URINALYSIS

A typical medical urinalysis usually includes:

• a description of color and appearance.
• specific gravity - normally 1.002 to 1.028. This test detects ion concentration of the urine. Small amounts
of protein or ketoacidosis tend to elevate results of the specific gravity. Specific gravity is an expression of
the weight of a substance relative to the weight of an equal volume of water. Water has a specific gravity
of one. The specific gravity of your urine is measured by using a urinometer. Knowing the specific gravity
of your urine is very important because the number indicates whether you are hydrated or dehydrated. If
the specific gravity of your urine is under 1.007, you are hydrated. If your urine is above 1.010, you are
dehydrated.
• pH - normally 4.8 to 7.5. \
• ketone bodies - normally negative (absent). When there is carbohydrate deprivation, such as starvation or
high protein diets, the body relies increasingly on the metabolism of fats for energy. This pattern is also
seen in people with the disease diabetes mellitus, when a lack of the hormone insulin prevents the body
cells from utilizing the large amounts of glucose available in the blood. This happens because insulin is
necessary for the transport of glucose from the blood into the body cells. The metabolism of fat proceeds
in a series of steps. First, triglycerides are hydrolyzed to fatty acids and glycerol. Second the fatty acids
are hydrolyzed into smaller intermediate compounds (acetoacetic acid, betahydroxybutyric acid, and
acetone). Thirdly, the intermediate products are utilized in aerobic cellular respiration. When the
production of the intermediate products of fatty acid metabolism (collectively known as ketone bodies)
exceeds the ability of the body to metabolize these compounds they accumulate in the blood and some
end up in the urine (ketonuria).
• proteins - normally negative (absent)
• Albustix Test - Since proteins are very large molecules (macromolecules), they are not normally present in
measurable amounts in the glomerular filtrate or in the urine. The detection of proteins in your urine may
indicate that the permeability of the glomerulus is abnormally increased. This may be caused by renal
infections or it may be caused by other diseases that have secondarily affected the kidneys such as
diabetes mellitus, jaundice, or hyperthyroidism.
• nitrites
• urobilinogen
• Bilirubin - The fixed phagocytic cells of the spleen and bone marrow destroy old red blood cells and
convert the heme groups of hemoglobin to the pigment bilirubin. The bilirubin is secreted into the blood
and carried to the liver where it is bonded to (conjugated with) glucuronic acid, a derivative of glucose.
Some of the conjugated bilirubin is secreted into the blood and the rest is excreted in the bile as bile
pigment that passes into the small intestine. The blood normally contains a small amount of free and
conjugated bilirubin. An abnormally high level of blood bilirubin may result from: an increased rate of red
blood cell destruction, liver damage, as in hepatitis and cirrhosis, and obstruction of the common bile duct
as with gallstones. An increase in blood bilirubin results in jaundice, a condition characterized by a
brownish yellow pigmentation of the skin and of the sclera of the eye.
• Icotest - The test used to detect the destruction of old Red Blood Cells (RBC) in the urine.
• glucose - normally negative (absent)
• Benedict's Test - Although glucose is easily filtered in the glomerulus, it is not present in the urine because
all of the glucose that is filtered is normally reabsorbed from the renal tubules back into the blood.
• Hemoglobin Test - Hemolysis in the blood vessels, a rupture in the capillaries of the glomerulus, or
hemorrhage in the urinary system may cause hemoglobin to appear in your urine.
• RBC number
• WBC number
• hCG - normally absent, this hormone appears in the urine of pregnant women. Home pregnancy tests
