Patron saints of urinalysis:

Cosmas and Damien, brothers, perhaps

twins.
Physicians in Aegea, Asia minor (Turkey.)
Beheaded 303 AD because they treated the
poor for nothing – “the silverless ones”.
Hostility from colleagues, say some.
Feast day is September 27th.
Urinalysis, dipstick and
microscopy
Fresh urine, less than 4 hours old.
Supplier not exercised.
Most concentrated overnight
For metabolic diseases – 2 hours after
meal.
 Macroscopic urinalysis, volume
Healthy 600 mL to 2L/day
Anuria < 100 mL/d
Oliguria 100-500 mL/d
Polyuria. >2L
Renal failure, polydipsia, osmotic
obstruction, diuresis, diabetes
ischaemia, vomiting, insipidus – CNS or
diarrhea, excessive renal, sweating,
 Macroscopic urinalysis, colour
Terms Possible pathology or cause
Healthy – pale yellow None
Milky (turbid) WBC, urate, Phosph, sperm
Deep yellow Riboflavin supplements
Tan to olive green Liver disease
Red Hb, myogl,dyes, beet, porph
Purple to brown Porphyrins
Brown to black Old blood, melanin, homoge
 Macroscopic urinalysis, smell
Terms Possible pathology or
cause
Healthy – slight smell Diet e.g. asparagus

Ammonia Bacteria – stale (old)

urine
Sweet or fruity Ketones – starvation,
diabetes mellitus.
Maple syrup Inherited disease.
Urinalysis by dipstick
Urinalysis dipstick
Urinalysis dipstick, the famous 5
pH – acidification function.
Protein – glomerular membrane problem or
inflammatory disease of tubules.
Glucose – overload or lower renal threshold
Blood – bleeding into the genital urinary
tract.
Specific gravity – concentrating function.
Urinalysis dipstick, another 5:
Ascorbic acid
Bilirubin
Urobilinogen
Nitrite.
Leukocyte esterase.
Dipsticks are not quantitative
Used to be reported as “negative, +, ++,
+++” or “small”, “moderate” and “large”.
Note “negative” does not mean “nothing”.
Now reported as ..mg/L or .. RBC/HPF but
this is bogus because reaction depends on
 Osmolality
 Hydrogen ion concentration
 and other constituents.
 Dipstick pH
Terms Possible pathology

Healthy 5-9

Strongly acid Acidosis – sulfates,

phosphates, chlorides
Strongly alkaline Alkalosis – vegetarian,
stale (old) urine.
 Dipstick protein
Terms Possible pathology or
problem
Healthy < 150 mg/d
Small amount constant Early renal failure
Unusual protein Myeloma, pancreatitis etc
Large amount g/d Nephrotic syndrome
False +: PVP, quaternary
ammonia, chlorohexidine
 Dipstick glucose
Terms Possible pathology or
problems
Healthy - negative
Glucose overload Diabetes, pregnancy
Renal tubular cells Heavy metals
poisoned
False negative - Vitamin False positive - peroxides
C at low abnormal
glucose levels.
 Dipstick, ketones
Terms Possible pathology

Healthy – negative

Present Starvation or diabetes

mellitus coma.
 Dipstick, (blood) haem
Terms Possible pathology or
problem
Health - negative

Present Free haemoglobin

False negative –(vitamin False positive -

C, iodate compensation) myoglobin
 Dipstick, specific gravity
Terms Possible pathology

Healthy – 1.010-1.022

Hyposthenuria < 1.007 Loss of concentrating

ability
Isosthenuria 1.010 Same as blood

Hypersthenuria > 1.010 Dehydration, diabetes

mellitus etc.
 Dipstick, leukocyte esterase
Terms Possible pathology or
problem
Healthy – none present
Present Inflammation or infection.
In 1 hour 40% of
leukocytes are lysed but
esterase stays positive
False negative – high False positive - HCHO as
protein, cephalexin preservative.
 Dipstick, bilirubin
Terms Possible pathology or
problem
Healthy – negative

Present Liver disease: bilirubin

diglucuronide in cholestasis
False negative – False positive
sunlight, vitamin C, -phenoazopyridine
nitrite
 Dipstick urobilinogen
Terms Possible pathology or
problems
Healthy – negative

