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Urine analysis
Dr. Shweta
Introduction
 Urine is formed in the kidneys, is a product
of ultrafiltration of plasma by the renal
glomeruli.
Collection of urine
 Early morning sample-qualitative
 Random sample- routine
 24hrs sample- quantitative
 Midstream s...
24 hour urine sample
1. For quantitative estimation of proteins
2. For estimation of vanillyl mandelic acid,
5-hydroxyindo...
Specimen CollectionSpecimen Collection
Suprapubic Needle AspirationSuprapubic Needle Aspiration
Preservation of urine sample
 HCl- for 24 hr urinary sample preservation
for adrenaline, noradr, VMA, steroids.
 Toluene...
 For routine analysis, preservatives should
be avoided as they interfere with reagent
strip technique and chemical test f...
Urine examination
 Macroscopic examination
 Chemical examination
 Microscopic examination
Macroscopic examination
 Volume
 Color
 Odour
 Reaction or urinary pH
 Specific gravity
 Osmolality
Urinary volume
 Normal = 600-2000ml with night urine not in
excess of 400 ml.
 Polyuria- >2000ml/24 hrs
 Oliguria-<500m...
Causes of polyuria
 Diabetes mellitus
 Diabetes insipidus
 Polycystic kidney
 Chronic renal failure
 Diuretics
 Intr...
oliguria
 Dehydration-vomiting, diarrhoea,
excessive sweating
 Acute glomerulonephritis
 Congestive cardiac failure
Anu...
Color & appearance
 Normal= clear & pale yellow due to the
presence of various pigments called
urochrome.
1. Colourless- ...
Urinary pH/ reaction
 Reaction reflects ability of kidney to
maintain normal hydrogen ion
concentration in plasma & ECF
...
Acidic urine
 Ketosis-diabetes, starvation, fever
 Systemic acidosis
 UTI by E.coli
 Acidification therapy
 High prot...
Alkaline urine
 Strict vegetarian
 Systemic alkalosis
 UTI by pseudomonas or Proteus
 Alkalization therapy
 CRF
Odour
 Normal= aromatic due to the volatile fatty
acids
 Ammonical – bacterial action(E. coli)
 Fruity- ketonuria, star...
Specific gravity
 Depends on the concentration of various
solutes in the urine.
 Normal range- 1.003 to 1.035
 Measured...
Urinometer
 This method is based on the principle of
buoyancy.
 Take 2/3 of urinometer container with urine
 Allow the ...

High specific
gravity(hyperosthenuria)
 Causes
All causes of oliguria
Gycosuria, DM, Dehydration, nephrotic
syndrome.
Low specific
gravity(hyposthenuria)
 All causes of polyuria except gycosuria
 DI, pyelonephritis, glomerulonephritis.
 ...
Osmolality
 Normal adult with normal fluid intake wil
produce urine of 500-850 mOsm/kg water.
 The normal kidney is able...
Chemical examination
 Proteins
 Sugars
 Ketone bodies
 Bilirubin
 Bile salts
 Urobilinogen
 Blood
Tests for proteins
 Test – HEAT & ACETIC ACID TEST
 Principle-proteins are denatured & coagulated
on heating to give whi...
Other Tests for Protien
 Nitric acid test
 Sulphosalicylic acid test
 Test with Esbach’s reagent
 Protienreagent strip...
Protein % of Total Daily Maximum
Albumin 40% 60 mg
Tamm-Horsfall 40% 60 mg
Immunoglobulins 12% 24 mg
Secretory IgA 3% 6 mg...
Causes of proteinuria
 Glomerular proteinuria: due to increased
permeability of glomerular capillary wall.
Selective( onl...
 Overflow proteinuria: Bence jones
proteins(plasma cell dyscrasia),
hemglobin( intravascular hemlysis),
myoglobin(skeleta...
microalbuminuria
 It is presence of albumin in urine above
normal level bt below detectable range of
conventional urine d...
Significance of microalbuminuria
 an indicator of subclinical cardiovascular
disease
 an important prognostic marker for...
Detection of microalbuminuria:
 Methods for detection :
 Measurement of albumin creatinine ratio
in random urine sample....
Bence Jones proteins
 These are monoclonal immunoglobulin light
chains (kappa or lamda) synthesized by
neoplastic plasma ...
