Chrissa Mae T.

Catindoy BS Medical Technology 3A

PRELIMS [LECTURE II]: AUBF: Physical examination of urine

Urine volume

o Normal daily urine output: 600-2000mL (with night urine <400mL)

o Average urine output: 1200-1500mL (1% of the filtered plasma volume)
- Main determinant: water intake (body’s state of hydration).
- Not routinely performed.
- 120mL/min – filtered at the glomerulus, only an average of 1mL/min is finally
excreted as urine.
o Dehydration: 0.3mL/min
o Excessive hydration: 15mL/min
- Kidney excretes 2-3x more during the day than the night.

Variations of urine volume:

Oliguria

- Decrease in urine output.

o Adults: <400mL/day
o Infants: <1mL/kg/hr
o Children: <0.5mL/kg/hr
- Seen in dehydration as a result of excessive water loss from vomiting, diarrhea,
perspiration or several burns.
- May lead to anuria if not corrected.

Anuria

- Cessation of urine flow (complete lack of urine excretion).

- Decrease in blood flow to the kidney or from any serious damage to the kidneys
(hypotension, hemorrhage, shock, or heart failure).
- <100mL/day during 2-3 consecutive days in spite high fluid intake.

Nocturia

- Increase in nocturnal excretion of urine.

- Associated with chronic progressive renal failure.
- >500mL at night with specific gravity <1.018.

Polyuria

- Increase in daily urine volume.

- Adults: >2.5L/day
- Children: 2.5-3mL/kg/day
- Often associated with diabetes mellitus and diabetes insipidus.
- May be artificially induced by diuretics, caffeine, or alcohol (suppress ADH).

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Chrissa Mae T. Catindoy BS Medical Technology 3A
Diabetes mellitus Diabetes insipidus
Decreased or defective insulin leading to
Decreased or defective ADH.
increased glucose concentration.
Kidneys excrete increased amounts of Water needed for adequate body hydration
water to remove the dissolved glucose. is not reabsorbed.
Polyuria + High specific gravity Polyuria + Low specific gravity

Urine color

- Normal urine has wide range of color – mainly determined by its concentration.
o Pale yellow – dilute urine
o Dark yellow – concentrated urine

**NOTE: How to examine urine color?

Examine the specimen under a good light source, looking down through the container
against a white background.

- Normal urine color: colorless, pale yellow, yellow, dark yellow, amber.
- Urine pigments:
o Urochrome – causes the yellow color of urine.
o Uroerythrin – a pink pigment most evident in refrigerated specimens as a result
of amorphous urates precipitation.
o Urobilin – oxidation products of urobilinogen and imparts an orange-brown color
to urine that is not fresh.

Urochrome

- Lipid soluble, yellow pigment which was named by Thudicum in 1864.

- Present in plasma and excreted in urine.
- Product of endogenous metabolism, and is produced at a constant rate.
o Increased amount produced in thyroid conditions and fasting states.
o Increases in urine that stands at room temperature.

Variations of urine color:

Colorless

- Recent fluid consumption.

- Polyuria due to diabetes mellitus or diabetes insipidus.

Substance Color Clinical correlation

Abnormal pigment from degradation of
Dark yellow –
Bilirubin hemoglobin.
amber
Produced a stable yellow foam when shaken.
Dark yellow – Oxidation product of urobilinogen.
Urobilin
amber No yellow foam when shaken.

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Chrissa Mae T. Catindoy BS Medical Technology 3A
Dark yellow –
Biliverdin Oxidation product of bilirubin.
green
Phenazopyridine Urinary analgesic.
(pyridium) or Orange Produces yellow foam when shaken which
azoganstrisin comp. could be mistaken for bilirubin.
High consumption of vegetables or fruits with
Carotene Orange
carotene.
Warfarin (coumadin) Orange Anticoagulant
Riboflavin Bright yellow B-complex vitamin
Intact cells from bleeding in the urinary tract.
Red, pink, or RBCs in acidic urine for several hours produce
Red blood cells
brown brown urine (oxidation of hemoglobin to
methemoglobin)
Hemoglobin Red or pink Intravascular hemolysis.
Rhabdomyolysis or skeletal muscle
Myoglobin Red or brown
breakdown
Port wine (red- Oxidation of prophobilinogen/porphyrinogens
Porphyrins
purple) to porphyrins.
Contamination
Menstruation Red
Non-pathogenic
In alkaline urine of genetically susceptible
Beets Red
people.
Blackberries Red In acidic urine.
Red/bright-
Rifampin Anti-tuberculosis medication.
orange red
Used in renal blood flow or tubular secretion
Phenolsulfonphthalein Pink – red
testing.
Anticoagulant
Phenindione Red or orange
Color disappears on acidifying.
Phenothiazines Red Anti-psychotic
Senna Red Laxative

Hematuria vs hemoglobinuria/myoglobinuria

Hematuria – red and cloudy urine.

