ABNORMAL CONSTITUENTS OF URINE - 1
• Many of the pathological constituents are present in trace amounts and
their concentration is increased markedly in different conditions.
• Usually the analysis of urine is carried out in properly preserved 24-hour
specimen or when not possible, an early morning specimen or a random
specimen can also be used.
• Urine samples are preserved by means of refrigeration, or by adding
chemicals like Hydrochloric acid, Toluene or Chloroform.
PHYSICAL EXAMINATION
Appearance:
Urine appears turbid when it contains proteins, pus cells,
bacteria, epithelial cells & lipids.
Colour:
• Urine appears smoky brown due to the presence of blood,
• Greenish-yellow due to the presence of bilirubin,
• Milky due to the presence of pus, proteins, epithelial cells & lipids
• Black due to the presence of melanin.
• Urine turns black on standing in case of phenylketonuria.
Odour:
• Urine has a fruity odour or smells like acetone in cases of starvation
& diabetic ketoacidosis.
• Urine has a smell of burnt sugar in cases of Maple syrup Urine
Disease
• Mousy odour in cases of Phenylketonuria.
Volume:
a. Increased urine output (>2000 ml) is called ‘polyuria’ and is seen in
i. Diabetes mellitus,
ii. Diabetes insipidus and
iii. after administration of drugs such as digitalis, salicylates &
diuretics.
b. Decreased urine output (<300 ml) is called ‘oliguria’ and is seen in
i. Fever,
ii. Diarrhea,
iii. Vomiting &
iv. Nephritis.
c. Total suspension of urine output (<50 ml) is called ‘anuria’ seen in
i. Shock,
ii. Renal failure,
iii. Incompatible blood transfusion &
iv. Mercury poisoning.
pH:
a. Decreased pH is seen in
i. Metabolic acidosis,
ii. Diabetic ketoacidosis
iii. Acute nephritis &
iv. Fever.
b. Increased pH is seen in Metabolic Alkalosis.
Specific Gravity:
a. Specific gravity is increased in
i. Diabetes mellitus,
ii. Acute nephritis &
iii. Fever.
b. Specific gravity is decreased in Diabetes Insipidus
c. A fixed specific gravity of 1.010 is seen in Chronic Renal Failure.
CHEMICAL EXAMINATION
Abnormal constituents that are routinely tested for include
• Glucose,
• Ketone bodies,
• Protein,
• Blood,
• Bile salts
• Bile pigments.
TEST FOR REDUCING SUGAR (Glucose) – BENEDICT’S TEST
Principle : A Reducing sugar has a free aldehyde or keto group, on boiling in
an alkaline medium it tautomerizes to form 1,2 enediol. Enediol has got strong
reducing property. It reduces cupric ions to cuprous ions which initially form
yellow cuprous hydroxide and then red coloured cuprous oxide
Reagents Required : Benedict’s reagent (Copper sulphate + Sodium citrate +
Sodium carbonate)
➢ Copper sulphate provides Cu 2+ ions in solution.
➢ Sodium citrate prevents precipitation of cupric ions as cuprous hydroxide
by forming a loose cupric-sodium citrate complex, which on dissociation
gives a continuous supply of cupric ions.
➢ Sodium carbonate provides the alkaline pH to the solution.
PROCEDURE OBSERVATION INFERENCE
To 5ml of Benedict’s Appearance of brick red Indicates the presence of
reagent taken in a test precipitate reducing sugar in the
tube, add 8 drops Urine
(.5ml) of test solution.
Mix well & boil for 2
minutes & cool.
CLINICAL APPLICATION:
• Benedict’s test is used to detect the presence of reducing substances in
urine.
• It can be used as a semi-quantitative test depending on the colour of the
precipitate as follows.
Blue colour - No Reducing Sugars
Green Colour + 0.5%
Green precipitate ++ 0.5 to 1%
Green to Yellow precipitate +++ 1 to 1.5%
Yellow to Orange precipitate ++++ 1.5 to 2%
Brick red precipitate +++++ > 2%
• The % indicates the amount of glucose excreted in urine.
• Positive Benedict’s test is usually taken for glucose.
• Excretion of glucose in urine is called ‘glycosuria’, which is seen in
Diabetes mellitus & Renal glycosuria.
• Lactose (Lactosuria) – in pregnancy & lactation
• Galactose (Galactosuria) – in Galactosemia
• Pentose (Pentosuria) – in Essential Pentosuria.
TEST FOR KETONE BODIES - ROTHERA’S TEST
This test is answered by acetone & acetoacetic acid.
Principle: Acetone liberated from acetoacetic acid reacts with sodium
nitroprusside at alkaline pH to give purple or permanganate coloured
ring.
Reagents Required : Ammonium sulphate crystals ,Sodium nitroprusside solution
(Freshly prepared), Liquor ammonia
PROCEDURE OBSERVATION INFERENCE
Take 3 ml of urine sample Formation of purple or Indicates the presence of
in a test tube and permanganate coloured acetone & acetoacetic
saturate with ring acid
ammonium sulphate
crystals. Add 2-3 drops of
freshly prepared
sodium nitroprusside
solution and mix well.
Add 1 ml of liquor
ammonia slowly along
the sides of the tube
CLINICAL SIGNIFICANCE:
1. Acetone, acetoacetic acid and β-hydroxybutyric acid are called
ketone bodies.
2. They are formed in the body and excreted in urine in excess during
diabetic ketoacidosis & starvation which involves excessive fat catabolism.