Test for sugar Test-BENEDICT’S TEST(semiquantitative)
 Principle-benedict’s reagent contains
cuso4.In the presence of re...
Benedict’s test
 Detects all reducing substances like
glucose, fructose, & other reducing
sustances.
 Sensitivity of the...
Reagent strip method:
 Specific for glucose.
 Based on glucose oxidase peroxidase
reaction.
 More sensitive (sensitivit...
Glycosuria
 Other Methods of detecting glycosuria
 Fehling’smethod
 Osazone test
Causes of glycosuria
 Glycosuria with hyperglycaemia-
diabetes,acromegaly, cushing’s disease,
hyperthyroidism, drugs like...
Ketone bodies
 3 types
 Acetone
 Acetoacetic acid
 β-hydroxy butyric acid
 They are products of fat metabolism
Rothera’s test
 Principle-acetone & acetoacetic acid react
with sodium nitroprusside in the presence
of alkali to produce...
Other tests:
 Acetest tablet test
 Ferric chloride test(Gerhardt’s test)
 Reagent strip method
 Hart’s test for beta h...
Causes of ketonuria
 Diabetes
 Non-diabetic causes- high fever,
starvation, severe vomiting/diarrhoea
 Glycogen storage...
Bilirubin
 Test- fouchet’s test.
In 5 ml of urine add 2.5 ml of 10% Barium
chloride and mix well. Then filter to obtain
p...
Other tests:
 Foam test
 Gmelin’s test (nitric acid)
 Lugol’s iodine test
 Reagent strip with diazo reagent
Urobilinogen
 Test- ehrlich test
In 5 ml of urine add 0.5 ml of Ehrlich’s
reagent(HCl 20 ml, d/w 80 ml, p-
dimethylaminob...
Bile salt:
 Hay’s sulphur test:
In 5 ml of urine sprinkle a pinch of
sulphur particles. If bile salt is present
sulphur p...
Blood in urine
 Test- BENZIDINE TEST
 Principle-The peroxidase activity of hemoglobin
decomposes hydrogen peroxide relea...
Causes of hematuria
 Pre renal- bleeding diathesis,
hemoglobinopathies, malignant
hypertension.
 Renal- trauma, calculi,...
Type Plasma color Urine color
Hematuria normal Smoky red
m/s-plenty of
RBC’s
hemoglobunuria Pink,hepatoglob
in reduced
Red...
Microscopic examination
 A well mixed sample of urine (12 ml) is
centrifuged in machine for 5 min at 1500 rpm.
The top li...
Contents of normal urine m/s
 Contains few epithelial cells, occasional
RBC’s, few crystals.
EPITHELIAL CELLS.
squamous cell Transitional cell Tubular
epithelial cell
RED
BLOOD
CELLS
WHITE
BLOOD
CELLS
Crystals in urine
Crystals in acidic
urine
 Uric acid
 Calcium oxalate
 Cystine
 Leucine
Crystals in alkaline
urine
 ...
Microscopic ExaminationMicroscopic Examination
Calcium Oxalate CrystalsCalcium Oxalate Crystals
Microscopic ExaminationMicroscopic Examination
Calcium Oxalate CrystalsCalcium Oxalate Crystals
Dumbbell ShapeDumbbell Sha...
Microscopic ExaminationMicroscopic Examination
Triple Phosphate CrystalsTriple Phosphate Crystals
Microscopic ExaminationMicroscopic Examination
Urate CrystalsUrate Crystals
Microscopic ExaminationMicroscopic Examination
Leucine CrystalsLeucine Crystals
Microscopic ExaminationMicroscopic Examination
Cystine CrystalsCystine Crystals
Microscopic ExaminationMicroscopic Examination
Ammonium Biurate CrystalsAmmonium Biurate Crystals
Microscopic ExaminationMicroscopic Examination
Cholesterol CrystalsCholesterol Crystals
casts
 Urinary casts are cylindrical aggregations
of particles that form in the distal nephron,
dislodge, and pass into t...
Types of casts
 Acellular casts
Hyaline casts
Granular casts
Waxy casts
Fatty casts
Pigment casts
Crystal casts
 Cellula...
Hyaline casts
 The most common type of cast, hyaline
casts are solidified Tamm-Horsfall
mucoprotein secreted from the tub...
