PHYSICAL EXAMINATION OF

URINE

📌 reference discussion by miss Rolaine the Great <3 (use school email to access :>):
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📌 pdf link:
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physical examination serves as preliminary reporting of the state of our body

what are the 5 parameters of physical/gross/macroscopic examination of urine:

1. color

2. clarity

3. others: specific gravity, volume, odor

what are the 3 portion of parts of urinalysis?

1. physical examination (gross or macroscopic)

2. chemical examination

3. microscopic examination

COLOR
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the concentration of urine should be more correlated to osmolality rather than color
and specific gravity

what is the normal range of color of the urine? Pale to Dark yellow

PHYSICAL EXAMINATION OF URINE 1

 also depends on physiologic and metabolic activities (e.g. what we eat, drink;
medications and diseases)

what are the three common pigments that can be seen in urine?

1. urochrome

2. urobilin

3. uroerythrin

Urochrome
this pigment causes yellow color urine specimen. Urochrome

when the kidney filters the plasma, the urochrome is also filtered and becomes part
of the filtrate and therefore excreted as urine which imparts a yellow color

this is also the major pigment of urine

urochrome is produced in what organ of the body? Liver

Urobilin
this pigment causes orange-brown pigment of urine. Urobilin

this is the by-product of the oxidation of the colorless pigment urobilinogen. Urobilin

urine has <4mg/dL or urobilinogen and are colorless

when urine is exposed to room temperature (standing for several minutes) it will be
oxidized by ordinary light (photooxidation) into the pigmented urobilin which
imparts the yellowish or orange-brown color of the urine

Uroerythrin
this pigment causes pink color of the urine specimen. Uroerythrin

it is attached to amorphous urates crystal giving a pink pigment

pink pigment uroerythrin can only be viewed if the specimen is refrigerated

crystals will form when refrigerated depending upon the pH of the urine:

After refrigeration (pH) Crystal formed

acidic amorphous urates (pink)

alkaline/basic amorphous phosphates (white)

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 COLOR VARIATIONS
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list the variation of color of the urine:

light yellow

yellow

amber

brown

red

1. Dark yellow/Amber/Orange
dark yellow/amber/orange is caused by:

bilirubin

the heme ring is cleaved by the enzyme microsomal heme oxygenase to form
biliverdin (verde = “green”), which is then converted to the tetrapyrrole pigment
bilirubin by the cytosolic enzyme biliverdin reductase

reduced product of biliverdin

should not be exposed to light (coz light sensitive) and will decrease its value

polar to nonpolar bilirubin and inactive it then excreted into the bile, bacteria in
the large intestine reduces bilirubin into pigments which is excreted (urobilin
in urine, and stercobilinin feces)

other way to confirm the presence of bilirubin in urine is to perform “foam” or

“shake” test

shake the urine specimen inside the container if yellow large bubbles are
present then it is positive for bilirubin

confirmatory test: chemical examination (+), bilirubin crystals (+)

urobilin

biliverdin

this is the oxidized counterpart of the bilirubin

if yellow-green urine is present, it is (+) for biliverdin

PHYSICAL EXAMINATION OF URINE 3

 phenazopyridine (pyridium) or azo-gantrisin (drug)

drug use for patients with UTI and are renal analgesic

others are: carotene, warfarin (coumadin), riboflavin, nitrofurantoin

2. Red/Pink/Brown
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the most common abnormal color of urine is. Red

red/pink/brown color of the urine is caused by:

intact RBCs

presence of this is termed as “hematuria” (hema=blood, uria=urine)

if urine is dark red and smoky, (+) hematuria

hemoglobin

presence of this is termed as “hemoglobinuria”

if urine is clear red can be both (+) for hemoglobinuria & myoglobinuria

if the plasma in the clear red urine is red then it is (+) for hemoglobinuria

myoglobin

very small protein and low molecular weight, and are easily excreted as urine
compare to hemoglobin

presence of this pigment is termed as “myoglobinuria”

if the plasma in the clear red urine is clear then it is (+) for myoglobinuria

others include:

porphyrins

if the patients have porphyria

port-wine color urine maybe observe

menstruation, beets, rifampin, phenolphthalein, phenosulphthalein,

phenindione, phenothiazines, senna, blackberries

3. Brown to Black
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PHYSICAL EXAMINATION OF URINE 4

 brown to black color of the urine is caused by:

homogentisic acid

by product of tyrosine metabolism

melanin

others: levodopa, methyldopa, metronidazole, phenol derivatives

4. Blue to Green
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blue to green color of the urine is caused by bacterial infections and:

pseudomonas (proteus)

indicans

others: clorets, azure A, methocarbamol, methylene blue, amitriptyline,

catheterized patients

CLARITY
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it refers to the transparency or turbidity of the urine. Clarity

may be caused by pathologic states and nonpathological states

a normal freshly voided mid-stream clean catch urine specimen should be? Clear

it provides key to the microscopic examination results. Clarity

Reporting of Urine Clarity

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Clarity Term

no visible particulates,
Clear
transparent

few particulates, print easily

Hazy
seen through urine

many particulates, print

Cloudy
blurred through urine

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 Clarity Term

print cannot be seen

Turbid
through urine

may precipitate or be
Milky
clotted

To view color and clarity:

1. use a well mixed urine specimen

book: via swirling, miss: inversion (homogenously)

2. view through a clear container

e.g. test tube

3. view against a white background

newsprint can also be use

4. maintain adequate room lighting

should be place under a good light source NOT against

Non-Pathologic VS Pathologic Causes of Turbidity

Non-pathologic Pathologic

1. squamous epithelial cells

1. RBCs
(SECs)

2. mucus 2. WBCs

3. amorphous phosphates,
3. bacteria
carbonates, urates

4. semen, spermatozoa 4. yeast

5. non-squamous epithelial cells

5. fecal contamination
(NSECs)

