URINALYSIS

IRA PUSPITAWATI
CLINICAL PATHOLOGY DEPARTMENT FACULTY OF
MEDICINE UGM
Urinalysis
 Analyzing urine was
actually the beginning
of laboratory
medicine.
 URINALYSIS
 Aims of urinalysis:
a. To help the diagnosis
of the diseases
b. To monitor therapy
c. To monitor the
diseases progression
d. To screen and
monitor hereditary
diseases
URINALYSIS
Urinalysis
 Following collection, specimens should be
delivered to the laboratory promptly and
tested within 2 hours.

“Generally after standing two hours at room temperature, the

chemical composition of urine changes, and formed elements
begin to deteriorate”
Changes in Unpreserved Urine
Types of specimens
The first morning specimen
- Eight-hour specimen, is a concentrated
specimen  assuring detection of
chemicals and formed elements that may
not be present in a dilute random
specimen.
- Must be delivered it to the laboratory
within 2 hours
Types of specimens
Fasting specimen
 Being the second voided specimen after a
period of fasting.
 This specimen will not contain any
metabolites from food ingested before
the beginning of the fasting period.
 It is recommended for glucose
monitoring.
Types of specimens
24-Hour (or Timed) Specimen
 A carefully timed specimen must be
used to produce accurate quantitative
results.
Types of specimens
Catheterized Specimen
 This specimen is collected under sterile
conditions by passing a hollow tube
(catheter) through the urethra into the
bladder.
 Bacterial culture.
Types of specimens
Midstream Clean-Catch Specimen
 Strong bacterial agents, such as
hexachlorophene or povidone-iodine,
should not be used as cleansing agents.
Types of specimens
Suprapubic Aspiration
 Suprapubic aspiration provides a sample
for bacterial culture that is completely free
of extraneous contamination.
Macroscopis

Color

Turbidity

Specific Gravity
Macroscopis
 Chemichal  Reagent Strips
pH SPECIFIC GRAVITY
 The Multistix and  The reagent strip
Chemstrip brands of reaction is based on
reagent strips measure the change in pKa
urine pH in 0.5- or 1- (dissociation
unit increments constant) of a
between pH 5 and 9. polyelectrolyte in an
alkaline medium.
pH
GLUCOSA BLOOD

 The finding of a positive

 Reagent strips employ reagent strip test result
the glucose oxidase for blood indicates the
testing method that is presence of red blood
specific for glucose. cells, hemoglobin, or
myoglobin.
 Detect peroxidase
activity of hemoglobine.

Reagen strips
Hemoglobinuria
Glucosuria & Ketonuria
Ketone Protein
 The term ketones  Clinical proteinuria is
represents three indicated at ≥30 mg/dL (300
mg/L).
intermediate products of
fat metabolism, namely,  Normal urine contains very
acetone, acetoacetic acid, little protein: usually, less than
10 mg/dL or 100 mg per 24
and betahydroxybutyric
hours is excreted.
acid.
 This protein consists primarily
of low-molecularweight
 Strips: Specific for detecting
albumin.

Reagen Strips
Proteinuria
LEUCOCYTE ESTERASE
 The LE test detects the
presence of esterase in the
granulocytic white blood
cells (neutrophils,
eosinophils, and basophils)
and monocytes.
 LE test is that it detects the
presence of leukocytes that
have been lysed
Reagen Strips
NITRITE
 Produced by bacteria that
have enzyme reductase that
can reduce nitrate to
nitrite.
 Reductase is found in the
gram-negative bacteria
(Enterobacteriaceae) that
most frequently cause UTI.
Urine Nitrite & Leucocyte
BILIRUBIN UROBILINOGEN

 A highly pigmented yellow

compound, is a degradation  Urobilinogen appears in the
product of hemoglobin. urine because, as it
 Conjugated bilirubin circulates in the blood en
appears in the urine when route to the liver, it passes
the normal degradation
cycle is disrupted by through the kidney and is
obstruction of the bile duct filtered by the glomerulus.
(e.g., gallstones or cancer)
or when the integrity of the
liver is damaged, allowing
leakage of conjugated
bilirubin into the
circulation.

Reagen Strips
Urine Bilirubine
Testing Procedure
Testing Procedure
Microscopic Examination
 The normal urine sediment may contain a
variety of formed elements.
 Even the appearance of small numbers of
the usually pathologically significant RBCs,
WBCs, and casts can be normal.
RBC
 In the urine, RBCs appear as
smooth, non-nucleated, biconcave
disks measuring approximately 7
mm in diameter.

 Must be identified using high-

power (40) objective (400
magnification).

 RBCs  reported as the average

number seen in 10 hpfs.

Refference range: <5 cell/HPF

 The presence of RBCs in the
urine is associated with damage
to the glomerular membrane or
vascular injury within the
genitourinary tract.
Dysmorphic erythrocyte
Dysmorphic erythrocyte
Dysmorphic erythrocyte

Characteristic marker for Glomerular bleeding

WBC
 The predominant
WBC found in the
urine sediment is the
neutrophil.
 Neutrophils are
much easier to
identify than RBCs
because they contain
granules and
multilobed nucl Refference range: <5 cell/HPF
Squamous cell
 Squamous cells are
the largest cells
found in the urine
sediment.
Transitional cell
 Transitional cell 
vesica urinaria
Round Tubular Epitelial cell
 The presence of
more than two RTE
cells per highpower
field indicates tubular
injury  cytologic
urine testing.
 Cast chronic process

Hyaline cast RBC cast

Physiologic or pathologic condition Pathologic condition

Crystal
 Factors effect crystal formation:
a. Urine Ph  crystal formed in acid or
alkali urine
b. Solute concentration in urine
c. Blood flow
Crystal
Report
 Routinely, casts are reported as the average
number per low-power field (lpf) following
examination of 10 fields.
 RBCs and WBCs, as the average number per 10
high-power fields (hpfs).
 Epithelial cells, crystals, and other elements
are frequently reported in semiquantitative terms
such as, rare, few, moderate, and many, or as 1, 2,
3, and 4,