commonly detect this substance
Microscopic examination
A urine sample is about to be examined under a phase-contrast microscope using a Neubauer counting chamber.
The urine is under the cover slide, in the upper segment formed by the H-shaped grooves.
The numbers and types of cells and/or material such as urinary casts can yield a great detail of information and
may suggest a specific diagnosis.
• Hematuria - associated with kidney stones, infections, tumors and other conditions
• Pyuria - associated with urinary infections
• eosinophiluria - associated with allergic interstitial nephritis, atheroembolic disease
• Red blood cell casts - associated with glomerulonephritis, vasculitis, malignant hypertension
• White blood cell casts - associated with acute interstitial nephritis, exudative glomerulonephritis, severe
pyelonephritis
• (heme) granular casts - associated with acute tubular necrosis
• crystalluria -- associated with acute urate nephropathy (or "Acute uric acid nephropathy", AUAN)
• calcium oxalate - associated with ethylene glycol toxicity
COMPLETE BLOOD COUNT
A complete blood count will normally include:
Red cells
• Total red blood cells - The number of red cells is given as an absolute number per litre.
• Hemoglobin - The amount of hemoglobin in the blood, expressed in grams per decilitre. (Low hemoglobin
is called anemia.)
• Hematocrit or packed cell volume (PCV) - This is the fraction of whole blood volume that consists of red
blood cells.
• Red blood cell indices
○ Mean corpuscular volume (MCV) - the average volume of the red cells, measured in femtolitres.
Anemia is classified as microcytic or macrocytic based on whether this value is above or below
the expected normal range. Other conditions that can affect MCV include thalassemia and
reticulocytosis.
○ Mean corpuscular hemoglobin (MCH) - the average amount of hemoglobin per red blood cell, in
picograms.
 ○Mean corpuscular hemoglobin concentration (MCHC) - the average concentration of hemoglobin in
the cells.
• Red blood cell distribution width (RDW) - a measure of the variation of the RBC population
White cells
• Total white blood cells - All the white cell types are given as a percentage and as an absolute number per
litre.
A complete blood count with differential will also include:
• Neutrophil granulocytes - May indicate bacterial infection. May also be raised in acute viral
infections.Because of the segmented appearance of the nucleus, neutrophils are sometimes referred to as
"segs." The nucleus of less mature neutrophils is not segmented, but has a band or rod-like shape. Less
mature neutrophils - those that have recently been released from the bone marrow into the bloodstream -
are known as "bands" or "stabs". Stab is a German term for rod.[1]
• Lymphocytes - Higher with some viral infections such as glandular fever and. Also raised in lymphocytic
leukaemia CLL. Can be decreased by HIV infection. In adults, lymphocytes are the second most common
WBC type after neutrophils. In young children under age 8, lymphocytes are more common than
neutrophils.[2].
• Monocytes - May be raised in bacterial infection, tuberculosis, malaria, Rocky Mountain spotted fever,
monocytic leukemia, chronic ulcerative colitis and regional enteritis [3]
• Eosinophil granulocytes - Increased in parasitic infections, asthma, or allergic reaction.
• Basophil granulocytes- May be increased in bone marrow related conditions such as leukemia or
lymphoma. [4]
A manual count will also give information about other cells that are not normally present in peripheral blood, but
may be released in certain disease processes.
Platelets
• Platelet numbers are given, as well as information about their size and the range of sizes in the blood.
Interpretation
Certain disease states are defined by an absolute increase or decrease in the number of a particular type of cell in
the bloodstream. For example:

