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IV. Urinalysis Lab Test & Chemical Screening
IV. Urinalysis Lab Test & Chemical Screening
IV. Urinalysis Lab Test & Chemical Screening
SPECIMEN EVALUATION
r Proper labelling
r Proper specimen for requested test
r Proper receptacle (container)
r Storage conditions (time, temperature)
r Preservative NOTES!!!
r Visible signs of contamination UROCHROME – proportional to the metabolic rate and
r Transportation increased during starvation, fever, thyrotoxicosis
Normal concentrated urine may show sedimentary deposit if
URINE COMPOSITION allowed to stand after cooling from the body temp
ê Normal urine contains 90-95% water and about (phosphates & urates)
60 G/day of solid constituents which may be
organic or inorganic in nature VARIATIONS OF URINARY COLOR
A. PHYSIOLOGICAL VARIATIONS
ORGANIC constituents of urine S. No. Color Interpretation
S.No. Constituent Concentration
1 Dark yellow Concentrated urine – Mild
(G/day)
dehydration
1. Urea 25-30
Vitamin B complex
2. Uric acid 0.5-0.8
theraphy
3. Creatinine 1-1.8
4. Hippuric acid 0.7-0.8
2 Orange Drug induced
3 Pinkish Excessive beet root intake
INORGANIC constituents of urine
S.No. Constituent Concentration
(G/day) B. PATHOLOGICAL VARIATIONS
1. Chlorides 10-15 S. No. Color Interpretation
2. Sodium 3-5 1 DEEP jaundice
3. Potassium 2-2.5 YELLOW
4. Calcium 0.1-1-2
2 Reddish Haematuria
5. Phosphates 0.8-1.3
3 Brownish Hemoglobinuria,
6. Sulphates 1.0-1.2
myoglobinuria and
7. Ammonia 0.7-0.8
porphyrias
GROSS PHYSICAL EXAMINATION 4 Brown to Alkaptonuria
black
I. APPEARANCE 5 Cloudy Pus cells and bacteria in
infected cells
COLOR 6. Smoky Red blood cells
ê roughly indicates the degree of hydration and 7 Black Iron theraphy
urine concentration w/c correlates to urine 8. Pinkish brown Presence of urobilin –
specific gravity Hemolytic anemias
r UROCHROME (UROBILIN) 9. Milky white Chyluria (presence of fat
ê yellow pigment of the urine; globules)
r UROERYTHRIN
ê pink pigment; uric acid or urate crystals (brick
dust deposit); should not be confused with blood
r PALE COLOR
ê high fluid intake
r DARKER COLOR
ê decrease fluid intake
r NUBECULAE
ê small cloudy patches in normal urine; mucus
from urinary tract
1
Denielle
Genesis
B.
Camato
IV.
URINALYSIS
(LAB
TESTS/CHEMICAL
SCREENING)
ANALYSIS
O F
URINALYSIS
AND
BODY
FLUIDS
|
REVIEWER
ê Normal volume 800-2,500 mL/day with an average of 1500 a. LOW SPECIFIC GRAVITY 1.007 OR LESS
mL/day. ê Hyponuria
ê Approximately 500 mL/day is the minimum volume of urine ê Conditions:
needed in normal health to remove waste products û Compulsives polydipsia
ê The volume of urine is affected by – û Diabetes insipidus
þ Fluid intake û Glomerulonephritis
þ Fluid loss û Pyelonephritis
þ Type of diet
þ Cardio-vascular status b. HIGH SPECIFIC GRAVITY OF URINE 1.025 OR MORE
þ Renal functions ê Hypernuria
ê Conditions:
VARIATIONS IN VOLUME OF URINE EXCRETED û Severe dehydration
û nephrotic syndrome (due to proteinuria)
A) POLYURIA û Diabetes mellitus (due to glycosuria)
û Adrenal insufficiency (excess of sodium in urine)
ê Polyuria implies an increase volume of urine excreted û Congestive heart failure
per day; generally volume of urine exceeding 2,500 û Hepatic diseases
mL/day is termed as POLYURIA.
