urinalysis and urine culture presentation1).pptx

Analysis of urine

1. URINALYSIS AND URINE CULTURE.

2. Definition. Urinalysis is a common diagnostic test that involves the chemical, microscopic, and visual examination of urine. It provides valuable information about a person’s health, particularly the functioning of the kidneys and urinary tract. This test can help detect and manage a variety of conditions, such as urinary tract infections (UTIs), kidney disease, diabetes, and liver problems.

3. Components of urinalysis. Visual Examination: Evaluates the color, clarity, and volume of urine. Normal urine is typically pale yellow and clear. Variations in color can indicate different conditions, such as dehydration (dark yellow), liver disease (brown), or the presence of blood (red or pink).

4. 2..Chemical Analysis: Uses dipsticks with reactive pads to detect substances in the urine. Common parameters tested include: pH: Measures the acidity or alkalinity of urine. Protein: High levels can indicate kidney damage. Glucose: Presence of glucose may suggest diabetes. Ketones: Elevated levels can occur in diabetes or other metabolic disorders. Blood: Indicates bleeding in the urinary system. Leukocytes: White blood cells suggesting infection.Nitrites: Can indicate bacterial infection. Bilirubin: May point to liver disease.

5. 3. Microscopic Examination: Involves examining urine under a microscope to identify cells, crystals, bacteria, and other substances. It can reveal: Red blood cells: Indicate bleeding. White blood cells: Suggest infection or inflammation. Epithelial cells: High amounts can indicate a disorder. Crystals: May suggest kidney stones. Microorganisms: Presence of bacteria, fungi, or parasites indicates infection

6. Indications for urinalysis. 1. Suspected renal diseases like glomerulonephritis, nephrotic syndrome, pyelonephritis, and renal failure. 2. Detection of urinary tract infection. 3. Detection and management of metabolic disorders like diabetes mellitus. 4. Diagnosis of pregnancy. 5. Diagnosis of other systemic disease that affect kidney function

7. Collection of urine sample. Types of urine samples collected: First morning, midstream: Collected when the individual first wakes up. Preferred for routine urine examination. Random, midstream: Collected at any time of the day without prior notice. It is the most common type used for routine urinalysis. First morning, midstream, clean catch: Bacteriological examination. Postprandial: Collected a few hours after a meal. Estimation of glucose, urobilinogen 24-hour: Quantitative estimation of proteins or hormones. Catheterised : Collected using a catheter inserted into the bladder through the urethra.Bacteriological examination in infants, bedridden patients, and i . n obstruction of urinary tract.

8. Components of urine.

9. How to conduct urinalysis. PHYSICAL EXAMINATION/ VISUAL EXAMINATION. A physical examination in urinalysis involves evaluating several characteristics of a urine sample. Here are the key steps: 1. Collection and Preparation: Ensure the urine sample is collected correctly (e.g., midstream, first morning). Use a clean, dry, and appropriately labeled container. Examine the sample as soon as possible after collection to avoid changes in properties due to standing.

10. 2. Observation of Color: Normal: Pale yellow to amber. Abnormal:Red or pink: Hematuria (blood in urine).Dark yellow or brown: Concentrated urine, bilirubin, or certain medications.Green or blue: Certain infections, medications, or dyes.Cloudy or turbid: Possible infection, presence of crystals, or mucus. 3. Assessment of Clarity (Turbidity): Normal: Clear to slightly cloudy .Abnormal:Cloudy or turbid: Presence of cells (RBCs, WBCs), bacteria, yeast, crystals, or other substances. 4. Odor: Normal: Mild, characteristic odor .Abnormal:Strong, ammonia-like: Infection or urine that has stood too long.Sweet or fruity: Ketones, common in diabetes or fasting.Foul-smelling: Infection .