Hemoglobinuria/Myoglobinuria – red and clear urine.

Hemoglobin Myoglobin
Results from the breakdown of skeletal
Results from the in vivo breakdown of RBCs.
muscles.
Accompanied by red plasma. No change in color of plasma.

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Chrissa Mae T. Catindoy BS Medical Technology 3A
Substance Color Clinical correlation
Metabolite of phenylalanine.
Homogentisic acid Black Color develops upon standing in alkaline urine in
alkaptonuria.
Oxidation product of melanogen.
Dark brown –
Melanin Develops upon standing and associated with
black
malignant melanoma.
Levodopa Red then brown Drug for parkinsonism.
Darkens (red – Anti-hypersensitive
Methyldopa
brown) If oxidizing agent is present.
Brown (reddish Used to treat amoebiasis, trichomoniasis, and
Metronidazole
brown) giardiasis.
Phenol derivatives Brown Oxidized to quinones (green)
Pseudomonas Green UTI caused by Pseudomonas spp.
Intestinal tract infection causing increase in
Indicans Green
indicans.
Clorets Green Breath deodorizer
Used in Diagnex blue test for HCl (gastric
Azure A Blue
analysis)
Methocarbamol Green – brown Muscle relaxant
Urinary analgesic
Methylene blue Blue
Dye used to delineate fistulas.
Amitriptyline Blue Anti-depressant

Urinary clarity

- Refers to the transparency or turbidity of urine specimen.

- Assessed at the same time as urine color.
- Provides a key to the microscopic examination results.
o Amount of turbidity should correspond with amount of material observed under
the microscope.
- Reported as: clear, hazy, cloudy, turbid, and milky

**NOTE: How to examine urine clarity?

Visually examine the specimen in a clean container while holding it in front of a light
source.

Clarity Term Possible cause

Clear No visible particulates, transparent. All solutes present are soluble.
Few particles, print easily seen Clarity varies with substance and
Hazy
through urine. amount present (blood cells).
Many particulates, print blurred Crystals of normal and abnormal
Cloudy
through urine. solutes.

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Chrissa Mae T. Catindoy BS Medical Technology 3A
Turbid Print cannot be seen through urine. Epithelial cells, fats, and microbes.
Mucus, pus, radiographic contrast
Milky May precipitate or be clotted.
media, semen, and contaminants.

Urine foam

- Not reported in routine analysis.

- Serve as preliminary and supportive evidence for the presence of bilirubin and
abnormal amounts of protein in the urine.
o White, stable foam – moderate or large amount of protein.
o Yellow – sufficient amounts of bilirubin.

Cause of urine turbidity:

Non-pathologic Pathologic
Squamous epithelial cells and mucus Abnormal amounts on non-squamous
(particularly in women) epithelial cells
Bacterial growth in improperly preserved
RBCs, WBCs, bacteria, or yeast cell
specimens
White or beige cloudiness – amorphous
Abnormal crystals
phosphates and carbonates
Pink brick dust – amorphous urates Lymph fluid
Semen, spermatozoa Lipids
Fecal contamination
Radiographic contrast media
Talcum powder
Vaginal creams

Urine specific gravity

- Normal:
o Random: 1.002-1.035
o 24-hour: 1.015-1.025
- SG <1.002 – probably not urine.
- SG >1.035 – may be due to radiographic contrast media.
- Density of a solution compared with density of similar volume of distilled water (SG
1.000) at a similar temperature.
- Indicator of concentration of dissolved material or chemicals in the urine.
- Affected by both number and size of particles in the solution (vs osmolality which is
affected by number of particles only).
- Used to measure the concentrating and diluting ability of the kidney in its effort to
maintain homeostasis in the body.
o Tubular re-absorption – first function to diminish in renal disease.

