Duhok Polytechnic University

Duhok Technical institute

Dept. of Medical Laboratory Technology
Second semester
Second stage

CLINICAL CHEMISTRY

Report 3 about:-

ROUTINE URINALYSIS

Prepared by :- Evlin Imad khalaf

Supervisor:- Heevi Ameen Rajab

Routine urinalysis
A urinalysis is a test of your urine. it is one of the routine tests that are carried out to check on
public health, and it may be performed for other purposes, It is worth noting that the results of
urine analysis may vary depending on many factors; It should be noted that a urinalysis may
be performed in a hospital, emergency department, or outside laboratories, and in this context
it is indicated that a urinalysis is a test. A urinalysis involves checking the appearance,
concentration and content of urine. Abnormal urinalysis results may point to a disease or
illness:-
Or
A urinalysis is used to detect and manage a wide range of disorders, such as:-
-urinary tract infections
-kidney disease
-diabetes.
A urine test checks different components of urine, a waste product made by the kidneys. A
regular urine test may be done to help find the cause of symptoms. The test can give information
about your health and problems you may have.
The kidneys take out waste material, minerals, fluids, and other substances from the blood to
be passed in the urine. Urine has hundreds of different body wastes. What you eat and drink,
how much you exercise, and how well your kidneys work can affect what is in your urine.

The purpose of the test

A urinalysis is a general examination performed by a patient for

several reasons

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To check your general health: The doctor may recommend a urinalysis as
part of a regular medical examination, or to check the health status at the time
of pregnancy, or the time of preparation before operations, or upon
admission to the hospital, to check the presence of a variety of disorders
such as diabetes, kidney and liver disease

To diagnose a medical condition: A doctor may recommend a urinalysis if the

patient has abdominal pain, back pain, frequent urination, painful urination,
blood in the urine, or other urinary problems. A urinalysis can also help
diagnose the cause of these symptoms

To monitor a medical condition: If the doctor diagnoses a patient with a

medical condition, such as kidney disease or urinary tract disease, the doctor
may recommend urine analysis on a regular basis monitor the condition and
treatment

Other tests, such as a pregnancy test and drug tests, may be based
on a urine sample, but these tests look for substances that are not
:normally present in a regular urinalysis. For example

a pregnancy test measures a hormone known as human chorionic

gonadotropin (HCG). As for drug tests, they discover specific
drugs or their metabolic products, depending on the purpose of the
. test

When a urine sample is analyzed in the laboratory, it is

examined in three different ways:

visual inspection that helps to determine the color of the urine,

its odor, and the extent of its clearness or turbidity,

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the chemical screening that is performed using a special test strip
that can detect the acidity of the urine, and whether Urine contains
blood, protein, or sugar,

a microscopic screening that provides a visualization of urine

contents that cannot be seen with the naked eye; Such as white
blood cells, red blood cells, and bacteria.

Chemical examination

The chemical examination of urine is carried out using the test strip

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as the test strip contains plates arranged in a row, so that each plate carries a
chemical substance for a specific type of chemical tests for urine, so that
the laboratory dips the strip for a short period of time into the urine sample,
which enables the plates to absorb Urine appropriately, and this results in a
change in the color of the test plates on the strip as a result of a certain
chemical reaction, followed by a comparison of the color that appeared on the
strip with the natural color scheme on another standard test strip to determine
the result of each test, and the test strip result must be evaluated in a timely
manner As doing this within a shorter or longer period than the imposed leads
to giving incorrect results, and the most important criteria that the chemical
-:examination contributes to detecting can be explained as follow

Acidity or pH:- as this indicates the amount of acid in the urine, and -)1
abnormal acidity levels may indicate kidney or urinary tract disorders.
.Including kidney stones and infection

