The document discusses urinalysis and its value in clinical medicine. It describes the formation of urine and its physical composition. Normal components include urea, uric acid, and ammonia. Urinalysis involves physical, chemical, and microscopic examination to obtain health information. Physical examination assesses volume, color, odor, and specific gravity. Chemical examination detects substances like glucose, ketones, proteins, blood, and pH. Microscopic examination identifies cellular elements and crystals. Urine specimens are obtained through various collection methods and stored appropriately to prevent changes prior to testing.

1. Value Of
Urinalysis
In Clinical
Medicine
Dr./ Sahar HAMDY
Medical consultant el-mataria
teaching hospital, cairo

2. Introduction
Urine formed in the kidneys, is a product of
ultrafiltration of plasma by the renal glomeruli.

3. Formation of Urine
Three processes of
urine formation:
glomerular filtration
tubular reabsorption
tubular secretion
The nephron:
allows for •
reabsorption of
water and
electrolytes
plays a vital role in •
maintaining normal
fluid balance

4. Physical Composition and
Chemical Properties
Urine
95% water
5% waste products
Other dissolved
chemicals
Urea, uric acid, ammonia,
calcium, creatine,
sodium, chloride,
potassium, sulfates,
phosphates,
bicarbonates, hydrogen
ions, urochrome,
urobilinogen

5. Apply Your Knowledge
Components of normal urine include:
A - urea, uric acid and ammonia.
B - chloride, potassium and sugar.
C - red blood cells, sperm and H2O2
D - hydrogen ions, urochrome, and
uranium.
5

6. Apply Your Knowledge Answer
Components of normal urine include:
A - urea, uric acid and ammonia.
B - chloride, potassium and sugar.
C - red blood cells, sperm and H2O2
D - hydrogen ions, urochrome, and
uranium.
6

7. Obtaining Specimens
General guidelines:
 Follow the procedure
 Use the type of specimen container
indicated by the lab
 Label the specimen container before giving
it to patient
 Explain the procedure to patient
 Wash your hands before and after
procedure
 Complete all necessary paperwork

8. Specimens Types
It Varies in method used and in time frame in which to
collect specimen
Types of specimens:
Random 
First morning 
Clean catch midstream 
Timed 
24 hour 

9. Specimens Types (cont.)
 Random – most common, taken anytime of day
 First morning – has a greater concentration of
substances, taken in morning
 Clean catch midstream – genitalia is cleaned, urine
is tested for microorganisms or presence of infection
 Timed – specific time of day, always discard first
specimen before timing
 24 hour – used for quantitative and qualitative
analysis of substances

10. Urinalysis
Evaluation of urine to obtain information about body
health and disease
Four types of testing:
 Physical
 Chemical
 Microscopic
 Culture and sensitivity( beyond the scope of lecture)

11. Preservation and Storage
Changes that affect
the chemical or
microscopic
properties of urine
occur if urine is kept
at room temperature
for more than 1 hour
Refrigeration – most
common method for
storing and preserving
urine
It prevents bacterial
growth for 24 hours.
After 24 hours use
chemical preservation

12. Normal Values of Urine
 Normal values of various
elements have been
established
 A routine vol. of 12 mL
urine is analysed
 Average adult daily urine
output is 1250 mL/24
hours(>1mL/Kg/hour)
 Intake and output should
be approximately the
same

13. I- Physical Examination of Urine
Visual examination of
physical characteristics
Volume
Color and turbidity
Odor
Specific gravity/
Osmolality

14. Urinary volume
Normal = 600-1550ml
Polyuria- >2000ml
Oliguria-<400ml
Anuria-complete cessation of urine(<200ml)
Nocturia-excretion of urine by a adult of
>500ml with a specific gravity of <1.018 at
night (characteristic of chronic
glomerulonephritis)

15. Causes of polyuria






Diabetes mellitus
Diabetes insipidus
Polycystic kidney
Chronic renal failure
Diuretics
Intravenous saline/glucose

