GROSS PHYSICAL EXAMINATION of URINE
Ecxamination of Urine is a very important subject in laboratory testing. Urine examination is very common and need details knowledge and throu observation and examination. 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.
Normal volume in adult : 600-2000ml. night urine <400 ml
Normal volume in different age group
10-60days old: 250-450ml
60days-ti 1 year: 400-500ml
1-5 years: 500-700ml
5-8 years: 650-1000ml
Oliguria= <500 ml/24 hrs
Polyurea – > 2000 ml/24 hrs
Nocturia – >500 ml at night
Anuria <100ml/24 hrs
Drugs [ caffine, alcohol],
Progressive chronic renal failure
Prerenal- hgg/ dehydration /CCF/ sepsis/ anaphylaxis
Post renal- AGN/ ATN / nephrotoxic agent/ CRF /
Normal is clear /pale yellow/ straw
Normal colour is due toUrochrome, Urobilin, Uroerythryn
Red –hematuria/ hemoglobinuria/ porphyrin/ myoglobin/ beets/ mens
Cloudy- phos[hate/ urate/ bacteria/ pus/ contamination
Deep yellow- bile pigment in obs. Jaundice/ vit. B complex
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
Slightly sweetish, mild ammonical on standing
Fruty : ketoacidosis
Fishy : proteus infection
Ammonical : E. Coli infection
Rancid : tyrosinemia
Mousy : PKU
Rotting fish : trimethyl aminuria
Normal 1.016-1022 due to mainly Urea, NaCl, Sulphate, Phosphate
Dcreased : dilute urine
Fixed (isosthenuria) : 1.010
Severe renal damage
Polycystic kidney malignant HTN
Method of examination :
Urinometer : at least 40ml urine required.
Pour 40ml urine in cylinderà urinometer lower gently àtake time to settleà 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, look through refractometer light source.
Normal adult with a normal fluid intake 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.
Report about the colour of urine and appearance. Normally appearance is clear, but may be
Bacterial urinary infection
Presence of Fat/ chyle
Red and Cloudy
Brown and cloudy
Other condition cause intravascular hemolysis.
Some books discussed about Ph in physical examination, but that is a chemical reaction and will be discussed inj chemical examination of Urine.