AUBF: URINALYSIS 1 (INTRODUCTION TO URINALYSIS & PHYSICAL ▪ urine examinations can be used to detect other diseases (e.g.
detect other diseases (e.g. sample at the beginning of the collection period, then collect the
EXAMINATION OF URINE)
Learning Objectives:
▪ State the reasons for performing urinalysis
▪ Differentiate the types of urine specimens, the correct procedure of
collection & the diagnostic use of each.
▪ List the different urine specimen containers & their usage.
▪ Briefly discuss methods of preserving urine specimens
▪ List the changes that happen when urine is allowed to stand at room
temperature for more than 2 hours.
▪ Describe methods for identifying an unknown fluid as urine.
▪ State possible reasons for rejecting a urine sample.
▪ List the components of Routine Urinalysis
▪ Discuss the relationship of urochrome to normal urine color.
▪ Discuss the abnormal urine colors & their significance.
▪ List pathologic & non-pathologic causes of urine turbidity.
▪ State possible cause of abnormal urine odor.
▪ Describe the principle of pH determination & significance.
▪ Describe the principle of Specific Gravity determination & the
significance of the test.
▪ Recognize normal & abnormal daily urine volume.
BRIEF HISTORY AND IMPORTANCE
Urine analysis was actually the beginning of laboratory medicine. It began
6000 years ago with the analysis of human urine which was called Uroscopy
until the 17th century and today is termed as URINALYSIS.
Examination of urine back then was based only on the physical examination
of the urine sample: the color, turbidity, odor, volume, and viscosity. This
was based on the drawings they saw from Egyptian hieroglyphics and the
drawings of cavemen. They saw physicians examining a bloody-shaped glass
of urine.
Later on, it progressed to ant testing. If the urine attracts ants, it means the
urine is sweet (it contains a lot of glucose). Then, it progressed to taste
testing, they taste if the urine is sweet or not (lolol idk I really can’t hear).
After that, it progressed to chemical testing to the examination of protein:
the determination of albuminuria wherein if urine is boiled, the proteins will
coagulate. If it coagulates, there is an increased amount of protein in the
sample.
After that, the microscope was invented in the 17th century which led to the
examination of the urine sediments wherein they developed methods to
quantitate these sediments. Now, we have what we called Addis Count
wherein a 12hr urine sample is collected, and the cells are counted.
referred to as a liquid tissue biopsy of the urinary tract –
painlessly obtained
urine it yields a great deal of information quickly &
specimen economically
but like any other laboratory procedure, it should be
carefully performed & properly controlled
REASONS FOR PERFORMING URINALYSIS
1 diagnosis & management of renal or urinary tract diseases
detection of metabolic or systemic disease not directly related to
2 midstream portion in another container (2nd container). Prior to the
the kidney
liver disorders can be diagnosed of the presence of a certain
crystal in the urine sample; pregnancy testing for the presence of
the hormone hCG)
monitoring the progress of disease & effectiveness of therapy
▪ UTI then the physician is giving him antibiotics, there is an initial
3 urine analysis prior to the medication and after treatment, there
is a follow up urinalysis to check whether the drug is effective or
of the patient is improving
urine sample must be collected in a clean, dry container
& should be examined when freshly voided, within 2
urine
hours of voiding
collection
If analysis is to be delayed, urine should be refrigerated
or preserved
A. ROUTINE URINALYSIS
▪ most common examination
▪ method of collection: midstream collection (midstream spx)
advantage: can be collected any time of the day
and is susceptible for routine examination
disadvantage: the concentration of the formed
elements (e.g. urinary casts, WBCs, RBCs) will be
random
affected by the degree of hydration of the
specimen
patient (if the px takes in a lot of fluid during that
day, the urine is dilute; if less water, the patient
will have concentrated urine sample: it varies as
it depends on the degree of hydration)
the specimen of choice because the urine sample
is more concentrated and stable
▪ Why stable? Because the urine spx has an
acidic pH in early mornings in which the
formed elements are better preserved.