16. Causes of Oliguria
Acute renal failure: Pre-renal, renal and post-renal
Hypovolemia: Dehydration / vomiting, diarrhea, excessive
sweating
Renal ischemia
Acute tubular necrosis
Obstructive Uropathy

19. Urinary Color and Appearance
Normally urine is amber yellow and clear
Colourless: D.I., D.M., diuretics,..
Milky: Pus, chyluria
Orange: Fever, excessive sweating,
metronidazole, rifampicin,..
Red: Beet-root, hematuria, myoglobinuria,
Brown: Porphyria, alkaptonuria
Turbidity means cellular elements and bacteria(which clear by
centrifugation) and crystals(which clear by addition of acids or
bases); it’s the microscopic examination which will determine
which type…

20. Odour of Urine
Normal: Urinefrous(aromatic volatile acids)
Sweety: Glucose
Fruity: Ketones
Foul, offensive: old specimen, pus

21. Specific Gravity of Urine
Depends on the concentration of various solutes in the urine.
N.Sp.Gr. = 1.016 – 1.022
Hyperosthenuria: dehydr., D.M.,..
Hyposthenuria: polyuria(except diabetes)
Isosthenuria: Fixed at 1.010 in CRF

22. Measurement of Specific Gravity
It’s measured by:
 -urinometer
 -refractometer
 -dipsticks
Urinometer:
 Take 2/3 of urinometer container with urine
 Allow the urinometer to float into the urine
 Read the graduation at the lowest level of urinary
meniscus
*Correction of temperature & albumin is a must.*
Urinometer is calibrated at 15 or 200c
So for every 3oc increase/decrease add/subtract
0.001
For 1gm/dl of albumin add 0.001

23. Apply Your Knowledge
What is the specific gravity shown on this
refractometer screen?
23

24. Apply Your Knowledge Answer
What is the specific gravity shown on this
refractometer screen?
The specific
gravity
shown here
is 1.030
24

25. Urinary Dipsticks

26. Dipsticks Use
The main advantage of
dipsticks is that they
are
1. convenient,
2. easy to interpret,
3. and cost-effective
•
The main disadvantage
is that
1.Not very accurate (the
test is time-sensitive).
2. It is a qualitative and
not a quantitative test
(no precise information
about the severity of
the abnormality) .

27. II- Chemical Examination of Urine
Usually done with reagent strips or tablets
Used to determine body processes such as CHO metabolism,
liver or kidney function or acid-base balance.
Used to determine presence of drug, toxic environmental
substances or infections

28. Kidney involvement in multisystem disease

29. Chemicals Found in Urine
pH – provides information about metabolic status, diet,
medication or several conditions
Glucose –diabetes
Ketone bodies – Low carbohydrate diet, or starvation
Protein –Intrinsic renal disease
Blood (hemoglobinuria) –Menstruation, urinary tract infection or
trauma
Bilirubin / urobilinogen –liver disease
Nitrite –bacterial infection
Leukocyte esterase –Infection
Phenylketones / aminoacids –PKU, aminoaciduria
Others: Ur. Calcium, microalbuminuria, ur. Magnesium, ur.Po4, ..

30. 1- Urinary pH/ reaction
Reaction reflects ability of kidney to maintain normal hydrogen ion
concentration in plasma & ECF
Normal= 4.6-8
Tested by :- 1.litmus paper
2. pH paper
3. dipsticks
Significance:
Acidic PH <4.5= High ptn. Diet, metabolic acidosis, starvation, E.coli, ..
Alkaline PH >8= RTA, vegeterians, metabolic alkalosis, proteus, ..
Limitations:
 Interference: Bacterial overgrowth

Run-Over Effect: Protein pad effect on PH pad
Other Tests:
 Titrable acidity
 Blood gases

31. Dipstick for pH
Buffers from the protein area of the
strip (pH 3.0) spill over to the pH
area of the strip and make the pH of
the sample appear more acidic than
it really is.

