LABORATORY

Urinalysis

Definition: A urinalysis is a group of manual and/or automated qualitative and semi-quantitative tests performed on
a urine sample.

Purpose: Routine urinalyses are performed for several reasons:

 general health screening to detect renal and metabolic diseases
 diagnosis of diseases or disorders of the kidneys or urinary tract
 monitoring of patients with diabetes

Initial Observations
 Colour - This varies depending on the concentration of the urine and can be straw coloured through to
amber. A dark colour can indicate dehydration. Haematuria (blood in urine) can produce a bright red colour
or even brown-green or a strong yellow colour but it is worth bearing in mind that some foods and drugs
can change the colour of the urine, for example beetroot turns the urine red and the antibacterial drug
rifampicin turns it an orange-red.
 Clarity - Cloudiness or debris can indicate the presence of pus, protein or white cells.
 Odour - urine does smell but when it is fresh the smell should not be offensive, however a fishy smell can
indicate a UTI and a pear drop smell may suggest ketones are present. Again food stuffs can alter the smell,
for example asparagus.
Normal Values Significance

Specific gravity 1.015-1.025u A high SG suggests a concentrated

urine and may indicate
dehydration. A low SG in
indicative of a diluted urine
occuring in those with a high fluid
intake, diabetes insipidus or
hyperglycaemia.
pH 4.5/5.0-8.0u urine is normally acidic with 5.0 -
8.0 being the normal range of pH.
A low pH (acidic) may indicate
urinary stone formation and
alkalinity may indicate a UTI
caused by certain types of bacteria
such as pseudomanas the pH can
also be influenced by dietary
intake as a diet rich in protein can
cause acidic urine and a diet rich
in vegetables or dairy products can
lead to alkaline urine.
protein negative The detection of protein in urine
may indicate that
thepermeability of the glomerulus
is abnormally increased. This may
be caused by renal infections or it
may be caused by other diseases
that have secondarily affected the
kidneys such as diabetes
mellitus, jaundice,
 or hyperthyroidism.
glucose negative When glucose is present, the
condition is called glucosuria.
Some other conditions that can
cause glucosuria include hormonal
disorders, liver disease,
medications, and pregnancy.
When glucosuria occurs, other
tests such as blood glucose are
usually performed to further
identify the specific cause.
ketones negative Ketones resulting from either
diabetic ketosis or some other
form of calorie deprivation
(starvation), are easily detected
using either dipsticks or test
tablets containing sodium
nitroprusside.Some drugs, for
example captpril can cause false
positive result
blood negative hematuria is abnormal and be
associated with problems in the
urinary tract such as cancer, renal
damage or stones. It may also be
indicative of a blood clotting
problem or a side effect of anti-
coagulant drugs. Menstrual blood
can also contaminate the urine.
leukocyte negative the presence of these indicate a
UTI such as cystitis, or renal
disease, such as pyelonephritis or
glomerulonephritis.
Nitrite negative
A positive nitrite test indicates that
bacteria may be present in
significant numbers in urine.Gram
negative rods such as E. coli are
more likely to give a positive test.
Bilirubin negative Bilirubin in the urine is derived
from the liver, and a positive test
indicates hepatic disease or
hepatobiliary obstruction.
urobilinogen 0.1-1.0u Urobilinogen is a substance
formed in the gastrointestinal tract
by the bacterial reduction of
conjugated bilirubin. Increased
urinary urobilinogen occurs in
prehepatic jaundice (hemolytic
anemia), hepatitis, and other forms
of hepatic necrosis that impair the
circulation of blood in the liver
and surrounding organs. The
urobilinogen test is helpful in
differentiating these conditions
from obstructive jaundice, which
results in decreased production of
urobilinogen.