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Urine history, Composition, Normal Findings

Lab Tests (https://labpedia.net/category/lab-tests/) Urine Analysis (https://labpedia.net/category/lab-
tests/urine-analysis/)

Table of Contents

0.1. Urine history, Composition, Normal Findings, Advantages of Urine Analysis

0.2. Urine history
0.2.0.1. History of the urine examination
0.2.0.2. Moderne urine examination:
0.2.0.3. Urine definition
0.2.0.4. In a normal healthy person, urine is:
0.2.0.5. Urine Composition
0.2.0.6. Urine constituents depend upon the following:
0.2.1. The Urine analysis includes the following:
0.2.1.0.1. Physical properties include:
0.2.1.0.2. Chemical Tests include:
0.2.1.0.3. Microscopic Examination includes:
0.2.1.1. Normal Urine findings are :
0.2.1.2. Advantages of the routine urine analysis:
0.2.1.3. Questions and answers:

Urine history, Composition, Normal Findings,

Advantages of Urine Analysis
Urine History
History of the urine examination
1. Ancient Egyptian physicians used to taste the urine to find the disease.
2. Indian physicians started to use urine for the diagnosis of diseases in almost 2000 BC.
3. Greek physician Hippocrates also recognized the value of urine examination.
1. He noted that the color, odor, and even taste of the urine helped in the diagnosis.
4. Then in the middle ages, urine examination also got important.
1. They started measuring the specific gravity with a urinometer. Privacy - Terms
 5. In the 19th century, with the invention of the microscope, urine examination started helping
in the diagnosis of various diseases like hematuria and bacterial infection.
6. In the modern era, urine examinations diagnose diabetes mellitus, proteinuria, and ketone
bodies.
7. The analysis of the urine is actually the beginning of laboratory medicines.
8. At that time, the physicians checked the urine’s gross appearance, like color, turbidity, odor,
volume, and urinary infection.

(https://labpedia.net/wp-content/uploads/2020/01/Urine-physical-character-4.jpg)
Urine history: Urine’s physical character

9. They were testing the viscosity and even the sweetness. For sweetness, they were observing
the attraction of the ants to urine.
(https://labpedia.net/wp-content/uploads/2020/01/Urine-sugar-test-6.jpg)
urine history: Urine sugar test in ancient time

10. Hippocrates wrote a book on urine examination as uroscopy in 5th BC.

11. In 1140 AD, color char was developed, describing the significance of 20 different colors of
urine.
12. Chemical testing progressed after the ant gathered around the diabetic urine.
13. Later on, taste testing was also started.
14. In 1694, Frederick Dekkers discovered the protein, Albuminuria by boiling the urine.
15. Pisse prophets by the Charlatans became the subject of the book published by Thomas
Bryant in 1627.
16. The advent of the microscope in the 17th century led to the examination of urine sediments.
17. Richard Bright, in 1827 made the urine examination a routine for the patients.
18. In 1930 the number and the complexity of urine examinations made urine examination
impractical.
19. With modern facilities, the urine examination is a routine part of the patient’s doctor’s office
visit.

Moderne urine examination:

1. Now urine examination is popular due to the following:
Easily available sample.
Urine gives much of the body’s metabolism information.
This information from the urine is cheap.
2. The National Committee for clinical laboratory standards (NCCLS)
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936984/) defines the urine analysis
procedure as reliable, accurate, safe, and cost-effective.
Urine definition
1. Urine is a liquid biopsy obtained without pain or cost to the patient, but it provides a wealth
of diagnostic information.
2. Urine is the main source of information from sick (damaged) kidneys to physicians.
3. Urine is the fluid excreted through the kidneys, passes through the ureter, and is stored in
the urinary bladder. When the urinary bladder is full, it is discharged through the urethra.

In a normal healthy person, urine is:

1. Sterile.
2. Clear.
3. Amber color.
4. It is slightly acidic (pH 5 to 6).
5. Specific gravity is 1.024
6. It has a characteristic odor.
7. The daily output is 500 mL.
8. Anuria when the urine volume is <100 mL/24 hours.
9. Oliguria when the urine volume is <400 mL/24 hours.
10. Polyuria when the urine volume is > 2000 mL/24 hours.

Urine Composition
1. The kidneys continuously form the urine as an ultrafiltrate of the plasma. Reabsorption of
the water and filtered substances are essential to the body’s function, converting roughly
170,000 mL of filtered plasma to the average daily urine output of 1200 mL.
2. Urea. It is produced in the liver by the breakdown of proteins and amino acids.
1. This is 50% of the dissolved solid substances in the urine.
2. Organic substances like creatinine and uric acid.
3. Inorganic substances. The major substance is chloride (CL¯), followed by Na+ and K+.
1. The dietary intake makes it difficult to decide on the normal level.
4. Water.
5. Other substances found are:
1. Hormones.
2. Drugs.
3. Vitamins.
4. Cells.
5. Cast.
6. Crystals
7. Bacteria.
(https://labpedia.net/wp-content/uploads/2020/01/Urine-formation-in-kidney-7.jpg)
Urine formation and functions of kidneys

Urine constituents depend upon the following:

1. Physical activity.
2. Dietary intake.
3. Body metabolism.
4. Endocrine functions.

To confirm the urine sample:

1. Advise urea and creatinine; these are present in high concentrations than any other body
fluids and confirm that the specimen is urine.

