1. Professor: SENG SEREY prepared by: NAM MENG LY URINE ANALYSIS 2. • Urine Analysis: is an array of tests performed on urine and one of the most common method of medical diagnosis. • Why we have to do urine analysis? • - General evaluation of health • -Diagnosis of diseases or disorders of kidney and Urinary tract • -Diagnosis of other systemic disease that affect kidney function • -Monitoring of patients with diabetes • -Screening for drug abuse ( Sulfonamide and Aminoglycoside ) 3. Collecting Specimens 4. • Type Urine examination 1.Macroscopic examination Volume Color Odor pH Specific Gravity 5. A, Volume Normal: 600-1600ml 1.Polyuria: > 2000ml 2.Oliguria: < 400ml -Causes: -Causes .DM .Dehydration .DI .Renal Ischemia .Polycystic .Acute Tubular Necrosis .Chronic renal failure .Obstruction to Urinary Tract .Diuretic .Acute Renal Failure .IV saline/Glucose 6. • B, Color Normal : clear and pale yellow Colorless: dilution , DM, DI, Diuretic Milky: Purulent GUT infection, Chyluria Orange: Fever, excessive sweating Red: Beetroot ingestion, hematuria Brown: Melanin, Alkaptunuria. 7. • C, Odor 8. • D, pH (Normal: 4.6-8 ) Acidic Urine: Alkaline Urine: -Ketosis Diabetes -Strict Vegetarian -Systemic acidosis -Systemic Alkalosis -UTI => E.Coli -UTI => Proteus -Acidification Therapy -Alkalization Therapy E, Specific Gravity: ( Normal 1,016-1,022) depends on the concentration of various solutes in urine. High SG: Hypersthenuria causes by all causes of oliguria and Glycosuria Low SG: Hyposthenuria caused by all causes of polyuria 9. • 2.Microscopic examination A sample has been taken 10-15ml into a tube for 5-10min which produces a concentration of sediment at the bottom. A drop of sediment is poured onto a glass slide with coverslip put onto observed under microscopes. 10. • A variety of normal and abnormal cellular elements in urine such as: -RBC -WBC -Mucus -Various Epithelial Cells -Various Crystal -Bacteria -Casts 11. Abnormal Finding : .>3 RBC .>5 WBC .>2 Renal Tubular Cells .> 10 Bacteria .>3 Hyaline casts .>10 Squamous Cells ( Indicated of contaminated specimen) .Fungal hyphae or Yeast , Parasite, Viral Inclusion .Pathological Crystal ( cystine, leucine, tyrosine.) .Large number of Uric acid or Ca oxalade. 12. • Presents of Casts: Type of Casts: Acellular casts Cellular casts Hyaline Casts (fever, exercise) RBC casts( Glomerular damage) Granular casts (albumin) WBC casts(Infection) Waxy casts( Renal Failure) Epithelial casts(toxic ingestion Fatty casts ( NS, DM, SLE,ATN) Hg,ATN) Pigment casts( Hemolytic anemia, Rhabdomyosis, Liver disease) Crystal casts( crystallized urinary solute: Oxalate urate,,,) 13. • 3.Chemical Examinaion The chemical analysis of urine are undertaken to evaluate the level of the following components: 1.Protein ( Heat and Acetic acid test) 2.Glucose ( Benedict test) 3.Ketone 4.Blood 5.Bilirubin 6.Urobilinogen 7.Bile salts 14. The Dipstick method 15. 1.Tests for proteins •Test – HEAT & ACETIC ACID TEST •Principle-proteins are denatured & coagulated on heating to give white cloud precipitate. •Method-take 2/3 of test tube with urine, heat only the upper part keeping lower part as control. •Presence of phosphates, carbonates, proteins gives a white cloud formation. Add acetic acid 1-2 drops, if the cloud persists it indicates it is protein(acetic acid dissolves the carbonates/phosphates) 16. Other tests • Sulphosalicylic acid test • Dipsticks • Esbach’s albuminometer- for quantitative estimation of proteins 17. Causes of proteinuria •Prerenal causes-Heavy exercise,Fever,hypertension, multiple myeloma, eclumpsia •Renal –acute & chronic glomerulonephritis,Renal tubular dysfunction,Polycystic kidney, nephrotic syndrome •Post renal- acute & chronic cystitis, tuberculosis cystitis 18. • Selective proteinuria • Nonselective proteinuria 19. microalbuminuria • The level of albumin protein produced by microalbuminuria cannot be detected by urine dipstick methods. In a properly functioning body, albumin is not normally present in urine because it is retained in the bloodstream by the kidneys. Microalbuminuria is diagnosed either from a 24-hour urine collection 20. Significance of microalbuminuria •an indicator of subclinical cardiovascular disease •an important prognostic marker for kidney disease •in diabetes mellitus •in hypertension •increasing microalbuminuria during the first 48 hours after admission to an intensive care unit predicts elevated risk for acute respiratory failure , multiple organ failure , and overall mortality 21. Bence Jones proteins •These are light chain globulins seen in multiple myeloma, macroglobulimias, lymphoma. •Test- Thermal method(waterbath): Proteins has unusual property of precipitating at 400 -600c & then dissolving when the urine is brought to boiling(1000c) & reappears when the urine is cooled. 22. 2.Test for sugar • Test-BENEDICT’S TEST(semiquantitative) • Principle-benedict’s reagent contains CuSO4.In the presence of reducing sugars cupric ions are converted to cuprous oxide which is hastened by heating, to give the color. • Method- take 5ml of benedict’s reagent in a test tube, add 8drops of urine. Boil the mixture. Blue-green= negative Yellow-green=+(<0.5%) Greenish yellow=++(0.5-1%) Yellow=+++(1-2%) Brick red=++++(>2%) 23. Benedict’s test • Detects all reducing substances like glucose, fructose, & other reducing sustances. • To confirm it is glucose, dipsticks can be used (glucose oxidase) 24. Causes of glycosuria • Glycosuria with hyperglycaemia- diabetes,acromegaly, cushing’s disease, hyperthyroidism, drugs like corticosteroids. • Glycosuria without hyperglycaemia- renal tubular dysfunction 25. 3.Ketone bodies • 3 types Acetone Acetoacetic acid β-hydroxy butyric acid They are products of fat metabolism 26. Rothera’s test • Principle-acetone & acetoacetic acid react with sodium nitroprusside in the presence of alkali to produce purple colour. • Method- take 5ml of urine in a test tube & saturate it with ammonium sulphate. Then add one crystal of sodium nitroprusside. Then gently add 0.5ml of liquor ammonia along the sides of the test tube. • Change in colour indicates + test 27. Causes of ketonuria • Diabetes • Non-diabetic causes- high fever, starvation, severe vomiting/diarrhoea 28. 4.Bilirubin •Test- fouchet’s test. •Causes Liver diseases-injury,hepatitis Obstruction to biliary tract 29. 5.Urobilinogen • Test- ehrlich test • Causes-hemolytic anemia's 6.Bile salts Hay’s test Cause- obstruction to bile flow (obstructive jaundice) 30. 7.Blood in urine •Test- BENZIDINE TEST •Method- mix 2ml of benzidine solution with 2ml of hydrogen peroxide in a test tube. Take 2ml of urine & add 2ml of above mixture. A blue color indicates + reaction. 31. Causes of hematuria • Pre renal- bleeding diathesis, hemoglobinopathies, malignant hypertension. • Renal- trauma, calculi, acute & chronic glomerulonephritis, renal TB, renal tumors • Post renal – severe UTI, calculi, trauma, tumors of urinary tract 32. Type Plasma color Urine color Hematuria normal Smoky red m/s-plenty of RBC’s hemoglobunuria Pink,hepatoglob in reduced Red , occasional RBC’s Myoglobunuria Pink, normal hepatoglobin Red, occasional RBC’s 33. Thanks for pay attention !!!