PHYSICAL EXAMINATION OF URINE

 Color
 Abnormal colored urine is not always pathologic
 Normal colored urine may contain pathologic elements
 Normal Urine Color
 Urochrome:
 Principal pigment responsible for the characteristic yellow color of urine
 Lipid soluble
*Chronic renal failure  Decreased renal excretion of urochrome  Deposition in subcutaneous fats
 Urobilin: Imparts an ORANGE-BROWN color to urine samples that are not fresh
 *Uroerythrin: a PINK pigment most evident in REFRIGERATED SPECIMENS as a result of amorphous urates precipitation
(“brick-dust”)
Urine Color Terms and Common Causes
Color Substance Comments and Clinical Correlation
Colorless to Dilute urine Fluid ingestion; Polyuria due to diabetes mellitus or diabetes insipidus
pale yellow
Yellow Normal urine Due to normal pigment, urochrome (as well as urobilin and uroerythrin)
Dark yellow Concentrated urine, Limited fluid intake – dehydration, strenuous exercise, first morning
to amber excessive urobilin specimen, fever; excessive conversion of urobilinogen to urobilin in
time
Bilirubin If shaken, foam is yellow
Dark yellow Biliverdin Greenish coloration, due to bilirubin that is oxidized to biliverdin upon
green standing or improper storage
Orange Foods Carotene High consumption of vegetables and fruits that contain carotene
Drugs Phenazopyridine (Pyridium, Medication – urinary analgesic; bright color at acidic pH
Azo-Gantrisin)
Warfarin (Coumadin) Medication – anticoagulant
Rifampin Medication – tuberculosis treatment
Bright yellow Foods Riboflavin (Vitamin B2) Multivitamins, B-complex vitamins
Yellow-brown Drugs Nitrofurantoin Medication – antibiotic
Pink Blood Hemoglobin, red blood cells Blood in urine from urinary tract or from contamination (e.g., menstrual
bleeding)
Inherited Porphobilin Oxidized porphobilinogen (colorless); caused by improper handling and
storage of urine specimens; associated with acute intermittent
porphyria (a rare genetic disorder)
Red Blood Red blood cells Intact RBCs observed microscopically; urine cloudy;
Centrifugation leads to clearing of urine and deposition of the RBCs in the
bottom of tube
Hemoglobin Urine clear, if not intact RBCs present (e.g., intravascular hemolysis);
hemolysis evident in plasma/serum
Foods Beet ingestion In acidic urine of genetically predisposed individuals; alkaline urine is
yellow
Drugs Senna Over-the-counter laxatives (e.g., Ex-Lax)
Red-purple Inherited Porphyrins Excessive oxidation of colorless porphyrinogens and porphobilinogen to
“PORT WINE ( accumulated in conditions colored compounds (rare conditions); caused by improper handling and
COLOR” known as PORPHYRIAS) storage of these specimens
Brown Myoglobin Rhabdomyolysis – urine clear; plasma/serum normal yellow appearance
Blood Methemoglobin Oxidized hemoglobin
Drugs Metronidazole (Flagyl) Medication – treatment for trichomoniasis, Giardia, amebiasis; darkens
the urine
Dark brown to Melanin Oxidized melanogen (colorless); develops upon standing and associated
black with malignant melanoma
Inherited Homogentisic acid Color develops upon standing in alkaline urine; associated with
alkaptonuria (a genetic metabolic disorder)
Blue or green Infection Pseudomonas Urinary tract infection with Pseudomonas
Indican Infection of the small intestine
(Tryptophan  indole (feces)  indican (bacteria in GIT)  urine 
oxidized  indigo blue)
Dyes Methylene blue Urinary analgesics (e.g., TracTabs, Urised, Uro blue, Mictasol bleu);
excessive use of mouthwashes
 Chlorophyll Breath deodorizers (Clorets), excessive use of mouthwashes

Drugs Amitriptyline (Elavil) Medication – antidepressant

Indomethacin Medication - analgesic

 Foam
 Normal: White foam that eventually dissipates
 Protein: Stable white foam
 Bilirubin: Yellow foam