first morning
also recommended for pregnancy testing to
specimen
prevent a false negative pregnancy test: the
hormone hCG is more concentrated in the first
morning sample
this is also used for the evaluation of orthostatic
proteinuria
B. QUANTITATIVE ANALYSIS
spx of choice: timed specimen
▪ 2 to 12-hour timed collection
▪ 24-hour specimen
usually used for urobilinogen determination because
2hr it is the time of peak excretion of urobilinogen
take between 2-4 pm (afternoon specimen)
used for quantitative cell count, one example is
12hr Addis counting (the cells, WBCs and RBCs, are
counted)
a clearance testing (for glucose, protein, or
24hr
creatinine)
For timed specimens, collection instructions are very important. For
example, a big brown plastic container (3000ml urine sample) is needed.
Depending on the type of examination needed, a urine preservative is
also added.
Example situation: A patient for 24hr testing started at 7am. You have to
instruct the patient that the urine is voided but discard the first urine
succeeding samples. The last sample will be collected at 7am on the
following day.
After the collection, the specimen is brought to the lab for examination.
The MT checks the label and measures the volume of the urine. Hence,
the first examination done is the determination of urine volume. After
that, aliquots are taken. You get several small samples of the 24-hr
collection and store it in the freezer if it cannot be examined right away.
You can’t keep the whole container in the freezer for a long period (takes
up lots of space and can be mistaken as juice bottles since we use
recycled bottles for their volume capacity).
NOTE: During the 24-hour collection, the sample should be refrigerated.
Each time a patient voids, the sample is added to the container.
COLLECTION ERROR PROBLEMS
loss of voided specimen: whenever px forget that they are doing
the 24hr collection and fails to collect the urination.
1
▪ The MT should not accept specimen. Discontinue the
procedure and start over again.
failure to discard the first specimen: at the start of the collection
2
period, always remind the px to discard the first sample
poor preservation: aside from refrigerating the sample, you also
need to add in preservative
3
▪ e.g. addition of acid to prevent the growth of bacteria
because we will be storing it for 24hrs
4 inadequate refrigeration: should not stay at room temp.
C. BACTERIOLOGIC or MICROBIOLOGIC EXAMINATION
spx of choice: clean-catch spx (collected clean catch and midstream)
A clean-catch midstream specimen is desirable but sometimes
catheterization or suprapubic aspiration of the bladder is necessary. If
the px is unable to void, another alternative is catheterized sample or
suprapubic aspiration of the bladder is done by the physician (not by
MT).
One important consideration: The spx container should be sterile unlike
in routine urinalysis (can use a clean, dry, chemical-free container).
However, in bacteriologic examinations, a sterile container is needed.
Bacterial culture should be done immediately but if not possible, urine
should be refrigerated at 4°C until cultured.
Strong bacterial agents (e.g. hexachlorophene or povidone iodine)
should not be used. Mild antiseptic towelletes are recommended.
SPECIAL COLLECTION TECHNIQUE
1 Urethral catheterization
Introduce a catheter into the urethra & bladder. Necessary for
patients who are unable to void.
2 Suprapubic aspiration
Urine is aspirated with a syringe & needle above the symphysis pubis
through the abdominal wall into the full bladder. This is used for:
▪ anaerobic cultures
▪ problem cultures (contamination cannot be ruled out)
▪ infants (difficulty to collect sample, and is contaminated)
3 Glass Collection
This is used to determine prostatic infection. Instead of discarding
the 1st urine passed, it is collected in a sterile container & the
3rd collection, the prostate is then massaged so that prostatic fluid
AIRAH M.
will be passed with the remaining urine into the 3rd bottle. (These 3
containers should be sterile.)
After collection of samples, quantitative cultures are made on each
specimen.
1st container
examined microscopically
2nd container
used as control for bladder or kidney infection.
in prostatic infection, this will have a WBC/hpf &
rd
3 container
bacterial count 10x that of the 1st specimen
4 Ureteral catheterization
This is used to differentiate bladder infection from kidney infection.
Ureteral catheters are inserted via a cytoscope into each ureter.
