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PHYSICAL EXAMINATION Determination of


OF URINE Urine color
Clarity
Specific gravity aids in renal tubular function evaluation
Provides preliminary information concerning disorders
Glomerular bleeding
Liver disease
Inborn errors of metabolism
Urinary tract infection
COLOR Colorless to black
o Normal metabolic functions
o Physical activity
o Ingested materials
o Pathologic conditions
Normal Urine Color Pale yellow
Urochrome Yellow
Uroerythrin Dark Yellow
Urobilin PIGMENTS
Urochrome by Thudichum in 1864
o Product of endogenous metabolism
o Amount produced is dependent n the bodys metabolic state
Increases
Thyroid conditions
Fasting states
When urine stands at room temperature
o Excreted at constant rate
Intensity of yellow can estimate urine concentration
Dilute pale yellow
Concentrated dark yellow
Uroerythrin
o Pink pigment
o In refrigerated specimens = precipitation of amorphous urates
o Uroerythrin attaches to urates producing a pink color to the sediment
Urobilin
o An oxidation product of the normal urinary constituent urobilinogen
o Orange-brown color = urine that is not fresh
Abnormal Urine Color Dark Yellow/ Amber/Orange
Bilirubin Not always signify a normal conc urine
Urobilinogen & Can be caused by the presence of the abnormal pigment bilirubin
urobilin o If bilirubin is present = can be detected in chemical examination
Phenazopyridine Suspected if yellow foam appears when specimen is shaken
(azo-gantrsn Can also contain hepatitis virus
compounds) o Normal urine produces only a small amount of rapidly disappearing foam when
Biliverdin shaken and a large amount of white foam indicates an increased concentration of
protein
Yellow-orange urine
o Photo-oxidation of large amounts of excreted urobilinogen to urobilin
No yellow foam
o Administration of phenazopyridine (Pyridium) or azo-gantrisn compounds
For UTI
Can interfere with chemical tests
Can produce yellow foam when shaken, mistaken for bilirubin
Yellow-green
o Biliverdin - photo-oxidation of bilirubin
Red/Pink/Brown
Presence of blood most common causes of abnormal urine
o Ranges from pink to brown
pH
amount of blood
length of contact
o Red
RBCs red and cloudy urine
Hemoglobin red and clear urine; red plasma from in vivo breakdown of
RBCs
Myoglobin red and clear urine; breakdown of skeletal myscle; no change
in plasma
Non-pathogenic
Menstrual contamination
Ingestion of highly pigmented foods
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o Fresh beets = red color in alkaline urine
o Blackberries = red in acidic urine
Medications
o Rifampin
o Phenolphthalein
o Pheninodione
o Phenothiazines
o Brown
RBCS in acidic urine for several hours
Due to oxidation of hemoglobin to methemoglobin
If fresh
Glomerular bleeding = conversion of hemoglobin to
methemoglobin
o Port Wine
Contain porphyrins (can also be red)
From oxidation of porphobilinogen to porphyrins

Brown/Black
Melanin
o Oxidation product of melanogen (colorless pigment) produced in excess when a
malignant melanoma is present
Homogentisic acid
o Metabolite of phenylalanine
o Black color to alkaline urine from persons with alkaptonuria
Medication
o Levodopa
o Methyldopa
o Pehon derivatives
o Metronidazole (Flagyl)
Blue/Green
Bacterial infections
o UTI Pseudomonas spp
o Intestinal tract infections = increased urinary indican
Green urine
o Ingestion of breath odorizes (Clorets)
o Phenol derivatives in intravenous medications = green urine on oxidation
Blue
o Medications
Methocarbamol (Robaxin)
Methylene blue
Amitriptyline (Elavil)
Purple
o In catheter bags = indican in urine/bacterial infection
Klebsiella / Providencia spp
CLARITY 1. Clear - no visible particualtes, transparent
- Transparency or 2. Hazy few particulates, print easily seen through urine
turbidity of a 3. Cloudy many particulates, print blurred through urine
urine specimen 4. Turbid Print cannot be seen through urine
5. Milky may precipitate or be clotted
Normal Clarity Clear - Freshly voided midstream clean-catch
White cloudiness precipitation of amorphous phosphates and carbonates
Nonpathologic Hazy but normal
Turbidity o In women, presence of
Squamous epithelial cells
Mucus
Allowed to stand or are refrigerated
o Bacterial growth
Refrigerated = thick turbodity
o Precipitation of amorphous
Urates = produce precipitate in acidic urine, resembling pink brick dust
(presence of uroerythrin)
Carbonates & Phosphates = white precipitate in alkaline pH
Semen, spermatozoa
Fecal contamination
Radiographic contrast media
Talcum powder
Vaginal creams

Pathologic Turbidity From systemic organ disorder of infections


o RBCs
o WBCs
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o Bacteria
Less frequent causes of patho turb
o Non squamous epithelial cells
o Yeast
o Abnormal crystals
o Lymph fluid
o Lipids
Clear is not always normal
Criteria used to determine the necessity of micro exam
o Clarity
o Chem tests for RBCs, WBCs, bacteria, and protein
SPECIFIC GRAVITY Kidneys important function
- A density of a o To concentrate glomerular filtrate by selectively reabsorbing essential chemicals and
solution water
compared with A routine urinalysis for urine conc evaluation
the density of a SG of plasma filtrate entering the glomerulus = 1.010 (isosthenuric)
similar volume Hyposthenuric - <1.010
of dwater Hypersthenuric - >1.010
(1.000) at a Normal random: 1.002 1.035
similar o Random: 1.015-1.030
temperature <1.002 = not urine
Influenced by: number of particles, size
Methods
o Refractometery refractive index; required correcting
o Reagens strips pKa changes of a polyelectrolyte by ions present
o Osmolality changes in colligative properties by particle number
Refractometer Refractive index
- Determines the o Comparison of the velocity of light in air with the velocity of light in asolution
conc of o The conc of dissolved particles present in the sol determines the v and angle at
dissolved which light passes through a solution
particles in a o Uses prisms to direct specific monochromatic wavelength of daylight against a
specimen by manufacturer-calibrated SG scale
measuring o Conc of specimen determines the angle at which the light beam enters the prism
refractive index Uses only small volumes (1-2 drops)
Temp corrections are not necessary
o Light beam passes through a temperature-compensating liquid
o Temp is compensated 15-28 deg. C
- 0.003 for each g of protein
- 0.004 for each g of glucose
Calibrated using dwater, should read 1.000
o Further checked with 5% NaCl = 1.022 +- 0.001
o 9% sucrose = 1.034 +- 0.001
Abnormally high
>1.040
patients who have recently undergone an intravenous pyelogram excretion of injected
radiographic contrast media
Receive dextrans or other HMW intravenous fluids
o Not affected by reagent strips and osmometry
Osmolality Affected only by the number of particles present
Evaluate renal conc ability
o Na (23 MW)
o Cl (25.5 MW)
o Urea (60 MW)
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