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Urine Examination
1 -Physical Examination2 -Chemical Examination
3 -Microscopic Examination
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URINE ANALYSISPhysical Examination
1 -Volume2 -Specific Gravity
3 -Apperance4 -Color5 -Odor
6 -Deposit7 -Reaction (pH)
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URINE ANALYSISPhysical Examination
1- Volume: Normal urine volume in 24 hours is 600-2000 ml
A- Urine volume increases (Polyuria) in the following conditions:
Physiological: Increased fluid intake Diuretic
Pathological: Diabetes mellitus Diabetes insipidus Chronic renal failure
B- Urine volume decreases (Oliguria or anuria) in the following conditions: Dehydration Acute renal failure Obstruction
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2- Specific gravity (SG): • Specific gravity measures solute concentration (urea and sodium). • Normally the specific gravity ranges between 1.015-1.025.
A- Increased in • Dehydration (with oliguria)• Diabetes Mellitus (with polyuria)• Acute renal failure (with oliguria)
B- Decreased in • Diabetes insipidus (with polyuria)
URINE ANALYSISPhysical Examination
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3- Appearance:- Normal fresh urine: clear (transparent) - Abnormal : Cloudy urine
Indicates possible abnormal constituents such as:• White blood cells• Epithelial cells• Crystals• Bacteria
N.B. Stored urine with no preservative & no cooling may turn clear urine samples into cloudy urine.
URINE ANALYSISPhysical Examination
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URINE ANALYSISPhysical Examination
4- Color: - Normal color: pale yellow (amber yellow)
due to the presence of pigments of urobilin or urobilinogen
- Abnormal colors of urine:• Colorless• Orange• Greenish yellow• Red• Black• Smoky
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Left to right: (Straw, clear) (yellow, clear) (yellow, hazy) (yellow, clear) (red-orange, clear)
(brown, hazy)
Urine Colour
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URINE ANALYSISPhysical Examination
Color (cont.)
1- Colorless Urine:
Chronic renal failure Diabetes insipidus. 2- Orange Urine:
Ingestion of large amount of carotenoids (vitamin A)
3- Yellowish - brown urine:
due to presence of billirubin in cases of :
• Obstructive Jaundice • Hepatic Jaundice
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URINE ANALYSISPhysical Examination
Color (cont.)
4- Red urine: due to presence of blood, hemoglobin & RBCs.
5- Black urine:
Methemoglobin Homogentisic acid in alkaptonuria Malignant malaria (black water fever due to Malaria falciparum). Melanin (melanoma)
6- Smoky urine:• presence RBCs. in the urine, in cases of acute glomerulonephritis
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URINE ANALYSISPhysical Examination
5- Odor: Normal Urineferous odor:
The normal odor of fresh voided urine sample
Abnormal Odors:
1- Fruity odor: due to presence of acetone in the urine as in
diabetic ketoacidosis2- Ammonia odor: due to release of ammonia as result of: - the bacterial action on urea in the
contaminated urine - or long standing exposed urine samples.
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URINE ANALYSISPhysical Examination
6- Deposits:
• Normally the urine is devoid of deposits.
• The presence of deposits is mainly due to various types of crystals, salts and cells.
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URINE ANALYSISPhysical Examination
7- Reaction (pH):
Normally: The pH of urine varies from 4.6 - 8.0
1- Acidic urine:• Large intake of meat & certain fruits (cranberries)• Metabolic & respiratory acidosis
2- Alkaline urine:• Vegetarians• Metabolic & respiratory alkalosis• Urinary tract infection by urea splitting bacteria which split urea to
ammonia (alkaline)
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URINE ANALYSISChemical Examination
The presence of normal and abnormal chemical elements in the urine are detected using dry reagent strips.
These plastic strips contain absorbent pads with various chemical reagents for determining a specific substance.
When the test strip is put in urine the reagents are activated and a chemical reaction occurs. The chemical reaction results in a specific color change.
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Used in the LAB for routine urine analysis (10 Chemical Tests)
Used in Emergency Room (ER) for diagnosis of Diabetic Ketoacidosis
(DKA) (3 chemical tests: Glucose, Ketones &
protein)
URINE ANALYSISChemical Examination
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URINE ANALYSISChemical Examination
Glucose
Protein
Specific
Gravity
pH
primarily detects glucose (sugar);
important indicator
of diabetes mellitus
primarily detects protein called
albumin; important indicator
in the detection of renal disease
state of kidney
and hydration status
of patient
partial assessment of acid
base status; alkaline
pH indicates
old sample or
urinary tract
infection
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URINE ANALYSISChemical Examination
Urobilinogen
Bilirubin
Ketone Blood
another by-product of
red cell breakdown;
increased amounts seen in fever,
dehydration, hemolytic anemia
and liver disease
detects bilirubin
(a product of red cell breakdow
n); indicator of liver function
normal product of
fat metabolism; increased amounts seen in
diabetes or
starvation (extreme dieting)
red blood cells,
hemoglobin, or
myoglobin (muscle
hemoglobin); sensitive
early indicator of renal disease
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Ascorbic Acid
Leukocyte
EsteraseNitrite
Ascorbic acid (vitamin C) is
known to interfere with the oxidation
reaction of the blood and
glucose pad on common urine
test strips.
