EXPERIMENT 6

METABOLISM AND ENERGY PRODUCTION:

ANALYSIS OF URINE
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Written Report
Presented to:
Ma’am Elizabeth Abesia

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Requirements for the

BIOCHEMISTRY LABORATORY

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By:

Reinell Go
Shaine Nantin
Mitchie Agcopra
Joshua Okayama
Jashmine Alawaddin
Mark Spencer Agapay
Justin Joshua Espinas
Kaye Marnelle Jacosalem

November 2018
 UROBILINOGEN AND BILE PIGMENTS: Gmelin’s Test

SPECIFIC OBJECTIVES: To test the Urobilinogen and bile pigments in the urine sample.
PROCEDURE:

 Label 2 tubes as “normal” and “abnormal” samples

 Place 2mL of concentrated nitric acid and 1mL of yellow nitrous acid in 2 clean and dry
test tube.
 Slowly add and let flow 10 drops of urine samples long the side of the tube containing the
acid. Do Not Mix. Note the resulting color formed at the junction of the two liquids.
 A band of colored ring at the point of the two fluids indicates the presence of bile
pigments. These rings are green, blue, violet, red, and yellow.
REAGENT:

 Nitric Acid
 Yellow Nitrous Acid
RESULT:
 POSITIVE – Presence of color ring band (red, green, blue, yellow, violet)
 NEGATIVE – No color ring band

EXPLANATION:

Gmelin's test is a chemical test used for detecting the presence of bile pigments in urine, in which a
positive result can indicate a liver disease such as hepatitis, cirrhosis and can occur before clinical
symptoms such as jaundice develop. Urobilinogen is a colorless by product of bilirubin reduction, it is
formed in the intestines by bacterial action. The bilirubin is an orange-yellow pigment formed in the liver
by the breakdown of hemoglobin and excreted in bile. Then the bile pigments, is a colored compound- a
breakdown products of the blood pigment hemoglobin. In this test, the reagent used is Nitric acid, it is
used as an oxidizing reagent for us to detect the bile pigments in urine. The positive result will give a red,
green, blue, yellow, and violet ring. Other bile pigments present are also oxidized tovarious colored
products aside from biliverdin (green) and bilirubin (golden-yellow) such as: bilicyanin (blue), bilifuscin
(red), and choletelin (yellow). Nitric Acid were being used as an oxidized agent as a substance that can
oxidize other substance in other words to cause them to lose electrons. In which the Nitric acid has a
strong acid and its conjugate base is more stable that is not very basic while the nitrous acid composes of
weak acid that is not stable in its conjugate base resulting to basic. The steps in the degradation of
hemoglobin to bilirubin, urobilinogen and finally, urobilin. Bilirubin, a highly pigmented yellow compound,
is a degradation product of hemoglobin. Under normal conditions, life span of red blood cells is
approximately 120 days, at which time they are destroyed in the spleen and liver by the phagocytic cells
of the reticuloendothelial system. The liberated hemoglobin is broken down into its component’s parts:
iron, protein, and protoporphyrin. The body reuses the iron and protein, and the cells of the
reticuloendothelial system convert the remaining photoporphyrin to bilirubin. The bilirubin is then
released into the circulation, where it binds with the albumin and is transported to the liver. At this point,
the kidneys cannot excrete the circulating bilirubin because not only is it bound to albumin but also but
also it is water insoluble. In the liver, bilirubin is conjugated with the glucuronic acid by the action of
glucuronyl transferase to form water-soluble bilirubin diglucuronide (conjugated bilirubin). Usually, this
conjugated bilirubin will not appear in the urine because it is passed directly from the liver into the bile
duct and on the intestine. In the intestine, intestinal bacteria reduce bilirubin to urobilinogen, which is
then oxidized and excreted in the feces in the form of urobilin.

CONCLUSION: In this test the positive result may not be seen if the concentration of the bile pigments is
low in urine. Since both normal and abnormal urine resulted to having low concentration of bile pigments
bilirubin (yellow).

CONDUCTED BY: Kaye Marnelle Jacosalem and Shaine Natin

 BLOOD: GUAIAC’S TEST

SPECIFIC OBJECTIVE: To determine the presence of blood in urine.