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Chrissa Mae T. Catindoy BS Medical Technology 3A
Variations of urine specific gravity:

Isostenuria

- Urine with fixed specific gravity of 1.010 (seen in end stage renal disease).

Hyposthenuria

- Urine with fixed specific gravity of <1.010.

Hypersthenuria

- Urine with fixed specific gravity of >1.010.

Summary of methods for determining specific gravity and their principles:

Direct
Urinometer Density
Harmonic oscillation densitometry Density
Indirect
Refractometer Refractive index
Reagent strip pKa change of polyelectrolyte

Direct methods

Urinometer

- “hydrometer”
- Less accurate than the other methods; not recommended by the CLSI.
- Major disadvantage: large volume of urine (10-15mL).
- Calibrated at 20°C.
- Calibrated daily with distilled water (SG 1.000).
- Temperature correction required:
o If specimen is cold, subtract 0.001 from the reading for every 3°C that the
specimen is below 20°C.
o If specimen is warm, add 0.001 from the reading for every 3°C that the
specimen is above 2°C.
- Glucose and protein correction required:
o Subtract 0.004 for every 1g/dL glucose.
o Subtract 0.003 for every 1g/dL protein.
- When using the urinometer:
o An adequate of urine is poured into proper-sized container and the urinometer
is added with a spinning motion.
o The scale reading is then taken at the bottom of the urine meniscus.
o Level to which urinometer sinks represents the specimen’s mass or specific
gravity.

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Chrissa Mae T. Catindoy BS Medical Technology 3A
Harmonic oscillation densitometry (HOD)

- “Harmonic resonance”
- Initially used on a semi-automated urinalysis work station known as the yellow iris.
- Principle: “the frequency of a sound wave entering a solution changes in proportion to
the density of the solution.”
- A microprocessor corrects sample temperature.
- Result is valid up to a specific gravity of 1.080.

Indirect methods

Refractometer

- “total solids meter”

- Principle: “measures the refractive index (comparison of the velocity of light in air with
the velocity of light in a solution).”
- The path of light is deviated when it enters a solution and the degree of deviation or
refraction is proportional to the density of the solution.
- Advantage: uses small volume of specimen (1-2 gtts/drops)
- Calibrated between 15-38˚C (60-100˚F)
- Temperature corrections are not necessary
- Glucose and protein correction required:
o Subtract 0.004 for every 1g/dL glucose
o Subtract 0.003 for every 1g/dL protein
- Calibration is checked daily or whenever it is in use
o Distilled water – 1.000
o 3% NaCl – 1.015
o 5% NaCl – 1.022 ± 0.001
o 9% Sucrose – 1.034 ± 0.001
- Reading is slightly lower than urinometer reading on the same urine specimen by
about 0.002.

Reagent strip

- Principle: “pKa change of polyelectrolyte”

- No temperature nor protein or glucose correction required.

Urine odor

- Seldom of clinical significance and not part of the routine urinalysis.

- Normal odor of freshly voided urine: faint aromatic
- As specimen stands, the odor becomes ammoniacal (due to breakdown of urea)
- Lack of odor: acute tubular necrosis in patients with acute renal failure

Odor Cause
Aromatic Normal
Foul, ammonia-like Bacterial decomposition, UTI, old urine
Pungent, fetid UTI
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Chrissa Mae T. Catindoy BS Medical Technology 3A
Fruity, sweet Ketones
Maple syrup MSUD
Mousy, barny or musty Phenylketonuria
Rancid Tyrosinemia
Sweaty feet Isovaleric acidemia and glutaric acidemias
Cabbage, hops Methionine malabsorption
Rancid butter or fishy Hypermethioninemia
Rotting fish or old fish Trimethylaminuria
Bleach Contamination or adulteration of specimen
Menthol-like Phenol-containing medications
Rotten eggs Cystinuria
Swimming pool Hawkinsinuria
Unusual, pungent, or distinctive Ingestion of onions, garlic, and asparagus

Normal urine physical findings:

 Volume: 600-2000 mL/day; average of 1200-1500 mL

 Color: Colorless-Amber
 Transparency: Clear (Midstream clean catch)
 Specific gravity: 1.002-1.035
 Odor: Faintly aromatic

Urine taste

- Historically done to detect the presence of urinary sugars

- Diabetes (disorder producing copious amounts of urine).
o Mellitus – sweet
o Insipidus – tasteless

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