Clin Mic: Physical Examination in Urine (Lec 3)

Physical, chemical, microscopic

Urinalysis is the ____________, ______________, and ___________ examination of urine

1) Urine color

2) Clarity

3) Specific gravity

4) Odor

The physical examination of urine includes the determination of?

Odor

Is seldom of clinical significance and is not part of the routine urinalysis, yet is still a noticeable physical property

Color & Clarity

Early physicians base many medical decisions on the _________ and __________ of urine.

1) Glomerular bleeding

2) Liver disease

3) Inborn errors of metabolism

4) UTI (Urinary Tract Infection)

Today, physical examination of urine provides preliminary information to patients with the disorders such as?

Renal tubular function

Measurement of specific gravity will also evaluate _________?

True

TRUE OR FALSE

Physical evaluation of urine is only the preliminary information of the urinalysis because the results of the physical portion of the urinalysis can also be used to confirm or explain findings in the chemical and microscopic areas of urinalysis

False

TRUE OR FALSE

You CAN diagnose any condition or pathologic condition right away just by only doing the physical examination

1) Normal Metabolic Functions

2) Physical Activity

3) Ingested Materials

4) Pathologic condition

Variation of Urine color

Darker

If there is an increase of specific gravity, what will be the color of the urine?

Paler

If there is a decrease of specific gravity, what will be the color of the urine?

Diabetes Mellitus

When there is pale yellow colored urine but increased specific gravity, it is a characteristic of a urine sample of a the patient with __________?

Polyphagia, Polydipsia, Polyuria

3 P's Symptoms of Diabetes Mellitus

Polyphagia

Excessive hunger

Polydipsia

Excessive thirst

Polyuria

Excessive urination

Urochrome

Pigment that causes yellow color of urine

Thudichum

Who named the pigment 'Urochrome' in 1864?

Constant rate

Under normal body conditions, the body produces urochrome at a _____________?

Pale yellow

Dilute urine

Dark yellow

Concentrated urine

thyroid conditions, fasting state

Urochrome is increased in ____________________, also in _________________

Chronic Renal Failure

Patients with _________________ have decreased excretion of the urochrome

Uroerythrin

A pink pigment, most evident in specimens that have been refrigerated, resulting in the precipitation of amorphous urates

Urobilin

Oxidation product of the normal urinary constituent urobilinogen, imparts an orange-brown color to urine that is not fresh

colorless to deep yellow

The normal color of urine

Colorless

Urine color when there's recent fluid consumption

Pale yellow

Urine color that can be a sign of diabetes mellitus or diabetes insipidus

insulin resistance

Diabetes mellitus is due to _______________?

Diabetes insipidus

there is a decreased production of ADH (Antidiuretic hormone)

True

TRUE OR FALSE

In diabetes insipidus, glucose is within the normal range.

Hepatitis virus

A urine specimen that contains bilirubin may also contain ________?

Bilirubin

With abnormal urine color (dark yellow/amber/orange), it can signify the presence of an abnormal pigment called ____________?

Yellow-orange specimen

Frequently encountered in the urinalysis laboratory; caused by the administration of phenazopyridine

Shaking the urine vigorously

Another physical test to differentiate whether the urine is normal or abnormal

Proteins

Large white foam : increased concentration of ______________?

Yellow orange urine

The photooxidation of large amounts of excreted urobilinogen to urobilin also produces a ________________?

Biliverdin

The photooxidation of bilirubin imparts a yellow-green color to the urine, which is caused by the presence of ______________?

Phenazopyridine

Specimens containing ______________ produce a yellow foam when shaken so which could be mistaken for bilirubin.

Presence of blood

Most common cause of abnormal urine color

Brown urine

Produced when RBC's remain in an acidic urine for several hours due to the oxidation of your hemoglobin to methemoglobin

Fresh brown urine

A fresh brown urine containing blood may also indicate _______________ resulting from the conversion of hemoglobin to methemoglobin

Hemoglobin and Myoglobin

They produce red urine and they are positive in the chemical test results for blood.

RBC

When urine appears RED AND CLOUDY, what is present

Hemoglobin and Myoglobin

When urine appears RED BUT CLEAR, what is present?

Melanin

is an oxidation product of the colorless pigment melanogen produced in excess when a malignant melanoma or a skin cancer is present.

Homogentisic acid

is a metabolite of phenylalanine also this imparts black color to an alkaline urine from persons with an inborn error of metabolism called alkaptonuria

Alkaptonuria

otherwise known as your black urine disease, is a very rare inherited disorder that prevents the body from fully breaking down two protein building blocks or amino acids, what we call the tyrosine and phenylalanine

Alkaptonuria

the urine gets black upon becoming

upon alkaline

1) Levodopa

2) Meghyldopa

3) Phenol derivatives

4) Metronidazole (Flagyl)

Medications producing brown/black urine include?

