URINALYSIS

BIOCHEMISTRY LECTURE
Presented by: Group 8

Sabalburo, Maurene Claire

Soberano, Althea Zhaira
Tebia, Zyryll Kate
Tweddle, Fiona Mae
Viloria, Princess Jasmine
 Topic Outline
MICROSCOPIC
BRIEF HISTORY EXAMINATION OF URINE

INTRODUCTION TO HEALTH-RELATED
URINALYSIS DISORDERS

TYPES OF URINE CLINICAL SIGNIFICANCE

SPECIMEN OF URINE COMPONENTS

PHYSICAL EXAMINATION
OF URINE FORMATION OF URINE

CHEMICAL EXAMINATION
OF URINE
 Objectives
Discuss the basic procedure of urine
specimen handling

Enumerate the different types of

urine specimen

Identify and interpret the different

properties of urine, namely physical,
chemical and microscopic properties.

Understand the clinical significance of

urinalysis and urine constituents.
Brief History of Urinalysis
Urine was the main diagnostic tool from ancient times until
the Victorian era, but today doctors use it to diagnose
specific illnesses. Uroscopy, now referred to as urinalysis,
was the first procedure in laboratory medicine to analyze
human urine, 6000 years ago.
Physicians then believed that uroscopy was the key to
understanding the “body’s inner workings” through a liquid
window. So much so, that they solely depended on the
presence of urine specimens for the diagnosis of disease,
instead of the presence of the patients.
Babylonian and Egyptian physicians began the art of
uroscopy in 4000 BC. Uroscopy, from the word ‘uroscopia,’
means ‘scientific examination of urine.’ The word is derived
from the Greek ‘ouron’ meaning ‘urine’ and ‘skopeo’,
meaning to ‘behold, contemplate, examine, inspect’. Urine
was analyzed mainly for their physical properties, that is
volume, color, turbidity and odor.
 Brief History of Urinalysis
Ancient Sumer, one of the earliest civilizations, realized that urine
properties were altered with various illnesses.
Hindu cultures believed that some people's urine tasted sweet, which
caused ants to be attracted to this sweet urine, a characteristic of the
disease now known as diabetes mellitus.
There was also the creation of a theory of disease causation in the 16th
century, that is there are four humors: blood, phlegm, yellow bile, and
black bile, and that these humors have to be kept balanced in order to
prevent disease. During the 4th century BC, Hippocrates (460–355 BC)
hypothesized that urine was a filtrate of the humors, and was filtered
through the kidney. However, 6 centuries later, Galen (AD 129–200) refined
Hippocrates’ ideas, stating that urine represented, not a filtrate of the four
humors, but rather of just one humor, blood.
Introduction
to Urinalysis
 What is
Urinalysis?
Urinalysis is the analysis/examination of
the different properties of urine. These
include the physical, chemical, and
microscopic properties.
Urine is the most analyzed non-blood
specimen of the body as it is an inexpensive
test, it is a specimen that is available most of
the time, and most importantly, it reveals
much about the state of the body by
providing a picture of the many metabolic
functions that take place within the body.
Why do we
do it?
Monitoring wellness
Diagnosing and treating urinary tract
infections
Detecting and monitoring the progress
of treatment in metabolic diseases
Identifying the effectiveness of an
administered therapy
Screening the body for early detection
of disorders, such as kidney disease,
diabetes, and many more.
 Basic Procedure of the Collection and
Handling of Urine specimen
The accuracy of urinalysis results greatly depends
on the following factors:

1. Collection method (type of urine specimen) -

Random, first morning, fasting,midstream etc.

2. Container used - Container must be clean,

dry and leak-proof, made of clear material, with a
wide mouth and flat bottom. The recommended
capacity is 50ml.