Microscopic ExaminationMicroscopic Examination
Hyaline CastHyaline Cast
Granular casts
 Granular casts can result either from the
breakdown of cellular casts or the
inclusion of aggregates of p...
Microscopic ExaminationMicroscopic Examination
Granular CastGranular Cast
Waxy casts
 waxy casts suggest severe,
longstanding kidney disease such as
renal failure(end stage renal disease).
Microscopic ExaminationMicroscopic Examination
Waxy CastWaxy Cast
Waxy casts

On fluoroscent microscopy

Fatty casts
 Formed by the breakdown of lipid-rich
epithelial cells, these are hyaline casts
with fat globule inclusions
...
Microscopic ExaminationMicroscopic Examination
Fatty CastFatty Cast
Fatty casts

Pigment casts
 Formed by the adhesion of metabolic
breakdown products or drug pigments
 Pigments include those produced
...
Crystal casts
 Though crystallized urinary solutes, such
as oxalates, urates, or sulfonamides, may
become enmeshed within...
Red cell casts
 The presence of red blood cells within the
cast is always pathologic, and is strongly
indicative of glome...
Microscopic ExaminationMicroscopic Examination
RBCs CastRBCs Cast
White blood cell casts
 Indicative of inflammation or infection,
 pyelonephritis
 acute allergic interstitial nephritis...
Microscopic ExaminationMicroscopic Examination
WBCs CastWBCs Cast
Leucocyte cast

Epithelial casts
 This cast is formed by inclusion or
adhesion of desquamated epithelial cells
of the tubule lining.
Thes...
Microscopic ExaminationMicroscopic Examination
Tubular Epith. CastTubular Epith. Cast
Miscellaneous structures in
urine:
BACTERIA
Microfilaria
TRICHOMONAS VAGINALIS
SCHISTOSOMIA HAEMATOBIUM
SPERMATOZOA
5.OVAL FAT BODIES
YEAST
Urine dipsticks
 Urine dipstick is a narrow plastic strip which
has several squares of different colors
attached to it. E...
Chemical AnalysisChemical Analysis
Urine DipstickUrine Dipstick
Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protei...

 The squares on the dipstick represent the
following components in the urine:
∀ specific gravity (concentration of urine)...
 The main advantage of dipsticks is that
they are
1. convenient,
2. easy to interpret,
3. and cost-effective
The main disadvantage is that the
1. Information may not be very accurate as
the test is time-sensitive.
2. It also provid...
Automated urine analyser:
 It is based on the principle of flow
cytometry.
 This system classifies particles based on
fl...
 This system uses flow imaging analysis
technology and Auto Particle Recognition
software.
 It requires minimum of 3 ml ...
References:
 Henry’s Clinical diagnosis and
Management of Laboratory Methods
 Clinical Pathology Kawthalkar
 Clinical P...
Urine analysis
Urine analysis
Urine analysis
Urine analysis
Urine analysis
Urine analysis
Urine analysis
Urine analysis
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Urine analysis

  1. 1. Urine analysis Dr. Shweta
  2. 2. Introduction  Urine is formed in the kidneys, is a product of ultrafiltration of plasma by the renal glomeruli.
  3. 3. Collection of urine  Early morning sample-qualitative  Random sample- routine  24hrs sample- quantitative  Midstream sample-UTI  Post prandial sample-D.M  Catheterised- in infants, bedridden patients  Suprapubic needle aspiration
  4. 4. 24 hour urine sample 1. For quantitative estimation of proteins 2. For estimation of vanillyl mandelic acid, 5-hydroxyindole acetic acid, metanephrines. 3. For detection of hormones in urine 4. For detection of microalbuminuria
  5. 5. Specimen CollectionSpecimen Collection Suprapubic Needle AspirationSuprapubic Needle Aspiration
  6. 6. Preservation of urine sample  HCl- for 24 hr urinary sample preservation for adrenaline, noradr, VMA, steroids.  Toluene- as a physical barrier  Boric acid- general preservative  Thymol- inhibits bacteria, fungi  Formalin- for preservation of formed elements
  7. 7.  For routine analysis, preservatives should be avoided as they interfere with reagent strip technique and chemical test for proteins.  Sample should be examined within 1-2 hrs of voiding.  If delay is expected, sample can be kept in refrigeration for max 8 hrs.
