Urine analysis.pdf

Infoation about urine salts and their treatment help in hospital and pharmacy doctor and pharmacist

1. Urine analysis
=Urinalysis.
CUA UA
لوبلا ليلحت

3. Urine analysis:
1-Urineisamoreconvenient
sample.
2-Concentrate for many
substances.
3-Detectioniseasierthanin
blood.

6. Function of the kidney:
Regulation of: water , electrolyte
ADHALD

7. ADH
Aldosterone

8. Acid base balance.

9. Excretion of the products of :Protein
and nucleic acid metabolism
Urea.
Creatinine
Uric acid.
NPN

10. ENDOCRINE ORGAN
ADH

11. Urine formation:

13. Composition of urine
1-Water :95%.
2-Non protein nitrogenous compound 2.2%:
•Creatinine.
•Urea.
•Uuricacid.2.2%.
3-Dissolved salts and other ions as Na+, K+,H+,
Ca++,Cl-, phospate:2.8%

15. Urine sample:
Itmustbeanalyzedwithin1hourofcollectionifheldat
roomtemperatureorelserefrigeratedat2°–8°Cfornot
morethan8hoursbeforeanalysis.
Thechemicalchangeswhichmayoccurinurine
specimensstoredatroomtemperatureinclude:
•Breakdownofureatoammoniabybacteria,leadingto
anincreaseinthepHoftheurine.Thismaycausethe
precipitationofcalciumandphosphates.
•Destructionofglucosebybacteria.
•Precipitationofuratecrystalsinacidicurine.These
chemicalchangescanbesloweddownbyrefrigerating
theurineat2–8°Coraddingpreservatives.

16. 3-Microscopicexaminations.
Routine urinalysis is composed of 3 examinations:
2-Chemicalexaminations.
1-Physicalexaminations.

17. 1. Physical examinations
abnormal characters:
1.Volume.
2.Color.
3.Odor.
4.Specific gravity.
5.Reaction(pH).
6.Aspect.

18. 2. Chemical examinations:
1.Proteins.
2.Glucose.
3.Ketone bodies.
4.Bile salts.
5.Bile pigments.
6.Blood.

19. 3. Microscopic examinations:
For abnormal insoluble constituents:
1.Cells.
2.Crystals.
3.Casts.

20. Types of urine samples:
Morning
urine
sample:
24 hours
urine
sample
Mid-stream
urine
sample:
Random
urine
sample:
Urine is concentrated
Quantitative
for a culture
Not quantitative
Must stop
antibiotic 48
hrs. before

21. A) Physical examination of urine:
Volume:
Odor
ColorSpecific gravity
Aspect (appearance):
Reaction (PH)

22. 1-Volume:
Normal: 500-2000 ml/day.
Polyuria:
Urinary volume=
>2000 ml/day.
Oliguria:
Urinaryvolume=
<500 ml/day.
Anuria:
Urinary volume=
<125 ml/day.

23. A. Polyuria:
Urinary volume= >2000 ml/day.
I-Physiological polyuria
1-Winter.
2-High fluids intake (Tea, coffee, cola, beer
and alcohol Diuretics.
3-High protein diet Urea(osmotic diuresis).

24. II-Pathological polyuria:
•Diabetes mellitus(D.M) (3-5 L/day).
•Diabetes insipidus (D.I.) (10-15 L/day).
•Diuretics drugs.
3D

25. Diabetes mellitus(D.M).
Diabetes insipidus(D.I.)

26. B. Oliguria and anuria:
Oliguria: Urinaryvolume=<500ml/day.
.
Anuria: Urinaryvolume=<125ml/day

27. I-Physiological oliguria:
•Summer (hot weather).
•Fasting.
•Low fluid intake in diet.
•Hyperactivity and physical exercise.

28. II-Pathological oliguria:
Pre-renal :
•Heart failure(CHF)
•Complete burns.
•Vomiting.
•Diarrhea.

29. Renal oliguria
•Acute tubular necrosis,
•Acute nephritis.
•Renal failure.

30. Post-renal oliguria
•Prostate hypertrophy
•Stone.
•Cancer.

31. 2-Odor:
Odor interpretation
Aromatic =Uriniferous Normal urine odor
Ammoniacal On standing decomposition of urea by
bacteria ammonia
Acetone like odor = (fruity) •Diabetic ketoacidosis
•Starvation
Offensive Bacterial infection
Mousy Phenylketonuria (PKU) inheriteddisorder
with deficiency of phenyl alanine
hydroxlase
Caramelized Maple syrup disease inheriteddisorder of
metabolism of branched chain amino
acids(leucine-isolucine& valine)

32. 3-Color:
Color Interpretation
Amber yellow Normal urine color
Pale yellow •Very dilute urine
•Infants
•Diabetes mellitus (D.M.)
•Diabetes insipidus (D.I.)
•Increase fluid intake
Dark yellow •Fever
•Hyperthyroidism
•Dehydration
Light brown
(tae like color)
Jaundice
Red •trauma of urinary tract
•Porphyrinuria
Black Alkaptonuria

33. 4-Aspect=Appearance:
Normally, freshly urine transparent &clear.
Turbid urine:
•Pus =Pyuria.
•Red cells =hematuria
•Crystals (calcium phosphate or urate).
•Epithelial cells.