3.Transportation and handling of specimens -

In order to maintain the integrity of the specimen,
after collection, they must be sent to the
laboratory and tested within 2 hours.
 Basic Procedure of the Collection and
Handling of Urine specimen
The specimens can be preserved in 2 ways:

1. Physical - Refrigeration of the specimen at a

temperature of 2-8 degrees Celsius. The
effects are:

Decreasing bacterial growth and metabolism

Precipitation of amorphous phosphates and
urates

2. Chemical - Chemical preservatives include:

Boric acid - used for culture transport

Formalin - preservation for addis count
Saccomano fixative - used for cytology
studies
Types of Urine
Specimen
 RANDOM SPECIMEN

Collection Test
Collected any time or Use for routine screening
collected what time is tests (Cholesterol/Lipid
convenient to the patient. Profile Test, Pap Smear,
Colon Cancer Test) and to
diagnose Urinary Tract
Infection
 FIRST MORNING SPECIMEN

Collection Test
Collected immediately upon rising
from a night’s sleep. The bladder is Use for pregnancy testing,
emptied before lying down and bacterial cultures and
the specimen is taken upon rising. microscopic examinations.
The first urine voided in the
morning is preferred because it
has a more uniform volume and
concentration and a lower pH,
which helps preserve the formed
elements.
 FASTING SPECIMEN

Collection Test
This differs from a first morning Use for glucose
specimen by being the second monitoring/testing
voided specimen after a period of
fasting. You should not eat for
It refers to a urine specimen eight hours before having
which is collected after first your blood glucose
emptying the bladder and then measured to check for
waiting until another specimen diabetes or to see how
can be collected. well treatments are
working
2-HOUR POSTPRANDIAL SPECIMEN

Collection Test
Collected before consuming For monitoring insulin
a routine meal and collected therapy in diabetic patients
again 2 hours after eating

'Postprandial' means after having a

meal.
 TIMED SPECIMEN

Collection Test
Collected at specific intervals during the
For creatinine clearance
day.
tests and other hormone
The following instructions for example
are:
studies
Day 1 - 7 am - Patient voids and For analytes that exhibit
discards specimen. Patient collects diurnal variations and are
all the urine for the next 24 hours. affected by changes
Day 2 - 7 am - Patient voids and brought by daily activities
adds this urine to the previously
collected urine.
CATHETERIZED URINE SPECIMEN

Collection Test
Collected under sterile For bacterial culture
conditions by passing a To measure kidney
hollow tube through the function
urethra into the bladder.
MIDSTREAM “CLEAN CATCH” SPECIMEN

Collection Test
Using a bedpan, collecting Test use to determine
the midportion without bacteria, which may be
contaminating the container. causing an infection in the
urinary tract
 SUPRAPUBIC ASPIRATION

Collection Test
Collected by external Used for cytologic
introduction of a needle into examination
the bladder.
 PEDIATRIC SPECIMEN

Collection
Collected by attaching a soft,
clear plastic bag with
adhesive to the general area
of both boys and girls.
Test
To examine if the child has
Urinary Tract Infection
 DOUBLE VOIDED SPECIMEN

Collection Test
This refers to a urine To test for sugar (glucose
specimen which is collected testing)
after first emptying the
bladder and then waiting until
another specimen can be
collected.
 physical
examination
 Volume
Physical Examination Normal =800-2,500 ml/day with an average
involves: of 1500 ml/day.
1. Volume Polyuria-greater than2500 ml
3. Clarity/appearance Oliguria- less than 500ml
4. Odor Anuria-complete cessation of urine (less
5. Urinary pH
than 200 ml).
6. Specific gravity
Nocturia-excretion of urine by a adult of
greater than 500ml with a specific gravity of
less than 1.018 at night (characteristic of
chronic glomerulonephritis).
 VOLUME
Causes of polyuria
Diabetes mellitus and diabetes insipidus
Polycystic kidney disease, Chronic renal failure
Diuretics, Intravenous saline/glucose

Causes of oliguria
Dehydration-vomiting, diarrhea, excessive sweating
Renal ischemia, Acute renal failure
Acute tubular necrosis
Obstruction to the urinary tract
 Clarity/Appearance
Urine is normally clear. Bacteria, blood, sperm, crystals, or
mucus can make urine look cloudy.
In normal urine: the main cause of cloudiness is crystals and epithelial cells.
In pathological urine: cloudiness is due to pus, blood and bacteria.
Degree of cloudiness depends on: pH and dissolved solids
Turbidity: may be due to gross bacteriuria.
Smoky appearance: is seen in hematuria.
Thread-like cloudiness: is seen in samples full of mucus.
 COLOR
Normal- pale yellow in color due to pigments
urochrome, urobilin and uroerythrin.
Cloudiness may be caused by excessive cellular
material or protein, crystallization or
precipitation of non pathological salts upon
standing at room temperature or in the
refrigerator.
Color of urine depends upon its constituents.
ABNORMAL COLORS:
Clear/Colorless
You may be drinking too much water If accompanied by excessive
thirst. It could be an indication of diabetes insipidus. Caused by a
malfunctioning pituitary gland and/or kidney.