33. 2- Urinary Glucose detection
Detection of reducing sugars by:
Benedict’s Test 
Urinary dipsticks 
Benedict: Semi-quantitative)
Principle-Benedict’s reagent contains cuso4.In the presence of •
reducing sugars cupric ions are converted to cuprous oxide which is
hastened by heating, to give the color.
Method- take 5ml of benedict’s reagent in a test tube, add 8drops of •
urine. Boil the mixture.
 Blue-green = negative
 Yellow-green = +(<0.5%)
 Greenish yellow = ++(0.5-1%)
 Yellow = +++(1-2%)
 Brick red = ++++(>2%)
N.B: Renal threshold must be passed in order for glucose to spill into urine

34. Urinary Dipsticks for Glucose
However, Benedict detects all
reducing substances like glucose,
fructose, & other reducing
sustances such as:
Sugar
Disease
Galactose
Galactosemia
Lactose
Lactase def. or
intolerance
Fructose
Fructose intolerance
Pentose
Essential pentosuria
Maltose
Non-pathogenic
N.B: Sucrose is not a reducing substance
To confirm it is glucose,
dipsticks can be used
(glucose oxidase)

35. Causes of glycosuria
Glycosuria with
hyperglycaemia• Diabetes,
• Acromegaly,
• Cushing’s disease,
Hyperthyroidism,
• Drugs like
corticosteroids
Glycosuria without
hyperglycaemia• Renal tubular
dysfunction
• Renal Glycosuria
• TTT with SGLT(sodium
glucose transport
inhibitors used to treat
DM)

36. 3- Urinary ketone detection
There are 3 types of ketone bodies:
 Acetone
 Acetoacetate
 Beta-hydroxy-butyrate
Detection of ketones by:
 Rothera’s Test
 Dipsticks
Rothera’s t. principle:Acetone & acetoacetic acid react with
sodium nitroprusside in the presence of alkali to produce
purple colour.
Method- take 5ml of urine in a test tube & saturate it with •
ammonium sulphate. Then add one crystal of sodium
nitroprusside. Then gently add 0.5ml of liquor ammonia along
the sides of the test tube.
Change in colour indicates a positive result •
•

37. Ketonuria
Significance:
Diabetes
Starvation
Severe vomiting/diarrhea
High fever
Limitations:
 Measure only acetoacetate
and not other ketones
>>>Cannot detect alcoholic
KA(with ↑BHB >AA)
 Reagents can undergo
degradation with exposure
to moist of air

38. 4- Urinary protein detection
--Normally, up to 150 mg total
proteins may be found in urine per
24 hours
--More than 300 mg per 24 hours is
termed “ Frank Proteinuria “
N.B
Test-thermal method:water-bath)
Proteins has an unusual and peculiar
property of precipitation at 400 -600c
& then dissolving when urine is
brought to boiling at 1000c & then
reappearing de novo on cooling of
sample.
Protein
Max.
(mg/day)
% of
Total
Albumin
60
40
TammHorsefall
60
40
Igs
24
12
Secretory 6
IgA
3
Others
5
10

39. Tests for proteins
Test – heat & acetic acid test
Principle-proteins are denatured & coagulated on heating to
give white cloud precipitate.
Method-take 2/3 of test tube with urine, heat only the upper part
keeping lower part as control.
Presence of phosphates, carbonates, proteins gives a white
cloud formation. Add acetic acid 1-2 drops, if the cloud persists it
indicates it is protein(acetic acid dissolves the
carbonates/phosphates)
Other Tests:
-Sulphosalicylic acid SSA turbidity test
-Dipsticks
-Esbach-albuminometer- for quantitative estimation of proteins
-Urine protein electrophoresis(UPEP)

40. Albumin Excretion:
Alternative Methods for expressing the normal range
Sample
Normal Value
24-h urine collection
< 30 mg / 24 hrs
Timed sample from ambulant pt.
< 20 micro-g / min
Timed sample for recumbent pt.(or
over-night sample)
< 10 micro-g / min
Albumin / creatinine ratio on a
random urine sample
< 2.5 mg / mmol in male)
< 3.5 mg / mmol (in female)

