Urinalysis

II. URINE PHYSICAL PROPERTIES A. Physical Properties a group of extremely simple and useful observations 1. Importance a. b. Gives clues to subsequent findings Abnormal physical properties can dictate the need for additional tests not always included in routine UA

2.

Volume - not usually recorded except for timed (24hr) quantitave tests. Volume depends on the body's state of dehydration. Influenced by fluid intake, loss by non renal sources (sweat, fever, vom iting, diarrhea), ADH secretion, increased need to secrete large amounts of glucose or salts.

a. b.

Normal = 600-1600 ml/24 h our (produce 2 -3 tim es m ore during d ay th an nigh t) Polyuria constant elimination of abnormally large amounts of urine

c. d.

Diuresis an y increa se in vo lume, eve n if tempora ry Oliguria decrease in volume

e.

Anuria absence of urine formation

f.

Nocturia excretion of urine at night

g. Q NS - quantity not sufficient.

3.

Color a. b. c. Varies with concentration Listed as: straw, light yellow, yellow, dark yellow, and amber Ca use d by a m ixture of the following pigments 1) 2) Uro chrom e yellow p igment (predominan t) Uroerythrin red pigment
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3) d. Urobilin orange-red pigment

Abnorm al urine colors 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) Ve ry pale Brow n bile or b ilirubin Oran ge-red increa sed urob ilin Cle ar red hem oglobin or myoglobin Clo udy red intact red cells Port wine porphyrins Cola m yoglobin and o thers Black melanin and hom ogentisic a cid Bizarre i.e., g ree ns, blues can be due to drug s and chem icals Am ber - possible bile or bilirubin, ofte n asso ciated with hepatitis

4.

Transparency a. b. c. Clear normal Cla ssifications: clear, slightly hazy, hazy, cloudy, very cloudy, turbid Causes 1) 2) 3) 4) 5) Mucin Amorphous crystalline material Pu s and bacteria Ce lls Other substances

5.

Odor - not normally reported out a. No rmal aro matic

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b. c. Amm onia from bacterial breakdown of urea Others sweet, fruity, map le syrup, mousy, etc.

6.

Foam - not reported out a. b. White foam possible prote in Ye llow foam m ay be due to bile/bilirubin

7.

Sp ecific Gravity (Concentration of D isso lved S olutes) - m easure o f the kidney's ability to reabsorb water and che micals. a. Definition: Relation of the weight of a solution to the weight of an equal volum e of w ater at a given tem pera ture 1) 2) A measure of the density of a solution Describes the weight of a solution as compared to the weight of an equal volum e of distilled w ater at the same tempera ture Water is used as the point of reference and is assigned the value of 1.000 (sp. gr. is a ratio and has no un its) Addition of solutes (electrolytes, urea, etc.) incre ase sp. gr.

3)

4) b.

Normal value 1) 2) 3) 4) Overall 1.015 - 1.025 First morning specimens greater than 1.020 Kidneys are capable of 1.001-1.030 Isosthenuria - specific gravity is fixed at 1.010

c.

Clinical significance 1) Osm otic pressure Sp. gr. is a means o f assessing kidne ys ability to regu late osmo tic pressure Kidney function State of hydration

2) 3)

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4) Oliguria severe dehydration

acute rena l failure

5)

Diabetes insipidus (not to be confused w ith diabetes m ellitus) Deficiency of ADH (antidiure tic hormone, vasopressin). Patien ts excrete very large volumes of dilute, low specific gravity urine.

d.

Measurement 1) Urinometer - rarely used a) b) Also called a hydrometer A floating device with a m ercury we ight in its bottom and an air bulb with a graduate stem a bove The float displaces a certain weight and the level to wh ich it sinks is a m easure of spe cific gra vity The pro blem with rou tinely using the urinometer for sp ecific gravity is that (in addition to the volume of urine it requires) it may require corrective calculations for temperature, increased amounts of glucose and prote in The following is a summ ary of the information concerning these calculations (1) Tem perature most urinom eters are ca librated at 20C (a) For every 3C below the calibration temperature, you must subtract 0.001 from the reading (b) For every 3C above the calibration temperature, you add 0.001 to the reading

c)

d)

e)

(2) Protein Every gram of protein will cause the urinom eter to read 0.003 higher than it is supposed to read. Therefore, you must subtract the 0.003 amount for each gm /dl of pro tein dem onstrated by the dipstick

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(3) Glucose Each gram of glucose causes the urinometer to read 0.004 higher than it is supposed to read. So aga in, you must subtract the amount (0.004) from the original rea ding to obtain a corrected specific gravity result

2)

Refractom eter (total solids o r TS me ter) a) Measures den sity of solutions by their refractive index - compares the velocity of light in air vs velocity of light in solution. Depends on the concentration of dissolved substance s.

b)

Advantages - small volume need ed, less interference

3)

Osmometer

a)

Not routinely used

b) c)

Measurement is a function of the number of dissolved particles Two types (1) Vapor pressure depression (2) Freezing point depression - most common

d)

Values are reported in milliosmo les/kg Norm al for serum = 275 - 300 mO sm/kg Normal for urine = no set normals. The ratio of serum to urine is more important and sho uld b e 1:1

4)

Urine dipstix with spe cific gravity Mo st comm on m ethod used today. The polyelectrolytes in the reagent area con tain acid groups which dissociate according to the ionic concentration of the specimen. Bromthymol blue measures the pH change.

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