Physical examination of urine

Physical examination of urine

1. PHYSICAL EXAMINATION OF URINE SUNIL KUMAR.P DEPARTMENT OF CLINICAL PATHOLOGY ST.JOHN’S MEDICAL COLLEGE BANGALORE 10/13/2018 1 SUNIL KUMAR.P

2. urine analysis Physical examination Chemical examination Microscopy examination 10/13/2018 2 SUNIL KUMAR.P

3. Collection of urine Done in clean container Should be examined freshly Best sample early morning Culture-sterile containers are used 10/13/2018 3 SUNIL KUMAR.P

4. Types of sample Random sample-ordinary qualitative test Early morning sample –nephritis 2hr post prandial sample-DM Mid stream urine collection-culture 24hrurine sample-quantitative analysis 10/13/2018 4 SUNIL KUMAR.P

5. Collection method 24hr urine –void & discard urine at particular time. Collect all urine for next 24hr. Mid stream urine-initial portion of urine should be discard. only the mid stream urine should be collected. Catheterized specimen-insertion of tube or catheter through the ureter into the bladder 10/13/2018 5 SUNIL KUMAR.P

6. Preservation of urine Preservative Concentration limitation toluene 2ml/100ml Floats on the surface of the urine. good for constituent formalin 3drops /100ml urine Good for sediment. Precipitate protein. thymol 1crystal/100ml Interfere with acid precipitation test for protein chloroform 5ml/100ml Forms upper layer. changes cellular sediment charactrestics . Boric acid 0.3gm/120ml of urine Yeast can still grow .uric acid crystal get precipitated. Conc.HCL 10ml/24hr urine Best preservative for all chemical examination, especially for ca,uric acid , crea,urea . 10/13/2018 6 SUNIL KUMAR.P

7. Physical examination of urine volume Colour Odour Apperance pH Specific gravity 10/13/2018 7 SUNIL KUMAR.P

8. volume ● VOLUME-24hr neonates-30-60ml children -600-700ml adult -600-2500ml Oliguria -urinary excretion less than 500ml Polyuria -urinary excreation greater than 2500ml. Anuria -complete cessation of urine. Disuria - painful in voiding time. 10/13/2018 8 SUNIL KUMAR.P

9. polyuria -DM/ Insipidus -diuretics -intravenous saline /glucose -chronic renal failure - addison’s disease, decrease of adreno cortical hormone. 10/13/2018 9 SUNIL KUMAR.P

10. Oliguria -dehydration vomiting diarrhea exessive sweating -renal ischemia -acute renal tubular necrosis -acute glomerulonephritis -obstruction to urinary outflow 10/13/2018 10 SUNIL KUMAR.P

11. Anuria -complete suppression of urine formation . -renal collapse -severe case of acute nephritis -burns -transfusion reaction -traumatic shock 10/13/2018 11 SUNIL KUMAR.P

12. colour Normal –straw colour Colourless - dilution DM Milky- chyluria due to filariasis ,ABD Lymphodenopathy Yellow to Brown -jaundice Brownish yellow or green-bile pigment Orange red or orange brown- urobilinogen Bright red-fresh blood Brownish black-poisoning Black- alkaptnuria 10/13/2018 12 SUNIL KUMAR.P

13. odor Fresh urine-aromatic odour Urine allow to stand-strong ammonic smell because of decomposition of urea with liberation of ammonia. Ketone bodies-fruity odor Infants with phenylketouria -musty odour Putrid odor-UTI Fecal odor – E.coli cystitis 10/13/2018 13 SUNIL KUMAR.P

14. Appearance Normal-clear Cloudy due to -amorphous phosphate(neutral or alkaline condition) -amorphous urates (acidic urine) Which disappear on heating. In disease – urine cloudy due to -presents of WBC -presents of bacteria or fungi -colloidal suspension of fat or chyle 10/13/2018 14 SUNIL KUMAR.P

15. p H Average - 4.6-8.0 Average pH -6.0-presents of sulphates , phoshate,chloride . Alkaline urine-vegetarian &urine on standing Measurements of pH- 1.litmus paper 2.pH paper or nitrazine paper 3.Dip stick method 10/13/2018 15 SUNIL KUMAR.P

16. Dip stick method Reagent 0.2% w/w methyl red 2.8%w/w bromo thymol blue 97.0%w/w non reactive ingradiant Principle:- - Based on double indicator principle. -gives broad range of colors covering entire urinary PH. -color change from orange- yellow-green-blue (Acidic) (alkaline) 10/13/2018 16 SUNIL KUMAR.P