detects esterase enzyme
present in certain white blood cells
(e.g, neutrophils, monocytes); indicator of urinary tract
infection
certain bacteria convert normal urine
nitrate to nitrite;
indicator of urinary tract
infection
URINE ANALYSISChemical Examination
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URINE ANALYSISChemical Examination
Abnormal Constituents of Urine
1- Proteins (proteinuria)2- Sugars (glucosuria, fructosuria & galactosuria) 3- ketone Bodies (ketonuria)4- Billirubin (billirubinuria) & Bile Salts5- Nitrites
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URINE ANALYSISChemical Examination
1 -Proteins: (proteinuria)
Proteinuria is divided into prerenal, renal and postrenal proteinuria.
1-Prerenal proteinuria : Bence-Jones protein: This abnormal gamma globulin (light chains only) is synthesized by malignant plasma cells (multiple myeloma). It precipitates at 60oC, redissolves at 100oC and reprecipitates on cooling.
2-Renal proteinuria: • Severe muscular exercise • After prolonged standing• Acute glomerulonephritis • Nephrotic syndrome
3- Postrenal proteinuria:• Lower urinary tract inflammation, tumors or stones.
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URINE ANALYSISChemical Examination
2 -Glucose: (glycosuria)Presence of detectable amount of glucose in urine which occurs in the following conditions:
Uncontrolled Diabetes Mellitus (DM) Renal glucosuria with lowering of renal threshold : e.g. during pregnancy (gestational
diabetes).
-Fructose (Fructosuria)Presence of fructose in urine & may be due to :
- Alimentary causes following the ingestion of large amounts of fructose - Fructosemia & hereditary fructose intolerance (Metabolic disorders of fructose).
-Galactose (Galactosuria): Presence of galactose in urine& may be due to:
- Alimentary causes following the ingestion of large amount of galactose. - Galactossemia
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URINE ANALYSISChemical Examination
3- Ketone Bodies (Ketonuria): Presence of acetone, acetoacetic acid & β hydroxybutyric acid in
urine due to:
• Diabetic ketoacidosis (uncontrolled DM)• Starvation• Unbalanced diet: high fat & low carbohydrates diet.
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URINE ANALYSISChemical Examination
4- Bilirubin (bilirubinuria) Billirubin appears in urine in cases of:• Hepatocellular Jaundice: as in viral hepatitis • Obstructive Jaundice as any cause of obstruction of bile duct
5 -Nitrites:
• In bacteruria in urine (in cases of Urinary Tract Infection, UTI)
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• The urine specimen is centrifuged and the liquid portion is poured off.
URINE ANALYSISMicroscopic Examination
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• The concentrated cellular sediment, is then placed on a microscope slide, covered with a coverslip and read under microscope.
URINE ANALYSISMicroscopic Examination
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A variety of normal and abnormal cellular elements may be seen in urine sediment such as:
• Casts• Crystals • Amorphus• Microorganisms• Pus cells• RBCs• Epithelial cells• Mucus
URINE ANALYSISMicroscopic Examination
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RBCs- presence of a few
is normal (2 – 5 cells/HPF)
- higher numbers are indicator of renal disease
- result of bleeding at any point in urinary system
40x objective
URINE ANALYSISMicroscopic Examination
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Pus cellsa few are normal
(2 – 4 cells /HPF)high numbers
indicate inflammation or infection somewhere along the urinary or genital tract.
40x objective
URINE ANALYSISMicroscopic Examination
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Mucus– look like long,
ribbon-like threads– common finding in
urine sediment– secreted by glands
in the lower urinary tract.
– Become more with UTI, ulcerative colitis, kidney stones
40x objective
URINE ANALYSISMicroscopic Examination
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Epithelial Cells
–cells are large and flat
–normal cells that line the urinary and genital tract or renal tubules
40x objective
URINE ANALYSISMicroscopic Examination
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URINE ANALYSISMicroscopic Examination
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Crystals of calcium oxalatecolorless octahedronfound in acid urine
Crystals of triple phosphatecolorless, “coffin-lid”
prism common finding; no
clinically significant
URINE ANALYSISMicroscopic Examination
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URINE ANALYSISMicroscopic Examination
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URINE ANALYSISMicroscopic Examination (Casts)
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Amorphous urate(Acidic urine)
Amorphous phosphate (alkaline urine)
URINE ANALYSISMicroscopic Examination
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Bacteria Yeast
URINE ANALYSISMicroscopic Examination
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schistosoma haematobium Trichomonas vaginalis
URINE ANALYSISMicroscopic Examination (Parasites)
Characterized by Central spin
It is not Urinary system protozoa, it’s vagina
protozoa
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THANK YOU
It’s not just water!