PRACTICAL No.

URINE ANALYSIS
FUNCTIONS OF THE KIDNEY
1. Water balance of the body
2. Electrolyte balance & fluid pressure
3. Acid Base balance
4. Retention of substances useful to the body
5. Maintains noral B! " Renin#An$iotensin echanis
%. Erythropoitein secretion
FORMATION OF URINE
NEPHRON a) Renal corpuscle
# &loerular capillary tuft
# Bo'an(s capsule
) Renal !uular
# !)*
# +oop of ,enle
# -)*
"LOMERULAR FILTRATE
Water
.ubstances 'ith ol. Wt / 012111
)rystalloids
3rea
3ric acid
.u$ar
!roteins 'ith lo' ol. Wt. e.$. ,b2 yo,b2 B4 proteins
Albuin2 &lobulin2 fibrino$en cannot pass throu$h $loerular filtrate.
Renal !uules #o$%&' (lo#erular &%l!ra!e.
Reabsorption of hi$h threshold substances ,252 &lu2 AA2 6it)2 7a2 82
M$2 )l
-iffusion of lo' threshold substances 3rea2 uric acid2 creatinine2
sulphates2 !54
.ecretion 7,32 )reatinine
A$)an!a(es o& ur%ne e*a#%na!%on+
1. .iplicity in obtainin$ specien
2. 9ields $reat deal of inforation :uic;ly
3. Econoical
INDICATIONS OF URINE E,AMINATION+
1. Routine in<esti$ation
2. -ia$nosis & ana$eent of urinary tract disorders
3. -ia$nosis of endocrine & etabolic disorders " -M2 ainoaciduria2 horonal
probles
4. !re$nancy dia$nosis
5. 4aundice
%. !arasitic infections " .chistsoa heatobiu2 trichoonas <a$inalis
0. -ru$ o<er dose
=. -ia$nosis of enteric fe<er >culture e?aination@
A. !hysical fitness
11. -ia$nosis of $enetic disorders " )ystinuria2 Al;aptonuria2 !83
COLLECTION OF URINE SPECIMEN
*he saple should be fresh & e?ained iediately >'ithin 1 [email protected] urine is ;ept
for lon$er than one hour before analysis2 to a<oid deterioration of cheical and cellular
aterial and to pre<ent ultiplication of bacteria2 it should be stored at 2#=B) in a
refri$erator.
)han$es in coposition of urine stored at roo teperature areC
+ysis of red blood cells by hypotonic urine
-ecoposition of casts
Bacterial ultiplication
-ecrease in $lucose le<el2 due to bacterial $ro'th.
Doration of aonia fro urea by the action of bacteria >and the p, of urine
chan$es to al;aline@.
!recipitation of urates. !hosphates
Edeal ediu for $ro'th of bacteria
-.SIN"LE SPECIMEN C
6oided id strea clean catch
A<oid containation by <a$inal dischar$e
A<oid urine collection durin$ enstrual period2 if necessary should be so
labelled.
Random specimen # Routine analysis
# Fualitati<e cheical tests
First morning specimen # concentrated
+o' p, " preser<es fored eleents
MGE " pus2 cellular eleents
7itrites
!roteins
!re$nancy
Dastin$ $lucose le<els
3.4 hours after meals
# Metabolic disorders2 albuin2 $lucose
Post-prandial specimen
# &lucose2 3robilino$en2 creatinine
Con!a%ner C 'ide outh bottleGHar 'ith ti$ht lidG disposable 'a? lined plastic paper cups
'ith lids
.. ./ HOUR COLLECTION
A ./ 0ours collec!%on is essential for :uantitati<e studies.
E?cretion of horones2 proteins2 electrocytes is <ariable durin$ 24 hrs period.
24 hrs specien collected for estiation of C
o 3robilino$en
o 24 hrs protein
o Iylose e?cretion
o 24 hrs $lucose
o *b#!)R
o Enborn errors of etabolis
Con!a%ner: 1 $allonG5 lit 'ith appropriate recoended preser<ati<e.
Me!0o$+
=C11 a to =C11 a ne?t day
-iscard first early ornin$ saple
)ollect all urine passed durin$ ne?t 24 hrs period includin$ early ornin$ urine
ne?t day
Moderate restriction of fluids durin$ nest 24 hrs
Withhold alcohol2 certain foods & dru$s.
