Urine Analysis

Urine Analysis Diploma of Biochemical Analysis 2007/2008
Urine Analysis
The kidneys continuously form urine. It is actually an ultrafiltrate of plasma from which
glucose, amino acids, water and other substances essential to body metabolism have
been reabsorbed. The physiologic process by which approximately 170,000ml of filtered
plasma is converted to the average daily urine output of 1200ml is complex. Blood
chemistry, blood pressure, fluid balance and nutrient intake, together with the general state
of health, are key elements in this entire metabolic process.
Urine Constituents:
Normal urine is actually a highly complex aqueous solution of organic and inorganic
substances. The majority of the constituents are either waste products of cellular
metabolism or products derived directly from certain foods that are eaten. The total
amount of solids in a 24-hour urine sample averages around 60 g. Of this total, 35 g are
organic and 25 g are inorganic.
Organic substances: Urea, a metabolic waste product produced in the liver from the
breakdown of protein and amino acids, accounts for almost half of the total dissolved
solids in urine. Other organic substances include primarily creatinine and uric acid.
Inorganic solids: The major inorganic solid dissolved in urine is chloride, followed by
sodium and potassium. Small or trace amounts of many additional inorganic chemicals
are also present in urine.
Hormones, vitamins and medications.
Others: Although they are not a part of the original plasma filtrate, the urine may also
contain formed elements such as cells, casts, crystals, mucus and bacteria. Increased
amounts of these formed elements are often indicative of disease.
Some normal urine constituents excreted (in g/24 hours)

Urea 25-30 Potassium 2-4
Uric acid 0.6-0.7 Calcium 0.2-0.3
Creatinine 1.0-1.2 Magnesium 0.1
Hippuric acid 0.7 Chloride 7
Ammonia 0.7 Phosphate 1.7-2.5
Amino acids 3 Sulfate 1.8-2.5
Sodium 1-5 (NaCl 15.0)
Mohammed Al-Gayyar -1-

Urine collection:
Clean-catch, midstream urine specimen collected after cleansing the
external urethral. A cotton sponge soaked with benzalkonium
hydrochloride is useful and non-irritating for this purpose. A
midstream urine is one in which the first half of the bladder urine is
discarded and the collection vessel is introduced into the urinary
stream to catch the last half. The first half of the stream serves to
flush contaminating cells and microbes from the outer urethra prior to
collection.
Catherization of the bladder through the urethra for urine
collection is carried out only in special circumstances, i.e., in a
comatose or confused patient. This procedure risks introducing
infection and traumatizing the urethra and bladder, thus producing
iatrogenic infection or hematuria.
Suprapubic transabdominal needle aspiration of the bladder. When done under ideal
conditions, this provides the purest sampling of bladder urine. This is a good method
for infants and small children.
Urine specimens:
Random collection: it is taken at any time of day with no precautions regarding
contamination.
Early morning collection: it is collected before ingestion of any fluid. This is usually
hypertonic and reflects the ability of the kidney to concentrate urine during dehydration,
which occurs overnight. If all fluid ingestion has been avoided since 6 p.m. the previous
day, the specific gravity usually exceeds 1022 in healthy individuals.

Second-voided specimen: First sample after the first void of the day. It may contain
cells that are destroyed during stasis in the bladder while the patient sleeps and
therefore not seen in the first morning specimen.
Post prandial collection: At a timed interval (for example, two hours) after the patient
has eaten. This is the best sample for confirming the presence of elevated
urobilinogen. May also be used to detect glucose.
Day specimen: Usually collected from 9:00 a.m. to 8:00 p.m. Used for quantitative
determinations of analytes that may undergo a diurnal variation or be diet dependent.
Night specimen: Usually collected from 8:00 p.m. to 8:00 a.m. Used for quantitative
determinations of analytes that may undergo a diurnal variation or be diet independent.
Timed: Requires collection at certain time as 2 hour volume and 24 hour volume.

Routine urinalysis (UA) and related tests

Urinalysis is an essential procedure for patients undergoing hospital admission or physical
examination. It is a useful indicator of a healthy or diseased state and has remained an
integral part of the patient examination. Two unique characteristics of urine specimens can
account for this continued popularity:
1. Urine is a readily available and easily collected specimen.
2. Urine contains information about many of the body's major metabolic functions and this
information can be obtained by simple laboratory tests.
General characteristics Chemical determinations Microscopic examination

