The physical examination of urine includes the determination of the urine

PHYSICAL AND color, clarity, and specific gravity.

CHEMICAL ● preliminary information concerning disorders such as glomerular

bleeding, liver disease, inborn errors of metabolism, and urinary tract

EXAMINATION
infection.
● Measurement of specific gravity aids in the evaluation of renal
tubular function.
OF URINE
ANALYSIS OF URINE AND OTHER BODY
FLUIDS (part 1)

Prepared by:
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LGGRMT

COLOR
● may be due to normal metabolic functions,
physical activity, ingested materials, or
pathologic conditions.
● Urochrome = a pigment responsible to the
yellow color of urine.
Excretion of which is generally proportional
to the metabolic rate.
● intensity of the yellow color in a fresh urine
specimen can give a rough estimate of
urine concentration.
COLOR
● Uroerythrin = a pink pigment, is most
evident in specimens that have been
refrigerated, resulting in the precipitation of
amorphous urates.
● Uroerythrin attaches to the urates,
producing a pink color to the sediment
● Urobilin = an oxidation product of the
normal urinary constituent urobilinogen,
imparts an orange-brown color to urine that
is not fresh.

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ABNORMAL Dark Yellow/Amber/Orange ABNORMAL Dark Yellow/Amber/Orange

URINE COLOR URINE COLOR
● There might be a presence of the abnormal ❖ Yellow orange
pigment bilirubin. - Concentrated urine
● If bilirubin is present = can be detected during - Urobilin in excess bilirubin
chemical examination of urine. - Dehydration, fever
● Yellow foam = suspected by the presence of - No yellow foam (normal)
bilirubin. - Administration of phenazopyridine (Pyridium)
or azo-gantrisin compounds to persons with
● Normal urine = small amount of rapidly
disappearing foam when shaken. urinary tract infections

● White foam = increased conc. of protein.

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ABNORMAL Red/Pink/Brown ABNORMAL
URINE COLOR ● most common causes of abnormal urine color URINE COLOR
is the presence of blood.
● Red blood cells (RBCs) remaining in an acidic
urine for several hours produce a brown urine
due to the oxidation of hemoglobin to
methemoglobin
● Fresh brown urine containing blood = indicate
glomerular bleeding resulting from the
conversion of hemoglobin to methemoglobin
● Hematuria (presence of red blood cells (RBCs)
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ABNORMAL Red/Pink/Brown ABNORMAL
URINE COLOR Myoglobinuria = presence of an excess amount of URINE COLOR
myoglobin in the urine. It is mostly caused by muscle
breakdown, releasing a high amount of myoglobin in
the blood.
➢ Myoglobin is more rapidly cleared from the
plasma.
➢ Fresh urine containing myoglobin frequently
exhibits a more reddish-brown color than
hemoglobin.
● Urine specimens containing porphyrins: resulting
from the oxidation of porphobilinogen to
porphyrins.
💡referred to as having the color of port wine. 11
Red/Pink/Brown
● Hemoglobin & myoglobin = produce a red
urine. (+) chemical result for blood.
➢ RBCs - red & cloudy
➢ Hemoglobin/Myoglobin - red & clear.
💡distinguishing between hemoglobinuria and
myoglobinuria may be possible by examining
the patient’s plasma.
Hemoglobinuria = in vivo breakdown of RBCs is
accompanied by red plasma.
Red/Pink/Brown
NON PATHOLOGIC CAUSE:
➢ Menstrual contamination,
➢ Ingestion of highly pigmented foods
➢ Medications (rifampin, phenolphthalein, phenindione,
and phenothiazines)
➢ genetically susceptible persons, eating fresh beets
causes a red color in alkaline urine
➢ Ingestion of blackberries can produce a red color in
acidic urine.
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ABNORMAL Red/Pink/Brown ABNORMAL Brown/Black
URINE COLOR NON PATHOLOGIC CAUSE: URINE COLOR
● may contain melanin or homogentisic acid
➢ Menstrual contamination, ● Acid urine containing hemoglobin will darken on
➢ Ingestion of highly pigmented foods standing because of the formation of
methemoglobin
➢ Medications (rifampin, phenolphthalein, phenindione,
and phenothiazines) ● Cola colored urine = seen with rhabdomyolysis and
in some patients taking L-dopa (a precursor to
➢ genetically susceptible persons, eating fresh beets
dopamine that passes the blood-brain barrier and
causes a red color in alkaline urine
is mainly taken up by the dopaminergic neurons that
➢ Ingestion of blackberries can produce a red color in convert L-DOPA to dopamine and increase their
acidic urine. dopamine production and storage.)

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ABNORMAL Brown/Black
URINE COLOR
● Homogentisic acid, a metabolite of phenylalanine,
imparts a black color to alkaline urine from persons
with the inborn-error of metabolism, called
alkaptonuria.
● Urine-containing homogentisic acid will darken more
rapidly when alkaline.
● Medications: levodopa, methyldopa, phenol
derivatives, and metronidazole.