  8. 8. Urine examination  Macroscopic examination  Chemical examination  Microscopic examination
  9. 9. Macroscopic examination  Volume  Color  Odour  Reaction or urinary pH  Specific gravity  Osmolality
  10. 10. Urinary volume  Normal = 600-2000ml with night urine not in excess of 400 ml.  Polyuria- >2000ml/24 hrs  Oliguria-<500ml/24 hrs  Anuria-complete cessation of urine(<200ml)  Nocturia-excretion of urine by a adult of >500ml with a specific gravity of <1.018 at night (characteristic of chronic glomerulonephritis)
  11. 11. Causes of polyuria  Diabetes mellitus  Diabetes insipidus  Polycystic kidney  Chronic renal failure  Diuretics  Intravenous saline/glucose
  12. 12. oliguria  Dehydration-vomiting, diarrhoea, excessive sweating  Acute glomerulonephritis  Congestive cardiac failure Anuria - Acute tubular necrosis - Complete urinary tract obstruction
  13. 13. Color & appearance  Normal= clear & pale yellow due to the presence of various pigments called urochrome. 1. Colourless- dilution, diabetes mellitus, diabetes insipidus, diuretics 2. Milky-purulent genitourinary tract infection, chyluria 3. Orange- urobilinogen 4. Red-beetroot ingestion,haematuria, hemoglobinuria 5. Brown/ black- alkaptunuria, melanin
  14. 14. Urinary pH/ reaction  Reaction reflects ability of kidney to maintain normal hydrogen ion concentration in plasma & ECF  Normal= 4.6-8  Tested by- 1.litmus paper 2. pH paper 3. Reagent strip method
  15. 15. Acidic urine  Ketosis-diabetes, starvation, fever  Systemic acidosis  UTI by E.coli  Acidification therapy  High protein diet
  16. 16. Alkaline urine  Strict vegetarian  Systemic alkalosis  UTI by pseudomonas or Proteus  Alkalization therapy  CRF
  17. 17. Odour  Normal= aromatic due to the volatile fatty acids  Ammonical – bacterial action(E. coli)  Fruity- ketonuria, starvation  Musty- Phenylketonuria  Fishy- UTI with Proteus  Rancid- Tyrosinemia
  18. 18. Specific gravity  Depends on the concentration of various solutes in the urine.  Normal range- 1.003 to 1.035  Measured by-urinometer - refractometer - reagent strip method - falling drop method
  19. 19. Urinometer  This method is based on the principle of buoyancy.  Take 2/3 of urinometer container with urine  Allow the urinometer to float into the urine  Read the graduation at the lowest level of urinary meniscus  Correction of temperature & albumin is a must.  Urinometer is calibrated at 15or 200 c So for every 3o c increase/decrease add/subtract 0.001
  20. 20.
  21. 21. High specific gravity(hyperosthenuria)  Causes All causes of oliguria Gycosuria, DM, Dehydration, nephrotic syndrome.
  22. 22. Low specific gravity(hyposthenuria)  All causes of polyuria except gycosuria  DI, pyelonephritis, glomerulonephritis.  Fixed specific gravity (isosthenuria)=1.010 Seen in chronic renal disease when kidney has lost the ability to concentrate or dilute
  23. 23. Osmolality  Normal adult with normal fluid intake wil produce urine of 500-850 mOsm/kg water.  The normal kidney is able to produce urine osmolality in the range of 800-1400 mOsm/kg water in dehydration and minimal osmolality of 40-80 mOsm/kg water during diuresis.
  24. 24. Chemical examination  Proteins  Sugars  Ketone bodies  Bilirubin  Bile salts  Urobilinogen  Blood
  25. 25. Tests for proteins  Test – HEAT & ACETIC ACID TEST  Principle-proteins are denatured & coagulated on heating to give white cloud 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 1-2 drops of 10% acetic acid, if the cloud persists it indicates it is protein(acetic acid dissolves the carbonates/phosphates)
  26. 26. Other Tests for Protien  Nitric acid test  Sulphosalicylic acid test  Test with Esbach’s reagent  Protienreagent strip  Biuret method
  27. 27. Protein % of Total Daily Maximum Albumin 40% 60 mg Tamm-Horsfall 40% 60 mg Immunoglobulins 12% 24 mg Secretory IgA 3% 6 mg Other 5% 10 mg TOTAL 100% 150 mg Proteins in “Normal” UrineProteins in “Normal” Urine
  28. 28. Causes of proteinuria  Glomerular proteinuria: due to increased permeability of glomerular capillary wall. Selective( only albumin n transferrin bands seen) Nonselective: pattern same as serum e.g. nephrotic syndrome  Tubular proteinuria: in acute n chronic pyelonephritis, heavy metal poisoning, TB kidney etc.
