Introduction

to
Urinalysis
HISTORY
Scientist Discovery
Hippocrates Uroscopy
Frederik Dekkers Albuminuria
Wrote a book about “pisse
Thomas Bryant
prophets” (charlatans)
Examination of urine
Thomas Addis
sediment
Richard Bright Introduced urinalysis
Urine Formation
 The kidneys form urine as an ultrafiltrate of plasma
 Converts approximately 170,000 mL filtered plasma to daily
urine output of 1200 mL

 Order of urine formation:

1. Glomerulus 4. DCT 7. Renal Pelvis
2. PCT 5. CD
3. LH 6. Calyx
Urine Composition
95 – 97 % Water
Solids – 60 grams = Total Solids (TS) in 24
3–5%
hours

35 grams (Organic) 25 grams (Inorganic)

UREA = Major CHLORIDE = Major > Sodium >

Others: uric acid, hippuric acid, Potassium
creatinine, carbohydrates, Principal salt = NaCl
pigments, fatty acids, mucin, Others: sulfate, phosphate,
enzymes, hormones ammonium, magnesium, calcium
Specimen Collection
 Must be collected in clean, dry, leak-proof containers
 Wide mouth containers
 Container capacity is 50 mL
 Labeled properly with the patient’s name and
identification number, the date and time of collection
 Requisition form must accompany specimens
Specimen Rejection
 Specimens in unlabeled containers
 Nonmatching labels and requisition forms
 Specimens contaminated with feces or toilet paper
 Containers with contaminated exteriors
 Specimens of insufficient quantity
 Specimens that have been improperly transported
Specimen Handling
Specimen Integrity
 Urine must be tested within 2 hours
CHANGES IN UNPRESERVED URINE
INCREASED DECREASED
pH Clarity Urobilinogen
Bacteria Glucose RBC/WBC/Casts
Odor Ketones Trichomonas
Nitrite Bilirubin
Specimen Preservation
URINE PRESERVATIVES
Preservatives Advantages Disadvantages Additional Information
• Raises SG by
hygrometer
Does not interfere with • Precipitates Prevents bacterial
Refrigeration
chemical test amorphous growth for 24 hours
phosphates and
urates
Interferes with acid
Preserves glucose and
Thymol precipitation test for
sediments well
protein

• Keeps pH about 6.0

• Preserves protein and
• Bacteriostatic at 18
formed elements well May precipitate crystals
g/L; can be used for
Boric acid • Does not interfere when used in large
culture transport
with routine analysis amounts
• Interferes with drug
other than pH
and hormone analyses
 Preservatives Advantages Disadvantages Additional Information

Reducing agent,
Rinse specimen
interferes with chemical
Excellent sediment container with formalin
Formalin tests for glucose, blood,
preservative to preserve cells and
leukocytes and copper
casts
reduction

Floats on surface of
Does not interfere with specimens and clings to
Toluene
routine tests pipettes and testing
materials

May use sodium

• Prevents glycolysis Inhibits reagent strip
benzoate instead of
Sodium fluoride • Good preservative for tests for glucose, blood
fluoride for reagent strip
drug analysis and leukocytes
testing
Does not interfere with Use 1 drop per ounce of
Phenol Causes an odor change
routine tests specimen
Preserves cellular Used for cytology studies
Saccomanno fixative
elements (50 mL urine)
 Preservatives Advantages Disadvantages Additional Information
• Convenient when
refrigeration not
May contain one or more Check tablet composition
Commercial possible
of the preservatives to determine possible
preservative tablets • Have controlled
including sodium fluoride effects on desired tests
concentration to
minimize interference
Contains collection cup,
Urine collection kits C and S preservative
tube or UA tube
Sample stable at room Decreases pH; do not use Preservative is boric acid
Gray C and S tube temperature for 48 hrs; if urine is below and may not be used for
preserves bacteria minimum fill line UA
Use on automated Must refrigerate within 2
Yellow plain UA tube Round or conical bottom
instruments hrs
Bilirubin and
Stable for 72 hrs at room urobilinogen may be Preservative is sodium
Cherry red/yellow top
temperature; instrument decreased if specimen is propionate; conical
tube
compatible exposed to light and left bottom
at RT
Types of Urine Specimen
1. Random
• for routine and qualitative UA
2. First morning
• ideal specimen for routine UA and pregnancy test
3. Second morning
• 2nd voided urine after a period of fasting
• for glucose determination
4. 2 – hour postprandial
• for diabetic screening/monitoring
5. Glucose tolerance
• optional with blood samples in glucose tolerance test

