Urine Examination by Uristix MethodRoutine urine examination is detailed analysis of urine. It helps detect alterations in the composition of the urine which help in the diagnosis of many disorders.
When a sample of urine is submitted to a pathological laboratory, the following examinations are done:
Physical Examination
Volume
- Normal volume of an early morning mid–stream sample is 50 – 300ml.
- If it is more than 500ml, it indicates diabetes or polyuria (frequent passing of urine).
- If it is less than 20ml, it indicates some kidney disorder.
- The normal color of urine is pale yellow.
- If it is dark yellow to orange, it indicates some liver disorder.
- If it is white, it shows the presence of pus.
- If it is pink to red, it indicates the presence of red blood cells.
- If it is brownish black, it indicates the presence of melanin or homogenistic acid (a rare disorder).
- If it is blue to green, it is a liver disorder.
Appearance
- Usually, it is clear, sometimes, it is cloudy.
- Sometimes, it is turbid due to the presence of WBCs (White Blood Cells), epithelial cells.
- Sometimes, it is hazy due to mucus.
- Smoky, due to red blood cells.
- Milky due to chyle (lymph).
- Usually acidic pH range 4.5 – 7.5.
- If pH less than 4.7 it is more acidic.
- If pH more than 7.5 it is more alkaline.
- Usually, it is aromatic in normal conditions.
- It has a fruity odor in diabetes.
- Ammoniacal odor in cases of urine retention.
- Foul smelling due to urinary tract infection.
- Usually, there is no or very little formation of sediment in normal conditions.
- If pus cells, red blood cells, cysts or epithelial cells are present, the sedimentation rate ranges from moderate to high.
- Usually varies from 1.003 to 1.060.
- A low special gravity indicates diabetes insipidus or kidney infection (chronic).
- High specific gravity indicates diabetes mellitus or acute kidney infection.
Chemical Examination of Urine
Examination
Protein
- Normally absent.
- Present in kidney disorders, dehydration, heart disease, and severe diarrhea.
Glucose
- Normally absent.
- If present, it indicates diabetes mellitus or hyperactivity of the endocrine glands.
- It can be present after brain injury or coronary thrombosis.
Urine Chemical Analyser- Normally absent.
- If test shows ketones, it is due to severe diabetes mellitus, fevers, certain nervous disorders or prolonged diarrhea and vomiting.
- Even when a person starves, the urine shows a presence of ketone bodies.
- Normally absent.
- Present in liver disorders.
- Normally absent.
- Present in liver disorders.
- Normally present in very low concentrations.
- Increased in liver disorders.
- Normally absent.
- Present in acute kidney infections, kidney cancer, tuberculosis of the kidneys, chronic infections, stone formation in the kidneys, severe burns or a reaction to blood transfusion.
Non–glucose Sugars
- Lactose: May be present normally. It is present in lactating women.
- Fructose: Present in liver disorders.
- Pentoses: Are present due to drug therapy or hereditary conditions.
- Ascorbic acid: Present in Vitamin C therapy.
- Salicylic acid: Due to drugs having salicilates.
- Menthol: Due to the intake of food containing menthol.
Present due to bacterial infection
Indican
- It is present in very low concentrations.
- It is increased due to intestinal obstruction, cholera, typhoid fever or peritonitis.
- Sometimes, it is due to the intake of diets rich in proteins.
Microscopic Examination of Urine
Examinations
Pus Cells
- Normally 2 to 3 pus cells are present in HPF (high power field of microscope).
- If more than 5 it indicates urinary tract infection or non infectious condition such as fever, stress, dehydration irritation to urethra, bladder or urethra.
- Normally two to three present in males.
- Normally two to five present in females.
- More than five epithelial cells per HPF indicates tubular damage, pyelonephritis or kidney transplant rejection.
Granular cast in urine- Normally absent.
- There are hyaline cysts, red cell cysts, white cell cysts, granular cysts, waxy cysts, and fatty cysts. They are present due to kidney disorders.
- Occasional Hyaline cysts may be present due to physical exercise and physiological dehydration.
- Granular cysts may be present after strenuous exercise for a short duration.
- Amorphous urates of sodium, potassium or calcium are present normally.
- Amorphous phosphates of calcium and magnesium are present normally.
Unusual fine sheaves of Calcium Phosphate- Uric acid, calcium sulphate, calcium oxalate and ammonium magnesium phosphate (triple phosphate) crystals are indicative of the presence of kidney stones.
- Hippuric acid, calcium carbonate, ammonium biurate and calcium phosphate crystals are non–significant.
- Following crystals, found in acidic urine indicate abnormal metabolism – cystine, cholesterol, leucine, tyrosine, bilirubin, hematoidin and sulphonamides.
Ammonium Biurate- Normally absent.
- If present indicates infection.
- Normally absent.
- May be present in acidic urine containing sugar.
- Normally absent.
- If present, they are Trichomonas Vaginalis (from vagina) or Trichononas Hominis (from rectum).
It is disorder due to hormonal imbalance. Kidneys become overactive and a person urinates excessively. A person has a raging thirst and an increased appetite.
Diabetes mellitus
It is a disorder in which the body cannot make use of sugars and starches in a normal way.
Peritonitis
It is inflammation of the peritoneum – the membrane that lines the abdominal cavity and covers the abdominal organs.
Pyelonephritis
It is an inflammation of the kidney and the renal pelvis (the hollow cone into which urine flows from the kidney).
Endocrine glands
It is a ductless body organ which produces hormones. These hormones affect and help control various other organs.
Occult blood
“Occult” means hidden. Here blood is present in very minute traces. It is not visible to the naked eyes.