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URIN EXAMINATION
PURPOSE
-To find out metabolic / Endocrine disturbance
Eg: Metabolic disturbance-Bilirubin in urin
DM-Endocrine abnormality
-To detect intrinsic conditions –Urinary tract/ Kidney
Eg: Diseased kidney-Cannot function normally
- Volume -Composition of body fluids - Maintaining acid base balance
Structural elements:-
LeukocytesRBCEpithelial cells Cast cells in urin.
REGULATION
3 process1.Filtration of blood plasma –Glomeruli
2.Selective reabsorption – Threshold Substances- Fatty acids, Amino acids, Salt , Water
3.Secretion-Creatinin, Potassium, Uric acid, Organic ions of H+
VOLUME
GFR-120 ml/Minute
Normal urin excretion – 1200 ml-1500ml / Day
Poly urea - >2000ml / 24 hours
Oligo urea- <500ml / 24 hours
Anurea - <100ml / 24 hours
COMPOSITION OF NORMAL URIN
Volume – 600ml-2500ml/24 hours (1500ml)
Specific gravity – Random : 1.003-1.030 24 hrs specimen-1.015-1.030PH- 4.7-7.5 (6)
Total solids- 30-70 gram/litre
CONSTITUENTS
Na+ - 3-4 gram/24 hours
K+ - 1.5-2 gram / 24 hours
Cl- - 9 – 16 gram / 24 hours
Calcium – 0.1-0.3 gram / 24 hours
Inorganic phosphate - 1- 1.5 gram / 24 hours
Sulphur – 0.7 – 3.5 gram / 24 hours
Magnesium – 0.005-0.2gram / 24 hours
Ammonia – 0.3 - 1 gram / 24 hours
Iodine – 50 – 250 micro gram / 24 hours
Arsenic , Lead - < 50 micro gram / 24 hours
Urea – 25 – 30 gram / 24 hours
Creatinine - 60 – 150 mg/24 hours
Ketone bodies – 3 – 15 mg / 24 hours
Oxalic acid – 15 – 20 mg / 24 hours
Phenols – 0.2 – 0.5 gram / 24 hours
Vitamins, Hormones, Enzymes – detected in small quantity
LABOURATORY TESTS
1.Physical examination
2.Chemical examination
3.Microscopic examination
Collection of urin specimen
Type of specimen – 1.First voided mid stream morning urin More concentrated urin 2.For urgent urin examination Random urin specimen
Container used for urin collection :
Clean & Dry wide mouth glass / Plastic bottles with screw cap tops
( Capacity about – 250-300ml)
Instruction given to the patient:
Void directly in to the containerDuring the collection initial portion of urin stream is allows to escape while the mid stream portion is collected
Specimen from infants & young children can be collected in a disposable collection apparatus.
Qualitative test – First voided mid stream morning urine
Quantitative tese – 24 hours collection
PreservationRoutine urin analysis – should be examined while fresh (with in 1 hour of collection)When urin is kept for longer than 1 hour before analysis- Should be stored at 2-8 degree centigrade in refrigerater.To avoid deterioation of chemical & cellular material Prevent multiplication of bacteria.
Recommended preservatives1.Toluene-2ml/100ml of urin (Effective if bacteria are already)2.Formalin-3drops /100ml of urin (Good for sedimentation, may precipitate proteins)3.Thymol-1 small crystal / 100ml of urin (May interfere with the acid precipitation test for proteins)
4.Chloroform- 5ml/100ml of urin ( form upper layer)5.Commercial preservative tablets these release formaldehyde – 1 tab/30ml of urine (Concentration of formaldehyde is controlled)
PHYSICAL EXAMINATION1.Volume2.Colour3.Appearence4.Sediment formation5.Odour – Ketone bodies : Sweet/ fruity odour Bacterial contaminations-Pungent odour 6.Reaction of PH – Phenyl ketone urin – musty odour
CHEMICAL EXAMINATION1.Glucose – Benedict’s qualitative test2.Protein – Heat coagulation test3.Ketone bodies – Rothera’s test4.Bile pigments – Fouchet’s test5.Bile salt – Hay’s test6.Urobilinogen – Ehrlich’s test7.Occult blood – Benzididene test
MICROSCOPIC EXAMINATION
1.Leucocytes2.RBC3.Casts4.Mucus threats5.Yeast cells6.Bacteria7.Fat bodies and droplets9.Crystals
PHYSICAL EXAMINATION
Determination Normal finding
Abnormal finding
Pathologic condition
Non pathologic condition
VOLUME1.1st voided morning urin
2.24hrs collection
50-200ml >500ml
<20ml
>2000ml<500ml<100ml
Poly uria-DM,DI
Oliguria, Anuria, Renal conditions, Post renal conditions
Poly uriaOligo uriaAnuria
Increase water intakeClimate changes
