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Published byVictoria Powell Modified over 9 years ago
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Urine Analysis 1- Physical Examination 2- Chemical Examination 3- Microscopic Examination 4- Microbiological Examination
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Collection of Urine for Analysis
Urine Analysis Collection of Urine for Analysis Urine is collected over a period of 24 hours. A preservative (as toluene, chloroform, thymol & formalin) is added to prevent contamination of the urine keeping urine in refrigerator is greatly advisable especially in hot weather.
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URINE ANALYSIS Physical Examination
1- Volume 2- Specific Gravity 3- Aspect 4- Color 5- Odor 6- Deposit 7- Reaction (pH)
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URINE ANALYSIS Physical Examination
1- Volume: Normal urine volume in 24 hours is ml 1- Urine volume increases (Polyuria) in the following conditions: Physiological: Increased fluid intake Diuretic Pathological: Diabetes mellitus (type-1 & type-2) Diabetes insipidus (due to decrease of ADH) Chronic renal failure 2- Urine volume decreases (Oliguria or anuria) in the following conditions: Dehydration Acute renal failure Obstruction
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URINE ANALYSIS Physical Examination
2- Specific gravity (SG): Specific gravity measures solute concentration (urea and sodium). Normally the specific gravity ranges between 1- Increased in Dehydration (with oliguria) Diabetes Mellitus (with polyuria) Acute renal failure (with oliguria) 2- Decreased in Diabetes insipidus (with polyuria)
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URINE ANALYSIS Physical Examination
3- Appearance: Normal fresh urine: clear (transparent) Abnormal : Cloudy urine may indicate possible abnormal constituents such as white cells, epithelial cells, crystals and bacteria. N.B. Stored urine with no preservative & no cooling may turn clear urine samples into cloudy.
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URINE ANALYSIS Physical Examination
4- Color: Normal color: pale yellow (amber yellow) due to the presence of pigments of urobilin or urobilinogen Abnormal colors of urine: Colorless Orange Greenish yellow Red Black Smoky
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URINE ANALYSIS Physical Examination
Color (cont.) 1- Colorless Urine: Chronic renal failure Diabetes insipidus. 2- Orange Urine: Ingestion of large amount of carotenoids (vitamin A) 3- Yellowish brown urine: due to presence of billirubin in cases of: Obstructive Jaundice Hepatic Jaundice
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URINE ANALYSIS Physical Examination
Color (cont.) 4- Red urine: due to presence of blood, hemoglobin & RBCs. 5- Black urine: Methemoglobin Homogentisic acid in alkaptonuria Malignant malaria (black water fever due to Malaria falciparum). Melanin (melanoma) 6- Smoky urine: presence RBCs. in the urine, in cases of acute glomerulonephritis
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URINE ANALYSIS Physical Examination
5- Odor: Normal Urineferous odor: The normal odor of fresh voided urine sample Abnormal Odors 1- Fruity odor due to presence of acetone in the urine as in diabetic ketoacidosis 2- Ammonia odor due to release of ammonia as result of: the bacterial action on urea in the contaminated urine or long standing exposed urine samples.
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URINE ANALYSIS Physical Examination
6- Deposits: Normally the urine is devoid of deposits. The presence of deposits is mainly due to various types of crystals, salts and cells.
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URINE ANALYSIS Physical Examination
7- Reaction (pH): Normally: The pH of urine varies from 1- Acidic urine: Large intake of meat & certain fruits (cranberries) Metabolic & respiratory acidosis 2- Alkaline urine: Vegetarians Metabolic & respiratory alkalosis Urinary tract infection by urea splitting bacteria which split urea to ammonia (alkaline)
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URINE ANALYSIS Chemical Examination
Normal Constituents of Urine Normal urine contains about 50g of solids dissolved in about 1.5 liters of water per day. Urine contains organic and inorganic solids. A) Chief Inorganic Solids Sodium, potassium & chlorides Smaller amounts of calcium, magnesium, sulfate & phosphates Traces of iron, copper, zinc and iodine. B) Chief Organic Solids: 1- Non-protein nitrogen: amino acids, ammonia, urea, uric acid , creatine & creatinine 2- Organic acids: lactic acid, citric acid & oxalic acid ketone bodies (few amounts) 3- Sugars: Normally not more than 1g of sugars is excreted in the urine per day. Sugars cannot be detected by ordinary tests. Very small amounts of glucose not exceeding 150 mg of glucose are normally excreted per day. Other sugars present in urine are: pentose and lactose . Lactosuria occurs in infant and in women during the late months of pregnancy and during lactation
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URINE ANALYSIS Chemical Examination
Abnormal Constituents of Urine 1- Proteins (proteinuria) 2- Sugars (glucosuria, fructosuria & galactosuria) 3- ketone Bodies (ketonuria) 4- Billirubin (billirubinuria) & Bile Salts 5- Nitrites
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URINE ANALYSIS Chemical Examination
1- Proteins: (proteinuria) Proteinuria Presence of more than 150 mg proteins in urine in 24 hours detected by ordinary laboratory means heavy proteinuria : >4 gm/24 hours moderate proteinuria: gm/24 hours minimal proteinuria: < 1.0 gm/24 hours
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URINE ANALYSIS Chemical Examination
1- Proteins: (proteinuria) Proteinuria is divided into prerenal, renal and postrenal proteinuria. 1-Prerenal proteinuria: Bence-Jones protein: This abnormal gamma globulin (light chains only) is synthesized by malignant plasma cells (multiple myeloma). It precipitates at 60oC, redidssolves at 100oC and reprecipitates on cooling. Heart failure 2-Renal proteinuria: Severe muscular exercise After prolonged standing Acute glomerulonephritis Nephrotic syndrome 3- Postrenal proteinuria: Lower urinary tract inflammation, tumors or stones.
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URINE ANALYSIS Chemical Examination
2- Sugars: (glycosuria) Glucose (Glucosuria); Presence of detectable amount of glucose in urine which occurs in the following conditions: - Uncontrolled Diabetes Mellitus (DM) - Renal glucosuria with lowering of renal threshold : e.g. during pregnancy (gestational diabetes). Fructose (Fructosuria): Presence of fructose in urine & may be due to: - Alimentary causes following the ingestion of large amounts of fructose Fructosemia & herditary fructose intolerance (Metabolic disorders of fructose). Galactose (Galactosuria): Presence of galactose in urine& may be due to: - Alimentary causes following the ingestion of large amount of galactose. - Galactosemia
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URINE ANALYSIS Chemical Examination
3- Ketone Bodies (Ketonuria): Presence of acetone, acetoacetic acid and β hydroxybutyric acid in urine due to: Diabetic ketoacidosis (uncontrolled DM) Starvation Unbalanced diet: high fat & low carbohydrates diet.
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URINE ANALYSIS Chemical Examination
4- Bilirubin (bilirubinuria) Billirubin appears in urine in cases of: Hepatocellular Jaundice: as in viral hepatitis Obstructive Jaundice as any cause of obstruction of bile duct
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URINE ANALYSIS Chemical Examination
5- Nitrites In bacteruria in urine (in cases of Urinary Tract Infection, UTI)
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