1. Practical Urine analysis
Physiology
232 BMS
Dr/Nahla Yacout
2016/2017

2. Objectives
Identify contents of urine & different types of urine samples
Identify the normal urinalysis
Explain the abnormal urinary constituents & their possible causes
Identify & explain some diseases of renal system
Glomerulonephritis
Nephrotic syndrome
Acute pyelonephritis
Chronic pyelonephritis
Acute renal failure
Chronic renal failure

3. The kidneys take out waste materials, minerals, fluids & other substances from the blood to be passed in urine
Contents of urine:
Urea … A metabolic waste product produced in the liver from the breakdown of proteins & amino-acids (Accounts for almost half of the dissolved solids in urine)
Creatinine
Uric acid
Chloride, Sodium, Potassium

4. Urine specimens:
During the 24 hours, the composition & concentration of urine changes continuously, as it is affected by water intake & activities
In order to get a specimen that is representative of the patient’s metabolic state, you must regulate certain aspects as: Time of collection – Patient’s dietary – Medicinal intake

5. Characteristics & Importance
Types of urine sample
Type
Characteristics & Importance
First morning sample
Most concentrated
Free of dietary influences
Important for pregnancy tests
Random sample
Most common
Collected at any time
Midstream
Used for bacterial culture
Second sample (The first morning sample is discarded, the second one is collected & tested)
Less concentrated
Accurately reflects the urine components, & so used for diabetic monitoring
Postprandial (Collected 2 hours after meal)
Used for diabetic monitoring
Timed 2 hour volume (Urine saved for 2 hours)
Used for urobilinogen determination

6. Normal urinalysis
Color: Pale yellow Clarity: Clear PH: 5 – 6 Volume: 600 – 2500 ml/24 hours – Average: 1200ml/24hours Glucose: Negative Blood: Negative Proteins: Negative Crystals: Negative White blood cells: Negative or Rare Epithelial cells: Few

7. Color & Transparency …. Fresh urine is clear & pale to deep yellow
This yellow color is due to Urochrome (A pigment that results from the destruction of hemoglobin)
The more concentrated the urine …. The deeper its yellow color
Abnormal colors may be due to: Eating certain foods, taking certain drugs & vitamin supplements
Odor … Fresh urine is slightly aromatic
If allowed to stand …. It will develop ammonia odor because of the bacteria
Some drugs, vegetables & diseases alter the usual odor of urine (In uncontrolled diabetes … the urine smells fruity because of its acetone content)
Specific gravity …. Urine is water & solutes ….. And so a given volume of urine has a greater mass than the same volume of distilled water
The ratio between the mass of a substance to the mass of an equal
volume of distilled water is called: Specific gravity

8. Specific gravity of distilled water = 1 Of Urine = 1. 001 to 1
Specific gravity of distilled water = 1 Of Urine = to Depending on its solute concentration The higher the specific gravity ….. The more solutes present in urine PH … Urine is usually slight acidic

9. Abnormal urinary constituents
Substance
Name of condition
Possible causes
Glucose
Glycosuria
Diabetes mellitus
Proteins
Proteinuria OR Albuminuria
Pregnancy – Renal disease
Ketone bodies
Ketonuria
Excessive formation & accumulation o ketone bodies, as in starvation & untreated diabetes mellitus
Erythrocytes
Hematuria
Bleeding in urinary tract
Leukocytes (Pus)
Pyuria
Urinary tract infection
Bile pigments
Bilirubinuria
Liver diseases – Obstruction of bile ducts om liver or gall bladder

10. Why urine analysis is done???
1. To check for a disease or infection of urinary tract
2. To check the treatment of conditions such as: Diabetes, Kidney stones, Urinary tract infections
3. As a part of regular physical examination
What affects the test results???
Menstruation
Taking medicines as: Diuretics
Having an X-ray test with contrast material in the past 3 days
Not getting the urine sample to the lab in 1 hour

11. Some diseases of renal system
1. Glomerulonephritis (GN)
It is an inflammatory conditions of the glomerulus
Many cases of GN occur because of the formation of immune complexes that damage the glomeruli
There are many types of GN which are classified according to the immunological characteristics & microscopic findings
Microscopic findings are based on:
A. Extent of damage:
Diffuse: Affecting all glomeruli
Focal: Affecting some glomeruli
B. Appearance:
Proliferative: Increased number of cells in the glomeruli
Membranous: Thickening of the glomerular basement membrane

12. Some types of GN:
Type
Presenting features
Description
Diffuse proliferative GN
Hematuria
Proteinuria
Deposition of immune complexes in all glomeruli stimulates the inflammatory response
Focal proliferative GN
An inflammatory response develops in parts of some glomeruli
Membranous GN
Deposition of immune complexes in the glomerular basement membrane stimulates the inflammatory response, causing its thickening

13. 2. Nephrotic syndrome:
It is not a disease in itself, but is an important feature of several kidney diseases
Main signs are:
Proteinuria
Hypoalbuminemia
Generalized edema
Hyperlipidemia

14. When glomeruli are damaged, permeability of glomerular membrane is increased … And so plasma proteins will pass from blood to the kidney in the filtrate (Albumin is the main protein which is lost) ….. Leading to fall in plasma protein level …. And so plasma osmotic pressure will decrease ….. Leading to edema ….. And so decrease in renal blood low …. Then stimulation of renin-angiotensin-aldosterone mechanism ….. Causing increase in water & salt re-absorption from the renal tubules …. The re-absorbed water will decrease the osmotic pressure more, increasing the edema

17. Acute pyelonephritis

18. 3. Acute pyelonephritis:
It is an acute microbial infection of the renal pelvis, spreading to the kidney substance, causing formation of small abscesses
This infection may travel up from the urinary bladder or may be blood-borne
Ascending infection Blood borne infection
It is the upward travel of microbes The source of microbe may be
from the urinary bladder to reach renal septicemia, infected wounds
pelvis & kidney substance or abscesses
When the infection spreads to
the kidneys ….. It causes
destruction of nephrons

19. 4. Chronic pyelonephritis:
It occurs because of repeated attacks of acute pyelonephritis with scar tissue formation
Usually associated with reflux of urine from urinary bladder to the ureters, enabling microbes to pass to kidneys

20. 5. Acute renal failure:
Is a sudden & severe decrease in glomerular filtration rate (GFR) & kidney function that is usually reversible over days or weeks when treated
Causes of acute renal failure:
Pre-renal: Decrease in renal blood flow
Renal: Damage to the kidney itself
Post-renal: Obstruction to the outflow of urine
6. Chronic renal failure:
Reached when irreversible damage to nephrons occurs so that 75% of renal function is lost & the kidneys can’t function effectively