41. Dipsticks for proteins
Limitations:
Interference: Highly alkaline urine
-Almost all dipsticks detect proteins if present
in an amount more than 300 mg / 24 Hs
-They cannot detect micro-albuminuria (30150 mg) alb./24-h urinary sample >>>>>
Esbach –albuminometer can be used …
Bences- Jones proteins are light chain
globulins present in multiple myeloma,
macroglobulinemias and lymphomas
They are detected by: UPEP

42. Importance of micro-albuminuria
 It is an early indicator of subclinical nephropathy
either due to on intrinsic kidney disease or due to a
cardiovascular disease..
 It may be an important prognostic marker..?
 It is considered as a routine check-up in all cases of
diabetes mellitus or in hypertension (every 6
months)..
 Serial rise in micro-albuminuria during the first 48
hours after admission to an intensive care unit can
predict elevated risk for acute respiratory failure ,
multiple organ failure , and overall /CV mortality (as
a bad prognostic criterion.. )

43. Causes Of Proteinuria
Functional
• Pregnancy
• Orthostatic(<1
gm/24h)
• Severe
Ms.exertion
Prerenal
• Fever
• Hypoxia
• HTN
• Renal vein
thrombosis
• Severe
exfoliative
skin dis.(eg
psoriasis)
Renal
Postrenal
• GN
• NS
• Diabetes
• SLE
• Amyloidosis
• UTI
• Tumours
• Cystitis/Ureth
ritis
• Prostatitis
• Obstructive
uropathy
• Contaminated
vaginal
secretions

45. Apply Your Knowledge
A urine analysis has detected that a
patient has protein in his urine. Why
is this important?
45

46. Apply Your Knowledge Answer
A urine analysis has detected that a
patient has protein in his urine. Why
is this important?
Protein in the urine usually indicates an
intrinsic kidney disease
46

47. 5-Urine blood detection
Test- BENZIDINE TEST
Principle-The peroxidase activity of hemoglobin
decomposes hydrogen peroxide releasing nascent
oxygen which in turn oxidizes benzidine to give blue
color.
Method- mix 2ml of benzidine solution with 2ml of
hydrogen peroxide in a test tube. Take 2ml of urine &
add 2ml of above mixture. A blue color indicates +
reaction.

48. Significance
- Hematuria: Nephritis, trauma,..
- Hemoglobinuria: Hemolysis (decr.haptoglobin),..
- Myoglobinuria: Rhabdomyolysis
(N.haptoglobin),..
Limitations
- Interference: reducing agents, microbial
peroxidases
- Cannot distinguish between the above disease
processes
Other Tests
- Urine microscopic examination
- Urine cytology

49. Causes of hematuria
Pre renal- bleeding diathesis, hemoglobinopathies,
malignant hypertension.
Renal- Trauma, calculi, ac. & chr.
glomerulonephritis,
pyelonephritis, renal TB, renal tumours, Good-pasture syndrome and
Henoch-shonlein purpura
Post renal – severe UTI, calculi, trauma, tumors of
urinary tract

50. The Urine Dipstick:
Negative
Trace (non-hemolyzed)
Moderate (non-hemolyzed)
Trace (hemolyzed)
+ (weak)
++ (moderate)
+++ (strong)
Blood
Chemical Principle
Lysing agent to lyse red blood cells
Diisopropylbenzene dihydroperoxide +
Tetramethylbenzidine
Heme
------------> Colored Complex
Read at 60 seconds
RR: Negative
Analytic Sensitivity: 10 RBCs