Bladder urine is first collected, then a bladder washout specimen.
Ureteral urine specimens are obtained separately from each kidney
pelvis & carefully labeled right ureter & left ureter.
SPECIMEN CONTAINERS
D. DIABETIC MONITORING
TYPES OF SPECIMEN
2nd morning specimen
2nd voided specimen after a period of fasting
fasting specimen this specimen will not contain any metabolite
from food taken or ingested prior to the
beginning of the fasting period
patient is instructed to void shortly before
consuming a routine meal and to collect a
2hr postprandial specimen 2 hrs. after eating
specimen specimen is tested for glucose and used
primarily for monitoring insulin therapy in
person w/ diabetes mellitus
specimens are collected to correspond with the
blood samples drawn during a GTT
tested for glucose & ketones
most tests include fasting, ½ hr., 1hr., 2hrs., and
3hrs
Glucose
e.g. The patient is asked to fast. A fasting urine
Tolerance Test
(GTT) specimens spx is collected together with the blood
sample. After the blood is drawn, the px is
asked to drink a glucose load (usually 100g). 30
minutes after, blood sample is drawn and
another urine sample is also collected. (1 hr,
2hrs, and 3 hrs after)
usually for pregnant women to check for 3 chemical preservatives
diabetes, they prefer 2hr glucose tolerance commonly used are toluene, formalin, thymol
state wherein a 75g glucose load is given for preservation of acetone, diacetic acid,
E. DRUG SPECIMEN COLLECTION toluene
reducing substances & protein
Urine collection is the most vulnerable part of a drug testing program. for preservation of formed elements
Correct collection procedure & documentation are necessary to ensure formalin (40%) an excess will cause pption of urea
that drug testing results are those of the specific individual submitting
will cause a false (+) Clinitest & Fehling’s test
the specimen.
good preservative for most chemical tests
is the process that provides this documentation of
will cause a false (+) reaction for protein w/ heat
thymol
proper sample ID from time of collection to the and acetic acid test
receipt of lab results does not affect the dipstick method
is a standardized form that must document and delay the decomposition of chemical as well as
chain of
accompany every step of drug testing, from formed elements but does not stop the growth
custody (COC) boric acid
collector, to courier, to lab, to medical review of yeast
officer, to employer (every step is documented so it will precipitate uric acid
each person who has taken part during the test preserve glucose in 24 hr. collection to inhibit
should affix their signature) glycolysis by cells & bacteria
sodium fluoride
Urine specimen collections may be “witnessed” or “unwitnessed”. The it will inhibit the reagent strip for glucose
laboratory should also make sure that the person to be tested should not it is a good preservative for drug analyses
have any access to water in the toilet to avoid dilution or adulteration of cytologic
specimen. 50% alcohol – for evaluation of tumor cells
preservative
1. Collect sample about 30 to 45 ml. urine. SACCOMANNOS preserve cellular elements
2. Urine temperature must be taken within 4 min. of collection to fixative used for cytology studies
confirm that the specimen has not been adulterated. Temperature urine C & S for U/A and C&S on the same specimen,
should read between 32.5 °C to 37.7 °C. transport kit decreases pH – preservative is boric A
3. Urine color is inspected to identify any sign of contaminants. Toilet used for transportation of urine for routine
lid + faucet handles are taped to eliminate source of H2O. Toilet water screening U/A, preserve glucose & other
reservoir is added with bluing agent (dye) to prevent adulterated constituents by releasing formaldehyde (will not
specimen. react with the copper reduction test: remember
the formalin we use in the lab will affect the
▪ disposable plastic containers, 100 to 200 ml. with Clinitest which is a test for sugar)
lids for routine screening also contain benzoate & mercury & have an acid
▪ 12 ml. capped plastic disposable tubes are also reaction
available if you know that glucose is to be tested and the
▪ rigid brown plastic containers, 3000 ml. with wide urine contains a preservative table, you need to
preservative
use another method of determination: 95 mg.
