Urine analysisUrine analysis

Macroscopic urinalysisMacroscopic urinalysis

Is the direct visual observation of the urine, Is the direct visual observation of the urine, noting its quantity, color, clarity or cloudiness, noting its quantity, color, clarity or cloudiness, etcetc

Normal urine is typically Normal urine is typically light yellowlight yellow and and clearclear . Obvious abnormalities in the color, clarity, . Obvious abnormalities in the color, clarity, and cloudiness may suggest possibility of an and cloudiness may suggest possibility of an infectioninfection, , dehydrationdehydration, , blood in urineblood in urine, , liver liver diseasedisease, , break down of muscle or red blood break down of muscle or red blood cells in the bodycells in the body..

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Dipstick chemical analysisDipstick chemical analysis

Urine dipstick is a narrow plastic strip which Urine dipstick is a narrow plastic strip which has several squares of different colors has several squares of different colors attached to itattached to it . .

Each small square represents a component of Each small square represents a component of the test used to interpret urinalysisthe test used to interpret urinalysis . .

The entire strip is dipped in the urine sample The entire strip is dipped in the urine sample and color changes in each square are notedand color changes in each square are noted . .

The squares on the dipstick represent The squares on the dipstick represent the following components in the urinethe following components in the urine

Specific gravity

Protein in the urine (mainly albumin)

Glucose

Ketone bodies

Blood, leukocyte esterase (indicative of white blood cells in urine)

Nitrite (suggestive of bacteria in urine) Bilirubin ( possible liver disease or red blood cell break down) Urobilinogen ( possible liver disease)

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MICROSCOPIC URINALYSIS

MICROSCOPIC MICROSCOPIC URINALYSISURINALYSIS

11 . .Red Blood CellsRed Blood Cells::Hematuria is the presence of abnormal Hematuria is the presence of abnormal numbers of red cells in urine due tonumbers of red cells in urine due to::

a. Glomerular damagea. Glomerular damage

b. Tumorsb. Tumors

c. Urinary tract stonesc. Urinary tract stones

d. Upper and lower urinary tract d. Upper and lower urinary tract infectionsinfections

HematuriaHematuria

Two Types of HematuriaTwo Types of Hematuria

Gross hematuriaGross hematuria means that the  means that the blood can be seen by the naked eye. blood can be seen by the naked eye. The urine may look pinkish, The urine may look pinkish, brownish, or bright redbrownish, or bright red..

Microscopic hematuriaMicroscopic hematuria means that  means that the urine is clear, but blood cells can the urine is clear, but blood cells can be seen when urine is looked at be seen when urine is looked at under a microscope or tested in a under a microscope or tested in a lablab..

RBC's may appear normally shaped, swollen by dilute urine (in fact, only cell ghosts and free hemoglobin may remain) or crenated by concentrated urine.

White Blood CellsWhite Blood Cells

PyuriaPyuria refers to the presence of abnormal refers to the presence of abnormal numbers of leukocytes that may appear numbers of leukocytes that may appear with infection in either the upper or lower with infection in either the upper or lower urinary tract or with acute urinary tract or with acute

glomerulonephritisglomerulonephritis..

Epithelial CellsEpithelial Cells

Renal tubular epithelial cells, contain Renal tubular epithelial cells, contain a large round or oval nucleus and a large round or oval nucleus and normally slough into the urine in normally slough into the urine in small numbers. However, with small numbers. However, with nephrotic syndrome nephrotic syndrome and in and in conditions leading to conditions leading to tubular tubular degenerationdegeneration, the number sloughed , the number sloughed is increasedis increased

CastsCasts

Urinary casts are formed only in the distal Urinary casts are formed only in the distal convoluted tubule (DCT) or the collecting duct convoluted tubule (DCT) or the collecting duct (distal nephron)(distal nephron) . .

The proximal convoluted tubule (PCT) and loop The proximal convoluted tubule (PCT) and loop of Henle are not locations for cast formation. of Henle are not locations for cast formation. Hyaline casts are composed primarily of a Hyaline casts are composed primarily of a mucoprotein (mucoprotein (Tamm-Horsfall proteinTamm-Horsfall protein) ) secreted by tubule cells. The Tamm-Horsfall secreted by tubule cells. The Tamm-Horsfall protein secretion (green dots) is illustrated in protein secretion (green dots) is illustrated in the diagram below, forming a hyaline cast in the diagram below, forming a hyaline cast in the collecting the collecting ductduct::

The factors which favor protein cast formation are:

*low flow rate,*high salt concentration ,

*and low pH,all of which favor protein denaturation and precipitation, particularly that of the Tamm-Horsfall protein.

Protein casts with long, thin tails formed at the junction of Henle's loop and the distal convoluted tubule are called cylindroids. Hyaline casts can be seen even in healthy patients

Red blood cells may stick together and form red blood cell casts. Such casts are indicative of glomerulonephritis, with leakage of RBC's from glomeruli, or severe tubular damage

White blood cell casts are most typical for acute pyelonephritis, but they may also be present with glomerulonephritis. Their presence indicates inflammation of the kidney, because such casts will not form except in the kidney.

Bence Jones proteins are small proteins found in the urine. Testing for these proteins is done to diagnose and monitor multiple myeloma and other similar diseases.Bence Jones proteins are considered the first tumor marker.

A tumor marker is a substance, made by the body, that is linked to a certain cancer, or malignancy. Bence Jones proteins are made by plasma cells, a type of white blood cell. The presence of these proteins in a person's urine is associated with a malignancy of plasma cells.

Bence Jones proteins

Bence Jones protein cast (myeloma cast) from the urinary sediment of a patient with lambda-Bence Jones type multiple myeloma. Sternheimer stein, X200

  steroid, 17-ketosteroid, 17-keto- (17-KS)- (17-KS) , ,

nn steroidal compounds with a ketone (carbonyl) group steroidal compounds with a ketone (carbonyl) group at carbon 17. Derived from cortisol and adrenal and at carbon 17. Derived from cortisol and adrenal and

testicular androgentesticular androgen . .Urinary neutral 17-ketosteroids represent the catabolic Urinary neutral 17-ketosteroids represent the catabolic

end products of the endocrine glands. Produced by the end products of the endocrine glands. Produced by the adrenal cortex and testes. Increased values occur in adrenal cortex and testes. Increased values occur in

adrenogenital syndromesadrenogenital syndromes, , adrenocortical carcinomaadrenocortical carcinoma , , Normal adult values for a 24-hour urine sample are 10 Normal adult values for a 24-hour urine sample are 10

to 20 mg for men and 5 to 15 mg for womento 20 mg for men and 5 to 15 mg for women

  Pregnancy testsPregnancy tests

Home pregnancy tests consist of Home pregnancy tests consist of placing a drop of urine on a prepared placing a drop of urine on a prepared chemical strip or placing the strip in chemical strip or placing the strip in the urine stream. The strip is the urine stream. The strip is designed to detect a pregnancy designed to detect a pregnancy hormone called hormone called human chorionic human chorionic gonadotropingonadotropin (hCG) (hCG)..

hCG is released into the body by the hCG is released into the body by the placenta when a woman is pregnantplacenta when a woman is pregnant . .

This hormone is also responsible for This hormone is also responsible for causing some of the initial symptoms of causing some of the initial symptoms of pregnancy such as breast tenderness pregnancy such as breast tenderness and nauseaand nausea..

hCG levels usually become detectable in hCG levels usually become detectable in the urine about 10 days after the urine about 10 days after conceptionconception