51. 6- Urine bilirubin or Urobilinogen
Bilirubin
Test- fouchet’s test.
Causes
•
•
Liver diseases, injury, hepatitis
Obstruction to biliary tract
Significance
It correlates with D. serum
bilirubin
Limitations
Urobilinogen
Test- Ehrlich test
Causes- hemolytic anemia's and
hepatocellular jaundice
Significance
- High: increased hepatic processing of
bilirubin
- Low: bile obstruction
- Interference: prolonged
exposure of sample to light
- Only measures direct
bilirubin--will not pick up
indirect bilirubin
Limitations
- Ictotest (more sensitive
tablet version of same assay)
Other Tests
Other Tests
- Interference: prolonged exposure of
specimen to oxygen (urobilinogen --> urobilin)
- Cannot detect low levels of
urobilinogen
- Serum total and direct bilirubin

52. Dipsticks for bilirubin and urobilinogen
Bilirubin
Urobilinogen

53. 7- Urinary detection of nitrites
Significance:>>>>>>Gram negative bacteriuria
Limitations
- Interference: bacterial overgrowth
- Only able to detect bacteria that reduce nitrate to
nitrite
Other Tests
- Correlate with leukocyte esterase and urine
microscopic examination (bacteria)
- Urine culture

54. The Urine Dipstick for
nitrite:
Chemical Principle
Negative
Positive
Acidic
Nitrite + p-arsenilic acid -------> Diazo compound
Diazo compound + Tetrahydrobenzoquinolinol
----------> Colored Complex
Read at 60 seconds
RR: Negative

55. 8- Urinary detection of leucocyte esterase
Significance
- Pyuria
- Acute inflammation
- Renal calculus
Limitations
- Interference: oxidizing agents, menstrual
contamination
Other Tests
- Urine microscopic examination (WBCs and
bacteria)
- Urine culture

56. The Urine Dipstick:
Leukocyte Esterase
Chemical Principle
Derivatized pyrrole amino acid ester
Negative
Trace
+ (weak)
Esterases
------------> 3-hydroxy-5-phenyl pyrrole
3-hydroxy-5-phenyl pyrrole + diazo salt
-------------> Colored Complex
++ (moderate)
+++ (strong)
Read at 2 minutes
RR: Negative
Analytic Sensitivity: 3-5 WBCs

62. III- Microscopic Examination of Urine
•
•
•
Centrifuge the urine sample for a few minutes(10-20fold conc.)
Discard the supernatant.
The solid part left in the bottom of the test tube (the urine sediment) is
mixed with the remaining drop of urine in the test tube and one drop
is analyzed under a microscope FOV:field of view:What is seen
through the ocular lens)
A normal urine contains few epithelial cells,
occasional RBC’s, few crystals.
 RBCs: N. Vs. Dysmorphic cells > 10 / Hpf
 Leucocytes: PNLs(glitter cells) > 3 / Hpf
Eosinophils, special stain
 Epithelial cells: Squamous cells; indicating contamination
Renal tubular and transititional cells; few are N.
Oval fat bodies; indicating IKD

63. Types of microscopy:
1. Phase contrast
2. Polarized
3. Bight field with special staining
N.B:Cells and casts begin to disintegrate in 1 - 3 hrs. at room
temp( refrigeration for up to 48 hours is a must to limit cell loss).
Presence of the following is considered “abnormal”:
Fungal hyphae or yeast, parasite, viral inclusions
Sperms(post-vasectomy),starch, mucus, fibres
Pathological crystals (cystine, leucine, tyrosine)
Large number of uric acid or calcium oxalate crystals

64. Abnormal microscopic findings
Per high power field(x40)
 > 3 erythrocytes
 > 5 leukocytes
 > 2 renal tubular cells
 > 1 bacteria
 Yeast
 Trichomonas
 Crystals
Per low power field(x10)
 > 3 hyaline casts
 > 1 granular cast
 > 10 squamous cells
(contaminated specimen)
 Any other cast (RBCs,
WBCs)

