URINE EXAMINATION

1. Ideal Urine specimen for Urine Examination?

 Routine Examination – First morning sample is ideal, more concentrated,
good in volume. Best for pregnancy test and hormone analysis

2. Indication for urine analysis?

 Suspect renal diseases – Glomerulonephritis, Nephrotic syndrome,

pyelonephritis & renal failure
 Detect UTI
 Detection & management of metabolic disorders - DM
 To evaluate Jaundice
 Diagnosis of pregnancy.
3. What are methods of collection of urine sample?
 24 hours urine sample
 First morning midstream urine sample
 Random sample
 Postprandial urine sample
 Catheterized urine sample - Unconscious patients.
 Infants - Collected in condoms
 Culture - midstream urine
4. What are Ideal preservatives used to preserve urine sample?
 HCL
 Toluene
 Boric acid
 Thymol
Formalin
5. What is average 24 hr urine output?

Adult - 1200-2000 ml

Children – 50 -100 ml per kg body weight.

6. What is polyuria?

Urinary volume >2000ml/24 hr.

7. Conditions causing polyuria?

PHYSIOLOGICAL PATHOLOGICAL
Diuretic therapy Diabetes Mellitus
IV fluids Diabetes Insipidus
Increased intake of water, Chronic renal failure
coffee, alcohol, high salt, protein

8. What is oliguria?

Urinary volume - <400ml/24 hrs.

9. Conditions causing oliguria?

PRE-RENAL RENAL POST RENAL

(Decrease renal blood (Bilateral Ureteral
flow) Obstruction)
Diarrhea Acute glomerulonephritis Stones
Vomiting Tubular necrosis Stricture
Burns Chronic renal failure Blood clot
Hemorrhage Prostatic carcinoma
Anaphylaxis Prostatic hyperplasia
Renal artery Urethral Stricture
Thrombosis
cardiac failure

10. What is anuria?

Urinary output - <100ml/24 hrs. OR complete cessation of urine output

11. What are the conditions causing anuria?

 Shock
 Acute transfusion reaction
 Acute glomerulonephritis
 Hemolytic transfusion reaction
 Urinary tract obstruction
12. What is normal color urine?

Pale yellow/straw color /Amber color – due to presence of Urochrome

pigment

13. Enumerate the different colour changes of Urine with its causes?

Colorless Diabetes insipidus, alcohol

intake
Dark yellow to orange Fever, concentrated Urine,
Starvation
Yellowish brown, green Presence of bilirubin
(Obstructive jaundice)
Dark brown, black Urine Hemoglobinuria, Melanoma
Brown Hemoglobinuria
Brown black Drug intake like cascara
Milky Filariasis
Red Menstruation, hematuria, dyes,
drugs like rifampin

14. Enumerate the conditions causing Red coloured urine?

 Hematuria
 Hemoglobinuria
 Porphyria
 Myoglobinuria

15. Enumerate the conditions causing dark or black coloured urine?

 Alkaptonuria
 Melanoma

16. Enumerate the conditions causing brown coloured urine?

Hemoglobinuria

17. Enumerate the conditions causing yellow coloured urine?

Jaundice
18. Enumerate the conditions causing orange coloured urine?

 Urobilinogen
 Porphobilinogen
 Porphyria

19. Milky-White urine indicates the presence of?

Chyluria

20. What are the physiological and pathological causes of cloudy or turbid
urine?

PHYSIOLOGICAL PATHOLOGICAL
Amorphous phosphates, Amorphous UTI, RBCs, Pus cells, fungus, bacteria,
urates epithelial cells
Carbonate salt Spermatozoa, blood clot, mucus

21. What is the normal odour of urine?

Freshly voided urine - typical aromatic odour due to volatile organic acid.

On standing it will change to ammonical because of decomposition of urea

to ammonia.

22. What are the other abnormal odours, with associated condition?

 Odorless - Acute tubular necrosis.

 Fruity odour - ketoacidosis, starvation.
 Mousy or musty odour – Phenylketonuria
 Fishy odour - UTI [Proteus, Tyrosinemia]
 Ammoniacal odour - UTI [E-coli, long standing urine]
23. Define specific gravity?