Pale Yellow
This is the optimal color of urine. Your body is properly hydrated.

Dark Yellow
You are becoming dehydrated. You need to drink more water.
ABNORMAL COLORS:
Dark Brown
Certain foods, such as fava beans and aloe or particular medications
may be the cause a urinary tract infection could also be the culprit.

Red or Pink
This may be due to red-or dark-colored foods or certain medications.
It can also stem from a bladder or kidney problem.
 ODOR
Freshly voided urine has a typical aromatic odor due to volatile organic acids. After
standing, urine develops ammoniacal odor formation of ammonia occurs when urea is
decomposed by bacteria).

Some abnormal odors with associated conditions are:

Fruity odor: Ketoacidosis, Starvation
Mousy or musty odor: Phenylketonuria
Fishy odor: Urinary tract infection with Proteus, Tyrosinemia
Ammonia odor: Urinary tract infection with escherichia com old standing urine.
Foul odor: Urinary tract infection
Sulfurous odor: Cystinuria
Maple syrup odor: Maple syrup urine disease
Sweaty feet odor: Isovaleric Acidemia
 URINARY PH
pH measures acidity or alkalinity (basicity) of
urine
Normal urine pH: 4.5-8.
Increased acidity in urine: due to diabetes or
medications.
Urine samples must be fresh (why?) (on standing
urine becomes alkaline as a result of ammonia
liberation due to urea decomposition).
 URINARY PH
A urine pH of 4 is strongly acidic, 7 is neutral
(neither acidic nor alkaline), and 9 is strongly
alkaline.
Sometimes the pH of urine is affected by certain
treatments. For example, your doctor may instruct
you how to keep your urine either acidic or alkaline
to prevent some types of kidney stones from
forming.
 SPECIFIC GRAVITY
Measures the amount of substances dissolved in urine.
Also indicates how well the kidneys are able to adjust the
amount of water in urine.
Higher SG: more solid material is dissolved in urine.
When you drink a lot of fluid, your kidneys make urine with a
high amount of water in it which has a low specific gravity.
When you do not drink fluids, your kidneys make urine with a
small amount of water in it which has a high specific gravity.
 CHEMICAL
EXAMINATION
 What is the examination of the chemical
properties of urine?
Urinalysis is the physical, chemical, and microscopic
examination of urine. It involves a number of tests to detect
and measure various compounds that pass through the urine.

Normal constituents of urine

Urine contains a large number of inorganic and organic
substances which are called normal constituents.
NORMAL CONSTITUENTS OF URINE
INORGANIC CONSTITUENTS: ORGANIC CONSTITUENTS:

Sodium: 3-5g/day Urea: 25-30g/day

Chloride: 10-15g/day Uric acid: 0.5-0.8g/day
Potassium: 2-2.5g/day Creatinine: 1-1.8g/day
Calcium: 0.1-0.3g/day Hippuric acid: 0.7-
Phosphates: 0.8-1.3g/day 0.8g/day
Sulphates: 1.0-1.2g/day
Ammonia: 0.7-0.8g/day
 ABNORMAL CONSTITUENTS OF URINE AND THEIR LAB
TESTS
1. SUGARS (URINE GLUCOSE)
QUALITATIVE ESTIMATION:
1. BENEDICT’S TEST:
Principle: Benedict’s reagent contains copper sulfate (CuSO4). Alkaline medium is provided to
the reaction by sodium carbonate (Na2CO3) being present in the reagent. In the presence of
reducing sugars, cupric ions are converted to cuprous oxide which is quickened by heating,
to give the color.
Result:
blue- sugar absent
green- 0. 5% sugar
yellow-1% sugar
orange- 1. 5% sugar
brick red- 2 % or more sugar.
 1. SUGARS (URINE GLUCOSE)
2. FEHLING’S TEST:
Principle: During the reduction process of copper hydroxide(CuH4O2) to copper oxide (Cu2O)
by the glucose. Copper oxide and its degradation product, copper oxide or cuprous oxide, are
colored compounds.

