URINALYSIS

IN
LIVER DISEASE

by
Rika Nilapsari
 Live
r

Largest & most complex internal organ

About 1.4 kg
Involved in most of the metabolic
functions
Laboratory tests of liver function are
more sensitive than clinical signs &
symptoms
 Normal Liver Function
1. Metabolism of carbohydrate, lipid &
protein
2. Synthesis of coagulation factors
3. Synthesis of bile salts
4. Processing of drugs & hormones
5. Excretion of bilirubin
6. Strorage of glycogen, certain vitamins (A,
B12, D, E, K) & minerals (Fe & Co)
7. Phagocytosis
8. Activation of vitamin D
Laboratory in liver disorder

Liver damage

Blood Urine

- Bilirubin - Bilirubin
- Enzymes - Urobilin/
Urobilinogen
 Bilirubin

Major metabolite of heme (Hb, myoglobin &

cytochromes)
Produced 250-350 mg/day
Types:
-bilirubin (Unconjugated bilirubin)
bilirubin (Monoglucuronida bilirubin)
bilirubin (Diglucuronida bilirubin =
conjugated bil)
bilirubin (Bilirubin tightly bound
albumin: irreversible albumin bound)
Laboratory tests of bilirubin: diazotized
sulfanilic acid
The pathway of Bilirubin metabolism
 Pathophysiology :
Inflammation

liver cell oedem

Liver cell necrosis pressed

cholangioles

increased
permeability
 Tests of Liver Injury

Commonly measured enzymes:

1. ASTm: aspartate aminotransferase
mitochodrial
2. ASTc: aspartate aminotransferase
cytosol
3. ALT: Alanine aminotransferase
4. ALP: Alkaline phosphatase
5. GGT: -glutamyltransferase
6. LDH: Lactate dehydrogenase
 Tests of Liver Injury

Cellular Locations of Enzymes

ASTm

ALT & ASTc

GGT

ALP & GGT

URINALYSI
S
Urine test strip:
Rapid, easy, specific,cheap

SPECIFIC GRAVITY

PROTEIN
NITRITE
KETOBODY
GLUCOSE
UROBILINOGEN
BLOOD

PLASTIK ROD

NYLON COVER

TEST FIELD
(PAPER CONTAIN REAGENT)

FILTER PAPER
DIPSTICK TEST
 Dipstick urine test

1. Specific gravity
2. pH
3. Leukocytes
4. Nitrates
5. Protein
6. Glucose
7. Ketones
8. Urobilinogen
9. Bilirubin
10. Blood
 Specific Gravity (1.003-1.035)

specific gravity is a means by which the

kidney's ability to concentrate urine is
measured
In the presence of cations, protons are
released by a complexing agent in the test
and produce a color change. The indicator
bromthymol blue changes from blue via
blue-green to yellow.
 pH (4.6-8)

Symbol "pH" expresses the strength of the

urine as a dilute acid or base solution and
measures the free hydrogen ion (H+)
concentration in the urine.

Dipstick contains the indicators methyl

red and bromthymol blue. These
indicators give clearly distinguishable
colors over the pH range of 5-9.
 Leukocytes (negative)

leukocytes (esterase) + indoxylcarbonic

acid ester
indoxyl.
indoxyl + diazonium salt a
purple color; any shade of purple is
considered a positive test
 Nitrates (negative)

Specific groups of bacteria create nitrates as

a by-product of their metabolism.
When present, these bacteria can be
indirectly detected by screening for nitrate
levels.
Nitrate + aromatic amine diazonium
salt
Diazonium salt + 3 hidroxy-tetrahidro-
benzoquinolin
yields a red-violet azo dye.
 Protein (negative)

in health, the urine contains no protein

or only trace amounts of protein
the detection of protein is based on the
protein error of pH indicators in which
tetrachlorophenol and
tetrabromosullfophthalein react with one
another to change from yellow to light
green/green
 Glucose (negative)

Glucose is normally present in glomerular

filtrate, but it is reabsorbed by the
proximal tubule.

D-Glucose + O2 GOD -D
gluconolactone + H2O2
POD
H2O2 + 0-tolidine H2O + co
 Ketones (negative)

in healthy individuals, ketone bodies are

formed in the liver and are completely
metabolized so that only negligible amounts
appear in the urine

sodium nitroprusside and glycerin +

acetoacetate and acetone alkaline medium
violet dye complex.
 Urobilinogen (random sample : negati

one of the most sensitive tests used to

determine impaired liver function

urobilinogen + 4-methoxybenzene-
diazonium-tetrafluoroborate acid medium a
red azo dye.
 Bilirubin (negative)

Normally, there is a small amount of

urobilinogen, not bilirubin, in the urine

the detection of bilirubin is based on the

coupling reaction of diazonium salt with
bilirubin in an acid medium. The reaction
yields a pink to red-violet color
proportional to the total bilirubin conc.
 Blood (negative)

blood in the urine is usually occult blood

that has been hemolyzed or dissolved

Hb(2,5 dimethyl 2,5 dihydroperoxyhexa

+
tetramethylbenzidi
ne
Green-blue