PHYSICAL EXAMINATION OF URINE

Physical Examination OBJECTIVE observation of color, volume, clarity, odor, & specific gravity that will provide PRELIMINARY information for diagnosing a disorder. can also be used to confirm the chemical and microscopic findings in urine sample. VOLUME Adult- 600-2000 mL/ 24 hours Less than 1 year old- 100-500 mL/ 24 hours 1 to 14 years old- 500-1400 mL/ 24 hours

Toxic agents Complete obstruction Collapse

Nocturia increase amount of urine at night due to the inability of the kidney to regulate water excretion competently Seen in cases of: renal dysfunction glomerulonephritis polyuric state COLOR Normal Urine Color (yellow- dark yellow) Yellow - UROCHROME (Thudichum, 1864) Increased in fever, thyrotoxicosis, starvation. Increases in urine sample upon standing. Pink - UROERYTHRIN Seen in precipitation of Amorphous urates upon refrigeration. Orange-brown - UROBILIN Smallest amount present Indication that the urine sample is NOT FRESH! Other Urine Color Dark yellow/ Amber Concentrated specimen (may be considered as normal) Phenazopyridine (Pyridium) or Azo-gantrisin administration given to patients with UTI thick orange pigment yellow foam (commonly mistaken with bilirubin) Nitrofurantoin intake Phenindione Anticoagulant, can cause orange - Bilirubin (positive yellow foam test; pathologic) - Bilirubin Biliverdin = beer-brown color, greenish foam Pink/ Red/ Red Brown most common abnormal color unstable hemoglobin Dipyrrole or bilifuscin (negative for blood, negative for bilirubin) For genetically susceptible person Beets ingestion - red in alkaline urine Blackberries ingestion - red in acidic urine medication, menstrual contamination(nonpathologic) SMOKEY Hematuria (presence of intact RBCs) CLEAR Hemoglobinuria Myoglobinuria Porphyrinuria (port wine color)

Urine volume is greatly affected by water intake kidney diseases foods drugs temperature occupation metabolism age Night Volume normally smaller than the day volume Day volume 3-4 times larger than the night volume output influenced by body weight, diet, exercises, metabolism, age Residual urine Obtained by a catheter immediately after the patient has emptied the bladder voluntarily Amount of urine that remains in the bladder after voluntary urination ABNORMAL VOLUME Polyuria increased amount of urine Seen in the following cases: Diabetes mellitus Diabetes insipidus Chronic nephritis Nervous conditions Excessive fluid intake Absorption of large quantity of edema fluid Oliguria decreased amount of urine Seen in cases of: Acute nephritis or glomerulonephritis Calculus or tumor of the kidney Severe diarrhea Dehydration due to vomiting, diarrhea, fever, sweating and hemorrhage. Uremia Shock Transfusion reaction Toxic agents mercury chloride, carbon tetrachloride, sulfonamides and ethylene glycol Anuria total suppression of urine production Seen in cases of: Acute nephritis Poisoning with bichloride of mercury Transfusion reaction

Blue/ Green PATHOLOGIC Green in the case of: Bacterial infections (Pseudomonas aeruginosa) Severe obstructive jaundice (dark green color) Blue in the case of: Increased urinary indican- INDICANURIA (Hartnups Syndrome/ Blue Diaper Syndrome) NON-PATHOLOGIC Green in the case of: Clorets ingestion (breath deodorizer) Blue in the case of: Methocarbamol (Robaxin) Amitriptyline (Elavil) Methylene blue Phenol

Brown/ Black PATHOLOGIC Melanuria (brown-black) over production of melanin seen in cases if malignant melanoma Alkaptonuria inborn error of metabolism deficiency in homogentisic acid oxidase NON-PATHOLOGIC Intake of the following medications: Metronidazole (Flagyl)- treatment for amoebiasis Levodopa/ Methydopa (antihypertension) Cola-colored urine Rhabdomyolysis - high hemiglobin L-dopa intake CLARITY General term that refers to transparency/ turbidity of urine specimen. Manner of Reporting in the Laboratory Clarity Term Clear No visible particulates, TRANSPARENT Hazy Few particulates, print easily seen through Cloudy Many particulates, print blurred through urine Turbid Print cannot be seen through urine Milky May precipitate or be clotted.

