COMPOSITION (NORMAL&ABNORMAL) AND CHARACTERISTICS OF URINE

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CONTENTS…..PHYSICAL CHARACTERISTIC OF URINE COLOUR

ODOUR

TURBIDITY

PH

VOLUME

DENSITY ( Specific Gravity)

MAIN TERMS ASSOSIATED WITH URINE COMPOSITION

CHEMICAL COMPOSITION OF URINE

ABNORMAL CONSTITUENT OF URINE

•Urine is a liquid product of the body secreted by kidney Through the process is called urination ( micturition) Excreted through urethra

•Cellular metabolism generates numerous by product , (rich in nitrogen) that require clearence from the blood stream as urination

•Urination is the primary method for excreting water soluble chemicals from the body

•Human urine with human faecus are collectively called human waste

URINE

● 95% of volume of normal urine is due to waterOrganic components:● urea● urobilinogen● uric acid● creatinine● amino acids● metabolites of hormonesInorganic components:● cations: Na+, K+, Ca2+, NH4

+

● anions: Cl-, SO4 2-, HCO3

-, HPO4-

COMPOSITION OF URINE

PHYSICAL CHARACTERISTICS OF URINE

Color and transparencyClear, pale to deep yellow (due to urochrome)Concentrated urine has a deeper

yellow/amber colorA red or red-brown (abnormal) color could be

from a food dye, eating fresh beets, a drug, or the presence of either hemoglobin or myoglobin.

If the sample contained many red blood cells, it would be cloudy as well as red.

Turbidity or cloudiness may be caused by excessive cellular material or protein in the urine

Dark yellow urine is often indicative of hydration

Yellow ,orange colour is due to the removal of b vitamin

Orange urine is also form at certain medication such as rifamine

brown urine can be a symptoms of jaundice,rhabdomylosis or gilberts syndrome

Pinkish urine can result from the consumption of beet

URINE COLOUR CHART

Odor Fresh urine is slightly aromatic

Standing urine develops an ammonia odor

Some drugs and vegetables (asparagus) alter the usual odor

Elevated ketones smells fruity or acetone-like

Consumption of alchohol,saffron cofee,tunafis and onion can result in teltate scents…

PH -5.5 – 6.8

Acidic – meat food, diabetes mellitus, starvation, fever

Alkaline – plant food, cystitis, pyelitis

•Acidic urine contribute to the formation of stones of uric acid (kidneys,ureter,bladders)

•Diet with citrus ,vegetables and dairy product increase urine ph(more basic)

•Diet with meat,cranberries,druds, will decrease urine ph(more acidic)

Volume

•Average urine production in humanis about 1-2 L per day•Volume is depending on the state of hydration,activity level,environmental factor,and health of the individual

Density

• Density of the urine ranges between 1.003-1.035 g cm^-3

MAIN TERMS ASSOSIATED WITH URINE COMPOSITION

ANURIA : COMPLETE STOPPAGE OF URINE

OLIGURIA :REDUCED AMOUNT OF URINE

POLYURIA :INCREASED AMOUNT OF URINE

NOCTURIA :INCREASED AMOUNT OF URINE @ NIGHT

CHEMICAL COMPOSITION OF URINE

• Urine is 95% water and 5% solutes• Nitrogenous wastes include urea, uric

acid, and creatinine• Other normal solutes include:• Sodium, potassium, phosphate, and

