Physical Examination of Urine

GROSS PHYSICAL EXAMINATION of URINE

Physical Examination of Urine is a very important subject in laboratory testing of urine. Urine examination is a very common procedure of and need details knowledge about examination and through observation and examination. As because it gives an idea about urinary problems of the patient. It is a mirror of kidney disease. so, every doctor, lab technician shoud know the basics of urine examination in details.

here is first post- Physical examination of Urine. next post will discuss other parameter. so follow and subscribe: https://swapanlifeline.blogspot.com

Volume:

Normal volume in adult :  600-2000ml.  night urine <400 ml

Normal volume in different age group

Newborn: 30-60ml

10-60days old: 250-450ml

60days-ti 1 year: 400-500ml

1-5 years: 500-700ml

5-8 years: 650-1000ml

8-12years: 800-1200ml

Oliguria= <500 ml/24 hrs

Polyurea – > 2000 ml/24 hrs

Nocturia – >500 ml at night

Anuria <100ml/24 hrs

Increased vol-

  • Excessive intake
  • Drugs [ caffine, alcohol],
  • Diuretics
  • Diabetes insipidus
  • Diabetes mellitus
  • Progressive chronic renal failure
  • hyperparathyroidism

Decreased volume

  • Prerenal- hgg/ dehydration /CCF/ sepsis/ anaphylaxis
  •  Post renal- AGN/ ATN / nephrotoxic agent/ CRF /

Colour

Normal is clear /pale yellow/ straw

Normal colour is due toUrochrome, Urobilin, Uroerythryn

Abnormal colour

Red –hematuria/ hemoglobinuria/ porphyrin/ myoglobin/ beets/ mens

Cloudy- phos[hate/ urate/ bacteria/ pus/ contamination

Deep yellow in case of bile pigment in obsstructive Jaundice or vitamin B complex intake

Yellow- acreflavin dye

Yellow-green : bilirubin-biliverdin

Yellow-brow : bilirubin-biliverdin (beer brown)

Yellow-orange: haemolysis, Hepatocellular jaundice

Milky/milky whitew: Chyle/ lipid, Bancroftian filariasis

Brown : hgg/ porphyria

Black : alcaptonuria

Blue green : indicans dye/ pseudomonas infection

Blue : indigo caramine dye

Odour

Slightly sweetish, mild ammonical on standing

Fruty : ketoacidosis

Fishy : proteus infection

Ammonical : E. Coli infection

Rancid : tyrosinemia

Mousy : PKU

Rotting fish : trimethyl aminuria

Specific gravity

Normal 1.016-1022 due to mainly Urea, NaCl, Sulphate, Phosphate

Increased

Glycosuria

Albuminuria

Oliguria

Hematuria

Excessive sweating

Dcreased : dilute urine

Water intake

CGN

Benign nephrosclerosis

Diabetis insipidus

Polyurea

Fixed (isosthenuria) : 1.010

Severe renal damage

ADH deficiency

Polycystic kidney malignant HTN

Method of examination :

Urinometer :  at least 40ml urine required.

Pour 40ml urine in cylinder of urinometer lower gently take time to settle take reading

Correction : urinometer calibrated at 200C.  Add 0.001 for each 3Oc increase , substract 0.001 for for 3Oc decrease .

If urine quqntity in less, dilute with equal vol of water & multiply readingx2.

ii.      Reagent strip : Multistrix- colour change due to Na/K ion (> in conc. Urine) than H ion.

iii.      Refractometer : a few drops of urine is placed on glass surface and the look through refractometer light source.

Osmolality

Normal adult with a normal fluid intake the is 500-850mOsm/kg. the normal kidney is able to produce a urine osmolality  in the range of 800-1400 mOsm in dehydration, and 40-80mOsm during dieresis.

After a period of dehydration urinary osmolality shoud be 3 to 4 times that of plasma.

Appearance

Report about the colour of urine and appearance. Normally appearance is clear, but may be of other colour in appearance.

Cloudy in

Bacterial urinary infection

Amorphous phosphate

 Amorphous urates

Pus cell

Presence of Fat or chyle

Red and Cloudy

Urinary schistosomiasis

Bacterial infection

Brown and cloudy

Blackwater fever

Other condition cause intravascular hemolysis.

Some books discussed about Ph in physical examination, but that is a chemical reaction and will be discussed in chemical examination of Urine.

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