Urine Routine Test
Urine Routine Test, A urine analysis is a test that examines the Physical, chemical, and microscopic examination of your urine. Routine urine cultures can look for a urinary tract infection (UTI) and see which germs are causing it.
Table of Content:
- What is Urine analysis?
- Physical Examination of Urine.
- What are the parameters of Urine analysis?
- Volume, Color, Apperance, ph, ordor
- Specific gravity
It is used to diagnose a serious disease like:
The urine Sample must be tested in the Lab within 2 hrs of collection to get the correct results if the urine sample is left standing at room temperature for long after the group, the following changes occur.
Cause Of False Result:
It can cause false results due to the growth of back
- Increased pH.
- Decreased Glucose.
- Loss of ketone bodies.
- Formation of Crystals.
- Damage of cellular elements.
|Physical Examination||Chemical Examination|
|Specific gravity||Bile Salts|
Prevention of Urine:
Con. Sulphuric Acid,
10%. Acetic Acid,
Physical Examination of Urine:
It is the first part of routine urine analysis. It is done by direct observation and it gives hints for subsequent urine analysis.
|Normal||Average 24 hrs Urine 800 ml to 1800 ml/day: |
It means urinary volume is 2000ml /24 hours Seen in Diabetes Mellitus,
Diabetes Insipidus (deficiency of ADH)
Increase water ingestion
|Polyuria||> 2 L /day: |
It means urinary volume 400ml /24 hours, it occurs in febrile states,
|oliguria||> 400 ml/day: |
It means urinary output ( 100ml /24 hours or complete nit).
It occurs in the complete urinary tract and renal shutdown.
Bilateral obstruction of the Ureter
Incomplete blood transfusion
|Anuria||Cessation of Urine output (Urine excretion is blocked), |
It is a condition in which you wake up during the night because you have Urinate,
High fluid intake
Sleep also roller
|Variation||Volume varies due to fluid intake diet and climate:|
Urine gets its color from the Pigment urochrome Urobilin and Uroerythrin.
Lage fluid intake, climbers millitus, diabetes insipid a clear urine can also indicate a liver problem like liver cirrhosis and viral hepatitis if you are not Consuming large amounts of water and have ongoing clear urine.
|Pale Yellow Straw Coloured to Yellow||Pale to Colourless||Dark Yellow to Brown red||Yellow Brown Beer Brown||Clear Red||Cloudy Red||Dark Brown|
|Normal Urachrome Urobillin||Large fluid intake Diabetes millitus Diabetes insipida||Dehydration Fever Medications||Bilirubin jaundice||Hemolysis globinura||Hematuria Kidney Stone Medicines Pyridium||Porphyr Melanin Hemgenti acid|
|Milky White Urine||Red color||Light Yellow||Rasty Yellow||Normal||Turbid Sample|
|Fat opting, Crystals, WBCs, Phosphates, fats UTI, Mucus in Urine, ChyLuria,||Beet Rifampicin||B Complex||Sulfonamides||Clear, Transparent||Pus cells (UTI), Leucocytes, Epithelial cells, Nitrates, Phosphates, Filariasis, (Chyle)|
|Black Urine or Cola Colored Urine||Green or Blue||Orange Unine|
|Muscle injury, kidney damage,|
|Inherited disorders, Some foods, medicines Doing UTI,||Anti-inflammatory chemotherapy drays Problem indicated with your liver on bile duct,|
Normal fresh urine is clear and transparent in appearance.
|Turbid Urine||Cloudy Urine||Foamy Urime|
|Pus cells UTI, Leukocytes, epithelial cells, Nitrites, Phosphates,||Concentrated, UTI, Urates, Phosphates, Uric Acid,||Presence of Proteins,|
(Smell) Some abnormal odor accounted conditions:
|Fruity odor||Diabetic ketoachlesis|
|Burnt Sugar odor||Maple Syrup wine disease|
|Foul smell||Bacterial infection|
4.8 7.5 Means (6) on standing Alkaline (Formation of ammonia from bacterial decomposition of urea).
|Acidic Urine <4.5||Alkaline Urin >8.5|
Crystal in Urine
|Metabolic Alkalosis |
Urinary tract infection
Specific gravity (SG) = Density of Urine (Density of water):
If the urine has a lot of solutes if the wine is concentrated then the specific gravity will be of the urine is very dilute, which means it has a lot of water and hence urine is very dilute.
