URINALYSIS

CLINICAL PATHOLOGY & LABORATORY MEDICINE

DEPARTMENT FACULTY OF MEDICINE UGM
Urinalysis
Analyzing urine
was actually the
beginning of
laboratory
medicine.
 URINALYSIS
Aims of urinalysis:
a. To help the
diagnosis of the
diseases
b. To monitor therapy
c. To monitor the
diseases
progression
d. To screen and
monitor hereditary
diseases
URINALYSIS
Urinalysis
Following collection, specimens
should be delivered to the
laboratory promptly and tested
within 2 hours.

Generally after standing two hours at room

temperature, the chemical composition of urine
changes, and formed elements begin to
deteriorate
Changes in Unpreserved
Urine
Increased
Color Oxidation/reduction of
metabolites

Decreased
Bacterial growth or
Clarity precipitation of amorphous
material
Increased
Bacterial multiplication or
Odor breakdown amonia into
urea
Changes in Unpreserved
Urine
Increased
Breakdown of urea to
pH ammonia by bacterial
urease

Decreased
Glucose Glycolysis or bacterial use

Decreased
Ketones Volatilization and bacterial
metabolism
Changes in Unpreserved
Urine
Decreased
Bilirubine Exposure to light or
photooxidation

Urobilinog Decreased
en Oxidation to urobilin

Increased
Change of nitrate to nitrite
Nitrite by nitrate-producing
bacteria
Changes in Unpreserved
Urine
Red and
white Decreased
blood Disintegration
cells, cast

Increased
Bacterial Multiplication
Types of specimens
The first morning specimen
- Eight-hour specimen, is a
concentrated specimen
assuring detection of chemicals
and formed elements that may
not be present in a dilute random
specimen.
- Must delivered it to the
laboratory within 2 hours
Types of specimens
Fasting specimen
Being the second voided
specimen after a period of
fasting.
This specimen will not contain
any metabolites from food
ingested before the beginning of
the fasting period.
It is recommended for glucose
monitoring.
Types of specimens
24-Hour (or Timed) Specimen
A carefully timed specimen
must be used to produce
accurate quantitative results.
Types of specimens
Catheterized Specimen
This specimen is collected under
sterile conditions by passing a
hollow tube (catheter) through
the urethra into the bladder.
Bacterial culture.
Types of specimens
Midstream Clean-Catch
Specimen
Strong bacterial agents, such as
hexachlorophene or povidone-
iodine, should not be used as
cleansing agents.
Types of specimens
Suprapubic Aspiration
Suprapubic aspiration provides a
sample for bacterial culture that
is completely free of extraneous
contamination.
 Types of specimens
Prostatitis Specimen
Similar to the midstream clean-catch
collection, the threeglass collection
procedure is used to determine
prostatic infection.
Macroscopis

Color

Turbidity

Specific
Gravity
Macroscopis
Chemichal Reagent
Strips
pH SPECIFIC GRAVITY
The Multistix and The reagent
Chemstrip brands strip reaction is
of reagent strips based on the
measure urine pH change in pKa
in 0.5- or 1-unit
(dissociation
increments
constant) of a
between pH 5 and
polyelectrolyte
9.
in an alkaline
medium.
pH
GLUCOSA BLOOD
The finding of a
Reagent strips positive reagent strip
test result for blood
employ the indicates the presence
glucose oxidase of red blood cells,
testing method hemoglobin, or
that is specific for myoglobin.
glucose. Detect peroxidase
activity of
hemoglobine.

Reagen strips
Hemoglobinuria
Glucosuria
Ketone Protein
Clinical proteinuria is
The term ketones
indicated at 30 mg/dL
represents three (300 mg/L).
intermediate products Normal urine contains very
of fat metabolism, little protein: usually, less
namely, acetone, than 10 mg/dL or 100 mg
acetoacetic acid, per 24 hours is excreted.
and This protein consists

betahydroxybutyric primarily of low-

acid. molecularweight
Strips: Specific for
detecting albumin.