QUANTITATIVE ESTIMATION:
1. Benedict’s quantitative reagent method (BQR method):
Principle: BQR contains copper sulphate, potassium thiocyanate and other chemicals in
alkaline solution. Copper ions of BQR are reduced to cuprous oxide by reducing
monosaccharide glucose, glucose in presence of Sodium Carbonate(Na2CO3) undergoes
tautomerization and forms powerful reducing agents enediols. These enediols show their
reducing actions and reduces cupric ions to cuprous oxide and they get oxidized into gluconic
acid.
- Cuprous oxide is maintained in solution by potassium ferrocyanide and it reacts with
potassium thiocyanate and forms a white precipitate of cuprous thiocyanate instead
of the usual red precipitate of cuprous oxide.
- Disappearance of blue color from solution indicates complete reduction of copper
sulphate and end point of the titration.

2. Proteins (URINE PROTEINS)

QUALITATIVE TESTS
1. Sulphosalicylic Acid Test:
Principle: It lowers the pH of the medium of the protein, so that both globular proteins
become cationic and will react with an ionic sulphosalicylic acid and forms a
precipitate.
Result: Formation of turbidity indicates presence of protein
 2. Proteins (URINE PROTEINS)
2. HELLER'S TEST:
Principle: When protein solution is treated with strong acids like Nitric Acid (HNO3),
Sulfuric Acid (H2SO4) and Hydrogen Chloride (HCl) forms precipitate possibly due to
change in pH or denaturation of protein. The denatured protein is less soluble in water
and gets precipitated.

3. Heat & Acetic Acid Test:

Principle: proteins are denatured & coagulated on heating to give white cloud
precipitate.
- Presence of phosphates, carbonates, proteins gives a white cloud formation.
- Add acetic acid 1 -2 drops, if the cloud persists it indicates it is protein.
 2. Proteins (URINE PROTEINS)
QUANTITATIVE TEST FOR ALBUMIN:
1. ESBACH'S METHOD
Esbach’s reagent: 5g of picric acid and 10g of citric acid in 500 ml water.
Principle: Precipitation of protein by picric acid.

3. KETONE BODIES
The term ketones refer to 3 intermediate products of fat metabolism, they are
acetone, acetoacetic acid and beta-hydroxybutyric acid.
— Both acetone and beta hydroxybutyric acid are produced from diacetic acid.
— Diacetic acid is the form detected by most ketone test procedures.

 3. KETONE BODIES

- Ketone is found when there is excessive fat metabolism which occurs in various
situations:
Impaired ability to metabolize carbohydrates, Inadequate carbohydrate intake.
Excessive carbohydrate loss.
Increased metabolic demand.

1) ROTHERA'S TEST:
Principle: Nitroprusside in alkaline medium reacts with a ketone group to form a
purple ring. It is given by acetone and acetoacetate, but not by Beta-hydroxy butyric
acid.
 3. KETONE BODIES
2) Gerhardt’s ferric chloride test
Principle: A purplish color is given by acetoacetate. On boiling acetoacetate is
converted to acetone and does not give this test positive. This test is only given by
acetoacetate and not by beta- hydroxybutyrate.

3) Hart’s test for β- OH butyric acid (Beta-hydroxybutyric acid)

Principle: This basically involves the conversion of beta- hydroxybutyric acid to acetone,
which can then be detected by the nitroprusside method.

4. BILE PIGMENTS
1. FOUCHET'S TEST
Principle: Barium chloride (BaCl 2) reacts with sulphate in urine to form barium sulphate.
If bilirubin is present in urine, it adheres to precipitate and is detected by oxidation with
Ferric Chloride (FeCl3) in the presence of trichloro acetic acid to form biliverdin (Green).
 4. BILE PIGMENTS
2. GMELIN'S TEST
Principle: Nitric acid oxidizes Bilirubin to Biliverdin giving different colors from green to
violet.

3. IODINE TEST
Procedure: Dilute some tincture of iodine with one to two volumes of water and layer it
carefully on to some urine in a test tube, a green ring at the junction of two fluids
indicates the presence of Bilirubin. It is not a sensitive test, and cannot detect small
amounts of bilirubin present in the given sample.