û Extra renal water losses (fever, vomiting and
ê Conditions causing POLYURIA diarrhea)
þ Diabetes mellitus
þ Diabetes insipidus c. FIXED SPECIFIC GRAVITY
þ Late stage of chronic glomerulonephritis ê (ISOTHENURIA)
þ Drug induced – diuretics ê Is seen in chronic renal failure
þ Alcohol ê Specific gravity of urine is based on tubular function
þ Compulsive polydipsia ê In the late stages of chronic renal failure, kidneys fail
to concentrate or dilute urine, which has a constant
specific gravity ranging between 1.008-1.012 (average 1.010)
B) OLIGURIA same as that of plasma.
ê Volume of urine less than 500mL/day is termed as
OLiGURIA MEASUREMENT OF SPGR
þ Conditons causing OLIGURIA ê The specific gravity is measured by URINOMETER
þ Fever ê The instrument floats in the urine
þ Diarrhea (loss of fluid from extra renal ê The calibration mark that corresponds to the surface level
sites) of urine is read
þ Severe edema ê It is calibrated at 15°C, temperature correction is done by
þ Acute nephritis adding 0.001 for every 3 degree above 15°C or subtracting
þ Early stage of acute glomerulonephritis 0.001 for every 3 degree below 15°C.
þ Cardiac failure and hypertension (reduced ê Proteinuria increases SPGR, 0.003 is subtracted for every
circulatory volume) G/L of urinary protein
2
Denielle
Genesis
B.
Camato
IV.
URINALYSIS
(LAB
TESTS/CHEMICAL
SCREENING)
ANALYSIS
O F
URINALYSIS
AND
BODY
FLUIDS
|
REVIEWER
3
Denielle
Genesis
B.
Camato
IV.
URINALYSIS
(LAB
TESTS/CHEMICAL
SCREENING)
ANALYSIS
O F
URINALYSIS
AND
BODY
FLUIDS
|
REVIEWER
b. Nitroprusside test
Procedure:
§ to 5ml of urine add a few frops of sodium nitroprusside and
make the solution alkaline with sodium hydroxide (NaOH).
§ A ruby red color is formed that turns yellow.
§ This test is also called Wey’s test.
4
Denielle
Genesis
B.
Camato
IV.
URINALYSIS
(LAB
TESTS/CHEMICAL
SCREENING)
ANALYSIS
O F
URINALYSIS
AND
BODY
FLUIDS
|
REVIEWER
5
Denielle
Genesis
B.
Camato
IV.
URINALYSIS
(LAB
TESTS/CHEMICAL
SCREENING)
ANALYSIS
O F
URINALYSIS
AND
BODY
FLUIDS
|
REVIEWER
b) renal
û all inflammatory, degenerative or
destructive diseases of kidney; the most
common ones are:
û nephrotic syndrome TEST FOR β- OH butyric acid
û pyelonephritis § No direct test for B-OH butyric acid
û acute & chronic glomerulonephritis § Indirect test is performed
û nephrosclerosis § Procedure: add a few drops of acetic acid to urine diluted 1:1
û tuberculosis of kidney with distilled water. Boil for a few minutes to remove
û renal failure acetone and aceto acetic acid. Add about 1.0ml of H2O warm
gently, cool, and perform Rothera’s test
c) post renal § Acetone, acetoacetate and beta hydroxy butyrate are
ketone bodies. Ketonemia and hence ketonuria occurs mostly
û also called false proteinuria because these
in conditions of glucose deprivation.
conditions proteins do not pass through the
kidneys. § Causes:
ü Uncontrolled diabetes mellitus
û Causes includes:
ü Starvation
û severe urinary tract infections
ü High fat feeding
û inflammatory, degenerative or traumatic
ü Heavy exercise
lesions of pelvis, ureters, bladder, prostate
ü Toxemia of pregnancy
or urethra
û bleeding genitor urinary tract
û pus in urine
û contamination of urine by semen or vaginal
secretions
6
Denielle
Genesis
B.
Camato
IV.
URINALYSIS
(LAB
TESTS/CHEMICAL
SCREENING)
ANALYSIS
O F
URINALYSIS
AND
BODY
FLUIDS
|
REVIEWER
URINE STRIP
ü 10 different substances in urine can be detected
ü Easy, quick and bedside procedure
7