mouths & screw caps for 24 hr. collection tablet
tablet is used with 20 ml. urine (in this
▪ pediatric urine collectors of clear pliable polyethylene are available for
concentration, formaldehyde will not react with
male & female infants
the copper reduction tests (Clinitest) & the
▪ sterile containers are used for cultures: make sure that the px is properly preservative properly used does not interfere
informed regarding the collection (e.g. prior to collection of urine, for with common reagent strips)
female patients, the genitals have to cleansed with mild antiseptic; for this formaldehyde tablet will slightly increase the
uncircumcised male, the foreskin should be retracted) specific gravity of the sample (0.002/tablet):
that’s why if you know that the spx contains a
HANDLING AND PRESERVING SPECIMENS
preservative tablet, you subtract 0.002 from the
1 refrigeration
specific gravity
▪ if sample is not tested within 2 hours, refrigeration is needed
▪ (2-8 °C) most routinely used – decrease bacterial growth a very low pH (< 3) will prevent bacterial growth
▪ in general, many substances for qualitative or quantitative chemical pH adjustment & stabilize substances such as catecholamines,
determinations (cells & casts) preserve best when refrigerated at an VMA or 5 HIAA
acid pH (about 6) w/out preservation
2 freezing
▪ useful for aliquots of urine to be used for quantitative chem. tests
▪ light sensitive pigments are preserved in dark-colored containers
o will help retard loss of labile subs. such as urobilinogen, bilirubin,
& porphobilinogen but not completely
AIRAH M.
 CHANGES IN URINE WITH DELAYED TESTING The presence of considerable amounts of urea nitrogen and creatinine is an acid urine containing hemoglobin will
What will happen when urine is allowed to stand at room temperature? highly suggestive of urine, as most other body fluids contain only small darken on standing (because hemoglobin is
RESULT REASON amounts of these substances. dark brown or
already converted to methemoglobin)
breakdown or alteration of chromogen or other black urine
TESTS TO IDENTIFY URINE can also be caused by homogentisic acid and
urine constituents (e.g. hemoglobin, melanin, melanin
test for urea test for creatinine
homogentisic acid, porphyrins)
change in color in urine: 600 mg/100 ml in urine: 50 mg/100 ml color of urine can be due to certain food and
e.g. hemoglobin converted into methemoglobin: candy dyes as well as drugs (e.g. red urine:
(will darken) in blood: 20mg% in blood: 1-2mg%
brown color ingestion of beets)
other factors
e.g. homogentisic acid: urine turns black upon COMPONENTS OF ROUTINE URINALYSIS note: red is the most common abnormal color
standing A SPECIMEN EVALUATION (presence of blood)
▪ bacterial growth Before doing any testing, the MT should evaluate its acceptability.
changes in odor
▪ decomposition A red color of urine can be caused by the two mentioned below, but
1 proper labelling; name, date, time of collection, birthday of px
▪ increased bacteria (multiplication) what are their differences?
increased proper specimen for the requested test (e.g. urine culture for
▪ crystal formation may appear cloudy, smoky, pink, red or
turbidity 2 C&S test, make sure that it was properly collected through clean
▪ precipitation of amorphous material brown
catch, or if urine container is sterile)
glucose converted to acids and alcohols by bacteria smoky: most common description
3 proper preservative (e.g. for timed spx) hematuria
producing ammonia = CO2 lost
visible signs of contamination (e.g. very turbid with foul smelling commonly caused by infections
commonly, the pH of the sample increases (the 4
odor or ammoniacal: the urine has been stood for some time) (glomerulonephritis), tumors, trauma (stones
falsely low pH usual phenomenology of the sample)
transportation delays (that’s the reason that there is also the & injury), poisoning
however, in patients who have increased glucose in
time of collection labelled: if it’s more than two hours from the clear red, clear red brown, or dark brown
the urine, the glucose is converted to acids and 5
time of delivery to the lab, reject it and ask the px to provide clear: most common description
alcohols (urine becomes acidic instead)
another sample) caused by severe burns, incompatible blood
▪ volatilization of acetone
false negative in specimens submitted for multiple testing, bacteriologic exam transfusion, fever, snake venom
▪ breakdown of acetoacetate by bacteria hemoglobinuria
ketone should be done first (e.g. tests for both routine urinalysis and
yields false negative result congenital erythropoietic porphyria
6 C&S, you should first give it to the microbiology section first for
▪ destroyed by light drugs (ex. Rifampin: used in treating TB) and
false negative the C&S, prior to performing the routine urinalysis, to make sure
▪ oxidation to biliverdin dyes in diagnostic tests (ex.