PROCEDURES:
 Label 2 clean dry test tubes
 Mix 1.0 ml of guaiac solution and 1.0 ml of old oil turpentine together.
 Layer on this solution about 0.5ml of the urine sample to be tested.
REAGENTS:
 Guaiac Solution
 old oil of turpentine
RESULT:

 NEGATIVE - Random urine

 NEGATIVE - Abnormal urine
 NEGATIVE - Fasting urine
 POSITIVE - Blue

EXPLANATION:

Three urine samples were used (random urine, abnormal urine, and fasting urine) to know if there was
any traces of blood. By that reason, 3 separate test tubes was used with the mixture of the active reagent
of guaiac solution (1 ml) and old oil of turpentine (1ml) along with the different urine samples (0.5ml). The
guaiac solution is the reagent that determine the presence of blood by using peroxidase- like activity found
in hemoglobin to generate an oxidative reaction. When the turpentine oil was mixed with the guaiac
solution there was no discoloration happens; but, in the presence of blood in urine there will be alteration
of color since the oxidative reaction of the guaiac solution is carried out and will be catalyze by the
turpentine oil by absorbing the 3 oxygen molecule of the blood to make the oxidation much faster hence,
that make the turpentine oil an ozonise turpentine oil. Upon this reaction the positive color or detection
of blood of urine will give you a blue solution, if negative there is no discoloration of the solution.

If the presence of blood is detected there will be a different possible types of blood that can be found in
urine. First is the hematuria which means the presence of res blood cells in the urine. There is 2 kinds of
hematuria the gross hematuria that can be seen easily by the red or brown discoloration of the urine and
the microscopic hematuria that cannot be seen in our naked eyes. In the presence of hematuria it
indicates that there are possible disease’s you’ve acquired such as urinary tract infection that occurs when
bacteria enter your body through urethra and multiply in your bladder or possible kidney diseases such
as a small and hard stones in kidneys (kidney stones). Next is the hemoglobinuria, is a condition which
the oxygen transport protein hemoglobin is found in abnormally high concentrations in urine. The
condition is often associated with hemolytic anemia ( abnormal breakdown of red blodd cells) in which
RBC are destroyed, thereby releasing free hemoglobin into the plasma. Excess hemoglobin is filtered in
the kidney, which excrete into the urine, giving urine a purple color it indicates that the person maybe
experiencing a iron defieciency or trauma. Lastly, myoglobinuria which is the presence of myoglobin in
urine associated usually of muscle destruction. Myoglobin is present in muscle cells as a reserve oxygen,
because of trauma or damage in muscles, myoglobin is released in circulation specifically kidneys that will
be filtered and excrete in urine.

CONCLUSION:

Blood occult test in urine will help us to know if there is the presence of blood in urine. Moreover, we will
enable to know where in the body this blood occurs by determining what kind of blood urine is present.
Upon conductining this experiment there is no presence of blood among the three urine samples which
means all urine were negative in blood.

CONDUCTED BY: Mark Spencer Agapay and Justin Joshua Espinas

 ELECTROLYTES
FLAME TEST: SODIUM ION

SPECIFIC OBJECTIVES: To detect the presence of certain metal ions.

PROCEDURES:
 Dip a cleaned flame test wire (clean in 3M HCI) into each urine specimen.
 Place the wire loop in a flame.
REAGENT:

 Hydrochloric Acid

RESULTS:

 NORMAL URINE – Strong persistent yellow-orange

ABNORMAL URINE – Orange-red

ELEMENT COLOR
Li Red
Na Strong persistent yellow-orange
K Lilac (pink)
Rb Red (Reddish- violet)
Cs Blue-violet
Cs Orange-red
Sr Red
Ba Pale Green
Cu Blue Green w/ white flashes
Pb Greyish-white

EXPLANATION:

Flame test is a procedure used in chemistry to detect the presence of certain metal ions, based on each
element's characteristic emission spectrum. normal and abnormal urine are used in the experiment to
determine the electrolytes on the samples. copper wire is first dip on HCl before dipping in the urine for
the urine will be converted into their metallic chlorides. urine must be converted to metallic chlorides
because it must be volatile. after dipping, the copper wire is pointed on the Bunsen burner and note the
color of the flame. on the experiment, normal urine produced strong persistent yellow orange while the
abnormal urine produced orange red. The color produced signifies a specific electrolyte. strong persistent
yellow orange represents Na(sodium) while orange red represents Ca (Calcium). The results are used to
track if there are electrolyte imbalance or any diseases related to the results.

CONDUCTED By: Reinell Go

ELECTROLYTES
SILVER NITRATE TEST: CLORIDE ION

SPECIFIC OBJECTIVE: To detect presence of chlorine ion in urine sample.

