Patron saints of urinalysis

:
Cosmas and Damien, brothers, perhaps twins. Physicians in Aegea, Asia minor (Turkey.) Beheaded 303 AD because they treated the poor for nothing – “the silverless ones”. Hostility from colleagues, say some. Feast day is September 27th.

Urinalysis, dipstick and microscopy
Fresh urine, less than 4 hours old. Supplier not exercised. Most concentrated overnight For metabolic diseases – 2 hours after meal.

Macroscopic urinalysis, volume
Healthy Anuria Oliguria Polyuria. Renal failure, obstruction, ischaemia, vomiting, diarrhea, excessive 600 mL to 2L/day < 100 mL/d 100-500 mL/d >2L polydipsia, osmotic diuresis, diabetes insipidus – CNS or renal, sweating,

Macroscopic urinalysis, colour
Terms Healthy – pale yellow Milky (turbid) Deep yellow Tan to olive green Red Purple to brown Brown to black Possible pathology or cause None WBC, urate, Phosph, sperm Riboflavin supplements Liver disease Hb, myogl,dyes, beet, porph Porphyrins Old blood, melanin, homoge

Macroscopic urinalysis, smell
Terms Healthy – slight smell Ammonia Sweet or fruity Maple syrup Possible pathology or cause Diet e.g. asparagus Bacteria – stale (old) urine Ketones – starvation, diabetes mellitus. Inherited disease.

Urinalysis by dipstick

Urinalysis dipstick

Urinalysis dipstick, the famous 5
pH – acidification function. Protein – glomerular membrane problem or inflammatory disease of tubules. Glucose – overload or lower renal threshold Blood – bleeding into the genital urinary tract. Specific gravity – concentrating function.

Urinalysis dipstick, another 5:
Ascorbic acid Bilirubin Urobilinogen Nitrite. Leukocyte esterase.

Dipsticks are not quantitative
Used to be reported as “negative, +, ++, +++” or “small”, “moderate” and “large”. Note “negative” does not mean “nothing”. Now reported as ..mg/L or .. RBC/HPF but this is bogus because reaction depends on
Osmolality  Hydrogen ion concentration  and other constituents.

Dipstick pH
Terms Healthy 5-9 Strongly acid Strongly alkaline Acidosis – sulfates, phosphates, chlorides Alkalosis – vegetarian, stale (old) urine. Possible pathology

Dipstick protein
Terms Healthy < 150 mg/d Small amount constant Early renal failure Unusual protein Large amount g/d Myeloma, pancreatitis etc Nephrotic syndrome False +: PVP, quaternary ammonia, chlorohexidine Possible pathology or problem

Dipstick glucose
Terms Healthy - negative Glucose overload Renal tubular cells poisoned False negative - Vitamin C at low abnormal glucose levels. Diabetes, pregnancy Heavy metals False positive - peroxides Possible pathology or problems

Dipstick, ketones
Terms Possible pathology

Healthy – negative

Present

Starvation or diabetes mellitus coma.

Dipstick, (blood) haem
Terms Health - negative Present False negative –(vitamin C, iodate compensation) Free haemoglobin False positive myoglobin Possible pathology or problem

Dipstick, specific gravity
Terms Healthy – 1.010-1.022 Hyposthenuria < 1.007 Isosthenuria 1.010 Hypersthenuria > 1.010 Loss of concentrating ability Same as blood Dehydration, diabetes mellitus etc. Possible pathology

Dipstick, leukocyte esterase
Terms Healthy – none present Present Inflammation or infection. In 1 hour 40% of leukocytes are lysed but esterase stays positive False positive - HCHO as preservative. Possible pathology or problem

False negative – high protein, cephalexin

Dipstick, bilirubin
Terms Healthy – negative Present False negative – sunlight, vitamin C, nitrite Liver disease: bilirubin diglucuronide in cholestasis False positive -phenoazopyridine Possible pathology or problem

