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11
MUHAMMAD ABDULLAH KHOSAMUHAMMAD ABDULLAH KHOSA
MSc MLTMSc MLT
TRAINEE TECHNOLOGIST TRAINEE TECHNOLOGIST STAT LAB LAHORE
UrinalysisUrinalysis
22
CONTENTSCONTENTS
IntroductionIntroduction
Types of SpecimenTypes of Specimen
Sources of errorsSources of errors
Types of AnalysisTypes of Analysis
Microscopic ImagesMicroscopic Images
33
INTRODUCTIONINTRODUCTION
First laboratory test performed First laboratory test performed
Used for more than 6000 yearsUsed for more than 6000 years
Powerful diagnostic toolPowerful diagnostic tool
An index to many normal and pathological mechanisms.An index to many normal and pathological mechanisms.
By composition:By composition:
95% water
Remaining 5% is composed of mainly urea
Trace amounts of vitamins, minerals,
enzymes, hormones, proteins and antibodies 44
Types of Types of Specimen Specimen
First morning First morning ((most concentratedmost concentrated) )
Second voidedSecond voided
Random specimen Random specimen ( ( most convenientmost convenient) )
Post-prandial specimen Post-prandial specimen ( usually after 2 hour)( usually after 2 hour)
24 hour urine24 hour urine
55
SOURCES OF ERRORSOURCES OF ERROR
Contamination with:Contamination with: Bacteria or chemicalsBacteria or chemicals
menstrual bloodmenstrual blood
vaginal or urethral dischargevaginal or urethral discharge
Inadequate mixing before examinationInadequate mixing before examination
Wrong/inadequate preservativeWrong/inadequate preservative
66
− MacroscopicMacroscopic
− Chemical Chemical
− Microscopic Microscopic
Types of AnalysisTypes of Analysis
77
Macroscopic Macroscopic ExaminationExaminationOdor:Odor:− Ammonia-like:Ammonia-like: (Urea-splitting bacteria)(Urea-splitting bacteria)− Offensive:Offensive: Old specimen, pus or Old specimen, pus or
inflammationinflammation− Sweet: Sweet: GlucoseGlucose− Fruity: Fruity: KetonesKetonesColor:Color:− Colorless Colorless Diluted urineDiluted urine− Deep YellowDeep Yellow Concentrated UrineConcentrated Urine− Turbid cells or crystals Turbid cells or crystals − Yellow-GreenYellow-Green Bilirubin / BiliverdinBilirubin / Biliverdin− RedRed Blood / HemoglobinBlood / Hemoglobin
88
Chemical AnalysisChemical Analysis Urine Urine DipstickDipstick
GlucoseGlucose
BilirubinBilirubin
KetonesKetones
Specific GravitySpecific Gravity
BloodBlood
pHpH
ProteinProtein
UrobilinogenUrobilinogen
NitriteNitrite
Leukocyte Leukocyte
30 sec RR: Negative30 sec RR: Negative D. mellitus. Renal glycosuria.
30 sec RR: Negative30 sec RR: Negative -increased bilirubin (correlate urobilinogen, S.bilirubin)
40 sec RR: Negative40 sec RR: Negative Diabetic ketoacidosis Prolonged fasting
2 min RR: 1.003-1.0352 min RR: 1.003-1.035 - Diabetes insipidus
60 sec RR: Negative60 sec RR: Negative Hematuria - Hemoglobinuria
2 min R.R.: 4.5-8.02 min R.R.: 4.5-8.0 <4.5): high-protein diet, >8.0): renal tubular acidosis
60 sec RR: Negative60 sec RR: Negative - Proteinuria and the nephrotic syndrome.
60 sec RR: 0.02-1.0 mg/dL60 sec RR: 0.02-1.0 mg/dL High: increased hepatic processing of bilirubin- Low: bile obstruction
60 sec RR: Negative60 sec RR: Negative Gram negative bacteriuria
2 min RR: Negative - Pyuria - Acute inflammation Renal calculus99
SIGNIFICANCEPARAMETERS
TIME OF READING
Microscopic Microscopic ExaminationExamination
Per High Power Field (HPF) (400x)Per High Power Field (HPF) (400x)– > 3 erythrocytes> 3 erythrocytes
– > 5 leukocytes> 5 leukocytes
– > 2 renal tubular cells> 2 renal tubular cells
– > 10 bacteria> 10 bacteria
Per Low Power Field (LPF) (200x)Per Low Power Field (LPF) (200x)– > 3 hyaline casts or > 1 granular cast> 3 hyaline casts or > 1 granular cast
– > 10 squamous cells > 10 squamous cells
– Any other cast (RBCs, WBCs)Any other cast (RBCs, WBCs)
Presence of:Presence of:– Fungal hyphae or yeast, parasite, Fungal hyphae or yeast, parasite,
– Pathological crystals (cystine, leucine, tyrosine)Pathological crystals (cystine, leucine, tyrosine)
– Large number of uric acid or calcium oxalate crystalsLarge number of uric acid or calcium oxalate crystals
Abnormal Abnormal FindingsFindings
1010
Microscopic Microscopic ExaminationExamination RBCsRBCs
1111
Microscopic Microscopic ExaminationExamination WBCsWBCs
1212
Microscopic Microscopic ExaminationExamination Tubular Epithelial Tubular Epithelial
CellsCells
1313
Microscopic Microscopic ExaminationExamination YeastsYeasts
1414
Microscopic Microscopic ExaminationExamination RBCs CastRBCs Cast
1515
Microscopic Microscopic ExaminationExamination WBCs CastWBCs Cast
1616
Microscopic Microscopic ExaminationExamination Tubular Epith. CastTubular Epith. Cast
1717
Microscopic Microscopic ExaminationExamination Granular CastGranular Cast
1818
Microscopic Microscopic ExaminationExamination Hyaline CastHyaline Cast
1919
Microscopic Microscopic ExaminationExamination Waxy CastWaxy Cast
2020
Microscopic Microscopic ExaminationExaminationCalcium Oxalate CrystalsCalcium Oxalate Crystals
2121
Microscopic Microscopic ExaminationExaminationCalcium Oxalate CrystalsCalcium Oxalate Crystals
Dumbbell Dumbbell Shape Shape
2222
Microscopic Microscopic ExaminationExaminationTriple Phosphate CrystalsTriple Phosphate Crystals
2323
Microscopic Microscopic ExaminationExamination Urate CrystalsUrate Crystals
2424
Microscopic Microscopic ExaminationExamination Cholesterol CrystalsCholesterol Crystals
2525
Microscopic Microscopic ExaminationExamination Leucine CrystalsLeucine Crystals
2626
Microscopic Microscopic ExaminationExamination Cystine CrystalsCystine Crystals
2727
Thank youThank you
2828