PROCEDURES:
 Place 3 mL of each urine specimen in a separate test tube.
 Add 5 drops of 3M HNO3 and 5 drops of 0.1M AgNO3. Mix thoroughly.
REAGENTS:
 HNO3
 AgNO3
RESULTS:
 White precipitation – Normal Urine
 White precipitation – Abnormal Urine

EXPLANATION:
This is a simple test to identify the presence of Chloride in solutions like urine. The steps require two
separate test tubes. One test tube should have an abnormal urine while normal urine for the other. Both
are added with nitric acid so that the other ions may not interfere and react to silver nitrate. The next step
is adding silver nitrate to both tubes and mix. The presence of chloride is indicated by the forming of white
precipitate which is silver chloride, a product of the ionic bonding of ions of silver nitrate and chloride.
Sodium chloride is an important electrolyte in the body. It helps maintain balance of the fluids in & out of
cells, blood volume, and blood pressure. Lack and excessive sodium chloride cause hypochloremia and
hyperrchloremia. The symptoms of the two are similar such as muscles spams and body weakening.

Conducted by: Joshua Okayama

 DIPSTICK TEST

SPECIFIC OBJECTIVES: To identify the substance in the urine associated with diseases.
PROCEDURES:
 Use the normal and abnormal urine samples.
 Dip the strip completely, but briefly, into the specimen.
 Compare the reaction of colors with the manufacturer’s chart.
RESULTS:

NORMAL URINE ABNORMAL URINE

GLUCOSE (-) TRACE .5
BILIRUBIN NEGATIVE NEGATIVE
KETONE TRACE .5 TRACE .5
SPECIFIC GRAVITY 1.005 1.020
BLOOD (-) (-)
Ph pH 7.5 Ph 6
PROTEIN (-) (-)
UROBILINOGEN (Normal) (NORMAL)
NITRITE (-) (-)
LEUKOCYTES TRACE 15 TRACE 15

EXPLANATIONS:

What is a Dipstick or Test Strip Urinalysis?

A urinalysis is a urine test best performed on a full bladder first thing in the morning. A urinalysis checks
appearance, concentration and content of urine and is used to detect and/or manage a wide range of medical
disorders, such as urinary tract infections (UTI's), kidney disease and diabetes.
These are the indicators of what are the high and normal level of these subtances detect on the
dipstict:
Bilirubin

Bilirubin is a brownish-yellow pigment that’s produced when red blood cells break down. The substance is
found in the liver and is normally passed out of the body during digestion. The natural process of red blood
cells dying while new cells are produced means that everyone has bilirubin in their bodies.Bilirubin only
becomes dangerous when it accumulates in the bloodstream. High levels of bilirubin can cause jaundice,
which is a medical condition that causes your skin to look yellow. This can be a sign of liver disease in
children and adults.Bilirubin levels are affected by age and overall health. For babies, bilirubin that
measures higher than 20-25 milligrams per deciliter can lead to neurological damage. This is why it’s
important to check their bilirubin levels. A urine test is one way of measuring how much bilirubin you have
in your body.

Results: Bilirubin test results are expressed as direct, indirect or total bilirubin. Total is a combination of
direct and indirect bilirubin. Typically, you'll get results for direct and total bilirubin.
Normal results for a bilirubin test are 1.2 milligrams per deciliter (mg/dL) of total bilirubin for adults, and
usually 1 mg/dL for those under 18. Normal results for direct bilirubin are generally 0.3 mg/dL.
These results may vary slightly from laboratory to laboratory. Normal results may be slightly different for
women and children, and results may be affected by certain foods, medications or strenuous exercise. Be
sure to tell your doctor about any foods or medications you've taken and your activity levels so that your
results can be interpreted correctly.
Lower than normal bilirubin levels are usually not a concern. Elevated levels may indicate liver damage or
disease.
Higher than normal levels of direct bilirubin in your blood may indicate your liver isn't clearing bilirubin
properly. Elevated levels of indirect bilirubin may indicate other problems.
One common, and harmless, cause of elevated bilirubin is Gilbert's syndrome, a deficiency in an enzyme
that helps break down bilirubin. Your doctor may order further tests to investigate your condition. Bilirubin
test results also may be used to monitor the progression of certain conditions such as jaundice.
Disease
Gilbert's syndrome produces an elevated level of unconjugated bilirubin in the bloodstream, but normally
has no serious consequences. Mild jaundice may appear under conditions of exertion, stress, fasting, and
infections, but the condition is otherwise usually asymptomatic.

Glucose (Urine) (trace 5)

What is this test?

A urine glucose test is used to indirectly determine whether your levels of glucose, or blood sugar, are
within a healthy range. It's used to monitor both type 1 and type 2 diabetes.If your blood glucose rises above
normal, your kidneys get rid of the extra glucose in your urine. That's why a urine glucose test may be able
to determine whether your blood glucose is too high.Although easier to perform than a blood test, a urine
test for glucose is not as accurate as a blood test. Urine tests are usually used only when blood testing for
glucose is difficult or impossible.

