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NORMAL VALUES:
Ph: 4.5-8.0
Negative for: bilirubin, blood, acetone, glucose, protein, nitrite, leukocyte esterase, reducing
substances
Trace: bilirubin
WBC: 0-4/hpf
Bacteria: none
APPEARANCE:
Blood (Hematuria): if the dipstick is positive for blood, but no red cells seen, free Hbg may
be present or myoglobin
Positive: stones, trauma, tumors, BPH, Urethral stricture, coagulopathy, infection,
menses, polycystic kidneys, interstitial nephritis, hemolytic anemia, transfusion
reaction, instrumentation
Glucose: glucose oxidase technique in most kits is specific for glucose and does not react
with lactose, fructose, or galactose; therefore screen infant urine with another assay such
as Clinitest.
Glucose
Ketones: used primarily to detect acetone and acetoacetic acid but not betahydroxybutyric acid
Positive: Starvation, high fat diet, DKA, vomiting, diarrhea, hyperthyroidism, Febrile
state (esp. in children), aspirin overdose; false positive: some Parkinson
medications, cystinurai, stimulant laxative
Leukocyte Esterase: used to detect 5 WBCs/ hpf or lysed WBCs. Combined with the
nitrite test, leukocyte esterase has a positive predictive value of >97%if both tests are
negative. May not be reliable in children with UTI.
Odor: (limited utility: strong ammonia smell suggests UIT, asparagus consumption)
Ph
Acidic: High protein diet, ammonium chloride, mandelic acid and other medications,
acidosis
Basic:UTI, RTA, diet, sodium bicarbonate therapy, vomiting, metabolic alkalosis
Protein: Proteinuria in dipstick shoul be quantified with 24-h urine studies. Normal protein
excretion is <150 mg/hr or 10 mg/100ml in a spot specimen
Positive: pyelonephritis, glomerulonephritis, glomerular sclerosis, nephrotic
syndrome, myeloma, postural causes, preeclampsia, inflammation and malignant
diseases of the lower urinary tract, functional causes (fever, stress, heavy exercise),
malignant hypertension, CHF
SPECIFIC GRAVITY
Increased: volume depletion, CHF, Adrenal insufficiency, DM, SIADH, increased
proteins, newborn state, artifact or recent administration of readiographic contrast
media
Decreased: diabetes insipidus, pyelonephritis, glomerulonephritis, waterload with
normal renal function
Urobilinogen:
Urine sediments:
RBCs: trauma, pyelonephritis, geniturinary TB, cystitis, prostatitis, tumors,
coagulopathy, and any cause of blood on dipstick test
WBCs :infection anywhere in the urinary tract, TB, renal tumors, acute
glomerulonephritis, radiation, interstitial nephritis
Epithelial cells: ATN, necrotizing papillitis,
Parasites: T. vaginalis, S. haematobium
Crystals:
Normal
Acidic urine: calcium oxalate, uric acid
Contaminants: cotton threads, hair, wood fibers, amorphous substances; dirty urine may
suggest enterovesical fistula
Casts:
Hyaline: acceptable unless numerous, benign hypertension, nephrotic syndrome,
after exercise
Rbc casts: agn, lupus nephritis, goodpasture disease, aftermath strep infection,
vasculitis, malignant hypertension
WBCs: pyelonephritis, acute interstitial nephritis, glomerulonephritis
Epithelial/ tubular casts: tubular damage, nephrotoxin, virus
Granular casts: breakdown of cellular casts, leads to waxy casts; dirty brown
granular casts- ATN
Waxy casts: all cellular casts can become waxy casts, severe chronic disease,
amyloidosis
Fatty casts: nephrotic syndrome, DM, damaged renal tubular epithelial cells
Broad casts: chronic renal disease