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.

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- 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

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 cylinderà urinometer lower gently àtake time to settleà take reading

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

Osmolality

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.