Why do I need this test?

You may need this test if you have signs of diabetes. These include increased thirst, unexplained weight
loss, increased urination, tiredness, blurred vision, and sores that don't heal. Sometimes people with
prediabetes or diabetes don't have any symptoms.
Your healthcare provider may check your glucose levels if you have risk factors for diabetes, including
being overweight or obese, being physically inactive, having high blood pressure, having high cholesterol,
 or having a family history of diabetes. If you do not have these risk factors, but are age 45 or older, you
should also be checked for diabetes at least every three years as long as your results are normal.
If you are pregnant and are at risk of developing gestational diabetes, you may be screened frequently
during and after your pregnancy.
Results: The normal amount of glucose in urine is 0 to 0.8 mmol/L (millimoles per liter). A higher
measurement could be a sign of a health problem. Diabetes is the most common cause of elevated glucose
levels. Your doctor will perform a simple blood test to confirm the diagnosis.

In some cases, a high amount of glucose in urine can be due to pregnancy. Pregnant women tend to have
higher urine glucose levels than women who aren’t pregnant. Women who already have increased levels of
glucose in their urine should be carefully screened for gestational diabetes if they become pregnant.

Elevated levels of glucose in urine may also be a result of renal glycosuria. This is a rare condition in which
the kidneys release glucose into the urine. Renal glycosuria can cause urine glucose levels to be high even
if blood glucose levels are normal.

Low blood sugar level can be an effect of Hypoglycemia.

Ketone Bodies (Urine)

What is this test?

This test is used to check the level of ketones in your urine. Normally, your body burns sugar for energy.
But if you have diabetes, you may not have enough insulin for the sugar in your bloodstream to be used for
fuel. When this happens, your body burns fat instead and produces substances called ketones. The ketones
end up in your blood and urine.
It's normal to have a small amount of ketones in your body. But high ketone levels could result in serious
illness or death. Checking for ketones keeps this from happening.

Why do I need this test?

You may need this test if you have a high level of blood sugar. People with high levels of blood sugar often
have high ketone levels. If you have high blood sugar levels and type 1 or type 2 diabetes, it's important to
check your ketone levels.
People without diabetes can also have ketones in the urine if their body is using fat for fuel instead of
glucose. This can happen with chronic vomiting, extreme exercise, low-carbohydrate diets, or eating
disorders.
Checking your ketones is especially important if you have diabetes and:
 Your blood sugar goes above 300 mg/dL
 You abuse alcohol
 You have diarrhea
 You stop eating carbohydrates like rice and bread
 You're pregnant
 You've been fasting
 You've been vomiting
 You have an infection
Your healthcare provider may order this test, or have you test yourself, if you:
 Urinate frequently
 Are often quite thirsty or tired
 Have muscle aches
 Have shortness of breath or trouble breathing
 Have nausea or vomiting
 Are confused
 Have a fruity smell to your breath

What other tests might I have along with this test?

Your healthcare provider may also check for ketones in your blood if you have high levels of ketones in
your urine.
If your healthcare provider suspects you have diabetes, he or she may order other urine tests to check for
these substances:
 Glucose, or blood sugar
 Protein
 pH, or acid level
 Blood ketones

Result: High ketone level:

Ketones can make your blood acidic. Acidic blood can cause Diabetic KetoAcidosis. The most serious
effects of DKA include:

 swelling in your brain

 a loss of consciousness
 diabetic coma
 death
What are nitrates and nitrites?

Nitrates and nitrites are both forms of nitrogen. The difference is in their chemical structures — nitrates
have three oxygen atoms, while nitrites have two oxygen atoms.

Both nitrates and nitrites are found naturally in certain vegetables, like leafy greens, celery, and cabbage,
but are also added to processed foods like bacon, as a preservative.

Having nitrates in urine is normal and not harmful. However, having nitrites in your urine could mean you
have an infection.
The presence of nitrites in urine most commonly means there’s a bacterial infection in your urinary tract.
This is usually called a urinary tract infection (UTI).

A UTI can happen anywhere in your urinary tract, including your bladder, ureters, kidneys, and urethra.

Harmful bacteria find their way into the urinary tract and reproduce rapidly. Some types of bacteria have
an enzyme that converts nitrates into nitrites. This is why the presence of nitrites in your urine is an indicator
that you may have a UTI.

UTIs usually have other symptoms, such as:

 burning with urination

 feeling the need to urinate often without passing much urine
 increased urgency of urination
 blood in the urine
 cloudy urine
 strong smelling urine

Some people won’t experience symptoms of a UTI right away. If you’re pregnant, your doctor may want
to test your urine for nitrites and other factors at several points during your prenatal care as a precautionary
measure, even if you don’t have symptoms of a UTI.