1) Clorets

2) Indican

3) Methylene Blue

4) Phenol-Green

Substances that can cause blue/green urine

Purple staining

may occur in catheter bags and is caused by indican in the urine or a bacterial infection, frequently caused by Klebsiella or Providencia species

Indican

is an indole, it is a byproduct made by the bacteria in the intestines when they break down a specific amino acid called tryptophan

Alcohol, ethyl

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Pale yellow or colorless

Amitriptyline (Elavil)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Blue-green

Anthraquinone laxatives (senna, cascara)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Reddish, alkaline; yellow-brown, acid

Chlorzoxazone (Paraflex) (muscle relaxant)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Red

Deferoxamine mesylate (Desferal) (chelates iron)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Red

Ethoxazene (Serenium) (urinary analgesic)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Orange, red

Fluorescein sodium (given intravenously)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Yellow

Furazolidone (Tricofuron) (an antibacterial, nitrofuran)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Brown

Indigo carmine dye (renal function, cystoscopy)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Blue

Iron sorbitol (Jectofer) (possibly other iron compounds forming iron sulfide in urine)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Brown on standing

Levodopa (I-dopa) (for parkinsonism)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Red then brown, alkaline

Mepacrine (Atabrine) (antimalarial)

URINE COLOR CHANGES W/ COMMONLY USED DRUGS:

Yellow

Methocarbamol (Robaxin)

muscle relaxant; green-brown

Methyldopa (Aldomet)

antihypertensive; Darken; if oxidizing agents present, red to brown

Methylene blue

used to delineate fistulas; Blue, Blue-green

Metronidazole (Flagyl)

for Trichomonas infection, amebiasis, Giardia ; Darkening, reddish brown

Nitrofurantoin (Furadantin)

antibacterial; Brown-yellow

Phenazopyridine (Pyridium)

urinary analgesic, also compounded with sulfonamides (Azo-Gantrisin) ; Orange-red, acid pH

Phenindione (Hedulin)

anticoagulant ; Orange, alkaline; color disappears on acidifying

Phenol poisoning

Brown; oxidized to quinones (green)

Phenolphthalein (purgative)

Red-purple, alkaline pH

Phenolsulfonpht halein (PSP, also BSP)

Pink-red; alkaline pH

Rifampin(Rifadin, Rimactane)

(tuberculosis therapy) ; bright orange-red

Riboflavin

multivitamins ; bright yellow

Sulfasalazine (Azulfidine)

for ulcerative colitis ; Orange-yellow, alkaline pH

Clarity

the transparency or the turbidity of a urine specimen

Clear

No visible particulates, transparent

Hazy/Slightly Cloudy

Few particulates, print easily seen through urine

Cloudy

Many particulates, print blurred through urine

Turbid

Print cannot be seen through urine

Clear

Possible causes (Urine Clarity):

1) All solutes present are soluble

2) Possibility of an abnormal solute such as glucose,proteins, (albumin, hemoglobin, myoglobin), or bilirubin is not ruled out

Hazy/Slightly Cloudy

Possible causes (Urine Clarity):

Clarity varies with the substance and the amount present: (Blood cells - RBC's, WBC's)

Cloudy

Possible causes (Urine Clarity):

1) Crystals of normal or abnormal solutes

2) Epithelial cells

3) Fat (Lipids, chyle)

4) Microbes (bacteria, yeast, trichomonads)

Turbid

Possible causes (Urine Clarity):

Mucus, mucin, pus Radiographic contrast media, Semen, spermatozoa, prostatic fluid

Contaminants:

Feces, powders, talc, creams, lotions

Milky

Urine clarity where it may be precipitate or be clotted

Nubecula

Faint clouds in urine after standing, due to white blood cells, epithelial cells and mucus

RBC's, WBC's, and Bacteria

The most commonly encountered pathologic causes of turbidity in a fresh specimen, which is caused by infection or systemic organ disorder

Normal amounts of:

1) Non squamous epithelial cells

2) Yeast

3) Abnormal crystals

4) Lymph fluid

5) Lipids

These are less frequently encountered causes of pathologic turbidity

True

TRUE OR FALSE

Clear urine is not always normal

Acidic urine

LABORATORY CORRELATIONS IN URINE TURBIDITY:

Amorphous urates, radiographic contrast media

Alkaline urine

LABORATORY CORRELATIONS IN URINE TURBIDITY:

Amorphous phosphates, carbonates

Soluble with heat

LABORATORY CORRELATIONS IN URINE TURBIDITY:

Amorphous urates, uric acid crystals

Soluble in dilute acetic acid

LABORATORY CORRELATIONS IN URINE TURBIDITY:

RBC's, amorphous phosphates, carbonates

Insoluble in dilute acetic acid

LABORATORY CORRELATIONS IN URINE TURBIDITY:

WBC's, bacteria, yeast, spermatozoa

Soluble in ether

LABORATORY CORRELATIONS IN URINE TURBIDITY:

Lipids, lymphatic fluid, chyle

Amorphous phosphates and carbonates

Produce a white precipitate in urine with an alkaline pH

Amorphous urates

Produce a precipitate in acidic urine that resembles pink brick dust due to the presence of uroerythrin