URINALYSIS

DR. MINH NGUYEN

CONTENT

• General principles
• Gross assessment of urine
• Urine dipstick analysis / chemical examination
• Microscopic examination of the urinary sediment
GENERAL PRINCIPLE

Gross assessment of urine

GENERAL PRINCIPLE

Urine dipstick analysis

GENERAL PRINCIPLE

Microscopic examination of the urinary sediment

GENERAL PRINCIPLE: INDICATIONS

• Urinalysis
• Evidence of REDUCED GFR
• Proteinuria
• Suspected kidney disease
• Urine sediment:
• All AKI
• Initially in undifferentiated CKD
• Abnormal urine dipstick
GENERAL PRINCIPLE: SPECIMEN
COLLECTION
PROPER collection -> RELIABLE results
• Avoid collecting when: on menstrual period, ongoing GI bleeding,
abnormally large amount of anal/vaginal discharge
• Clean external genitalia
• When collecting urine:
• Best in the early morning
• Without urinary catheters: midstream specimen
• Indwelling urinary catheters: recently produced urine directly from tubing ,
NOT from containing bag (-> avoid contamination)
• Try NOT to collect IMMEDIATELY after performing urinary catheterization
GENERAL PRINCIPLE: SPECIMEN
COLLECTION
PROPER collection -> RELIABLE results
• Stored in clean, dry containers
• T0:
• room tem: best analyzed in 2h
• 20 – 80: then re-warm for exam
GROSS ASSESSMENT OF URINE

• Color
• Foam
• Clarity / Turbidity
• Odor
GROSS ASSESSMENT OF URINE: COLOR
GROSS ASSESSMENT OF URINE: COLOR
GROSS ASSESSMENT OF URINE: COLOR
GROSS ASSESSMENT OF URINE: COLOR

• Red/Pink/Brown/Black
GROSS ASSESSMENT OF URINE: COLOR

• Red/Pink/Brown/Black
GROSS ASSESSMENT OF URINE: COLOR

• Red/Pink/Brown/Black
• RBCs
GROSS ASSESSMENT OF URINE: COLOR

• Red/Pink/Brown/Black
GROSS ASSESSMENT OF URINE: COLOR

• Red/Pink/Brown/Black
• Hemoglobinuria vs Myoglobinuria
GROSS ASSESSMENT OF URINE: COLOR

• Red/Pink/Brown/Black
• Hemoglobinuria vs Myoglobinuria
GROSS ASSESSMENT OF URINE: COLOR

Other colors
• White:
• Turbid urine: see below
• Crystals (phosphate)
• Chyluria
• Propofol
GROSS ASSESSMENT OF URINE: COLOR

Other colors
• Green
GROSS ASSESSMENT OF URINE: COLOR

Other colors
• Purple
GROSS ASSESSMENT OF URINE: COLOR

Other colors
• Dark yellow/Brown
GROSS ASSESSMENT OF URINE: COLOR

Other colors
• Drug - induced
GROSS ASSESSMENT OF URINE: COLOR

Other colors
• Drug - induced
GROSS ASSESSMENT OF URINE: FOAM
GROSS ASSESSMENT OF URINE: CLARITY /
TURBIDITY
GROSS ASSESSMENT OF URINE: CLARITY /
TURBIDITY
• Divided based on
pathologic pattern
GROSS ASSESSMENT OF URINE: ODOR
URINE DIPSTICK ANALYSIS / CHEMICAL
EXAMINATION
URINE DIPSTICK ANALYSIS / CHEMICAL
EXAMINATION
• rapid semiquantitative assessment of urinary characteristics
• series of colorimetric pads embedded on a test strip
• core parameters: specific gravity, pH, heme, leukocyte
esterase, nitrite, albumin, and glucose
• adhere to manufacturer instructions: amount of urine
required and the time that needs to elapse before
interpreting the color
• Differences between manufacturers
URINE DIPSTICK ANALYSIS / CHEMICAL
EXAMINATION
• Types:
• Reagent strips / machine
• Tablet tests
• Chemical tests
URINE DIPSTICK ANALYSIS / CHEMICAL
EXAMINATION
URINE DIPSTICK ANALYSIS / CHEMICAL
EXAMINATION
• Heme detection (BLOOD)
• Leukocyte esterase detection (LEU)
• Protein (PRO)
• Nitrite (NIT)
• Specific gravity (SG)
• Glucose
• Ketone
URINE DIPSTICK ANALYSIS / CHEMICAL
EXAMINATION:
HEME DETECTION
• Mecs: Heme acts as a pseudoperoxidase , when heme-
containing urine is exposed to peroxide and a chromogen
on the test pad, a color change takes place
• highly sensitive test: RBCs equivalent to 1 to 2 RBCs per
high-powered field
• False-negative: unusual
• BUT NOT highly specific to Hematuria