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Urine routine examination

details about routine examination of urine specimen

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Urine routine examination

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  1. Urine routine examination Dr. Murad Ali Assistant professor (medicine)

  2. Learning objectives

  3. Urine Urine is an ultrafiltrate of plasma from which glucose, amino acids, water, and other substances essential to body metabolism have been reabsorbed. • Urine carries waste products and excess water out of the body.

  4. Urine consists of: Inorganic: Cl-, Na, K. trace amounts of: sulfate, HCO3 etc.) (96%) water (4%) dissolved solids: (2%) Other compounds (2%) Urea: (half) Organic:creatinine uric acid

  5. Urinalysis/Urine Routine Examination(Urine R/E) Urinalysis is a diagnostic test commonly performed in clinical settings to analyze the physical, chemical, and microscopic properties of a urine sample obtained from a patient. In conjunction with the history, physical examination, and laboratory testing, the urinalysis plays a central role in evaluating acute and chronic kidney disease. Nephrologists call it a liquid biopsy of the kidney when performed properly.

  6. Indications for urinalysis .Routine Health Screening: Urinalysis is often included as part of routine health check-ups to assess overall kidney function and detect early signs of kidney disease, urinary tract infections (UTIs), diabetes, or other health problems. .Evaluation of Symptoms: Healthcare providers may order a urinalysis if a patient presents with symptoms such as frequent urination, painful urination, urinary urgency, urinary incontinence, blood in the urine (hematuria), cloudy or foul-smelling urine, or abdominal pain. .Monitoring Chronic Conditions: Patients with chronic conditions such as diabetes, hypertension, kidney disease, or urinary tract disorders. Suspected Urinary Tract Infection (UTI): Symptoms suggestive of a UTI, such as a burning sensation during urination, urinary urgency, or pelvic pain, may prompt healthcare providers to order a urinalysis to detect the presence of bacteria, white blood cells, and other signs of infection. Evaluation of Kidney Function: Urinalysis can provide valuable information about kidney function by assessing parameters such as protein levels (proteinuria), blood in the urine (hematuria), glucose levels, and specific gravity. Abnormal findings may indicate kidney damage or dysfunction.

  7. Preoperative Assessment: Urinalysis may be ordered as part of preoperative testing to evaluate kidney function and detect any underlying urinary tract abnormalities or infections before surgery. Monitoring Medication Side Effects: Certain medications can affect kidney function or cause urinary abnormalities. Urinalysis may be performed periodically to monitor for potential side effects of medications, such as nephrotoxicity (kidney damage) or urinary tract irritation. Evaluation of Metabolic Disorders: Urinalysis may be used to detect metabolic abnormalities such as ketonuria (presence of ketones in urine), which can occur in conditions like diabetes or starvation.

  8. Specimen collection -The specimen must be collected in a clean dry, disposable container. • The container must be properly labeled with the patient name, date, and time of collection. • Patients should be asked to clean the external genitalia and provide a midstream specimen for analysis. • In patients with indwelling urinary catheters, a sample should be obtained directly from the catheter tubing, rather than from the urometer or drainage bag. This will ensure that the sample represents recently produced urine and avoids contamination by debris in the collection bag. - The specimen must be delivered to the laboratory on time and tested within 1hr. If this is not feasible, the sample should be refrigerated at 2 to 8°C and then re-warmed to room temperature before assessment.

  9. CHANGES OCCUR IN NON PRESERVED SPECIMEN • Transformation of urea to ammonia which increase pH. urease • Urea ─────── 2NH3 + CO2 • (Bacteria) • Decrease glucose due to glycolysis and bacterial utilization. • Decrease ketones because of volatilization. • Decrease bilirubin from exposure to light. • Increase bacterial number. • Increase turbidity caused by bacteria & amorphous. • Disintegration of RBCs casts. • Increase nitrite due to bacterial reduction of nitrate. • Changes in color due to oxidation or reduction of metabolic.

  10. Urine analysis The urine specimen is analyzed in 3 main parts Macroscopic/ Gross visual examination Chemical examination/ Urine Dipstick analysis Microscopic examination of urine sediment

  11. Reference range /normal values of urine analysis • Color – Yellow (light/pale to dark/deep amber) • Clarity/turbidity – Clear or cloudy • pH – 4.5-8 • Specific gravity – 1.005-1.025 • Glucose - ≤130 mg/d • Ketones – None • Nitrites – Negative • Leukocyte esterase – Negative • Bilirubin – Negative • Urobilirubin – Small amount (0.5-1 mg/dL) • Blood - ≤3 RBCs • Protein - ≤150 mg/d • RBCs - ≤2 RBCs/hpf • WBCs - ≤2-5 WBCs/hpf • Squamous epithelial cells - ≤15-20 squamous epithelial cells/hpf • Casts – 0-5 hyaline casts/lpf • Crystals – Occasionally • Bacteria – None • Yeast - None

  12. 1. Macroscopic/ Gross visual examination of urine

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