5. Bile salts
PRIMARY BILE ACIDS:
- Cholic acid and chenodeoxycholic acid (CDCA) synthesized from cholesterol in the
liver, conjugated with glycine or taurine, and secreted into the bile.
 5. Bile salts
SECONDARY BILE ACIDS:
— Deoxycholate and lithocholate are formed in the colon as bacterial metabolites of
the primary bile acids.
— Sodium taurocholate and sodium glycocholate are found in urine.

TEST FOR BILE SALTS

Hay’s Sulphur test
Principle: Bile salts lower the surface tension allowing the sulphur powder to sink.
Result:
— In the control, sulphur powder remains immiscible with the underlying liquid. In the
positive test, the sulphur powder sinks to the bottom.
— Interpretation: Bile salts and bile pigments are present in urine in obstructive
jaundice.
 6. Blood
1. BENZIDINE TEST
Principle: The peroxidase activity of hemoglobin decomposes hydrogen peroxide
releasing nascent oxygen which in turn oxidizes benzidine to give blue color.
Reagents: Saturated solution of benzidine in glacial acetic acid, Hydrogen
peroxide.
Positive result: Green or blue color. (Hematuria)
 REAGENT STRIP/DIPSTICK
TESTING & THEIR PRINCIPLE
AND REACTION
 REAGENT STRIP/DIPSTICK METHOD
OF URINALYSIS
Seven different reagent areas are affixed on the strip.
These different cellulose areas are impregnated with specific testing
chemicals according to the test which reacts with specific substances
present in urine by changing the color.
The entire strip is dipped in the urine sample and color changes in each
square noted. The color change takes place after several seconds to a few
minutes from dipping the strip. If read too early or too long after the strip is
dipped, the results may not be accurate.
Color change chart is observed and compared to the color chart for the
presence of abnormal levels of substances.
 REAGENT STRIP/DIPSTICK METHOD
OF URINALYSIS
PRINCIPLES
Consists of chemical-impregnated
absorbent pads attached to a plastic strip
A color producing chemical reaction takes
place when the absorbent pad comes in
contact with urine
Reactions are interpreted by comparing the
color produced on the pad with a chart
supplied by the manufacturer.
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
1. pH
Clinical Significance and Principle: The pH value is only of significance in
relation to other parameters. More acid urine (lower pH values) is found in
case of an increased protein metabolism, high fever, serious diarrhea and
metabolic acidosis (serious form of diabetes mellitus). Alkalinity (increased pH
value) may be noted in urinary tract infections, respiratory or metabolic
alkalosis.
REAGENT STRIP: DOUBLE INDICATOR SYSTEM
REACTION:
a. red-orange yellow (pH 4 to 6)
b. green blue (pH 6 to 9)
Read at: 60 secs
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
2. PROTEIN
Principle: The test is based on the “protein error” principle of indicators. The
test zone is buffered to a constant pH value and changes color from yellow to
greenish blue in the presence of albumin. Other proteins are indicated with
less sensitivity.
CLINICAL SIGNIFICANCE: CLINICAL PROTEINURIA (PRERENAL, RENAL,
POSTRENAL)
REAGENT STRIP: PROTEIN ERROR OF INDICATOR
Reaction: yellow to blue-green
Read at: 60 secs
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
3. GLUCOSE
Principle: The detection is based on the glucose oxidase-peroxidase-
chromogen reaction. The oxidation of glucose by atmospheric oxygen is
catalyzed by glucose oxidase to form gluconic acid lactone and hydrogen
peroxide. Peroxidase catalyzes the reaction of hydrogen peroxide with the
chromogen. Apart from glucose, no other compound in urine is known to give
a positive reaction.

