This document provides an overview of urine analysis including physical, chemical, and microscopic examination. Physical examination assesses volume, color, odor, pH, and specific gravity. Chemical examination tests for proteins, sugars, ketone bodies, bilirubin, and blood. Microscopic examination identifies epithelial cells, red blood cells, crystals, and casts which can indicate various conditions. Urine dipsticks provide a convenient qualitative analysis of various urine components. A comprehensive urine analysis evaluates kidney and bladder function and detects underlying diseases.

1. Urine analysis
Dr. Janani Mathialagan

2. OVERVIEW
• Physical examination
• Chemical examination
• Microscopic examination

3. Types of collection of urine:
• 24hrs sample – Glycosuria,
microalbuminuria
• Random sample - glucose, protein
• Midstream sample - UTI

4. PHYSICAL
EXAMINATION

5. Urine examination
• Physical examination
• Chemical examination
• Microscopic examination

6. Physical examination
• Volume
• Color
• Odour
• Reaction/pH
• Specific gravity

7. Urinary volume
• Normal = 700-2500ml passed in 24 hrs
• Polyuria >2500ml passed in 24 hrs
• Oliguria <500ml passed in 24 hrs
• Anuria complete suppression of urine
production (<150ml in 24 hrs)
• Nocturia excretion of >500ml of urine at
night (a sign of early renal failure)

8. Color
• Normal= clear, pale yellow/ straw colour (Urochrome)

9. 1. Colourless - diabetes mellitus, diabetes insipidus, diuretics,
excessive intake of water.
2. Milky – pus, chyluria(fat)
3. Orange – urobilinogen, conc. Urine, ATT
4. Deep amber colour – high grade fever, muscular exercise
5. Smoky – Vit B12 therapy, aniline dye
6. Red – hematuria, haemoglobinuria
7. Brown – Bile
8. Green – phenol poisoning, putrified sample.

10. Urinary pH/ reaction
• Reaction reflects ability of kidney to maintain normal
hydrogen ion concentration in plasma & ECF
• Normal= 4.6-7
• Tested by- 1.litmus paper
2. pH paper strips
3. dipsticks
4. Electronic pH meter

11. Acidic urine
• High protein intake (meat)
• Ingestion of acidic fruits
• Respiratory and metabolic acidosis
• UTI by E.coli

12. Alkaline urine
• Strict vegetarian
• Respiratory and metabolic alkalosis
• UTI- Proteus, Pseudomonas

13. Odour
• Normal – faintly aromatic due to the volatile fatty
acids
1.Pungent – ammonia produced by bacterial
contamination
2.Putrid – UTI
3.Fruity – ketoacidosis

14. Specific gravity
• Ratio of weight of 1ml of urine to 1ml of distilled water.
• Depends on the concentration of various solutes in the urine.
• Purpose – to measure the concentrating and diluting power of
kidneys.
• Measured by-urinometer
- refractometer
- dipsticks

15. Urinometer
• Take 3/4th of urinometer container with urine
• Allow the urinometer to float in the urine without
touching the walls or bottom of the container.
• Read the graduation at the lowest level of urinary
meniscus
• Urinometer is calibrated at 15 or 200
c
• Correction of temperature is necessary
So for every 3o
c increase/decrease add/subtract 0.001
Normal-1.016-1.022

16. •

17. High specific
gravity(hyperosthenuria)
• Causes
Dehydration
Albuminuria
Gycosuria

18. Low specific gravity
(hypo-osthenuria)
• Diabetes insipidus
• Excess water intake
• Fixed specific gravity
(iso-osthenuria)=1.010
Seen in chronic renal disease when kidney has lost the ability to
concentrate or dilute

19. CHEMICAL
EXAMINATION

20. Chemical examination
• Proteins
• Sugars
• Ketone bodies
• Bilirubin
• Bile salts
• Blood

21. Tests for proteins
• Test – HEAT & ACETIC ACID TEST
• Principle-proteins are denatured & coagulated on
heating giving a white cloudy precipitate.
• Method-take 2/3 of test tube with urine, heat only
the upper part keeping lower part as control.
• Presence of phosphates, carbonates, proteins gives a
white cloud formation. Add acetic acid 1-2 drops, if
the cloud persists it indicates it is protein(acetic acid
dissolves the carbonates/phosphates)

22. • Method-
take 2/3 of test tube with urine,
heat only the upper part keeping lower part as control.
when precipitate of turbidiy occurs, add few drops of
10% acetic acid
(acetic acid dissolves the carbonates/phosphates)

24. • Grading:
Negative – no cloudiness
Traces – cloudiness against dark background
+ - cloudiness without granularity
++ - cloudiness with granularity
+++ - precipitation and flocculation
++++ - thick solid precipitation

25. Other tests
• Sulphosalicylic acid test
• Heller’s test
• Reagent strip method
• Esbach’s albuminometer- for quantitative estimation
of proteins
• Turbidimetric method

26. Causes of proteinuria
• Normal - <150mg/day
• Prerenal causes-Heavy
exercise,Fever,hypertension, multiple myeloma,
ecalmpsia
• Renal –acute & chronic glomerulonephritis,Renal
tubular dysfunction,Polycystic kidney, nephrotic
syndrome
• Post renal- acute & chronic cystitis, tuberculosis
cystitis

27. • Microalbuminuria
20-200mg/L of albumin
indicates early & reversible glomerular damage.

