Physical examination of urine

1. URINE ANALYSIS
P.Sunil kumar
Haematology & Transfusion Medicine
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4. INTRODUCTION
• Urine is an excretory product of the body.
• It is formed in the kidney.
• Urine examination helps in the diagnosis of
various renal as well as systemic diseases.
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5. Collection of urine
• Done in clean container
• Should be examined freshly
• Best sample early morning
• Culture-sterile containers are used
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6. Types of Specimens
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7. Types of sample
• Random sample-ordinary qualitative test
• Early morning sample –nephritis
• 2hr post prandial sample-DM
• Mid stream urine collection-culture
• 24hrurine sample-quantitative analysis
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8. Collection method
• 24hr urine –void & discard urine at particular
time. Collect all urine for next 24hr.
• Mid stream urine-initial portion of urine
should be discard. only the mid stream urine
should be collected.
• Catheterized specimen-insertion of tube or
catheter through the ureter into the bladder
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9. Preservatives of urine
Preservative Concentration limitation
toluene 2ml/100ml Floats on the surface of the urine.
good for constituent
formalin 3drops /100ml urine Good for sediment. Precipitate
protein.
thymol 1crystal/100ml Interfere with acid precipitation
test for protein
chloroform 5ml/100ml Forms upper layer. changes
cellular sediment charactrestics.
Boric acid 0.3gm/120ml of
urine
Yeast can still grow .uric acid
crystal get precipitated.
Conc.HCL 10ml/24hr urine Best preservative for all chemical
examination, especially for ca,uric
acid ,crea,urea.
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10. COMPOSITION OF NORMAL URINE
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11. CHEMICAL CONSTITUENTS
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12. urine analysis
• Physical examination
• Chemical examination
• Microscopy examination
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14. PHYSICAL PROPERTIES
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15. Physical examination of urine
• volume
• Colour
• Odour
• Apperance
• pH
• Specific gravity
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17. volume
●VOLUME-24hr
neonates-30-60ml
children -600-700ml
adult -600-2500ml
• Oliguria-urinary excretion less than 500ml
• Polyuria-urinary excreation greater than 2500ml.
• Anuria-complete cessation of urine.
• Disuria- painful in voiding time.
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18. polyuria
-DM/Insipidus
-diuretics
-intravenous saline /glucose
-chronic renal failure
-addison’s disease, decrease of
adreno cortical hormone.
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19. Oliguria
-dehydration
vomiting
diarrhea
exessive sweating
-renal ischemia
-acute renal tubular necrosis
-acute glomerulonephritis
-obstruction to urinary outflow
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20. • Anuria -complete suppression of urine
formation .
-renal collapse
-severe case of acute nephritis
-burns
-transfusion reaction
-traumatic shock
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21. COLOR
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22. colour
• Normal –straw colour
• Colourless- dilution DM
• Milky-chyluria due to filariasis ,ABD Lymphadenopathy
• Yellow to Brown -jaundice
• Brownish yellow or green-bile pigment
• Orange red or orange brown-urobilinogen
• Bright red-fresh blood
• Brownish black-poisoning
• Black-alkaptnuria
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23. ODOR
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24. odor
• Fresh urine-aromatic odour
• Urine allow to stand-strong ammonic smell
because of decomposition of urea with
liberation of ammonia.
• Ketone bodies-fruity odor
• Infants with phenylketonuria-musty odour
• Putrid odor-UTI
• Fecal odor –E.coli cystitis
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25. Appearance
• Normal-clear
• Cloudy due to
-amorphous phosphate(neutral or alkaline
condition)
-amorphous urates(acidic urine)
• Which disappear on heating.
• In disease – urine cloudy due to
-presents of WBC
-presents of bacteria or fungi
-colloidal suspension of fat or chyle
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26. pH
• Average - 4.6-8.0
• Average pH -6.0-presents of sulphates,
phoshate,chloride.
• Alkaline urine-vegetarian &urine on standing
• Measurements of pH-
1.litmus paper
2.pH paper or nitrazine paper
3.Dip stick method
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27. Dip stick method
• Reagent
 0.2% w/w methyl red
 2.8%w/w bromo thymol blue
 97.0%w/w non reactive ingradiant
• Principle:-
- Based on double indicator principle.
