Analysis Of Urine and other Body Fluids

Week 3 / Strasinger’s Urinalysis and Body Fluids 6th Edition

 Increased amounts produced in thyroid

conditions and fasting states.
PHYSICAL EXAMINATION OF URINE
 Increases in urine that stands at room
TOPIC OUTLINE temperature.
1 Urine color Uroerythrin
2 Urine foam
3 Urine clarity  A pink pigment
4 Specific gravity  Most evident in specimens that have
5 Urine odor been refrigerated
 Attaches to the urates, producing a pink
color to the sediment.
Physical Examination Urobilin
 Color
 Clarity  An oxidation product of the normal
 Specific Gravity urinary constituent urobilinogen
 Imparts an orange-brown color to urine
Provides Preliminary Information: that is not fresh
 Glomerular bleeding, liver disease, inborn errors
of metabolism, and urinary tract infection
Laboratory Correlation of Urine Color
 Used to confirm or to explain findings in the
chemical and microscopic areas of urinalysis Colorless
• Recent fluid consumption - Commonly
observed with random specimens
Pale Yellow
URINE COLOR  Polyuria or Diabetes Insipidus - Increased
24-hour volume
 Colorless to Black  Diabetes Mellitus - Elevated specific
 Normal metabolic functions gravity and positive glucose test result
 Physical Activity  Dilute random specimen - Recent fluid
 Ingested materials consumption
 Pathologic conditions
 Responsibility of the laboratory to determine Dark yellow
whether this color change is normal or  Concentrated specimen
pathologic
Amber
 Dehydration from fever or burns
Normal Urine Color Yellow-Green to Yellow-brown
 Differ slightly among laboratories  Bilirubin oxidized to biliverdin - Colored
 But should be consistent within each foam in acidic urine and false-negative
laboratory. chemical test results for bilirubin.
 Pale Yellow, Yellow, Dark Yellow and
Amber.
Urochrome Orange
 Bilirubin →Yellow foam when shaken and
 Yellow color positive chemical test results for bilirubin.
 Product of endogenous metabolism, and  Acriflavine →Negative bile test results and
under normal conditions the body possible green fluorescence .
produces it at a constant rate  Phenazopyridine (Pyridium) →Drug
commonly administered for urinary tract
 infections. →May have orange foam and Green / Blue
thick orange pigment that can obscure or  Pseudomonas infection→ Positive urine
interfere with reagent strip readings culture
 Nitrofurantoin →Antibiotic administered  Phenol → When oxidized
for urinary tract infections.  Methocarbamol (Robaxin)→ Muscle
 Phenindione →Anticoagulant, orange in relaxant, may be green-brown
alkaline urine, colorless in acid urine.  Amitriptyline→ Antidepressant
 Clorets
Pink to Red  Indican→ Bacterial infection (Klebsiella,
 RBCs - Cloudy urine with positive Providencia)
chemical test results for blood and RBCs  Methylene Blue→ Fistulas
visible microscopically
 Hemoglobin - Clear urine with positive
chemical test results for blood;
intravascular hemolysis
 Myoglobin - Clear urine with positive
chemical test results for blood; muscle
damage
 Porphyrins - “Port wine colored urine” -
Negative chemical test results for blood
- Detected with Watson-Schwartz
screening test or fluorescence under
ultraviolet light
 Beets
 Rifampin
 Menstrual Contamination - Cloudy
specimen with RBCs, mucus, and clots
NOTE
Brown to Black  Pale yellow “straw”
 RBC’s oxidized to Methemoglobin -  If urobilin or not fresh, ask for another specimen
Seen in acidic urine after standing;  Hematuria – smokey red
positive chemical test result for blood.  In hemoglobin and myoglobin – use plasma to
 Homogentisic acid (Alkaptonuria) -Seen differentiate
in alkaline urine after standing; specific  Hemoglobin – remain red after centrifugation
tests are available.  Myoglobin – remain clear
 Melanin - Urine darkens on standing  Alkaptonuria – deficient homogentisic scid
and reacts with nitroprusside and ferric oxidase
chloride  Melanuria – infect individual who have malignat
melanoma
Phenol Derivatives - Interfere with copper  Cola- colored urine : rhabdomyolysis
reduction tests  Green blue- obstructive jaundice
 Argyrol (Antiseptic) - Color disappears  Indicanuria- metabolic disorder “ heart knobs
with ferric chloride syndrome “ or “blue diaper syndrome”
 Methyldopa or Levodopa –
 Antihypertensive Metronidazole
(Flagyl) - Darkens on standing

