Chapter Three

Physical Examination of Urine

 Objective
 At the end of this chapter, the student will be able to:
 carry out physical examination of urine such as odour,
volume, color, transparency, foam, specific gravity of
urine and interpretation of the test result.
 Explain each interfering factors at the moment doing
the test
 Identify the crucial physical examination for each test
 3.0 Physical Examination of urine

3.1 -Volume
3.2 -Color
3.3 -Transparency
3.4 -odor
3.5 -Foam
3.6 -Specific gravity
 Introduction
 Physical examination of urine :
 the first part of routine urinalysis.
 It is simplest procedure of all urine examination
 But this simplicity doesn’t mean that any one can do it
without any background knowledge and experiences.
 Despite its simplicity, It provides hint for the subsequent
chemical and microscopic urinalysis
 It includes measurement of the volume of urine,
examination of color and appearance, detecting the
foam, odour, and measuring the specific gravity.
 Volume

 Not measured as part of a routine urinalysis

 But volume of urine excreted in 24 hours aids for clinical
diagnosis.
 The 24-hour urine voided by a healthy
 adult range 600-2000ml
 Children (6 to 12 years) about 1000ml
 infants about 600ml.
 Volume Cont’d…

 Factors that affect the urine output

 fluid intake
 Diet
 physiological and environmental factors of the body
 Volume Cont’d…

 Procedures :for measurement of urine volume

 collect 24-hour urine specimen in a container of clean
and dry, brown colored.
 Add appropriate preservative for the desired urine
chemical test
 Label on the container that indicates name of patient,
collection time and date, type of chemical test ordered
and preservative used.
 Pour the collected urine into a graduated cylinder of
suitable size (500ml or 2000ml)
 measure the volume and report in terms of ml in 24hrs
 Volume Cont’d…

 Clinical Significance
 Abnormal urine volume
 suggests several renal diseases but it is confirmed by
confirmatory tests
 Helps for determination of protein
 Indicates some clinical features like abnormal
execration of urine/ day
 Volume Cont’d…

 Measurement of urine volume used for:

 Quantitative tests
 GFR
 Clearance tests
 Evaluation of fluid balance and kidney function
 Volume Cont’d…
 Anuria urine formation<100ml per 24 hours
 Complete urinary tract obstruction
 Hemolytic transfusion reaction
 Polyuria urine volume is greater than normal >2000ml per
24 hours for prolonged period.
 Diabetic mellitus
 Tubular necrosis [improper function of urine tubules]
 Intravenous fluid intake
 Volume Cont’d…

 Oliguria :urine volume is less normal <400ml per 24 hours

for prolonged period
 Dehydration or poor blood supply to the kidneys
 Mechanical obstruction of the urinary system [e.g. due
to renal calculi or tumors]
 Excessive salt intake.
 Diuresis: temporal increment of urine due to excessive
fluid intake
 color
 Urine color is recorded within 30 minute after
collection
 Pale to colorless urine may indicate
 Large fluid intake
 Diabetic mellitus
 Alcohol consumption
 Dark yellow or brown red urine may indicate
 Concentrated urine
 Decreased fluid intake
 Fever
 Dehydration
 Color cont’d…

 Yellow brown or “beer brown” color may indicate the

presence of bilirubin.
 Clear red color may indicate presence of hemoglobin
 Cloudy red or smoky red color indicates hematuria.
 odour

 Normally freshly voided urine from healthy individuals has

faint aromatic odor
 The test is conducted by smelling of urine and the result is
not used for reporting but for the purpose of comparison
with the subsequent chemical test result.
 If the urine specimen is old, it will have ammonical or
pungent odor, which results from the break down and
conversion of urea in the urine into ammonia by the action
of bacteria.
 Sweet fruity odor of urine results from the presence of
ketone bodies due to diabetes mellitus, prolonged
vomiting, starvation or strenuous exercise.
 foam

 Normally fresh urine produces small amount of white foam,

But during certain abnormal conditions, it may be changed.
 Yellowish foam indicates the presence of bilirubin in the
urine
 must be confirmed by chemical test
 When high concentrations of protein are present in the
urine, a large amount of white foam may be seen
 Transparency

 Freshly voided urine specimen is normally clear and

transparent
 Excretion of turbid urine is not always un abnormal
 Refrigeration of urine results in the turbidity of the urine.
 Occasionally turbidity of urine may result from
 White blood cells [pus cells]
 Kidney stones
 Yeast cells
 High number of bacteria cells
 High number of mucus treads
N.B All the above physical findings must be confirmed by
chemical and/or microscopic examination
 Note:
 Ifthe urine is so cloudy, microscopical examinations
should be done for the suspended solutes in the
sample.
 All urine specimens should be assessed for color and
transparency in similar containers to ensure
consistent results.
 Specific gravity (Sp.g)