 Specific gravity also called as relative mass density

 It depends on amount of solutes in solution
 It is a comparison of density of urine against the density of distilled
water at a particular temperature
 SG of urine is a measure of concentrating ability of kidney and to
determine the tubular function.

24. What is normal SG of urine?

1.015 to 1.025

25. what is SG of distilled water?

1.000

26.What are causes of increased SG of urine?

 Diabetes mellitus
 Nephrotic syndrome
 fever
 dehydration
 Glycosuria, Albuminuria-Acute glomerular nephritis, nephritic
syndrome
 Hematuria, oliguria.

27. What are causes of decrease in SG of urine?

 Diabetes insipidus
 Chronic renal failure
 Compulsive water drinking.
 Chronic glomerulonephritis.

28. What is low or fixed SG of urine?

SG -1.010 due to loss of concentrating ability of tubules.

29. What are the conditions causing fixed SG of urine?

 ADH deficiency
 Chronic nephritis
 End stage renal disease.

30. What are the methods for measuring SG of urine

 Urinometer method
 Refractometer method
 Reagent strip method.

31. What is temperature correction of specific gravity?

Available Urinometer is calibrated at temperature of 25°C. For every 3°C

rise in urine temperature add 0.001 to the reading to correct specific gravity.

32. What is the normal PH of urine?

Urine is acidic PH about 6.

33. Enumerate the causes of high acidic and alkaline urine?

MORE ACIDIC PH < 4 MORE ALKALINE PH

>8
FOOD High protein, meat Vegetables, Citrus fruits
INFECTION E. coli Protease, Pseudomonas
Bacterial Overgrowth
KETOSIS Starvation, fever, Hyperventilation, Milk,
diabetes, respiratory Alkali ingestion
acidosis

34. What is the principle and procedure of Benedict’s test?

Procedure: Take 5ml of Benedic reagent in a test tube, boil it for 2 minutes, add 8
drops of urine and boil it for another 2 minutes. Note the colour change and report
as

1. No change in colour- blue – negative

2. Very pale greenish and slightly cloudy- Trace
3. Cloudy green- 1+ (0.5-1 g%)
4. Yellow to orange precipitate– 2+ (1 – 1.5 g%)
5. Orange to red precipitate– 3+ (1.5-2 g%)
6. Brick red precipitate – 4+ (more than 2 g%)

Principle: On heating, glucose reduces the cupric ions to cuprous oxide in alkaline
media

35. What is the composition of benedict’s reagent?

It is made up of copper sulphate, sodium carbonate, sodium citrate dissolved in

distilled water

1. copper sulphate - It provide cupric ions.

2. sodium carbonate - It provide alkaline media.

3. sodium citrate - It prevent precipitation of cupric ions

36. What is hyperglycemia? What is glycosuria?

Hyperglycemia - When blood glucose > 140 mg/dl

Glycosuria - When the Urine contains detectable glucose. (Only trace amount of
glucose < 15mg/dl passed in urine which is not detectable).

37. What are the causes of glycosuria with and without hyperglycemia?
GLYCOSURIA WITH GLYCOSURIA WITHOUT
HYPERGLYCEMIA HYPERGLYCEMIA
Pregnancy, DM, Cushing’s syndrome, Pregnancy, renal glycosuria or fanconi
IV glucose infusion, intracranial syndrome
hemorrhage & tumors, thyrotoxicosis,
pancreatic diseases (Pancreatitis,
hemochromatosis, cystic fibrosis),
drugs intake like steroids, OCPs

38. False positive conditions- benedict’s test?

False positive reaction can be due to presence of other reducing

substance in urine such as ascorbic acid (during intake of vitamin supplements),
drugs(leuodopa), Alkaptonuria.
39. What test is commonly done in our laboratory to identify the chemical
constituents of urine?

Reagent strip test

40. Is Benedict test specific for urine glucose?

No, benedict test is not specific

41. Which test is specific for urine glucose?

Reagent strip test

42. Is Benedict test a qualitative or Quantitative test?

Benedict test is qualitative test

43. What are ketone bodies? How are they produced?

Acetone, acetoacetic acid, Beta Hydroxybutyrate.