Type of Cell Increase Decrease Many disease states are heralded by changes in
the blood count:
Red Blood Cells erythrocytosis or anemia or • leukocytosis can be a sign of infection.
(RBC) polycythemia erythroblastopenia • thrombocytopenia can result from drug
White Blood toxicity.
Cells (WBC):
leukocytosis leukopenia • pancytopenia is generally as the result of
decreased production from the bone
-- lymphocytes -- lymphocytosis -- lymphocytopenia marrow, and is a common complication of
cancer chemotherapy.
-- granulocytopenia or
-- granulocytes: -- granulocytosis
agranulocytosis
Elevated hematocrit
-- --neutrophils -- --neutrophilia -- --neutropenia In cases of dengue fever a high hematocrit is a
danger sign of an increased risk of dengue shock
syndrome.
-- --eosinophils -- --eosinophilia -- --eosinopenia
Polycythemia vera (PV), a myeloproliferative
disorder in which the bone marrow produces
-- --basophils -- --basophilia -- --basopenia excessive numbers of red cells, is associated with
elevated hematocrit.
Platelets thrombocytosis thrombocytopenia Chronic obstructive pulmonary disease
(COPD) and other pulmonary conditions
All cell lines - pancytopenia associated with hypoxia may elicit an
increased production of red blood cells. This
increase is mediated by the increased levels
of erythropoietin by the kidneys in response to hypoxia.
Professional athletes' hematocrit levels are measured as part of tests for blood doping or
Erythropoietin (EPO) use; the level of hematocrit in a blood sample is compared with the long-term
level for that athlete (to allow for individual variations in hematocrit level), and against an absolute
permitted maximum (which is based on maximum expected levels within the population, and the
hematocrit level which causes increased risk of blood clots resulting in strokes or heart attacks).
Steroid use can also increase the amount of RBC's and therefore impact the hematocrit.
If a patient is dehydrated, the hematocrit may be elevated. Repeat testing after adequate hydration
therapy will usually result in a more reliable result.
Lowered hematocrit
Lowered hematocrit can imply significant hemorrhage
The mean corpuscular volume (MCV) and the red cell distribution width (RDW) can be quite helpful in
evaluating a lower-than-normal hematocrit, because it can help the clinician determine whether blood
loss is chronic or acute. The MCV is the size of the red cells and the RDW is a relative measure of the
variation in size of the red cell population. A low hematocrit with a low MCV with a high RDW suggests
a chronic iron-deficient erythropoiesis, but a normal RDW suggests a blood loss that is more acute,
such as a hemorrhage.
Groups of individuals who are at risk for developing anemia include:
• infants who may not have adequate iron intake
• children going through a rapid growth spurt, during which the iron available cannot keep up
with the demands for a growing red cell mass
• women in childbearing years who have an excessive need for iron because of blood loss during
menstruation
• pregnant women, in whom the growing fetus creates a high demand for iron.
 • patients with chronic kidney disease, as their kidneys no longer secrete sufficient levels of the
hormone erythropoietin, which stimulates red blood cell
production by the bone marrow.
Lo Hig Comment
TesT Unit
w h s
Sodium 13 mmol/
145
(Na) 6 L MCV (MEAN CORPUSCULAR VOLUME)
Potassiu mmol/ Interpretation
3.5 5.5 The normal reference range is typically 80-100 fL[1].
m (K) L
High
BUN - In presence of hemolytic anaemia, presence of reticulocytes can increase
mmol/
Urea 2.5 6.4 blood urea MCV. In pernicious anemia (macrocytic), MCV can range up to 150
L
nitrogen femtolitres. An elevated MCV is also associated with alcoholism[2] (as are
an elevated GGT and a ratio of AST:ALT of 2:1). Vitamin B12 and/or Folic
Urea 7 18 mg/dL
Acid deficiency has also been associated with macrocytic anemia (high
Creatinin μmol/ MCV numbers).
62 115
e - male L Low
The most common causes of microcytic anemia are iron deficiency (due
Creatinin to inadequate dietary intake, gastrointestinal blood loss, or menstrual
μmol/
e- 53 97 blood loss), thalassemia, or chronic disease.
L
female A low MCV number in a patient with a positive stool guaiac test (bloody
Creatinin stool) is highly suggestive of GI cancer.
0.7 1.3 mg/dL In iron deficiency anemia (microcytic anemia), it can be as low as 60 to 70
e - male
femtolitres. In cases of thalassemia, the MCV may be low even though the
Creatinin patient is not iron deficient.
e- 0.6 1.1 mg/dL ESR (ERYTHROICYTE SEDEMENTATION RATE)
female The ESR is increased by any cause or focus of inflammation. The ESR is
See also increased in pregnancy or rheumatoid arthritis, and decreased in
glycosylat polycythemia, sickle cell anemia, and congestive heart failure. The basal
Glucose mmol/ ESR is slightly higher in females
3.9 5.8 ed
(fasting) L
hemoglobi
n Blood culture is a microbiological culture of blood. It is employed to
detect infections that are spreading through the bloodstream (such as
Glucose bacteremia, septicemia amongst others). This is possible because the
70 105 mg/dL
(fasting) bloodstream is usually a sterile environment
Indications of septicemia: · Core temperature out of normal range. · Focal
signs of infection. · Tachycardia, hyper or hypotension or raised respiratory rate. · Chills or rigors. · Raised or very
low WCC. · New or worsening confusion.
The signs of sepsis may be minimal or absent in the very young and the elderly.
To identify the causative organisms in severe pneumonia, postpartum fever, pelvic inflammatory disease, cannulae
sepsis, neonatal epiglottitis and sepsis. Investigations of patients with pyrexia of unknown origin (PUO). However,
negative growths do not exclude infection.
A glucose test is a type of blood test used to determine the amount of glucose in the blood.
There are several different kinds of glucose tests:
• Fasting blood sugar (FBS), fasting plasma glucose (FPG): 12 hours after eating
• Postprandial (PC): 2 hours after eating
• Glucose tolerance test: continuous testing
A range of 4 to 7 mmol/l (72 to 126 mg/dl) before a meal is normal. Continual fasting mg/dl of 100 or higher causes
concern of possible prediabetes and may be worth monitoring.
A level of < 10 mmol/l (180 mg/dl) 90 minutes after a meal is normal.
A range of 7 to 8 mmol/l (126 to 144 mg/dl) at bedtime is normal.
After a 12 hour fast, a range of 3.9 to under 6.1 mmol/l (70.2 to 100 mg/dl) is normal (a level of 6.1 to under 7
mmol/l (100 to 126 mg/dl) is considered a sign of prediabetes).

