Urinalysis Overview PDF

Urinalysis MLT 004- 2 Credits Prepared by: Ms. Yeama Singh Composition of Normal Urine Components of the urine include: ► Cells e.g RBCs, WBCs, Epithelial, Renal ► Crystals e.g Uric Acid, Bilirubin, Calcium oxalate ► Casts e.g Granular, Cellular, Hyaline ► Debris e.g hair, crysta...

Urinalysis MLT 004- 2 Credits Prepared by: Ms. Yeama Singh Composition of Normal Urine Components of the urine include: ► Cells e.g RBCs, WBCs, Epithelial, Renal ► Crystals e.g Uric Acid, Bilirubin, Calcium oxalate ► Casts e.g Granular, Cellular, Hyaline ► Debris e.g hair, crystals from powders ► Microoganism/Bacteria e.g Trichomonas vaginalis Indications for Urinalysis ► Suspected Renal Diseases such as glomerulonephritis, nephrotic syndrome, pyelonephritis and renal failure. ► Detection of Urinary Tract Infection ► Detection and Management of Metabolic disorders like Diabetes Mellitus ► Differential Diagnosis of Jaundice ► Detection and management of plasma cell dyscarasias ► Diagnosis of Pregnancy Collection of Urine ► First Morning Urine, Midstream – Preferred Urine for Routine Urinalysis ► Random, Midstream – Routine Urine Examination ► First Morning, Midstream, Clean catch- Bacteriological examination ► Post prandial- Estimation of Glucose, Urobilinogen ► 24 –hours – Quantitative estimation of Proteins or hormones ► Catheterized - Bacteriological examination in infants, bed ridden patients, and in obstruction of urinary tract. What happens to Urine if it remains at Room Temperature unprocessed after 2 hours? ► Increase in pH due to the production of Ammonia from urea by urease producing bacteria. ► Formation of crystals due to precipitation of phosphates and calcium (Turbid) ► Loss of ketone bodies, since they are volatile ► Decrease in glucose due to glycolysis and utilization of glucose by cells and bacteria. What happens to Urine if it remains at Room Temperature unprocessed after 2 hours? ► Oxidation of Bilirubin to biliverdin causing false negative test for bilirubin ► Oxidation of Urobilinogen to Urobilin causing a false negative test for Urobilinogen ► Bacterial Proliferation ► Disintegration of cellular elements, especially in alkaline and hypotonic urine. Preservation of Urine Sample ► Refrigeration (4-6°C)This is the best method of preservation of urine sample up to 8 hours. Following chemical Preservatives can be added to the 24-hour urine sample: ► Hydrochloric acid - is used for the preservation of a 24- hour urine sample for adrenaline, noradrenaline and steroids ► Toluene – this forms a thin layer over the surface and acts as a physical barrier for bacteria and air. It is used to measure biochemical Preservation of Urine Sample ► Boric Acid – general preservative ► Thymol – inhibits bacteria and fungi ► Formalin - It is an excellent chemical for preservation of formed elements. Performing Urinalysis ► Physical Examination (Color, clarity, volume) ► Biochemical Test – Leukocytes, Nitrite, Ketone, pH, Specific Gravity, Blood, Urobilinogen, Protein, Glucose, Bilirubin ► Microscopy Physical Examination Colour Fresh urine has a pale yellow to an amber color and this is due to pigment referred to as urochrome (urobilin). Urinary incontinence (involuntary urination) this is the unintentional leakage of urine. It can be caused by urinary tract infections, medications, constipation, or weak pelvic floor muscles Physical Examination - Colour Abnormal Colours of Urine ► Amber Colour Urine Severely dehydrated -this because of low water content compared to high levels of urochrome. ► Some medications, such as diuretics, can cause your urine to have no color. Other medications, such as laxatives, anti-inflammatories, and chemotherapy drugs, can cause orange urine. Possible Conditions: Dehydration Injuries: to muscle cells resulting in Rhabdomyolysis Jaundice Physical Examination Colour ► Orange Colour Urine Severe dehydration – there are traces of bile due to liver malfunction, food items containing beta-carotene such as carrots, and certain medications can contribute to an orange colour in urine. Possible conditions: Dehydration Problems with the liver & Bile Ducts Physical Examination - Colour ► Brown Colour Urine This could be due to liver issues, extreme dehydration, or even the presence of small amounts of blood. Possible Conditions: Hepatitis or cirrhosis of the liver Urinary tract infections (UTIs) Bleeding : internal bleeding, bleeding in Urinary Tract Porphyria: rare inherited conditions that affect hemoglobin, the protein in blood that carries oxygen. Muscle injury: caused by intense exercise and urine can appear the color of cola. Dehydration Physical Examination Colour ► Red Colour Urine ( usually Hematuria) Food items such as beets and blackberries or certain medications. Medications that can cause this Metronidazole, Nitrofurantoin and laxatives. However, injuries, kidney stones, and medical conditions can also cause your urine to turn red due to the presence of fresh blood. Physical Examination Colour Possible Conditions: Urinary Tract Infections, Bladder or Kidney Infections Kidney Stones Cancers : Bladder, Kidney, Urethra, Prostate Inflammation: Bladder, Urethra, Prostate, Kidney Injury: Bladder or Kidney Kidney Disease: Post streptococcal glomerulonephritis Urinary Tract Procedure: Circumcision, Catheterization, Kidney Biopsy Menstruation Physical Examination Colour ► Blue Green Urine Urine which is blue or green in colour is quite rare and not a cause of concern. Certain medications or dyes usually cause it. Urinary tract infections: A bacterial infection called Pseudomonas can cause urine to appear green. Rare genetic disorders: A rare inherited disorder called familial benign hypercalcemia can cause blue urine in children. Medical procedures and tests: Dyes used for some kidney and bladder tests can turn urine blue. Physical Examination Colour ► White Urine (Milky) Milky or cloudy urine can be a symptom of a number of clinical conditions. Possible Conditions: Dehydration Diabetes Chyluria: a condition where lymphatic fluid is excreted into the urine, causing it to become milky white, often triggered by parasitic infections. Physical Examination Colour Pyuria: condition where there are high levels of white blood cells or pus in the urine. Sexually transmitted infections (STIs): Vaginitis : inflammatory condition of the vagina Prostatitis: can be either inflammation or infection of the prostate. Kidney stones (Renal Calculus): solid material is developed within the urinary tract Preeclampsia: in hypertensive pregnant mothers Chronic kidney disease (CKD): long term kidney disease Physical Examination - Colour Physical Examination - Colour Physical Examination - Volume ► Average adult urine output in 24 hours is 600-2000mls. ► Volume can vary based on factors such as fluid intake, climate & diet. Physical Examination - Volume Abnormalities of Urine Volume: 1. Polyuria (Urine volume excreted is >2000ml/24 hours – excess urine output). Conditions: Diabetes mellitus, Diabetes insipidius, Chronic Renal failure, Diuretic therapy 2. Oliguria (Urine volume excreted