34. 5-Specific gravity:
•Itisthedensityofurinecomparedwiththedensityofdistilled
waterthatisconvenientlyfixedas1at20⁰C.
•Itmeasurestheabilityofthekidneytoconcentrateurine.
•Itvariesdirectlywiththegramsofsolutesexcretedinurine
andinverselywithvolume.
.
Measured using Urinometer

35. Urinometer:

36. Specific Gravity Interpretation
1.015 –1.025 Normal urine
> 1.025 Physiologically:
Summer
First morning specimen.
Pathologically:
•Dehydration.
•Presence of glucose in urine (D.M.)
•Presence of protein in urine (Proteinuria).
•Shock.
•Heart failure.
<1.025 Physiologically:
High fluid intake.
Pathologically:
D.I.

37. 6-Reaction of urine(pH):
pH Interpretation
5 -7 Normal urine
Alkaline
pH
•After meal.
•High citrus fruits and vegetables??.
•Bacterial colonization of urine
•Administration of certain drugs as sodium bicarbonate
•Metabolic and respiratory alkalosis
Acidic
pH
•High protein diet ????.
•Fever
•D.M.
•Metabolic and respiratory acidosis

38. B-Microscopic examination of urine:
Preparation of sample:
1-5.0 ml fresh urine
2-Remove 4.9 ml supernatant fluid.
3-Place a drop of the sediment
4-microscope.
10 min -high speed

39. Constituents of the sediment:
Crystals
Casts
cells
Normallyurinedoesnotcontain
•Redbloodcells.N.R.=(0-2RBCs/HPF).
•Puscells.N.R.(0-2WBCs/HPF).
•Casts.(0-5hyalinecast/LPF)

40. 1-Crystals:
According to the pHof urine we can classify the
crystals into:
Acidic urine:
•amorphous urate.
•uric acid.
•Na urate.
•calcium oxalate.
Alkaline urine:
•amorphous phosphate.
•calcium phosphate.
•triple phosphate.
•calcium carbonate.
•calcium oxalate.
oxph
urate
Uric acid

41. 2-Cells:
Incaseofglomerulonephritistheurine
willcontainredbloodcells;puscells
andcasts(hyalineorgranularcasts).

42. 3-CASTS:
Theyarefoundinthelumenofthedistalconvolutedtubule
andcollectingduct.Theyaretheonlyelementsfoundinthe
urinarysedimentthatareuniquetothekidneys.

43. C) Chemical examination of urine:
1-Proteins or Albumin: للازلا
Mostproteinsaretoolargetopassthrough
theglomeruli.
Theglomeruliarenegativelycharged,sothey
repelthenegativelychargedproteins.
whentheglomeruliaredamaged,proteinsof
varioussizespassthroughthemandappear
intheurine.

44. Appearanceofproteinsinurineisreferredas
ProteinuriaorAlbuminuriawhichisasymptomof
Nephroticsyndrome (damage the
glomerulicapillarywalls)

45. Itischaracterizedbyincreasedglomerular
permeability:
•Glomerulonephritis.
•toxinsasgold.
•penicillamine.
Proteinuriaresultsindecreaseofserumalbumin
concentration generalizededema.

46. 2-GLUCOSE:
Presence of more than the usual amount of glucose
in urine is called glucosuria.
a)A rise in blood glucose concentration
•Untreated diabetes mellitus.
•Glucose infusion.
b) rate of glucose reabsorption:
Tubular damage.
c) rate of glomerular filtration
During pregnancy.

47. 3-ketone bodies:
Acetone.
acetoacetate.
β-hydroxybutyricacids.
Ketonuria :
•diabetic ketoacidosis
•severe starvation.

48. 4-Blood:
Presence of blood in urine is called hematouria.
a)Infections as :
•Schistosoma haematobium.
•urinary tract infections (UTI).
b) Renal causes:
•Glomerulonephritis(Inflammation of the glomeruli) .
•Renal tract stones.
•Kidney tumours.
c) Toxins or drugs as
•Phenols.
•Cyclophosphamide.

49. 5-Bile salts (bile acids):
Theyaresodiumandpotassiumsaltsofbile
acidsthataremetabolicendproductsof
cholesterolmetabolism(e.g.:Taurocholic
acid,Glycocholicacid,Deoxycholicacid).
Theyactassurfactantsandhelpinthe
digestionandabsorptionoffats.
Theyarenormallyexcretedinbiletothe
intestinesotheyarenormallyabsentinurine.
Thepresenceofbilesaltsinurineconfirms
thepresenceofobstructivejaundice.