Present Liver disease: in early

and late stages of
hepatitis.
False negative - sunlight False positive – severe
over time. HCHO formal stress.
 Dipstick, nitrite
Terms Possible pathology or problem
Healthy - negative
Present E. coli, proteus, enterobacter,
klebsiella have nitrate
reductase. Need 4 hours of
urine in bladder.
False negative - False positive – stale (old)
dilution, urine, phenazopyridine
starvation, stale
(old), vitamin C
 Dipstick, ascorbic acid
Terms Tests made false negative

Healthy < 50 mg/L

> 750 mg/L Glucose, haemoglobin,

leukocyte esterase may be
altered
Microscopy:
Erythrocytes
Leukocytes,
Casts
Crystals
Bacteria
Yeast, spermatozoa, epithelial cells.
Erythrocytes (RBC)
Erythrocytes Bleeding
0-2/ high power field Deformed erythrocytes
with blebs –
glomerular bleeding.
Shrunken, crenellated
- means concentrated
urine.
Leukocytes (WBC)

Leukocytes Inflammation
0-5/HPF in the
genitourinary
tract.
Casts
0-1/LPF Hyaline – dehydration
Tamm-Horsfall Granular – debris from
protein secreted by the epithelial cells or from
renal tubular cells to leukocytes and/or
inflammation/infection
form a plug (cast) of
the tubule lumen Erythrocyte or haem-
granular – bleeding
(hole). from glomerulus.
Broad – chronic cast/
obstruction of flow.
Crystals
Acid urine – uric acid, Renal stones.
sodium urate, calcium Gout
oxalate – usual. Urinary tract
Alkaline urine – infections – struvite.
calcium carbonates, Cystinuria
calcium phosphate – Cholesterol
usual. Leucine, tyrosine –
liver disease.
Drugs
 Bacteria, protozoa

Health -none. Pathology:

Urinary tract
infection.
Trichomonas
Epithelia cells, spermatazoa,
yeast
Health -none Renal tubular
Squamous cells may epithelial cells -
be present but they are poisonings, kidney
of no significance. infections, transplant
rejection.
Yeast may be harmless
or Candida seen in
AIDS, diabetes
mellitus
Creatinine clearance
Volume of plasma cleared of creatinine in a
a unit of time
Approximated the glomerular filtration rate,
Measure serum/plasma and urine creatinine
before and after the time period. Usually 24
hours.
UV/P. Should be corrected for surface area
and/or weight.
Creatinine clearance

Creatinine clearance increases with

age.
Correlates with glomerular
filtration rate.
Not much better that serum
creatinine in diagnosis and
prognosis.
Osmolality
In renal disease urine is neither
concentrated or diluted.
Polyuria, nocturia.
Specific gravity strips give false
information in glycosuria or proteinuria,
Compare plasma to urine values. Urine has
much higher osmolality (spec grav) usually.
Protein in urine
Chemically, turbidimetrically or by dip
stick
Special stick microalbumin for diabetes m.
In early renal failure there is a small
constant leak of protein.
After strenuous exercise or exposure to
severe cold there is a transient leak of
protein. No significance.
 Point of Care systems
Test Clinical use Usual place
Glucose Diabetes mellitus Clinic/home
Urea Kidney disease Clinic
Creatinine Kidney disease Clinic
Therapeutic drugs Comply or toxicity Clinic
Drugs of abuse OD, employer ER or work
Arterial blood gas Acid base Clinic
Bilirubin Neonatal jaundice Clinic
 POCT 2
Salicylate Poisoning ER
Paracetamol Poisoning ER
Parathyrin(PTH) Thyroidectomy Surgery
Lactate Athletic testing Sports medicine
Cholesterol Heart disease Home
Pregnancy Pregnancy Clinic/home
Urine dipstick Kidney etc Clinic/home
Clotting time Coagulation Home
Ethanol Fitness to drive Police/bars
 POCT issues:
For Against
Produces results more Costs are much higher
quickly (but perhaps not)
Fewer people in chain, No professional input
less chance for error added. Could be built in.
No sample delivery Quality assurance is
system or laboratory manufacturers’ and
needed. unskilled users’
problem.