CLINICAL SIGNIFICANCE

OF URINALYSIS

A SEMINAR PRESENTATION BY IZUAKOR

CHIOMA BENITA (INTERN)
SUPERVISOR: MRS NDUBUISI
DECEMBER 2024
AIM
• To enhance awareness and understanding
of the clinical significance of urinalysis.
OBJECTIVES
• To understand the importance of urinalysis
in clinical practice.
• To recognize the role of urinalysis in
diagnosing and managing diseases.
OUTLINE
• INTRODUCTION
• TYPES OF URINE COLLECTION
• COMPONENTS OF URINALYSIS
• CLINICAL SIGNIFICANCE OF
URINALYSIS
• CASE PRESENTATION
• CONCLUSION
• REFERENCES
INTRODUCTION
• Urinalysis is a test that examines urine to
detect and measure various compounds
that pass through the body.
• Urine is a byproduct of your blood-filtering
system which your kidneys perform.
• Urinalysis is often used to check for
infections,kidney problems or diabetes,but
it can also be used to monitor other medical
conditions and treatments
(Chung et al 2022,US CDCP 2021).
TYPES OF URINE COLLECTION
FOR URINALYSIS
• Clean Catch (CC) is a non-invasive type of urine
collection where the patient cleans the area and
collects a midstream urine sample.
• Suprapubic aspiration (SPA) is an invasive type
of urine collection which involves inserting a
needle into the bladder and aspirating urine.
• Urethral catheterization is a less invasive type of
urine collection which involves inserting a Foley
catheter through the urethra into the bladder to
collect the urine.
• (NCBI 2023)
COMPONENTS OF URINALYSIS
• A full urinalysis test involves:
• Physical examination: This involves
checking the colour,clarity and other things
that can be seen with the naked eye.
• Chemical examination: This involves the
use of a chemical reagent test strip to
analyze the urine for parameters such as
specific gravity, pH, protein, glucose,
ketones, hemoglobin, leukocyte esterase,
nitrite,bilirubin, and urobilinogen.
COMPONENTS OF URINALYSIS
(CONTD)
• Microscopic examination: This involves
the examination of drops of concentrated
urine under a microscope for cells, cellular
debris, bacteria and crystals.
(A.D.A.M 2020)
Pictures of clear,cloudy and foamy urine.
Source:Artmed, Shutterstock
Picture of Urinalysis chemical test kit Source:68 NARHY Pathology Laboratory.
CLINICAL SIGNIFICANCE OF
URINALYSIS
• Clarity: This assesses whether the urine is
clear,turbid,cloudy or foamy. Cloudy or turbid urine
could indicate infection,foamy urine can be related
to its protein content.
• Colour: This assesses the colour of the urine,
including whether there are any signs of blood in
the urine.
• Odour: This involves checking for any unusual
odour from the urine. Unusual odour from the urine
could be indicative of infection or could be due to
some drugs or foodstuffs previously consumed.
CLINICAL SIGNIFICANCE OF
URINALYSIS CONTD
• Protein:Proteinuria can be a significant indicator
of various health issues.Normally, the kidneys
filter waste and excess fluid from the blood, but
they prevent large molecules like proteins from
passing through. however,when the kidneys are
damaged or diseased,proteins may leak into the
urine.Proteinuria can be signs of diseases such
as CKD, cardiovascular disease,preeclampsia in
pregnant women etc.
• Although protein in urine can also be due to
strenous exercise,dehydration,stress,diet etc
(NLM 2022)
CLINICAL SIGNIFICANCE OF
URINALYSIS CONTD
• Specific Gravity [SG]:SG in urinalysis is a
measure of the concentration of substances in
the urine.It helps to provide valuable information
about hydration status,kidney function and
various medical conditions.A normal SG range is
between 1.015 and 1.030.
• Abnormal values of <1.015 may indicate
overhydration,kidney disease or could be due to
some medications such as diuretics.
• Abnormal values of >1.030 may indicate
dehydration,concentrated urine due to
glomerulonephritis or diabetes insipidus
CLINICAL SIGNIFICANCE OF
URINALYSIS CONTD
• pH:pH in urine helps to provide important
information about some physiological and
pathological conditions.Urine pH helps to
evaluate kidney function particularly acid base
balance. A normal urine pH range is between
4.5 and 8.0 with an average of 5.0 to 6.0.
• Abnormal values of <4.5 may indicate diabetic
ketoacidosis,kidney damage or disease ,
sometimes could be due to some medications.
• Abnormal values of >8.0 may indicate
UTIs,kidney disease or due to medications like
antacid.
(Lewis,Baird 2018)
CLINICAL SIGNIFICANCE OF
URINALYSIS CONTD
• Leukocytes:The presence of leukocytes also
known as leukocyturia or pyuria can be a
significant indicator of various health issues.
• Leukocytes in urine can confirm the presence of
UTIs. They can also indicate kidney damage or
disease eg pyelonephritis and can also indicate
systemic infections such as sepsis.
(AJKD 2018)
CLINICAL SIGNIFICANCE OF
URINALYSIS CONTD
• Ketones:The presence of ketones in urine
(ketonuria) can be a significant indicator of
various metabolic states and health
conditions.Ketonuria can be caused by fasting or
starvation, low carbohydrate diets,prolonged
exercise, certain medications (eg
corticosteroids),metabolic disorder eg glycogen
storage diseases.
(Calimag et al 2023)
CLINICAL SIGNIFICANCE OF
URINALYSIS CONTD
