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Kristine Joy D. GalvezDiagnostic Work-Ups

URINALYSIS Result Day 1 Result Day 2 Normal Values Possible Significance

Transparency Turbid Turbid Clear

ABNORMAL

urine commonly becomes turbid on s tanding because of precipitation of phosphates. hematuria makes urine slightly cloudy when RBCs not quite sufficient to produce

visible color change

in chyluria, urine milky and laden with fat and leukocytes; implies a fis tula betweenlymphatic system and the bladder (most common cause is filariasis)

Color Yellow Yellow Yellow NORMAL Nitrofurantoin can also cause yellow colored urineSpecific Gravity 1.025 1.030 1.002-1.030 NORMAL Increased markedly by proteinuria and glycosuria

value of >1.030 in the absence of proteinuria, glycosuria is usually due to radiocontrastagent

Volume depletion SG usually >1.020 Fixed SG 1.010 (isosthenuria) characteristic of chronic renal impairment. Fixed SG 1.000-1.005 in DI

pH 5.0 7.0 4.5-8 NORMAL may rise to 7 on vegetarian diet 5.0 in uric acid stones 7-8 in infection stones

Glucose Negative Negative Negative NORMAL Present in DMAlbumin +2 +4 Negative ABNORMAL Specific loss of proteins into the urine such as in nephrotic syndrome occurs on a

molecular weight basis, with smaller proteins being lost more rapidly than larger

ones.

RBC >50/hpf TNTC 0-2/hpf ABNORMAL The presence of increased numbers of erythrocytes in the urine may indicate a varietyof urinary tract and systemic conditions. These include:

(1) renal disease glomerulonephritis, lupus nephritis, interstitial nephritis associatedwith drug reactions, calculus, tumor, acute infection, tuberculosis, infarction, renal

vein thrombosis, trauma (including renal biopsy), hydronephrosis, polycystic kidney,

and occasionally acute tubular necrosis and malignant nephrosclerosis;

(2) lower urinary tract disease acute and chronic infection, calculus, tumor,stricture, and hemorrhagic cystitis following cyclophosphamide therapy;

(3) extrarenal disease acute appendicitis, salpingitis, diverticulitis, acute febrileepisodes, malaria, subacute bacterial endocarditis, polyarteritis nodosa, malignant

hypertension, blood dyscrasias, scurvy, and tumors of the colon, rectum, and pelvis;

(4) toxic reactions due to drugs, such as sulfonamides, salicylates, methenamine, andanticoagulant therapy; and

(5) physiologic causes, including exercise.WBC 1-3/hpf 10-15/hpf 0-2/hpf ABNORMAL Increased numbers of leukocytes (principally neutrophils) in the urine is termed

pyuria, and indicates the presence of infection or inflammation in the urinary tract.

When accompanied by leukocyte casts or mixed leukocyteepithelial cell casts,increased urinary leukocytes are considered to be renal in origin.

Infection, either bacterial or nonbacterial, may be centered in the renal parenchyma(pyelonephritis), or may be localized as cystitis, prostatitis, urethritis, or balanitis.

Epithelial cells occasional rare Occasional NORMAL a. Squamous Epithelial Cells.These cells are the most frequent epithelial cell seen in normal urine, and likewise the least

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Kristine Joy D. Galvezsignificant

b. Transitional (Urothelial) Epithelial CellsA few urothelial cells are present in normal urine, reflecting normal desquamation; like squamous

cells, they are rarely of pathologic significance

c. Renal Tubular Epithelial Cells.These are the most significant types of epithelial cells found in urine because the finding of an

increased number indicates tubular damage

Amorphic Urates occasional rare Occasional NORMAL Amorphous urates will precipitate upon standing in concentrated urine of a slightly acidpH.

Amorphous urates will convert to uric acid crystals with acidification with acetic acid,and dissolve with heat (60 C) and with dilute alkali.

Bacteria few - few NORMAL Finding bacteria in urine may or may not be significant, depending on the method ofurine collection and how soon after collection of the specimen the examination takes

place.

Most commonly, rod-shaped bacteria are seen, since the enteric organisms are thecausative agents in the majority of urinary tract infections

Leukocytes will usually be seen in the sediment as well.

Result Normal Values Possible Significance

BUN 7.27 1.8-6.4 mmol/L ABNORMAL There are two possible reasons for this. The f irst isprerenalwhere renalplasma flow is reduced, from such lesions as renal artery stenosis, renal

vein thrombosis and the like. This causes a reduction in the GFR.

The second cause of elevated BUN is true renaldisease.Creatinine 64.28 88-133 mmol/L NORMAL Low serum creatinine values are rare; they almost always reflect low

muscle mass.

Theoretically, low values may also reflect increased glomerular filtrationrates (GFRs).

Serum creatinine increases with decreases in GFR (acute kidney injury orchronic kidney disease)

ESR 42mm/hr M 0-20 mm/hr

F 0-30 mm/hrC 0-10 mm/hr

ABNORMAL Increased in acute bacterial infection, cancer, infectious disease,numerous inflammatory states

Decreased in polycythemia vera and sickle cell anemiaTotal Cholesterol 4.39 mmol/L Desirable

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Kristine Joy D. Galvez

McPherson & Pincus: Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed. Copyright 2006 W. B. Saunders Company

Twenty-First Edition

metabolic disorders related to endocrinopathies.

Increased triglycerides may also be medication-induced (eg, prednisone).Serum Na 143.3 138-146 mmol/L NORMAL Increased in increased intake, either orally or parentally

Decreased in Addisons, sodium-losing nephropathy, vomiting, diarrhea,fistulas, tube drainage burns, renal insufficiency with acidosis, starvation

with acidosis, paracentesis, ascites

Serum K 3.71 3.5-5.0 mmol/L NORMAL Increased in DKA, renal failure, Addisons

Decreased in Thiazide diuretics, Cushings syndrome, cirrhosis withascites, hyperaldosteronism, steroid therapy, malignan HPN, poor dietary

habits, chronic diarrhea, diaphoresis, renal tubular necrosis

malabsorption syndrome,vomiting

C3 Determination _ _ Increased complement activity may be seen in:

Cancer Ulcerative colitis

Decreased complement activity may be seen in:

Bacterial infections (especially Neisseria) Cirrhosis Glomerulonephritis Hepatitis Hereditary angioedema Kidney transplant rejection Lupus nephritis Malnutrition Systemic lupus erythematosus

Chest X-ray Pneumonia,

Bilateral

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