50. 6-Bile pigments (bilirubin):
Bilirubinisthemetabolicendproductof
hemoglobinmetabolism.
Normalurineisfreeofbilirubin.
Plasmaandhenceurinarylevelsofbilirubin
increasewhenthereisa:
•Biliaryobstructionjaundice
•Hepatitis
•Livercirrhosis.

51. 7) Nitrite:
Normalurinedoesnotcontainnitrite.
Presenceofnitriteinurineurinarytractinfections
(causedbynitratereducing-bacteria)

52. URINE ANALYSIS USING DIPSTICK

54. 1) PROTEIN:
This test is based on the color change of the indicator
tetrabromophenolblue. A positive reaction is indicated by
a color change from yellow through green and then to
greenish-blue.
tetrabromophenolblue

55. 2) GLUCOSE:
. First, glucose oxidase catalyzes the formation of gluconicacid
and hydrogen peroxide from the oxidation of glucose.
A second enzyme, peroxidase, catalyzes the reaction of
hydrogen peroxide with potassium iodide chromogento oxidize
the chromogento colors ranging from blue through
greenishbrown, and brown to dark-brown.
KI
peroxidase
glucose oxidase
gluconicacid

56. 3) KETONE BODIES:
This test is based on the reaction of acetoaceticacid in the urine with
nitroprusside. The resulting color ranges from tan when no reaction
takes place, to purple for a positive reaction. Normal urine specimens
ordinarily yield negative results with this reagent.

57. 4) BLOOD:
This test is based on the pseudoperoxidaseactivity of hemoglobin
which catalyzes the reaction of tetramethylbenzidineand buffered
organic peroxide. The resulting color ranges from, greenish-yellow
through bluish-green to dark blue.

58. 5) NITRITE:
This test is based on the reaction of p-arsanilicacid and nitrite in urine
to form a diazoniumcompound. The diazoniumcompound in turn
couples with N-(l-naphthyl) ethylenediaminein an acid
medium and the resulting color is pink. Any degree of pinkcolor is
considered positive.

59. 6) UROBILINOGEN :
Thetestisbasedonadiazotisationreactionof4-
Methoxybenzenediazoniurnsaltandurinaryurobilinogenina
strongacidmedium.Thecolorchangesfrompinktobrown-red.

60. 7) BILIRUBIN:
This test is based on the coupling of bilirubin with 2.4-dichlorobenzene
diazoniumsalt in a strong acid medium. The color changes from light
tan to pinkish-purple. No bilirubin is detectable in normal urine by even
the most sensitive methods.
Since the bilirubin in samples is sensitive to light, exposure of the urine
samples to light for a long period of time may result in a false negative
test result.

61. 8) LEUCOCYTES:
This test reveals the presence of granulocyte esterases. The esterases
cleave a derivatizedpyrazoleamino acid ester to liberate derivatized
hydroxypyrazole. This pyrazolethen reacts with a diazoniumsalt to
produce a purple color.
esterases
diazoniumsalt

62. 9) REACTION (PH)
This test is based on double indicators (methyl red and bromothymol
blue), which give a broad range of colors covering the entire urinary pH
range. Colors range from orange through greenish yellow and green
to blue. This test indicates the pH values within the range of 5 to 9.

63. 10) SPECIFIC GRAVITY
This test is based on the pka(dissociation constant)
change of certain pretreated polyelectrolytes in relation to the ionic
concentration. In the presence of an indicator, the color changes
from deep blue in urine of low ionic concentration.

64. 1) test for albumin (heat coagulation
test):
Proteins in urine are coagulated (denaturated)
by heat
Procedure:
1)Toacleandrytesttube,add5mlofurine
sample.
2)Toasecondtube,add5mldistilledwater.
3)Heatbothtubeinboilingwaterbathfor5
minutes
4)Notetheformationofturbidity

65. 2) Test for glucose (Benedict’s test):
Procedure:
1)To a clean dry test tube, add 1 ml of urine
sample.
2) Add 1 ml of Benedict’s reagent.
3) Mix well and heat both tube in boiling water
bath for 5 minutes.
4) Note the formation yellow to orange-red color.

66. 3) test for ketone bodies (rotheratest):
Procedure:
1)To a clean dry test tube, add 2 ml of
urine sample.
2) Supersaturate with ammonium sulphate
powder.
3) Add 1 ml of 2% sodium nitroprusside
solution and mix well.
4) Add conc. Ammonia dropwiseon the
wall of tube.
5) Note the formation violet ring.

67. 4) test for bile salts (hay’s sulphurtest):
Procedure:
1)To a clean dry test tube, add 2 ml of
urine sample.
2) To a second clean dry test tube, add 2
ml water.
3) Sprinkle a little of sulphurpowder on
the surface.
4) Sulphurremains on the surface in
normal urine but sinks down in the
presence of bile salts