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ABNORMAL Blue/Green CLARITY
URINE COLOR POSSIBLE CAUSES:
● general term that refers to the transparency/turbidity of a urine specimen.
● urinary tract infection by Pseudomonas species ● REPORTING: clear, hazy, cloudy, turbid, and milky
● intestinal tract infections resulting in increased
urinary indican. NORMAL CLARITY:
● Freshly voided normal urine is usually clear, particularly if it is a midstream
● Chlorophyll clean-catch specimen
● Ingestion of breath deodorizers (Clorets) can result ● Precipitation of amorphous phosphates and carbonates may cause a white
in a green urine color. cloudiness

● Medication: methocarbamol (Robaxin), methylene NON PATHOLOGIC CLARITY:

blue, and amitriptyline (Elavil) may cause blue urine. ● presence of squamous epithelial cells and mucus, particularly in specimens
from women, can result in a hazy but normal urine.
● Phenol derivatives found in certain intravenous
medications produce green urine on oxidation 17 18

CLARITY CLARITY

CLEAR HAZY CLOUDY TURBID

MILKY

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● Refrigerated specimens frequently develop a thick PATHOLOGIC TURBIDITY:
turbidity caused by the precipitation of amorphous
● RBCs
phosphates, carbonates, and urates
● white blood cells (WBCs)
● White precipitate = Amorphous phosphates and
carbonates (urine with an alkaline pH) ● bacteria caused by infection or a systemic organ
disorder.
● Pink precipitate (pink brick dust) = amorphous urates
produce a precipitate in acidic urine; due to the
presence of uroerythrin.
ADDITIONAL NON PATHOLOGIC CAUSE:
➢ semen
➢ fecal contamination
➢ radiographic contrast media
➢ talcum powder
➢ vaginal cream
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SPECIFIC GRAVITY
● reabsorption is often the first renal function to become
impaired.
● detects possible dehydration or abnormalities in
antidiuretic hormone
● Defined as: the density of a solution compared with
the density of a similar volume of distilled water at a
similar temperature.
● Performed in main two types:
a. direct methods
- urinometer (hydrometer)
- harmonic oscillation densitometry (HOD)
b. Indirect methods
- Refractometer
- chemical reagent strip.
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SPECIFIC GRAVITY
❖ URINOMETER
- consists of a weighted float attached to a scale that
has been calibrated in terms of urine specific gravity
- designed to sink to a level of 1.000 in distilled water.
- Urinometry is less accurate than the other methods
currently available and is not recommended by the
Clinical and Laboratory Standards Institute (CLSI)
formerly the National Committee for Clinical
Laboratory Standards (NCCLS).
SPECIFIC GRAVITY
❖ URINOMETER
- also need to be corrected for temperature, inasmuch
as urinometers are calibrated to read 1.000 in distilled
water at a particular temperature.
- If the specimen is cold, 0.001 must be subtracted from
the reading for every 3℃ that the specimen
temperature is below the urinometer calibration
temperature.

Disadvantage: measure specific gravity is that it requires

a large volume (10 to 15 mL) of specimen.

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SPECIFIC GRAVITY
❖ REFRACTOMETER
- Measuring refractive index.
- Refractive index is a comparison of the velocity of light
in air with the velocity of light in a solution
- the specific gravity scale is calibrated in terms of the
angles at which light passes through the specimen
- ADVANTAGE: using a small volume of specimen (one
or two drops)
- Temperature is compensated between 15℃ and 38℃.
- Corrections for glucose and protein are still calculated,
although refractometer readings are less affected by
particle density than are urinometer readings. 27 28
 SPECIFIC GRAVITY SPECIFIC GRAVITY
❖ REFRACTOMETER
- CALIBRATION: distilled water that should read 1.000.

❖ HARMONIC OSCILLATION DENSITOMETRY

- Principle: frequency of a sound wave entering a
solution changes in proportion to the density of the
solution.
- Results are linear up to a specific gravity of 1.080.

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ODOR
💡MUST KNOW: ● Freshly voided urine has a faint aromatic odor.
➢ The specific gravity of the plasma filtrate entering the glomerulus is 1.010 ● Lack of odor in urine from patients with acute renal
failure suggests acute tubular necrosis rather than
Isosthenuric = urine with a specific gravity of 1.010 prerenal failure.
Hyposthenuric = Specimens below 1.010 ● Ammonia odor = The breakdown of urea
Hypersthenuric = above 1.010

➢ Normal random specimens may range from 1.003 to 1.035, depending on

the patient’s amount of hydration
➢ Specimens measuring lower than 1.003 probably are not urine.

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ODOR
Amino Acid Disorder

Isovaleric acidemia and glutaric acidemia

Urine Odor

Sweaty feet
THANK
Maple syrup urine disease (MSUD)

Methionine malabsorption
Maple syrup

Cabbage, hops YOU

Phenylketonuria Mousy

Trimethylaminuria Rotting fish

Tyrosinemia Rancid

Based on Henry’s 22nd Ed.

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