1. 2ACTERIOLO"ICAL E,AMINATION+
Con!a%ner+ .terile bottle
All containers should be first labeled 'ith peranent in; before urine is collected.
)opletely filled lab for should accopany urine saple. *ie of urine collection
should be 'ritten on the lab for.
In$%ca!%on+
3*E2 enteric fe<er
Me!0o$+
A Jid strea( clean catch saple is collected in a sterile test tube & subHected to cultural
studies iediately. -o not add preser<ati<es. Bacterial2 <iral2 fun$al culture.
24 hrs specien for ycobacterial cultures2 schistoa2 oncocerca2 catheteriKation
T0e reco##en$e$ preser)a!%)es are as &ollo3s+
!reser<ati<e )oncentration )oents
*oluene 2l G 111l urine Dors a thin layer on the surface of urine. Enterferes
'ith protein e?aination
Doraldehyde 1#2 dropGounce &ood for sedients. May precipitate proteins.
*hyol 1.1 $G111 l of
urine
!reser<es sedient 'ell. May interfere 'ith tests for
su$ar & acetone
.odiu flouride Dor blood su$ar estiation2 inhibits $lycolysis
O!0er preser)a!%)es+
Boric acid 1.5 $G%1 l
)onc ,)+ for estiation of )aLL2 7a
51M alcohol e:ual <olue " cytolo$ic e?aination for tuor cells
Refri$eration
7o preser<ati<es used for " detection of pre$nancy2 icrobiolo$y studies.
URINE E,AMINATION
I. PHYSICAL E,AMINATION
-. Appearance
)lear " 7oral
)loudy " ppt of aorphous phosphates >al;aline urine@2 urate ppts of coolin$
urine >acidic urine@
Decal containation " fistula
*urbid " pus cells2 RB)2 bacteria2 speratoKoa2 chyluria
.. Colour
7oral pale yello' colour of urine is due to urochroes.
)olour intensified in conc. urine e$. De<er
)olourless " <ery dilute >polyuria@ -E
9ello'G yello'ish $reenC bile pi$ents2 <it B cople?2 carotene
RedG bro'nC heo$lobin2 beet2 aniline dyes2 heaturia2 enstrual flo'
containation
.o;y redG bro'nC blood2 rubarb2 senna
Mil;yC lar$e aounts of pus2 bacteria2 fat or chyle
Blac;C elanin2 hoo$entesic acid
!ort 'ineC porphyria
WhiteC chyluria >il;y@2 pyuria2 phosphates2
5palescentC fat2 lipiduria# nephrosis2 crush inHury
BlueC *hyol2 ethylene blue
3. 4olu#e
Adult #7oral a<era$e 24 hrs <olue of urine is about 1511l.
7i$ht urine not ore than 411l.
9oun$ children e?crete 3#4 ties urineG;$
7 pre$nancy "7octuria2 e?cretion of dilute urine
Et <aries 'ith fluid inta;e2 diet2 en<ironental teperature & huidityN e?ercise2
a$e & e?cretion of fluid by s;in2 respiratory & intestinal tract.
5a) Pol'ur%a # abnoral increase in the e?cretion of urine >O 22511 lG24 hrs@.
Causes:
!olydypsia
Encreased salt & 'ater inta;e
,i$h protein diet
)affeine2 thiaKides2 diuretics
)old 'eather2 rainy season
E6 $lucose2 saline
-M2 -E
)hronic !yelonephritis2 renal failure
DIURESIS " transient increase in urine flo'
NOCTURIA " e?cretion of adult O511l urine of sp.$r. /111= at ni$ht
5) Ol%(ur%a # decrease in 24 hrs urinary e?cretion >/ 511 l@
Causes:
acute & chronic $loerulonephritis
con$esti<e cardiac failure
shoc;2
dehydration " 'ater depri<ation2 hot 'eather2 <oitin$2 diarrhea2 febrile
states
oedea
5c) Anur%a # coplete suppression of urine foration inspite of hi$h fluid inta;e.
Causes:
Renal ischeia >))D2 ,*7@
acute $loerulonephritis
crush inHuries2 sur$ical shoc;
ercurial poisonin$
isatched transfusion.
