URINE
URINALYSIS – The testing of urine with procedures
commonly performed in an expeditious, reliable,
REQUISITIONS- A requisition form (manual or
accurate, safe and cost-effective manner. (Clinical
computerized) must accompany specimens
and Laboratory Standards Institute definition)
delivered to the laboratory. The information on
URINE FORMATION
the form must match the information on the
Ultrafiltrate of plasma
specimen label.
Kidneys convert approximately 170,000 mL of filtered
o Additional information:
plasma
a)method of collection or type of specimen
Average daily urine output of 1200 ml
b)possible interfering medications
URINE COMPOSITION
c)patient’s clinical information
95% water, 5% solutes
o Note: The time the specimen is received in
SOLUTE/S
the laboratory should be recorded on the
ORGANIC INORGANIC form
UREA CHLORIDE
PHYSICAL EXAMINATION OF URINE
CREATININE SODIUM
URIC ACID POTASSIUM URINE COLOR- A noticeable change in urine color is
URINE VOLUME often the reason that a patient seeks medical
Depends on the amount of water that the advice. It becomes the responsibility of the
kidneys excrete= usually determined by the laboratory to determine whether the color change
body’s state of hydration. is normal or pathologic
Factors that influence urine volume NORMAL URINE COLOR- The characteristic yellow
• fluid intake color of urine is caused by the presence of a
• fluid loss from nonrenal sources pigment called urochrome. Because urochrome
• variations in the secretion of antidiuretic production and excretion are constant, the intensity
hormone need to excrete increased amounts of of the color of urine provides a crude indicator of
dissolved solids (glucose or salts) urine concentration and body hydration.
Normal daily urine output: usually 1200 to 1500 URINE CLARITY- Refers to the transparency or
mL turbidity of a urine specimen. Common terminology
A range of 600-2000 mL is considered normal used to report clarity includes clear, hazy, cloudy,
SPECIMEN COLLECTION turbid, and milky
CONTAINER NORMAL URINE CLARITY- Freshly voided normal
o Clean, dry, leak-proof containers, Properly urine is usually clear, particularly if it is a midstream
applied screw-top lids, Wide mouth, Clear clean-catch specimen. Precipitation of amorphous
material for observation of color and clarity phosphates and carbonates may cause a white
o Recommended capacity: 50 mL cloudiness.
LABEL
CLARITY TERM
o All specimens must be labeled properly
Clear No visible particles, transparent
with:
Hazy Few particles, print easily seen
a)Patient’s name through urine
b)Identification number Cloudy Many particles, print blurred through
c)Date and time of collection urine
d)Additional information (e.g. patient’s age and Tubid Print cannot be seen through urine
location; healthcare provider’s name, as Milky May precipitate or be clotted
required by institutional protocol) URINE SPECIFIC GRAVITY- Evaluation of the kidney’s
o Note: Labels must be attached to the reabsorption ability can be performed by measuring
container, not to the lid. the specific gravity of a specimen. The specific
gravity of urine is a measure of the density of the TEST FOR CHLORIDES
dissolved chemicals in the specimen Reaction: Urine → NaCl crystals + HNO3 + AgNO3 →
URINE ODOR- Normal urine has a characteristic white precipitate
aromatic odor. A long standing urine specimen is
Amount of Cl varies with intake and excreted NaCl
ammoniacal due to the conversion of urea to
ammonia TEST FOR CARBONATES
Reaction: Urine + HCI→ slight effervescence
ODOR CAUSE
Aromatic, faintly Normal urine Carbonates are present in the urine in the form of
Ammoniacal Old urine- improperly bicarbonates
stored
Pungent, fetid Urinary tract infection TEST FOR SULFONATES
Sweet, fruity Ketone production due to: Reaction: Urine + HCI + BaCl2 → white precipitate
a. Diabetes mellitus
Sulfates are derived from sulfur containing proteins
b. Starvation, dieting,
malnutrition TEST FOR PATHOLOGIC CONSTITUENTS
c. Strenuous exercise
d. Vomiting, diarrhea TEST FOR GLUCOSE
REACTION: URINE + BENEDICT’S REAGENT