11. 5. Specific Gravity:Measured using a refractometer or dipstick. Normal Range: 1.005 to 1.030. Abnormal:Low (below 1.005): Overhydration , diabetes insipidus.High (above 1.030): Dehydration, glycosuria, proteinuri .6. Volume (if required):For timed collections (e.g., 24-hour urine), measure the total volume. Normal: Varies depending on fluid intake. Abnormal:Polyuria : Excessive volume, often seen in diabetes.Oliguria : Reduced volume, possible in dehydration or kidney disease.Anuria : Very little or no urine, indicating severe kidney dysfunction
.7. Foam: Normal: Minimal and quickly dissipating . Abnormal:Persistent foam: Proteinuria (protein in urine).

12. Examples of different colours in urine.

13. Chemical analysis of urine. The chemical analysis of urine is undertaken to evaluate the levels of the following componen: Protein Glucose Ketones Occult blood Bilirubin Urobilinogen Bile salts

14. The presence of normal and abnormal chemical elements in the urine are detected using dry reagent strips called dipsticks. When the test strip is dipped in urine the reagents are activated and a chemical reaction occurs. The chemical reaction results in a specific color change. After a specific amount of time has elapse, this color change is compared against a reference color chart provided by the manufacturer of the strips.

15. Procedure: 1. Preparation: Ensure the urine sample is fresh and well-mixed. Dip the reagent strip briefly into the urine sample, ensuring all test pads are submerged. Remove the strip, and tap it against the side of the container to remove excess urine. Hold the strip horizontally to avoid mixing of reagents between pads. 2. Reading the Results: Compare the color change on each pad to the corresponding color chart provided by the manufacturer at the specified time intervals (usually within 30-120 seconds) as illustrated in the image shown.

16. 3. Substances Tested: 1.pH:Normal Range: 4.5 to 8.0. ndications:Acidic (low pH): High protein diet, diabetes, or respiratory/metabolic acidosis.Alkaline (high pH): Vegetarian diet, urinary tract infection (UTI), or respiratory/metabolic alkalosis. 2.Specific Gravity:Normal Range: 1.005 to 1.030. Indications:Low: Overhydration, diabetes insipidus.High: Dehydration, glycosuria, proteinuria. 3.Protein:Normal: Negative to trace amounts. Indications:Presence indicates possible kidney disease, infection, or glomerular damage. 4.Glucose:Normal: Negative. Indications:Presence indicates possible diabetes mellitus or renal glycosuria.

17. 5.Ketones:Normal: Negative.
Indications:Presence indicates possible diabetic ketoacidosis, fasting, or starvation.
6.Bilirubin:Normal: Negative.
Indications:Presence suggests liver disease, bile duct obstruction, or hemolysis.
7.Urobilinogen:Normal: Small amounts (up to 1 mg/dL).
Indications:Elevated levels suggest liver disease or hemolytic anemia.Absent levels suggest bile duct obstruction.
8.Blood (Hemoglobin/Myoglobin):Normal: Negative.
.Indications:Presence indicates hematuria, hemoglobinuria, or myoglobinuria due to kidney disease, trauma, infection, or other causes

18. 3. Microscopic examination of urine. Microscopic examination of urine in urinalysis involves analyzing the solid components (sediment) present in the urine after centrifugation. Here are the key steps and components typically examined: 1. Sample Preparation. Centrifugation: Centrifuge a well-mixed urine sample (usually 10-15 mL) at approximately 1500-2000 rpm for 5-10 minutes to separate the sediment from the supernatant. Decant the supernatant, leaving a small amount of urine to resuspend the sediment. Slide Preparation: Place a drop of the resuspended sediment on a clean glass slide. Cover with a coverslip. 2. Examination Under Microscope: Low Power (10x Objective):Scan the slide to identify larger elements like casts, crystals, and squamous epithelial cells. High Power (40x Objective):Examine to identify and count smaller elements like red blood cells (RBCs), white blood cells (WBCs), and bacteria.3

