URINE ANALYSIS-NORMAL AND ABNORMAL FINDINGS)

URINE ANALYSIS-NORMAL AND ABNORMAL FINDINGS)

Definitions

·         Urinalysis is the examination of urine based on normal and abnormal findings.

·         Polyuria is the passage of large volume of urine in a given period.

·         Haemoglobinuria is the presence of haemoglobin in urine.

·         Haematuria is the presence of red blood cells in urine.

·         Oliguria Reduced output volume of urine (below 500mls) can be caused by acute nephritis, fever, perspiration.

·         Anuria is the stoppage of urine output.

·         Urochrome is the chemical component that give the normal colour of urine.

·         Glycosuria is the passage of glucose in urine

·         Proteinuria is the passage of protein in urine

·         Ketonuria is a medical condition in which ketone bodies are present in the urine.

Mention the constituents of urine 

·                  Water 95% Electrolyte (Sodium, Potassium, Magnesium, Chloride, and Bicarbonate).

·         Protein – It can be found in the urine of person with urinary schistosomiasis, UTI, Nephrotic syndrome, renal disease, pregnant women.

·         Glucose – It can be found in diabetic patient.

·         Ketones – It can be found in untreated diabetic patient or starvation.

·         Bilirubin – It can be found in a patient with hepatocellular jaundice or cholestatic (obstructive jaundice).

·         Urobilinogen – Increase amount can be found in severe haemolysis

·         Nitrite – Can be found in patient with UTI.

·         Blood – Can be found in urinary schistosomiasis, bacteria infection acute Glomerularnephritis, sickle cell disease, calculi.

·         Specific gravity – Normal relative density ranges from 1.002 – 1.050 depending on the state of hydration of the person. Its proportional based on urea and sodium concentration.In renal failure the ability of the kidney to concentrate and dilute urine is reduced.

·         Usually high relative mass density can be found when the urine contains glucose,proteins or other heavy particles

Cells

·         Blood cells – Normal erythrocyte 0-3/high power field.

·         Large number indicates infection, trauma, renal tumour or renal calculi.

·         Normal Leucocytes: 0 – 5/high power field. Large numbers indicate infection e.g UTI.

·         Yeast cells – Suggestive candidiasis.More predominant in diabetic,pregnant women,or obesity.

Crystals

·         Triple phosphate crystals appers in alkaline urine which suggestive to renal calculi.

·         Calcium crystals appears in acidic urine which suggestive to renal strictures.

·         Cholesterol crystals suggestive to be severe UTI,Nephritis,rupture in lymph drainage in thoracic.

·         Leucine/Tyrosin suggestive to be severe liver disease.

·         Uric acid can be increased in gout,malignat lymphoma,fever or leukaemia.

Casts

·         Hyaline cast indicate damage of glomerular filter membrane, strenuous exercise or fever.

·         Granular cast indicate renal damage.

·         Cellular cast suggestive to be pyelonephritis or Glomerularnephritis,severe injury to glomerular,bacterial infection ,endocarditis or septicaemia

Parasites 

·         Trophozoite of Trichomonas vaginalis which appears in dancing movement indicates that the patient suffered from Trichomoniasis

·         Filarial worms:-microfiralial larva can be seen moving across microscopic field

·         Schistosome haematobium ova can be observed under microscope with terminal spine structure ,it indicates URINARY SCISTOSOMIASIS

 List significance of each constituent 

·         Protein: to diagnose and monitor proteinuria e.g in pregnancy or nephritic syndrome

·         Glucose: to screen for and monitor glucose intolerance such as in Diabetes mellitus

·         Bilirubirin: to assist in the diagnosiss of hepatocellular and obstructive jaundice

·         Urobilinogen: To investigate jaundice

·         Ketones:-To detect and monitor ketonuria eg in Diabetes

·         Haemoglobin:-To investigate intravascular haemolysis, microbial infection and glomerular nephritis

·         Nitrite and leucocyte esterase:-To assist in the diagnosis of Urinary tract infection

·         Specific gravity:-To investigate the concentrating and diluting powder of kidney

Describe the characteristics of urine 

·         Physical examination

·         Determination of chemical compositions

·         Microscopic examination

Physical examination

§  The examination can be done using naked eyes which includes appearance, measuring volume for 24 hourly urine.

§  Colour: Normal appearance of urine pale yellow due to chemical compound know as urochrome. It should be clear or only slightly hazy.

§  Physical Appearance (colour and clarity) of urine can be altered in many conditions

§  Urinary tract infection –Urine appear cloudy due to pus cells and bacteria

§  Urinary schistosomiasis-urine appear red and cloud because it contain blood (haematuria)

§  Haemoglobinuria (black water fever) – urine appear brown and cloudy because it contain free haemoglobin.

§  Jaundice – Urine appear yellow brown or green brown because it contain bile pigments or increase amount of urobilin (oxidized urobilinogen)

§  Bancroftian filariasis Urine appears milky – whitish, because it contains chyle.

Volume

·         Normal volume urine output excreted per day is 1.0 - 2.0L.

·         Abnormal output can be:-

·         Polyuria – That is increase output volume of urine, can be caused by; diabetic patient, excessive fluid intake.

