Interpretative Routine Urine Analysis

I. Physical Examination of Urine

Parameter Color Normal Values Light yellow to amber Color 1) Blue-green Non-pathologic Causes Variations and Clinical Rationale Pathologic Causes Drugs Bacterial infections, esp. Amitriptyline, cimetidine (IV), indomethacin, methocarbamol, Pseudomonas UTI (with positive methylene blue, phenol, promethazine (IV), triamterine urine culture) Alkaptonuria (with alkaline urine Anticoagulants, cascara (with acidic urine), chloroquine, ferrous after standing), melanotic tumors, sulfate, levodopa, methyldopa, methocarbamol, metronidazole, bile pigments, methemoglobin nitrofurantoin, quinine, salicylates, senna, sulfonamides Presence of bilirubin (yellow foam Cascara when shaken) Alcoholism Presence of bile, fever Anticoagulants, fluorescein sodium, phenazopyrizine, phenothiazines Sulfasalazine (with alkaline urine) Anticoagulants, doxorubicin, ibuprofen, phenytoin, salicylates

2) Brown-black

3) Dark yellow 4) Light straw / very pale yellow 5) Orange 6) Orange-yellow 7) Pink 8) Purple 9) Red

Concentrated urine, foods such as carrots Large fluid intake, dilute urine

Appearance

Clear to slightly turbid

Phenothiazines Excessive exercise; foods such as Porphyria, blood Anticoaguklants, cascara (with alkaline urine) deferoxamine beets, rhubarb, blackberries mesylate, doxorubicin, ibuprofen, methyldopa, phenazopyridine, phenolphthalein (n some laxatives), phenothiazines, phenytoin, rifamin, salicylates, senna (with alkaline urine) 10) Red-brown Levodopa, phenytoin 11) Red-orange Rifabutin, rifampin 12) Rust Phenothiazines, sulfonamides 13) Yellow Nitrofurantoin, riboflavin, sulfonamides Cloudy - may be due to the presence of bacteria, fat, red blood cells, or white blood cells; may also be due to change in pH Smoky - may be due to the presence of blood

II. Chemical Examination of Urine using Reagent Strip Methods

Analyte Specific gravity Normal Values Adult: 1.005 - 1.030 (random sample usually 1.015 - 1.025) Elderly: decreased Infant: 1.001 - 1.018 (through 2 years of age) 4.6 - 8.0 with a mean of 5.0 - 6.0 (diet dependent) Variations and Clinical Rationale Increased in: 1) Acute glomeruloneophritis (due to trauma, stress, drugs) 2) Congestive heart failure 9) Liver failure 3) Dehydration, low fluid intake 10) Nephrosis 4) Diabetes mellitus 11) Toxemia of pregnancy 5) Diarrhea 12) Vomiting 6) Excessive fluid loss 13) Drugs: albumin, dextran, glucose, 7) Fever isotretinoin, penicillin, radiopaque 8) Excessive secretion of ADH contrast media, sucrose 1) Bacteriuria 8) Urinary tract infection 2) Chronic renal failure 9) Starvation 3) Fanconis syndrome 10) Foods: most fruits and vegetables 4) Metabolic alkalosis 11) Drugs: acetazolamide, amiloride, 5) Pyloric obstruction antibiotics, potassium citrate, sodium 6) Respiratory alkalosis 12) Long-standing urine 7) Renal tubular acidosis 13) Postprandial alkaline tide 1) Diabetes mellitus 12) Drugs: aceazolamide, amikacin, 2) Emotional stress aminoglycosides, amphotericin B, 3) Exercise aspirin, auranofin, basiliximab, 4) Glomerular nephritis carbamazedine, carvedilil, 5) Malignant hypertension cephalosporins, cisplatin, diazoxide, 6) Multiple myeloma doxorubicin, gold preparations, 7) Orthostatic proteinuria indinavir, lithium, nephrotoxic 8) Pre-eclampsia medications, probenicid, quaternary 9) Premenstrual state ammonium compounds, radiopaque 10) Pyelonephritis contrast media, sulfonamides, 11) Systemic lupus erythematosus venlafaxine 1) Acromegaly 14) Stress 2) Cushings syndrome 15) Trauma involving hypothalamus 3) Diabetes mellitus 16) Drugs: ammonium chloride, 4) Fanconis syndrome asparaginase, carbamazepine, 5) Galactose intolerance corticosteroids, lithium, nicotinic acid, 6) Gestational diabetes phenothaizines, thiazides, diuretics 7) Hyperalimentation 17) Drugs which may cause false 8) Infection positives: cephalosporins, chloral 9) Multiple myeloma hydrate, chloramphenicol, 10) Lowered renal threshold for glucose corticosteroids, indomethacin, (pregnancy) isoniazid, nalidixic acid, nitrofurantoin, 11) Pancreatic disease penicillin, probenicid, streptomycin, 12) Pheochromocytoma sulfonamides, tetracyclines, sugars 13) Proximal tubular dysfunction other than glucose 1) Alcoholism 9) Post-anesthesia 2) Anorexia 10) Pregnancy 3) Diabetes mellitus 11) Starvation 4) Diarrhea 12) Vomiting 5) Fasting 13) Drugs which may cause false6) Fever positives: bromosulfophthalein, 7) High protein diet isoniazid, phenothiazines, levodopa, 8) Hyperthyroidism phenazopyridine, phenolsulfophthalein 1) Acute hepatitis 7) Drugs: acetazolamide, 2) Cirrhosis bromsulfophthalein, cascara, 3) Cholangitis chlorpromazine, phenazopyridine, 4) Hemolytic anemia phenothiazines, sulfonamides 5) Severe ecchymosis 8) False-positive results may occur in 6) Severe infection porphyria and pheochromocytoma 1) Cirrhosis of the liver 4) Drugs which may cause false2) hepatitis positives: phenazopyridine, 3) Obstructive jaundice phenothiazines, salicylates 1) Urinary tract infection 2) Contamination of specimen by inadequate cleansing of external genitalia may cause false-positive results 1) Bacteriuria 2) False-positive results may occur in the presence of vaginal secretions 1) Bacteriuria 2) False-positive results may occur in the presence of Gram-negative bacteria 6) Testicular cancer 7) Drugs which may cause false-positive results: anticonvulsants, 1) 2) 3) 4) 5) 6) Decreased in: ADH deficiency (diabetes insipidus) Chronic pyelonephritis Cystic fibrosis Diuretics High fluid intake Drugs: aminoglycosides, lithium