Colour: pale yellow to amber Glucose: negative Casts negative: occasional hyaline casts
Appearance: clear to slightly hazy Ketones: negative Red blood cells: negative or rare
Specific gravity: 1.005–1.025 with a normal Blood: negative Crystals: negative (none)
fluid intake
pH: 4.5–8.0; average person has a pH of Protein: negative White blood cells: negative or rare
about 5 to 6
Volume: 600–2,500 ml/24 h; average 1200 Bilirubin: negative Epithelial cells: few; hyaline casts 0–1/lpf
ml/24 h (low-power field)
Urobilinogen: 0.5–4.0 mg/d
Nitrate for bacteria: negative
Urine strips:
They are plastic strips to which chemically specific reagent pads are applied to the coating.
The reagent pads react with the sample urine to provide a standardized visible colour
reaction within 30 seconds to one minute depending on the specific panel screen. Urine
analysis by strips depends on the following procedure:
1. Mix the urine to be tested by inverting the sample several times.
2. Completely immerse all reagent areas of the strip briefly but completely in the urine.
3. Remove excess urine by drawing the strip across the top of the container or pressing
the edge of the strip against an absorbent paper.
4. Compare test areas closely with corresponding colour charts on the bottle label at the
times specified. Hold strip horizontally and close to the colour blocks.

General characteristics
1- Urine Volume
Urine volume measurements are part of the assessment for fluid balance and kidney
function. The normal volume of urine voided by the average adult in a 24-hour period
ranges from 600 to 2500 ml; the typical amount is about 1200 ml. The amount voided over
any period is directly related to the individual's fluid intake, the temperature and climate,
and the amount of perspiration that occurs. Children void smaller quantities than adults do,
but the total volume voided is greater in proportion to their body size.
The volume of urine produced at night is <700 ml, making the day-to-night ratio
approximately 2:1 to 4:1.
Clinical Implications:
1. Polyuria (increased urine output) with elevated blood urea nitrogen (BUN) and
creatinine levels: Diabetic ketoacidosis and Partial obstruction of urinary tract
2. Polyuria with normal BUN and creatinine: Diabetes mellitus, diabetes insipidus and
Certain tumors of brain and spinal cord.
3. Oliguria (<200 ml in adults, or <15–20 ml/kg in children, per 24 hour)
Renal causes: Renal ischemia, Renal disease due to toxic agents (certain drugs are
toxic to the renal system) and Glomerulonephritis
Dehydration caused by prolonged vomiting, diarrhea or burns
Obstruction (mechanical) of some area of the urinary tract or system
Cardiac insufficiency
4. Anuria (<100 ml in 24 hours)
Complete urinary tract obstruction
Glomerulonephritis (acute, necrotizing)
Acute tubular necrosis
Hemolytic transfusion reaction
Interfering Factors:
1. Polyuria
Intravenous glucose or saline
Pharmacologic agents such as thiazides and other diuretics
Coffee, alcohol, tea and caffeine
2. Oliguria
Water deprivation, dehydration
Excessive salt intake

2- Urine Appearance
Fresh urine is clear to slightly hazy. Cloudy urine signals a possible abnormal constituent,
such as white blood cells (WBCs), RBCs or bacteria.
On the other hand, excretion of cloudy urine may not be abnormal
because a change in urine pH can cause precipitation, within the
bladder, of normal urinary components. Alkaline urine may appear
cloudy because of phosphates; acid urine may appear cloudy
because of urates.
1. Pathologic urines are often turbid or cloudy.
2. Urine turbidity may result from urinary tract infections (UTIs).
3. Urine may be cloudy because of the presence of RBCs, WBCs, epithelial cells or
bacteria.
1. After ingestion of food, urates, carbonates, or phosphates may produce cloudiness in
normal urine on standing.
2. Semen or vaginal discharges mixed with urine are common causes of turbidity.
3. Fecal contamination causes turbidity.
4. Extraneous contamination (eg, talcum, creams) can cause turbidity.
5. “Greasy” cloudiness may be caused by large amounts of fat.
6. Often, normal urine develops a haze or turbidity after refrigeration or standing at room
temperature because of precipitation of crystals of calcium oxalate or uric acid.
3- Urine Colour
The yellow colour of urine is caused by the presence of the pigment urochrome, a product
of metabolism that under normal conditions is produced at a constant rate.
Urine specimens may vary in colour from
pale yellow to dark amber. Variations in the
yellow colour are related to the body's state
of hydration. The darker amber colour may
be directly related to the urine concentration.