CLINICAL SIGNIFICANCE: detection and monitoring of DIABETES MELLITUS

RENAL THRESHOLD FOR GLUCOSE: 160 to 180 mg/dL
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
NORMAL URINE GLUCOSE: 15mg/dL
REAGENT STRIP: DOUBLE SEQUENTIAL ENZYME REACTION
Reaction:
a. Multistix: green to brown
b. Chemstrip: yellow to green
Read at: 30/60 secs
NOTE: Glucosuria/ glycosuria- presence of detectable levels of glucose
in the urine.
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
4. KETONES
Principle: The test is based on the principle of Legal’s test. Acetoacetic
acid and acetone form a violet colored complex with sodium
nitroprusside in alkaline medium.
NORMAL URINE KETONE: NORMALLY NOT IN URINE
REAGENT STRIP: SODIUM NITROPRUSSIDE REACTION
Read at: 40/60 secs
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
5. BLOOD
Principle: The detection is based on the pseudoperoxidative activity
of hemoglobin and myoglobin, which catalyze the oxidation of an
indicator by an organic hydroperoxide, producing a green color.
REAGENT STRIP: PSEUDOPEROXIDASE ACTIVITY OF HEMOGLOBIN
Reaction: color change from orange to green to dark blue
Read at: 60 secs
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
7. UROBILINOGEN
Clinical significance: An increased urobilinogen concentration in urine is a
sensitive index of liver dysfunction or hemolytic diseases. Urobilinogen uria is
caused by virus hepatitis, chronic hepatitis, liver cirrhosis, infections,
poisonings, congestion or carcinoma of liver, hemolytic, and pernicious
anemia, polycythemia and pathological state of the intestinal tract with an
increased resorbence.
NORMAL URINE UROBILINOGEN: (less than) <1 mg/dL or 1 EHRLICH UNIT
REAGENT STRIP: EHRLICH REACTION
Read at: 30 to 60 seconds
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
8. NITRITES
Principle: Microorganisms, which are able to reduce nitrate to nitrite, are
indicated indirectly with this test, which is based on the principle of
Griess reagent. The test paper contains an amine and a coupling
component. Diazotization and subsequent coupling result in a red
colored azo compound. Only nitrite can produce a diazonium salt for
coupling reaction, therefore falsely positive results are virtually impossible
in this case.
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
Clinical Significance: Bacteria, which cause infections, and can produce
nitrite in the urine are E. coli, Aerobic Bacteria, Citrobacteria, Klebsiella,
Proteus, Salmonellae and in part Enterococci, Pseudomonas and
Staphylococci. If the test is positive a microscopic examination and
determination of susceptibility of pathogenic bacteria to chemotherapeutic
agents should follow.

REAGENT STRIP: GRIESS REACTION

Read at: 30 to 60 secs
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
9. LEUKOCYTE ESTERASE
Clinical Significance and Principle: An increased excretion of leukocytes in
urine is an important symptom for infectious diseases of the kidneys and/or urinary
tract including the prostate.
- Leukocyturia is especially important for diagnosis of chronic pyelonephritis.
Often it is the only symptom between acute attacks. Other causes for leukocyturia
may be: analgesic nephropathy, glomerulopathy and intoxications, cystitis,
urethritis, kidney or urogenital tuberculosis, fungus and trichomonas infections,
gonorrhea, urolithiasis, tumors with obstructions.

REAGENT STRIP: LEUKOCYTE ESTERASE

Read at: 120 secs
 REAGENT STRIP/DIPSTICK & THEIR PRINCIPLE AND
REACTION
10. SPECIFIC GRAVITY
REAGENT STRIP PRINCIPLE: pKa (acid dissociation constant) change of
polyelectrolyte
Read at: 45 secs
MICROSCOPIC
EXAMINATION
 Red blood cells
Hematuria is the presence of abnormal numbers of red
cells in urine due to:
Glomerular damage

Kidney trauma
Urinary tract stones
Upper and lower urinary tract infection
Nephrotoxins
Physical stress
Red cells may also contaminate the urine from the vagina in
menstruating women
 Red blood cells
RBC's may appear normally shaped, swollen by
dilute urine (in fact, only cell ghosts and free
hemoglobin may remain). Both swollen, partly
hemolyzed RBCs are sometimes difficult to
distinguish from WBC's in the urine.

Dysmorphic RBCs have odd shapes as a consequence

of being distorted via passage through the abnormal
glomerular structure.
 White blood cells
Normally about 1-2 cells increase in case of infection.

- These cells are usually polymorphonuclear phagocytes ,

commonly known as segmented neutrophils.

- They are observed when there is acute glomerulonephritis , UTI ,

or inflammation of any type.

 White blood cells

Pyuria refers to the presence of abnormal numbers of
leukocytes that may appear with infection in either the
upper or lower urinary tract or with acute
glomerulonephritis.
Usually, WBC's are granulocytes. White cells from the
vagina, especially in the presence of vaginal and
cervical infections.
If two or more leukocytes per each high power field
appear in non-contaminated urine, the specimen is
probably abnormal.
Leukocytes have lobed nuclei and granular cytoplasm.
 Epithelial cells

Normally a few epithelial cells occur in the urine.

