URINALYSIS

Dr. Samuel Adegoke

WGH, Ilesa.
Introduction
The Human urine is the effluent fluid
that is disposed from the kidney.

Thus, It is highly reflective in its
properties, of the state of health of
each individual.
Urinalysis
A routine/ basic investigation.

Involves:
Physical & chemical examination of urine.
Complete urinalysis: Includes microscopic exam.

Cheap, Fast & Simple.

Evaluation, diagnoses & monitoring health status.
Indications:
To:
1. Evaluate the general health status (Routine test)

2. Diagnose & monitor renal disorders.

3. Monitor for hyperglycemia/ Diabetes Mellitus.

4. Screen for drug abuse (e.g. steroids in athletes).

5. Pregnancy test
Analysis
Can be performed:

Bedside.

Side laboratory.

Chemical pathology laboratory.
How is urinalysis done?
1. Obtain Consent & Cooperation of Patient & Parent.
2. Urine collection:
a) Freshly voided urine

b) Timing:
Any time of the day.
Early morning is most valuable: Being most concentrated, it is more
reliably measures kidney function.

c) Clean the genitalia: cotton wool, water.
i. *Soap & disinfectant may contaminate urine.
ii. *Methylated spirit is astringent & kills germs in urine.
Procedure:
a) Collect mid-stream (clean
catch) or terminal urine
samples.

b) Other methods of collection:
i. Catheterisation.
ii. Supra-pubic aspiration.

Collect sample in a clean,
transparent containers:
i. Urinalysis
ii. MCS
Precautions:
Read immediately (Max: 15
min) as Chemistry changes.

Otherwise refrigerate urine.

Put the dipstick into the urine

May use Urinometer to
measure S.G
The Normal Urine Vs Abnormality:
Colour & Clarity
Normal Appearance:

Colour:
Colourless
Amber
Straw-coloured.

Clarity:
Clear (i.e. not turbid).
Abnormalities:
Dark-coloured:
Dehydration.
Haematuria:
Schistosomiasis, Hb SS.

Haemoglobinuria: G6PD Def
Bilirubinuria: Hepatitis
Foods & drugs: Rifampicin.
Amino-acidurias. In-born errors of
Metabolism.
Cloudy/ Turbid : Suggest UTI.
Normal Urine Vs. Coca-Cola Urine
The Normal Urine Vs Abnormality
Odour & Sediments
Normal Appearance:

Odour:
Slight ammonical odour.


Sediments:
Nil.

Abnormalities:

Odour: Has fishy odour in UTI
particularly in Proteus Sp.

Sediments:

The Normal Urine Vs Abnormality
Volume, S.Gravity & pH
Vol: 1 - 2mls/ Kg/ hour.

S. Gravity: a simple
measure of concentrating
ability of kidneys = 1.015
1.025.

pH: 4.5 8.0 (i.e. Slightly
acidic)
Oliguria: < 0.5 -1.0 mL/ kg.
ARF, Dehydration, Shock

Persistently 1.010
CRF.
DI.

> 1.035:
Shock,
Severe dehydration

pH: If Alkaline = UTI
Urinometer (Hygrometer)
Urine Chemistry: Proteinuria
Proteinuria:
About 150mg/ 24hours,
(usually Albumin).
This amount is usually
not dipstix detectable.
Trace, 1+, 2+
ARF, CRF, UTI,
Exercise
3+/ 4+
Nephrotic Syn.
Trace: 10 29 mg/ dL

1+: 30 99 mg/ dL

2+: 100 299 mg/ dL

3+: 300 999 mg/ dL

4+: 1 g/ dL
Dipsticks (Combi-9 Dipstix)
Urine Chemistry: Sugar
Glucose: Nil.
Glycosuria reflects
hyperglycemia:
DM
Monitor Patients on IV
glucose infusion
Other Reducing
Substances:
Usually absent.
E.g. Galactosuria.
Clinitest: ROYGBIV
Normal (0%): Blue

Glycosuria:
Green: %
Yellow: %
Orange: 1%
Red: 2% suggestive of
(RBS 15 mmol/ L)
Urine Chemistry: Normal Vs AbN
Bilirubin:
Nil.
Conjugated
hyperbilirubinaemia.

Urobilinogen:
Trace.
Unconjugated hyperbil.

Haemoglobin:
Nil.
Haemoglobinuria: intra-
vascular haemolysis.
Ketones:
Nil.
Ketonuria: Starvation, DKA.

Nitrite:
Not usually detectable.
Presence indicative of UTI
(Proteus sp).
Urine Microscopy
Cells:
RBC: 0 2/ hpf
WBC: 0 5/ hpf but > 5/ hpf: Pyuria.
Epithelial Cells: Few, more in newborn

Organisms: Nil.

Casts: Small fibrous objects formed when protein &
other materials deposit in the kidney tubules & coll. ducts.
Hyaline cast: 0-1/ hpf; found in Nephrotic Syn.
Red cell/ granular: Nil; found in AGN.
Limitation
A limitless test, Simple, Cheap, Easil
reproducible.
Protein + Glucose: N50
Protein + Glucose + pH: N75
Combi-9: N150
Microscopy: N225
Full Urinalysis: N375.

Limitation: We often forget to do it.
Conclusion
Must be done on all patients.


The findings must be followed with
appropriate investigations.
Best combined with other tests .e.g. E/ U + Cr &
24Hour urinalysis.
Thank
you!