Physical Examination of Urine

Urinalysis & Body FluidsCLS 431

2nd semester 2014-2015

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Routine Urine Analysis

Urine consists of:

(96%)

water

Inorganic:

Cl-, Na, K.

trace amounts of:

sulfate, HCO3 etc.)

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.

(4%) dissolved solids:

(2%)Urea: (half)

(2%)Other compounds

Organic:creatinine uric acid

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• 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.

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Factors affect on urine constituents:

• dietary intake, • physical activity, • body metabolism, • endocrine function • others.

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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: • macroscopic analysis:

• microscopic examination: urine sediment is examined under microscope to identify the components of the urinary sediments.

physical characteristics

chemical analysis

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Steps in basic urine analysisThree 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.

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Urine CollectionTypes 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 specimen2. Random urine specimen3. Fractional collection4. Timed collection

• Composition and concentration of urine changes during 24hr• Urine conc. vary according: to water intake and physical activities.

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Truly representative sample: • 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.

• 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.

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• 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

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Physical Characteristics

1- Color:

• Many things affect urine color, including fluid balance, diet, medicines, and diseases.

• Color intensity of urine correlates to concentration. • Darker color means more concentrated sample.

•Amber yellow Urochrome (derivative of urobilin, produce from bilirubin degradation, is pigment found in normal urine).

• Colorless due to reduced concentration.

• Silver or milky appearance Pus, bacteria or epithelial cells

• Reddish brown Blood (Hemoglobin).

• Yellow foam Bile or medications.

• Orange, green, blue or red medications.

•Vitamin B supplements can turn urine bright yellow.12

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2- 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.

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3- 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.

4- Volume:• Is important part of assessment for fluid balance and kidney functions.• Adults produce from 750ml-2500ml / 24h, with the average of about 1.5L

per person.

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5- pH:• pH measure acidicity or alkalinity (basic) 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.

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6. Specific Gravity (SG):• Measures the amount of substances dissolved in urine. • also 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.• Normal specific gravity of urine: 1.000 to 1.030

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• increases in specific gravity of urine (hypersthenuria, i.e. increased concentration of solutes in the urine) in following cases:

• may be associated with dehydration• diarrhea, • excessive sweating• urinary tract/bladder infection• glucosuria• Others

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Refractometer

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Summary

• Results of the physical examination of urine can give important clues to the physician about the underlying disease or condition of a patient.

• Variations in the normal parameters of a urine specimen can be seen in changes of color, appearance and volume.

• For best results of the physical examination of urine the specimen should be evaluated immediately after voiding.

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Assessment

• What are the normal observations that make up the macroscopic or physical component of the urinalysis examination?

• What compound is responsible for giving urine its color?• What is the color of urine that contains bilirubin?• What is the normal transparency of urine?

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