• Nitrites:The presence of nitrites in urine is a
significant indicator of urinary tract infections
(UTIs), particularly those caused by gram
negative bacteria. Positive nitrite test indicates
the presence of ntrate reducing bacteria such E
coli, Klebsiella pneumonia, Pseudomonas
aeruginosa,Enterobacter cloacae.
• Gram positive bacteria do not reduce nitrates
and therefore may cause false negative results.
• Urine samples can also be contaminated with
bacteria from the genital area,leading to false
positive results.
(JCM 2018)
CLINICAL SIGNIFICANCE OF
URINALYSIS CONTD
• Urobilinogen: Urobilinogen is a colourless
compound produced during the breakdown of
bilirubin, a yellow pigment found in bile. A normal
urine sample typically contains small amounts of
urobilinogen.Increased levels may indicate
haemolytic anemia,liver disease,infections etc.
• Decreased urobilinogen may indicate complete
bile duct obstruction, severe liver dysfunction
could also be due to certain medication (eg
antibiotics).
(JCG 2019)
CLINICAL SIGNIFICANCE OF
URINALYSIS CONTD
• Glucose: The presence of glucose in urine,also
known as glycosuria can be a significant
indicator of various health conditions,particularly
those related to diabetes and kidney function.
• A normal urine sample should not contain
glucose.Presence of glucose can indicate
diabetes mellitus, gestational diabetes, kidney
damage or disease or could be due to certain
medications such as steriods.
(JCE 2018)
CLINICAL SIGNIFICANCE OF
URINALYSIS CONTD
• Bilirubin: The presence of bilirubin in urine
(bilirubinuria) can be an indication of liver
disease and bile duct obstruction. A normal urine
sample should not contain bilirubin. Bilirubinuria
may also indicate haemolytic anaemia (eg sickle
cell anaemia), liver disease and can also be due
to medications like rifampicin.
(NIH 2021)
CASE PRESENTATION
• A 30 year old male ,EMR no 6***7 presented to
the A & E department with complaints of
persistent fever,vomiting episodes, abdominal
pain, difficulty breathing,body weakness,loss of
appetite etc.Symptoms began about a week ago
and worsened as the days passed along with
increased frequency of urine and increased
thirst.
• A urinalysis test was performed along with
HBA1c and some other tests and the results of
the urinalysis were as follows:
CASE PRESENTATION
• App & colour:Clear amber
• pH:6.0,SG:1.025,Uro:Normal,Glu:+++,Ket:++
+,Others:Negative.
• Based on the results from the urinalysis,the
presence of ketones is indicative of diabetic
ketoacidosis and the presence of glucose
suggests hyperglycaemia which was later
confirmed by the HBA1c result of 10.4%. (ref
range is 4.0 to 6.4%) and the previously done
RBS of 206mg/dl.
• As at Dec 2024,he was diagnosed with type II
Diabetes.
CONCLUSION
• Urinalysis is a non-time consuming valuable
diagnostic tool that provides essential
information about various physiological and
pathological conditions.
• The clinical significance of urinalysis lies in its
ability to detect kidney damage or
disease,diagnose metabolic disorders,identify
infections, monitor liver function,assess
nutritional status and also detect other health
issues such as hemolytic anemia, preeclampsia
etc.
RECOMMENDATION
Periodic Assessment: Conducting regular
competency training and evaluation in
protocols,processes and procedures of urinalysis
test will go a long way to help healthcare
professionals to be able to better
diagnose,manage and prevent various diseases,
ultimately improving patient outcomes.
REFERENCES
• A.D.A.M. Medical Encyclopedia. Clean Catch Urine Sample. Updated
August 13, 2020. Accessed September 28, 2022.
https://medlineplus.gov/ency/article/007487.htm
• A.D.A.M. Medical Encyclopedia. Urinalysis. Updated January 16, 2021.
Accessed September 28, 2022.
https://medlineplus.gov/ency/article/003579.htm
• A.D.A.M. Medical Encyclopedia. Bilirubin Urine Test. Updated July 19, 2021.
Accessed September 28, 2022,
https://medlineplus.gov/ency/article/003595.htm
• American Journal of Kidney Diseases "Urinary Leukocytes and Kidney
Disease" 2018.
• Angela Pauline P. Calimag,Sylvia Chlebek DO ,Edgar V. Lerma MD(Clinical
Professor of Medicine) Joumana T. Chaiban MD, MBA Diabetic
Ketoacidosis Volume 69 Issue 3.
• Chung PH. Urinalysis and Urine Culture. Merck Manual Consumer Edition.
Updated May 2022. Accessed September 28, 2022.
https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/dia
gnosis-of-kidney-and-urinary-tract-disorders/urinalysis-and-urine-culture
REFERENCES CONTD
• Journal of Clinical Microbiology 2017 "Evaluation of the Nitrate Test for
Detection of Urinary tract Infections".
• Journal of Clinical Endocrinology and metabolism 2018 "Glycosuria in
diabetes,a review"
• Journal of Clinical Gastroenterology 2019 "Urobilinogen: A review of its
Clinical Significance.
• Lerma EV, Slivka K. Urinalysis. In: Devaraj S, ed. Medscape. Updated June
15, 2022. August 23, 2022.
https://emedicine.medscape.com/article/2074001-overview#showall
• National L of Medicine Medline Plus ,Protein in Urine 2022
• Pictures Sources:68 NARHY Pathology Lab,Artmed, Shutterstock.
• Urinalysis And Body Fluids by Susan A. Lewis and Lynne S. Baird 2018
THANK YOU