1. Almost colourless (straw-coloured) urine: Large fluid intake, Untreated diabetes
mellitus, Diabetes insipidus, Alcohol and caffeine ingestion and Diuretic therapy.
2. Orange-coloured (amber) urine:
Concentrated urine caused by fever, sweating reduced fluid intake, or first morning
specimen
Bilirubin (yellow foam when shaken)
Carrots or vitamin A ingestion (large amounts)
Certain urinary tract medications (eg, phenazopyridine, nitrofurantoin)
3. Brownish-yellow or greenish-yellow urine: may indicate bilirubin in the urine that
has been oxidized to biliverdin (greenish foam when shaken).
4. Green urine: Pseudomonal infection, Indican and Chlorophyll.
5. Pink to red urine: RBCs or Porphyrins
6. Brown-black urine:
RBCs oxidized to methemoglobin
Homogentisic acid (alkaptonuria)
7. Smoky urine may be caused by RBCs.
8. Milky urine: is associated with fat, cystinuria, many WBCs or phosphates (not
pathologic).
1. Normal urine colour darkens on standing because of the oxidation of urobilinogen to
urobilin. This decomposition process starts about 30 minutes after voiding.
2. Some foods cause changes in urine colour:
Beets turn the urine red.
Rhubarb can cause brown urine.
3. Many drugs alter the colour of urine:
Cascara and senna laxatives in the presence of acid urine turn the urine reddish
brown; in the presence of alkaline urine, they turn the urine red.
Bright-yellow colour in alkaline urine may be a result of riboflavin or
phenazopyridine.
Urine that darkens on standing may indicate antiparkinsonian agents such as
levodopa.
Black urine may be caused by cascara, chloroquine, iron salts (ferrous sulfate,
ferrous fumarate, ferrous gluconate), metronidazole, nitrofurantoin, quinine or
senna.

Blue urine may be caused by triamterene.
Blue-green urine may be caused by amitriptyline, methylene blue or mitoxantrone.
Orange urine may be caused by heparin, phenazopyridine, rifampin, sulfasalazine
or warfarin.
Red-pink urine may be caused by chloroxazone, daunorubicin, doxorubicin,
heparin, ibuprofen, methyldopa, phenytoin, rifampin or senna.
Pink to brown urine may be caused by laxatives.
Brown urine may be caused by chloroquine, furazolidone or primaquine.
Green urine may be caused by indomethacin.
4- Urine Odour
Normal, freshly voided urine has a faint odour owing to the presence of volatile acids. It is
not generally offensive. Although not part of the routine UA, abnormal odours should be
noted.
1. The urine of patients with diabetes mellitus may have a fruity (acetone) odour because
of ketosis.
2. Bacteria result in foul-smelling urine due to urea splitting to form ammonia.
3. The urine of infants with an inherited disorder of amino acid metabolism known as
“maple syrup urine disease” smells like maple or burnt sugar.
4. Cystinuria and homocystinuria result in a sulfurous odour.
5. Tyrosinemia is characterized by a cabbage-like or “fishy” urine odour.
1. Some foods, such as asparagus, produce characteristic urine odours.
2. Bacterial activity produces ammonia from the decomposition of urea, with its
characteristic pungent odour.
5- Urine pH
The pH is an indicator of the renal tubules'
ability to maintain normal hydrogen ion
concentration in the plasma and
extracellular fluid. The pH of normal urine
can vary widely, from 4.6 to 8.0. The
average pH value is about 6.0 (acidic).

1. Acidic urine (pH < 7.0) occurs in:
Metabolic acidosis, diabetic ketosis, diarrhea, starvation and uremia
Respiratory acidosis (carbon dioxide retention)
Renal tuberculosis
2. Alkaline urine (pH > 7.0) occurs in:
Renal tubular acidosis and chronic renal failure
Metabolic acidosis (vomiting)
Respiratory alkalosis involving hyperventilation (“blowing off” carbon dioxide)
Potassium depletion
1. With prolonged standing, the pH of a urine specimen becomes alkaline because
bacteria split urea and produce ammonia.
2. Sodium bicarbonate, potassium citrate and acetazolamide may produce alkaline urine.
3. Urine becomes alkaline after eating because of excretion of stomach acid; this is
known as the “alkaline tide”.
6- Specific gravity (SG)