6. radiographic contrast media 6. abnormal crystals

7. talcum powder 7. lymph fluids

8. vaginal creams 8. lipids

SPECIFIC GRAVITY

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it refers to the density of the solutions compared to the density of the distilled H2O
(1.00) at a similar temperature. Specific Gravity

what is the normal value of SG in the urine? 1.002-1.035 (with 24hr urine SG of 1.015-
1.025)

specific gravity provides key to urine _____. Concentration

but osmolality provides more key to urine concentration because SG is affected by

the number and size of the solution but ang osmolality is the number lang

SPECIFIC GRAVITY VARIATIONS

what are the specific gravity variations? Variations Specific Gravity

1. isosthenuria Isothenuria 1.010

2. hyposthenuria Hyposthenuria <1.010

Hypersthenuria >1.010
3. hypersthenuria

no problem if less than or greater than isosthenuria ang value of SG as long as the
analyte that contribute are not the abnormal analyte (e.g., protein, glucose, RBCs)

SPECIFIC GRAVITY METHODS

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Direct Indirect

1. Urinometer 1. Refractometry

2. Harmonic Oscillation
2. Reagent strip
Densitometry

the principles of direct methods in SG is based on. Density

the principles of refractometry method in SG is based on. Refractive index

the principles of reagent strips method in SG is based on. Polyelectrolyte change

Urinomety/Hydrometry
what are the disadvantage of urinometer?

PHYSICAL EXAMINATION OF URINE 7

 less accurate

uses large volume of urine (10-15mL)

temperature sensitive

sensitive to the presence of protein and glucose

other characteristics:

should be calibrated (20 deg. Celsius using distilled H20 with a SG of 1.00)

temperature, protein, and glucose correction must be performed

Refractrometry
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it uses refractive index. Refractometer

what are some advantages of refractometer?

uses small volume of urine (1-2gtts or drops)

not temperature sensitive (means NO need for temperature correction)

other characteristics:

should be calibrated (15-38 deg. Celsius using distilled H20 with a SG of 1.00)

calibrators used with normal value/result:

distilled H2O

3% NaC (1.015)

5% NaCl (1.022 +/-0.001)

9% Sucrose (1.034 +/-0.001)

PHYSICAL EXAMINATION OF URINE 8

 TEMPERATURE & SOLUTE CORRECTIONS
(SG)
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PHYSICAL EXAMINATION OF URINE 9

 EXAMPLES:
A. TEMPERATURE

A.1

if u take out urine sample from the ref nya 17 deg. Celsius (which is BELOW 20 deg.
Celsius) iyang temperature and your reading was 1.020, then your final SG will be 1.019
(1.020-0.001=1.019) after temperature correction

for every 3 deg. centigrade BELOW 20 deg. centigrade diha raka mag substract
og 0.001 (18-19 deg. centigrade is not included daw)

A.2

if u take out urine sample from the ref nya 23 deg. Celsius (which is ABOVE 20 deg.
Celsius) iyang temperature and your reading was 1.020, then your final SG will be 1.021
(1.020+0.001=1.021) after temperature correction

for every 3 deg. centigrade ABOVE 20 deg. centigrade diha raka mag add og 0.001
(21-22 deg. centigrade is not included daw)

GLUCOSE & PROTEIN

if the urine specimen has has the presence of both 1g/dL of glucose and protein then
you subtract it with 0.007 (0.004 from glucose + 0.003 from protein=0.007)

VOLUME
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this provides key to the body’s state of hydration. Volume

but it’s not routinely performed during microscopic examination

what is the normal volume of the urine?

24-hr urine: 600-2000mL

night urine: <400mL

Volume Variations
what is the urine volume when you experience oliguria. <400mL/day

PHYSICAL EXAMINATION OF URINE 10

 what is the urine volume when you have diabetes mellitus and insipidus or you
experience polyuria. >2,500mL/day

what is the urine volume when you experience anuria. <100mL/day for 2-3
consecutive days

what is the urine volume when you experience nocturia. >500mL@night (SG: <1.018)

Table 1.0 : Summary of Volume Variations

Variations Volume

Oliguria <400mL/day

Polyuria >2,500mL/day

Anuria <100mL/day for 2-3 days

Nocturia >500mL@night (SG: <1.018)

Urine Volume (DM vs. DI)

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these diseases are usually associated with increased volume of urine or polyuria.

diabetes insipidus

diabetes mellitus

Diabetes Insipidus
what is the main problem in diabetes insipidus? ADH is either absent or released in
decreased amount

maybe caused by tumors in brain especially compressing the pituitary gland

(remember that ADH is produced by pituitary gland)

water retention is dysfunctional

specific gravity is low compare to diabetes melllitus

what are the signs and symptoms of diabetes insipidus?

excessive urination (polyuria)

excessive thirst

elevated serum sodium

PHYSICAL EXAMINATION OF URINE 11

 increased dehydration

Diabetes Mellitus
what is the main problem in diabetes mellitus? Insulin

such as when your pancreas is not producing insulin or are resistant to insulin
production (e.g. obese) which causes increased glucose value (which is highly
osmotic) and are prone to dehydration

specific gravity is high compare to diabetes insipidus due to the presence of

glucose

what are the signs and symptoms of diabetes mellitus?

excessive urination (polyuria)

excessive thirst

weight loss and fatigue

elevated blood glucose

ODOR
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not routinely performed same as specific gravity and volume. Odor

what is the normal odor of a fresh urine? faintly Aromatic

what is the normal odor of an old urine? Ammoniacal

what are some factors that contribute to the urine odor? Food & Metabolic disorders

Odor Variations

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