65. RBCS appear dysmorphic in glomerular bleeding;
whilst derived from LUT, they look normal

66. WBCs(leucocytes) denote GN or IN

67. Squamous cells
Tubular Epithelial cells

68. Transitional Cells

69. Oval Fat Bodies

70. LE Cells

71. Bacteria

72. Yeasts

73. Cytomegalovirus

74. Crystals in urine
Crystals are not a normal finding in a fresh urinary sample
Crystals in acidic urine
 Uric acid
 Calcium oxalate
 Cystine
 Leucine
 Tyrosine
 Cholesterol
 Bilirubin
Crystals in alkaline urine
 Amorphous phosphates
 Triple phosphates (NH4 Mg PO4)
 NH4 bi-urate
 Calcium carbonate
Others
Drug-induced (sulfonamide and radiocontrast)

75. Oxalate Crystals
Bi-pyramidal or bi-concave ovals

76. Triple Phosphate Crystals

77. Urate Crystals Flat-square plates

78. Leucine crystals

79. Cystine Crystals Flat Hexagonal Plates

80. Ammonium bi-urate crystals

81. Cholesterol crystals

85. Urinary Casts
 Urinary casts are cylindrical
aggregations of particles that form in
the distal nephron, dislodge, and
pass into the urine.
 In urinalysis they indicate kidney
disease.
 They form via precipitation of TammHorsfall mucoprotein which is
secreted by renal tubule cells.
 Cast formation is enhanced by:
• PH of urine
• Solute conc.
• Presence of plasma
proteins(albumin, globulin,
hemoglobin, myoglobin,..

86. Types of casts
Acellular casts
•
•
•
•
•
•
•
Hyaline casts
Granular casts
Waxy casts
Fatty casts
Pigment casts
Crystal casts
Broad casts
Cellular casts
• Red cell casts
• White cell casts
• Epithelial cell cast

87. Casts and clinical significance
Urinary Cast
Clinical Significance
RBCs Cast
• Glomerulo-nephritis
• Tubular bleeding
WBCs Cast
• Pyelo-nephritis, or interstitial nephritis(acute
Allergic), ATN
• AGN(post-strept), nephrotic syndrome,..
Hyaline Cast
• Normal(Tamm-Horsfall glycoprotein)
• Fever, exercise, dehydration, emotional stress,..
Tubular Cast
• Acute tubular necrosis
• Interstitial nephritis
Granular Cast
Non-Specific(can result either from breakdown of
cellular cast or from aggregation of pps)>>>indicate
CKD
Fatty Cast
• NS, DM, ATN, SLE

88. Casts and clinical significance
Urinary Cast
Clinical Significance
Broad Cast
CRF
(Formed in dilated remaining
tubules showing compensatory
hypertrophy)
Pigment Cast
(Formed by the adhesion of
metabolic breakdown products or
drug pigments)
•
•
•
Hemolytic anemia
Rhabdomyolysis
Liver disease
Epithelial Cast
ATN, intoxication with mercury,
salicylate or diethylene glycol
Crystal Cast
(Formed by incorporation of
Heavy crystal load
crystallised urinary solutes with
hyaline casts)
Waxy Cast
Prolonged stasis (ESRD

89. RBCS Cast

90. WBCs Cast

91. Hyaline Cast

92. Tubular Cast

93. Granular Cast

94. Fatty Cast

95. Waxy Cast

96. Cytological Examination
Staining:
o
o
o
o
o
Papanicolaou stain
Wright’s stain
Hansel’s stain
Immunoperoxidase sp. stain
Immunofluorescence sp. stain

97. Cytology
Normal
Reactive

98. Transitional Cell Carcinoma
Low Grade
High Grade

99. Squamous Cell Carcinoma
Prostatic Carcinoma

100. Common Microscopically Urinary
Findings in various Diseases
DISEASE
FINDINGS
1- Acute glomerulonephritis
Dysmorphic RBCs – RBCs and mixed
cellular Casts
2- Chronic glomerulonephritis
RBCs and broad waxy Casts
3- Acute pyelonephritis
Bacteria – Leucocytes – Granular,
leucocyte, waxy and renal tubular
epithelial Casts
4- Nephrotic syndrome
Oval fat bodies – Fatty casts – Waxy
casts
5- Acute tubular necrosis
Renal tubular epithelial cells –
Pathological Casts
6- Eosinophilic cystitis
No significant casts – Numerous
eosinophils(Hansel’s stain)

