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Urinalysis
Urinalysis tests
Introduction
 Urine is formed in the kidneys, is a product of ultra
filtration of plasma by the renal glomeruli.

Urine sample
 Early morning sample-qualitative
 Random sample- routine
 24hrs sample- quantitative
 Midstream sample-UTI
 Post prandial sample-D.M

Urine examination
 Macroscopic examination
 Chemical examination
 Microscopic examination

Color & appearance
 Normal= clear & pale yellow
1. Colourless- dilution, diabetes mellitus, diabetes
insipidus, diuretics
2. Milky-purulent genitourinary tract infection
3. Orange-fever, excessive sweating
4. Red-haematuria
5. Brown/ black- melanin

Urinary volume
 Normal = 600-1550ml/day
 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)

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

oliguria
 Dehydration-vomiting, diarrhoea, excessive sweating
 Renal ischemia
 Acute tubular necrosis
 Obstruction to the urinary tract
 Acute renal failure

Chemical tests-
1. Protein
Causes of proteinuria
 Prerenal causes-Heavy exercise,Fever,hypertension,
multiple myeloma, ecalmpsia
 Renal –acute & chronic glomerulonephritis,Renal
tubular dysfunction,Polycystic kidney, nephrotic
syndrome
 Post renal- acute & chronic cystitis, tuberculosis
cystitis

2. Bilirubin
Test- fouchet’s test.
 Causes
Liver diseases-injury,hepatitis
Obstruction to biliary tract
3. Urobilinogen
 est- ehrlich test
 Causes-hemolytic anemia's
Bile salts-
Hay’s test
Cause- obstruction to bile flow (obstructive jaundice)

3. Urobilinogen
 Test- ehrlich test
 Causes-hemolytic anemia's
 Bile salts-
Hay’s test
Cause- obstruction to bile flow (obstructive jaundice)

4. Blood
RBCs-Causes of hematuria
 Pre renal- bleeding diathesis,
hemoglobinopathies, malignant hypertension.
 Renal- trauma, acute & chronic
glomerulonephritis, renal tumors
 Post renal – severe UTI, calculi, trauma, tumors of
urinary tract

Crystals in urine
Crystals in acidic urine
Uric acid
Calcium oxalate
Cystine
Leucine
Crystals in alkaline urine
Ammonium magnesium
phosphates(triple
phosphate crystals)
Calcium carbonate

Different crystals (indicative of
renal disfunction)


Types of casts
 Acellular casts
Hyaline casts
Granular casts
Waxy casts
Fatty casts
Pigment casts
Crystal casts
 Cellular casts
Red cell casts
White cell casts
Epithelial cell cast

Fatty casts
 Formed by the breakdown of lipid-rich epithelial
cells, these are hyaline casts with fat globule
inclusions
They can be present in various disorders, including
 nephrotic syndrome,
 diabetic or lupus nephropathy,
 Acute tubular necrosis

Red cell casts
 The presence of red blood cells within the cast is
always pathologic, and is strongly indicative of
glomerular damage.
 They are usually associated with nephritic syndromes.

White blood cell casts
 Indicative of inflammation or infection (especially
when there is a pus),
 pyelonephritis
 acute allergic interstitial nephritis,
 nephrotic syndrome, or
 post-streptococcal acute glomerulonephritis

Negative
Trace (100 mg/dL)
+ (250 mg/dL)
++ (500 mg/dL)
+++ (1000 mg/dL)
++++ (2000+ mg/dL)
The Urine Glucose Dipstick:
Significance
– Diabetes mellitus
– Renal glycosuria
Normal concentration: 15 mg/dl

Negative
+ (weak)
++ (moderate)
+++ (strong)
The Urine Bilirubin Dipstick:
Bilirubin : is a break down
of aged RBC or
hemoglobin-result in
yellowish color-it is
excretd in urine and bile
Significance
-jaundice (direct
bilirubin)
 Hepatitis, cirrhosis, other
liver disorders
 Biliary obstruction

Negative
Trace (5 mg/dL)
+ (15 mg/dL)
++ (40 mg/dL)
+++ (80 mg/dL)
++++ (160+ mg/dL)
The Urine Ketones Dipstick:
Ketones: are produced
by the liver as part of
fatty acid
metabolism/when
lack of glucose
occured
Significance
- Diabetic ketoacidosis
- Prolonged fasting
(starvation)

1.000
1.005
1.010
1.015
1.020
1.025
1.030
It measures the concentration of
all chemical particles of urine
Normal-1.016-1.022
Significance
- Diabetes insipidus (a disorder
of the pituitary gland that causes
the body to produce large
amounts of urine).
Urine Specific Gravity

Negative
Moderate
Trace
+ (weak)
++ (moderate)
+++ (strong)
The Urine Blood Dipstick:
Significance
- Hematuria
 Renal problem
 Glomerulonephritis
 Tumors

5.0
6.0
6.5
7.0
7.5
8.0
8.5
The Urine pH Dipstick:
Significance
- Acidic (less than 4.5)
- Alkaline (greater than 8.0):
renal tubular acidosis (>5.5)
• respiratory or metabolic
acidosis/ketosis
respiratory or metabolic
alkalosis
• renal tubular acidosis
• renal calculi /renal
stoneformation

Negative
Trace
+ (30 mg/dL)
++ (100 mg/dL)
+++ (300 mg/dL)
++++ (2000 mg/dL)
The Urine Protein Dipstick:
Significance
- Proteinuria:- indicative
of early kidney damage
 Tubular damage
 Glomerular damage

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