URIN EXAMINATION

PURPOSE

-To find out metabolic / Endocrine disturbance

Eg: Metabolic disturbance-Bilirubin in urin

DM-Endocrine abnormality

-To detect intrinsic conditions –Urinary tract/ Kidney

Eg: Diseased kidney-Cannot function normally

- Volume -Composition of body fluids - Maintaining acid base balance

Structural elements:-

LeukocytesRBCEpithelial cells Cast cells in urin. 

REGULATION

3 process1.Filtration of blood plasma –Glomeruli

2.Selective reabsorption – Threshold Substances- Fatty acids, Amino acids, Salt , Water

3.Secretion-Creatinin, Potassium, Uric acid, Organic ions of H+

VOLUME

GFR-120 ml/Minute

Normal urin excretion – 1200 ml-1500ml / Day

Poly urea - >2000ml / 24 hours

Oligo urea- <500ml / 24 hours

Anurea - <100ml / 24 hours

COMPOSITION OF NORMAL URIN

Volume – 600ml-2500ml/24 hours (1500ml)

Specific gravity – Random : 1.003-1.030 24 hrs specimen-1.015-1.030PH- 4.7-7.5 (6)

Total solids- 30-70 gram/litre

CONSTITUENTS

Na+ - 3-4 gram/24 hours

K+ - 1.5-2 gram / 24 hours

Cl- - 9 – 16 gram / 24 hours

Calcium – 0.1-0.3 gram / 24 hours

Inorganic phosphate - 1- 1.5 gram / 24 hours

Sulphur – 0.7 – 3.5 gram / 24 hours

Magnesium – 0.005-0.2gram / 24 hours

Ammonia – 0.3 - 1 gram / 24 hours

Iodine – 50 – 250 micro gram / 24 hours

Arsenic , Lead - < 50 micro gram / 24 hours

Urea – 25 – 30 gram / 24 hours

Creatinine - 60 – 150 mg/24 hours

Ketone bodies – 3 – 15 mg / 24 hours

Oxalic acid – 15 – 20 mg / 24 hours

Phenols – 0.2 – 0.5 gram / 24 hours

Vitamins, Hormones, Enzymes – detected in small quantity

LABOURATORY TESTS

1.Physical examination

2.Chemical examination

3.Microscopic examination

Collection of urin specimen

Type of specimen – 1.First voided mid stream morning urin  More concentrated urin 2.For urgent urin examination Random urin specimen

Container used for urin collection :

Clean & Dry wide mouth glass / Plastic bottles with screw cap tops

( Capacity about – 250-300ml) 

Instruction given to the patient:

Void directly in to the containerDuring the collection initial portion of urin stream is allows to escape while the mid stream portion is collected

Specimen from infants & young children can be collected in a disposable collection apparatus.

Qualitative test – First voided mid stream morning urine

Quantitative tese – 24 hours collection

 

PreservationRoutine urin analysis – should be examined while fresh (with in 1 hour of collection)When urin is kept for longer than 1 hour before analysis- Should be stored at 2-8 degree centigrade in refrigerater.To avoid deterioation of chemical & cellular material Prevent multiplication of bacteria.

Recommended preservatives1.Toluene-2ml/100ml of urin (Effective if bacteria are already)2.Formalin-3drops /100ml of urin (Good for sedimentation, may precipitate proteins)3.Thymol-1 small crystal / 100ml of urin (May interfere with the acid precipitation test for proteins)

4.Chloroform- 5ml/100ml of urin ( form upper layer)5.Commercial preservative tablets these release formaldehyde – 1 tab/30ml of urine (Concentration of formaldehyde is controlled)

PHYSICAL EXAMINATION1.Volume2.Colour3.Appearence4.Sediment formation5.Odour – Ketone bodies : Sweet/ fruity odour Bacterial contaminations-Pungent odour 6.Reaction of PH – Phenyl ketone urin – musty odour  

CHEMICAL EXAMINATION1.Glucose – Benedict’s qualitative test2.Protein – Heat coagulation test3.Ketone bodies – Rothera’s test4.Bile pigments – Fouchet’s test5.Bile salt – Hay’s test6.Urobilinogen – Ehrlich’s test7.Occult blood – Benzididene test

MICROSCOPIC EXAMINATION

1.Leucocytes2.RBC3.Casts4.Mucus threats5.Yeast cells6.Bacteria7.Fat bodies and droplets9.Crystals