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 URINE FOAM
 URINE WITH LARGE AMOUNT OF PROTEIN
(ALBUMIN) cause a stable white foam to be
produced when urine is poured or agitated.
 URINE WITH BILIRUBIN FOAM IF PRESENT WILL
BE CHARACTERISTICALLY YELLOW

NOTE
 Albumin – stable white foam
 Bilirubin – yellow foam
 Liver disease

URINE CLARITY
Transparency/Turbidity of a urine specimen
 Clear container
 Visually examine → WELL LIGHTED AREA
 Mix-well
 View in clear container & against white
background
 Maintain adequate light
 Evaluate volume consistency
Laboratory Correlations in Urine Turbidity
NORMAL CLARITY Acidic Urine Amorphous urates, Radiographic
 Clear contrast media
- midstream clean-catch Alkaline Amorphous phosphates, carbonates
Urine
 PRESENCE OF TURBIDITY Soluble Amorphous urates, uric acid crystals
- provides a key to the microscopic With Heat
examination results the amount of turbidity Soluble in RBCs, Amorphous phosphates,
should correspond with the amount of Dilute carbonates
material observed under the microscope. Acetic Acid
Insoluble in WBCs Bacteria, yeast Spermatozoa
Dilute
Acetic Acid
Soluble in Lipids, Lymphatic fluid, chyle
Ether

SPECIFIC GRAVITY
 Density of a solution compared with the density
of a similar volume of distilled water at a similar
temperature.
 assessment of the kidney’s ability to reabsorb

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Direct method: Advantage:
 Urinometer  Small volume (1 or 2 drops)
 Harmonic oscillation densitometry  Temperature compensated bet. 15-38°C
Indirect method:
 Refractometer COMMON CAUSE OF ERROR:
 Reagent Strip 1. Glucose and CHON must be corrected
 although readings are less affected by
particle density than urinometer readings.
Urinometer (Hydrometer)
Principle : Density 2. Glucose & Protein Sensitive:
 weighted float attached to a scale  1 g/dl protein subtract 0.003
 sink to a level of 1.000 in distilled water  1g/dl glucose subtract 0.004
 less accurate than the other methods
 Major disadvantage → Calibration:
 Requires large volume (10-15ml)  (Distilled H2O)
 Spinning motion  1.022 ± 0.001 (5% NaCl)
 Read at lower meniscus  1.034 ± 0.001 (9% sucrose)

Temperature Sensitive (20°C):

 Subtract 0.001 in every 3°C decrease
below calibration temperature
 Add 0.001 in every 3°C increase above
calibration temperature

Always change temperature to centigrade:

C=F-32 X 5/9 or .555

Harmonic Oscillation Densitometry

 Principle → Density
- The frequency of a sound wave entering a
solution changes in proportion to the
density of the solution
 Uses mass gravity meter
Refractometer  All dissolved solutes are measured
 Results are linear up to a specific gravity of
Principle: Refractive Index 1.080
 The concentration of dissolved particles
present in the solution determines the
velocity and angle at which light passes
through a solution.
 concentration of the specimen
determines the angle at which the light
beam enters the prism

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 Reagent Strip Method

Principle: pKa changes of a polyelectrolyte

SPECIFIC GRAVITY CLINICAL CORRELATIONS

The sg of the plasma filtrate entering glomerulus

:
 Isosthenuric – 1.010 SG OF URINE
 Hyposthenuric – < 1.010 SG OF URINE
 Hypersthenuric – > 1.010 SG OF URINE
 SPECIMEN WITH S.G OF 1.002 PROBABLY ARE
NOT URINE.
 S.G OF RANDOM SPECIMEN FALLS BETWEEN
1.015 AND 1.030
 ABNORMALLY HIGH S.G RESULTS ARE SEEN: >
1.035

 IV Pyelogram
 Radiographic Contrast Media
 Dextran (Plasma Expanders)

NOTE
 Bromothymol blue and polymethyl vinyl
ether are reagents in line with the
chemical pad

Urine Odor

 Not part of routine urinalysis

Aromatic Odor
 Freshly voided urine
Ammoniacal
 Prolonged standing of specimen
 Breakdown of urea