pH

Protein

Negative

1) Alkaptonuria 8) Renal tuberculosis 2) Dehydration 9) Respiratory acidosis 3) Diabetes mellitus 10) Foods: cranberry juice, eggs, 4) Diarrhea meats, pineapple juice, high5) Fever protein diets 6) Metabolic acidosis 7) Phenylketonuria False-negative results may occur if the urine is highly diluted

Glucose

Negative

Drugs which may cause false-negative results: cancer metabolites (hydroxyindoleacetic acid), hydrogen peroxide (contaminant) Drugs which may cause either false-positive or false negative results: ascorbic acid, homogentisic acid, levodopa, methyldopa, phenazopyridine hydrochloride, salicylates Interferences may occur due to high ketone levels, high specific gravity, and low temperatures

Ketones

Negative

Diets high in fat and protein and low in carbohydrates may alter test results.

Urobilinogen

Negative or 0.1 - 1.0 Ehrlich units/dL

1) 2) 3) 4) 5)

Biliary obstruction Inflammatory disease Renal insufficiency Severe diarrhea Drugs: anitbiotics

Bilirubin Bacteria Leukocyte esterase Nitrates

Negative (routine) No more than 0.2 mg/dL (<0.34 mol/L) Negative Negative Negative

Drugs which may cause false-negative results: ascorbic acid Exposure of the specimen to light may affect test results

Pregnancy test

Positive: pregnant 1) Choriocarcinoma Negative: Nonpregnant 2) Ectopic pregnancy 3) Embryonal carcinoma

False-negative results may occur in the presence of ascorbic acid, tetracycline, and protein False negative results may occur due to presence of yeasts, Gram-positive bacteria, inadequate nitrate levels (diet lacking in green vegetables), large number of bacteria, high specific gravity, antibiotic therapy, freshly voided specimen, or urine withdrawn from a urinary catheter 1) Abortion 2) Fetal demise 3) Threatened abortion

4) Hydatidiform mole 5) Pregnancy

aniparkinsonian agents, hypnotics, tranquilizers (phenothaizines)

False negative results may occur if the test was performed too early in the pregnancy (should be performed no earlier than five days after first missed menstrual period) or in the presence of hematuria and proteinuria

Results should always be interpreted in conjunction with patients medical history, clinical presentation, and other findings.