Fatty acid

acetoacetate

AcetoneBeta Hydroxybutyrate

44. What are the causes of ketonuria? What is it significant?

DKA (diabetic ketoacidosis)

Type 1 DM

Fever, starvation, severe Exercise, vomiting, hyperemesis gravidarum, Post

anesthetic, low carbohydrate intake, storage disorders.

45. What is the principle and procedure of Rothera’s test?

PROCEDURE:

5ml of urine taken in test tube and saturate it with ammonium sulphate or
chloride.

Few drops of sodium Nitroprusside are added and shaken to mix.

5 ml of liquor ammonia (ammonium hydroxide) is added from the side.

Purple coloring at the function of 2 layer indicates test is positive.

PRINCIPLE:

In alkaline media sodium Nitroprusside will form purple colour complex

with acetone and acetoacetic acid.

46. Describe the procedure of heat and acetic acid test?

Fill ¾ th of a clean test tube with urine sample. Heat the upper portion of the test
tube cloudiness in the upper portion of the test tube indicate positive result.

47.Why should we heat upper 1/3 rd?

 Lower portion will act as a control.

48. What is the advantage and disadvantage of this method?

Advantage- It is simple and economical test.

Disadvantage- More amount of urine is needed. Specific type of protein is

not made out.

49. What are the causes of proteinuria?

Normally there is very scanty amount of protein in urine (<150 mg/day)

PHYSIOLOGICAL PATHOLOGICAL

Cold bath, exercise, Mild (0.5g/day)- Fever, trauma, Eclampsia.

heavy protein diet, Moderate(0.5-3 g/day)- CCF, Diabetics,
pregnancy, prolonged pyelonephritis, pre eclampsia cystitis, Urethritis,
standing and walking chronic glomerulonephritis
Severe(>3g/dl)-nephrotic syndrome, UTI, acute
glomerulonephritis, heavy metal poisoning, TB
Kidney, malignant hypertension, rapidly progressive
GN.

50. What are Bence jones proteins? How will you demonstrate them?

It is free light chain of Immunoglobulins. It is a low molecular weight protein seen

in multiple myeloma and plasmacytoma. It is demonstrated in heat and acetic acid
test. This protein precipitates between 50-60 °C. It dissolves on further heating. It
has less sensitivity and specificity. Used only for screening purpose.

51. What are the methods to estimate urine protein?

  Heat and acetic acid test.
 Sulfosalicylic test -Positive for different protein
 Dip stick test- Positive only for albumin
 Eshbach’s method
 Heller’s nitric acid test.

52. What is microalbuminuria?

Excretion of 2-20mg/dl of albumin. It is indicative of early and possible

reversible glomerular damage.

53.What are bile pigments?

The bile pigments are bilirubin and its derivatives (urobilinogen, biliverdin
& urobilin). They are formed from hemoglobin, conjugated in the liver
secreted in the bile, excreted in urine and stool.

Normally 0-4mg of bile pigment is excreted in urine/day.

Its excretion increased in hepatic and obstructive jaundice, hemolytic

jaundice.

54. Procedure and principle of fouchet’s test (Harrison test)?

Test- Fouchet’s test- ferric chloride in fouchet’s reagent oxidizes yellow

coloured bilirubin to green biliverdin.

55. Enumerate the conditions where bile pigments are detected in urine?

Hepatic and obstructive jaundice, hemolytic jaundice, parenchymal liver

diseases, hemolytic anemia.

56. False positive and false negative test- Fouchet’s test?

False positive – Aspirin metabolites.

False negative - ascorbic acid, high level of nitrates, oxidation of bilirubin.

57. What are bile salts?

 Sodium taurocholate, sodium glycocholate, cholic acid, chenodeoxycholic
acid.

They are synthesized from cholesterol in liver. They are secreted into
duodenum for lipid absorption.

58. Describe Hay’s test? What is the principle of Hay’s?

Procedure: Take 2 ml of fresh urine in test tube. Sprinkle a pinch of day

Sulphur powder on it. Sinking of the sulphur indicates presents of bile
salts.

Principle-bile salts reduce the surface tension of urine for sulphur.

59. Enumerate the conditions where bile salts are detected in urine?

Obstructive jaundice, presence of bile salts in the blood causes severe

body itching.