INTRODUCTION TO URINALYSIS Uroerythrin adds a slight pink pigment, mostly

Urinalysis is the practice of examining urine for apparent following refrigeration.

diagnostic purposes; it aids in following the Pale yellow (straw) samples are generally dilute,
course or treatment of disease. whereas dark yellow samples are usually
IMPORTANCE OF URINE concentrated.
• Urine contains most of the body's waste ABNORMAL URINE COLOR
products. Colorless/pale yellow
• Urine chemical changes are directly related • Random specimen
to pathologic conditions. • Diabetes insipidus or diabetes mellitus
• A complete urinalysis is composed of Dark yellow
multiple tests, including physical, • Concentrated specimen: First morning
chemical, and microscopic analysis. • Caused by dehydration from fever, burns,
• Urinalysis is used for disease diagnosis, etc.
disease monitoring, drug screening, and Intense yellow/amber/orange
initial diagnosis of inborn errors of • Pyridium (phenazopyridine): medication for
metabolism. UTI.
STAGES OF URINE ANALYSIS • Bilirubin: from liver problems (yellow foam
1. PHYSICAL EXAMINATION forms when urine is shaken)
2. CHEMICAL EXAMINATION Green/blue
3. MICROSCOPIC EXAMINATION • Medications and dyes such as
amitriptyline,indican, and phenols
PHYSICAL EXAMINATION OF URINE • Infections caused by Pseudomonas species
1. COLOR Red/pink
2. CLARITY • Blood Hemoglobin
3. SPECIFIC GRAVITY • Erythrocytes
4. ODOR • Myoglobin (muscle trauma)
5. COLOR • Porphyrins
Varies from colorless to any color shade (black, Brown/black
red, green, etc.). • Denatured hemoglobin
Changes in color can be due to normal metabolism, • Melanin
disease, diet, and physical activity. • Homogentisic acid
The normal color of urine (yellow) is derived from CLARITY
urochrome. Clear, Hazy, Cloudy, Turbid, Milky, and Bloody.
Urobilin, formed from the oxidation of urobilinogen Freshly voided normal urine is usually clear,
as urine stands, adds minimally to the normal particularly if it is a midstream clean-catch
yellow color. specimen.
As urine sits unpreserved, the color deepens to
orange-brown.
SPECIFIC GRAVITY
Specific gravity determines the kidney's ability
to reabsorb essential chemicals and water from
the glomerular filtrate.
Specific gravity (SG) values: Plasma filtrate
entering the glomerulus has a SG of 1.010.
a. Normal random urine ranges from 1.003 to
1.035, with the average SG falling between 1.015
and 1.025.
b. Isosthenuric urine: 1.010 (fixed SG indicates
loss of concentrating and diluting ability)
c. Hyposthenuric urine: Less than 1.010
d. Hypersthenuric urine: Greater than 1.010
ODOR
Not generally a part of the routine urinalysis but
may provide useful information to the
physician.
CHEMICAL EXAMINATION OF URINE
Reagent Strips
Reagent strips are used for the following tests: pH,
protein, glucose, ketones, blood, bilirubin,
urobilinogen, nitrite, leukocytes, creatinine, and
specific gravity.
Reagent strips are the method of choice for the
chemical analysis of urine.
Basic use: Reagent strips are chemical-containing
absorbent pads that react with urine, producing a
chemical reaction that results in a color change.
The color is characteristic of positive reactions for
various substances. Color intensity is
semiquantitative for these substances.
Confirmatory tests are then performed for some
analytes.
 Creatinine testing in a random urine is performed
only for comparison with the protein level to
rule out microalbuminuria.
GLUCOSE
Glucose testing is most commonly used to detect
and monitor diabetes mellitus.
Glucosuria is the presence of urine glucose and is
seen in the following conditions: diabetes mellitus,
impaired tubular reabsorption seen in Fanconi
syndrome, advanced tubular renal disease, central
nervous system (CNS) damage, thyroid disorders,

pH and pregnancy.