Protein: the blood contains a certain amount of protein in the normal -)2
situation, but the urine must be free of protein or contain very small
quantities that are not detectable, but if protein leaks into the urine, this
may indicate kidney damage or kidney disease, and from On the other
hand, other conditions may cause high levels of protein in the urine. This
includes having multiple myeloma, or having conditions that destroy red
.blood cells, or mixing vaginal secretions in women with urine

Glucose: The urine does not contain glucose in the normal state, but the -)3
presence of glucose in the urine may indicate an increase in its concentration
in the blood. This may be linked to diabetes, or kidney disorders that cause
.a decrease in the ability to absorb sugar

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Bilirubin: Bilirubin is a waste product that results from the -)4
breakdown of old red blood cells. In normal conditions, bilirubin is
removed by the liver, and the presence of bilirubin in the urine may
.indicate liver disease

Blood: This test is used to detect the extent of the presence of -)5
hemoglobin of red blood cells in the urine, and the appearance of
blood on the test strip may indicate infection or kidney disease, the
use of certain types of drugs, or the practice of vigorous exercise

and it is worth noting the need to tell women The doctor in charge
of whether the urine test performed during the menstrual period;
The presence of blood in the urine may be caused by vaginal
bleeding and is not a cause for concern, in addition to the
.possibility of blood in the urine of people with hemorrhoids

Ketones: ketones represent an intermediate product resulting )-6

from the metabolism of fats in the body, and their presence in the
urine may give an early indication that there is not enough insulin
in a person with diabetes, and in other cases the presence of
ketones may indicate that carbohydrates are not consumed in
sufficient quantity, either as a result of not eating at all Either
because of the focus on foods rich in protein, and this is what drives
the body to consume fats, causing the appearance of ketones in the
urine, and other reasons that stimulate the metabolism of fats:
extremely cold weather, engaging in intense exercise, and frequent
.vomiting

White blood cells: There are few white blood cells in the urine -)7
in the normal situation, but this does not give a positive result when
performing a urine chemical examination. Meaning that this amount
is not detectable, but when the number of white blood cells

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increases significantly, this will give a positive result, and this may
be due to infection of the urinary system or kidneys with
infections, and this may be related to the mixing of vaginal
.secretions with the urine sample

Nitrite: This may be associated with a urinary tract infection, -)8

and it should be noted that the level of nitrite is not necessarily
.elevated in all cases of urinary tract infection

Urobilinogen: It is found in urine in low concentrations in the -)9

normal situation, but if its levels are higher than normal, this may be
related to liver disease, or to conditions that cause the destruction
of red blood cells, and it is indicated that the disappearance of
urobilinogen from the urine or its presence At lower than normal
.levels, it may be associated with obstruction of the bile duct or liver

Density Specific Gravity: which is a physical property of urine, -)10

as it indicates the concentration of urine, and the fact that the
concentration of urine depends on the amount of chemical
dissolved in the urine compared to pure water, and the high
concentration at a higher level than normal is often attributed to
not drinking fluids In sufficient quantities

Visual examination

The visual examination plays a role in evaluating the color of the urine,
the extent of its clarity, and its smell, as this is an indication of the
substances that may be present in the urine, and it is indicated that the
results of the visual examination are not interpreted alone in most cases, but

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rather in conjunction with the results that are made. It is obtained during
the chemical and microscopic examination, which confirms the nature of
the substances in the urine. In this context, it is indicated to infer the presence
of a defect when results differ from the normal situation appear, and with
regard to the natural smell of urine, it is light and harmless. As for the
color Normal urine is yellow or straw colored, and it may be closer to
something colorless, and when talking about the clarity and clarity of urine It
is indicated that urine is relatively clear or slightly cloudy in the normal
situation, and imbalances in urine color and turbidity can be explained in some
detail as follows

Variation in the color of urine: The color of urine may differ from the
normal as a result of consuming certain types of food, or a drug, or
having a certain health condition, and the color of urine is an important
,indicator in many cases

the color of dark yellow urine may indicate dehydration, and light -)1
,yellow may indicate dehydration. Taking vitamin supplements

and your urine is red or pink due to bleeding or eating certain foods; -)2
,Like beetroot