101. Urinalysis
Disease diagnosis
AND
Case study

102. Case 1
A 35-year old man undergoing routine
pre employment drug screening.
Glucose
Negative
Bilirubin
Negative
Ketones
Negative
S.G.
1.001
Blood
Negative
pH
5.5
Protein
Negative
Urobilinogen
0.2 mg/dL
Nitrite
Negative
L.E.
Negative
Physical characteristics: Clear.
. Microscopic: Not performed
Drugs Identified: None
Questions :
- What is your differential diagnosis?
- What would you do next to confirm
your suspicion?
- Would you order a microscopic
analysis on this sample?

103. Answer 1
Diluted urine with a low Sp. Gr.>>>>>
Request a morning urine sample>>>>>
If persisting low Sp.Gr.>>>>>
Possible diagnosis of diabetes insipidus

104. Case 2
A 42-year old woman presents with “dark
urine”
Glucose
Negative
Bilirubin
+++
Ketones
Negative
S.G.
1.020
Blood
Negative
pH
5.5
Protein
Negative
Urobilinogen
0.2 mg/dL
Nitrite
Negative
L.E.
Negative
Physical characteristics: Red-brown.
Microscopic: Not performed.
Questions
- What is your differential diagnosis?
- Could this be a case of hemolytic
anemia?
- How would you rule it out?
- What tests would you order next? Why?
- Would you order a microscopic analysis?

105. Answer 2
Possible gallbladder or hepatic disease.
No hemolytic anemia.
Perform Serum assessment for total and direct
bilirubin
Microscopic exam. is unlikely to provide additional
information for diagnosis

106. Case 3
A 27-year old woman presents with severe
abdominal pain.
Glucose
++
Bilirubin
Negative
Ketones
Trace
S.G.
Physical characteristics: clear-yellow.
Microscopic: Not performed.
1.015
Blood
Negative
pH
6.0
Protein
Negative
Urobilinogen
1.0 mg/dL
Nitrite
Negative
L.E.
Negative
Questions
- What is the most likely diagnosis?
- What do you make of the ketone result?
- What do you expect to happen to the
ketone measurement when treatment
begins?

107. Answer 3
Diabetes
May be associated with ketoacidosis
Ketones should become negative after treatment

108. Case 4
8-year old boy presents with discolored
urine
Glucose
Negative
Bilirubin
Negative
Ketones
Negative
S.G.
1.015
Blood
+++
pH
6.5
Protein
+
Urobilinogen
1.0 mg/dL
Nitrite
Negative
L.E.
Negative
Physical characteristics: Red, turbid.
Microscopic: erythrocytes = >100 per HPF
(almost all dysmorphic)
Red cell casts present.
Questions:
- What is the most likely diagnosis in this
case?
- Does the presence of red cell casts help
you in any way?
- If the erythrocytes were not dysmorphic
would that change your diagnosis?

109. Answer 4
Glomerulonephritis
RBC casts reveals renal cortex
involvement

110. Case 5
Glucose
22-year old man presenting for a routine
physical required for admission to medical
school
Negative
Bilirubin
Negative
Ketones
Negative
S.G.
1.010
Blood
Negative
pH
5.0
Protein
+
Urobilinogen
0.2 mg/dL
Nitrite
Negative
L.E.
Negative
Physical characteristics: Yellow
Microscopic: Not performed
Questions:
- What is your differential diagnosis?
- Would you order a microscopic analysis on
this sample?
- What would you do next to confirm the
diagnosis?

111. Answer 5
“Functional” proteinuria ?
Microscopic may reveal a few leukocytes
Request protein concentration in 24 h urine