bilirubin it won’t be contaminated)
yields false negative result Phenolsulfonphthalein)
B PHYSICAL TESTS
destroyed by light 2 CHARACTER (CLARITY)
false negative 1 COLOR
to avoid, samples should be placed in brown- ▪ presence of particulate
urobilinogen ▪ normally yellow, however, variations in color may be caused by
colored bottles then wrap the container with foil matter in unspun urine
diet, medication, and disease
it will be false positive because when the urine is needs to be explained
▪ sometimes provide a clue for the diagnosis of certain diseases
allowed to stand after voided, the bacteria will microscopically
false positive ▪ yellow color is due to the pigment urochrome and to small
multiply, then nitrite, being produced by bacteria, ▪ cloudy urine may not be
nitrite amounts of urobilin and uroerythrin
will turn the reagent strip result positive pathologic
▪ urochrome excretion is increased during fever, thyrotoxicosis,
side note: nitrite can be tested with a reagent strip and starvation ▪ turbidity might be due to:
nitrite converts to nitrogen and evaporates ▪ color indicates the degree of hydration and urine concentration a precipitation of crystals or non-pathologic salts
when the patient really has a bacterial infection seen in a normal person with high fluid intake ▪ amorphous phosphates (occasionally carbonates) in alkaline
(when urine is freshly voided and is allowed to pale urine urine but redissolve when acetic acid is added
false negative pale color: can be an indication of low sp.gr.
stand, instead of the bacteria producing nitrite, the ▪ uric acid & urates in acid urine and redissolve on warming to
nitrite maybe seen when fluids are withheld
nitrite will convert into nitrogen so by the time you 60°C (do not boil)
will examine it, it is no longer there, it has darker urine can be due to the presence of other ▪ under the microscope, uric and phosphate looks the same,
evaporated) substances (e.g. bilirubin) hence, you have to check the pH (if alkaline, it is phosphate)
increased bacteria multiply in specimen before analysis pale urine of is found in patients with diabetes mellitus and then confirm (addition of acetic acid: if it redissolves, it is
bacteriuria high sp.gr. after the use of radiographic media phosphate)
“uria”: present in the urine in an increased amount
often associated with bile pigments, chiefly b leukocytes
unstable environment, especially in alkaline urine,
bilirubin ▪ especially in patients with UTI, it forms a white cloud similar
disintegration of hypotonic urine or both
yellow brown side note: an easy test for checking bilirubin: to phosphates but cloud remains after the addition of dilute
cells/casts e.g. if the urine is alkaline or not hypotonic, the
or greenish the shake test (you simply put urine on a test acetic acid
formed elements will disintegrate
brown urine tube and shake it, if a yellow foam is ▪ confirmed microscopically
Sometimes, the doctor will send an unknown fluid into the lab. He wants it produced, bilirubin might be present) (white c bacterial growth
to be tested to verify if the sample is urine or not. What will the MT do to foam indicates withheld urine only) ▪ causes a uniform opalescence that is not removed by
identify if the fluid is urine? The best way is to check for the presence of urea dark green severe obstructive jaundice acidification or by filtering
and creatinine, the waste products of metabolism. They are also present in orange red or ▪ e.g. E. coli, Proteus, Enterococcus, yeast, Staph. (skin
large amounts of urobilin
the blood but can be also found on urine in large amounts. orange brown contaminant)

AIRAH M.