6. Fractional specimen
• at least 2 voided collection

7. Midstream clean-catch
• for routine screening and bacterial cultures
8. Catheterized
• for bacterial culture
9. Suprapubic aspiration
• bladder urine for anaerobic bacterial culture and urine cytology
10. Pediatric specimen
• use of soft; clear plastic bag with adhesive
• sterile specimen obtained by catheterization or suprapubic
aspiration
11. Three-glass specimen
• for prostatic infection
1. First portion of voided urine
2. Middle portion of voided urine
3. Urine after prostatic massage
12. Timed specimen
A. 24-hour (ex: 8am-8am)
• begin and end the collection period with an empty bladder
• requires preservative
B. 12-hour (ex: 8am-8pm)
• for Addis count
C. 4-hour
• for nitrite determination
D. Afternoon (2pm-4pm)
• for urobilinogen
 Renal
Function
Renal Function
I. Renal blood flow
II. Glomerular filtration
III.Tubular reabsorption
IV.Tubular secretion
I. Renal blood flow
ORDER:
1. Renal artery
2. Afferent arteriole
3. Glomerulus
4. Efferent arteriole
5. Peritubular capillaries
6. Vasa recta
7. Renal vein
II. Glomerular filtration
Glomerulus
• consists of a coil of approximately 8 capillary lobes
• within the Bowman’s capsule
• resembles a sieve
• non-selective filter of plasma substances
III. Tubular reabsorption
• 1st function to be affected in renal disease
Proximal Convoluted Tubule
• 65% of reabsorption of substances
• reabsorbs salts, water, amino acids, glucose and urea

Anti-diuretic Hormone
• released by the posterior pituitary gland
• regulates water reabsorption in the DCT and CD
Aldosterone
• regulates sodium reabsorption
Renin-Angiotensin-Aldosterone System (RAAS)

Renin ACE
Angiotensinogen Angiotensin I Angiotensin II
Na, BP Lungs

• corrects renal blood flow

• release of aldosterone and ADH
• increased sodium and water reabsorption
• increased blood pressure
 Active Transport Passive Transport
Substance Location Substance Location
PCT,
Glucose, amino
PCT Water descending LH,
acids, salts
CD
PCT, Ascending
Chloride Ascending LH Urea
LH
Sodium PCT and DCT Sodium Ascending LH
IV. Tubular secretion
2 Major Functions:
• elimination of waste products not filtered by the
glomerulus
• regulation of the acid-base balance in the body through
secretion of hydrogen ions
Renal Tubular Acidosis
• inability to produce an acid urine
• hydrogen ions are not excreted in the urine
• urine is alkaline in pH
Renal Function Tests
Glomerular Filtration
Clearance tests – used to evaluate glomerular filtration
1. Urea
2. Creatinine
3. Inulin
4. Beta2-macroglobulin
5. Radionucleotides
6. Cystatin C
Creatinine Clearance
Ccr = UV x 1.73 NORMAL VALUE:
MALE: 107-139 mL/min
(mL/min) P A FEMALE: 87-107 mL/min
Where:
Ccr = Creatinine clearance (mL/min)
U = Urine creatinine (mg/dL)
P = Plasma creatinine (mg/dL)
V = Urine volume (mL/min)
A = Body surface area
Tubular Reabsorption

OBSOLETE TESTS RECENT TESTS

1. Fishberg Test 3. Specific Gravity

 the patient is deprived of fluid for 24
hrs then measure urine SG
 SG should be > 1.026
2. Mosenthal Test
 compare day and night urine in terms
of volume and SG
 influenced by the number and density
of particles in a solution
4. Osmolality
 influenced by the number of particles
in a solution
 Principle: Freezing point depression
• 1 Osm or 1000 mOsm/Kg of H20 will
lower the freezing point of H2O by
1.86°C
Tubular Secretion and Renal Blood Flow

1. PAH (p-aminohippuric acid) test

2. PSP (phenolsulfonphthalein) test