28. microalbuminuria
• The level of albumin protein produced by
microalbuminuria cannot be detected by urine
dipstick methods. In a properly functioning body,
albumin is not normally present in urine because it is
retained in the bloodstream by the kidneys.
Microalbuminuria is diagnosed from a 24-hour urine
collection

29. • Mild proteinuria: (<1gm/day)
Hypertension
polycystic kidney
Chronic pyelonephritis
UTI
Fever

30. • Moderate proteinuria (1-3gm/day)
Chronic glomerulonephritis
Nephrosclerosis
Multiple myeloma
pyelonephritis

31. • Heavy proteinuria (>3gm/day)
Nephrotic syndrome
Renal vein thrombosis
Diabetes mellitus
SLE

32. Test for sugar
• Test- BENEDICT’S TEST(semiquantitative)
• Principle
Benedict’s reagent contains CuSO4.
In the presence of reducing sugars cupric ions are converted
to cuprous oxide which is hastened by heating, to give the
color.
REDUCING SUBSTANCES PRESENT IN URINE: glucose,
fructose, maltose, lactose (not sucrose)

33. • Method-
take 5ml of benedict’s reagent in a test tube
add 8 drops of urine.
Boil the mixture.
No change in blue colour = negative
Greenish= Traces (<0.5gm%)
Green/Cloudy green=+(1gm%)
Yellow=++(1-1.5gm%)
Orange=+++(1.5-2gm%)
Brick red=++++(>2gm%)

34. Benedict’s test
• Detects all reducing substances like glucose, fructose,
& other reducing sustances.
• To confirm it is glucose, dipsticks can be used
(glucose oxidase)

36. Causes of glycosuria
• Diabetes mellitus
• Renal glucosuria
• Sever burns
• Administration of corticosteroids
• Severe sepsis
• Pregnancy

37. Ketone bodies
• 3 types
Acetone
Acetoacetic acid
β-hydroxy butyric acid
They are products of fat metabolism

38. Rothera’s test
• Principle-
acetone & acetoacetic acid react with sodium
nitroprusside in the presence of alkali to produce
purple colour.

39. • Method-
take 5ml of urine in a test tube & saturate it with ammonium
sulphate.
Then add few crystals of sodium nitroprusside and shake.
Then gently add 0.5ml of liquor ammonia along the sides of the
test tube.
• Appearance of purple coloured ring at the junction indicates +
test

41. Causes of ketonuria
• Diabetic ketoacidosis
• Dehydration
• Hyperemesis gravidarum
• Fever
• Cachexia

42. Other tests for ketone bodies
• Gerhardt’s test
• Reagent strip test

43. Bilirubin
• Test- fouchet’s test.
• Principle:
ferric chloride oxidises bilirubin to green biliverdin
Procedure:
• 10ml of urine in test tube
• 3-5 ml of 10% barium chloride is added
• Filter through filter paper
• to the precipitate, add few drops of fouchet’s reagent
(ferric chloride + trichloroacetic acid)
Green colour indicates bilirubin

44. Bilirubin
• Causes
• Hepatocellular jaundice
• obstructive jaundice

45. BILE SALTS
• Cholic acid and
• chenodeoxycholic acid

46. BILE SALTS
Hay’s test
Principle: bile salts lowers the surface tension
Fill 2/3rd
of beaker with urine
Sprinkle finely powdered Sulphur powder over it
Sinks - presence of bile salts

48. Blood in urine
• Test- BENZIDINE TEST
• Principle-The peroxidase activity of
hemoglobin decomposes hydrogen peroxide
releasing nascent oxygen which in turn
oxidizes benzidine to give blue color.

50. Blood in urine
• Method-
mix 2ml of benzidine solution with 2ml of
hydrogen peroxide in a test tube.
Take 2ml of urine & add 2ml of above
mixture.
A blue color indicates + reaction.

51. Causes of hematuria
• Renal stones
• Renal tumors
• Polycystic kidney
• Bleeding disorders
• trauma

52. Microscopic
examination

53. Microscopic examination
• Microscopic urinalysis is done by pouring the urine
sample into a test tube and centrifuging it for a few
minutes.
• The top liquid part (the supernatant) is discarded.
• The solid part left in the bottom of the test tube (the
urine sediment) is mixed with the remaining drop of
urine in the test tube
• one drop of this is analyzed under a microscope

54. Contents of normal urine m/s
• Contains few epithelial cells, occasional RBC’s, few
crystals.

55. crystals
•

56. casts
• Urinary casts are cylindrical aggregations of
particles that form in the distal nephron

57. Red cell casts
• The presence of red blood cells within the cast is
always pathologic, and is strongly indicative of
glomerular damage.
• They are usually associated with nephritic syndromes.

58. Erythrocyte cast
•

59. White blood cell casts
• Indicative of inflammation or infection,
• pyelonephritis

60. Leucocyte cast
•

62. Urine dipsticks
• Urine dipstick is a narrow plastic strip which has
several squares of different colors attached to it.
• Each small square represents a component of the
test used to interpret urinalysis.
• The entire strip is dipped in the urine sample and
color changes in each square are noted.
• The color change takes place after several seconds
to a few minutes from dipping the strip.
• If read too early or too long after the strip is
dipped, the results may not be accurate.

63. Urine dipsticks
• The color change takes place after several seconds
to a few minutes from dipping the strip.
• If read too early or too long after the strip is
dipped, the results may not be accurate.

64. •

65. • The main advantage of dipsticks is that they are
1. convenient,
2. easy to interpret,
3. and cost-effective

66. The main disadvantage is that the
1. Information may not be very accurate as the test is
time-sensitive.
2. It also provides limited information about the urine
as it is qualitative test and not a quantitative test

67. • Thankyou