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PHYSICAL EXAMINATION

OF URINE
WEEK 3
AUBF

PREPARED BY:
PRINCESS ALEN I. AGUILAR,RMT
• Following collection, urine specimens should be delivered
to the laboratory promptly and tested within 2HOURS.

INCREASED (pBaON)
1. pH Urea - - - - - - (Urease) - - - - - >
Ammonia
2. Bacteria Multiplication
3. Odor Urea - - - --(Urease) - - - -- > Ammonia
4. Nitrite Due to bacterial multiplication
DARKENED/MODIFIED
5. Color Oxidation or reduction of metabolites
DECREASED
6. Clarity Due to bacterial multiplication
Precipitation of amorphous urates (pink) or PO4s
(white)
7. Glucose Due to glycolysis
8. Ketones Due to volatilization/evaporation (left uncapped)
9. Bilirubin Due to light exposure (B2-water soluble)
10. Urobilinogen Oxidized to urobilin
11. RBC/WBC/Cast Disintegrate in alkaline urine
12. Protein Least unaffected parameter in unpreserved urine
1. Colorless/pale yellow – recent fluid consumption, polyuria, DM,
DI, diluted
2. Yellow – Mepacrine (Atabrin) – antimalarial Tx: intestinal worms,
Giardiasis)
3. Dark Yellow – Concentrated specimen; Streneous exercise,
First morning specimen
4. Bright yellow- Riboflavin/ Multivitamins
5. Amber- Dehydration; fever, burns
6. Orange – Bilirubin (tea-colored urine; Tietz), Phenazopyridine
(Pyridium; Tx for UTI; Orange and viscous urine with orange
foam)Nitrofurantoin, Phenindione, Acriflavin
7. Yellow-green – oxidation of bilirubin to biliverdin
8. Blue/green – Indican, Pseudomonas Infection, Amitriptyline,
Methocarbamol, Clorets, Methylene Blue, Phenol
9. Pink/Red
1. Intact RBCs (Cloudy/Smoky red) Hematuria,
2. Hemoglobin (Clear Red); Intravascular hemolysis,
3. Myoglobin (Clear red or reddish-brown); muscle damage
4. Rifampin –Tx for TB
5. Beets -Alkaline urine of genetically susceptible persons
6. Menstrual contamination
10. Brown/black
1. Methemoglobin (acidic)
2. Homogentisic Acid (alkaline urine); Alkaptonuria
3. Melanin (Upon exposure)
4. Phenol derivatives, Argyrol,
5. Metronidazole (Flagyl)- Tx: Trichomoniasis
11. Burgundy/Purplish Red, Portwine – Porphyrins
12. Green-Brown - Methyldopa/Levodopa (Aldomet); anti-
hypertensive
• View the urine against a white background using adequate room
lighting
• View through a newspaper print
• 1. Normal – faint aromatic due to volatile acids; becomes
ammoniacal as the specimen stands
• 2. Variations
1) Ammoniacal (freshly voided) – UTI (ex. Proteus vulgaris)
2) Mousy – PKU
3) Fruity/ sweet – Diabetes Ketoacidosis (Ketones), Starvation,
vomitting
4) Rancid – Tyrosinuria
5) Sweaty feet – Isovaleric Acidemia, glutaric acidemia
6) Maple syrup/ caramelized sugar/curry – MSUD
7) Rotting fish (galunggong)– Trimethyl Aminuria
8) Sulfur odor – Cystine Disorders
9) Fecaloid – Recto-vesicular Fistula
10) Cabbage/ hops – Methionine Malabsorption M
11) Pungent/Asparagus- methylMercaptan, Garlic, Onion, And Eggs
12) Bleach – Contamination
PRINCIPLE =
REFLECTANCE PHOTOMETRY

 Light reflection from the test pads


decrease in proportion to the intensity
of color produced by the concentration
of the test substance
• Density of solution compared with density of
similar volume of distilled water at a similar
temperature
• Influenced by number and size of particles in a
solution

Normal SG
1.003-1.035 Isosthenuria SG: 1.010
(random)

When SG Not a urine (except


Hyposthenuria SG: <1.010
<1.003 in DI)
Due to radiographic
When SG
dye Hypersthenuria SG: >1.010
>1.040
(Refractometer)
• Calibration temperature : 20oC
• Requires temperature correction:
• (-)0.001 for every 3oC that the specimen temp
is below the calibration temperature
• (+) 0.001 for every 3oC that the specimen temp
is above the calibration temperature
• Requires correction for glucose and
protein
• 1g/dL glucose = (-)0.004
• 1g/dL protein = (-)0.003
• Urine volume required = 10-15mL
• Calibration: Potassium sulfate (K2SO4)
• 20.29 g K2SO4 to 1 L H2O
• SG = 1.015
• Sample problem:
• Urine SG BY urinometer is 1.025
• Urine temp is 260C
• With 2g/dL glucose
• With 2g/dL protein
What is the corrected SG?
• Indirect method based on refractive
index (RI)
• RI = ligh velocity in air___
Light velocity in solution
• Compensated to temperature (15-38oC)
• Requires correction for glucose and
protein (same as urinometer)
• CALIBRATION:
• DISTILLED WATER = 1.000
• 5% NaCl = 1.022 + 0.001
• 9% Sucrose = 1.034 + 0.001
• Adjust the set crew to zero
NOTES TO REMEMBER!
• Both refractometer and urinometer require correction for
glucose and protein
• Refractometry reading is lower than the urinometer
reading by 0.002

SPECIFIC GRAVITY DILUTION:


Specimens with very high SG readings can be diluted and retested
To obtain the actual SG, multiply the decimal portion of SG by the dilution
factor
EX: 1:4 dilution has a reading of 1.014
PRINCIPLE: Change in pKa (dissociation constant) of a polyelectrolyte

BLUE -------- GREEN ---------- YELLOW


(dec. H+) (inc. H+) (markedly inc. H+)

Reagent is sensitive to the no. of ions in the urine specimen; indicator


changes color in relation to ionic concentration
REAGENTS:
Multistix =poly (methyl vinyl ehter/ maleic anhydride) bromthymol blue
Chemstrip= Ethyleneglycoldiaminoethylether tetraacetic acid bromthymol blue
Blue (SG 1.000) to yellow (SG 1.030)
NOTES: Add 0.005 to SG reading when pH is > 6.5 due to interference with the
bromthymol blue indicator
Not affected by glucose, protein and radiographic dye (NO CORRECTION!)
• Sound waves of specific frequency are generated at one
end of the tube and as the sound waves oscillate through
urine, their frequency is altered by the density of the
specimen.
• Mass gravity meter- used by YELLOW IRIS (International
Remote Imaging System)
IRIS DIAGNOSTICS
*Models 300 and 500 workstations:
*6mL = required urine volume
* 4mL (of 6mL) = for IRIS slideless microscope
*2mL (of 6mL) = for IRIS Mass Gravity Meter ( for SG
determination- by using harmonic oscillation)
OBSOLETE  on year 2011, changed principle into Refractometry
List of References
Lillian Mundt & Kristy Shanahan, Graff’s Textbook of
Urinalysis and Body Fluids, 2nd Ed.
Susan Strassinger & Marjorie Di Lorenzo, Urinalysis and
Body Fluids, 5th & 6th Ed.
Erol Coderres,RMT-AUBF notes
Roderick Balce, RMT-CEU Professor AUBF Notes
Ridley,J. et al, Essentials of Clinical Laboratory Science,
©2011
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