 Clarity
 Presence of pathologic substances may be indicative of:
 Deterioration of the urinary tract and blood barrier
 Disease process
 Metabolic dysfunction
 Clear urine is not necessarily normal
Classification of Substances Causing Urine Turbidity
Pathologic Nonpathologic
RBCs Normal solute crystals (e.g., urates, phosphates,
WBCs calcium oxalates)
Bacteria (fresh urine) Squamous epithelial cells
Yeast Mucus, mucin
Trichomonads Radiographic contrast media
Renal epithelial cells Semen, spermatozoa, prostatic fluid*
Fat (lipids, chyle) Contaminants: feces*, powders, talc, creams, lotions
Abnormal crystals
Semen, spermatozoa, prostatic fluid*
Feces (fistula)*
Calculi
Pus
*indicates that substance could be nonpathologic or pathologic, depending on the cause of its presence in
urine

 Odor
ODOR CAUSE
Aromatic, faintly Normal urine
Ammoniacal Old urine – improperly stored
Pungent, Fetid Urinary tract infection
Sweet, Fruity Ketone production due to:
Diabetes mellitus
Starvation, dieting, malnutrition
Strenuous exercise
Vomiting, diarrhea
Unusual odors
Mousy, barny Phenylketonuria
Maple syrup Maple syrup urine disease
Rancid Tyrosinemia
Rotting/old fish Trimethylaminuria ( in bacterial vaginosis)
Cabbage/hops Methionine malabsorption
Sweaty feet Isovaleric and glutaric acidemias
Distinctive Ingested substances: asparagus, garlic, onions
**Asparagus—mercaptan smell
Menthol-like Phenol-containing medications
Bleach Adulteration of specimen or container contamination
Sulfuric Cystine decomposition
 Taste
 “mellitus” : sweet
 “insipidus” : tasteless

 Concentration
 Specific gravity
 an expression of urine concentration in terms of density (i.e., the mass of solutes present per volume of solution)
 affected by the number and molecular sizes of solutes present in urine
 Isosthenuria 1.010
 Hyposthenuria <1.010
 Hypersthenuria >1.010
 Urinometer
 Based on the principle of Buoyancy
 The upward buoyant force that is exerted on a body immersed in a fluid, whether fully or partially submerged,
is equal to the weight of the fluid that the body displaces and acts in the upward direction at the center of
mass of the displaced fluid.
 Disadvantages: Requires large volume (10-15mL), Calibrated daily, Temperature corrections, Glucose and Protein
corrections
 Temperature Corrections:
 based on calibration temperature (20oC)
 0.001 subtracted for every 3°C below calibration temperature
 0.001 added for every 3°C above calibration temperature
 Glucose and Protein Corrections
 0.003 subtracted for every 1g/dL of PROTEIN
 0.004 subtracted for every 1g/dL of GLUCOSE
 Refractometer
 Also known as Total Solids Meter (TS Meter)
 Measures refractive index
 A comparison of the velocity of light in air with the velocity of light in a solution
 The concentration of dissolved particles present in the solution determines the velocity and angle at which light
passes through a solution
 Advantages: Requires small volume, No temperature correction (15-38oC)
**Reading is slightly lower than urinometer (by 0.002)
 Calibration
 Distilled Water 1.000
 3% NaCl 1.015 ± 0.001
 5% NaCl 1.022 ± 0.001
 9% Sucrose 1.034 ± 0.001
 Glucose and Protein Corrections
 0.003 subtracted for every 1g/dL of PROTEIN
 0.004 subtracted for every 1g/dL of GLUCOSE
**For both the urinometer and refractometer, dilute the urine sample if it is highly concentrated (specific gravity reading is
beyond the scale)

Dilution Factor = Total Volume (TV)/ Original Volume (OV)

  Reagent Strip
 Indirect colorimetric estimation of the quantity of ionic (charged)
solutes in urine (ex. Na+, Cl-, K+, NH4+)
 Measures ionic specific gravity (SGionic)
 Based on a change in the pKa of a polyelectrolyte on the reagent
pad
 pKa: Acid dissociation constant, quantitative measurement of
the acid strength
 Increased ions in solution causes the polyelectrolyte on the pad
to produce free H+ Free H+ cause a change in pH on the reagent
pad  Change in pH is detected by the color indicator
(Bromothymol blue)