Dipstick urobilinogen
Terms Healthy – negative Present Liver disease: in early and late stages of hepatitis. False negative - sunlight False positive – severe over time. HCHO formal stress. Possible pathology or problems

Dipstick, nitrite
Terms Healthy - negative Present E. coli, proteus, enterobacter, klebsiella have nitrate reductase. Need 4 hours of urine in bladder. False positive – stale (old) urine, phenazopyridine Possible pathology or problem

False negative dilution, starvation, stale (old), vitamin C

Dipstick, ascorbic acid
Terms Tests made false negative

Healthy < 50 mg/L

> 750 mg/L

Glucose, haemoglobin, leukocyte esterase may be altered

Microscopy:
Erythrocytes Leukocytes, Casts Crystals Bacteria Yeast, spermatozoa, epithelial cells.

Erythrocytes (RBC)
Erythrocytes 0-2/ high power field Bleeding Deformed erythrocytes with blebs – glomerular bleeding. Shrunken, crenellated - means concentrated urine.

Leukocytes (WBC)
Leukocytes 0-5/HPF Inflammation in the genitourinary tract.

Casts
0-1/LPF Tamm-Horsfall protein secreted by the renal tubular cells to form a plug (cast) of the tubule lumen (hole). Hyaline – dehydration Granular – debris from epithelial cells or from leukocytes and/or inflammation/infection Erythrocyte or haemgranular – bleeding from glomerulus. Broad – chronic cast/ obstruction of flow.

Crystals
Acid urine – uric acid, sodium urate, calcium oxalate – usual. Alkaline urine – calcium carbonates, calcium phosphate – usual. Renal stones. Gout Urinary tract infections – struvite. Cystinuria Cholesterol Leucine, tyrosine – liver disease. Drugs

Bacteria, protozoa
Health -none. Pathology: Urinary tract infection. Trichomonas

Epithelia cells, spermatazoa, yeast
Health -none Squamous cells may be present but they are of no significance. Renal tubular epithelial cells poisonings, kidney infections, transplant rejection. Yeast may be harmless or Candida seen in AIDS, diabetes mellitus

Creatinine clearance
Volume of plasma cleared of creatinine in a a unit of time Approximated the glomerular filtration rate, Measure serum/plasma and urine creatinine before and after the time period. Usually 24 hours. UV/P. Should be corrected for surface area and/or weight.

Creatinine clearance
Creatinine clearance increases with age. Correlates with glomerular filtration rate. Not much better that serum creatinine in diagnosis and prognosis.

Osmolality
In renal disease urine is neither concentrated or diluted. Polyuria, nocturia. Specific gravity strips give false information in glycosuria or proteinuria, Compare plasma to urine values. Urine has much higher osmolality (spec grav) usually.

Protein in urine
Chemically, turbidimetrically or by dip stick Special stick microalbumin for diabetes m. In early renal failure there is a small constant leak of protein. After strenuous exercise or exposure to severe cold there is a transient leak of protein. No significance.

Point of Care systems
Test Glucose Urea Creatinine Therapeutic drugs Drugs of abuse Arterial blood gas Bilirubin Clinical use Diabetes mellitus Kidney disease Kidney disease Comply or toxicity OD, employer Acid base Neonatal jaundice Usual place Clinic/home Clinic Clinic Clinic ER or work Clinic Clinic

POCT 2
Salicylate Paracetamol Parathyrin(PTH) Lactate Cholesterol Pregnancy Urine dipstick Clotting time Ethanol Poisoning Poisoning Thyroidectomy Athletic testing Heart disease Pregnancy Kidney etc Coagulation Fitness to drive ER ER Surgery Sports medicine Home Clinic/home Clinic/home Home Police/bars

POCT issues:
For Produces results more quickly Fewer people in chain, less chance for error No sample delivery system or laboratory needed. Against Costs are much higher (but perhaps not) No professional input added. Could be built in. Quality assurance is manufacturers’ and unskilled users’ problem.

Sign up to vote on this title
UsefulNot useful