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Biochemicalcompositionof

Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

normalurine

AtifAminBaig
Lecturer,
FacultyofMedicineandHealthSciences,
UniversitiSultanZainalAbidin
TotalBodyWater(TBW)=60%ofbodyweight
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Highestinnewbornsandadultmales
lowestinadultfemalesandinadultswithalargeamountofadiposetissue

TotalBodyWater
2/3 1/3
K+ Na+
Mg+2 ClandHCO3
Intracellular
Proteinorganicphosphates Extraracellular
(ATP,ADPorAMP)

1/4 3/4
Albumin
globulin Plasma Interstitialfluid
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Functionofkidney
Controllingthebloodvolumeandcomposition
HumanMetabolicWastes
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Thebyproductofallchemicalreactionsinthebodythat
needs to be excrete or else the build up of these
compoundswillsickenandeventuallykilltheperson.

Metabolicwastes

CO2 Nitrogenouswastes

Respiratorysystem

Urinarysystem Urinarysystem
Nitrogenouswastes
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Proteinmetabolism 2NH3+CO2H2NC0NH2 Urea

Nucleicacidmetabolism Majorportionfrompurines Uricacid

Creatine
azotemia Creatinine

Uremia

Ureacomprised50%oftotalnitrogenouswastesinthehumans
Urine
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Definition
Bydefinitionurineisa?

Aliquidcontainingmultiplewasteproductsof
metabolism,especiallyureaandothernitrogenous
compounds,thatarefilteredfromthebloodbythe
kidneys.Urineisstoredintheurinarybladderandis
excretedfromthebodythroughtheurethra.
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011
Ultrafiltrationofplasma
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Ultrafiltrationoccursthroughglomerulusgivingrisetoprimaryurine
Theprimaryurineisisotonicwithplasma.

Anionicmoleculesarerepelled
CollagenTypeIV
bythenegativechargeofthebasementmembrane

Poresizewith
meandiameterof
2.9nm
Plasmacomponent
morethan64KDaare Plasmacomponent
totallyblocked lesserthan15KDa
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

C.Inorganicconstituents
Urinalysis
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Theroutineurineexamination.
Mostusefultoolforthecliniciansasanindicatororhealthor
disease.
Particularly,usedinrenalmetabolicdisorders.
Oftendoneforpatientsadmittedtothehospital.

Theroutineurineanalysisisdividedintofourmaingroups:

1. PhysicoChemicalproperties.
2. Chemicalexamination.
3. Microscopicexamination.
4. Bacterialscreening
1.PhysicoChemicalproperties 2.Chemicalexamination
Color pH
Appearance Sugar
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Volume Protein
Specificgravity Ketonebodies
Odor Bilirubin
Urobilinogen
Occultblood
Nitrite
Ascorbicacid
3.Microscopicexamination
WBCs
Epithelialcells
RBCs 4.Bacterialscreening
Casts Gramstaining
Crystals Colonycount
Bacteria
Yeasts
Nonbacterialorganisms
Urinecollection
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Urinemustbecollectedinasterilebottle.
Theroutineurineexaminationmustbe
conductedwithin30min.
Incaseofdelay,urinemustberefrigerated.

Delayinsampleexaminationwillresultin:
DecreasedpHbytheutilizationofglucosebybacteria.
IncreasedpHbytheconversionofureatoammoniabybacteria.
InincreasedpH,thetendencyofphosphatestoprecipitatewill
increase.
Oxidationofurobilinogentourobilin.Itmaygivefalsenegative
resultforjaundice.
Typesofspecimen
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Random First Afternoon 24hours


morning
Chemical& Usedforclearance
microscopic testofkidney
Specimenof Takenbetween24
examination choice pm
Samplesare
Takenanytime collectedfor24
Most Bestfordetecting
afterfirstmorning hours(foreg,
concentrated urobilinogen
urine 8amtonextday8
am).
Microscopicand
Night Day
chemical Postprandial
Itistoavoidany
examination
changesinthe
Allurinesamples Allurinesamples Takenafter2hoursof dilutionofvarious
arecollectedin12 arecollectedin meal suspended
hourofnight(for 12hourofday constituentsof
eg,8pmto8am) (foreg,8amto urine
8pm)
PhysicoChemicalproperties
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Colorofnormalurine
Normalurinecolorrangesfrompaleyellowtodeep
amber.
itistheresultofapigmentcalledurochrome.

