Urine Routine Test

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:

  1. what is Polyuria?
  2. What is Anuria?
  3. what is oliguria?
  4. what is nocturia?

Urine Analysis:

Diagnose:

It is used to diagnose a serious disease like:

Sample Collection:

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

Urine Analysis:

Physical ExaminationChemical Examination
VolumeGlucose
Odorketone bodies
AppearanceProtein
OdourBlood
Specific gravityBile Salts
pHBile pigment
Total SolidsUrobiologen

Urine Samples:

Urine Routine Test

Prevention of Urine:

2N HCL,
Con. Sulphuric Acid,
Toluence,
Thymal,
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.

Volume:

NormalAverage 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)
Diuretics
Increase water ingestion
Polyuria> 2 L /day:

It means urinary volume 400ml /24 hours, it occurs in febrile states,
Dehydration Shock
Acute glomerular
Nephritis
Vomiting, fever
Renal disease
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
Shock
Hg Puistoning
Incomplete blood transfusion
AnuriaCessation 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
VariationVolume varies due to fluid intake diet and climate:

Color:

Urine gets its color from the Pigment urochrome Urobilin and Uroerythrin.

Colourless:

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.

Color:

Pale Yellow Straw Coloured to YellowPale to ColourlessDark Yellow to Brown redYellow Brown Beer BrownClear RedCloudy RedDark Brown
Normal Urachrome UrobillinLarge fluid intake Diabetes millitus Diabetes insipidaDehydration Fever MedicationsBilirubin jaundiceHemolysis globinuraHematuria Kidney Stone Medicines PyridiumPorphyr Melanin Hemgenti acid
Milky White UrineRed colorLight YellowRasty YellowNormalTurbid Sample
Fat opting, Crystals, WBCs, Phosphates, fats UTI, Mucus in Urine, ChyLuria,Beet RifampicinB ComplexSulfonamidesClear, TransparentPus cells (UTI), Leucocytes, Epithelial cells, Nitrates, Phosphates, Filariasis, (Chyle)
Black Urine or Cola Colored UrineGreen or BlueOrange Unine
Muscle injury, kidney damage,
Alkaptonulla Medicines,
Inherited disorders, Some foods, medicines Doing UTI,Anti-inflammatory chemotherapy drays Problem indicated with your liver on bile duct,

Appearance:

Normal fresh urine is clear and transparent in appearance.

Turbid UrineCloudy UrineFoamy Urime
Pus cells UTI, Leukocytes, epithelial cells, Nitrites, Phosphates,Concentrated, UTI, Urates, Phosphates, Uric Acid,Presence of Proteins,

Odor:

(Smell) Some abnormal odor accounted conditions:

On standingAmmoniacal
Fruity odorDiabetic ketoachlesis
Moury odorPhenylketonuria
Cabbage odorTyrosinemia
Burnt Sugar odorMaple Syrup wine disease
Foul smellBacterial infection

pH:

Normal:

4.8 7.5 Means (6) on standing Alkaline (Formation of ammonia from bacterial decomposition of urea).

Acidic Urine <4.5Alkaline Urin >8.5
Fever
metabolic Acidosis
Diabetes Mellitus
Starvation
Crystal in Urine
Amorphous urates
Metabolic Alkalosis
Vomiting
Alkali therapy
Urinary tract infection
Urine Routine Test

Specific Gravity:

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 DilutionWater Lose
As the patient voids all
the Urine
SG. It should be around 1.003
Give him 1200ml of waterDo not give him water from 8 pm to 10 AM
See how much urine is produced in 2 hrsIf high- the kidney can concentrate Urine
Check the Specific gravity of the urineCollect the urine and check Sp Gr.
SG. Should be around 1.003SP.Gr should be around 1.025
Dilute urinePale Yellow

Buoyancy Principle:

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.

Temperature Correction:

  • (adding 0.001 for every 3°c rise above 15°C)
  • Or
  • (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
Hyperthermia1.005-1.030
Isosthenuria 1.008 – 1.012
Hyperthermia1.003 (Decreased Specific gravity)
Dilute in Urine
Diabetes insipidus chronic renal failure.
Hyperthenuria1.030 (increased urine Specific gravity)
Concentrated urine
Fever Diabetes millitus

Total Solids:

Total Solids: last two digits of specific gravity X 2.66 Long’s coefficient Gm/L.

Abnormal Constituents of Urine:

Chemical Tests:

Abnormal ConstituentsNormal Constituents of Urine
GlucoseAmmonia
KetoneUrea
ProteinCreatinine
BloodSodium
Bile SaltsPotassium
Bile PigmentChloride
Urobilinogen

Glucose:

How to perform the Glucose test in Urine:

Benedict Test:

Benedict Test Principle:

Substances producing positive benedict’s Test Lactose, galactose, fructose, pentoses Home gentistic acid, creatinine (high conec.) ascorbic, and, salicylic acid.