17. Acidic urine High protein intake and ingestion of acidic fruits. Respiratory acidosis Metabolic acidosis-uremia, diabetes mellitus, starvation . E.coli infection 10/13/2018 17 SUNIL KUMAR.P

18. Alkaline urine Respiratory alkalosis Metabolic alkalosis(excessive vomiting) UTI due to proteus and pseudomonas 10/13/2018 18 SUNIL KUMAR.P

19. SPECIFIC GRAVITY Normal specific gravity-1.015-1.025 Urines of low specific gravity are called hyposthenuric (<1.007) while urines of fixed sp.gravity of about 1.010 are known as isothenuric . 10/13/2018 19 SUNIL KUMAR.P

20. Specific gravity measurement Urinometer Refractometer Dip stick method Osmometer 10/13/2018 20 SUNIL KUMAR.P

21. urinometer This is a bulb shaped instrument that has a cylindrical stem ,which contains a scale calibrated in sp.gravity reading. This instrument is floated in a cylinder containing urine. The depth to which it sinks in the urine indicates the sp.gravi of urine Stem reading-1.000 to 1.060. 10/13/2018 21 SUNIL KUMAR.P

22. Urinometer method Principle:- The method of measuring sp.gravity of urine is based on the principle of buoyancy. An increased solute concentration or increased sp.gravity increases the upthrust of the solution correspondingly. 10/13/2018 22 SUNIL KUMAR.P

23. procedure Mix the urine & pour into the cylinder of 25ml capacity. Carefully float the urinometer by grasping the stem of urinometer at the top and inserting slowly into the urine. Swirl the urinometer slightly as it is inserted.make sure the instrument floats freely away from the sides of container. Take the reading from the graduation gives on the stem at lower meniscus formed at eye level. 10/13/2018 23 SUNIL KUMAR.P

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25. Correction for temperature To correct the sp.gravity reading for temp, place the thermometer in the urine & note the exact temp. Then add 0.001 to the reading for each 3ºC above the temperature for which the urinometer is caliberated . Subtract 0.001 from the reading for each 3ºC which the urine is below the temp of caliberation . 10/13/2018 25 SUNIL KUMAR.P

26. Eg :- Temp of urine is 32ºC caliberation temp is20ºC sp.gravity of the urine is measure at 1 .011 corrected sp.gravity = [(32-20)×0.001] +1.011=1.015 3 10/13/2018 26 SUNIL KUMAR.P

27. Correction for abnormal solute concentration Albumin :- for each gram of albumin/100ml, sp.gravity rises by 0.003 and this is subtracted . Glucose :- for each gram of glucose /100ml, sp.gravity raises by 0.004 and this must be subtracted. 10/13/2018 27 SUNIL KUMAR.P

28. Correction for dilution If the volume of urine is insufficient for measuring sp.gravity , urine can be diluted with distilled water. Multiply the last two numbers of the recorded sp.gravity by the dilution factor. Eg :- urine dilution is1:5 , record sp.gravity is 1.003 corrected sp.gravity is 1.003×5=1.015 10/13/2018 28 SUNIL KUMAR.P

29. Disadvantages of urinometer Large amount of urine is required. Turbid urine may make reading of the scale difficult. 10/13/2018 29 SUNIL KUMAR.P

30. refractometer To determine the sp.gravity of urine by this method require only few drops of urine. PRINCIPLE:- The refractive index of a solution is related to the content of dissolved solids present in solution. µ= Va /Vs This ratio varies directly with the number of dissolved parti - cles in the solution . 10/13/2018 30 SUNIL KUMAR.P

31. Conti………. Although the instrument measures the refractive index of a solution , scale reading is generally calibrated in terms of sp.gravity . 10/13/2018 31 SUNIL KUMAR.P

32. Dipstick method Reagent 2.8% w/w bromothymol blue 28.4% w/w NaOH Principle P H change of pretreated polyelectrolyte in relation to ionic strength, the released hydrogen ion is indicated by P H indicator. Colour changes from a dark blue at a low sp.gravity to yellow green at high sp.gravity 10/13/2018 32 SUNIL KUMAR.P

33. High sp.gravity excessive sweating glycosuria acute nephritis albuminuria all causes of oliguria 10/13/2018 33 SUNIL KUMAR.P

34. Low specific gravity(less than 1.010) -excessive water intake -chronic nephritis - dibetic incipidus -all causes of polyuria except DM Low or fixed sp.gravity (1.010-1.012) -chronic nephritis -ADH deficiency - arteroscerotic kidney 10/13/2018 34 SUNIL KUMAR.P

35. Thank you 10/13/2018 35 SUNIL KUMAR.P