BvitaminsturnurineaneyepoppingneonyellowBUTmayalso
indicateliverdisease.
porphyria,adiseasethataffectsyourskinandnervoussystem,
turnsurinethecolorofportwine.
Colorofnormalurine
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Mostchangesinurinecolorareharmlessandtemporary
andmaybedueto:

Certainfoodsbeetsmayturnurinered
Dyesinfoods/drinks
Supplementsvitamins
Prescriptiondrugs

Unusualurinecolorcanindicateaninfectionorserious
illness.
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Different colors of urine


pale yellow (straw)
light yellow
yellow
green-yellow (olive)
red-yellow
red
red-brown
brown-black
black
milky
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Clarityofurine
Appearanceofnormalurine
Appearanceofurine
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Substancesthatcausecloudinessbutthatare
notconsideredunhealthyinclude:

mucous,
spermandprostaticfluid,
cellsfromtheskin,
normalurinecrystals,and
contaminants(likebodylotionsandpowders).

Othersubstancesthatcanmakeurinecloudy
(suchasredbloodcells,whitebloodcells,or
bacteria)indicateaconditionthatrequires
attention.
Volumeofurine
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Normalvolumeis7502000ml/24H

Under 750 ml (oligouria) dehydration, infection, obstruction, renal


stones,kidney,failure,etc).

Over 2000ml (polyuria) diabetes insipidus, hypertension,


nephroticsyndrome, ingestion of alcohol or drugs, endocrinal
disorders.

Absentofurine(anuria)obstruction,kidneyfailure,stenosis.
Odorofurine
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Healthyurinemayhaveamildsmellbutgenerallydoes
nothaveafoulodor.

Insomecases,anunusualorstrongurineodormaybe
duetobenignconditionsthatarenotharmful,suchas
eatingcertainfoodsortakingcertainmedicationsand
volatileacids.

Insomecases,anunusualorstrongurineodormaybe
duetobenignconditionsthatarenotharmful,suchas
eatingcertainfoodsortakingcertainmedications.
Specificgravity
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Specific gravity reflects kidney's ability to concentrate.


Want concentrated urine for accurate testing, best is first morning
sample.
Low specimen not concentrated, kidney disease.
High first morning, certain drugs
Random specimen (1.003 to 1.032)
24 hours specimen (1.015 to 1.025)
Severe renal tubular damage, sp. Gravity is fixed at 1.010 isothenuric
Osmolalityofurine
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Determination of urinary osmolality is more important


than specific gravity because it gives more accurate
reflectionoftheconcentrationofdissolvedsubstances.

Itisthemeasureofthemolesofdissolvedparticles(un
dissociatedmoleculesandions)containedinakilogram
(Kg)ofasolvent.

The normal osmolality of random urine specimen varies from 401350


m,osmol/kg.
The normal osmolality of 24 hours urine specimen varies from 500800
m,osmol/kg.
ChemicalExamination
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Reagent strips are used only once and discarded.


Testing
Perform within 1 hour after collection
Allow refrigerated specimens to return to room
temperature.
Dip strip in fresh urine and compare color of pads
to the color chart after appropriate time period.
Instruments are available which detect color
changes electronically
UsingReagentStrips
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

BRIEFLY dip the strip in urine.


Colors are matched to those on the bottle label at the
appropriate times.
Timing is critical for accurate results.
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

ReagentStrips
Glucose
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Presence of glucose (glycosuria) indicates that the blood


glucose level has exceeded the renal threshold.
Useful to screen for diabetes.
Bilirubin
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Bilirubin is a byproduct of the breakdown of hemoglobin.