 d increased number of epithelial cells ▪ normal odor: slightly aromatic odor o acid indicator: methyl red
▪ usually, this will affect female patients ▪ chiefly important in the recognition of contaminated specimens & o alkaline indicator: bromthymol blue
▪ doctors will try to confirm and ask the patient to submit on standing are ammoniacal, fetid so unsuitable for laboratory o read 60 seconds after dipping (don’t dip for a long period
another sample examination because the reagents also will be washed out)
▪ sometimes, not a midstream urine sample ▪ urine odors associated with amino acid disorders: o pH ranges from 5.0 to 8.5 in half units
e RBCs (hematuria) sweaty feet isovaleric acidemia & glutaric acidemia ▪ in healthy individuals: first morning specimen (pH 5-6), after
does not clear on warming and needs to be confirmed maple syrup maple syrup urine disease meals (a more alkaline pH: alkaline tide)
microscopically cabbage methionine malabsorption ▪ normal random samples: pH 4.5-8.0
f spermatozoa and prostatic fluid mousy phenylketonuria CLINICAL SIGNIFICANCE OF URINE pH
g mucus from the urinary passages rotting fish trimethyl aminuria 1 respiratory or metabolic acidosis/ketosis
increased in inflammatory states of the lower urinary tract rancid tyrosinemia 2 respiratory or metabolic alkalosis
h fecal material in urine (especially during LBM) 4 URINE VOLUME defects in renal tubular secretion & reabsorption of acids &
3
contamination with powders or antiseptics that become ▪ is being measured when you perform the ____ testing (can’t hear) bases – renal tubular acidosis
i
opaque with water (e.g. phenol) ▪ if you have timed specimens, you need to measure the volume 4 renal calculi formation
in its concentrated form, phenol is clear, but if you will dilute it ▪ not measured during routine urinalysis 5 treatment of urinary tract infection
after, it will become turbid ▪ average daily volume in normal adult: 1200-1500 ml 6 precipitation/ identification of crystal
j chyluria normal range 600-2000ml 7 determination of unsatisfactory specimens
▪ maybe normal, opalescent, milky (same with lipiduria) normal cause nocturia (at night) and the excretion of
▪ urine contains lymph associated with obstruction to lymph pregnancy a dilute urine sample POSSIBLE CAUSES OF:
flow & rupture of lymphatic vessels into the renal pelvis, excretion by an adult of more than 500 ml. ACID URINE ALKALINE URINE
ureter, bladder, or urethra nocturia urine with a specific gravity of less than 1.018 emphysema hyperventilation
k lipiduria at night diabetes mellitus vomiting
▪ fat globules appear in the urine increase in urine volume of more than 2000 starvation renal tubular acidosis
▪ caused by nephrotic syndrome and crush injury (due to major polyuria
ml. in 24 hours presence of urease-producing
skeletal trauma with one or more fractures to major long oliguria decrease in urine output dehydration
bacteria
bones or pelvis)
anuria patient can no longer void diarrhea vegetarian diet
▪ one way of checking this: mix it with ether (both chyluria and
lipiduria are soluble in ether, resulting to a clear solution) high protein diet old specimens
cranberry juice
Since in the physical examination, you need to describe the color and
the transparency, here is a guide on describing clarity. You need to medications for UTI
check the appearance of the urine sample by placing a print at the (ex. Mandelamine)
back of the sample. presence of acid-producing
HOW TO DESCRIBE URINE CLARITY bacteria (E. coli)
clear no visible particulates, transparent 6 SPECIFIC GRAVITY AND OSMOLALITY
▪ considered as a part of the physical examination, however, it can
hazy few particulates, print easily seen through urine
5 HYDROGEN ION CONCENTRATION OF URINE (pH) still be a part of the chemical examination because of another
cloudy many particulates, print blurred through screen method (several methods of determining sp.gr.)