 (Sp.g):

ratio of the weight of a fixed volume of solution to that
of the same volume of water at a specified temperature
usually
 Indicator of the kidneys ability to concentrate or dilute
urine.
 Loss of concentrating or diluting capacity is an indication
of renal dysfunction.
 Reflect degree of hydration or dehydration.
 A concentrated urine may have a specific gravity of 1.025
–1.030
 A diluted urine can have a specific gravity of 1.001-1.010.
 Measurement of Specific Gravity

 There are different methods to measure the

urine specific gravity
 Urinometer
 Refractometer
 Reagent strip
 Falling drop method
 Weighing technique
A) Urinometer method

 Urinometer : a glass float weighted with mercury, with an

air bulb above the weight and a graduated stem on the top.
 Weighted to float at the 1.000 graduations in pure water
when placed in a glass urinometer cylinder or appropriate
sized test tube.
 It is important that the cylinder, or test tube, be of the
correct size so that the urinometer can float freely.
 The specific gravity of the urine is read directly from the
graduated scale in the urinometer stem at the lower
meniscus.
 The scale of the urinometer is calibrated from 1.000 – 1.060
with each division being equal to 0.001.
 1000

1010
1020
1030

Reading the urinometer scale

 Calibration of urinometer:
 The urinometer must be calibrated everyday.
 Distilled water should read 1.000.
 If the reading is 1.003, subtract the reading from all the
specific gravity readings.
 Following two standards may also be used for calibrating
the urinometer at different specific gravities
 a. Specific gravity 1.011 (750 mOsm/kg): This is
prepared by weighing 24.03 g of oven-    dried sodium
chloride and adding it to 1000mL of distilled water .
 b. Specific gravity 1.023 (1600 mOsm/kg): Weigh 51.37
g of oven-dried sodium chloride     and add it to 1000 mL
of distilled water
Correction or urinometer reading

 Temperature Correction
 Most urinometer are calibrated at 15 oC.
 For each 3oC difference 0.001 must be added if
above
 subtracted if lower than the calibration temperature.
 For example, if the specific gravity of the urine is
1.022 at 23oC, and the urinometer has been
calibrated at 20 oC, the correct reading is
1.022+0.001= 1.023.
Correction or urinometer reading

 Correction for abnormal Dissolved Substances

 The specific gravity increases by
 0.004 for every 1% glucose in urine
 0.003 for every 1% protein in solution.
 Therefore subtract 0.004 from the specific gravity
reading for every 1% glucose in urine.
 And subtract 0.003 from the specific gravity reading for
every 1% protein in the urine.
 Sources of Error:

 Temperature differences
 Proteinuria (if not correcting Proteinuria)
 Glycosuria ( if not correcting Glycosuria)
 X-ray contrast media, it increases urine specific gravity
 Chemical preservatives
 Refractometer method:

 Refractometer is an instrument, which indirectly

measures the specific gravity by measuring the refractive
index
 the ratio of the velocity of light in air to the velocity of
light in solution.
 This ratio varies directly with the number of dissolved
particles in solution.
 Principle:

 Refractometer is based on the principle of light

refraction.
 When a ray of light passes through the optical system of
the refractometer, the path of light going through air and
glass deviates when it meets the fluid or the urine
specimen.
 The degree of refraction is proportional to the amount of
solute concentration or the specific gravity of the fluid.
Refractometer cont’d…

 Limitation:
 It require pure test tube transparent light
 Needs skilled professional about handling of the test
tube
Clinical significance:
 the same as urine sp.gv. Measurment using
urinometer
 Reagent Strip Test

 Reagent strips have been developed as an indirect

method of measuring specific gravity of urine.
 These strips actually measure ionic concentration,
which is related to specific gravity.
 Principle

 It is based on Pka, which changes in relation to ionic

concentration of urine.
 When the ionic concentration is high (high specific
gravity), the Pka decreases thus the pH decreases.
 The bromthymol blue indicator changes color ranges
from deep blue to green (low ionic concentration)
through green to yellow (high ionic concentration.)
 Weighing technique

 This technique requires the use of an analytical balance

 As urinometer method, adjustments to the value are
necessary if the urine contains large amount of protein or
glucose. :
 Assume that 10 ml of urine weighs 10.15gm
 Assume that 10ml of distilled water is10gm.
 specific gravity urine should be:

10.15gm =1.015
10gm
 Clinical Significance

 used to obtain information about two general functions:

 the state of the renal epithelium, and
 the state of hydration of the patient.
 If the kidney is performing adequately, it is capable of
producing urine with a specific gravity ranging from
1.003-1.030 or higher.
 Exercise
1. Define the following term
 Specific gravity
 Oliguria
 Refractive index

2. Describe abnormal color and transparency of urine

specimen and the significance of each.
3. Describe normal and abnormal odour and foam of
urine specimen and the significant of each.
4. How can you correct specific gravity value measured
by urinometer for temperature glucose and protein?
5. Describe the terminologies that indicates abnormal
urine volume and the significance of each.
6. List the method used for determining the specific
gravity of urine and write the principle of each method.