The acid-base balance of the body is primarily KETONES

regulated by the lungs and the kidneys. The Normal urine contains no ketones when

kidneys provide regulation through secretion of metabolized fat is broken down completely, but

hydrogen ions via ammonium ions, hydrogen when fat reserves are needed for energy, ketones

phosphate, and organic weak acids. The kidneys will show up in the urine.

also facilitate the reabsorption of bicarbonate from Ketonuria: The presence of ketones in the urine

the convoluted tubules. Clinical significance: Uncontrolled diabetes

The pH of urine ranges from 4.5 to 8.0 for random mellitus, insulin dosage monitoring, electrolyte

urines and from 5.0 to 6.0 for the first morning void. imbalance, and dehydration due to excessive
carbohydrate loss such as vomiting, starvation,

PROTEIN exercise, and rapid weight loss.

Proteinuria is often associated with early renal BLOOD

disease, making the urinary protein test an Reagent strip test detects hematuria and

important part of any physical examination. hemoglobinuria.

Normal urine will contain less than 10 mg/dL of Types of blood/hemoglobin in the urine

protein or 100 mg/24 hr. Hematuria (intact RBCs in the urine)

Protein types include albumin, microglobulins, Hemoglobinuria (hemoglobin in the urine)

and uromodulin (Tamm-Horsfall). Myoglobin (hemoglobin-like protein found in

Clinical proteinuria is indicated at 30 mg/dL or muscle tissue)

greater (300 mg/L). BILIRUBIN

The causes of proteinuria are varied and can be Detects bilirubinuria, a degradation product of

grouped into three major categories: prerenal, hemoglobin.

renal, and postrenal, based on the origin of the Bilirubinuria may result from hepatitis, cirrhosis,

protein. biliary obstruction, and early liver disease when

CREATININE conjugated bilirubin enters the circulation.

UROBILINOGEN
Formed from hemoglobin metabolism; produced SEDIMENT STAINS
from the reduction of bilirubin by bacteria in the Staining increases the overall visibility of sediment
small intestine. elements being examined using bright-field
Increased urobilinogen in the urine can indicate microscopy by changing their refractive index.
early liver disease, hepatitis, and hemolytic The most frequently used stain in urinalysis is the
diseases. Sternheimer-Malbin stain.
UROBILINOGEN
Formed from hemoglobin metabolism; produced
from the reduction of bilirubin by bacteria in the URINE FORMED ELEMENTS
small intestine. Erythrocyte
Increased urobilinogen in the urine can indicate Leukocyte
early liver disease, hepatitis, and hemolytic Epithelial cells
diseases. Bacteria
NITRITE Yeast
Rapid test for UTIs Parasite
A positive nitrite can indicate cystitis (bladder Spermatozoa
infection) and pyelonephritis. Mucus
Used for evaluation of UTI antibiotic therapy Cast
LEUKOCYTES Crystals
Indicate possible urinary tract infection, Uric acid
inflammation of urinary tract.
Amorphous urates
Reagent strip method does not quantify the number
Calcium oxalate
of WBCs.
Amorphous phosphate
SPECIFIC GRAVITY
Calcium phosphate
Gives an approximate specific gravity value in
Triple phosphate
increments of 0.005
Ammonium biurate
Clinical significance: Monitors hydration and
Calcium carbonate
dehydration, loss of renal tubular concentrating
ability, and diabetes insipidus
MAJOR ABNORMAL URINE CRYSTALS
MICROSCOPIC EXAMINATION OF URINE
Cystine
Must be done to identify insoluble substances from
Cholesterol
the blood, kidney, lower urogenital tract, and
Leucine
external contaminants
Tyrosine
Formed elements: Erythrocytes, leukocytes,
Bilirubin
epithelial cells, bacteria, yeast, fungal elements,
Sulfonamides
parasites, mucus, sperm, crystals, and artifacts.
Radiographic dyes
Examine urine while fresh or when properly
preserved. Ampicilin