,while the appearance of brown urine may indicate a defect in the liver-)3

its appearance in green may be an indication that a person has consumed -)4
sedatives for a long period of time, and this male is not limited to

The difference in the extent of urine clearance: The turbidity

of the urine may be associated with an increase in the
concentration of some substances in it, which is related to the
incidence of certain cases, this may indicate an increase in the
percentage of protein in the urine, or the turbidity of urine may
be related to the presence of many microorganisms and other
,substances

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the most prominent of which can be mentioned as The
:following

.bacteria :- Including sexually transmitted bacteria

.Calcium crystals:- which may be a sign of kidney stones

.Fungi:- Including infection with Candidiasis

.Red blood cells:- which may be an indication of bleeding

.White blood cells:- which are an indication of an infection

.Uric acid crystals:- which may be an indicator of gout

.Sperm:- and this may indicate retrograde ejaculation

Different smell of urine: the smell of urine may differ when eating
certain types of foods. Eating asparagus, which is one of the
types of foods with a strong flavor, may lead to the appearance of
a strange smell of urine, and in cases where the smell of urine is
similar to the smell of fish, this may indicate infection of the urinary
tract-but if it smells similar to acetone, this may indicate the
presence of ketones; This is exemplified by the development of
diabetic ketoacidosis, which is a complication of high blood sugar

Reference Range
Normal values are as follows:

• Color – Yellow (light/pale to dark/deep amber)

• Clarity/turbidity – Clear or cloudy
• pH – 4.5-8
• Specific gravity – 1.005-1.025
• Glucose - ≤130 mg/d
• Ketones – None
• Nitrites – Negative

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 • Leukocyte esterase – Negative
• Bilirubin – Negative
• Urobilirubin – Small amount (0.5-1 mg/dL)
• Blood - ≤3 RBCs
• Protein - ≤150 mg/d
• RBCs - ≤2 RBCs/hpf
• WBCs - ≤2-5 WBCs/hpf
• Squamous epithelial cells - ≤15-20 squamous epithelial cells/hpf
• Casts – 0-5 hyaline casts/lpf
• Crystals – Occasionally
• Bacteria – None
• Yeast - None

Your doctor may evaluate the results of your urinalysis

alongside the results of other tests - or order additional
. tests - to determine next steps

For example, if you are otherwise healthy and have no signs or symptoms of
disease, results slightly above normal levels may not be a cause for concern
.and may not need follow-up

However, if you've been diagnosed with a kidney or urinary tract disease,

.elevated levels may indicate a need to change your treatment plan

How Do I Prepare for a Urinalysis?

If urinalysis is the only test you’re having, you should be able to eat and drink
normally before the procedure. Beets and food dyes can discolor your urine, so you
may want to watch what you eat beforehand.

Be sure to let your doctor know about all the medicines you take, including over-
the-counter drugs, vitamins, and supplements. If you’re having your period, let the
doctor know before the test.

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You’ll either be asked to collect a urine sample at home and bring it with you, or
you’ll make it at your doctor’s office. The office will give you a container for the
sample.

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References

1- https://labtestsonline.org/tests/urinalysis
2- Medical Review:Adam Husney MD - Family Medicine & Brian D. O'Brien MD - Internal Medicine &
Martin J. Gabica MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Avery L.
Seifert MD - Urology
3- https://www.healthlinkbc.ca/medical-tests/hw6580
4- https://emedicine.medscape.com/article/2074001-overview#a1
5- Medically reviewed by Deborah Weatherspoon, Ph.D., R.N., CRNA — Written
by Brian Krans — Updated on September 20, 2018

6-Brewster S (2001) Urological

7-investigations. In Brewster S,
8-Cranston D, Noble J, Reynard J
9-(Eds) Urology: A Handbook for
10- Medical Students. Bios Scientific
11- Publishers, Oxford, 7-14