PHYSICAL EXAMINATION OF URINE

ANALYSIS OF URINE AND OTHER BODY FLUIDS MODULE 4

PREPARED BY GROUP 1: ABELLERA, BARIDA, BENGIL, BERGANIO, CATAJAY, SALILAMA

 LEARNING OBJECTIVES
1. To state the normal and abnormal urine colors
2. To discuss the significance of the abnormal
urine color
3. To list the pathologic and non pathologic
causes of cloudy urine
4. Define specific gravity and tell its importance in
routine urinalysis.
5. Describe the principles of refractometer,
reagent strip and osmolality in determining
specific gravity
6. To describe normal and abnormal urine odor
PHYSICAL EXAMINATION OF THE URINE

Specific
Color Clarity
gravity
 COLOR
The color of urine varies from almost colorless to black

PHYSICAL EXAMINATION OF THE URINE

 These variations may be due to
normal metabolic functions,
physical activities, ingested
materials, or pathologic conditions.
A noticeable change in urine color
is often the reason that a patient
seeks medical advice; it then
becomes the responsibility of the
laboratory to determine whether
this color change is normal or
pathologic.

PHYSICAL EXAMINATION OF THE URINE

 CLARITY
General term that refers to the transparency
or turbidity of the urine

PHYSICAL EXAMINATION OF THE URINE

 CLARITY

In routine urinalysis, clarity is determined in the same

manner that ancient physicians used by visually examining the
mixed specimen while holding it in front of a light source.  The
specimen should be in a clear container. Color and clarity are
routinely determined at the same time. Common terminology in
reporting clarity includes: clear, hazy, cloudy, turbid, and milky.

PHYSICAL EXAMINATION OF THE URINE

URINE CLARITY Clear

DETERMINATION
No visible particulates
Transparent

View the urine against a white Hazy

background using adequate room Few particulates
lighting. Print easily seen through urine
View through a news paper print Cloudy
Many particulates
Print blurred through urine

Turbid
Print cannot be seen through urine
Milky
May precipitate or be clotted
 NON PATHOLOGIC TURBIDITY
The presence of squamous epithelial cells and mucus,
particularly in specimens from women
Specimens that are allowed to stand or are refrigerated;
improper preservation results bacterial growth
Amourphous crystal formation due to refrigeration
Caused by contamination of semen, fecal contamination,
radiographic contrast media, talcum powder, and vaginal
creams

PHYSICAL EXAMINATION OF THE URINE

 PATHOLOGIC TURBIDITY
Most common: the presence of RBC’s, WBC's and bacteria
caused by infection or a systemic organ disorder.
Less common: abnormal amounts of nonsquamous epithelial
cells, yeast, abnormal crystals, lymph fluid, and lipids.
Clear urine is not always normal
*With the increased sensitivity of routine chemical
tests, most abnormalities in clear urine will be
detected prior to the microscopic analysis.

PHYSICAL EXAMINATION OF THE URINE

 PATHOLOGIC TURBIDITY
The clarity of a urine specimen certainly provides a key to the
microscopic examination results, because the amount of
turbidity should correspond with the amount of material
observed under the microscope.
Current criteria used to determine the necessity of
performing a microscopic examination on all urine specimens
include both clarity and chemical tests for RBCs, WBCs,
bacteria and protein.

PHYSICAL EXAMINATION OF THE URINE

SPECIFIC GRAVITY
Evaluation of urine concentration

PHYSICAL EXAMINATION OF THE URINE

SPECIFIC GRAVITY is defined as the density of a solution compared with the density of
a similar volume of distilled water (SG 1.000) at a similar temperature.

The specific gravity of the plasma filtrate entering the glomerulus is 1.010. The
term is isosthenuric is used to describe urine with specific gravity of 1.010.
Specimens below 1. 010 is hyposthenuric;
Specimens above 1. 010 is hypersthenuric .
Normal random specimens may range from 1.002 to 1.035, depending on the
patient’s amount of hydration. Most random specimens fall between 1.015 to
1.030.

PHYSICAL EXAMINATION OF THE URINE

SPECIFIC GRAVITY is defined as the density of a solution compared with the density of
a similar volume of distilled water (SG 1.000) at a similar temperature.

Urine is actually water that contains dissolved chemicals, the specific gravity of
urine is a measure  of the density of the dissolved chemicals in the specimen. As a
measure of specimen density, specific gravity is influenced not only by the number of
particles present but also their size. Therefore, large molecules contribute more to the
reading than do the small molecules. This may require the need to correct the
presence of substances that are not normally seen in the urine such as glucose and
protein in the specimen.

PHYSICAL EXAMINATION OF THE URINE

CURRENT URINE SPECIFIC GRAVITY
MEASUREMENTS
Refractometry 
Principle: Refractive index

Osmolality
Principle: changes in the colligative
properties by particle number

Reagent Strip
Principle: pKa changes of a
polyelectrolyte by ions present

PHYSICAL EXAMINATION OF THE URINE

 ODOR
Urine that contains a lot of water and few waste
products has little to no odor. If urine becomes highly
concentrated — a high level of waste products with little
water — your urine may have a strong ammonia odor.

PHYSICAL EXAMINATION OF THE URINE

 URINE ODOR & THEIR CAUSES
Aromatic: Normal
Foul, ammonia-like: Longstanding urine
Fruity, sweet: Ketones (Diabetes mellitus, starvation, vomitting)
Maple Syrup: Maple Syrup Urine Disease
Mousy: Phenylketonuria
Rancid: Tyrosenimia
Sweaty feet: Isovaleric acidemia
Cabbage: Methionine malabsorption
Bleach: Contamination

PHYSICAL EXAMINATION OF THE URINE

 HOW DO WE CALCULATE THE CORRECTED
SPECIFIC GRAVITY OF URINE WHEN GLUCOSE
AND PROTEIN ARE PRESENT IN THE SPECIMEN?

Corrections for glucose and protein must be calculated

by subtracting 0.003 for each gram of protein
present and 0.004 for each gram of glucose
present. The amount of protein or glucose present can
be determine from the chemical reagent strip test.
THANK YOU