Denielle

Genesis B. Camato

V. URINALYSIS
ANALYSIS O F URINALYSIS AND BODY FLUIDS | REVIEWER

URINALYSIS

[
[

CHEMICAL URINALYSIS BY REAGENT STRIP

Probably the oldest clinical laboratory practice

Usually involves gross observation and assessment of general appearance,
dipstick analysis, and microscopic assessment
One of the most commonly performed laboratory test

[
URINE

pale yellow fluid produced by the kidneys, composed of dissolved wastes

and excess water or chemical substances from the body

produced when blood is filtered through the kidneys

CHANGES IN URINE AT ROOM TEMPERATURE

Bacteria multiply and may cause turbidity and a positive protein

reaction

r
r
r
r
r
r
r

Bacteria convert urea to ammonia, which increases pH.

Bacteria metabolize glucose.
RBCs lyse in dilute or alkaline urine.
Casts lyse in alkaline urine.
WBCs disintegrate.
Bilirubin/urobilinogen are lost through exposure to light and/or oxidation.
Ketones are lost through evaporation.

URINE VOLUME
Normal daily volume

1200-1500 mL

Normal day-night ratio

Diuresis
Polyuria

2:1 3:1
Increased urine production
>2000 mL/day

Oliguria

Anuria

r
r

diabetes mellitus

r
r
r

dehydration

diabetes insipidus
<500 mL/day
renal disease

obstruction of urinary
tract
No urine production

URINE COLOR AND CLARITY

Urochrome

Normal yellow color

Dilute urine
Concentrated urine
Bilirubin

Colorless
Dark yellow, amber
Yellow-brown or olive green
Yellow foam on shaking
Normal on voiding
Brown or black on standing
Beginning at surface
Brown or black on standing
Brown or black due to oxidation of
hemoglobin in acid urine
Cola on standing
Pink or red when fresh
Cola or Smoky on standing
Cloudy with RBCs
Clear with hemoglobin
Port-wine
Green, blue, orange
Green, blue-green
Colorless when excreted
Oxidized to orange-brown urobilin

Homogentistic acid

Melanin
Methemoglobin
Myoglobin
Blood/hemoglobin

Porphyrin
Drugs, medications, food
Pseudomonas infection
Urobilinogen
Crystals, WBCs, RBCs, epithelial cells,
bacteria

Denielle Genesis B. Camato

V. URINALYSIS
ANALYSIS O F URINALYSIS AND BODY FLUIDS | REVIEWER

Sources of error may vary with brand of reagent strip. Refer to

manufacturers package insert.

CONFIRMATORY/ SUPPLEMENT URINE CHEMISTRY TESTS

Test

Substance(s) Detected

Principle

Sources of Error

Comments

Sulfosalicylic acid

Protein

Acid precipitation

Detects all proteins,

including Bence Jones
proteins.

Clinitest

Reducing substances

Copper reduction

False-positive:
Radiographic dyes,
tolbutamide, some
antibiotics, turbid
urine. False-negative:
highly buffered
alkaline urine
False-positive: High
levels of ascorbic acid.
False-negative:
Glycolysis, pass
through. (Color goes
through orange and
returns to blue or
blue-green. Repeat
using two-drop method
and two-drop color
chart.)

Acetest

Ketones

Sodium nitroprusside
reaction

Most sensitive to
acetoacetic acid

Ictotest

Bilirubin

Diazo reaction

Watson-Shwartz Test

Urobilinogen,
porphobilinogen

Ehrlichs aldehyde
reaction

Hoesch Test

Porphobilinogen

Ehrlichs aldehyde
reaction

False-negative:
Improperly stored
specimen
Drecreased: exposure
to light, improperly
stored specimen, high
levels of ascorbic acid,
nitrites. False-positive:
Urine pigments.
Decreased: exposure
to light, more than 1
hour at room
temperature. Falsepositive: Warm
aldehyde reaction.
(Urine should be at
room temperature.)
Similar to WatsonSchwartz

Non-specific. Reacts
with glucose,
galactose, fructose,
maltose, lactose.
(Sucrose is not
reducing sugar.) Test
all infants to diagnose
galactosemia. Not as
sensitive for glucose as
reagent strip. Selfheating method.
Perform in rack to
avoid burning.

