URINALYSIS
Pr. Innocent Twebaze, DMLT, BMLS,
MBA, MPH Fellow (MakSPH)
Department of Internal Medicine
Overview
• Urinalysis simply means analysis of urine.
• Is a simple test which can provide
important clinical information
• Has a quick turn-around time, and is also
cost effective.
Importance of Urinalysis
• Diagnosing urinary tract infections (UTIs),
kidney stones,
• Screening for and evaluating many types of kidney
diseases, and
• Monitoring the progression of diseases such as
diabetes mellitus and high blood pressure
• Pregnancy testing
• TB antigen (LAM) testing
Procedure
6. Urobilinogen
1. Collection
7. Bilirubin
2. Appearance
8. Specific Gravity
3. Protein
9. Wet preparation
4. Glucose
10. Deposit
5. Ketone bodies
11. Gram stain
Collection (Mid-Stream)
• Men - the opening of the urethra should be wiped clean
with a cleansing wipe
• Women - the area around the urethra wiped with a
cleansing wipe. The labia and the external genitalia are
spread and wiped from front to back
• Collection begins by discarding the initial stream of urine
to flush off any hanging organisms
• Collect 10-15 ml of urine in a sterile specimen cup by
directly urinating into the cup
• Remaining urine may be voided in the toilet
Appearance
Normal – Straw and clear
Abnormal:
• Cloudy: bacterial infection
• Red cloudy: bacterial infection, urinary schistosomiasis
• Brown and cloudy: blackwater fever, other conditions that cause
intravascular hemolysis.
• Yellow-brown or green-brown: acute viral hepatitis, obstructive
jauandice
• Yellow-orange: hemolysis, hepatocellular jaundice
• Milk white: bancronftian filariasis
Obvious colors
• Dehydration
• Infection
• Liver disease
• Muscle breakdown (rhabdomyolysis)
• Certain medications/sweets
Protein
• Uristix – dip in clear urine and read within 60
seconds
• Normal: less than 30 mg/dl
• Increased value: urinary infection, nephritic
syndrome, glomerulonephritis, urinary
schistosomiasis, congestive heart failure, severe
febrile illnesses.
Glucose
• Use uristix according to instructions on
package
• Works well when urine is freshly collected
• Detectable urine glucose indicates blood
glucose values in excess of 210 mg/dL
(renal glucose threshold ranges from 160
to 180 mg/dL).
Ketone Bodies
Use uristix in fresh urine
Band for ketones will show purple color if
positive
• Normal value: Negative
• Positive: In untreated diabetes mellitus,
starvation, vomiting
Urobilinogen
• Use uristix in fresh urine
• Compare color change in urobilinogen band with color codes
on the chart
• Normal values: Less than 1 mg/dl
• Increased: Hemolytic anemia, paralytic ileus, viral hepatitis
(in early and recovery stages).
• Absent: Obstructive jaundice, disability of liver cells to
conjugate and excrete bilirubin, reduction of bacterial flora in
the intestine due to intensive antibiotic treatment.
Bilirubin
• Use uristix on a fresh sample
• Normal value: Negative
• Increase: conjugated bilirubin in the
blood (cholestatic jaundice, hepatocellular
jaundice, early stage of viral hepatitis,
NOT in hemolytic jaundice (What
happens?).
Specific Gravity
• Use uristix
• Compare value on the band with standard
values on the chart
• Normal values: 1.010-1.025
• Decreased: kidney or endocrine disorders
• Increased: glycosuria, proteinuria
Wet preparation
Add 1 drop of un-crentrifuged urine on a slide
Observe with x10 objective and x40 objective for
the presence of:
- WBCs and RBCs,
- Bacteria.
• If present in the un-centrifuged urine highly
significant for UTI, etc
• Proceed to Gram stain if bacteria are present
Deposit
Centrifuge urine 5 minutes at 2500 RPM
Discard supernatant and re-suspend the deposit
Place 1 drop of deposit on a clean slide, cover with a
coverslip and observe with x10 and x40 objective.
Report average of 10 high power fields (using x40
objectives) e.g. 6-8 WBCs per HPF
Look for: WBCs, RBCs, yeast cells, epithelial cells, cast,
crystals and parasites
Do a Gram stain if bacteria are present
Normal WBCs: less than 5/HPF
Other Abnormal Findings
• RBCs: Possibly urinary schistosomiasis,
bacterial infection, sickle cell disease,
acute glomerulonephritis, infective
endocarditis
• Yeast cells: Vaginal candidiasis, diabetes
Candida species
Casts
• Formed in the distal convoluted tubule and
collecting ducts
• Precipitation of Tamm-Horsfall
mucoprotein secreted by renal tubule
cells, and sometimes by albumin in
conditions of proteinuria
Casts
Hyaline Granular
Waxy Cast
WBC casts
RBC casts
Importance
• Hyaline casts: Mucoprotein matrix secreted by tubule,
non-specific, but increased in damage of glomerular filter
membrane
• Granular casts: Tubular protein droplets in hyaline casts,
present with any form of nephritis but most abundant
with nephritic syndrome
• RBC casts: Protein matrix variably filled with red cells,
often have orange-red appearance, present in proliferative
glomerulonephritis
Urine Crystals
Formed due to:
- insufficient water intake,
- urinary tract infection, or
- change in pH values of urine
- urolithiasis
- diet
Main types:
- Calcium oxalate
- Uric acids
Calcium oxalate Uric acid
Parasites
• Trichomonas Vaginalis,
• Schistosoma haematobium,
• Enterobius vermicularis,
• Wuchereiria bancrofti
• Dictophyma renale
Trichom onas vaginalis
Wet Preparation Stained Smear
Dictophym a renale
Adult Egg
Schistosom a haem atobium
Adult Egg
Enterobius verm icularis
Adults Eggs
W uchereiria bancrofti
Staining Procedures
Can do:
• Gram
• Ziehl Neelsen
• Giemsa for parasites
Cultures: Microbiology
• Ordinary solid media
• Antibacterial activity
• Isolation of organisms
• Biochemicals
SUMMARY OF THE MICROSCOPICAL FEATURES OF COMMON UTI
Organism Wet prep. Gramsmear
E.coli Motile rods gram neg. rods
Ps. Areruginosa Motile rods gram neg. rods
Proteus Motile rods gram neg. rods
Klebsierlla Non motile rods gram neg. caps.rods
Enteroccoci cocci in short chains gram pos. cocci
Staph. saprophyte coca, attached to cells gram pos. cocci
Other tests
• Pregnancy test
• Bence Jones Proteins – Multiple myeloma
• Vinyl Mandelic Acid – Neuroblastoma and
other tumors of neural crest
• 24 hour urinary protein
Advances in Urine Examination
• Automated Urine strip readers with
integration of dilution parameters e.g for Crea
• Urinary flow cytometer
• Complementary metal oxide semiconductor
(CMOS) technology for microalbuminuria
testing
References
Oyaert, M., & Delanghe, J. (2018). Progress in
Automated Urinalysis. Annals of Laboratory Medicine,
39(1), 15-22. https://doi.org/10.3343/alm.2019.39.1.15
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