Physical Examination of Urine

Introduction Physical examination is 1st part of UA performed Includes: Observing urine color ( ) Measuring ( )

Physical Characteristics

Color Normal ranges from pale yellow to amber Variations caused by: ( ) Medications Physical activity disease

Colors Caused by Food or Medications Colors Caused By Disease States Red Beets, rhubarb Yellow-orange Carrots, vitamins, some antibiotics Green, blue-green Amitriptyline Brown-black Methyldopa, metronidazole Colors Caused By Disease States Color Cause Red, Red-brown RBC, Hgb, myoglobin Wine red Porphyrins Brown-black Melanin, homogentisic acid, Hgb Dark yellow-brown or green-brown Bilirubin, bile pigments

Yellow Urine ( ) produces the yellow-amber color More concentrated- ( ) Dilute- ( )

Red Urine Abnormal color seen most frequently ( )- presence of blood ( )- presence of hemoglobin/myoglobin

Brown or Black urine Hgb will become brown in acidic urine that has been standing ( ) Patients with advanced ( )

Yellow-Brown or Green-Brown ( ) Can form a yellow-green foam when shaken Can be present in ( ) patients

Transparency ( ) Normal- clear immediately after voiding Normal microscopic results As it reaches room temp. or after refrigeration- turbid

Normal Urines Transparency Causes Abnormal Urines Transparency Causes Hazy Mucus (females), talcum powder, squamous epithelial cells Cloudy Calcium oxalate, uric acid crystals, amorphous phosphates, amorphous urates Abnormal Urines Transparency Causes Cloudy-red RBCs Turbid or Cloudy WBCs, bacteria, yeasts, renal epithelial cells, lipids Opalescent, milky Fats, lipids

Odor Changes can be due to disease, diet, or presence of M.O. Not usually report on UA form but alerts to abnormality If unrefrigerated for hours- any bacteria present can break down urea to form ( ) Certain foods can produce abnormal odor- garlic and ( )

Odor Uncontrolled diabetes- fruity Phenylketonuria (PKU)- ( ) Presence of ketones Phenylketonuria (PKU)- ( ) Maple syrup urine disease Recently voided with foul odor- ( )

( ) Ratio of the weight of the solution compared to weight of an equal volume of distilled H20 at same temp. Normal urine- 1.005-1.030 Most are ( ) ( ) in the morning Estimates concentrations of solutes Urea, protein, sugars, phosphates Used to assess ability of kidneys to reabsorb essential chemicals and water ( )- may have high specific gravity

Performing a Physical Exam of Urine

Specimen Preparation Physical characteristics are best observed by examining immediately after voiding before it is refrigerated Can be refrigerated at 4 °C up to ( ) Needs to reach room temp before UA performed

Procedure Mixed well by gentle ( ) Portion is poured into clear tube Observed for color and transparency

Physical Characteristics of normal Urine Transparency-clear Color- pale yellow to amber Specific gravity- 1.005-1.030

Color and Transparency Pale (straw), yellow, amber or other Transparency- clear, hazy, cloudy, milky Measurement of Specific Gravity Urinometer, refractometer, reagent strip Urinometer-requires ( ) Refractometer- a drop

Urinometer Method Poured into a special glass cylinder A weighted float with a calibrated stem is placed in the urine with a slight spinning motion Specific gravity is read at the urine’s meniscus Urinometer will float high in concentrated sample Sink lower in ( ) sample

( ) Measure specific gravity optically by measuring the refractive index Ratio of the speed of light in air to speed of light in a solution Place a drop of urine on the glass plate and close it The specific gravity is read directly from a scale that converts it