PHYSICAL EXAMINATION

Determination Normal finding

Abnormal finding

Pathologic condition

Non pathologic condition

VOLUME1.1st voided morning urin

2.24hrs collection

50-200ml >500ml

<20ml

>2000ml<500ml<100ml

Poly uria-DM,DI

Oliguria, Anuria, Renal conditions, Post renal conditions

Poly uriaOligo uriaAnuria

Increase water intakeClimate changes

Determination Normal finding Abnormal finding Pathologic condition

Non pathologic condition

Colour Pale yellow YellowDark yellowBrownish yellow to orange

White

Pink to red

Presence of water soluble bilirubin- Hepatic and Post hepatic conditions

Presence of chyle Pus –Many WBCs

Presence of Hb,MyoglobinAcute febrile diseaseRBC-Renal disease

Intake of following food yellow colour Vit-B complexSennaSerotoninNitrofurantoinConcentrated urinPhosphates

Excretion of red urine after eating beets – Inherited metabolic sensitivity

Very pale colouration

Brownish

Blue to Green

DMDI

Presence of Homogentissc acid –Alkaptonuria

Melanin-Malignant melanoma

Presence of biliverdinPseudomonas infection

High fluid consumptionDirutic drugsNatural dirutics

Intake of Choloroquine, Iron compounds, Quinine

Intake of Methyl blue

Determination Normal finding Abnormal finding

Pathologic condition

Non pathologic condition

Appearance Usually clearSometimes Cloudy

Turbid

Hazy

Smoky

Milky

Presence of abnormal number of leucocytes,Epithelial cells, Bacteria

Mucus

RBC

Chyle, Fat

Precipitation of amorphous phosphate,Amorphous urates in acid urine

Determination Normal finding Abnormal finding

Pathologic condition

Non pathologic condition

Reaction Litmous paper –PH paper

Usually acidic4.8-7.5

<4.8

>7.5

UTI- E.coli infectionAcidosisFeverKetosis, Severe diarrhea, Uraemia

Urine retention, Choronic cystitisUTI-Proteus pseudomonas

Protein rich diet

Urine collected after taking large quantities of citrus fruits,As a result of taking alkalies

Determination

Normal finding

Abnormal finding

Pathologic condition

Non pathologic condition

Odour Characteristic aromatic

FruityAmmonicalFoul smelling

AcidosisKetosisPresence of acetoneCystitis, Urin retentionUTI, Colliform bacteria

Decomposition of urea to ammonia by bacterial action

Determination Normal finding Abnormal finding

Pathologic condition

Non pathologic condition

Sediment formation at the bottom of the container after collection

Usually no formation of sediment / very little sediment

Sediment present – Moderate to high propotion

Leukocytes –Pus cellsRBC, Epithelial cells, Casts

Bacteria-uniform cloudiness- Does not settle outGonorrhoea

Pricipitate of amorphous phosphate-WhiteAmorphous urates-pinkish white Phosphate-

dissolve when acid is added.

Urate-Dessolve when the specimen is heated

Determination Normal finding

Abnormal finding

Pathologic condition

Non pathologic condition

Specific gravity – Urino meter

Random specimen:1.003-1.06024 hrs collection:1.015-1.030

Low specific gravity-Hyposthes uria

High specific gravity-Hypersthen uria

Choronic nephiritisPylo nephritisDIProtein malnutrition

DMFeverDehydrationEclampsia

PROTEIN UREA

Heat coagulation test-Place 2/3 of clear urin in a test tube-Boil the upper portion over a flame-Turbidity develops-Add 1/2 drops of acetic acid-Reboil the specimen.

Observation

Presence of turbidity- Protein present

Principle of test

Coagulation of protein by heat

GLYCOSUREA

Benedict’s qualitative test

Reagent- Benedict’s qualitative reagent-Blue colour

Procedure

-Transfer about 5ml of Benedict’s qualitative reagent in a test tube.-Add 8 drops of urine.-Heat carefully on the flame of a spirit lamp for 2-3 minute.-Cool under tape water / by placing in a beaker containing tap water.

COLOUR CONCLUSIONBlue NilGreen +Yellow ++Orange +++Brick red ++++

Observations

BILE SALTSHay’s test

Procedure

-Place about 10ml urine in a test tube-Add a little dry sulfur powder in to the surface of urine-Observe the sulfur particles

Observation

Sulfur particles sink to bottom-Bile salt present

Sulfur particles remain floating-Bile salt absent

Causes

1.Hepatic jaundice

2.Post hepatic jaundice

Bile pigments

-Take few ml of urine in a test tube-Add to drops of marshal iodine along the wall of the test tubeKeep it for 2 min.

Observation

Green layer formed between the urine and marshal iodine- Present

No colour change- Absent

Causes

1.Hepatic jaundice

2.Post hepatic jaundice

Urobilinogen

Ehrlich test.

MICROSCOPIC EXAMINATION