Benedict Regent:

  • Sodium Citrate
  • Sodium Carbonate
  • Copper Sulphate

Procedure:

Take 5ml of Benedict reagent and add 8 drops of Urine. Mix and boil,

Observation:

  • Blue (Nil)
  • Green (+)
  • Yellow (++)
  • Red (+++)
  • Dark Red (++++)

Benedict Test Interpretation:

Glycosuria: Presence of glucose in Urine:

Hyperglycemia glycosuriaRenal glycosuria, Fanconi Syndrome
Diabetes Miletus, Commonest cause
Hyperthyroidism
Hypopituitarism
Hyperadrenalism
Diseases of pancreas
Due to a decrease in the glucose reabsorption
The capacity of renal tubular cells
Decrease overall threshold

Ketone Bodies:

ketone bodies test is the severe Uncontrolled Diabetes mellitus starvation:

Rothera’s test, Gerhardt’s test: Acetone, Acetoacetate, Acetoacetate:

Tags:

Rothera’s Test:

Procedure:

  • 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.

Observation:

Interference:

  • Acetone Acetoacetate Present:

Gerhardt Test:

Procedure:

  • Take 3ml of Urine Add ferric chloride dropwise

Observation:

  • No Portwine color (red color)

Interference:

  • Acetoacetate is absent

Protein:

Normal Protein excretion:

  • <150mg/day (albumin <30 mg/day) No detection by routine test.

Glomerular:

  • Fenestrated Capillary layer.

Filtration:

  • (Holes 70-100mm)

Membrane:

  • Basement membrane
  • Laminin enacting, type IV collagen Heparin
  • Epithelial cell layer
  • Filtration Salt (10-40mm)

Proteinuria:

  • Proteinuria, < 150mg/dl
  • Albumin, < 30mg/dl

Presence of Proteins in Urine:

Albumin: 30mg – 300 mg/day. Microalbuminuria:

Physiological:

Pathological Pre-renal:

  • Intraabdominal turners
  • Renal
  • Glomerulonephritis
  • Nephrotic syndrome
  • Diabetic nephropathy
  • Hypertensive nephropathy
  • Post-renal
  • Inflammation in the lower
  • Urinary tract

How to Perform the Test:

  • Heat Coagulation test
  • Heller’s test
  • Sulpho salicylic acid test

Heat Coagulation Test:

Principle:

Denaturation of Proteins Disruption of Secondary, tertiary, and quaternary Structure of proteins.

Interference:

In this process, the albumin is present.

Procedure:

  • Fill 3/4 of the tube with a Urine sample.
  • Heat the upper part of the flame till turbidity appears & urine start boiling.

Observation:

Heller’s Test:

Principle:

Denaturation of Protein by concentrated acid.

Interference:

In this Process the Protein is present.

Procedure:

Take 3ml of Conc. HNO3, Add 3ml of Urine slowly by the side of the test tube.

Observation:

A white ring at the junction of two solutions.

Sulphosalicyclic Acid Test:

Principle:

The acid reduces the pH of the medium, where proteins exist in cationic form, from the complex with an anionic form of acids.

Interference:

Protein is Present.

Procedure:

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

Observation:

The blue or bluish-green color appears immediately.

Interference:

Benzidine test Interpretation:

Hematuria:

  • Acute glomerulonephritis Trauma to Urinary Treat, Urine Stones.
  • Chowly red

Hemoglobinuria:

Bile Salts:

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:

Principle:

Bile salts lower the surface tension of urine, and hence sulfur sinks to the bottom.

Interference:

Bile Salts Present.

Procedure:

  • Take 3ml of urine in a test tube and sprinkle a Pinch of sulfur Powder.
  • Control: 3ml water + 3 Pinch of sulfur Powder.

Observation:

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.

Fouchet’s Test:

Principle:

Bile pigments absorbed on ppt of Basoy. Ferric chloride in Fouchet’s reagent oxidizes bilirubin into green biliverdin.

Interference:

Bile Pigments Present.

Procedure:

Take 5ml of urine + 1ml MgSoy +2ml 10%.
Backe Filter and the precipitate few drops of Fouchet’s reagents.

Observation:

Color changes from yellow to Pista green.

Interpretation: Hay’s Sulphur test/Fouchel’s Test:

Type of JaundiceHemolytic Jaundice Pre hapaticHepatocellular Jaundice (Hepatic)obstructive Jaundice Poste (Hepatic)
Bile saltsAbsent+++
Bile PigmentsAbsent+++++
Urine Routine Test

Summary

TestObservationInference
Benedict’s testBrick red PPtGlucose Present
Rothera’s testPurple ringAcetone Acetoacetate are Present
Gerhardt’s testNo Color changeAcetoacetate is absent
Heat Coagulation testWhite coagulationProtein Present
Heller’s testWhite RingProtein Present
Sulphos alicycle acid testWhite pptProtein Present
Benedict testBluish green ColourBlood Present
Haya Sulphur testBluish-green ColourBile salts present
Fouchet’s TestPasta greenBile 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.

UNORGANISED ELEMENTS:

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/CellularCast/Non CellularCrystal 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

Normal Urine:

Organisms:

  • Bacteria
  • Yeast cells
  • Micro filaria
  • Haematobium Trichomonas
  • Vaginitis

Crystal In Urine:

Acidic:

  • Calcium oxalate
  • Uric acid
  • Tyrosine cholesterol
  • Sulphonamide

Alkaline:

Urine Routine Test

Red Blood cells:

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.

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