Urine

PHYSICAL EXAMINATION OF URINE

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Examination of Urine is a very important subject in laboratory testing. Urine examination is very common and need details knowledge and through observation and examination. It gives an idea about urinary problems of the patient.

GROSS PHYSICAL EXAMINATION

physical examination of urine
physical examination of urine

It is a mirror of kidney disease. so, every doctor, lab technician should know the basics of urine examination in details. Here is first post- Physical examination of Urine.

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 3Oc increase , substract 0.001 for for 3Oc decrease .

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

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

Appearance

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

Turbid Urine
Cloudy Urine

Cloudy in

  • Bacterial urinary infection
  • Amorphous phosphate
  •  Amorphous urates
  • Pus cell
  • Presence of Fat/ chyle

Red and Cloudy

  • Urinary schistosomiasis
  • Bacterial infection

Brown and cloudy

Brown urine due to rhabdomyolysis
Brown urine due to rhabdomyolysis
  • 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 inj chemical examination of Urine.

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