Reagen Strips
Ketonuria
Proteinuria
LEUCOCYTE ESTERASE NITRITE
The LE test detects Produced by bacteria
the presence of that have enzyme
esterase in the reductase that can
granulocytic white reduce nitrate to
blood cells nitrite.
(neutrophils, Reductase is found in
eosinophils, and the gram-negative
basophils) and bacteria
monocytes. (Enterobacteriaceae)
LE test is that it that most frequently
detects the presence cause UTI.
of leukocytes that
Reagen Strips
have been lysed
Urine Nitrite & Leucocyte
BILIRUBIN
A highly pigmented yellow
compound, is a degradation
product of hemoglobin.
Conjugated bilirubin
appears in the urine when
the normal degradation
cycle is disrupted by
obstruction of the bile duct
(e.g., gallstones or cancer)
or when the integrity of the
liver is damaged, allowing
leakage of conjugated
bilirubin into the circulation.
Reagen Strips
UROBILINOGEN
Urobilinogen appears
in the urine because,
as it circulates in the
blood en route to the
liver, it passes
through the kidney
and is filtered by the
glomerulus.
Urine Bilirubine
Testing Procedure
Testing Procedure
Microscopic Examination
The normal urine sediment may
contain a variety of formed
elements.
Even the appearance of small
numbers of the usually
pathologically significant RBCs,
WBCs, and casts can be normal.
 RBC
In the urine, RBCs
appear as smooth,
non-nucleated,
biconcave disks
measuring
approximately 7
mm in diameter. Refference range: <5
Must be identified cell/HPF

using high-power The presence of

(40) objective (400 RBCs in the urine is
magnification). associated with
damage to the
RBCs reported as
glomerular
the average
membrane or
number seen in 10
vascular injury within
hpfs.
Dysmorphic erythrocyte
Dysmorphic erythrocyte
Dysmorphic erythrocyte

Characteristic marker for Glomerular

bleeding
WBC
The predominant
WBC found in the
urine sediment is
the neutrophil.
Neutrophils are
much easier to
identify than Reference range: <5
RBCs because cell/HPF

they contain
granules and
multilobed nucl
Squamous cell
Squamous cells
are the largest
cells found in the
urine sediment.
Transitional cell
Transitionalcell
vesica urinaria
Round Tubular Epitelial cell
The presence of
more than two
RTE cells per
highpower field
indicates tubular
injury
cytologic urine
testing.
Crystal
Factors effect crystal formation:
a. Urine Ph crystal formed in
acid or alkali urine
b. Solute concentration in urine
c. Blood flow
Normal Crystal low
level
Amorf Urat Uric acid
pH: acid pH: acid
Little clinical Associated
significance increased level
of purine and
nucleic acid.
Normal Crystal
Calcium oxalate Amorphous
pH: acid/neutral phosphate
May be related Ph:
renal calculi alkaline/neutral
(fresh urine) No clinical
Associated with significance
food high of
oxalic acid.
Normal Crystal
Triple Phosphate Ammonium
pH: alkaline, biurat
neutral pH: alkaline
No clinical Encountered old
significance specimen
Abnormal crystal
Cystine crystal Cholesterol
Cystinuria crystal
Disorders
producing
lipiduria, such as
the nephrotic
syndrome,
CAST chronic process
Casts are the only elements found in
the urinary sediment that are unique
to the kidney.

They are formed within the lumens of

the distal convoluted tubules and
collecting ducts, providing a
microscopic view of conditions within
the nephron.
CAST
Hyaline cast WBC cast
The presence of zero Signifies
to two hyaline casts
per lpf is considered infection or
normal strenuous inflammation.
exercise, dehydration,
heat exposure.
CAST
RBC cast WBC cast
Associated with Signifies
damaged to the infection or
glomerulus. inflammation.
CAST
Waxy cast Round tubular
Representatitives epithelial cast
Advanced tubular
urine stasis
destruction,
Indicates chronic
producing urinary
renal failure stasis along with
disruption of the
tubular lining
Report
Routinely,casts are reported as the
average number per low-power field (lpf)
following examination of 10 fields.
RBCs and WBCs, as the average number
per 10 high-power fields (hpfs).
Epithelial cells, crystals, and other
elements are frequently reported in
semiquantitative terms such as, rare, few,
moderate, and many, or as 1, 2, 3, and 4,
Thank you