sulfate ions• Calcium, magnesium, and

bicarbonate ions • Abnormally high concentrations of any

urinary constituents may indicate pathology

PRINCIPLE CONSTITUENT OF HUMAN URINEA.ORGANIC CONSTITUENTS

1.UREA :THE MOST ABUNDANT ORGANIC CONSTITUENT FORMED BY THE COMBINATION OF NH3 &CO22.URIC ACID : PRODUCT OF NUCLEIC ACID CATABOLISM.AND CRYSTALIZE AND CONTRIBUTES TO KIDNEY STONES.3.HIPPURIC ACID :FORMED FROM THE BENZOIC ACID OF DIETARY FRUITES.4.CREATININE : DERIVED FROM CREATINE.5.INDICAN :POTTTASSIUM SALT OF INDOLE. INDOLE IS FORMED IN LARGE INTESTINE BY THE PUTREFACTION OF PROTEIN.IN LIVER ,IT GET TRANSFORMED TO INDICAN.6.KETONE BODIES:ALSO CALLED ACETONE BODIES.NORMALLY FOUND IN SMALL AMOUNTS.BUT IN DIABETES AND ACUTE STARVATION,THEY APPEAR IN LARGE AMOUNTS.7.OTHER CONSTITUENTS:FOUND ONLY IN VERY SMALL AMOUNTS.INCLUDE CARBOHYDRATES,PIGMENTS,FATTY ACIDS,MUCIN, ENZYMES,HORMONES,ETC……….

B.INORGANIC CONSTITUENTS

1.WATER :THE MOST ABUNDANT OF ALL CONSTITUENT

2.NACL :PRINCIPLE INORGANIC SALT

3.K+,Ca+,Mg+ :OCCURS AS CHLORIDES,SULPHATES,AND PHOSPHATES

4.SO4-- :DERIVED FROM AMINOACIDS

5.PO4--- :OCCURS AS SODIUM COMPOUNDS

6.NH4+ :OCCURS AS AMMONIUM SALTS,DERIVED FROM PROTEIN CATABOLISM AND ALSO FROM GLUTAMINE

Urea is synthesized in the liver - it is transported by free diffusion through membrane

Ammonia is released from Gln - buffer function in the urine

Creatinine is a product of muscle metabolism-it is not reabsorbed by the tubules → creatinine clearance

Uric acid is a final product of endogenous and dietary purine degradation

Urobilinogen (UBG) is formed from bilirubin in a small intestine- can be oxidized to urobilin in urine.

N-containing compounds in urine

creatinine

Uric acid

AMMONIA

UROBILINOGEN

ABNORMAL COMPOSITION OF URINE

URINE AMOUNT URINE COLOUR URINE CINSISTENCY URINE ODOUR URINE STERILITY URINE PH URINE SPECIFIC GRAVITY URINE GLUCOSE URINE KETONE BODIES(acetone) BLOOD IN URINE BACTERIA IN URINECASTS CRYSTALS

Normal :1200-1500 mlAbnormal: Under 1200 ml Decreased fluid intake

Kidney failureAbnormal: Over 1500 ml

Diabetes Diuretics Increased fluid intake

URINE AMOUNT

Abnormal: • Dark amber

Insufficient fluid intake resulting in concentrated urine• CloudyInfectious process:

• Dark orangeDrugs (e.g., Pyridium)

• Red or dark brown:Disease process causing blood in urine

URINE COLOUR

Normal: Clear liquidAbnormal: Mucous plugs, viscid, thick

eg :Infectious process

URINE CONSISTENCY

Normal: Faint aromaticAbnormal: Offensive

Infectious process

URINE ODOUR•Foul smelling odour is a symptom of urinary tract infection

Normal: No microorganisms presentAbnormal: Microorganisms present

eg :Infection of the urinary tract

URINE STERILITY

Normal: 4.5 to 8Abnormal: Over 8

Urinary tract infection, metabolic / respiraory alkalosis, fanconis syndrome

Abnormal: Under 4.5Uncontrolled diabetes, starvation, dehydration, fever, phenyl ketonuria, alkaptonurea , acidosis

URINE – PH (4.6 -8.0)•Protein diet increase the acidity of urine ,vegetarian diet increases the alkalinity

Normal: 1.010 to 1.025Abnormal: Under 1.010

Eg :Diabetes insipidus, kidney disease, overhydration

Abnormal: Over 1.025Eg :Diabetes mellitus, underhydration, nephritic syndrome.