Normally contains no bilirubin.
Presence may be an indication of liver disease, bile duct obstruction or
hepatitis.
Since the bilirubin in samples is sensitive to light, exposure of the
urine samples to light for a long period of time may result in a false
negative test result.
Ketones
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Ketones are excreted when the body metabolizes fats


incompletely (ketonuria)
Blood
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Presence of blood may indicate infection, trauma to the


urinary tract or bleeding in the kidneys.
False positive readings most often due to contamination
with menstrual blood.
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Ph

pH measures degree of acidity or alkalinity of urine


Protein
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Presence of protein (proteinuria) is an important indicator


of renal disease.
False negatives can occur in alkaline or dilute urine or
when primary protein is not albumin.
Urobilinogen
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Urobilinogen is a degradation product of bilirubin formed


by intestinal bacteria.
It may be increased in hepatic disease or hemolytic disease
Nitrite
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Nitrite formed by gram negative bacteria converting


urinary nitrate to nitrite
Leukocytes
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Leukocytes (white blood cells) usually indicate infection.


Leucocyte esterase activity is due to presence of WBCs in
urine while nitrites strongly suggest bacteriuria.
NormalValues
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Negative results for glucose, ketones, bilirubin, nitrites,


leukocyte esterase and blood.
Protein negative or trace.
pH 5.5-8.0
Urobilinogen 0.2-1.0 Ehrlich units
HandlingandStorageof
Strips
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Handling and Storage


Keep strips in original container
Do not touch reagent pad areas
Reagents and strips must be stored properly to
retain activity
Protect from moisture and volatile fumes
Stored at room temperature
Use before expiration date
Procedure
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Dipstripbriefly,butcompletelyintowellmixed,room
temperatureurinesample.
Withdrawstrip.
Blotbrieflyonitsside.
Keepthestripflat,readresultsattheappropriatetimesby
comparingthecolortotheappropriatecoloronthechart
provided.
SourcesofError
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

TimingFailuretoobservecolorchangesatappropriate
timeintervalsmaycauseinaccurateresults.

Lighting Observe color changes and color charts


undergoodlighting.

QC Reagent strips should be tested with positive


controlsoneachdayofusetoensureproperreactivity.

Sample Proper collection and storage of urine is


necessarytoinsurepreservationofchemical.
SourcesofError
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Testing cold specimens would result in a slowing


down of reactions; test specimens when fresh or bring
themtoRTbeforetesting

Inadequate mixing of specimen could result in false


reduced or negative reactions to blood and leukocyte
tests;mixspecimenswellbeforedipping

Overdippingofreagentstripwillresultinleachingof
reagents out of pads; briefly, but completely dip the
reagentstripintotheurine
Parameter Normal Abnormal
Colour Yellowstraw, Darkamberconcentratedurineinsufficientoffluidintake
amber, Cloudyinfectiousprocess
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

transparent Darkorangedrug,eg:pyridium
Redordarkbrowndiseaseprocesscausingbloodin
urine
Consistency Clearliquid Mucousplug,viscid,thickinfectiousprocess
Odor Faintaromatic Offensiveinfectiousprocess
Sterility No MicroorganismpresentinfectiousofUT
microorganism
present
pH 4.58.0 Overthan8.0UTinfection
Under4.5uncontrolleddiabetes,starvation,dehydration
Specificgravity 1.010to1.025 Over1.025diabetesmellitus,underhydration
Under1.01diabetesinsipidus,kidneydisease,over
hydration
Urineglucose Notpresent Presentdiabetesmellitus
Urineketone Notpresent Presentdiabeticcoma,starvation,prolongedvomiting
bodies(eg:
acetone)
Urineblood Notpresent Occultkidneydisease
Brightredhemorrhage
Urinemicroscopy
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Whitebloodcells
Pyuriareferstothepresenceofelevatednumberof
leukocytes(granulocytes):

UpperorlowerUTinfection
Glomerulonephrotis
Vaginal&cervicalinfections
Externalurethralmeatus(men&women)

Normalrange:
02/HPF(5+indicatesaninfectionand10+indicatesmoresevere
conditions).
Urinemicroscopy
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Epithelialcells

Normalurinenotpresent/unquantified

Renal tubular epithelial cells, usually larger than


granulocytes, contain a large round or oval nucleus
arenormallysloughintotheurineinsmallamounts.