  29. 29.  Overflow proteinuria: Bence jones proteins(plasma cell dyscrasia), hemglobin( intravascular hemlysis), myoglobin(skeletal muscle trauma)  Hemodynamic proteinuria: seen in high fever, hypertension, heavy exercise, CCF etc.  Post-renal proteinuria: caused by imflammatory or neoplastic conditions in renal pelvis, ureter, bladder, prostate or urethra.
  30. 30. microalbuminuria  It is presence of albumin in urine above normal level bt below detectable range of conventional urine dipstick method.  Defined as urinary excretion of 30 to 300 mg/24 hrs of albumin in urine.
  31. 31. Significance of microalbuminuria  an indicator of subclinical cardiovascular disease  an important prognostic marker for kidney disease  in diabetes mellitus (earliest sign of renal damage in DM)  in hypertension  increasing microalbuminuria during the first 48 hours after admission to an intensive care unit predicts elevated risk for acute respiratory failure , multiple organ failure , and overall mortality
  32. 32. Detection of microalbuminuria:  Methods for detection :  Measurement of albumin creatinine ratio in random urine sample.  Measurement of albumin in early morning sample.  Measurement of urine in 24 hr sample.
  33. 33. Bence Jones proteins  These are monoclonal immunoglobulin light chains (kappa or lamda) synthesized by neoplastic plasma cells.  seen in multiple myeloma, macroglobulinemias, primary amyloidosis.  Test- Thermal method(waterbath): Proteins have unusual property of precipitating at 400 -600 c & then dissolving when the urine is brought to boiling(1000 c) & reappears when the urine is cooled.
  34. 34. 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.  Method- take 5ml of benedict’s reagent in a test tube, add 8drops of urine. Boil the mixture.  Blue= negative  Yellow=+(<0.5%)  green=++(0.5-1%)  Yellow-orange=+++(1-2%)  Brick red=++++(>2%)
  35. 35. Benedict’s test  Detects all reducing substances like glucose, fructose, & other reducing sustances.  Sensitivity of the test is about 200 mg reducing substance per dl of urine.  To confirm it is glucose, dipsticks can be used (glucose oxidase)
  36. 36. Reagent strip method:  Specific for glucose.  Based on glucose oxidase peroxidase reaction.  More sensitive (sensitivity- 100 mg glucose/dl)  Glu + oxygen---- gluconic acid+hydrogen peroxide  Hydrogen peroxide+chromogen-- oxidised chromogen(blue)+ H2O
  37. 37. Glycosuria  Other Methods of detecting glycosuria  Fehling’smethod  Osazone test
  38. 38. Causes of glycosuria  Glycosuria with hyperglycaemia- diabetes,acromegaly, cushing’s disease, hyperthyroidism, drugs like corticosteroids.  Glycosuria without hyperglycaemia- renal tubular dysfunction
  39. 39. Ketone bodies  3 types  Acetone  Acetoacetic acid  β-hydroxy butyric acid  They are products of fat metabolism
  40. 40. Rothera’s test  Principle-acetone & acetoacetic acid react with sodium nitroprusside in the presence of alkali to produce purple colour.  Method- take 5ml of urine in a test tube & saturate it with ammonium sulphate. Then add one crystal of sodium nitroprusside. Then slowly run the liquor ammonia along the sides of the test tube.  Formation of purple coloured ring at junction indicates + test
  41. 41. Other tests:  Acetest tablet test  Ferric chloride test(Gerhardt’s test)  Reagent strip method  Hart’s test for beta hydroxy butyric acid
  42. 42. Causes of ketonuria  Diabetes  Non-diabetic causes- high fever, starvation, severe vomiting/diarrhoea  Glycogen storage diseases
  43. 43. Bilirubin  Test- fouchet’s test. In 5 ml of urine add 2.5 ml of 10% Barium chloride and mix well. Then filter to obtain precipitate. To ppt add 1 drop of fouchet’s reagent. Development of blue green colour indicate + test. Principle: Bilirubin Adsorbs to the Barium Chloride and results in green color formation when fouchet’s reagent is added.  Causes  Liver diseases-injury,hepatitis  Obstruction to biliary tract
  44. 44. Other tests:  Foam test  Gmelin’s test (nitric acid)  Lugol’s iodine test  Reagent strip with diazo reagent
  45. 45. Urobilinogen  Test- ehrlich test In 5 ml of urine add 0.5 ml of Ehrlich’s reagent(HCl 20 ml, d/w 80 ml, p- dimethylaminobenzaldehyde 2 gm). Allow to stand for 5 min. development of pink colour indicates +test.  Causes-hemolytic jaundice, early hepatitis, hepatocellular jaundice.