A marked increase in these cells in the urine is seen
destruction of the tissues in the urinary tract.
Renal tubular epithelial cells, usually larger than
granulocytes, contain a large round or oval nucleus and
normally slough into the urine in small numbers.
However, with nephrotic syndrome and in conditions leading
to tubular degeneration, the number sloughed is increased.
In females they increase normally but in case of males they
indicate contamination from the genital tract.
 Casts

They are solid and cylindrical structures formed by precipitation

of debris in the renal tubules.
Urinary casts are formed only in the distal convoluted tubule
(DCT) or the collecting duct (distal nephron). The proximal
convoluted tubule (PCT) and loop of Henle are not locations for
cast formation.
Hyaline casts are composed primarily of a mucoprotein excreted by tubule
cells; hyaline casts are seen in healthy individuals.
RBCs casts are formed when RBCs stick together and in glomerular disease.
WBCs casts are seen in acute pyelonephritis and glomerulonephritis.
Granular and waxy casts are seen in nephrotic syndrome.
 Bacteria

Bacteria are common in urine specimens because

of the abundant normal microbial flora of the
vagina or external urethral and because of their
ability to rapidly multiply in urine standing at
room temperature.

Therefore, microbial organisms found in all but

the most carefully collected urines should be
interpreted in view of clinical symptoms.
 Yeast

Yeast cells may be contaminants or

represent a true yeast infection. They are
often difficult to distinguish from red cells
and amorphous crystals but are
distinguished by their tendency to bud.
Most often they are Candida, which may
colonize bladder and urethra.
 Crystals

Common crystals seen even in healthy

patients include calcium oxalate,
triple phosphate crystals and
amorphous phosphates.
Crystals in urine means crystalliuria.
It is normal to have crystals in urine,
but they may stick together and form
stones, which may block the urinary
tract, causing Acute Renal Failure.
HEALTH-RELATED PROBLEMS
 HEALTH-RELATED PROBLEMS
1. Urinary tract infection
It is an infection in any part of the urinary system. The kidneys,
ureters, bladder, and urethra are components of the urinary
system. Most infections affect the bladder and urethra, which are
parts of the lower urinary system.

UTIs can be found by analyzing a urine sample. The urine is

examined under a microscope for bacteria or white blood cells,
which are signs of infection. Your health care provider may also
take a urine culture. This test examines urine to detect and
identify bacteria and yeast that may be causing a UTI.
 Either nitrites or leukocyte esterase, a product of white
blood cells in your urine, might indicate a urinary tract infection.
Nitrites in urine may be a sign of a urinary tract infection (UTI).
 HEALTH-RELATED PROBLEMS
2. Kidney Disease
It is a condition in which the kidneys are damaged and cannot
filter blood as well as they should. Because of this, excess fluid and
waste from blood remain in the body and may cause other health
problems, such as heart disease and stroke.
Example: KIDNEY STONE

A kidney stone is a hard object that is made from chemicals in

the urine. There are four types of kidney stones: calcium oxalate,
uric acid, struvite, and cystine.

Urine tests can show whether your urine contains high levels of
minerals that form kidney stones. Urine and blood tests can also
help a health care professional find out what type of kidney
stones you have.
 HEALTH-RELATED PROBLEMS
3. Diabetes
Diabetes is a chronic, metabolic disease characterized by elevated
levels of blood glucose (or blood sugar), which leads over time to
serious damage to the heart, blood vessels, eyes, kidneys and
nerves.
Glucose test measures the amount of glucose in your urine. It may
be used as a screening test for diabetes. The glucose urine test
measures the amount of sugar (glucose) in a urine sample. The
presence of glucose in the urine is called glycosuria or glucosuria.
Urine tests can be used to detect and monitor glucose levels and
ketone levels in people with diabetes.
 HEALTH-RELATED PROBLEMS
4. Liver Disease
The term “liver disease” refers to any of several conditions that
can affect and damage your liver. Over time, liver disease can
cause cirrhosis (scarring). As more scar tissue replaces healthy
liver tissue, the liver can no longer function properly.

