1. Prof. Dr. Zeliha Büyükbingöl
Urine analysis
Prof. Dr. Zeliha Büyükbingöl

2. How the Tests Are Obtained Kidney function tests usually require a 24-hour urine sample and a blood test.
24-Hour Urine Sample
A 24-hour urine sample is a creatinine clearance test. It gives an idea of how much creatinine the body expels over a single day.
Spot urine
The sampling of a single, untimed urine specimen, voided spontaneously by the patient. The sample is analyzed to determine its protein, creatinine, or electrolyte content. This type of specimen differs from a timed urinary specimen, which represents all the urine a patient produces over a 12- or 24-hr period. Both types of specimen are used in the diagnosis and treatment of renal disease.

3. Routine Urinalysis A urinalysis is important in accessing the chemical constituents in the urine and the relationship to various disease states.
Macro and Microscopic Analyzes
The urine sample's color
Appearance
Specific gravity pH
Protein levels
Glucose
Ketones
Blood
Leukocyte esterase
Nitrite
Bilirubin
Urobilinogen

4. Macroscopic urinalysis
Macroscopic urinalysis is the direct visual observation of the urine, noting its quantity, color, clarity or cloudiness, etc.
Normal urine is typically light yellow and clear without any cloudiness. Obvious abnormalities in the color, clarity, and cloudiness may suggest possibility of
an infection (cloudy urine),
Dehydration (dark urine color),stains urine a tea or cola color),
blood in the urine (visible to the eye may indicate urinary tract infection, stones, tumors, or injuries), or breakdown of muscle (orange- or tea-colored urine).

5. Microscopic urine analysis
This test looks at a sample of urine under a microscope. It can see cells from your urinary tract, blood cells, crystals, bacteria, parasites, and cells from tumors.
This test is often used to confirm the findings of other tests or add information to a diagnosis.

6. Laboratory Reference Ranges in Healthy Adults
Each laboratory has specific reference ranges.
Reference range values are for apparently healthy people and often overlap significantly with values for those who are sick.
Actual values may vary significantly due to differences in assay methodologies and standardization. Institutions may also set up their ownreference ranges based on the particular populations that they serve, thus regional differences may occur.

7. Protein and Glucose Test
The protein test provides a rough estimate of the amount of albumin in the urine. When urine protein is elevated, a person has a condition called proteinuria.
Glucose is normally not present in urine. When glucose is present, the condition is called glucosuria. It results from:
An excessively high glucose level in the blood, such as person who have uncontrolled diabetes
Some other conditions: hormonal disorders, liver disease, medications, and pregnancy.
When glucosuria occurs, other tests such as a fasting blood glucose are usually performed to further identify the specific cause.

8. Leukocytes and nitrites Both of which are potential indicators of infection.
The presence of nitrite in the urine is highly specific of a bacterial infection.
If there is no leukocyte esterase in the urine, this means an infection is unlikely.

9. Bilirubin
Bilirubin is primarily derived from metabolism of hemoglobin. Only conjugated bilirubin is excreted into the urine and normally only trace amounts can be detected in urine. Elevated urinary bilirubin occurs in patients with obstructive jaundice or jaundice due to hepatocellular disease or injury. Hyperbilirubinemia due to hemolysis is principally due to unconjugated bilirubin, and therefore does not result in increased urinary bilirubin.

10. Normal Urine Characteristics
Normal values
Color
Pale yellow to deep amber
Odor
Odorless
Volume
750–2000 mL/24 hour pH
4.5–8.0
Specific gravity
1.003–1.032
Osmolarity
40–1350 mOsmol/kg
Urobilinogen
0.2–1.0 mg/100 mL
White blood cells
0–2 HPF (per high-power field of microscope)
Leukocyte esterase
None
Protein
None or trace
Bilirubin
<0.3 mg/100 mL
Ketones
Nitrites
Blood
Glucose

11. Excessive Urination Volume (Polyuria)
Excessive urination volume (or polyuria) occurs when the patient urinate more than normal. Urine volume is considered excessive if it equals more than 2.5 liters per day.
A normal urine volume depends on the age and gender. However, less than 2 liters per day is usually considered normal.
Excreting excessive volumes of urine is a common condition but should not last more than several days. Many people notice the symptom at night. In this case, it is called nocturnal polyuria (or nocturia).

12. Anuria
Anuria or anuresis occurs when the kidneys are not producing urine. A person may first experience oliguria, or low output of urine, and then progress to anuria.
Anuria is primarily linked to acute (sudden or short-term) or chronic (long- term) kidney disease. It may also be associated with other health conditions that cause kidney disease.