 Other Methods
 Harmonic Oscillation Densitometry
 Based on the principle that the frequency of a sound wave entering a solution changes in proportion to the
density of a solution
 Directly measures specific gravity
 Makes use of a U-shaped glass tube with an electromagnetic coil and motion detector
 Principle: Current (Coil) gives out a sound wave of fixed frequency  Sound wave enter the sample 
Attenuation (Weakening) of frequency  The level of frequency attenuation is directly proportional to density

 Falling Drop Method
 Involves timing the fall of a drop of body fluid of known size, through a definite distance in a mixture non-
miscible with the fluid
 Directly measures specific gravity
 More accurate than refractometer; More precise than urinometer

 Osmolality
 an expression of concentration in terms of osmoles of solute particles per kilogram of water

 Volume
 influenced by: fluid intake, fluid loss (nonrenal), antidiuretic hormone, excretion of dissolved solids
Normal value: 600-1800 mL/day
*Night: <400mL

 Polyuria
 >2.5L/day (adults)
 >2.5-3mL/kg/day (children)
 Nonpathologic causes:
 Diuretics
 Intravenous solutions
 Diet: increased salt and protein
 Pathogenic causes:
 Defective hormonal regulation (Insulin, ADH)
 Defective renal salt/water reabsorption
 Osmotic diuresis

 Nocturia
 Night urine: >500mL; SG < 1.018
 Chronic renal failure
  Oliguria
 <500 mL/day; SG >1.030
 Causes:
 Water deprivation
 Nonrenal fluid loss: Sweating, vomiting, diarrhea
 Decreased blood supply
 Decreased plasma protein
 Urinary tract obstruction

 Anuria
 Complete lack of urine excretion
 Can be fatal if not immediately addressed because of the accumulation of toxic metabolic by-products in the body
 Causes:
 Acute renal failure
 Ischemic (restrictions in the blood supply of the kidneys)
 Nephrotoxic (poisonous/ toxic effects of some substances, such as toxic chemicals and medications, on kidney
function
 Urinary tract obstruction
 Hemolytic transfusion reaction

Problem-solving
The specific gravity of a 1:2 dilution of urine sample was taken with a urinometer at 14 0C. The reading was 1.020. The original
sample contains 2 g/dL of protein and 4 g/dL of glucose. Compute for the corrected specific gravity.

One needs to correct for the dilution followed by correction for temperature, protein content, and glucose content.
For the given problem, the scientist needs to correct for the dilution first before correcting for the protein and glucose
content because the given protein and glucose concentrations were for the ORIGINAL (UNDILUTED) urine sample.

Correction for specific gravity

Since the dilution was 1:2, the dilution factor is 2. The scientist needs to multiply the dilution factor to the decimal
values of the specific gravity of the diluted urine sample (uncorrected specific gravity)
Uncorrected specific gravity = 1.020
.020 x 2 = 0.040; Hence, after correcting for the dilution, the specific gravity of the urine is set at 1.040.

Correction for temperature: 0.001 subtracted for every 30C below calibration temperature (200C)
140C; 60C below 200C. Therefore, the scientist needs to subtract 0.002

Correction for protein content: 0.003 subtracted for every 1 g/dL of protein
2 g/dL protein ; Therefore, the scientist needs to subtract 0.006

Correction for glucose content: 0.004 subtracted for every 1 g/dL of glucose
4 g/dL glucose; Therefore, the scientist needs to subtract 0.016

1.040 (corrected for dilution) – 0.002 – 0.006 – 0.016 = 1.016

The corrected specific gravity of the urine is equal to 1.016.

Practice Problems
1. A 42-year old male patient urine was submitted for urinalysis right after he underwent MRI. His sample was diluted 1:3 and
had a specific gravity of 1.017 when read using a urinometer at 260C. The diluted urine also had 1 g/dL of protein and 2 g/dL
of glucose. What is the corrected specific gravity of the undiluted sample?

2. A 23-year old female patient submitted her first-morning urine sample for urinalysis. As part of the lab protocol, you used a
refractometer to get her specific gravity which yielded 1.025 at a temperature of 230C. Reagent strip tests suggest that she
has 1 g/dL of glucose and 2 g/dL of proteins. What is the corrected specific gravity of the patient?