-gives broad range of colors covering entire urinary PH.
-color change from
orange-yellow-green-blue
(Acidic) (alkaline)
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28. Acidic urine
High protein intake and ingestion of acidic
fruits.
Respiratory acidosis
Metabolic acidosis-uremia, diabetes mellitus,
starvation .
E.coli infection
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29. Alkaline urine
• Respiratory alkalosis
• Metabolic alkalosis(excessive vomiting)
• UTI due to proteus and pseudomonas
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30. SPECIFIC GRAVITY
• Normal specific gravity-1.015-1.025
• Urines of low specific gravity are called
hyposthenuric (<1.007) while urines of fixed
sp.gravity of about 1.010 are known as
isothenuric.
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31. Specific gravity measurement
• Urinometer
• Refractometer
• Dip stick method
• Osmometer
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32. urinometer
• This is a bulb shaped instrument that has a
cylindrical stem ,which contains a scale
calibrated in sp.gravity reading. This instrument
is floated in a cylinder containing urine.
• The depth to which it sinks in the urine indicates
the sp.gravi
of urine
• Stem reading-1.000 to
1.060.
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34. Urinometer method
• Principle:-The method of measuring
sp.gravity of urine is based on the principle of
buoyancy. An increased solute concentration or
increased sp.gravity increases the upthrust of
the solution correspondingly.
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35. procedure
• Mix the urine & pour into the cylinder of 25ml
capacity.
• Carefully float the urinometer by grasping the
stem of urinometer at the top and inserting
slowly into the urine.
• Swirl the urinometer slightly as it is inserted.make
sure the instrument floats freely away from the
sides of container.
• Take the reading from the graduation gives on the
stem at lower meniscus formed at eye level.
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37. Correction for temperature
• To correct the Sp.gravity reading for
temp, place the thermometer in the urine &
note the exact temp.
• Then add 0.001 to the reading for each 3ºC
above the temperature for which the
urinometer is calibrated.
• Subtract 0.001 from the reading for each 3ºC
which the urine is below the temp of
calibration.
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38. • Eg:-
Temp of urine is 32ºC
calibration temp is20ºC
sp.gravity of the urine is measure at 1 .011
corrected sp.gravity =
[(32-20)×0.001] +1.011=1.015
3
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39. Correction for abnormal solute
concentration
• Albumin :- for each gram of albumin/100ml,
sp.gravity rises by 0.003 and this is subtracted
.
• Glucose :- for each gram of glucose /100ml,
sp.gravity raises by 0.004 and this must be
subtracted.
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40. Correction for dilution
• If the volume of urine is insufficient for
measuring Sp.gravity, urine can be diluted
with distilled water.
• Multiply the last two numbers of the
recorded Sp.gravity by the dilution factor.
• Eg:- urine dilution is1:5 , record Sp.gravity is
1.003
corrected Sp.gravity is 1.003×5=1.015
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41. Disadvantages of urinometer
• Large amount of urine is required.
• Turbid urine may make reading of the scale
difficult.
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42. Refractometer
• To determine the Sp.gravity of urine by this
method require only few drops of urine.
• PRINCIPLE:-
 The refractive index of a solution is related to
the content of dissolved solids present in
solution.
 µ=Va/Vs
This ratio varies directly with
the number of dissolved parti-
cles in the solution .
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43. Conti……….
Although the instrument measures the
refractive index of a solution , scale reading is
generally calibrated in terms of sp.gravity.
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44. Dipstick method
• Reagent
2.8% w/w bromothymol blue
28.4% w/w NaoH
• Principle
PH change of pretreated polyelectrolyte in
relation to ionic strength, the released hydrogen
ion is indicated by PH indicator.
• Colour changes from a dark blue at a low
sp.gravity to yellow green at high sp.gravity
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45. • High sp.gravity
excessive sweating
glycosuria
acute nephritis
albuminuria
all causes of oliguria
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46. • Low specific gravity(less than 1.010)
-excessive water intake
-chronic nephritis
-dibeticincipidus
-all causes of polyuria except DM
• Low or fixed Sp.gravity(1.010-1.012)
-chronic nephritis
-ADH deficiency
-arteroscerotic kidney
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47. Thank you
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