19. 3.Components Analyzed: 1.Cells: Red Blood Cells (RBCs):Normal: 0-2 RBCs per high-power field (HPF).Increased: Hematuria due to glomerulonephritis, trauma, infection, or stones. White Blood Cells (WBCs):Normal: 0-5 WBCs per HPF. Increased: Pyuria , indicating infection or inflammation (UTI). Epithelial Cells: Squamous Epithelial Cells: Indicative of contamination from the genital tract. Transitional Epithelial Cells: Seen in larger numbers in infections or after catheterization. Renal Tubular Epithelial Cells: Indicative of tubular damage or necrosis 2. Casts: Formed in the renal tubules and indicate specific types of kidney pathology. Hyaline Casts: Normal in small numbers, increased in dehydration, exercise, or renal disease . Rbc Casts: Indicate glomerulonephritis or severe kidney inflammation. WBC Casts: Indicate pyelonephritis or interstitial nephritis. Granular Casts: Degenerated cellular casts, indicating chronic kidney disease. Waxy Casts: Indicate advanced renal failure. Fatty Casts: Indicate nephrotic syndrome.

20. 3.Crystals: Normal Crystals: Uric Acid: Yellow to reddish-brown, seen in normal acidic urine.
Calcium Oxalate: Envelope-shaped, seen in normal urine and after ingestion of oxalate-rich foods.
Abnormal Crystals:Cystine: Hexagonal, seen in cystinuria . Tyrosine and Leucine: Seen in severe liver disease. Triple Phosphate ( Struvite ): Coffin-lid shape, seen in alkaline urine, often with UTIs. 4. Microorganisms:
Bacteria: Normal urine is sterile; presence indicates infection.
Yeasts: Indicative of fungal infection, especially in diabetics or immunocompromised patients.
Parasites:Trichomonas vaginalis : Pear-shaped, motile, indicating a parasitic infection.

21. Urine culture. A urine culture is a laboratory test used to detect and identify bacteria or fungi in a urine sample that may be causing a urinary tract infection (UTI). It is a diagnostic tool used to identify the presence of bacteria and other germs in a urine sample.

22. Procedure: Here are the key steps involved in conducting a urine culture: 1. Collection of Sample: Clean-Catch Midstream Sample: Clean the genital area thoroughly with antiseptic wipes. Start urinating, let the initial stream pass, and then collect the midstream urine in a sterile container. Catheterized Sample: Used when a clean-catch sample is not possible or for patients who are already catheterized. Suprapubic Aspiration: Involves inserting a needle directly into the bladder through the abdomen to obtain urine. This method is used for infants or when a sterile sample is essential. 2. Transporting the Sample: Ensure the urine sample is transported to the laboratory as soon as possible, ideally within 2 hours of collection. If a delay is anticipated, the sample should be refrigerated to prevent bacterial growth.

23. 3. Processing in the Laboratory: Plating the Sample: Inoculation: Use a calibrated loop to transfer a small, fixed volume of urine (usually 0.001 mL or 0.01 mL) onto a culture medium (such as blood agar and MacConkey agar). Streak the urine across the surface of the agar plate to isolate individual colonies. Incubation: Incubate the plates at 35-37°C for 24-48 hours in an aerobic environment. 4. Examination and Identification:
Colony Count: After incubation, count the number of colonies on the plate. Interpretation:<10,000 colony-forming units (CFUs)/mL: Typically considered contamination.10,000-100,000 CFUs/mL: Possible infection, interpretation depends on clinical symptoms.100,000 CFUs/mL: Significant infection.

24. 5.Identification:Perform further biochemical tests or use automated systems to identify the specific type of bacteria or fungi 6. Antibiotic Susceptibility Testing: Conduct susceptibility testing to determine which antibiotics are effective against the identified organism. This can be done using methods such as:Disk Diffusion (Kirby-Bauer) Test: Disks impregnated with antibiotics are placed on an agar plate inoculated with the bacteria. The zones of inhibition around the disks indicate susceptibility. Minimum Inhibitory Concentration (MIC): Determines the lowest concentration of an antibiotic that inhibits bacterial growth.