Measureent of <ol of urine is done only for 24 hr specien
5$) Res%$ual ur%ne 6 obtained by catheter iediately after bladder is eptied.
/. O$our
7oral odour # aroaticGuriniferous dGt <olatile aroatic acids
s'eet or fruity odour # ;etone bodies
aonical odour # decoposition fro stasis in the bladder >cystitis@.
usty odour # phenyl;etonuria
!utrid # infection
7. Reac!%on an$ pH
p, of urine is reflection of ability of ;idney to aintain noral hydro$en ion
conc in plasa2 E)*
Metabolic acti<ity of body produces non#<olatile acids 'hich cannot be e?creted
by lun$s.
*hese acids are e?creted by $loerulus 'ith cation 7aL
*he tubular cells e?chan$e ,L for 7aL2 urine becoes acidic.
Dreshly <oided noral urine is sli$htly acidic 'ith a p, of %.
5n standin$ p, becoes al;aline dGt release of aonia fro urea
Ac%$%c ur%ne C hi$h protein inta;e2 in$estion of acidic fruits2 respiratory & etabolic
acidosis2 hypo;aleia2 urinary tract infection caused by Escherichia )oli.
Al8al%ne ur%ne C al;aliniKation of urine2 hi$h <e$etables and citrus fruits inta;e2
respiratory & etabolic al;alosis2 treatent of 3*EG calculi2 urinary infection caused by
!roteus & pseudoonas2 renal tubular acidosis
Me!0o$6 *he reaction of urine is easured by litus paperGp, eter. En acidic urine2
blue litus turns red. En al;aline urine2 red litus turns blue.
7. Spec%&%c (ra)%!'
*he specific $ra<ity at a constant teperature is the ratio of the 'ei$ht of a
<olue of urine to the 'ei$ht of sae <olue of distilled 'ater.
.p.$r. of a solution depends on "
Aount of solute "directly proportional
*ep of solution " indirectly proportional
8idney aintains hoeostasis of body fluid & electrolytes by <aryin$
a@ <ol. of e?cretion
b@ conc. of solute in urine i.e. by concG dilutin$ urine
Measureent of sp.$r $i<es an idea about urinary tract solutes concentration
Nor#al ran(e &or a ./ 0r ur%ne spec%#en %s -.9-: !o -.9...
.p.$r / 1.11% " e?cess 'ater inta;e2 dilute urine
.p.$r O 1.125 " poor 'ater inta;e 'ith profuse perspiration 'ith noral urine
Anor#al sp.(r+
Encreased <ol 'ith decrease sp.$r > as lo' as 1.111@ " -E
Encrease <ol 'ith increase sp.$r. " -M >$lucosuria@2 proteinuria
Reduced <ol & reduced sp.$r " &72 !yelonephritis >failure of conc.
po'er@
Di?ed sp.$r # )RD
E?cretion of urine of unusually hi$h specific $ra<ity is called 0'pers!0enur%a & is seen
in dehydration2 eclapsia2 proteinuria etc.
E?cretion of urine of a fi?ed specific $ra<ity of 1.111 is called %sos!0enur%a & is seen in
the end sta$es of chronic $loerulonephritis.
H'pos!0enur%aC a urine 'ith a consistently lo' specific $ra<ity >/1.110@. Et is seen in
pyelonephritis2 hypertension2 diabetes insipidus2 protein alnutrition2 diuretic edicines
& natural diuretics such as alcohol &coffee.
Ur%no#e!er Me!0o$+
Pr%nc%ple6 based on principle of buoyancy. Encrease in solute conc. increases the
upthrust of soln 'hich is reflected by scale of urinoeter.
Sa#ple6 24 hrs urine saple
Proce$ure 6
Mi? urine at roo tep & pour it into container2 lea<e about 1P space at
top
)arefully float the urinoeter in urine by $raspin$ ste at top
.'irl the urinoeter sli$htly as it is inserted
Ma;e sure the instruent floats freely a'ay fro sides of container
Readin$ at eye le<el notin$ lo'est part of the eniscus2 the sp. &r as the
urinoeter coes to rest.
)orrection of urinoeter readin$ for roo tep.