  46. 46. Bile salt:  Hay’s sulphur test: In 5 ml of urine sprinkle a pinch of sulphur particles. If bile salt is present sulphur particles will sink to the bottom because bile salts lowers the surface tension of urine.
  47. 47. 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.  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 or green color within 5 min indicates + reaction.
  48. 48. Causes of hematuria  Pre renal- bleeding diathesis, hemoglobinopathies, malignant hypertension.  Renal- trauma, calculi, acute & chronic glomerulonephritis, renal TB, renal tumors  Post renal – severe UTI, calculi, trauma, tumors of urinary tract
  49. 49. Type Plasma color Urine color Hematuria normal Smoky red m/s-plenty of RBC’s hemoglobunuria Pink,hepatoglob in reduced Red , occasional RBC’s Myoglobunuria Pink, normal hepatoglobin Red, occasional RBC’s
  50. 50. Microscopic examination  A well mixed sample of urine (12 ml) is centrifuged in machine for 5 min at 1500 rpm. The top liquid part (the supernatant) is discarded. A drop of urine left at the bottom of the test tube (the urine sediment) is placed on glass slide and covered with cover slip. It is examined under high power.
  51. 51. Contents of normal urine m/s  Contains few epithelial cells, occasional RBC’s, few crystals.
  52. 52. EPITHELIAL CELLS. squamous cell Transitional cell Tubular epithelial cell
  53. 53. RED BLOOD CELLS
  54. 54. WHITE BLOOD CELLS
  55. 55. Crystals in urine Crystals in acidic urine  Uric acid  Calcium oxalate  Cystine  Leucine Crystals in alkaline urine  Ammonium magnesium phosphates(triple phosphate crystals)  Calcium carbonate
  56. 56. Microscopic ExaminationMicroscopic Examination Calcium Oxalate CrystalsCalcium Oxalate Crystals
  57. 57. Microscopic ExaminationMicroscopic Examination Calcium Oxalate CrystalsCalcium Oxalate Crystals Dumbbell ShapeDumbbell Shape
  58. 58. Microscopic ExaminationMicroscopic Examination Triple Phosphate CrystalsTriple Phosphate Crystals
  59. 59. Microscopic ExaminationMicroscopic Examination Urate CrystalsUrate Crystals
  60. 60. Microscopic ExaminationMicroscopic Examination Leucine CrystalsLeucine Crystals
  61. 61. Microscopic ExaminationMicroscopic Examination Cystine CrystalsCystine Crystals
  62. 62. Microscopic ExaminationMicroscopic Examination Ammonium Biurate CrystalsAmmonium Biurate Crystals
  63. 63. Microscopic ExaminationMicroscopic Examination Cholesterol CrystalsCholesterol Crystals
  64. 64. casts  Urinary casts are cylindrical aggregations of particles that form in the distal nephron, dislodge, and pass into the urine. In urinalysis they indicate kidney disease. They form via precipitation of Tamm-Horsfall mucoprotein which is secreted by renal tubule cells.
  65. 65. Types of casts  Acellular casts Hyaline casts Granular casts Waxy casts Fatty casts Pigment casts Crystal casts  Cellular casts Red cell casts White cell casts Epithelial cell cast
  66. 66. Hyaline casts  The most common type of cast, hyaline casts are solidified Tamm-Horsfall mucoprotein secreted from the tubular epithelial cells  Seen in fever, strenuous exercise, damage to the glomerular capillary
  67. 67. Microscopic ExaminationMicroscopic Examination Hyaline CastHyaline Cast
  68. 68. Granular casts  Granular casts can result either from the breakdown of cellular casts or the inclusion of aggregates of plasma proteins (e.g., albumin) or immunoglobulin light chains  indicative of chronic renal disease
  69. 69. Microscopic ExaminationMicroscopic Examination Granular CastGranular Cast
  70. 70. Waxy casts  waxy casts suggest severe, longstanding kidney disease such as renal failure(end stage renal disease).
