CHAPTER 4: PHYSICAL EXAMINATION ABNORMAL URINE COLOR

OF URINE Dark Yellow/Amber/Orange

- can be caused by the presence of
The physical examination of urine includes abnormal pigment of bilirubin.
the determination of - If bilirubin is present, it will be
● Urine Color detected during chemical
● Clarity examination.
● Specific Gravity - its presence is suspected if yellow
foam appears when the specimen is
Color - the color of urine varies from almost shaken.
colorless to black - a large amount of white foam
Normal Urine Color - common descriptions indicated an increased concentration
include pale yellow, ellow, and dark yellow. of protein.
Urochrome - the yellow color of urine is - photo-oxidation of large amounts of
caused by the presence of a pigment, which excreted urobilinogen to urobilin also
Thudichum named in 1864. produces a yellow-orange urine;
yellow foam does not appear when
shaken.
- photo-oxidation of bilirubin imparts a
yellow-green color to the urine
caused by the presence of biliverdin.
- Frequently encountered in the
urinalysis lab is yellow-orange
specimen caused by the
administration of phenazopyridine or
azo-gantrisin compounds to people
who have urinary tract infection.
TWO ADDITIONAL PIGMENTS:
Red/Pink/Brown
Uroerythrin - a pink pigment, is most
- One of the most common causes of
evident in specimens that have been
abnormal urine color is the presence
refrigerated, resulting in the precipitation of
of the blood.
amorphous urates.
- red is the usual color that blood
Urobilin - an oxidation product of normal
produced in urine but the color may
urinary constituent urobilinogen, imparts an
range from pink to brown, depending
orange-brown color to urine that is not fresh.
 on the amount of blood, the pH of - breakdown of skeletal muscle
the urine, and the length of contact. produces myoglobin.
- RBCs remaining in an acidic urine - myoglobin is more rapidly cleared
for several hours produce a brown from the plasma than is hemoglobin
urine due to the oxidation of and, therefore, does not affect the
hemoglobin to methemoglobin. color of the plasma.
- Fresh brown urine containing blood - fresh urine containing myoglobin
also indicates glomerular bleeding. frequently exhibits a more
- hemoglobin and myoglobin produce reddish-brown color than urine
red urine and result in positive containing hemoglobin.
chemical results for blood. Port wine
- urine specimens containing
porphyrins also may appear red,
resulting from the oxidation of
porphobilinogen to porphyrins.
- they are often referred to as having
the color of port wine.
Non Pathogenic causes of red urine include:
● When RBCs are present, the urine is
1. Menstrual contamination
red and cloudy.
2. ingestion of highly pigmented foods
● if hemoglobin or myoglobin is
3. medications
present, the specimen is red and
Brown/Black
clear.
- additional specimen is
● distinguishing between
recommended for urine specimens
hemoglobinuria and myoglobinuria
that turn brown or black on standing
may be possible by examining the
and have negative chemical test
patient’s plasma.
results for blood, inasmuch as they
Hemoglobinuria
may contain melanin or
- resulting in vivo breakdown of RBCs
homogentisic acid.
is accompanied by red plasma.
Melanin
- The possibility of hemoglobinuria
- is an oxidation product of the
being produced from the in vitro lysis
colorless pigment, melanogen,
of RBCs also must be considered.
produced in excess when malignant
Myoglobinuria
melanoma is present.
Homogentisic acid examining the mixed specimen while
- a metabolite of phenylalanine, holding it in from of a light source
imparts a black color to alkaline
urine from persons with the
inborn-error of metabolism called
alkaptonuria.
Blue/Green
- Pathogenic causes of blue/green are
limited to bacterial infections,
including urinary tract infection by
Pseudomonas species and intestinal
Normal Clarity
tract infections resulting in increased
- freshly voided normal urine is
urinary indican.
usually clear, particularly if it is a
- Ingestion of breath deodorizers
midstream clean-catch specimen.
(Clorets) can result in a green urine.
- precipitation of amorphous
- observation of specimen collection
phosphates and carbonates may
bags from hospitalized patients
cause a white cloudiness.
frequently reveals abnormally
colored urine.
- phenol derivatives found in certain
intravenous medications produce
green urine on oxidation.
- a purple staining may occur in
catheter bags and is caused by
indican in the urine or a bacterial
infection. Frequently caused by
Klebsiella or Providencia spp.
CLARITY
Nonpathologic Turbidity
- It is a general term that refers to the
- the presence of squamous epithelial
transparency or turbidity of a urine
cells and mucus, particularly in
specimen.
specimens from women, can result
- in routine analysis, clarity is a
in a hazy but normal urine.
determined in the same manner that
ancient physicians used: by visually
 - specimens that are allowed to stand
or are refrigerated also may develop
turbidity that is nonpathologic.
- refrigerated specimens frequently
develop a thick turbidity caused by
the precipitation of amorphous
Specific Gravity
phosphates, carbonates, and urates.
- The kidney’s ability to concentrate
Amorphous phosphates and carbonates
the glomerular filtrate by selectively
- produce a white precipitate in urine
reabsorbing essentia chemicals and
with an alkaline pH
water from glomerular filtrate is one
Amorphous urates
of the kidney’s most important
- produce a precipitate in acidic urine
functions.
that resembles brick dust due to the
- Specific gravity provides an
presence of uroerythrin.
additional function, which is to
determine whether specimen
concentration is adequate to ensure
the accuracy of chemical test
- The specific gravity of the plasma
filtrate entering the glomerulus is
1.010.
- Specific gravity is defined as the

Pathologic Turbidity density of a solution compared with

- the most commonly encountered the density of a similar volume of

pathologic causes of turbidity in a distilled water (SG 1.000) at a similar

fresh specimen are RBCs, white temperature.

blood cells (WBCs) Isosthenuric

- clear urine is not always normal. - used to describe with a specific

However, with the increased gravity of 1.010.

sensitivity of the routine chemical Hyposthenuric

tests, most abnormalities in clear - specimens below 1.010

urine will be detected prior to the Hypersthenuric

microscopic analysis. - above 1.010

Normal Random Specimen
 - it may range from approximately
1.002 to 1.035, depending on the
patient’s amount of hydration.
- Specimens measuring lower than
1.002 probably are not urine.
- Most random specimens fall
between 1.015 and 1.030.
Refractometer
- Refractometry determines the
concentration of dissolved particles
in a specimen by measuring
refractive index.
- The refractometer provides the
distinct advantage of determining
specific gravity using a small volume
of specimen (one or two drops)
- Temperature. is compensated
between 15C and 38C
Refractive Index
- A refractive index is a comparison of
the velocity of light in air with the
velocity of light in a solution.
Odor
- Although it is seldom of clinical
significance and is not part of the
routine urinalysis, urine odor is a
noticeable physical property.
- Ingestion of certain foods, including
onions, garlic, and asparagus, can
cause unusual or pungent urine
odor.