour------> Normal urine due to aromatic acids. 2. Ammonia odour------> On standing due to decomposition of urea. 3. Fruity odour--------> Diabetes due to the presence of ketones. Urine does not smell very strong, but has a slightly "nutty" odor. Some diseases cause a change in the odor of urine. For example, an infection with E. coli bacteria can cause a bad odor, while diabetes or starvation can cause a sweet, fruity odor. 8  12/24/2024 Average urine volume per day Is important part of assessment for fluid balance and kidney functions. For RUA, a 10ml-12ml of sample is optimal for accurate of analysis 9  12/24/2024 pH pH measure acidicity or alkalinity of urine Normal urine pH: 4.5-8. Increased acidity in urine: due to diabetes or medications. Urine sample must be fresh (why?) on standing urine become ALKALINE as a result of ammonia liberation due to urea decomposition. A urine pH of 4 is strongly acidic, 7 is neutral (neither acidic nor alkaline), and 9 is strongly alkaline. Sometimes the pH of urine is affected by certain treatments. For example, your doctor may instruct you how to keep your urine either acidic or alkaline to prevent some types of kidney stones from forming. Specific Gravity (SG) Measures the amount of substances dissolved in urine. Indicates how well kidneys are able to adjust amount of water in urine. Higher SG: more solid material is dissolved in urine When you drink a lot of fluid, your kidneys make urine with a high amount of water in it which has a low specific gravity. When you do not drink fluids, your kidneys make urine with a small amount of water in it which has a high specific gravity. The normal range of specific gravity is between 1.015-1.025. 10  12/24/2024 Organic: urea, uric acid, creatinine Inorganic: Cl-, PO4-3, HBO3, NH4, SO4-2 1- Urea: 1ml urine + 3ml NaOCL (sodium hypochlorite) ==>Evolution of N2 gas. 2- Uric acid UA: 1ml urine + 0.5 ml 10% NaOH +1ml Folins reagent ===> Blue color. 3- Creatinine: - 1ml urine + drops Picric acid + drops NaOH ====> red color ppt. Note: if reaction is acidified with HCL, the color changes to yellow. Replaced with the DIPSTICK Method 11  12/24/2024 Microscopic Examination Preservation - Cells and casts begin to disintegrate in 1 - 3 hrs. at room temp. - Refrigeration for up to 48 hours (little loss of cells). Specimen concentration - Ten to twenty-fold concentration by centrifugation. Types of microscopy - Phase contrast microscopy -Others Types of cells seen by microscopic examination Erythrocyte (> 10 per HPF) - “Dysmorphic” vs. “normal” Leukocytes More than 1 per 3 HPF- Neutrophils (glitter cells) Epithelial Cells Indicate level of contamination- Squamous cells Few are normal - Renal tubular epithelial cells Few are normal - Transitional epithelial cells 12  12/24/2024 RBCs – Normally NOT SEEN WBCs – Normally NOT SEEN 13  12/24/2024 Yeasts RBCs Cast – Normally NOT SEEN 14  12/24/2024 WBCs Cast – Normally NOT SEEN Granular Cast 15  12/24/2024 Hyaline Cast Calcium Oxalate Crystals 16  12/24/2024 Urate Crystals 17