  71. 71. Microscopic ExaminationMicroscopic Examination Waxy CastWaxy Cast
  72. 72. Waxy casts  On fluoroscent microscopy
  73. 73.
  74. 74. Fatty casts  Formed by the breakdown of lipid-rich epithelial cells, these are hyaline casts with fat globule inclusions They can be present in various disorders, including  nephrotic syndrome,  diabetic or lupus nephropathy,  Acute tubular necrosis
  75. 75. Microscopic ExaminationMicroscopic Examination Fatty CastFatty Cast
  76. 76. Fatty casts 
  77. 77. Pigment casts  Formed by the adhesion of metabolic breakdown products or drug pigments  Pigments include those produced endogenously, such as  hemoglobin in hemolytic anemia,  myoglobin in rhabdomyolysis, and  bilirubin in liver disease.
  78. 78. Crystal casts  Though crystallized urinary solutes, such as oxalates, urates, or sulfonamides, may become enmeshed within a hyaline cast during its formation.  The clinical significance of this occurrence is not felt to be great.
  79. 79. 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.
  80. 80. Microscopic ExaminationMicroscopic Examination RBCs CastRBCs Cast
  81. 81. White blood cell casts  Indicative of inflammation or infection,  pyelonephritis  acute allergic interstitial nephritis,  nephrotic syndrome, or  post-streptococcal acute glomerulonephritis
  82. 82. Microscopic ExaminationMicroscopic Examination WBCs CastWBCs Cast
  83. 83. Leucocyte cast 
  84. 84. Epithelial casts  This cast is formed by inclusion or adhesion of desquamated epithelial cells of the tubule lining. These can be seen in  acute tubular necrosis and  toxic ingestion, such as from mercury, diethylene glycol, or salicylate.
  85. 85. Microscopic ExaminationMicroscopic Examination Tubular Epith. CastTubular Epith. Cast
  86. 86. Miscellaneous structures in urine:
  87. 87. BACTERIA
  88. 88. Microfilaria
  89. 89. TRICHOMONAS VAGINALIS
  90. 90. SCHISTOSOMIA HAEMATOBIUM
  91. 91. SPERMATOZOA
  92. 92. 5.OVAL FAT BODIES
  93. 93. YEAST
  94. 94. 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 within 2 minutes from dipping the strip. If read too early or too long after the strip is dipped, the results may not be accurate.
  95. 95. Chemical AnalysisChemical Analysis Urine DipstickUrine Dipstick Glucose Bilirubin Ketones Specific Gravity Blood pH Protein Urobilinogen Nitrite Leukocyte Esterase
  96. 96.
  97. 97.  The squares on the dipstick represent the following components in the urine: ∀ specific gravity (concentration of urine), ∀ acidity of the urine (pH), ∀ protein in the urine (mainly albumin), ∀ glucose (sugar), ∀ ketones ∀ blood ∀ bilirubin and  Urobilinogen  Nitrites  Leukocyte esterase
  98. 98.  The main advantage of dipsticks is that they are 1. convenient, 2. easy to interpret, 3. and cost-effective
  99. 99. 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 (for example, it does not give a precise measure of the quantity of abnormality).
  100. 100. Automated urine analyser:  It is based on the principle of flow cytometry.  This system classifies particles based on fluoroscent intensity ( cells are stained with 2 fluoroscent dyes), electrical impedance and forward angle light scatter.  Next generation automated image based urinalysis system iQ200 is a walk away system.
  101. 101.  This system uses flow imaging analysis technology and Auto Particle Recognition software.  It requires minimum of 3 ml of urine and quantitates particles in 2 microlitre of sample.  Can analyse 60 urine samples per hr.
  102. 102. References:  Henry’s Clinical diagnosis and Management of Laboratory Methods  Clinical Pathology Kawthalkar  Clinical Pathology Sabitri Sanyal  Basics of Body fluids by Akhil Bansal  Internet
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PPT urine analysis

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