- Concentrated Urine: Specific gravity high:
- Dilute Urine: Very Dilute:
What is the role of Specific gravity in Urine analysis:
Specific gravity function of tubular:
|Water Dilution||Water Lose|
|As the patient voids all|
|SG. It should be around 1.003|
|Give him 1200ml of water||Do not give him water from 8 pm to 10 AM|
|See how much urine is produced in 2 hrs||If high- the kidney can concentrate Urine|
|Check the Specific gravity of the urine||Collect the urine and check Sp Gr.|
|SG. Should be around 1.003||SP.Gr should be around 1.025|
|Dilute urine||Pale Yellow|
When the solute concentration is high the level of the solution Increase and the urinometer is pushed upward due to high SG. if the solute Concentration is low variometer sinks into the urine due to low SG Urinometer is calibrated at IS’C.
- (adding 0.001 for every 3°c rise above 15°C)
- (Substracting 0.001 for every 3 degrees below 15°C)
Note the reading:
Room Temperature: 15°C Value +3= value x 0.001= Value + Urinometer reading.
Urine meter reading: 1.010
- Room temp – 21°C.
- 21-15= 6
- 6/3= 2
- 2 X 0.001= 0.002
- 0.002+1.010= 1.021
- In case the temperature is higher then add
- In case the temperature is lower Substrate
|Isosthenuria||1.008 – 1.012|
|Hyperthermia||1.003 (Decreased Specific gravity)|
Dilute in Urine
Diabetes insipidus chronic renal failure.
|Hyperthenuria||1.030 (increased urine Specific gravity) |
Fever Diabetes millitus
Total Solids: last two digits of specific gravity X 2.66 Long’s coefficient Gm/L.
Abnormal Constituents of Urine:
|Abnormal Constituents||Normal Constituents of Urine|
- Glucose or any other sugar is not normally excreted In healthy individuals.
- Glucose is completely reabsorbed by renal tubular epithelial cells.
- Rate of glucose absorption (Tubulas maximum for glucose): 350 mg/min.
- The renal threshold for glucose is 180 mg/dl Glycosuria: Excretion of glucose in the urine.
How to perform the Glucose test in Urine:
Benedict Test Principle:
- Sodium Citrate
- Sodium Carbonate
- Copper Sulphate
Take 5ml of Benedict reagent and add 8 drops of Urine. Mix and boil,
- Blue (Nil)
- Green (+)
- Yellow (++)
- Red (+++)
- Dark Red (++++)
Benedict Test Interpretation:
Glycosuria: Presence of glucose in Urine:
|Hyperglycemia glycosuria||Renal glycosuria, Fanconi Syndrome|
|Diabetes Miletus, Commonest cause|
Diseases of pancreas
|Due to a decrease in the glucose reabsorption|
The capacity of renal tubular cells
Decrease overall threshold
ketone bodies test is the severe Uncontrolled Diabetes mellitus starvation:
Rothera’s test, Gerhardt’s test: Acetone, Acetoacetate, Acetoacetate:
- Take 5ml of Urine, and Satucate it with ammonium sulfate.
- Add a drop of freshly prepared Sodium nitroprusside and Mix.
- Add 3 ml of strong ammonia carefully by the side of the tube.
- Acetone Acetoacetate Present:
- Take 3ml of Urine Add ferric chloride dropwise
- No Portwine color (red color)
- Acetoacetate is absent
Normal Protein excretion:
- <150mg/day (albumin <30 mg/day) No detection by routine test.
- Fenestrated Capillary layer.
- (Holes 70-100mm)
- Basement membrane
- Laminin enacting, type IV collagen Heparin
- Epithelial cell layer
- Filtration Salt (10-40mm)
- Proteinuria, < 150mg/dl
- Albumin, < 30mg/dl
Presence of Proteins in Urine:
Albumin: 30mg – 300 mg/day. Microalbuminuria:
- Severe exercise
- High Protein diet
- Intraabdominal turners
- Nephrotic syndrome
- Diabetic nephropathy
- Hypertensive nephropathy
- Inflammation in the lower
- Urinary tract
How to Perform the Test:
- Heat Coagulation test
- Heller’s test
- Sulpho salicylic acid test
Heat Coagulation Test:
- Fill 3/4 of the tube with a Urine sample.
- Heat the upper part of the flame till turbidity appears & urine start boiling.
Denaturation of Protein by concentrated acid.
Take 3ml of Conc. HNO3, Add 3ml of Urine slowly by the side of the test tube.
A white ring at the junction of two solutions.
Sulphosalicyclic Acid Test:
The acid reduces the pH of the medium, where proteins exist in cationic form, from the complex with an anionic form of acids.
Take 3ml of urine, Add dropwise sulpha sulindac, and observe white ppt.
