INTRODUCTION TO

URINALYSIS
Abiodun K. Favour AJEIGBE

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Learning objectives
• To know the different terms
• To review the functions of the kidneys
• To classify the different aspects of urinalysis
• To describe the process of urine analysis

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 OUTLINE
• INTRODUCTION
• BASIC TERMS AND DEFINITIONS
• REVIEW: RENAL FUNCTIONS
• URINE FORMATION
• COMPONENTS OF URINALYSIS
• CONSTITUENTS OF URINALYSIS
• URINE ANALYSIS

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 INTRODUCTION
• Urinalysis is a basic investigation in the laboratory and an important screening
tool
• Its assessment gives information on the internal milieu
• Point of care testing
• Characterized by its constituents which may deviate from normal
• Urinalysis is a function of physiologic activity of the kidneys
• Urinalysis is linked with renal function

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 Basic Terms
• Urine
• Is a complex solution of water and waste products of metabolism in
higher mammals including man
• Urinalysis
• Is a qualitative or semi quantitative examination of the urine involving
the physical, chemical and microscopic aspects.

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 Overview of the Nephron

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 The Nephron and Countercurrent mechanism

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 RENAL FUNCTIONS

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• Electrolyte Homeostasis
•Na: PCT- 60%, ATH- 30%, DCT – 5-8%,
• K: 90% excreted
• Cl: 60%
• Ca :
• 98% reabsorbed
• 62-75%, 25%, and 10%
• PCT, ALH, and DCT respectively
• Extracellular volume homeostasis
• Water Homeostasis
• 99% reabsorbed: ADH
• Acid Base homeostasis
• Blood Pressure Homeostasis
• Metabolic function
• Gluconeogenesis, Glutathione, Ammonia
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• Excretory Function
• Non-protein nitrogenous
compounds/wastes
• Creatinine, Urea. Urate. Ammonia
• Organic acids
• Urate, Oxalate, Bile salts
• Electrolytes
• Drugs and Toxins
• Endocrine function
• Target organ
• Parathyroid hormone (Ca++, Mg++)
• Aldosterone (salt balance)
• ADH (water balance)
• Production
• Erythropoietin, calcitriol, Renin
• Prostaglandins and Thromboxanes
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 Urine Formation
• Countercurrent mechanism
• Multiplication
• Occurs in the loop of Henle
• Active
• ADH independent
• Exchanger
• Occurs in the collecting ducts
• Passive
• ADH dependent
• Vasa recta

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 URINALYSIS

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 Components of Urinalysis
• Physical Examination of the urine
• Chemical examination of the urine
• Microscopic examination of the urine

• Note
• Wet chemical examination of the urine
• Dry chemical examination of the urine (POCT)

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 Urine Analysis
• Examination of the urine is often the first step in the assessment of a patients:
• suspected of having or confirmed as having, deterioration in kidney function.
• Appearance (color and odor) of urine can be helpful
• Darkening from the pale normal straw color
• concentrated urine
• presence of another pigment

• Pink-red-brown color
• Hemoglobin and myoglobin
• Turbidity
• may indicate infection
• fat particles in a patient with nephrotic syndrome
• Excessive foaming of urine
• when shaken suggests proteinuria.
• Urine is often chemically evaluated at the point of care with the help of reagent tests strip,
which11/04/2024
are available
03:01 AM
for a variety of RENAL
analytes, or it is microscopically examined.
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 Urine Analysis
Urine
Types of Urine Specimen
• .A complex fluid
• First morning urine
• Provides useful info about internal
• Random urine
milieu
• Fasting urine
• Readily available
• 24-hour urine
• Less time consuming
• Midstream urine
• Easy to obtain
• Post-prandrial urine
• cheap
• Timed urine
• Gives valuable info necessary for
diagnosis and management • Double void urine
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 Urine constituents
Abnormal
Normal
• Nitrogeneous wastes • Glucose
• Creatinine
• Cells
• Amino acids
• Protein • Red blood
• Uric acid • White blood
• Ammonia • Yeast
• Urea • Haemoglobin
• Organic acids
• Sulphates
• Positive protein
• Lactate • Bilirubin
• Oxalate
• Lipids
• Inorganic acids
• Electrolytes
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 Clinical Information from Urinalysis
• Volume
• Dark yellow:
• 1.5 to 3L normal
• bilirubin. Hb e.g G6PD def., Porphyrins
• > 3L : Polyuria
• <500ml Oliguria • Bloody:
• hematuria
• <100ml Anuria
• Smell
• Turbid/Milky:
• Alkaline urine containing phosphate
• No smell : fresh urine precipitate,
• Ammoniac smell: stale urine • Acid urine containing urates, Bacteria in infections,
Epithelial cells, Mucus, Stale urine
• Acetone smell
• starvation • Darkening on standing;
• DM • urobilin formed from urobilinogen,
• porphobilin from porphobilinogen
Colour:
• Greenish;
• straw colour or light brown
• biliverdin from bilirubin or bile
• Urochrome
• Black:
• Dark brown:
• homogentisic acid in alkaptonuria,
• increased concentration e.g starvation
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 Dipstick Urinalysis
Specific gravity • POCT
• Could be assayed directly or as •Polymethylvinyl ether,
Urinometer
•bromothymol blue
• measures the weight of a quantity
•NaOH
of urine to that of the same
quantity of pure water • Measurement of osmolality
preferred when concentrating ability
• Sg of pure water at 20oC is 1.000
being assessed
• 1.016 – 1.022 in a 24hr
•high urine specific gravity
specimen
• Diabetic patients with
• 1.024 – 1.026 after 14hr without
uncontrolled hyperglycemia
food or water
• Glucosuria
• 1.023 in random specimen
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 Urine pH
Osmolality