UTIs are common in pregnancy and are dangerous. They can cause high blood pressure and premature
delivery if left untreated. UTIs during pregnancy are also more likely to spread to the kidneys.

How are nitrites in urine diagnosed?

Nitrites in the urine are diagnosed with a test called a urinalysis. A urinalysis may be done for a variety of
reasons including:

 if you have symptoms of a UTI, like painful urination

 during a routine checkup
 if you have blood in your urine or other urinary problems
 before a surgery
 during a pregnancy checkup
 if you’re admitted to a hospital
 to monitor an existing kidney condition
 if your doctor suspects you have diabetes

Before a urinalysis, inform your doctor of any medications, vitamins, or supplements you're taking.
Analysis of the urine sample

There are several steps to analyze urine in a urinalysis:

 First, your doctor will visually inspect the urine to look for cloudiness — cloudy, red, or brown-
colored urine usually means there’s an infection.
 Second, a dipstick (a thin stick with strips of chemicals) is used to check for a variety of factors, such
as the pH, and the presence of protein, white blood cells, or nitrites. A dipstick test can be done
immediately after the sample is taken.
 If the dipstick test reveals abnormal results, the urine sample may be sent off to a laboratory for further
testing and microscopic evaluation.

What do the test results mean?

A positive test for nitrites in the urine is called nitrituria. If you have nitrituria, your doctor will likely want
to send your urine sample to a laboratory for a urine culture test. In a urine culture, your doctor can find out
which specific type of bacteria are causing your UTI.A urine culture usually takes about two to three days
to be completed, sometimes longer depending on the type of bacteria. On average though, you should expect
to see your results in three days.Keep in mind that not all bacteria are capable of converting nitrate to nitrite.
So, you can have a negative nitrite test and still have a UTI. This is why your doctor considers the result of
many tests, not just one test, when diagnosing a UTI.

Can nitrites in urine cause complications?

Untreated UTIs become more severe as they spread toward the kidneys. An infection in the upper urinary
tract is much more challenging to treat. Eventually, the infection can spread into your blood, causing sepsis.
Sepsis can be life-threatening.

Additionally, UTIs in pregnant women can be dangerous for the baby and mother.

Drinking plenty of water to flush out the bacteria is also an important step in helping you recover more
quickly.

What’s the outlook for people with nitrites in urine?

Even if you don’t have any other symptoms, nitrites in your urine means you have harmful bacteria growing
where they shouldn’t be. It’s very important to treat this infection as early as possible.
When dealt with promptly, UTIs are easily treatable and usually resolve quickly in a couple of days.
Blood
Blood in urine - known medically as hematuria - is usually not a reason for major alarm.Because blood in urine
can be a sign of a serious medical condition, however, it shouldn't be ignored. All cases of hematuria should be
evaluated by a doctor who can order tests to confirm or rule out an underlying cause.
There is no specific treatment for hematuria, because it's a symptom and not a specific condition. Instead,
treatment is aimed at the underlying cause if one can be found. In many cases, no treatment is necessary.

Where Blood in Urine Might Come From

Blood in urine can come from the kidneys, where urine is made. It also can come from other structures in the
urinary tract, such as:

 Ureters (the tubes from the kidneys to the bladder)

 Bladder (where urine is stored)
 Urethra (the tube from the bladder to the outside of the body)

Symptoms That May Accompany Hematuria

If there is blood in urine, the symptom is obvious. Instead of its normal pale yellow color, your urine may be
pink, red, brownish-red, or tea-colored. This is what doctors call gross hematuria.
Sometimes, blood in urine is not visible to the naked eye and the presence of red blood cells can only be detected
by the lab. This is what doctors call microscopic hematuria. It's usually only discovered when a urine sample is
tested with a dipstick and the results are confirmed with a microscopic examination.
Hematuria may occur without any other symptoms. Some underlying causes, however, are associated with
additional symptoms that can be moderate to severe. These include:

 Bladder infections (acute cystitis). In adults, bladder infections usually cause burning or pain with
urination. Infants with bladder infections may have fever, be irritable, and feed poorly. Older children
may have fever, pain and burning while urinating, urgency, and lower belly pain.
 Kidney infections (pyelonephritis). Symptoms may include fever, chills, and flank pain, which refers to
pain in the lower back.
 Kidney stones. Symptoms may include severe abdominal or pelvic pain.
 Kidney diseases. Symptoms may include weakness, high blood pressure, and body swelling, including
puffiness around the eyes.