3rinoeters are calibrated at 21 de$rees )
Add 1.111 for e<ery 3 de$rees rise in tep
II. CHEMICAL E,AMINATION
*he routine urinalysis includes cheical testin$ for
A@ !rotein
B@ &lucose
)@ 8etone bodies
-@ Blood
E@ Bile pi$ents
D@ Bile salts
&@ 3robilino$en
A. PROTEIN
7oral urine contains about 51$ protein >in a 24 hours saple@. !roteinuria iplies
an e?cretion of e?cess protein in urine.
Me!0o$s &or es!%#a!%on o& pro!e%nur%a are6
I. ;ual%!a!%)e a(en!s " ppt of proteins by heatGcheical a$ents
1. ,eat coa$ulation test
2. .ulfosalycilic acid test
3. ,eller(s nitric acid test
4. Rea$ent strips# detects only albuin
II. ;uan!%!a!%)e es!%#a!%on <
a@ 24 hr saple re:uired
b@ Esbach(s albuinoeter
III. Tes! &or 2ence =ones pro!e%ns
E. ;ual%!a!%)e a(en!s " ppt of proteins by heatGcheical a$ents
Pr%nc%ple6 proteins are pptd 'hen in acid solution. > 'hen urine not clear2 centrifu$e &
ta;e a clear supernatant@
-. Hea! coa(ula!%on !es!> Hea! ? ace!%c ac%$ !es!+
1. Dill a test tube Q full 'ith clear urine & $ently heat the upper portion & boil for 1#2
inutes. Ef turbidity appears2 it could be due to phosphates2 carbonates or proteins.
2. Add 1M acetic acid 1# 3 drops to the urine # cloudiness due to phosphates &
carbonates disappears. Et persists if proteins are present.
3. .i$nificance C cloudiness dGt phosphates disappears & that dGt proteins does not.
.. Sul&osal%c'l%c ac%$ !es!+
Mi? e:ual <olues of clear urine & 3#5M sulfosalicylic acid. )loudiness indicates
presence of proteins dGt hea<y precipitation.
1. Heller@s !es!C White rin$ at the point of contact of conc. nitric acid & urine indicates
presence of albuin.
Resul!s are repor!e$ as+
7e$ati<e " no cloudiness
*race " )loudiness Hust <isible a$ainst a dar; bac;$round
L -ense cloudiness
LL )loudiness 'ith $ranules & definite flocculation
LLL )loudiness 'ith hea<y flocculation
LLLL )loudiness 'ith flocculation & precipitation
II. ;uan!%!a!%)e es!%#a!%on of protein is done by Esbach(s ethod. 24 hours urine
saple is re:uired.
III. 2ence6Aones pro!e%ns+
*hey are icro$lobulins representin$ a li$ht chain of a hea<y olecular 'ei$ht
iuno$lobulin.
*he protein is secreted neoplatic plasa cells & is found in the urine of 35#%5M
cases of ultiple yeloa.
Also seen in Metastatic carcinoa of bone2 counited fractures & senile
osteoalacia2 leu;eia2 carcinoa of stoach & ;idney2 inacti<e pulonary
tuberculosis & priary ayloidosis.
B4 proteins are heat coa$ulable2 precipitate at teperatures bet'een 41#%1c &
redissol<e a$ain near 111c.
Dor the dia$nosis of ultiple yeloa a cobined seru & urine electrophoresis
for B#4 protein should be done.
Tes! &or 2A pro!e%ns+
*o 11 l clear urine add 2l saturated 7a)l
7o' add 3M acetic acid drop by drop to a;e p, 5
,eat urine in bea;er or 'aterbath at 41#51 de$rees ) & redissol<e a$ain
near 111 de$rees after ppt appears.
7oral protein e?cretion in urine is 35#51$G24 hrs 'hich is not
detectable by routine ethods.