Normal urine + Benedict's reagent → Blue solution
UNUSUAL ODOR ASSOCIATED WITH AMINO
Pathological urine + Benedict's reagent → Green
ACID DISORDER
solution
Mousy Phenylketonuria
Maple syrup Maple syrup urine disease
Rancid Tyrosinemia
Rotting/ old fish Trimethylaminuria
Cabbage, hops Methionine malabsorption
Sweaty feet Isovaleric acidemia
Distinctive Ingested substances;
asparagus, garlic, onions
Menthol-like Phenol containing
medications
Bleach Adulteration of the
specimen or container TEST FOR PATHOLOGIC CONSTITUENTS
contamination
TEST FOR GLUCOSE
TEST FOR ORGANIC CONSTITUENTS GRADE TURBIDITY
(-) Negative No change in color
TEST FOR CREATININE (+/-) Trace Green opacity, no precipitate
Reaction: Urine + picric acid + NaOH → reddish- (+) Positive Green solution with yellow
orange complex precipitate
(++) Positive Green to yellow solution with
Creatinine – produced from arginine, methionine and yellow precipitate
glycine (+++) Positive Muddy orange solution with
yellow precipitate
TEST FOR UREA
(++++) Positive Orange to brick red precipitate
Reaction: Urea + NaOH + Nessler's solution →
TEST FOR KETONES
reddish orange
REACTION: URINE + ROTHERA’S REAGENT +
Urea – principal end product of protein metabolism
AMMONIUM HYDROXIDE
TEST FOR INORGANIC CONSTITUENTS
GRADE RING FORMATION
Negative No ring or a brown ring
Trace Faint pinkish purple ring
1+ Narrow lavender-purple ring
2+ Narrow dark purple ring
3+ Wide dark purple ring
TEST FOR KETONES BLOOD
Normal urine + (NH4)2SO4 + Na nitroprusside → 3 major cell types
Yellow solution
Pathological urine + (NH4)2SO4 + Na nitroprusside 1. Erythrocytes
→ Red to purple ring
2. Leukocytes
TEST FOR PROTEINS
Normal urine + acetic acid + NaCl → with bubbles 3. Thrombocytes
Pathological urine + acetic acid + NaCl → white
Plasma- Liquid medium/matrix
gelatinous precipitate
Due to the presence of albumin -Makes up approximately 55% of the blood
TEST FOR BILE ACIDS volume and is composed of greater than 90% water
Urine → urine + sulfur powder
FLOAT- No bile acid present
SINK- Bile acid is present PLASMA PROTEINS
Prealbumin
Albumin
Globulins
Fibrinogen
NORMAL ORGANIC CONSTITUENTS
Constituents Normal Constituents Normal
value value
(mg/l00 (mg/100)
mL)
Nonprotein 25-35
Creatinine 1-2
Nitrogen
Urea 10-15 Glucose 70-120
Uric acid 2-3.5 Cholesterol 150-190
NORMAL INORGANIC CONSTITUENTS
CONSTITUENTS NORMAL VALUES
Chlorides as NaCl 450 - 500 mg/100 mL
Inorganic Phosphorus 3-4 mg./100 mL (higher
(serum) in children)
Calcium (serum) 9-11 mg/100 mL
Plasma Sodium 325-350 mg/100 mL
Plasma CO2 55-80 mg/100 mL
SEPARATION OF SERUM FROM WHOLE BLOOD
Whole blood + distilled water + Stoker's solution→
Dark red solution with precipitate and bubbles
• Reduced hemoglobin
TEST FOR CARBOHYDRATES
BENEDICT’S TEST
• Serum + Benedict’s Reagent
• Positive Result
o Brick red precipitate
o Indicates the presence of sugar
TEST FOR PROTEINS
TEST FOR SERUM ALBUMIN AND GLOBULIN
Serum + Saturated (NH4)2SO4 → Red orange
solution with precipitate
(NH4)2SO4 – precipitating agent
NaCl– dissolving agent
CHLORIDE DETERMINATION
Serum + AgNO3→white precipitate
Chemical equation involved in the reaction: Cl-+
AgNO3 →AgCl + NO3
PHOSPHATE DETERMINATION
Serum + (NH4)2MoO4→yellow precipitate
Chemical reaction involved: PO4-3 + NH4
MoO4→(NH4)3PO4
TEST FOR FIBRIN IN THE CLOTTED BLOOD
FIBRIN: pink cream color and thread like structure
Fibrin + Millon's reagent→ Brick red precipitate
• Brick red precipitate indicates the presence of
Tyrosine
Fibrin + Hopkin's→ Cole Violet ring at the junction
• Violet ring formation indicates the presence of
Tryptophan
TEST FOR THE PRESENCE OF CHOLESTEROL
LIEBERMANN BURCHARD TEST
Alcohol-ether mixture + whole blood evaporate→
residue +chloroform→ clear light green solution
Standard cholesterol→ dark green solution
IRON DETERMINATION
Whole blood→ ash + HCl→ filtrate +
NH4SCN→Salmon pink solution
• The purpose of adding NH4SCN is to detect the
presence of iron in the blood
BLOOD GASES
Whole blood + distilled water→ Brick red solution
• Due to the presence of oxyhemoglobin