Causes of Hematuria
Common causes of blood in urine include:

 Bladder or kidney infections

 Bladder or kidney stones
 Certain kidney diseases, such as inflammation in the filtering system of the kidneys
(glomerulonephritis)
 Enlarged prostate (benign prostatic hyperplasia) or prostate cancer
 Inherited diseases such as sickle cell anemia and cystic kidney disease
 Certain medications such as aspirin, penicillin, heparin, cyclophosphamide, and phenazopyridine
 A tumor in the bladder, kidney, or prostate
  Kidney injury from an accident or sports
 Vigorous exercise
Sometimes, what appears to be blood in urine is actually red pigment from other sources such as food dyes,
medications, or an excessive amount of beets. Doctors refer to this latter cause as "beeturia."
PROTEIN
People with proteinuria have urine containing an abnormal amount of protein. The condition is often a sign
of kidney disease.Healthy kidneys do not allow a significant amount of protein to pass through their filters.
But filters damaged by kidney disease may let proteins such as albumin leak from the blood into the
urine.Proteinuria can also be a result of overproduction of proteins by the body.
Kidney disease often has no early symptoms. One of its first signs may be proteinuria that's discovered by
a urine test done during a routine physical exam. Blood tests will then be done to see how well the kidneys
are working.

Risk Factors for Proteinuria

The two most common risk factors for proteinuria are:

 Diabetes
 High blood pressure (hypertension)
Both diabetes and high blood pressure can cause damage to the kidneys, which leads to proteinuria.
Other types of kidney disease unrelated to diabetes or high blood pressure can also cause protein to leak
into the urine. Examples of other causes include:

 Medications
 Trauma
 Toxins
 Infections
 Immune system disorders
Increased production of proteins in the body can lead to proteinuria. Examples include multiple
myeloma and amyloidosis.
Other risk factors include:

 Obesity
 Age over 65
 Family history of kidney disease
 Preeclampsia (high blood pressure and proteinuria in pregnancy)
 Race and ethnicity: African-Americans, Native Americans, Hispanics, and Pacific Islanders are
more likely than whites to have high blood pressure and develop kidney disease and proteinuria.
Some people get more protein into urine while standing than while lying down. That is known as orthostatic
proteinuria.
Urobilinogen in Urine
What is a Urobilinogen in Urine Test?
A urobilinogen in urine test measures the amount of urobilinogen in a urine sample. Urobilinogen is formed
from the reduction of bilirubin. Bilirubin is a yellowish substance found in your liver that helps break down
red blood cells. Normal urine contains some urobilinogen. If there is little or no urobilinogen in urine, it
 can mean your liver isn't working correctly. Too much urobilinogen in urine can indicate a liver
disease such as hepatitis or cirhosis.
What is it used for?
A urobilinogen test may part of a urinalysis, a test that measures different cells, chemicals, and other
substances in your urine. A urinalysis is often part of a routine exam.
Why do I need a urobilinogen in urine test?
Your health care provider may have ordered this test as part of your regular checkup, to monitor an existing
liver condition, or if you have symptoms of a liver disease. These include:

 Jaundice, a condition that causes your skin and eyes to turn yellow
 Nausea and/or vomiting
 Dark colored urine
 Pain and swelling in the abdomen
 Itchy skin

What do the results mean?

If your test results show too little or no urobilinogen in your urine, it may indicate:
 A blockage in the structures that carry bile from your liver
 A blockage in the blood flow of the liver
 A problem with liver function
 If your test results show a higher-than-normal level of urobilinogen, it may indicate:
 Hepatitis
 Cirrhosis
 Liver damage due to drugs
 Hemolytic anemia, a condition in which red blood cells are destroyed before they can be replaced. This
leaves the body without enough healthy red blood cells
If your results are abnormal, it does not necessarily indicate you have a medical condition requiring
treatment. Be sure to tell your health care provider about any medicines and supplements you are taking, as
these can affect your results. If you are a woman, you should tell your health care provider if you are
menstruating.