!roteinuria " increased $loerular pereability
Abnoral proteins in urine# Albuin2 $lobulin >B4 proteins@2 ,b2 Myo,b2
ucin
Causes o& pro!e%nur%a6
1. Renal+ -ue to alterations in $loerular pereability . $loerulonephritis >7.@2
nephrosclerosis2 diabetic $loerulosclerosis2 nephritic syndroe & !yelonephritis
.. Prerenal+
>i@ Alientary tract due to e?cessi<e in$estion of proteins
>ii@ Dollo'in$ hea<y e?ercise >functional proteinuria@
>iii@ )on$esti<e cardiac failure
>i<@ 7eural albuinuria # epilepsy2 brain tuours & cortical inHuries
><@ *o?ic albuinuria# se<ere febrile states2 infections >typhoid@2 cheical
poisonin$ >ercury@
><i@ !osturalG orthostatic albuinuria# seen in youn$ healthy adults. Albuin
appears in urine in erect position & disappears 'hen the person is lyin$ do'n.
Et is due to e?cessi<e lubar lordosis resultin$ in renal <ascular con$estion &
is of no clinical si$nificance.
3. Pos!6renal+ -ue to infections or lesions in the renal pel<is & lo'er urinary tract2
# deri<ed fro leu;ocytic blood2 ucus2 <a$inal dischar$e.
Ur%nar' M%cropro!e%ns 6 M%croalu#%nur%a+
E?cretion of albuin in urine in inor :uantity2 noral <alue < 211
$G24 hours.
6alues >411 $G24 hours indicate irre<ersible daa$e.
Earliest indication of renal <ascular daa$e in E--M2 -iabetes
nephropathy2 beni$n hypertension.
2. SU"AR
A sall aount of $lucose >2#21 $Gdl@ ay be present in
fastin$ urine 'hich is not detectable by cheical ethods.
*he presence of cheically detectable aount of $lucose in
urine is called $lycosuria >or $lucosuria@.
Reducin$ substances in urine $i<e positi<e Benedict(s test.
Reducin$ su$ars " $lucose2 lactose2 fructose2 $alactose2 pentose
5ther substances that reduce Benedict(s rea$ent # uric
acid2salicylates2 foralin2 chlorofor2 hoo$entisic acid2
orphine2 turpentine2 penicilliu etc.
Tes!s $one !o con&%r# !0e na!ure o& re$uc%n( su(arC
5saKone test >positi<e for $lu2 pentose2 lactose@
Derentation test 'ith yeast >positi<e for $lucose2 fructose only@
)hroato$raphy
5?idase test " >positi<e for $lucose@
Me!0o$s +
-. O*%$ase #e!0o$> Rea(en! s!r%p #e!0o$+ )linistic2 -iastic2 Multistic
Pr%nc%ple C &lucose o?idase reacts 'ith $lucose in the urine to for laconic acid &
hydro$en pero?ide. *he hydro$en pero?ide2 in the presence of pero?idase o?idiKes to
for orthotoluidine >blue colour@.
A$)an!a(es+
>i@ *he test is positi<e only 'ith $lucose
>ii@ -etects as little as 1.11M $lucose in urine
>iii@ Fuic; 'ithin fe' seconds.
..2ene$%c!@s Bual%!a!%)e !es!
Pr%nc%ple6 &lucose & other reducin$ su$ars reduce cupric ions of copper sulphate to
cuprous for in an al;aline ediu.
Proce$ure+ *a;e 5cc of :ualitati<e Benedict(s rea$ent in a test tube to 'hich add = drops
of urine. Boil for 2 inutes & e?aine after coolin$ for 2 ins. 5bser<e colour of the
precipitate.
S%(n%&%cance# *est positi<e if ori$inally blue rea$ent is discoloured $reen 'ith foration
of yello' ppt. !resence of su$arGreducin$ a$ents.
In!erpre!a!%on+
Color Conclus%on "lucose (C
1@ Blue .u$arC Absent
###
2@ &reen colour
.u$arC !resent2 trace
1.25
3@ &reen precipitate .u$arC !resent2 L 1.51
4@ 9ello' precipitate
.u$ar C !resent2 LL
1.05
5@ 1ran$e ppt .u$arC !resent2 LLL 1.11
%@ Bric; red ppt .u$ar C !resent2 LLLL 2.11
!resence of $lucose in urine < "l'cosur%a
7orally 1.11#1.13 $M not detectable by routine ethods
Renal threshold is 151$M
"l'cosur%a can e class%&%e$ as+
E. D%ae!%c < %n DM
II. Non6$%ae!%c+
>i@ Alientary $lycosuria " partial $astrectoy2 e?cessi<e
su$ar in$estion
>ii@ Renal $lycosuria # lo' renal threshold2 noral &**2
pre$nancy2 after anaesthesia
>iii@ Endocrine# hyperthyroidis2 pancreatitis2 acroe$aly2
)ushin$ syndroe
>i<@ +i<er disease
><@ Entracranial inHury or tuor of +6
><i@ .*AR6A*E57
C. KETONE o$%es
8etone bodies are interediate products of fat etabolis.
