pH

 Along with the lungs, the kidneys are the major regulators of the acid–base content in the body.
 A healthy individual usually produces a first morning specimen with a slightly acidic pH of 5.0 to
6.0; a more alkaline pH is found following meals (alkaline tide).
 The pH of normal random samples can range from 4.5 to 8.0.

pH reagent strip

 Principle: Double Indicator System

 Correlations with other tests: Nitrite, Leukocyte, Microscopic

Clinical Significance

 Respiratory or metabolic acidosis/ketosis

 Respiratory or metabolic alkalosis
 Defects in renal tubular secretion and reabsorption of acids and bases—renal tubular acidosis
 Renal calculi formation and prevention
 Treatment of urinary tract infections
 Precipitation/identification of crystals
 Determination of unsatisfactory specimen

PROTEIN

 protein determination is the most indicative of renal disease

 Normal urine contains very little protein: usually, less than 10 mg/dL or 100 mg per 24 hours is
excreted.
 albumin is the major serum protein found in normal urine
 Other proteins include small amounts of serum and tubular microglobulins; Tamm-Horsfall
protein (uromodulin) produced by the renal tubular epithelial cells; and proteins from prostatic,
seminal, and vaginal secretions

Protein Reagent Strip

 Principle: Protein Error of Indicators

 Correlations with other tests: Blood, Nitrite, Leukocytes, Microscopic

Clinical Significance:

Pre-Renal Immune complex disorders

Intravascular hemolysis Amyloids
Muscle injury Toxic agents
Acute phase reactants Diabetic nephropathy
Multiple myeloma Strenuous exercise
Dehydration
Renal Hypertension
Glomerular Disorders Pre-eclampsia
Orthostatic or postural proteinuria

Tubular Disorders Post-renal

Fanconi syndrome Lower urinary tract infection/inflammation
Toxic agents/heavy metals Injury/trauma
Severe viral infections Menstrual contamination
Prostatic fluid/spermatozoa
Vaginal secretions

GLUCOSE

 most frequently performed chemical analysis on urine (because of its value in the detection and
monitoring of diabetes mellitus)
 Renal Threshold: 160 – 180 mg/dL

Glucose Reagent Strip:

 Principle: Double Sequential Enzyme Reaction

 Correlations with other tests: Ketones and Protein

Clinical Significance

Hyperglycemia-Associated Central nervous system damage

Diabetes mellitus Stress

Pancreatitis Gestational diabetes

Pancreatic cancer Renal-Associated

Acromegaly Fanconi syndrome

Cushing syndrome Advanced renal disease

Hyperthyroidism Osteomalacia

Pheochromocytoma Pregnancy

KETONES

 Results from increased fat metabolism due to inability to metabolize carbohydrate, as occurs in
Diabetes Mellitus, increased loss of carbohydrates from vomiting, and inadequate intake of
carbohydrate associated with starvation and malabsorption
 The term “ketones” represents three intermediate products of fat metabolism, namely, acetone
(2%), acetoacetic acid (20%), and β -hydroxybutyrate (78%).

Ketone Reagent Strip

  Principle: Sodium nitroprusside reaction
 Correlations: Glucose

Clinical Significance

 Diabetic acidosis
 Insulin dosage monitoring
 Starvation
 Malabsorption/pancreatic disorders
 Strenuous exercise
 Vomiting
 Inborn errors of amino acid metabolism

BLOOD

 Blood may be present in the urine either in the form of:

Hematuria Hemoglobinuria Myoglobinuria

(cloudy red urine; intact red (clear red urine; product of red (clear, red urine; toxic to renal
blood cells is seen blood cell destruction, tubules)
microscopically) hemoglobin)
Renal calculi Transfusion reactions Muscular trauma/crush
Glomerulonephritis Hemolytic anemias syndromes
Pyelonephritis Severe burns Prolonged coma
Tumors Infections/malaria Convulsions
Trauma Strenuous exercise/red blood Muscle-wasting diseases
Exposure to toxic chemicals cell trauma Alcoholism/overdose
Anticoagulants Brown recluse spider bites Drug abuse
Strenuous exercise Extensive exertion
Cholesterol-lowering statin
medications

Blood Reagent Strip

 Principle: Pseudoperoxidase activity of hemmoglobin

 Correlation with other tests: Protein and Microscopic

BILIRUBIN

 Bilirubin is a highly pigmented yellow compound, is a degradation product of hemoglobin

 The appearance of bilirubin in the urine can provide an early indication of liver disease (often
detected long before the patient exhibits jaundice)

BILIRUBIN Reagent Strip

 Principle: Diazo reaction

  Correlation with other tests: Urobilinogen

Clinical Significance

 Hepatitis
 Cirrhosis
 Biliary obstruction (gallstones, carcinoma)

UROBILINOGEN

 when conjugated bilirubin is excreted through the bile duct into the intestine, the intestinal
bacteria convert the bilirubin to a combination of urobilinogen and stercobilinogen.
 Present in small amount in normal urine (<1 mg/dL)

Reagent Strip:

 Principle: Ehrlich’s reaction

 Correlation with other tests: Bilirubin

Clinical Significance:

 Early detection of liver disease

 Liver disorders, hepatitis, cirrhosis, carcinoma
 Hemolytic disorders

NITRITE

 provides a rapid screening test for the presence of urinary tract infection (UTI).
 detection of bacteriuria

Reagent Strip:

 Principle: Griess Reaction

 Positive nitrite corresponds to 100,000 organisms/mL
 Product: diazonium salt
 Correlation with other tests: Protein, Leukocytes, Microscopic

Clinical Significance

 Cystitis Pyelonephritis
 Evaluation of antibiotic therapy
 Monitoring of patients at high risk for urinary tract infection
 Screening of urine culture specimens

LEUKOCYTE ESTERASE
  chemical test for leukocytes offers a more standardized means for the detection of leukocytes
 detects the presence of leukocytes that have been lysed, particularly in dilute alkaline urine, and
would not appear in the microscopic examination

Reagent Strip:

 Principle: Leukocyte esterase reaction

 Detects the presence of esterase in the granulocytic white blood cells
 Esterase is also present in Trichomonas and histiocytes

Clinical Significance

 Bacterial and nonbacterial urinary tract infection

 Inflammation of the urinary tract
 Screening of urine culture specimens

REFERENCE:

Strasinger, S. and Di Lorenzo, M., Urinalysis and Body Fluids, 6th Edition