PHYSICAL EXAMINATION OF URINE SUMMARY

 Includes urine color, clarity, and specific gravity.

COLOR

 Colorless to black (due to normal or pathologic metabolic functions)

 Laboratory correlation of urine color (table 1)

NORMAL URINE COLOR

 Common descriptions:
o Pale yellow
o Yellow
o Dark yellow
 PIGMENTS
o UROCHROME
 Named by Thudichum in 1864
 Pigment that causes the yellow color of the urine.
 Product of endogenous metabolism
 Dependent on the body’s metabolic state
 Increased in urine that stand in room temperature.
o UROERYTHRIN
 Pink pigment
 Evident in specimens that are refrigerated causing the precipitation of
amorphous urates (pink-colored sediment)
o UROBILIN
 Oxidation product of urobilinogen.
 Orange-brown color on not fresh urine.

ABNORMAL URINE COLOR

 DARK YELLOW/AMBER/ORANGE
o Can be caused by the presence of the abnormal pigment bilirubin.
o If bilirubin is present it can be detected during chemical test or presence of large
amount of yellow foam if shaken.
o White foam on large quantities indicates increased concentration of protein.
o Yellow green color
 photo-oxidation of bilirubin, presence of biliverdin.
o Yellow Orange color
 Administration of phenazopyridine
 Medication for people who have Urinary Tract infection.
 Interferes with most chemical test because of its strong color.
 RED/PINK/BROWN
o RED
 Presence of blood
 Pink to brown (depending on the concentration of blood)
  Fresh brown urine – glomerular bleeding
 Presence of blood in urine (hemoglobinuria)
 Red / cloudy
 Presence of hemoglobin (myoglobinuria)
 Red/ clear
 Presence of porphyrins (port wine color)
 Nonpathogenic causes
 Menstruation
 Highly pigmented foods
 Admn. Of Rifampin (TB drug)
 BROWN/ BLACK
o May contain melanin or homogentisic acid
 On stading urine with neg chem test
 BLUE/GREEN
o Bacterial infections
o UTI caused by Pseudomonas spp.
o Ingestion of breath deodorizers (green urine)
o Ingestion methocarbamol, methylene blue, amitriptyline (blue urine)
 PURPLE
o Caused by Klebsiella or Providencia species
o Usually happens in the catheter bags

CLARITY

 Transparency or turbidity of urine specimens.

 Visually examined against on a white background with prints
 Terminologies:
o Clear
o Hazy
o Cloudy
o Turbid
o Milkty
 NORMAL CLARITY

CLARITY TERM
Clear No visible particulates, transparent
Hazy Few particulates, print easily seen
through urine
Cloudy Many particulates, print blurred through
urine
Turbid Print cannot be seen through urine
Milky May precipitate or be clotted
o Pathologic causes of Turbidity
 Squamous Epithelial cells , Mucus , Amorphous, Semen, Fecal contaminant
 o Pathologic causes of Turbidity
 RBC, WBC, Bacteria, Yeast, Nonsquamous Epithelial cells , Abnormal Crystals,
lymph fluid, lipids

SPECIFIC GRAVITY

 Evaluate urine concentration

 Density of a solution compared with the density of a similar volume of distilled water at a
similar temperature.
o Isosthenuric
 Specific gravity of 1.010
o Hyposthenuric
 Specific gravity <1.010
o Hypersthenuric
 Specific gravity >1.010
 Methods and principle:
o Refractometer
 For correction (Refractive index)
 Refractometry
 Determines the concentration of dissolved particles in a specimen by
measuring refractive index.
o Osmolality (Changes in colligative properties by particle number)
 Affected only by the number of particles present.
 Can be determined by measuring the colligative property of a solution
o Reagent strip (pKa changes of a polyelectrolyte by ions present)
 Blue – 1.000 (alkaline)
 Yellow – 1.030 (acid)

ODOR

 Normal odor: faint aromatic odor

 Possible causes of urine odor