EVALUATION OF RENAL

FUNCTION

ART AND SCIENCE OF

URINALYSIS

Introduction

UA : tool the clinical assessment of

altered renal function patients
Attention for collecting and preserving
the specimen
Physical and chemical property
measurements of the urine and
microscopic exam of cells, crystals, and
organism

Specimen Collection
Concern to periuretrhal contact (female
>>)
Midstrem urine
Catheterization is better chance to
avoiding contamination
Suprapubic aspiration is a sterile
specimen

Specimen Collection
Should ideally be examined within 30
mnt
The urine become progressively more
alkaline (urea is broken down,
generating ammonia)
The pH dissolves cast and promotes cell
lysis
Can be preserved for up 6 hrs if

refrigerated at 4 C.

PHYSICAL PROPERTIES
To be determined include
Color
Clarity
Odor
Foam
Specific gravity
Dipstick exam

To be determined include
Color
Clarity
Odor
Foam
Specific gravity
Dipstick exam

Normal color is pale to yellow

Dilute urine appears lighter and
concentrate a darker yellow shade
Red urine may be noted with
- hematuria
- large amount of foodstuffs with heme
derivate pigments (the presence of
excess urates,certain drugs,porphyria)

RBCs is clue to presence of Hb and

myoglobin
Black urine is describe in
- homogentisic acid oxidase deficiency
(alkaptonuria)
- phenol poisoning
- excess melanin production in
melanoma

To be determined include
Color

Clarity

Odor

Foam

Specific gravity

Dipstick exam

 Normal urine is clear

Hazy if cellular elements ; cast and
organism present, renal diseases
Infections due to clarity decreased

To be determined include
Color

Clarity

Odor

Foam

Specific gravity

Dipstick exam

 Normally should not have a strong odor

Allowed to stand until urea has been
converted to ammonia
Specific odor may impact of infection,
ketosis and medication excretion

To be determined include
Color

Clarity

Odor

Foam

Specific gravity

Dipstick exam

 Foamy urine is usually associated with

- high-grade protein or
- bilirubinuria

To be determined include
Color

Clarity

Odor

Foam

Specific gravity

Dipstick exam

 Measure using a urinometer,

refractometer, or ionic reagent strip
For ionic tes:
- pH urine 6 7
- Alb, glucose,urea, some AB,contrast:
give a falsely low specific gravity
Urine osmolality measurement is much
reliable than any of test
Normal 1.010 1.020 ?

To be determined include
Color

Clarity

Odor

Foam

Specific gravity

Dipstick exam

Urine pH
Can bed measure very accurate and is quite
reproducible
Normally 4.5 7.8
Large meat consumption tend to acidic urine
Vegetarian diets more alkaline urine
High urinary pH due to :
- prolonged storage (amonia from urea)
- infection with urea splitting organisms
(Proteus)

Glucose
Sensitive measurement but not specific
for quantification
Most of labs give out semiquantitative
(+ to ++++) but correlation with blood
glucose is approximate and varies

Ketones
Are detected using a nitroprusside
reaction
Detects only - acetoacetics acid
- beta-hydroxybutirate
False-positive results to
- ascorbic acid
- phenazopyridine

Leukocyte Esterase and Urine Nitrite

Depends on esterase released from
granulocytes in urine
Esterase produced from granulocyte lysis
in : - long standing urine
- of contaminating vaginal cells
(may cause false positive)
Hyperglycemia,albuminuria,tetracycline,
cephalosporins and oxaluria inhibited
reaction granulocyte with esterase ->
false negative

 Presence of nitrite depends on the ability

of bacteria to convert nitrate into nitrite
Reaction to test strip inhibited by ascorbic acid
and high specific gravity
Low levels of urinary nitrate due to
- diet
- degradation of nitrite caused prolonged
storage
- inadequate conversion of nitrate to
nitrites due to rapid transit in bladder may
contribute to false negative despite the
presence of urinary infection.

 Certain bacteria do not convert nitrate to

nitrite (S.faecalis,N.gonorrhoe,M.tbc)
Specificity for infection is best when both
leukocyte esterase and nitrate are positive
If both tests are negative,
infection cannot be completely ruled out

Protein

Important marker of kidney disease

MICROSCOPIC EXAM
Study sediment is very important and
Underutilized tool to evaluate renal
pathology
Requires fresh urine 10 ml
centrifuge at 400-450g/5mnt
Bright field microscope is standard
Polarized light is also helpful

Cells
RBCs
More than two RBCs per hpf is
abnormal and
Suggests bleeding from some point
in the GU system

WBCs
Characterized by their cytoplasmic
granulation
Associated with infection and
inflammation

Epithelial cells
Squamous epithelial cells; present
due to shedding from the distal
genital tract and essentially are
contaminants
Transitional epithelial cells;
seen intermitten with bladder
catheterization or irrigation,
associated with malignancy

 Renal tubular epithelial cells;

present in tubular injury
Oval fat bodies ;
typical seen in nephrotic syndrome
and lipid uria

Casts
Hyalline cast (physiologic states;
excersice and dehydration)
Granular cast
Waxy casts
Fatty casts
Red cell casts
White cell casts
Epithelial casts

Crystals
Produced from pathologic excess of
metabolic product
In acidic urine : uric acid, monosodium
urate, and Ca oxalat
In alkaline urine : triple phosphate,
ammonium biurate, Ca phosphate,Ca
oxalat and Ca carbonate