•pH changes with time in a collected • Assesses the diluting or concentrating

urine functions of the renal tubules
•Dipstick uses bromothymol blue and • Measured using colligative properties
methyl red of urine
•5.6 – 8.5 • 550 – 850 mOsm/Kg H2O
•Acid urine:
• 850mOsm/Kg
•Metabolic acidosis
• equiv to Sg o 1.025
•Alkaline urine:
• metabolic alkalosis • most dilute urine
• stale urine • 50mOsm/Kg H2O
•bacteriuria • most concentrated urine
•vegetarian diet • 1200mOsm/Kg

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Protein
• based on protein error of indicators phenomenon
• Chemical indicators demonstrate one color in the presence of protein and
another in its absence.
• Thus, tetrabromophenol blue is green in the presence of protein at pH 3 but
yellow in its absence.
• Detection limit is 150mg/dL
• Reagent is
• most sensitive to albumin
• less sensitive to
• Globulins
• Bence Jones protein
• Mucoproteins
• Haemoglobin
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 Overload proteinuria
Proteinuria • Excessive filtration of one protein
• Functional or benign
exceeds the re-absorptive capacity
• due to changes of blood flow through
• Bence-Jones proteinuria
the glomeruli
• Hemoglobinuria
• Exercise
• Myoglobinuria
• pyrexia
Post-renal proteinuria
• exposure to cold
• arise from the urinary tract below the
• CCF
kidneys
• HTN
• usually due to inflammation or
• Arteriosclerosis malignancy
• Glomerular proteinuria
• Tubular proteinuria
• Mostly albumin
• Low molecular weight proteins not
• Due to high concentration in plasma and reabsorbed by tubular cell
in filtered load • alpha-1 microglobulin
• From microalbuminuria to overt
proteinuria
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 Glucose
Haemoglobin
•Reasonable technically, however
screening and monitoring programs
•Glomerular, tubulointerstitial or for diabetes are now done by blood
post-renal source and Point-of-Care devices
•Reasonably sensitive •Glucose oxidase, peroxidase, K
•Positive dipstick and negative iodide, blue dye,
microscopy with lysed red cells •Green to dark brown
•Tetramethyl benzidine reacts with • Bilirubin
peroxidase activity of Hb • Ictostix
•gives a colour change from orange • Ictotest
to dark green • diazo reagent
• diazotized sulfalinic acid
• Urobilinogen
• Obsolete
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 Nitrite and Leucocyte Esterase Ketones

• Nitrite and Leucocyte Esterase • Ketones

• Nitrite is produced Nitrate by • Products of incomplete fat metabolism
bacteria action • DM
• reaction is based on arsanilic acid in • Starvation
the presence of nitrite converting • Malnutrition
to a diazonium salt, which couples • Vomiting
quinolol to produce a pink color. • Dehydration
• Leucocyte esterase released from • Severe exercise
WBC catalyse a pyrrole which • Gerhards test:
reacts with diazonium to produce • ferric chloride
purple colour. • Ketostix
• Positive results to nitrite and • Na Nitroprusside
leucocyte esterase is helpful in
diagnosing UTI. • Acetest:
• Na nitroprusside
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 Microscopic Examination of the Urine
• Cells
• RBC
• WBC
• Yeast cells
• Epithelial
• Casts
• Granular
• Hyaline
• waxy
• Cellular:
• WBC, RBC,
• Crystals
• Ca carbonate
• Ca sulfate
• Uric acid
• Triple phosphate
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• Oxalate
Conclusion
• Renal function tests are important investigations in clinical practice for
which a good understanding is necessary for patient management

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 THANK YOU

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