·         Oliguria – Reduced output volume of urine (below 500mls) can be caused by acute nephritis, fever, perspiration.

·         Anuria – Stoppage of urine output, can be caused by intravascular haemolysis, severe UTI, renal stricture BPH (benign prostate hypotrophy), impaired blood circulation.

 Identify normal and abnormal urine 

           

      

Image 1

This is budding yeast.

Normal chemical compositions of urine

·         The composition of urine depends on diet and cellular metabolic activities of the body.

·         In health it contains water 95%, Electrolyte (Sodium, Potassium, Magnesium, Chloride, and Bicarbonate).

·         Waste products (Urea, Uric acid, Creatinine,) acids and alkali in buffered form.

·         The normal pH reaction of freshly passed urine is around 6.0

Abnormal chemical components in urine

·         Protein – It can be found in the urine of person with urinary schistosomiasis, UTI, Nephrotic syndrome, renal disease, pregnant women.

·         Glucose – It can be found in Diabetes mellitus patient.

·         Ketones – It can be found in untreated diabetic patient or starvation.

·         Bilirubin – It can be found in a patient with hepatocellular jaundice or cholestatic (obstructive jaundice).

·         Urobilinogen – Increase amount can be found in severe haemolysis

·         Nitrite – Can be found in patient with UTI.

·         Blood – Can be found in urinary schistosomiasis, bacteria infection acute Glomerularnephritis, sickle cell disease, calculi.

·         Specific gravity – Normal relative density ranges from 1.002 – 1.050 depending on the state of hydration of the person. Its proportional based on urea and sodium concentration.In renal failure the ability of the kidney to concentrate and dilute urine is reduced.

·         Usually high relative mass density can be found when the urine contains glucose,proteins or other heavy particles

Cells

·         Blood cells – Normal erythrocyte 0-3/high power field.

·         Large number indicates infection, trauma, renal tumour or renal calculi.

·         Normal Leucocytes: 0 – 5/high power field. Large numbers indicate infection e.g UTI.

·         Yeast cells – Suggestive candidiasis. More predominant in diabetic, pregnant women, or obesity.

 

 WBCs and one RBC in the urine 

Crystals

·         Triple phosphate crystals appears in alkaline urine which suggestive to renal calculi.

·         Calcium crystals appears in acidic urine which suggestive to renal strictures.

·         Cholesterol crystals suggestive to be severe UTI,Nephritis, rupture in lymph drainage in thoraxic.

·         Leucine/Tyrosine suggestive to be severe liver disease.

·         Uric acid can be increased in gout, malignant lymphoma, fever or leukaemia.

Casts

·         Hyaline cast indicate damage of glomerular filter membrane, strenuous exercise or fever.

·         Granular cast indicate renal damage.

·         Cellular cast suggestive to be pyelonephritis or Glomerularnephritis, severe injury to glomerular, bacterial infection ,endocarditis or septicaemia

This picture shows hyaline casts in the urine viewed 40X microscopically. (Picture by ASCP)

HYALIN CAST

Parasites 

Trophozoite of Trichomonas vaginalis which appears in dancing movement indicates that the patient presence of haemoglobin in urine.

·         Haematuria is the presence of red blood cells in urine.

·         Oliguria Reduced output volume of urine (below 500mls) can be caused by acute nephritis, fever, perspiration.

·         Anuria is the stoppage of urine output.

·         Urochrome is the chemical component that give the normal colour of urine.

·         Glycosuria is the passage of glucose in urine

·         Proteinuria is the passage of protein in urine

·         Ketonuria is a medical condition in which ketone bodies are present in the urine.

Physical examination

§  The examination can be done using necked eyes which includes appearance, measuring volume for 24 hourly urine.

§  Colour: Normal appearance of urine pale yellow due to chemical compound know as urochrome.

Appearance of urine can be altered in many conditions:

§  Urine when appears cloudy can be due to pus cells and bacteria of urinary tract infection

§  Urine when appears red and cloud could be due to Urinary schistosomiasis-

Evaluation

What do you understand by the following terms?

·         Urinalysis,

·         Polyuria

·         Haemoglobinuria

·          Haematuria

·         Oliguria

·         Anuria

·         Glycosuria

·         Proteinuria

·         Urochrome

List the clinical significance of performing urinalysis.

Explain abnormalities found in urine, especially RBCs, WBCs, protein, glucose and ketones.

 References.

·         Carl A. Burtis et al, 2008,Fundamental of Clinical Chemistry,Six Edition,Saunders.

·         Ramnik Sood,2006,Medical Laboratory Technology,First Edition,Jintendar P Vij.

·         Monica Cheesbrough,2009, District Laboratory Practice in Practice in Tropical Coutries,Second Edition,Cambrige University Press.

·         Robert K. Murray (1990): Harper’s Biochemistry; 22^nd Edition Prentice – Hall International Inc.

·         Carl A. Burtis (2001): Fundamental of clinical chemistry, 15^th Edit W.B.Saunders Company.

·         Wendy Anerson 2007): Clinical Chemistry; Larboratory PerspectiveF.E.Davis Company.