Leukocytes
Leukocytes, also known as white blood cells, are a central part of the immune system. They help to protect
the body against foreign substances, microbes, and infectious diseases.These cells are produced or stored
in various locations throughout the body, including the thymus, spleen, lymph nodes, and bone
marrow.High leukocyte levels suggest that the body is trying to fight an infection.
Leukocytes travel throughout the body, moving between the organs and nodes and monitoring any
potentially problematic germs or infections.
Only very low levels of leukocytes, if any, are normally found in the urine. A high leukocyte content in the
urine may indicate an infection or other underlying inflammatory medical problems.
Causes: Leukocytes might be present in urine for a range of reasons.
 1. Bladder infections- A high number of leukocytes in the urine may indicate the presence a urinary tract
infection.
A urinary tract infection (UTI) is one of the most common causes of leukocytes in the urine. A UTI is an
infection that occurs in any part of the urinary system.
This system includes the kidneys, ureters, bladder, and urethra. Most infections involve the lower urinary
tract, and more specifically the bladder and urethra.
Most commonly, a UTI occurs when a bacterium or bacteria enter the urinary tract by way of the urethra
and begin to multiply in the bladder.
Women are at a greater risk of developing a UTI than men. Around 50 to 60 percent of women will develop
a UTI at some time.
A UTI in the urinary bladder can spread to the ureters and kidneys without prompt treatment, and this can
become serious.

2. Kidney stones- A higher-than-usual number of leukocytes may be a sign of kidney stones.

Urine normally contains lower levels dissolved minerals and salts. People with high levels of these in their
urine are at risk of developing kidney stones.
Symptoms include:
 pain
 nausea and vomiting
 fever and chills
Stones that make their way into the ureters can interfere with the forward movement of urine. This blockage
can allow bacteria to build up more easily and lead to an infection.
3. Kidney infection- A kidney infection can increase levels of white blood cells in the urine.
These infections often start lower in the urinary tract and spread up to the kidneys. Though less common,
it is also possible for bacteria from other areas in the body to spread through the bloodstream to the kidneys.
People with weak immune systems or who have been using urinary catheters for long periods face a higher
risk of developing a kidney infection.

4. Urinary system blockage- A blockage can lead to the development of hematuria, which is blood in the
urine, or hydronephrosis, which is fluid around the kidney or kidneys.
The blockage can be due to trauma or caused by kidney stones, tumors, or other foreign material.
5. Holding in urine- There is a reason why people should not make a habit of holding in their urine.
Holding in urine for extended periods of time can weaken the bladder and make it difficult to empty. If
urine spends too long building up in the bladder, bacterial presence and possible infection can more easily
occur.
This infection can lead to higher levels of leukocytes in the urine.
Other causes: White blood cells help all parts of the body fight infection.
These are just a few of the common causes, but there are others. The following can also cause raised levels
of leukocytes in the urine:

 some cancers, such as prostate, bladder, or kidney cancer

 blood diseases such as sickle cell anemia
 some pain-relieving medicines
 interstitial cystitis
Symptoms
Leukocytes in the urine cause different symptoms for different people, but there are a few symptoms or
signs that suggest leukocytes may be present in the urine.
One of the most visible signs is cloudy or foul-smelling urine. Other signs include frequent urination, a pain
or burning sensation when passing urine, or the presence of blood in the urine.
Other symptoms include:
 shivering and fever
 lower back and side pain
 acute pelvic pain
 nausea or vomiting
 long-term pelvic pain
 painful sex

Leukocytes in urine. An unusually high number of leukocytes in the urine indicates inflammation
or infection along the urinary tract, often in the bladder or kidney.

What is a urine pH level test?

A urine pH level test is a test that analyzes the acidity or alkalinity of a urine sample. It’s a simple and
painless test. Many diseases, your diet, and the medicines you take can affect how acidic or basic your urine
is. For instance, results that are either too high or low can indicate the likelihood that your body will
form kidney stones. If your urine is at an extreme on either the low or high end of pH levels, you can adjust
your diet to reduce the likelihood of painful kidney stones.

In short, your urine pH is an indicator of your overall health and gives your doctor important clues as to
what’s going on in your body.

Why do I need a urine pH level test?

Kidney stones are small masses of minerals that can collect in the kidneys and cause pain as they prevent
urine from passing through your kidneys and urinary system. Since these stones tend to form in a highly
acidic or basic/alkaline environment, your doctor may test your urine to determine the likelihood you will
form kidney stones.

Certain medications can make your urine more acidic. Your physician may order the urine pH level test to
determine whether your medications are making your urine too acidic.

The urine pH level test can also determine the best medication to prescribe when you have a urinary tract
infection.
How is the urine pH level test performed?

Prior to testing, your doctor may ask you to stop taking certain medications known to affect your urine pH.
Examples of these drugs include:

 acetazolamide, used to treat glaucoma, epilepsy, and other disorders

 ammonium chloride, used in some cough medicines
 methenamine mandelate, used to treat urinary tract infections
 potassium citrate, used to treat gout and kidney stones
 sodium bicarbonate, used to treat heartburn and acid indigestion
 thiazide diuretics, used to treat high blood pressure and to reduce the risk of stroke and heart attacks

However, don’t make changes to your diet prior to the urine pH level test unless directed to by your doctor.
The foods you eat affect your urine pH, and you want the test to be as accurate as possible in predicting
your typical urine pH level. The test will help your doctor identify the cause of the actual changes in your
urine pH.