Positive nephrotic syndrome, condition leading to


tubulardegeneration.
Urinemicroscopy
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Urinarycrystals
Normalurinepresentbutunquantified.
Typeofcrystals:
Calciumoxalate
Triplephosphate
Amorphousphosphates
Uricacids
Uricacidcrystals(hyoeruricemia)
Cyctine
Tyrosine
Leusine

Elevatednumbersofcrystalmayindicates:
Hipercalcemia
Cystinecrystalcystinuria

Mayduetorenalfailureorotherrenaldisease.
Urinemicroscopy
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Casts

Formedatthedistalconvolutedtubuleorthecollectingduct(distal
nephron).
Proteinbasedcylindricalmoldsoftherenaltubule
Resultofdamagetotherenaltubule
Cancontaincellsandothermaterial
Dehydrationandacidicurineespeciallypredisposestocastformation.

Typesofcasts
Protein
RBC
WBC
Other
Urinemicroscopy
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Urinarybacteria
Abundantnormalmicrobialfloraofthevaginaorexternalurethralmeatus.

Abilitytorapidlymultiplyinurinestandingroomtemperature.

However,itshouldbeinterpretinviewofclinicalsymptoms.

Bacterialculturemustbedoneincaseofbacteriuria
Urinemicroscopy
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

UrinaryYeast

Yeastcellsmaybecontaminantsorrepresentatrueyeastinfection.
Often difficult to distinguish from red cells and amorphous crystals
butcanbedistinguishedbytheirtendencytobud.
Mostoftentheyarecandida,whichmaycolonizebladder,urethraor
vagina.
Urinemicroscopy
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Nonbacterialorganisms

General "crud" or unidentifiable objects may find their way into a


specimen,particularlythosethatpatientsbringfromhome.

Spermatozoacansometimesbeseen.

Rarely,pinwormovamaycontaminatetheurine.

ovafrombladderinfestationswithschistosomiasismaybeseen.
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

WBCsinurine WBCscasts WBCscasts

Mixedcasturine Cellularcasts Nonrenalepithelialcells

Urineoxalatecrystals WBCandRBCsinurine Sq.epitheliumcell


Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

BacteriaandWBCs Mucous Buddingyeast

Hyalinecast Redbloodcellcast Whitebloodcellcast

coarselygranularcast waxycast Amorphousurates


Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Uricacidcrystals Calciumoxalatecrystals Amorphousphosphates

Triplephosphatecrystals Ammoniumuratecrystals Calciumphosphates

Calciumcarbonatecrystals Tyrosinecrystals Cystinecrystals


Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Lucinecrystals Cholesterolcrystals Sulfacrystals

Fecalmaterial Talcinurine Startchinurine

Cottonfibersinurine Cottonfibersinurine Epithelialcellsinurine


Requestingaurinalysis
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

Signsandsymptoms

Burning urination, difficulty in urination & painful urination


infectiousandobstruction.
Semen in urine with great exhaustion (semonorrhoea) prostate
problem.
Backache early in the morning infection, renal stones (fullnes of
kidney,pelvis).
UTI (leucorrhoea in females) spread of infection into UT
(honeymooncystitis).
Fatigueandexhaustionrenalproblems.
Lower abdominal pain or supra pubic pain due to infection or
stones.
Nature Precedings : doi:10.1038/npre.2011.6595.1 : Posted 12 Nov 2011

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