The Urine analysis includes the following:

Physical Properties Include:
1. Color
2. Appearance (opaque or colorless)
3. Odor

Chemical Tests Include:

 1. pH
2. Specific gravity
3. Protein
4. Glucose
5. Ketones
6. Bilirubin
7. Urobilinogen
8. Blood
9. Nitrite
10. Leukocyte esterase

Microscopic Examination Includes:

1. Red blood cells
2. White cells (WBC)
3. Casts
4. Crystals
5. Epithelial cells
6. Bacteria and other microorganisms

Normal Urine findings are :

Characteristic Normal

Appearance Pale or yellow

Transparency Clear

Volume 1200 to 2000 ml/24 hours

pH 5 to 7

Specific gravity 1.001 to 1.035

Cast (hyaline) 0 to 5 / HPF

Red blood cells ≤ 3 / HPF

Blood 1. Negative
2. Rarely 2 to 3 RBCs/HPF
White blood cells 1. ≤2 to 5 HPF
2. Male = 1 to 2 /HPF
3. Female = 0 to 5 /HPF

Squamous epithelial cells ≤ 15 to 20 / HPF

Yeast Negative

Bacteria Negative

Protein Negative

Glucose (Source 4) 1. Random sample = Negative

2. Qualitative = 0 (negative)
3. 24-hour sample = 1 to 15 mg/dL

Ketones (Source 4) Urine = Negative

Bilirubin (Source 4) 1. Negative

2. o to 0.02 mg/dL

Urobilinogen (Source 4) 1. Negative

2. Random sample= ≤1 mg/dL (0 to 4 mg/24 hours)
3. 2-hour sample = <1 mg /2 hours
4. 24- hours sample = 0.5 to 4.0 mg/dL
5. Another source = 0.2 to 4.0 mg/24 hours

Porphyrins <300 µg/24 hours

Nitrite Negative

Albumin 10 to 100 mg /24 hours

Amylase 260 to 950 smogi units/24 hours

Protein (Source 4) 1. Quantitative = negative
2. Urine 24-hours sample
1. Adult male = 1 to 14 mg/dL
2. Adult female = 3 to 10 mg/dL
3. Child <10 years = 1 to 10 mg/dL

Calcium (Source 4) 1. Normal diet = 100 to 300 mg/24 hours

2. Low-calcium diet = 50 to 150 mg/24 hours
3. (Another source = 0.3 g/24 hours)

Sodium chloride 1. average 10 g /24 hours

2. Patient with moderate to severe salt depletion = <10
mmol/L or <20 mmol/L /24 hours
3. Another source = 15.0 g/24 hours

Sodium (Source 4) 1. Adult = 40 to 220 meq/24 hours

2. Child = 41 to 115 meq/24 hours

Potassium (Source 4) 1. Adult = 25 to 125 meq/ 24 hours

2. Child = 10 to 60 meq/24 hours
3. Another source = 3.3 g/24 hours

Magnesium (Source 4) 1. 75 to 150 mg/24 hours\

2. Another source = 0.1 g/24 hours

Bicarbonate Negative

Creatinine 1. Male = 20 to 28 mg/Kg/24 hours

2. Female = 15 to 21 mg/Kg/24 hours
3. Another source = 1.5 g/24 hours
4. 1.0 to 1.6 gm/24 hours

Creatine 1. <100 mg/24 hours

2. higher value in children and pregnancy

Urea nitrogen 5 to 15 g/24 hours

Nitrogen 7 to 20 g/24 hours

 Urea 1. 10 to 35 g/24 hours
2. Another source = 25.0 to 35.0 g/24 hours

Uric acid (Source 4) 1. With a normal diet = 250 to 750 mg/24 hours
2. With a purine-free diet = <400 mg/24 hours
3. With a high-purine diet = <1000 mg/24 hours
4. Another source = 0.4 to 1.0 g/24 hours

Chloride (Source 4) 1. Adult = 110 to 250 meq/24 hours

2. Child <6 years = 15 to 40 meq/24 hours
3. Child 10 to 16 years = 64 to 176 meq/24 hours

Ammonium NH4+ 0.7 g/24 hours

Phosphate PO4¯ 2.5 g/24 hours

Lead 1. <0.08 µg/mL

2. or 120 µg/24 hours

Cystine Negative (0)

Homogentisic acid Negative (0)

δ-aminolevulinic acid 1.3 to 7.0 mg/24 hours

Phenyl pyruvic acid Negative (0)

Hemoglobin /myoglobin Negative (0)

Addis count 1. RBC = up to 1000,000/24 hours

2. WBC + epithelial cells= up to 2000,000/24 hours
3. Casts = up to 100,000/24 hours

Advantages of the routine urine analysis:

Parameter Advantages of the test
Appearance 1. Due to the presence of pigments
2. Concentrated or diluted urine

pH 1. To identify the crystals

2. Acid-base balance

Glucose and ketone bodies Useful in the diabetics

Bilirubin Indicates liver disease and jaundice

Urobilinogen 1. Help with hemolytic anemia

2. Obstructive jaundice

Presence of hemoglobin 1. Indicates hemoglobinuria

2. I/V hemolysis

Presence of myoglobin Seen in rhabdomy0lysis

Presence of light-chain Help to diagnose multiple myeloma

proteins

Porphobilinogen Diagnose porphyrias

(https://labpedia.net/wp-content/uploads/2020/01/Urine-Summary-of-urine-analysis-5.jpg)
Summary of urine analysis

Questions and answers:

Question 1: What was a test of ants on urine?
Show answer
Question 2: How can you confirm that the sample is urine?
Show answer
Please see the details in Urine Analysis Part 2.
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