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MUHAMMAD ABDULLAH KHOSAMUHAMMAD ABDULLAH KHOSA

MSc MLTMSc MLT

TRAINEE TECHNOLOGIST TRAINEE TECHNOLOGIST STAT LAB LAHORE

UrinalysisUrinalysis

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CONTENTSCONTENTS

IntroductionIntroduction

Types of SpecimenTypes of Specimen

Sources of errorsSources of errors

Types of AnalysisTypes of Analysis

Microscopic ImagesMicroscopic Images

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INTRODUCTIONINTRODUCTION

First laboratory test performed First laboratory test performed

Used for more than 6000 yearsUsed for more than 6000 years

Powerful diagnostic toolPowerful diagnostic tool

An index to many normal and pathological mechanisms.An index to many normal and pathological mechanisms.

By composition:By composition:

95% water

Remaining 5% is composed of mainly urea

Trace amounts of vitamins, minerals,

enzymes, hormones, proteins and antibodies 44

Types of Types of Specimen Specimen

First morning First morning ((most concentratedmost concentrated) )

Second voidedSecond voided

Random specimen Random specimen ( ( most convenientmost convenient) )

Post-prandial specimen Post-prandial specimen ( usually after 2 hour)( usually after 2 hour)

24 hour urine24 hour urine

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SOURCES OF ERRORSOURCES OF ERROR

Contamination with:Contamination with: Bacteria or chemicalsBacteria or chemicals

menstrual bloodmenstrual blood

vaginal or urethral dischargevaginal or urethral discharge

Inadequate mixing before examinationInadequate mixing before examination

Wrong/inadequate preservativeWrong/inadequate preservative

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− MacroscopicMacroscopic

− Chemical Chemical

− Microscopic Microscopic

Types of AnalysisTypes of Analysis

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Macroscopic Macroscopic ExaminationExaminationOdor:Odor:− Ammonia-like:Ammonia-like: (Urea-splitting bacteria)(Urea-splitting bacteria)− Offensive:Offensive: Old specimen, pus or Old specimen, pus or

inflammationinflammation− Sweet: Sweet: GlucoseGlucose− Fruity: Fruity: KetonesKetonesColor:Color:− Colorless Colorless Diluted urineDiluted urine− Deep YellowDeep Yellow Concentrated UrineConcentrated Urine− Turbid cells or crystals Turbid cells or crystals − Yellow-GreenYellow-Green Bilirubin / BiliverdinBilirubin / Biliverdin− RedRed Blood / HemoglobinBlood / Hemoglobin

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Chemical AnalysisChemical Analysis Urine Urine DipstickDipstick

GlucoseGlucose

BilirubinBilirubin

KetonesKetones

Specific GravitySpecific Gravity

BloodBlood

pHpH

ProteinProtein

UrobilinogenUrobilinogen

NitriteNitrite

Leukocyte Leukocyte

30 sec RR: Negative30 sec RR: Negative D. mellitus. Renal glycosuria.

30 sec RR: Negative30 sec RR: Negative -increased bilirubin (correlate urobilinogen, S.bilirubin)

40 sec RR: Negative40 sec RR: Negative Diabetic ketoacidosis Prolonged fasting

2 min RR: 1.003-1.0352 min RR: 1.003-1.035 - Diabetes insipidus

60 sec RR: Negative60 sec RR: Negative Hematuria - Hemoglobinuria

2 min R.R.: 4.5-8.02 min R.R.: 4.5-8.0 <4.5): high-protein diet, >8.0): renal tubular acidosis

60 sec RR: Negative60 sec RR: Negative - Proteinuria and the nephrotic syndrome.

60 sec RR: 0.02-1.0 mg/dL60 sec RR: 0.02-1.0 mg/dL High: increased hepatic processing of bilirubin- Low: bile obstruction

60 sec RR: Negative60 sec RR: Negative Gram negative bacteriuria

2 min RR: Negative - Pyuria - Acute inflammation Renal calculus99

SIGNIFICANCEPARAMETERS

TIME OF READING

Microscopic Microscopic ExaminationExamination

Per High Power Field (HPF) (400x)Per High Power Field (HPF) (400x)– > 3 erythrocytes> 3 erythrocytes

– > 5 leukocytes> 5 leukocytes

– > 2 renal tubular cells> 2 renal tubular cells

– > 10 bacteria> 10 bacteria

Per Low Power Field (LPF) (200x)Per Low Power Field (LPF) (200x)– > 3 hyaline casts or > 1 granular cast> 3 hyaline casts or > 1 granular cast

– > 10 squamous cells > 10 squamous cells

– Any other cast (RBCs, WBCs)Any other cast (RBCs, WBCs)

Presence of:Presence of:– Fungal hyphae or yeast, parasite, Fungal hyphae or yeast, parasite,

– Pathological crystals (cystine, leucine, tyrosine)Pathological crystals (cystine, leucine, tyrosine)

– Large number of uric acid or calcium oxalate crystalsLarge number of uric acid or calcium oxalate crystals

Abnormal Abnormal FindingsFindings

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Microscopic Microscopic ExaminationExamination RBCsRBCs

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Microscopic Microscopic ExaminationExamination WBCsWBCs

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Microscopic Microscopic ExaminationExamination Tubular Epithelial Tubular Epithelial

CellsCells

1313

Microscopic Microscopic ExaminationExamination YeastsYeasts

1414

Microscopic Microscopic ExaminationExamination RBCs CastRBCs Cast

1515

Microscopic Microscopic ExaminationExamination WBCs CastWBCs Cast

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Microscopic Microscopic ExaminationExamination Tubular Epith. CastTubular Epith. Cast

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Microscopic Microscopic ExaminationExamination Granular CastGranular Cast

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Microscopic Microscopic ExaminationExamination Hyaline CastHyaline Cast

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Microscopic Microscopic ExaminationExamination Waxy CastWaxy Cast

2020

Microscopic Microscopic ExaminationExaminationCalcium Oxalate CrystalsCalcium Oxalate Crystals

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Microscopic Microscopic ExaminationExaminationCalcium Oxalate CrystalsCalcium Oxalate Crystals

Dumbbell Dumbbell Shape Shape

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Microscopic Microscopic ExaminationExaminationTriple Phosphate CrystalsTriple Phosphate Crystals

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Microscopic Microscopic ExaminationExamination Urate CrystalsUrate Crystals

2424

Microscopic Microscopic ExaminationExamination Cholesterol CrystalsCholesterol Crystals

2525

Microscopic Microscopic ExaminationExamination Leucine CrystalsLeucine Crystals

2626

Microscopic Microscopic ExaminationExamination Cystine CrystalsCystine Crystals

2727

Thank youThank you

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