URINE-SPECIFIC GRAVITY

Normal: Not presentAbnormal: Present

Eg :Diabetes mellitus

URINE GLUCOSE

Normal: Not presentAbnormal: Present

Eg :Diabetic coma, starvation, prolonged vomiting

URINE KETONE BODIES (ACETONE)

• Red blood cell in blood can due to the vigourous exercise or exposure to toxic chemicals• High amount of WBC is a symptom of infection• Other symptoms of blood in urine due to bacterial infection, parasitic infection(malaria),scurvy, tumours•OTHER CELLS ARE ALSO FOUND IN URINE LIKE EPITHELIAL CELLS.

BLOOD IN URINE

Normal: Not presentAbnormal: Occult

Eg :Kidney diseaseAbnormal: Bright red

Eg :Hemorrhage

URINE -BLOOD

Microscopic Examination Pyuria: WBC in Urine

Normal:Men: <2 WBCs per hi power field

Women: <5

•WBC generally indicate the presence of an inflammatory process somewhere along the course of the urinary tract

BLOOD IN URINE -HEMATURIA

RBC's may appear normally shaped, swollen by dilute urine or crenated by concentrated urine.

The presence of dysmorphic (odd shaped) RBC's in urine suggests a glomerular disease such as a glomerulonephritis.

CRENATED

DYSMORPHIC

Too many squamous epithelial cells in urine….

EPITHELIAL CELLS

Sqamous epithelial cells

•Bacteria are common in urine specimens (from contamination)•Therefore, microbial organisms found in all but the most scrupulously collected urines should be interpreted in view of clinical symptoms.

BACTERIA IN URINE

A:CRENATED RBC B:RBCC:BACTERIA

• ↑ proteins → proteinuria (glomerulonephrititis, bacterial infection, pregnancy)

• 150 mg of proteins are excreted daily

● ↑ glucose → glycosuria (diabetes mellitus, emotion stress)

• renal threshold for Glc is around 10 mmol/L

• ↑ ketone bodies → ketonuria (starvation, diabetes, pregnancy)

• other pathological components: bilirubin, blood (ery, Hb),…

PATHOLOGICAL COMPONENT OF URINE

Urinary sediment = microscopic examination of urine

• examination of urinary sediment evaluates the presence and number of organ components – cells (ery, leu, epithelial cell, bacteria) and nonorgan components (crystals)

• crystals are mostly composed of calcium oxalate or calcium phosphate

• urate stones (from uric acid) - gout, acidic pH of urine

OXALATE CRYSTALS URIC ACID CRYSTALS

CAST

• Small fibrous object formed of protein & other material

•It settle in kidney tubules & collecting ducts

•Large number of cast in urine is a sign of kidney disease

Hyaline casts are composed primarily of a mucoprotein (Tamm-Horsfall protein) secreted by tubule cells.

Causes: Low flow rate, high salt concentration, and low pH, all of which favor protein denaturation and precipitation of the Tamm-Horsfall protein.

HYALINE CAST

Hyaline cast appear transparent

Red blood cells may stick together and form red blood cell casts. Indicative of glomerulonephritis, with leakage of RBC's from glomeruli, or severe tubular damage.

RED CELL CASTS

Usually indicates pyelonephritis (kidney infection)Other causes: Interstitial Nephritis (inflammation of the tubules and the spaces between the tubules and the glomeruli. )

WHITE CELLCASTS

NON ORGAN COMPONENTS IN

URINE ARE CALLED

CRYSTALS

oFormation is favored in alkaline urine.

oUrinary tract infection with urease producing bacteria (eg. Proteus vulgaris) can promote struvite crystals by raising urine pH and increasing free ammonia.

STRUVITE CRYSTAL

High uric acid in blood (by-product of purine digestion/high protein diet)Associated with gout (arthritis)

URIC ACID CRYSTALS

They can occur in urine of any pH. Causes: Dietary asparagus and ethylene glycol (antifreeze) intoxication

CALCICM OXALATE CRYSTALS

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