Blood: Benzidine Test:
A Pinch of benzidene Powder + 3ml glacial acetic acid + 3ml H2 Or
- Part 1 1 ml Urine
- Part 2 1 ml DW
- Blood is present,
- second Part: Control tube no change in color
Benzidine test Interpretation:
- Acute glomerulonephritis Trauma to Urinary Treat, Urine Stones.
- Chowly red
- Excretion of free Hb followed by homily Malaria, Severe burns, Hemolytic jaundice, and Enteric fever.
- Clear red.
Bile salts are one of the primary components of bile. Bile is a greenish-yellow fluid made by your liver and stored in the gallbladder.
Hay’s Sulphur Test:
Bile salts lower the surface tension of urine, and hence sulfur sinks to the bottom.
Bile Salts Present.
- Take 3ml of urine in a test tube and sprinkle a Pinch of sulfur Powder.
- Control: 3ml water + 3 Pinch of sulfur Powder.
Test: Sulphus Powder sinks to the bottom Control: Sulphur Powder floats.
Bile Pigments: Bilirubin, Biliverdin:
The bile pigments are formed by the decomposition of the porphyrin ring and contain a chain of four pyrrole rings. Bilirubin, for example, the brownish-yellow pigment that gives feces its characteristic color, is the end product of the breakdown of heme from destroyed red blood cells.
Bile pigments absorbed on ppt of Basoy. Ferric chloride in Fouchet’s reagent oxidizes bilirubin into green biliverdin.
Take 5ml of urine + 1ml MgSoy +2ml 10%.
Backe Filter and the precipitate few drops of Fouchet’s reagents.
Color changes from yellow to Pista green.
Interpretation: Hay’s Sulphur test/Fouchel’s Test:
|Type of Jaundice||Hemolytic Jaundice Pre hapatic||Hepatocellular Jaundice (Hepatic)||obstructive Jaundice Poste (Hepatic)|
|Benedict’s test||Brick red PPt||Glucose Present|
|Rothera’s test||Purple ring||Acetone Acetoacetate are Present|
|Gerhardt’s test||No Color change||Acetoacetate is absent|
|Heat Coagulation test||White coagulation||Protein Present|
|Heller’s test||White Ring||Protein Present|
|Sulphos alicycle acid test||White ppt||Protein Present|
|Benedict test||Bluish green Colour||Blood Present|
|Haya Sulphur test||Bluish-green Colour||Bile salts present|
|Fouchet’s Test||Pasta green||Bile Pigment Present|
Microscopic Examination of Urine:
Microscopic examination of Urine consists of microscopic elements clarified as ORGANISED ELEMENTS. They are RBCs, WBCs, Epithelial cells, cast, and bacteria.
They are crystals and amorphous materials.
Collection of Sample:
- A mide stream freshly voided sample is the best Specimen.
- Its Provides an acidic and concentrated sample that preserves the formed elements (RBCs, WBCs, Cast).
- The specimen should be examined fresh or after 2 hrs of collection.
- Cells and cast begin to disintegrate within 2-3 Hrs at room temperature.
- If there is a delay in the examination of urine keep the sample refrigerated.
Method to get the sediment of Urine:
Take 5-10ml of Urine in a test tube. Centrifuge for 5 min at 300 Rpm. Discard the supernatant. Place drops of sediment urine on a clean glass slide. Place a coverslip over it and examine it under a microscope.
|Cells/Cellular||Cast/Non Cellular||Crystal in Urine/Abnormal Urine|
|RBCs, WBCs, Epithelial cells, Pus Cells, RBCs Cast, WBCs Cast,||Hyline cast, Granular cast, Waxy cast, Fatty cast,||Billirubin, Cholesterol, Cysteine, Tyrosine, Sulfa, andinavis|
- Yeast cells
- Micro filaria
- Haematobium Trichomonas
Crystal In Urine:
- Calcium oxalate
- Uric acid
- Tyrosine cholesterol
- Ammonium Phosphate
- Triple Phosphate
- Calcium Carbonate
- Ammonium bitrate
- Calcium phosphate
Red Blood cells:
- Non-nucleated biconcave disks measuring approx 7um in diameter.
- Hematuria presence of Abnormal no of RBCs in Urine.
- Cells / Hpf is considered Abnormal.
- Hypotonic (diluted wine) Rbis swell up and lyse.
- Hypertonic (Gncentrated wine) the Rbcs crenate.
Causes of Red Blood Cells in Unine:
- Urinary tract stone.
- Stone in the urinary bladder.
- Infection Prostate infection.
- Acute tubular necrosis.
- Toxic reaction due to drugs.