Blood urea nitrogen

The blood urea nitrogen (BUN) test is a measure of the amount of nitrogen in the blood in the form of urea, and a
measurement of renal function. Urea is a substance secreted by the liver, and removed from the blood by the
kidneys.
Physiology
The liver produces urea in the urea cycle as a waste product of the digestion of protein. Normal human adult blood
should contain between 7 to 21 mg of urea nitrogen per 100 ml (7-21 mg/dL) of blood. Individual laboratories may
have different reference ranges, and this is because the procedure may vary.[1][2]
Interpretation
The most common cause of an elevated BUN, azotemia, is poor kidney function, although a serum creatinine level
is a somewhat more specific measure of renal function (see also renal function).

Medical test: Serology, reference range: blood tests

Clinical BMP: electrolytes (Na+/K+, Cl-/HCO3-) · renal function, BUN-to-

biochemistry creatinine ratio (BUN/Creatinine) · Glucose · Ca
Metabolic panel CMP: BMP + protein tests (Human serum albumin, Serum total
protein) · liver function tests (ALP, ALT, AST, Bilirubin)
derived values: Plasma osmolality · Serum osmolal gap

Acid-base homeostasis Arterial blood gas · Base excess · Anion gap · CO2 content

Iron tests Transferrin saturation = Serum iron / Total iron-binding capacity

 Ferritin · Transferrin · Transferrin receptor

Glucose test · Glucose tolerance test · Glycemia · Noninvasive

Blood sugar glucose · C-peptide · Fructosamine · Random glucose test ·
Glycosylated hemoglobin

Endocrine ACTH stimulation test · Thyroid function tests

Troponin test · CPK-MB test · Glycogen phosphorylase

Cardiac marker
isoenzyme BB

Other Beutler test · Blood lipids · Tumor marker

vWF: Ristocetin induced platelet agglutination

clotting factors: Prothrombin time · Partial thromboplastin time ·
Thrombin time
Clotting other/general coagulation: Bleeding time · animal enzyme
(Reptilase time, Ecarin clotting time, Dilute Russell's viper
venom time) · Thromboelastography
fibrinolysis: Euglobulin lysis time · D-dimer
Hematology/CB
C Hematocrit · Hemoglobin · RBC count
ratios: Mean corpuscular hemoglobin · Mean corpuscular
hemoglobin concentration · Mean corpuscular volume
Red blood cell indices
Fetal hemoglobin: Apt-Downey test · Kleihauer-Betke test · Red
blood cell distribution width
Reticulocyte index · Haptoglobin