Reference substance: 1. For solid and liquids: WATER 2. For gases: AIR URINE SPECIFIC GRAVITY Measure of concentration of solutes concentrating and diluting power of the kidney Specific gravity of glomerular filtrate: 1.007 Fixed urinary specific gravity of 1.007 Poor tubular reabsorption High specific gravity Dehydration Presence of abnormal solutes such as Diodrast, protein, and glucose GENERAL USE OF SPECIFIC GRAVITY: detection of diabetes insipidus to measure the hydration and dehydration state of a person to detect loss of the concentrating ability of the renal tubules Screening for unsuitable specimen due to low concentration. GENERAL TERMS Hypersthenuria urine specific gravity is increased above 1.010 Seen in cases of: Diabetes mellitus Fever Acute nephritis Hyposthenuria urine specific gravity is decreased. less than 1.007 Seen in cases of: Chronic nephritis Diabetes insipidus Isosthenuria Urine specific gravity is normal Fixed at about 1.010 Normal values: Random urine sample: 1.015 - 1.025 First morning specimen: 1.020 Timed specimen: 1.010 - 1.030

Bacterial Growth uniform opalscence Not removed by acidification/ titration uses double beam turbidimeter Useful for urine infection screening Chyluria urine contains lymph fluids clots may usually form caused by the obstruction of lymph flow or rupture of lymph vessels to renal pelvis Pseudochyluria use of paraffin based vaginal cream SPECIFIC GRAVITY Density of a solution compared with the density of a similar volume of distilled water at same temperature. Ratio of the weight of a substance to the weight of an equal volume of a reference substance. Specific Gravity= weight of object/weight of equal volume of reference substance = density of substance Density of water is 1.0 g/mL at 40 C. Sp. gr. of solids or liquids are expressed in g/cm3 or g/mL

URINOMETER PRINCIPLE: Density less accurate than the other method for urine specific gravity determination. not recommended by CLSI. requires large amount of urine sample calibrated with distilled water at a specific temperature. needs correction for the following instances: 3C increase or decrease in temperature Presence of protein and sugar in the specimen Procedure: Fill the cylinder with urine about full. Float the urinometer into it (rotate the urinometer to avoid touching the sides of the cylinder). Read the specific gravity at the lower meniscus of the urinometer. How to get corrected specific gravity? Get the specific gravity of the urine and specimen.

Get the temperature of the urinometer for which it was standardized and the room temperature. (Always change temperatures to centigrade; C=F-32 X 5/9 or .555) Subtract the lower temperature from the higher temperature or get the differences between the two temperatures, (Rule: In every 3 degrees centigrade rise from the standard temperature; add .001 and for every 3 degrees centigrade fall from the standard temperature, subtract .001) Divide the difference by 3 (to find out how many 3s are there in the difference). Add or subtract the product to or from the last two digits of the urinometers actual specific gravity reading of the specimen.

Mousy Rancid Sweaty Feet Cabbage Bleach Rotten Fish Odor Sulfur Odor/ Burnt Gun Powder

Phenylketonuria Tyrosinemia Isovaleric Acidemia Methionine malabsorption Contamination Trimethyl Aminoaciduria Cysteinuria, homocysteinuria, cysteinosis

Speegrav Method Temperature compensated instrument Operates on the principles of a float controlling a gate that exposes a photocell to light Specific gravity is determined photoelectrically Far superior to the hydrometer method Refractometer/ Total Solid Meter/ TS meter PRINCIPLE: Refractive Index (comparison of the velocity of light in air with the velocity of light in a solution) Reading is generally 0.002 lower than urinometer. temperature compensated at 60-100 F uses large drop of sample Subject to errors due to: Presence of CHO and CHON Must be calibrated daily with: Distilled water: 1.000 5% Sodium Chloride: 1.022 0.001 9% Sucrose: 1.034 0.001

Harmonic Oscillation PRINCIPLE: Density Based on the frequency of sound wave entering a solution that will change in proportion to the density of a solution. Drop Method (Drogamad Method) more accurate than refractometer more precise than urinometer Best method Utilizes graded series of oily solutions Mixture of bromobenzene and kerosene in services proportions ranging in specific gravity from 1.000-1.060 A drop of urine is added to each bottle Observed to detect whether it rises or sinks in the solution Similar to copper sulfate method used for blood specific gravity. Designed for a small amount of urine

Falling

Reagent Strip PRINCIPLE: pKa changes of a polyelectrolyte pad. Reagents: Bromthymol blue Polymethyl vinyl ether ODOR Aromatic Foul, Ammonia-like Fruity, sweet Maple syrup CAUSE Normal Bacterial decomposition, Urinary tract infection Ketones (DM, Starvation, Vomiting) Maple Syrup Urine Disease