*hese include acetone2 acetoacetic acid & hydro?yl butyric acid.
8etonuria is seen in # diabetic ;etoacidosis2 star<ation2 $lyco$en stora$e diseases2
eclapsia2 se<ere dehydration states2 febrile states & after $eneral anaesthesia.
Tes!s+ 1. Rothera(s# acetone2 acetoacetic acid
2. &erhardt(s " acetoacetic acid > ad<anced acidosis@
-. Ro!0era@s !es!C &or ace!one ? ace!oace!%c ac%$
!rincipleC .odiu nitroprusside is decoposed in an al;aline ediu into stron$
o?idiKin$ a$ents2 'hich in the presence of acetoneG acetoacetic acid yeald roseG purple
coloured cople?es.
Ma!er%al +
Aoniu sulphate
)onc. 7a 7itroprusside
.tron$ 7,45,
Me!0o$C
1. *a;e 3#5 l urine in t.t & saturate 'ith aoniu sulphate2
2. *hen add 1#2 crystals >1#2 drops@ of sodiu nitroprusside & i?
3. 7o' add aoniu hydro?ide alon$ the side of the test tube to for a layer.
4. ResultC
5. !urple rin$ at the Hunction of the t'o fluids indicates a positi<e test.
%. .i$nificanceC 8etone bodies present in star<ation2 diabetic ;etoacidosis2 e?cessi<e
<oitin$2 fe<er2 after &A
.. "er0ar$!@s !es!+ detects acetoacetic acid > indicates ad<anced acidosis@
Me!0o$+
1. *a;e 5#11 cc of urine
2. Add 11M ferric chloride solution drop by drop
3. A precipitate usually fors >of phosphates@ 'hich disappears on addin$ ore
ferric chloride.
4. Dilter & to the filtrate add an e?cess of ferric chloride.
Resul!C A clear red urine colour indicates positi<e test.
D. 2ILE SALTS
Ha'@s !es!+
Pr%nc%pleC Bile acids >in the conc. of 1.11M@ lo'er the surface tension of fluids in 'hich
they are contained.
Ma!er%alC sulfur protein
Proce$ure+ *a;e 5cc of urine in a test tube & $ently sprin;le sulphur po'der on the
surface.
Resul!C .in;in$ of sulphur $ranules indicates a positi<e test. Bile salts ha<e lo'ered the
surface tension . 3rine saple should be fresh2 control of noral urine should be done.
E. 2ILE PI"MENTS
Pr%nc%pleC Bile pi$ents are o?idiKed by acids forin$ a series of coloured deri<ati<es of
bilirubin. e$ bili<erdin >$reen@2 bilicyanin >blue@2 & choletelin >yello'@.
-. "#el%n@s n%!r%c ac%$ !es!C !lace a drop of urine on filter paper follo'ed by a drop of
conc. nitric acid. -e<elopent of colours ran$in$ fro $reen to yello' indicates a
positi<e test.
.. Fouc0e!@s !es! 5Harr%son@s !es!)+
MaterialC Ba)l2 >%1M@ a:ueous fouchet rea$ent. > *)A 25$ L distill ,25 111 l
L De)l3 11M a:. .oln 11 l@
Proce$ure+
1. *a;e 11l of urine in t.t
2. Add 5l of 11M bariu chloride solution to for bilirubin ppt.
3. Dilter throu$h filter paper.
4. *o the precipitate 1#2 drops of Douchet(s rea$ent are added >ferric chloride in
trichloroacetic acid@.
OR
)entrifu$e & discard supernatant. *o ppt add Douchet rea$ent & see colour chan$e.
Resul!+ Appearance of $reenG$reen blue colour indicates a positi<e test. !resence of
Bilirubin indicates hepatocellular & obstructi<e Haundice. *he pi$ent is absent in
heolytic Haundice.