Other Blood film · Blood viscosity · Absolute neutrophil count

viral infection: HIV (HIV test, BDNA test) · Epstein-Barr virus

(Monospot test)
bacterial infection: syphilis (VDRL, Rapid plasma reagin,
Immunology Infections Wassermann test, FTA-ABS) · rickettsia (Weil-Felix test) ·
helicobacter (HelicoCARE direct) · streptococcus
(Antistreptolysin O titre)
protozoan infection: toxoplasmosis (Sabin-Feldman dye test)

C-reactive protein · Erythrocyte sedimentation rate · MELISA ·

Inflammation
RAST test

A greatly elevated BUN (>60 mg/dL) generally indicates a moderate-to-severe degree of renal failure. Impaired
renal excretion of urea may be due to temporary conditions such as dehydration or shock, or may be due to either
acute or chronic disease of the kidneys themselves.
An elevated BUN in the setting of a relatively normal creatinine may reflect a physiological response to a
relative decrease of blood flow to the kidney (as seen in heart failure or dehydration) without indicating any true
injury to the kidney. However, an isolated elevation of BUN may also reflect excessive formation of urea without
any compromise to the kidneys.
Increased production of urea is seen in cases of moderate or heavy bleeding in the upper gastrointestinal tract (e.g.
from ulcers). The nitrogenous compounds from the blood are resorbed as they pass through the rest of the GI tract
and then broken down to urea by the liver. Enhanced metabolism of proteins will also increase urea production, as
may be seen with high protein diets, steroid use, burns, or fevers.
When the ratio of BUN to creatinine (BUN:Cr) is greater than 20, the patient is suspected of having prerenal
azotemia. This means that the pathologic process is unlikely to be due to intrinsic kidney damage.
A low BUN usually has little significance, but its causes include liver problems, malnutrition (insufficient dietary
protein), or excessive alcohol consumption. Overhydration from intravenous fluids can result in a low BUN. Normal
changes in renal bloodflow during pregnancy will also lower BUN.
Urea itself is not toxic. This was demonstrated by Johnson et al. by adding large amounts of urea to the dialysate of
hemodialysis patients for several months and finding no ill effects.[1]. However, BUN is a marker for other
nitrogenous waste. Thus, when renal failure leads to a buildup of urea and other nitrogenous wastes (uremia), an
individual may suffer neurological disturbances such as altered cognitive function (encephalopathy), impaired taste
(dysgeusia) or loss of appetite (anorexia). The individual may also suffer from nausea and vomiting, or bleeding
from dysfunctional platelets. Prolonged periods of severe uremia may result in the skin taking on a grey
discolouration or even forming frank urea crystals ("uremic frost") on the skin.
Because multiple variables can interfere with the interpretation of a BUN value, GFR and creatinine clearance are
more accurate markers of kidney function. Age, sex, and weight will alter the "normal" range for each individual,
including race. In renal failure or chronic kidney disease (CKD), BUN will only be elevated outside "normal" when
more than 60% of kidney cells are no longer functioning. Hence, more accurate measures of renal function are
generally preferred to assess the clearance for purposes of medication dosing.
Units
BUN is reported as mg/dL in the United States. Elsewhere, the concentration of urea is reported as mmol/L. To
convert from mg/dL of blood urea nitrogen to mmol/L of urea, divide by 2.8 (each molecule of urea having 2
nitrogens, each of molar mass 14g/mol)
Urea (in mmol/L) = BUN (in mg/dL of nitrogen) / 2.8
convert BUN to urea in mg/dL by using following formula: Urea= BUN*2.14 MW of urea =60 urea nitrogen : 28 =
60/28