Introduction To Urine Analysis: General Veiw
Introduction To Urine Analysis: General Veiw
Introduction To Urine Analysis: General Veiw
GENERAL VEIW
Urinary system
Urinary system consists of pair of kidneys and urinary tracts which includes (two
ureters, urinary bladder and urethra). Each kidney contains 1.3 million urinary units called
nephrons. Each nephron consists of glomerulus and urinary ducts (Bowman's capsule,
proximal convoluted tubule, Henley loop, distal convoluted tubule and collecting duct).
The kidneys extract the soluble wastes from the blood stream, as well as excess
water, sugars, and a variety of other compounds. The resulting urine contains high
concentrations of urea and other substances, including toxins.
Urination: is a voluntary process depends on person's choice to the suitable time and
place to empty the urinary bladder from storage urine, without pain.
Disturbances in urination include:
1- Painful urination, frequency, Urgency. Because of microbial UTI.
2- Impairment of urine flow, hesitancy, drubbing urine, incomplete emptying .Because
of urinary bladder obstruction.
3- Urinary retention, a sign of benign prostate enlargement (hypertrophy), urinary
incontinence (enuresis) due to disfunction of bladder muscles or sphincter muscles.
Etiology:
The most common cause of urinary tract infections (urethritis, cystitis, and
pyelonephritis) is E coli.
Staphylococcus saprophyticus is the second most common cause of these infections
in females between the ages of 13 and 40. In complicated cases of urinary tract infections
such as those resulting from anatomic obstructions or from catheterization, the most
common causes are E coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus, and
Pseudomonas aeruginosa.
Manifestations:
Urethritis: is an infection of the urethra that causes pain and discomfort during
voiding (dysuria).
Cystitis: is an infection of the urinary bladder. Signs and symptoms of cystitis include
urgency and frequency of urination, voiding small volumes of urine, and supra pubic
tenderness just before or immediately after voiding.
Pyelonephritis: is an infection of the upper urinary tract ascends the ureters to enter
the kidneys, the signs and symptoms include fever, flank pain and tenderness, cost
vertebral angle tenderness, and nausea and vomiting.
Kidney stones can serve as a location in which bacteria can escape antibiotics and
cause recurrent urinary tract infections. Proteus can cause stones to form when it
produces an enzyme called urease, which can catalyze the breakdown of urea to ammonia
and carbon dioxide. The ammonia that results from this reaction will increase the pH of
urine and cause formation of kidney stones.
Host factors that are important in protection from UTI:
These include: the normal daily flow of urine, the constant sloughing of the
uroepithelial cells lining the urinary tract, and the presence of large numbers of
Lactobacillus in the vaginal mucosa.
The most common sites of urinary tract infection (UTI) are the urinary bladder
(cystitis) and the urethra. From these sites the infection may ascend into the ureters
(ureteritis) and subsequently involve the kidney (pyelonephritis).
Physical examination
1-Urine volume:
This is dependent normally up on fluid intake, environmental condition, diet and
activity of the human.
Value above or below the normal value (1.5 L/Day) can be considered as pathological
disorder but it should be combined with clinical and laboratory examination.
- Above normal (polyuria) urine volume (< 2.5-3L/Day) due to large quantities intake
of liquids,diuretics, alcohol, in sufficient of urinary ducts in reabsorption of water and
urine concentrated as in diabetes mellitus or diabetes insipidus.
- Under normal (Oligourea) urine volume (< 400 ml/Day)
- Anuria, urine volume ( < 50 ml/Day), due to: hot weather, sweating, low water intake,
or due to disease in kidney or urinary ducts.
2-Color:
Can be observed in a test tube or in a urinometer tube, strip. The following
designations are used to observe the sample and correlated to the following terms.
*Colorless, Greenish yellow, Blue, Pale yellow, Green, Milky, Yellow, Red, Dark yellow,
Reddish brown, Yellow brown, Brown.
Interpretation
Yellow to amber (Normal); the color comes primarily from the presence of urobilin.
Urobilin is a final waste product resulting from the breakdown of heme from
hemoglobin during the destruction of aging blood cells.
Colorless to pale yellow; dilute urine with low specific gravity and polyuria.
Dark yellow or yellow brown; concentrated urine with a high specific gravity and
small quantity.
Yellow brown or greenish yellow; yellow green foam when urine is shaken
Urobilinoids – chromagon derived from heme , yellow-brown-billirubin-and urobilin.
Cloudy; hematuria (clearer after centrifugation).
Translucent; hemoglobinuria.
Brown to brownish black; hemoglobin up on standing bile large amounts.
Green; bile biliverdin
Red to pink; phenothiazine (beet root)
Blue; medication contain methylene blue or food with blue dyes.
3-Transparency (clarity):
Clear – freshly voided urine is clear.
Cloudy – not necessarily pathological as many samples may become cloudy.
Epithelial cells – present in large numbers.
Blood – red to brown color and smoky.
Leukocytes – may produce milky, ropy appearance if large number.
Bacteria – produce a uniform turbidity if in large number; the turbidity doesn’t settle out
and cannot be removed by filtration.
6-Foam:
Shake the sample and observe:
• If the amount of foam produced is in excess and slow to disappear – proteinuria
• If the color of the foam great – yellow or brown – bile pigments
• If the color of the foam red to brown – hemoglobinuria
Epithelial cells: presence normally due to sloughing the lining layer of urinary tubules,
bladder and urethra or because of some renal diseases.
Budding yeasts: Candida albicans, found in diabetes patient's urine because of the low
PH and the presence of sugar necessary for the growth.
Note: In many clinical laboratories, Robert’s test is routine method as it is simple, quick
and easy to read even when only a small amount of protein presents.
-Glucose in urine:
No glucose is present in the urine normally which passes glomerular filter,
because it is completely absorbed in the tubules. It present when the blood glucose
level elevated to(180mg/ml) which is called renal threshold, when blood glucose
elevated the glucose present in urine as in diabetes.
Glucose Test
Method: Qualitative method (Benedicts test)
Principle: Reducing sugars present in the urine react with the copper sulphate to
reduce the copric ions to cuprous oxide giving a
Color change from blue (negative) to green, yellow and red depending on the amount
of reducing substances present