Understanding Urinalysis: Importance and Interpretation
Urinalysis is a crucial diagnostic test used to detect various disorders like infections, kidney diseases, and diabetes by examining the physical, chemical, and microscopic properties of urine. It involves assessing color, specific gravity, and chemical content, such as pH and protein levels. The interpretation of urine properties can provide insights into a patient's health status, guiding further medical management.
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Clinical lab training fifth stage Clinical lab training fifth stage By By LECTURER LECTURER MSC. Raghdah Abd MSC. Raghdah Abd- -ulmonaam Razoqi ulmonaam Razoqi
Urinalysis: A urinalysis is a test of your urine. It's used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease and diabetes. A urinalysis involves checking the appearance, concentration and content of urine. Urinalysis generally refers to the gross (macroscopic) examination of the urine, chemical evaluation using urine test strips, and microscopic examination. Macroscopic examination targets parameters that can be measured with the naked eye (physical properties), including volume, color, and specific gravity.
Urine test strips measure chemical properties such as pH, glucose concentration, and protein levels; and light microscopy is performed to identify elements such as cells, urinary casts, crystals, and organisms. collected during a defined period of time. We can distinguish a short-term urine collection lasting 1 3 hours, and a long-term collection that takes 12 24 hours. Occasionally an overnight (8-hour) collection is performed, e.g. for estimation of micro albuminuria. For majority of qualitative and semi quantitative chemical analyses with urine test strips, no stabilizing additives into the urine sample are necessary. If, however, it is not possible to examine the urine sample within two hours since its collection, the urine should be kept refrigerated or chemically conserved.
Physical properties: color: It may surprising for some to learn that urine can come in as pectrum of colors and they can all mean different things. The changes in color could be caused by foods, medication, and diseases or disorders. The meaning behind urine color: Pale yellow urine : normal. Clear (transparent) urine. Foam urine Dark yellow urine. Fluorescent yellow urine. Red or Rust urine
Specific gravity(SG): Density of solutes in urine compared to density of water. SG of water is 1 while the SG of urine is 1.003 to 1.03. If the SG of urine over 1.03 meaning the following indications: SG : 1.03 a. Diabetes mellitus. b. Syndrome of inappropriate ADH. While in other cases the SG of urine will be below 1.003 which mean the patient may have: SG : 1.003 a. Hydration. b. Nephritis.
Dipstick chemical analysis Urine dipstick is a narrow plastic strip which has several squares of different colors attached to it. Each small square represents a component of the test used to interpret urinalysis. Colors generated by each pad are visually compared against a range of colors on brand- specific color charts The entire strip is dipped in the urine sample and color changes in each square are noted.
Volume of the Urine: refers to the quantity of urine produced per unit of time. Typically this volume is expressed per day or some fraction of a day. . . : Normal volume of urine : 800-2000 ml per day. . 2000 - 800 : If there is an increase in blood volume may be attributed to: : 1. DM. 2. Drugs. 3. ADH inhibitors. 4. Alcohol. IF there is decreased in blood volume may be attributed to Dehydration, trauma or injury, drugs such as ACE Inhibitors
Reagent test strip interpretation: Glucose (Glucosurea): in general the presence of glucose in urine indicated that the filtered load of glucose has exceeded the maximal tubular reapsorpative capacity for glucose is often substituted for blood glucose monitoring. : ) . - Threshold of glucose in kidney 160 mg/ml of blood. . / 160 Bilirubin: bilirubin in urine indicates the presence of liver disease or biliary obstruction. Very low amounts if bilirubin can be detected in the urine when serum levels are below the clinical detection of jaundice. . . : Ketones: The urine reagent strip test for ketones detects acetoacetic acid. In ketoacidosis due to insulin deficiency or starvation it can be present in large amount in the urine before any elevation is seen in plasma levels. . :
Blood: the presence of large numbers of RBCs in the urine sediment establish the diagnosis of hematuria . If the dipstick is more strong positive than would be expected from the number of RBCs, then the possibility of hemoglobinuria and myoglobinuria should be considered. PH: The urine PH is seldom of diagnostic value. Phosphates will precipitate in alkaline urine and urinates will precipitate in acidic urine. . . : Protein: heavy protein uria usually represents an abnormality in the glomerular filtration barrier. The test is more sensitive for albumin than for globulin or hemoglobin. . . : Microalbuminuria usually used in the diagnosis of Nephropathy. . Urobilinogen: Urine urobilinogen is increased in any condition that causes an increase in the production. : .
Nitrite: Bacteruria caused by some gram negative bacteria which produce the nitrate reductase enzyme give a positive test. : . Leukocytes: A positive leukocyte esterase test provides indirect evidence of the bacteruria. . : Bactria in urine
MICROSCOPIC URINALYSIS Microscopic examination used to view elements that are not visible without microscope. e.g cells 1. Red Blood Cells: Hematuria is the presence of abnormal numbers of red cells in urine due to: a. Glomerular damage b. Tumors c. Urinary tract stones d. Upper and lower urinary tract infections
2.White Blood Cells Pyuria refers to the presence of abnormal numbers of leukocytes that may appear with infection in either the upper or lower urinary tract or with acute glomerulonephritis. Usually, the WBC's are granulocytes WBCs - 2-5 WBCs/hpf
3. Epithelial Cells Renal tubular epithelial cells, contain a large round or oval nucleus and normally slough into the urine in small numbers. However, with nephrotic syndrome and in conditions leading to tubular degeneration, the number sloughed is increased. 15-20 squamous epithelial cells/hpf
4. Casts Urinary casts are cylindrical structures produced by the kidney and present in the urine in certain disease states. They are formed in the distal convoluted tubule (DCT) and collecting ducts of nephrons, then dislodge and pass into the urine, where they can detected by microscopy. -Urinary casts may be made up of cells (such as white blood cells, red blood cells, kidney cells) or substances such as protein.
Pregnancy tests It detects a hormone in the body called human choronic gonadotropin (hCG). hCG is a hormone produced during pregnancy. It appears in the blood and urine of pregnant women as early as 10 days after conception hCG is released into the body by the placenta when a woman is pregnant. The urine hCG test is usually performed by placing drops of urine on a prepared chemical strip. It takes 1-2 min. for a result.
Bence Jones proteins are small proteins found in the urine. Testing for these proteins is done to diagnose and monitor multiple myeloma and other similar diseases. Bence Jones proteins are considered the first tumor marker. A tumor marker is a substance, made by the body, that is linked to a certain cancer, or malignancy. Bence Jones proteins are made by plasma cells, a type of white blood cell. The presence of these proteins in a person's urine is associated with a malignancy of plasma cells. Bence Jones proteins
