AUBF Physical Examination Of Urine PDF

AUBF LECTURE Physical Examination of URINE Juan Paolo S. Capati, RMT, RPh URINE VOLUME Normal (24 hrs) = 600 to 2000 mL Average (24 hrs) = 1200 to 1500 mL Day : Night ratio = 2-3:1 ROUTINE UA: Capacity = 50 mL Required = 10 to 15 mL (Ave: 12 mL) URINE VOLUME TERMINOLOGIES POLYURIA Increased...

AUBF LECTURE Physical Examination of URINE Juan Paolo S. Capati, RMT, RPh URINE VOLUME Normal (24 hrs) = 600 to 2000 mL Average (24 hrs) = 1200 to 1500 mL Day : Night ratio = 2-3:1 ROUTINE UA: Capacity = 50 mL Required = 10 to 15 mL (Ave: 12 mL) URINE VOLUME TERMINOLOGIES POLYURIA Increased urine volume >2,000 mL/24 hrs (Henry) >2.5 L/day (Strasinger) 2.5-3.0 mL/kg/day (in children) Causes: Increased fluid intake Diuretics, nervousness Diabetes mellitus Diabetes in sipidus URINE VOLUME TERMINOLOGIES OLIGURIA Decreased urine volume <500 mL /24 hrs (in adults - Henry) <400 mL/day (in adults - Strasinger) <1 mL/kg/hr (in infants) <0.5 mL/kg/hr (in children) Causes: Dehydration Renal diseases Renal calculi or tumor URINE VOLUME TERMINOLOGIES ANURIA Complete cessation of urine flow <100 mL/24 hrs Causes: Complete obstruction (stones, tumors) Toxic agents Decreased renal blood flow URINE VOLUME TERMINOLOGIES NOCTURIA Excretion of more than 500 ml of urine at night S.G. <1.018 Causes: Pregnancy Renal diseases, bladder stones Prostate enlargement DIURESIS Any increase in urine excretion Causes: Excessive water intake (polydipsia) Diuretic therapy, hormonal imbalance Renal dysfunction, drug ingestion URINE COLOR Rough indicator of the degree of hydration Should correlate with urine S.G. Normal = Colorless to deep yellow Abnormal = Red / Red brown (most common) URINE COLOR DETERMINATION Examine the specimen under a good light source Look down through the container against a white background (also works for determining urine clarity but not the best way) NORMAL PIGMENTS IN URINE Examine the specimen under a good light source Look down through the container against a white background (also works for determining urine clarity but not the best way) 1. UROCHROME Major pigment (yellow) Lipid-soluble pigment that is a product of endogenous metabolism Production is directly proportional to metabolic rate Increase in thyrotoxicosis, fever, starvation 2. UROERYTHRIN Pink (or red) Derived from melanin metabolism May deposit in amorphous rates and uric acid crystals 3. UROBILIN Dark yellow/orange-brown Derived from oxidation of colorless urobilinogen Present in old specimens URINE COLOR 1. COLORLESS TO PALE YELLOW Recent fluid consumption, polyuria, dilute random specimen 2. DARK YELLOW TO AMBER Concentrated specimen: strenuous exercise, dehydration, fever, burns First morning specimen Excessive urobilin, bilirubin, carotene 3. ORANGE Bilirubin (yellow foam) Phenazopyridine (Pyridium): orange & viscous urine w/ orange foam Acriflavin, Nitrofurantoin, Phenindione URINE COLOR 4. YELLOW-GREEN / YELLOW-BROWN Bilirubin (oxidized) --> Biliverdin 5. GREEN Pseudomonas infection 6. BLUE-GREEN Amitriptyline, Methocarbamol, Clorets, Methylene blue, Chlorophyll Phenol Indican URINE COLOR 7. PINK, RED RBCs (cloudy/smoky red): Hematuria Hemoglobin (clear red) Myoglobin (clear red/reddish-brown/cola-colored/tea-colored) Porphobilin (derived from porphobilinogen) Beets, menstrual contamination Fuchsin (aniline dye from foods and candy) Rifampin 8. BURGUNDY / PURPLISH RED / PORTWINE Porphyrins URINE COLOR 9. BROWN / BLACK Methemoglobin (acidic urine) Homogentisic acid (alkaline urine): Alkaptonuria Melanin (upon air exposure) Phenol derivative, Argyrol, Methyldopa/Levodopa, Metronidazole (Flagyl) 10. MILKY WHITE Pyuria/leukocyturia DRUG CAUSE Alcohol, ethyl Pale yellow or colorless (dieresis) Levodopa Cola-colored (red then brown, alkaline) Nitrofurantoin Yellow-brown Mepacrine Yellow Methyldopa Green-brown Metronidazole Darkening, reddish brown Phenazopyridine Orange-red, acid pH Phenol poisoning Brown, oxidized to quinones (green) Rifampin Bright orange-red Riboflavin Bright yellow URINE CLARITY Thoroughly mix the specimen Examine the specimen while holding in front of a light source View through a newspaper print CLARITY TERM Clear No visible particulates, transparent' Hazy Few particulates, print easily seen through urine Cloudy Many particulates, print blurred through urine Turbid Print cannot be seen through urine Milky May precipitate or be clotted URINE CLARITY CAUSES OF URINE TURBIDITY 1. NONPATHOLOGIC Squamous epithelial cells Amorphous urates (pink sediment) Amorphous phosphates & carbonates (white or beige precipitate) Vaginal cream, semen, fecal contamination, radiographic contrast media, talcum powder URINE CLARITY CAUSES OF URINE TURBIDITY 2. PATHOLOGIC RBCs, WBCS Bacteria (uniform turbidity not cleared by acidification or filtration) Yeasts (fDM) Nonsquamous epithelial cells Abnormal crystals, lymph fluid (chyluria), lipids URINE CLARITY LABORATORY CORRELATIONS IN URINE TURBIDITY Acidic Urine Amorphous rates, radiographic contrast media Alkaline Urine Amorphous phosphates, carbonates Soluble With Heat Amorphous rates, uric acid crystals Soluble in Dilute Acetic Acid RBs, amorphous phosphates, carbonates Insoluble in Dilute Acetic Acid WBCs, bacteria, yeast, spermatozoa Soluble in Ether Lipids, lymphatic fluid, chyle URINE ODOR 1. AROMATIC, FAINTLY Normal (due to presence of volatile acids from food) 2. ______________ Acute tubular necrosis (acute renal failure) 3. FOUL, AMMONIACAL UTI (ex: Proteus vui garis), old urine 4. FRUITY, SWEET Ketones (Diabetes Mellitus, starvation, vomiting) 5. CAR AMELIZED SUGAR, CURRY, MAPLE SYRUP Maple syrup urine disease (MSUD) URINE ODOR 6. MOUSY, MUSTY, BARNY Phenylketonuria (PKU) 7. RANCID BUTTER Tyrosinemia 8. SWEATY FEET, ACRID Isovaleric acidemia, glutaric acidemia 9. MENTHOL-LIKE Phenol-containing medications 10. CABBAGE, HOPS (Oasthouse syndrome) 11. BLEACH Specimen adulteration or container contamination URINE ODOR 12. SULFUR Cystine disorder 13. ROTTING FISH Isovaleric acidemia, glutaric acidemia 14. PUNGENT, FETID Ingestion of onions, garlic, & asparagus (methylmercaptan), UTI 15. SWIMMING POOL Hawkins inuria 16. CAT URINE 3-hydroxy-3-methylglutaric aciduria 17. TOMCAT URINE Multiple carboxylase deficiency END Thank you for listening!