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
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.
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
- Excessive intake
- Drugs [ caffine, alcohol],
- Diabetes insipidus
- Diabetes mellitus
- 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
- Excessive sweating
Dcreased : dilute urine
- Water intake
- Benign nephrosclerosis
- Diabetis insipidus
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.
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
- Amorphous phosphate
- Amorphous urates
- Pus cell
- Presence of Fat/ 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 inj chemical examination of Urine.