o the pH of the urine reflects the ability of the kidney to maintain
turbid print cannot be seen through urine ▪ a measure of the concentrating and diluting power of the kidney
normal H+ concentration in the plasma and ECF
milky may precipitate or be clotted ▪ inability to concentrate & dilute urine is an indication of renal
TWO BASIC METHODS disease or hormonal deficiency
potentiometric unsuitable for routine urinary pH ▪ measurement of both tests should give an indication of the urinary
determination measurement but should be used for quality total solute concentration
(pH meter) control
depends on the number of solutes in a unit of
rapid, inexpensive but still gain useful
solution
information osmolality
e.g. Multistix & Chemstrip brands: make use a more exact measurement of urine
concentration than sp.gr.
indicator of a double-indicator system of Methyl red
paper strips and Bromthymol blue depends on the number of particles present in
Methyl Red + H+ ---- Bromthymol Blue -- H+ a solution & the density of these particles
specific
red -- yellow yellow -- blue is influenced by the size of the molecules such
gravity
(pH 4-6) (pH 6-9) as urea, glucose, & protein that are not
3 URINE ODOR significant in renal conc.
▪ not usually included in the physical examination but if you notice
hyposthenuric patients having constant urines of low Sp.Gr.
something different in the odor, you need to check it also because
urine (less than 1.007)
this can be caused by a certain disease(s)

AIRAH M.
 isosthenuric
patients having constant urine of fixed Sp.Gr.
urine
Sp.Gr. of the
free glomerular filtrate is 1.010
Protein
Freezing Point
commonly employed method for osmolality
Depression
determination
Method
METHODS OF SPECIFIC GRAVITY MEASUREMENT
In the laboratory, we have several methods to measure specific
gravity. We have the refractometer method, urinometer method,
reagent strip, and the automated method.
A. REFRACTOMETER (TS meter): measures the refractive index of a
solution and advantages include:
▪ temperature compensated between 60°F-100°F
▪ requires only 1 drop of urine
Calibration:
1. distilled water - 1.000
2. 5% NaCl - 1.022 ± .001
3. 9% Sucrose - 1.034 ± .001
This is the appearance of the refractometer. The one on the left will
have a light source, an electric bulb inside. The right one is handheld.
You face the light source so that you can read the calibration inside.
B. URINOMETER
▪ the image on the right shows a
urinometer: the urine container is
called the urinometer cylinder
while the instrument inside is called
the urinometer float
▪ a hydrometer adapted to measure
sp.gr. at room temperature: this is
calibrated at a specific temperature
unlike your refractometer wherein
it gives accurate result if the urine
temperature is between 60-100°F
▪ here, the urinometer is affected by temperature difference
▪ consists of a weighted float with a calibrated stem
▪ the float, the one inside, consists of a weighted float having a
calibrated stem where you will read the calibrations
▪ the float displaces a volume of liquid equal to its weight & has
been designed to sink to a level of 1.000 in distilled water
▪ it will displace an equal amount of liquid depending on the
amount of solute in the urine sample: the additional mass
provided by the dissolved substance causes the float to displace a
volume of urine smaller than that of distilled water
▪ requires a larger volume of urine, unlike refractometer
This is the calibration that you will see on the stem. The manufacturer
will put the temperature of calibration on the stem. The urinometer
float is also manufactured and calibrated.
The disadvantage of this method if compared to that of the
refractometer is that you will need a larger volume of urine because
you need to fill the urinometer cylinder about ¾ths full, while in the
refractometer, you need only a drop. Also, the refractometer is not
affected by temperature changes because it gives an accurate reading
between 60-100°F whereas in urinometer, it is affected by
temperature. If it is calibrated at 20°C, it means that if the urine
temperature is 20°C, the reading you see on the stem is fairly
accurate. However, if the urine temperature is higher or lower, then
you need to compute for this temperature change.
SOURCES OF ERROR
temperature differences: Most urinometers are calibrated
at 200°C. A difference of 30°C between urine temperature &
calibration temperature requires a correction of 0.001 to be
added if the temperature of the urine is above the
temperature of calibration & subtracted if below the proper
temperature. (For example, calibrated at 20°C, and the
temperature of the urine is 30°C, hence, it is above. So, the
1 difference between the two is 10°C which will then be divided
by 3 since it is for every 3-degree difference. The quotient will
then be multiplied by .001. So, that is about .003 to be added
to the specific gravity reading.) (However, if the temperature
of urine is 17°C so that it is below the temperature of
calibration. In this case, the difference is 3 divided by 3 x .001,
will give .001 which will then be subtracted to the specific
gravity reading.)