More sensitive than

reagent strip. Less
affected by
interfering substances

Collect specimen from

2-4pm. Store in dark.
Urobilinogen is soluble
in chloroform and
butanol.
Porphobilinogen is not
soluble in either.
Urobilinogen doesnt
react unless very high.

!
EFFECT OF HIGH LEVELS OF ASCORBIC ACID ON URINALYSIS TESTS

False-positive
Clinitest

False-Negative or Decrease*
Glucose
Blood
Bilirubin
Nitrite
Leukocyte esterase

!
*May vary with brand of reagent strip. Refer to manufacturers package insert.
2

Denielle Genesis B. Camato

V. URINALYSIS
ANALYSIS O F URINALYSIS AND BODY FLUIDS | REVIEWER

CELLS IN THE URINE SEDIMENT

CASTS

CELL

DESCRIPTION

ORIGIN

CLINICAL
SIGNIFANCE

COMMENTS

Squamous epithelial
cell

40-50 um. Flat

Prominent round
nucleus
40-50 um. Spherical,
pear shaped, or
polyhedral. Round
central nucleus.
Slightly larger than
WBC. Round. Eccentric
round nucleus
Usually
polymorphonuclear.
Approximately 12um.
Granular appearance

Lower urethra,
Vagina

Usually none.
Improperly collected
clean-catch specimen
Seldom significant

May form syncytia

WBC Brownian
movement of granules.
Stain faintly or not at
all.
Biconcave disk,
approximately 7um.
Smooth. Nonnucleated.

Transitional epithelial
cell

Renal tubular
epithelial cell
White blood cell
(WBC)

Glitter cell

Red blood cell (RBC)

Renal pelvis, ureters,

bladder, upper urethra

TYPE
Hyaline

DESCRIPTION

Homogenous with
parallel sides and
rounded ends

May form syncytia

Renal tubules

Same as renal tubular

epithelial cells

Maltese crosses with

polarized light.

Kidney, bladder, or
urethra

Cystitis, pyelonephritis,
tumors, renal calculi

Same as WBC

Same as WBC

0-5/high power field

(HPF) are normal.
Clumps of WBCs are
associated with acute
infection.
Seen in hypotonic urine

Kidney, bladder,
urethra

Infection, trauma,
tumors, renal calculi.
Dysmorphic RBCs
indicate glomerular
bleeding.

Granular

RBC

Same as Hyaline but

contain granule

RBCs in cast matrix

Yellowish to orange
color

Blood

WBC
Crenated in hypertonic
urine. Lyse in
hypotonic urine and
with 2% acetic acid.

Epithelial cell

Waxy

SIGNIFANCE
0-2/low power field (LPF)
are normal.
Increased with stress.
Fever, trauma exercise, renal
disease
0-1/LPF is normal
increased with stress,
exercise
Glomerulonephritis
Pyelonephritis
Acute Glomerulonephritis
Strenuous exercise

Contain hemoglobin.
Yellowish to orange
color
Leukocytes incorporated
into cast matrix.
Irregular in shape
Renal tubular epithelial
cells incorporated into
cast matrix

Same as RBC cast

Crystal
Amorphous urates

Uric acid

Calcium oxalate

Leucine

Cystine

Cholesterol
Bilirubin

Description
Irregular granules

Significance
None

Comments
From pink precipitate in
bottom of tube. May obscure
significant sediment.
Dissolved by warming to 60C
Birefringent. Polarized light.

Very pleomorphic, Four-sided,

six-sided, star-shaped,
rosettes, spears, plates.
Colorless, red brown, or
yellow.
Octahedral (eight-sided)
envelope form is most
common. Also dumbbell and
ovoid forms.

Usually normal

Yellow, oily-looking spheres

with radial and concentric
striations
Hexagonal (six-sided)

Severe liver disease

Cystinuria

Must be differentiated from

uric acid. Does not polarize
light.