S%(n%&%cance 2%le p%(#en! Uro%l%no(en
5bstructi<e 4. L R
,epatocellular 4. L L
,eolytic 4. R L
F. URO2ILINO"EN +
E0rl%c0 52enDal$e0'$e) Tes!+
Ehrlich Aldehyde rea$ent# )onc. ,)l >111l@ L distilled 'ater >111l@ L p# diethyl
ainobenKaldehyde >4$@.
Proce$ure+ *a;e 11l of undiluted fresh urine. Add 1l of Ehrlich aldehyde rea$ent.
Allo' to stand for 3 in.
Rea$%n(+ Entense cherry red color indicates increased aount of urobilino$en. +i$ht red
color indicates noral <alues.
Me!0o$C
!repare dilutions of urine & tap 'ater as " 1C112 1C212 1C512 1C1112 1C211. Add 1l of
rea$ent to 11l portion of each dilution. +et it stand for 3#5 in & ta;e the readin$.
E?press result in hi$hest dilution ters $i<in$ a faint but definite pin; color.
7orally >in health@ it is 1C21 dilution. Any $reater dilution indicates patholo$ical
aount of urobilino$en.
S%(n%&%cance+
3robilino$ens are absent totally in ne' born infants2 & coplete obstruction of
coon bile duct.
.tron$ly positi<e in ,eolytic aneia2 infarction & hepatic insufficiency.
Acetone2 bile pi$ent & porphobilino$en ay $i<e siilar color. *herefore2 do
the correspondin$ test.
". 2LOOD+
!resence of blood ay be in the for of intact RB)(s >heaturia@ or heo$lobin
>heo$lobinuria@.
BenKedine testC
1. 3rine is centrifu$ed
2. *he sedient is i?ed 'ith e:ual <olues of the rea$ent >saturated solution of
benKedine in $lacial acetic acid to 'hich e:ual :uantitiy of hydro$en pero?ide is
added@.
Resul!+ Appearance of blue colour indicates a positi<e test.
-. He#a!ur%aC >i@ acute nephritis >ii@ !yelonephritis >iii@ urinary calculi >i<@ renal
tuberculosis ><@ ebolic nephritis ><i@ leu;eias ><ii@ chronic passi<e con$estion of
;idney ><iii@ tuours of ;idney & urinary tract >i?@ sulfonaides & salicylates.
Bleedin$ can occur hi$h in the ;idney & renal pel<is > urine appears so;y bro'n due to
heatin@ or in lo'er urinary tract >bri$ht red urine@.
.. He#o(lo%nur%aC occurs 'hen there is disinte$ration of RB)(s 'ithin the
circulation 'ith e?cessi<e liberation of heo$lobin. When free heo$lobin dGt heolysis
is >151$M in plasa2 it is e?creted by the ;idneys. Et is seen in >i@ blac; 'ater fe<er
>ii@clostridial infection >iii@ se<ere burns >i<@ heolytic transfusion reaction ><@
autoiune heolytic aneia ><i@ !7, ><ii@ sulfonaide & phenacetin adinistration
><iii@ sna;e bite >i?@ &%!- deficiency.
III. MICROSCOPIC E,AMINATION
Dresh saple should be used. 15l of urine is centrifu$ed at 2111rp for 11 inutes.
.upernatant is separated lea<in$ a fe' drops to resuspend the sedient. A drop of this
sedient is put on a $lass slide & co<ered 'ith a co<erslip. *he preparation is e?ained
icroscopically 'iyh reduced illuination2 first under lo' po'er & then under hi$h
po'er. *he follo'in$ should be noted.
-. Cells
5a). Pus cellsC 7oral ran$e is 2#5G,!D. Round cells 'ith lobulated nuclei & $ranular
cytoplas2 the nuclei becoin$ proinent on addition of a drop of acetic acid. *hey are
seen in sall nubers in $loerulonephritis & renal infarction. +ar$e nubers >pyuria@
indicate pyo$enic infection of ;idney2 urinary or $enital tract.
5). Re$ cellsC appear as pale yello' refractile discs2 & disinte$rate on addition of 2M
acetic acid >yeast cells do not@. 7orally an occasional red cell ay be present.