Determination Normal finding Abnormal finding Pathologic condition
Non pathologic condition
Colour Pale yellow YellowDark yellowBrownish yellow to orange
White
Pink to red
Presence of water soluble bilirubin- Hepatic and Post hepatic conditions
Presence of chyle Pus –Many WBCs
Presence of Hb,MyoglobinAcute febrile diseaseRBC-Renal disease
Intake of following food yellow colour Vit-B complexSennaSerotoninNitrofurantoinConcentrated urinPhosphates
Excretion of red urine after eating beets – Inherited metabolic sensitivity
Very pale colouration
Brownish
Blue to Green
DMDI
Presence of Homogentissc acid –Alkaptonuria
Melanin-Malignant melanoma
Presence of biliverdinPseudomonas infection
High fluid consumptionDirutic drugsNatural dirutics
Intake of Choloroquine, Iron compounds, Quinine
Intake of Methyl blue
Determination Normal finding Abnormal finding
Pathologic condition
Non pathologic condition
Appearance Usually clearSometimes Cloudy
Turbid
Hazy
Smoky
Milky
Presence of abnormal number of leucocytes,Epithelial cells, Bacteria
Mucus
RBC
Chyle, Fat
Precipitation of amorphous phosphate,Amorphous urates in acid urine
Determination Normal finding Abnormal finding
Pathologic condition
Non pathologic condition
Reaction Litmous paper –PH paper
Usually acidic4.8-7.5
<4.8
>7.5
UTI- E.coli infectionAcidosisFeverKetosis, Severe diarrhea, Uraemia
Urine retention, Choronic cystitisUTI-Proteus pseudomonas
Protein rich diet
Urine collected after taking large quantities of citrus fruits,As a result of taking alkalies
Determination
Normal finding
Abnormal finding
Pathologic condition
Non pathologic condition
Odour Characteristic aromatic
FruityAmmonicalFoul smelling
AcidosisKetosisPresence of acetoneCystitis, Urin retentionUTI, Colliform bacteria
Decomposition of urea to ammonia by bacterial action
Determination Normal finding Abnormal finding
Pathologic condition
Non pathologic condition
Sediment formation at the bottom of the container after collection
Usually no formation of sediment / very little sediment
Sediment present – Moderate to high propotion
Leukocytes –Pus cellsRBC, Epithelial cells, Casts
Bacteria-uniform cloudiness- Does not settle outGonorrhoea
Pricipitate of amorphous phosphate-WhiteAmorphous urates-pinkish white Phosphate-
dissolve when acid is added.
Urate-Dessolve when the specimen is heated
Determination Normal finding
Abnormal finding
Pathologic condition
Non pathologic condition
Specific gravity – Urino meter
Random specimen:1.003-1.06024 hrs collection:1.015-1.030
Low specific gravity-Hyposthes uria
High specific gravity-Hypersthen uria
Choronic nephiritisPylo nephritisDIProtein malnutrition
DMFeverDehydrationEclampsia
PROTEIN UREA
Heat coagulation test-Place 2/3 of clear urin in a test tube-Boil the upper portion over a flame-Turbidity develops-Add 1/2 drops of acetic acid-Reboil the specimen.
Observation
Presence of turbidity- Protein present
Principle of test
Coagulation of protein by heat
GLYCOSUREA
Benedict’s qualitative test
Reagent- Benedict’s qualitative reagent-Blue colour
Procedure
-Transfer about 5ml of Benedict’s qualitative reagent in a test tube.-Add 8 drops of urine.-Heat carefully on the flame of a spirit lamp for 2-3 minute.-Cool under tape water / by placing in a beaker containing tap water.
COLOUR CONCLUSIONBlue NilGreen +Yellow ++Orange +++Brick red ++++
Observations
BILE SALTSHay’s test
Procedure
-Place about 10ml urine in a test tube-Add a little dry sulfur powder in to the surface of urine-Observe the sulfur particles
Observation
Sulfur particles sink to bottom-Bile salt present
Sulfur particles remain floating-Bile salt absent
Causes
1.Hepatic jaundice
2.Post hepatic jaundice
Bile pigments
-Take few ml of urine in a test tube-Add to drops of marshal iodine along the wall of the test tubeKeep it for 2 min.
Observation
Green layer formed between the urine and marshal iodine- Present
No colour change- Absent
Causes
1.Hepatic jaundice
2.Post hepatic jaundice
Urobilinogen
Ehrlich test.
MICROSCOPIC EXAMINATION