Flate plate with notched out

corner. Star-step
Yellowish-brown needles,
plates and granules

Nephrotic syndrome

Birefringent

Homogenous
Opaque
Notched edges
Broken ends
Cast containing lipid
droplets

Urinary stasis

Normal

Wide
Maybe cellular, granular
or waxy

Advanced renal disease

Pinpoints kidney as the site

of infection

Renal tubular damage

Transitional and squamous

epithelial cell cast do not
exist
These cells are found distal
to renal tubules and
collecting ducts where casts
are formed.
From degeneration of cellular
and granular casts
Unfavorable sign

Amorphous phosphates

Triple phosphate
Ammonium biurate

Calcium phosphate

Calcium carbonate

Irregular granules

coffin-lid crystal
Yellow-brown
thorn apples
spheres
Needles
Rosettes
pointing finger
Colorless dumbbells

STRUCTURE

DESCRIPTION

Bacteria

Yeast

Liver disease

Reagent strip or Ictotest

should be positive for
bilirubin.

Significance

Comments

None

Form white precipitate in

bottom of tube.
Dissolve with 2 acetic acid.

None
None

Sperm

Trichomonas

Mucus

Seen in old specimens

None

Maltese crosses with

polarized light.
Stain with Sudan and oil red
O
Formed in dilated distal
tubules and collecting ducts.
Renal failure casts.

MISCELLANEOUS URINE SEDIMENT

Only needle form seen in

alkaline urine

None

Broad

Nephrotic syndrome

Occasionally found in slightly

urine. Monohydrate form
maybe mistaken for RBCs.
Most common constituent of
renal calculi.
Often accompanied by
leucine

CRYSTALS FOUND IN ALKALINE URINE

Description

Crystal

Fatty

Pinpoints source of bleeding

in kidney.
Most fragile of casts.
Often in fragments.
From disintegration of RBC
casts

Pyelonephritis

!
CRYSTAL FOUND IN ACID OR NEUTRAL URINE

COMMENTS
Most common type.
Least significant.
Contain Tamm-Horsfall
protein only.
Maybe overlooked if light is
too bright
May originate from
disintegration of cellular
casts.

SIGNIFICANCE

COMMENTS

Rods
Cocci

Urinary tract infection or

contaminant

5-7um
ovoid
colorless
smooth
refractile
May be budding
4-6um head with 4060um tail

Usually due to vaginal or

fecal contamination.
May be due to kidney
infection.
May be seen in urine of
diabetic patients.
Usually not significant in an
adult.
Maybe a sign of sexual abuse
in a child.
Contaminant from genital
tract infection

Usually accompanied by
WBCs when clinically
significant,unless patient is
neutropenic
Differentiate from RBCs by
adding 2% acetic acid.
RBCs are lysed
Yeast are not.
Presence of pseudohyphae
indicates kidney function

Resembles WBC
Rapid
Jerky
Nondirectional motility
Transparent
Long
Thin
Ribbon-like structure
with tapering ends

Large amount seen with

chronic inflammation of
urethra or bladder

Should not be reported

unless motile

Maybe mistaken for hyaline

casts

Denielle Genesis B. Camato

V. URINALYSIS
ANALYSIS O F URINALYSIS AND BODY FLUIDS | REVIEWER

XXX PICTURES XXX

6.

CALCIUM PHOSPHATE

7.

AMMONIUM BIURATE

8.

AMORPHOUS POSHPHATES

9.

TYROSINE

10.

CHOLESTEROL CRYSTAL

11.

STAR-SHAPED URATE

12.

FINE GRANULAR CAST

13.

FATTY CAST

1. TRIPLE PHOSPHATE

2. CALCIUM OXALATE

3.

CYSTINE

4.

URIC ACID

5.

LEUCINE

Denielle Genesis B. Camato

V. URINALYSIS
ANALYSIS O F URINALYSIS AND BODY FLUIDS | REVIEWER

14.

15.

16.

17.

18.

19.

RBC CAST
YEAST

24.

SPERMATOZOA (2-HEADED)

25.

SCHISTOSOMA HAEMATOBIUM

26.

TRICHOMONAS VAGINALIS

27.

RENAL TUBULAR CAST

28.

OVAL FAT BODY

WBC CAST

GRANULAR CAST

WAXY CAST

HYALINE CAST

BROAD CAST

20.

BACTERIA

21.

SQUAMOUS EPITHELIAL CELLS

22.

COTTON FIBERS

23.