A bilirubin in urine test measures the levels of bilirubin in your

urine. Normally, urine doesn't have any bilirubin. If there is
bilirubin in your urine, it may be an early sign of a liver condition.
Bilirubin is a yellow substance that your body makes during the
normal process of breaking down red blood cells.
Cl in ic a l
S ig n if ic an ce
of u r in e
om p o n en ts
C
URINE GLUCOSE
Presence of glucose in urine is known as glucosuria. Persistent
glycosuria Indicates the presence of diabetes mellitus. Normal
value of glucose excretion in urine is 78.5 mg/day In general
glucose is seen in urine in 2 conditions.
A.When blood sugar is elevated.
B.When blood sugar is not elevated but renal tubular absorption-
glucose is impaired.

For example It is increased in:

Rapid intestinal absorption (post gastrectomy dumping, normal pregnancy.
Endocrine disorders, major trauma, stroke, myocardial infarction or
circulatory collapse, burns, and oral steroid therapy.
 PROTEINS
Urine proteins
Urine normally contains only a scant amount of protein which
derives both from blood and the urinary tract itself.
Mainly albumin is filtered from nephrons due to low molecular
weight, others are reabsorbed by renal tubules.

Interpretation- Insignificant amounts of proteins are excreted in urine in

normal health not exceeding 20-80 mg/dL. This small amount is not
detectable by routine methods. Under certain conditions, as much as
20grams or more proteins may be excreted per day in urine.
PROTEINS
When proteins appear in urine in detectable
amounts, it is called proteinuria. It can be caused by:
Increased glomerular permeability.
Reduced tubular reabsorption.
Increased secretion of proteins.
Increased concentration of low molecular
weight.
 KETONES
Ketonemia and hence ketonuria occurs mostly in conditions of glucose
deprivation.
Nondiabetic Ketonuria: Often due to the increased catabolism of adipose
tissue when there is limited intake of food. Severe Starvation / Fasting/
Anorexia (loss of appetite); High fat feeding; Heavy exercise; Severe
carbohydrate restriction.
Ketonuria is frequently seen in infants or children with acute febrile
diseases or toxic states which produce vomiting or diarrhea.
Also found when there is vomiting due to general ill health,
pregnancy, or anesthesia.
 BILIRUBIN
Bilirubin in urine means increased amount of conjugated
bilirubin because unconjugated bilirubin is water insoluble
and is also bound to albumin, hence cannot cross the
glomerular membrane.
Bilirubin passes from the blood to the liver, where it
becomes water soluble (conjugated), and enters into the bile
ducts. It then enters the intestine with the bile. Normally,
there is no bilirubin in the urine.

 UROBILINOGEN
Any Urobilinogen is found in urine in hepatic and prehepatic
jaundice.
lt is present in excessive amounts in prehepatic jaundice and is
completely absent in post hepatic jaundice.
An increased urobilinogen concentration in urine is a sensitive
index of liver dysfunction or hemolytic disorders.
 UROBILINOGEN
A.Gross hematuria: Urine appears reddish in gross hematuria and this is
observed in renal stones, malignancies, trauma, tuberculosis and acute
glomerulonephritis.
B. Microscopic hematuria: Blood is not visible to naked eyes. It is observed
in:
Malignant hypertension,
Sickle cell anemia,
Coagulation disorders,
Polycystic kidney disease,
Incompatible blood transfusion,
Physiology of urine
formation
 PHYSIOLOGY OF URINE
FORMATION
In the kidney, there are many functional units, called
nephrons, where blood plasma is filtered, resulting in
the production of urine. The nephrons and its
collecting ducts perform three basic processes that
evidently lead to the production of urine:

1.GLOMERULAR 2. TUBULAR 3. TUBULAR

FILTRATION
In the first step of urine
production, water and most
solutes in the blood plasma move
across the wall of the glomerular
capillaries, where they are filtered
and move into the glomerular
capsule and then into the renal
tubule.
REABSORPTION
As the filtered fluid flows
through the renal tubules,
99% of the filtered water and
useful solutes are reabsorbed
into the bloodstream.
SECRETION
At the same time, duct cells
secrete other substances into
the filtered fluid, such as
wastes, drugs, and excess
ions.
 SUBSTANCES FILTERED, REABSORBED
AND EXCRETED IN URINE

By filtering, absorbing, and excreting, nephrons help maintain homeostasis of the blood’s
volume and composition. And this is the reason why the immediate assumption for any causes
of abnormal urine composition/constituents, is kidney disorders.
THANK YOU!