2 proteinuria: subtract 0.003 for every 1g/100ml protein
3 glycosuria: subtract 0.004 for every 1g/100ml glucose
x-ray contrast media: sp.gr. may exceed 1.050 (There is a
contrast media in the urine which is used in the examination
of patients to follow the course of a dye. A certain dye is being
injected and the course of the dye is being followed through
4 density of the solution.
x-ray. So that, this dye is excreted later on through the urine.
The urine passed out now will have a very high specific gravity
that sometimes, you cannot reqd it on the calibration. What
you need to do is to simply dilute the urine with distilled water
and multiply your result for the reading of the diluted sample
by the dilution.)
urinary preservative: preservatives increase the urinary
specific gravity (One good example is the preservative tablet
for urine. The use of this tablet can increase the specific
5 gravity by .002. That’s why if this tablet has been added to
the urine sample being examined, you need to subtract .002
to your specific gravity reading. Let’s say if the reading is
1.015, subtract .002 so that what you will report is 1.013.)
Example: determine urine’s true sp.gr. in the urinometer method:
Name of Patient – Maria Cruz
Temp. of urine – 36.0 degrees Centigrade
Temp. of calibration- 21.0 degrees Centigrade
Urinometer reading – 1.015
Difference between the 2 temperatures =15÷3=5
5 is multiplied by .001 & will then be added to the urinometer reading
So, the True Sp.Gr. is 1.020.
If the patient Maria Cruz has proteinuria, her urine contains 2
gm.protein/100ml.What is the final Sp.Gr.to be reported?
1.020 – (.003x2) = 1.014
For urine samples with very high Sp.Gr., which can’t be read on both
Urinometer & Refractometer, simply dilute the urine with distilled
water and multiply the Sp.Gr. Reading of the diluted sample with the
dilution.
Ex. 5 ml.urine was diluted with 10 ml.dist.water.
Sp.Gr.reading= 1.020 x 3(dilution) = 1.060
Explanation: The dilution of the 5ml urine added with 15 ml water
(nani? In the example, it is 10 idk why she said 15) is 1:3. So, you
multiply the last three 3 digits by 3. Do not include the 1 because
sp.gr. always starts with 1. There is no sp.gr. which begins with 2 or
3, it only starts with 1. What you will multiply with 3 is only the .020,
hence, you will have 1.060.
C. REAGENT STRIP METHOD
▪ based on the change in pKa (dissociation constant) of a
polyelectrolyte in an alkaline medium
▪ the polyelectrolyte ionizes releasing hydrogen ions in proportion
to the number of ions in the solution
▪ the higher the concentration of urine, the more hydrogen ions are
released, thereby lowering the pH
▪ Indicator Bromthymol Blue measures the change in pH
D. HARMONIC OSCILLATION DENSITOMETRY
Principle:
The frequency of a sound wave entering a solution will change in
proportion to the density of the solution.
▪ used by the Yellow IRIS (International Remote Imaging Systems)
▪ A portion of urine enters a U-shaped tube. A sound wave of
specific frequency is generated at one end of the tube, and as the
sound wave passes thru the urine, its frequency is altered by the
AIRAH M.
E. FALLING DROP METHOD
▪ a direct method for measuring sp.gr.
▪ this is a more historical method
▪ more accurate than the refractometer and
more precise than the urinometer

Falling Drop Method by M.Winstead

Utilizes a specially designed column filled with
water–immiscible oil. A measured drop of urine
is introduced into the column, and as the drop
falls, it encounters two beams of light; breaking
the first beam starts a timer, while breaking the second turns it off.
The falling time is measured electronically & expressed as a specific
gravity.
C CHEMICAL EXAMINATION
D SEDIMENT EXAMINATION

AIRAH M.