.i$nificant nubers indicate heaturia. 5c). Ep%!0el%al cellsC *hese cells ay ori$inate
fro any site in the $enitourinary tract2 fro the pro?ial con<oluted tubule to the
urethra or fro <a$ina. 7orally fe' cells 3 # 5 per ,.!.D. *hree types ay be seenC
>a@tubular >b@transitional >c@ s:uaous cells.
.. CASTS
)asts are cylindrical structures 'ith parallel ed$es & are fored by precipitation of
proteins >*a ,onsefall protein@ 'ithin distal con<oluted & collectin$ tubules2 & are
associated 'ith patholo$ical chan$e in ;idney. -ifferent types are
>a@ ,yaline # fe<er2 anaesthesia2 &72 nephrosclerosis2 e?ercise
>b@ Epithelial " acute &72 ;idney infarct
>c@ &ranular " chronic &72 7.2 nephrosclerosis
>d@ Wa?y # chronic nephritis2 7.2 Anuria2 prolon$ed oli$uria
>e@ Broad " fored in ).*.2 seen in uraeia
>f@ RB) & WB) cast " pus cell cast
$@ !i$ent " blood2 heosiderin2 bile2 elanin
H'al%ne cas! Ep%!0el%al "ranular R2C
1. CRYSTALS+
Cl%n%call' %#p cr's!als < c's!e%neE !'ros%neE leus%neE sul&ona#%$e
-. Cr's!als o& ac%$%c ur%ne
>a@ uric acid
>b@ urates
>c@ calciu o?alate " en<elope shaped
.. Cr's!als o& al8al%ne ur%ne
>a@ triple phosphates " coffin lid shape
>b@ aorphous phosphates # po'dery
>c@ cysteine " he?a$onal
>d@ leucine " yello' oily spheres 'ith concentric radial striations
>e@ *yrosine " fine needles arran$ed in sheets 'ith constriction in iddle
>d@ aoniu biurate
/. PARASITES
*richoonas <a$inalis2 icrofilaria2 hoo;letsG scolices of Echinococcus $ranulosis2 o<a
of .chistosoa heatobiu
OTHER SPECIAL TESTS OF URINE+
MICRO2IOLO"ICAL E,AMINATION
!yo$enic or$anissC &ra(s stain MycobacteriaC S#7 stain
CYTOLO"ICAL E,AMINATION
.ears are ade fro fresh urine & fi?ed iediately2 & stained by !ap or ,&E.
,elpful in early dia$nosis of urinary tract ali$nancies
URINE REPORT
Na#e+ Mr. I9S Re( No.
A(eC 25 years Se*+ Male
C0%e& co#pla%ns+
P0's%cal e*a#%na!%onC Nor#al )alues
1.6olueC 051#1511 l
2.)olourC !ale yello'
[Link] )lear
4..pecific $ra<ity C 1.111 #1.124
[Link] 6ariable
%.5dourC 3riniferous
C0e#%cal e*a#%na!%onC
1.!roteins Absent
2..u$ars Absent
3.8etone bodies Absent
[Link] salts & bile pi$ents Absent
[Link] Absent
M%croscop%c e*a#%na!%on+
[Link]) Absent
2.!us cells 1#2Ghpf
[Link] cells 5ccasionalGhpf
4.)rystals
5. )asts
IMPRESSION+
URINARY FINDIN"S
ACUTE PYELONEPHRITIS
!hysical appearance# turbid
6olue# <ariable
)heical e?aination# !rotein >albuin@ present
Microscopy# !us cells2 pus cell casts2 $ranular casts
CHRONIC PYELONEPHRITIS
!hysical appearance# turbid
6olue# <ariable
)heical e?aination# !rotein >albuin@ present
Microscopy# !us cells2 pus cell casts2 $ranular casts2 hyaline casts
CHRONIC "LOMERULONEPHRITIS
!hysical appearance# turbid
6olue# <ariable2 decreased in later sta$es
.pecific $ra<ity# <ariable2 ay be fi?ed at 1.111 >isosthenuria@
)heical e?aination# !rotein >albuin@ present
Microscopy# RB)(s2 $ranular GhyalineG'a?yGRB) casts