To get the best results, the urine pH test requires obtaining a clean-catch urine sample. The clean-catch
method involves cleaning the genital area before urination and then collecting urine midstream. This
method helps eliminate certain organisms and pathogens that might affect your urine sample.

Your doctor will give you a cup to urinate into. Don’t touch the inner portion of the cup and be sure to not
let anything but urine into the cup in order to avoid contaminating the sample. After urinating using the
clean-catch method, give the cup to the appropriate medical staff. They will send your sample to a
laboratory as quickly as possible to ensure the most accurate results.

What do the results mean?

A laboratory will test your urine pH and return results.
A neutral pH is 7.0. The higher the number, the more basic (alkaline) it is. The lower the number, the more
acidic your urine is. The average urine sample tests at about 6.0.
If your urine sample is lower, this could indicate an environment conducive to kidney stones. Other
conditions that prefer an acidic environment are:

 acidosis
 dehydration
 diabetic ketoacidosis
 diarrhea
 Starvation
A higher-than-normal urine pH could indicate:

 gastric suctioning that takes away stomach acids

 kidney failure
 kidney tubular acidosis
 pyloric obstruction
 respiratory alkalosis
 urinary tract infection
 vomiting

Your diet also may determine how acidic or alkaline your urine is. For example, if you eat a diet low in
meat and high in fruits and vegetables, you’re more likely to have alkaline urine. Those who consume
higher amounts of meat are more likely to have acidic urine. Your doctor may recommend some changes
to your diet if your urine pH is too high or too low.

There are no side effects associated with the urine pH level test. You can typically resume your daily
activities following the test.

Specific Gravity

A urine specific gravity test compares the density of urine to the density of water. This quick test can help
determine how well your kidneys are diluting your urine.Urine that’s too concentrated could mean that your
kidneys aren’t functioning properly or that you aren’t drinking enough water.Urine that isn’t concentrated
enough can mean you have a rare condition called diabetes insipidus, which causes thirst and the excretion
of large amounts of diluted urine.

What is the test used for?

The main role of your kidneys is to filter your blood and maintain normal electrolyte balance. Testing urine
specific gravity is a quick way for your healthcare provider to tell if your kidneys are trying to compensate
for some abnormality.Specific gravity testing is useful if your healthcare provider thinks you have any of
the following conditions:

 dehydration or overhydration
 heart failure
 shock
 diabetes insipidus
 kidney failure
 kidney infection
 urinary tract infection
 hyponatremia, or low sodium levels
 hypernatremia, or elevated sodium levels
You may have to take a urine specific gravity test several times in one day. This will help your healthcare
provider to see how well your kidneys are compensating.

How are the results interpreted?

To understand urine concentrations, think about the dark color of your urine when you haven’t had anything
to drink in some time. Your urine is lighter and usually has lower specific gravity when you’re well-
hydrated.

Urine specific gravity is a more precise measurement of your urine’s overall concentration than looking at
the color of your urine alone.

Your healthcare provider will look at the ratio of the density of your urine to the density of water. To put it
another way, the specific density of water would be 1.000. Ideally, urine specific gravity results will fall
between 1.002 and 1.030 if your kidneys are functioning normally.

Specific gravity results above 1.010 can indicate mild dehydration. The higher the number, the more
dehydrated you may be.

High urine specific gravity can indicate that you have extra substances in your urine, such as:

 glucose
 protein
 bilirubin
 red blood cells
 white blood cells
 crystals
 bacteria

Your healthcare provider will use the results from your urine specific gravity test, along with other
urinalysis results, to come up with a diagnosis. Abnormal specific gravity results could indicate:

 excess substances in the blood

 kidney disease (high or low specific gravity can indicate an inability of the kidney tubules to function
correctly)
 infection, such as a urinary tract infection
 brain injuries, which can cause a person to develop diabetes insipidus

A urinalysis can also measure the concentration of various cells. White blood cells can indicate an infection.
And glucose can point to glucose intolerance or diabetes.
Other types of urine tests include urine pH tests, hemoglobin tests, and ketone tests. The results from these
tests can help your healthcare provider make a more accurate diagnosis.

What are the test’s side effects?

The urine specific gravity test involves urinating normally and isn’t associated with any harmful side
effects. However, if you have a urinary tract infection, urinating may cause a burning or painful sensation.

Always notify your healthcare provider if you experience discomfort urinating or any unexpected
symptoms.

Conducted by: Jashmine Alawaddin and Mitchie Agcopra