Basic Examination of Urine

Y examination of urine provides info regarding

diseases of the kidney and lower urinary tract
Y clinical lab disciplines involved in urinalysis:
chemistry, microbiology, routine wet
urinalysis, cytology, and other specialty
sections
Y new technologies include immunochemistry,
molecular and genetic biology, DNA ploidy,
and cell cycle analysis

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1. reagent strip (dipstick) urinalysis
 for screening laboratories, physician offices, and
patient home testing
 remains a valuable frontline test for the early
detection and monitoring of px for chemical
abnormalities
 encompasses the physiochemical analysis of urine
 requires less sophisticated training of personnel
 esily performed on multiple settings
 provides accurate information in several clinical
situations

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@. screening wet analysis
Y referred to as a routine or basic urinalysis
Y has 2 components:
 macroscopic urinalysis or physiochemical
determinations (appearance, sp gr, and
multiparameter reagent strip measurements of
several chemical constituents)
 brightfield or phase-contrast examination of urine
segment for evidence of hematuria, pyuria, cylinduria
(casts), and crystalluria

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R. cytodiagnostic urinalysis
Y specialized urinalysis
Y cytologic approach to the urine sediment
Y more sensitive test pathologic test for evaluating urine
sediment in several renal and lower urinary tract
disorders
Y this specialized urine cytology test has replaced the
quantitative `ddis count method
Y provides sequential info regarding the progression or
regression of many urinary system conditions

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 iypes of urine specimens
Y Ê
 

 most commonly received specimen
Y Ê Ê

 Ê

 the ideal screening specimen
 used for routine screening, pregnancy tests
and for determining orthostatic proteinuria
Y  
 

 Ê




 second voided urine specimen used for
glucose monitoring
Y @
Ê 

 timed specimen is used to determine
concentration of a particular substance
Y Ñ Ê 

 used for bacterial culture
Y Ê  Ñ 

Ñ  

 an ideal specimen for routine screening
and for bacterial culture
 patient is instructed to cleanse thoroughly
the genitalia and is asked to collect the
midstream portion of urine. When
collecting, patient should be instructed to
separate the labia in females or retract the
foreskin in uncircumcised males.
 Instruction: Y Ê  Ê 

Y Day 1 ʹ 7am
 used for bacterial culture and cytology
 patient voids and discards specimen
sterile needle is introduced into the
 patient collects all urine for the next 24
hours bladder to collect sample that is free
Y Day 2 ʹ 7am of contaminants
 patient voids and adds this urine to the Y  Ê 

previously collected urine
 soft, clear plastic bag w/ adhesive is
attached to the genital portion

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Y specimen evaluation
Y gross/physical examination
Y chemical screening
Y sediment examination

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Y urine specimen must be evaluated in terms of
acceptability
Y Considerations: proper labeling, proper specimen
for requested test, proper receptacle, storage
conditions (time, temperature) and preservative,
visible signs of contamination, and any
transportation delays in moving the specimen to
the lab
Y a properly labeled specimen must have the
patient͛s full name, and the date and time of
collection

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Y Appearance and Color
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Colorless Very dilute urine Polyuria, diabetes insipidus
Cloudy Phosphates, carbonates, urates, uric acid Phosphates, oxalates
Leukocytes, Red cells (͞smoky͟) bacteria, Rectovesical fistula
yeasts, spermatozoa, prostatic fluid, In acid urine
mucin, mucous threads, calculi, ͞gravel͟
clumps, pus, tissue, fecal contamination
radiographic dye
Milky Many neutrophils (pyuria) Nephrosis, crush injury ʹ soluble
Fat in ether
Lipiduria,opalascent Lymphatic obstruction ʹ soluble
Chyluria, milky in ether
Emulsified paraffin Vaginal creams
Yellow Acriflavine Green Fluorescence

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Yellow-orange Concentrated urine Dehydration, fever
Urobilin in excess No yellow foam
Bilirubin Yellow foam, if sufficient bilirubin

Yellow-green Bilirubin-biliverdin Yellow foam

Yellow-brown Bilirubin-biliverdin ͞beer͟ brown, yellow foam

Red Hemoglobin Positive reagent strip for blood

Erythrocytes Positive reagent strip for blood
Myoglobin Positive reagent strip for blood
Porphyrin May be colorless
Fuscin, aniline dye Foods, candy
Beets Yellow alkaline, genetic
Menstrual contamination Clots, mucus

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Red-purple Porphyrins May be colorless

Red-brown Erythrocytes
Hemoglobin on standing Acid pH
Methemoglobin Muscle injury
Myoglobin Result of unstable hemoglobin
Bilifuscin (dipyrrole)

Brown-black Methemoglobin Blood, acid pH

Homogentisic acid On standing, alkaline
Melanin On standing, rare
Blue-green Indicans Small intestine infection
Pseudomonas infections Mouth deodorants
Chlorophyll

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 Ñ Ê
Y 2ormal urine color ʹ Yellow (due to urochrome)
Color Pathologic NonPatho Drugs
O
 Bilirubin Rhubarb Phenazopyridine
Carrots
Dark Yellow Bilirubin Carrots Fluorescein
Urobilin Concentrated
Green Oxidized bilirubin Vit B complx Dithiazanine
Biliverdin Nitorfurans
Pseudomonas Phenol
Red or Pink RBCs Beets Benzene
Hemoglobin Acetophenetidin
Myoglobin Phenindione
Porphyrins

Brown or Black Biliary pigments Rhubarb Phenol derivatives

Melanin Methyldopa
Hmogentisic acid Levodopa

Pale Yellow Diabetes mellitus Large fluid intake Diuretics

Diabetes insipidus 12
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Y usually not a part of routine urinalysis
Y ammoniacal odor of urine is due to breakdown of urea

Odor Pathologic Nonpathologic

Ammonia UiI Old urine
Starvation, dieting,
Sweet Diabetes mellitus strenuous exercise,
vomiting, diarrhea
Mousy Phenylketonuria
Maple syrup Maple syrup disease
Garlic, onions,
Distinctive
asparagus

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Ê
 Ê
  Ê
Y Normal appearance:
 freshly voided urine is usually clear
Y white cloudiness may be caused by
precipitation of amorphous phosphates and
carbonates
Y Causes of turbidity:
 presence of phosphates, carbonates, crystals, red
blood cells, leukocytes, epithelial cells, etc.

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 [Ê 
Y density of a substance compared with the
density of a similar volume of distilled water
at a similar temperature
Y used to assess kidney͛s ability for reabsorption
Y Normal values = 1.015-1.025

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 ROUiINE URINALYSIS PROCEDURE

Urine in specimen container iransfer urine in a clean tube