Specific gravity is a measurement of the kidneys' ability to concentrate urine. It compares
the density of urine against the density of distilled water, which has an SG of 1.000.
Because urine is a solution of minerals, salts and compounds dissolved in water, the SG is
a measure of the density of the dissolved chemicals in the specimen. As a measurement
of specimen density, both the number of particles present and the size of the particles
influence SG.
Reference values:
Normal hydration and volume: 1.010 and 1.025
Concentrated urine: 1.025–1.030+
Dilute urine: 1.001–1.010
Infant < 2 years old: 1.001–1.018
1. Normal SG: SG values usually vary inversely with the amount of urine excreted
(decreased urine volume = increased SG). However, this relationship is not valid in
certain conditions, including:
Diabetes—increased urine volume, increased SG
Hypertension—normal volume, decreased SG
Early chronic renal disease—increased volume, decreased SG
2. Hyposthenuria (low SG, 1.001–1.010): occurs in the following conditions:
Diabetes insipidus (low SG with large urine volume). It is caused by absence or
decrease of ADH, a hormone that triggers kidney absorption of water. Without ADH,
the kidneys produce excessive amounts of urine that are not reabsorbed
(sometimes 15–20 L/day).
Glomerulonephritis (kidney inflammation without infection).
Severe renal damage with disturbance of both concentrating and diluting abilities of
urine. The SG is low (1.010) and fixed (varying little from specimen to specimen);
this is termed isosthenuria.
3. Hypersthenuria (increased SG, 1.025–1.035): occurs in the following conditions:
Diabetes mellitus
Nephrosis
Excessive water loss (dehydration, fever, vomiting and diarrhea)
Increased secretion of ADH and diuretic effects related to the stress of a surgical
procedure
Congestive heart failure
Toxemia of pregnancy
1. Elevated readings may occur in the presence of moderate amounts of protein (100–
750 mg/dl) or with patients receiving intravenous albumin.
2. Detergent residue (on specimen containers) can produce elevated SG results.
3. Diuretics and antibiotics cause high readings.
Mohammed Al-Gayyar - 10 -
Chemical determinations
1- Urine Blood or Hemoglobin (Hb)
The presence of free hemoglobin in the urine is referred to as hemoglobinuria.
Hemoglobinuria can be related to conditions outside the urinary tract and occurs when
there is such extensive or rapid destruction (intravascular hemolysis) of circulating
erythrocytes. Hemoglobinuria may also occur because of lysis of RBCs in the urinary tract.
When intact RBCs are present in the urine, the term hematuria is
used. Hematuria is most closely related to disorders of the renal or
genitourinary systems in which bleeding is the result of trauma or
damage to these organs or systems.
The use of both a urine dipstick measurement and microscopic
examination of urine provides a complete clinical evaluation of
hemoglobinuria and hematuria. When urine sediment is positive for
occult blood but no RBCs are seen microscopically, myoglobinuria
can be suspected. Myoglobin can be distinguished from free
hemoglobin in the urine by chemical tests.
Myoglobinuria is caused by excretion of myoglobin, a muscle protein, into the urine
because of:
1. Traumatic muscle injury, such as may occur in automobile accidents, football injuries or
electric shock.
2. A muscle disorder, such as an arterial occlusion to a muscle or muscular dystrophy.
3. Certain kinds of poisoning, such as carbon monoxide or fish poisoning.
4. Malignant hyperthermia related to administration of certain anesthetic agents.
1. Drugs causing a positive result for blood or hemoglobin include:
Drugs toxic to the kidneys (eg, bacitracin and amphotericin)
Drugs that alter blood clotting (warfarin)
Drugs that cause hemolysis of RBCs (aspirin)
Drugs that may give a false-positive result (eg, bromides, copper, iodides and
oxidizing agents)
2. High doses of ascorbic acid or vitamin C may cause a false-negative result.
3. High SG or elevated protein reduces sensitivity.
4. Myoglobin produces a false-positive result.
5. Hypochlorites or bleach used to clean urine containers causes false-positive results.
6. Menstrual blood may contaminate the specimen and alter results.
7. Prostatic infections may cause false-positive results.
2- Urine Protein (Albumin)

The presence of increased amounts of protein in the urine can be an important indicator of
renal disease. It may be the first sign of a serious problem and may appear before any
other clinical symptoms. However, other physiologic conditions (eg, exercise, fever) can
lead to increased protein excretion in urine. In addition, there are some renal disorders in
which proteinuria is absent.
In a healthy renal and urinary tract system, the urine
contains no protein or only trace amounts. These
consist of albumin (one third of normal urine protein is
albumin) and globulins from the plasma. Because
albumin is filtered more readily than the globulins, it is
usually abundant in pathologic conditions. Therefore,
the term albuminuria is often used synonymously with
proteinuria.
Normally, the glomeruli prevent passage of protein from the blood to the glomerular filtrate.
Therefore, the presence of protein in the urine is the single most important indication of
renal disease. If more than a trace of protein is found persistently in the urine, a
quantitative 24-hour evaluation of protein excretion is necessary.
Interfering Factors for Qualitative Protein Test:

1. Because of renal vasoconstriction, the presence of a functional, mild and transitory
proteinuria is associated with:
Strenuous exercise up to 300 mg/24 hours
Severe emotional stress or seizures
Cold baths or exposure to very cold temperatures
2. Increased protein in urine occurs in these benign states:
Fever and dehydration (salt depletion)
Non–immunoglobulin E food allergies
Salicylate therapy
In the premenstrual period and immediately after delivery
3. False or accidental proteinuria may occur because of a mixture of pus and RBCs in the
urinary tract related to infections, menstrual or vaginal discharge, mucus or semen.
4. False-positive results can occur from incorrect use and interpretation of the colour
reagent strip test.
5. Alkaline, highly buffered urine can produce false-positive results on the dipstick test.
6. Very dilute urine may give a falsely low protein value.
3- Microalbuminuria/Albumin
Microalbuminuria is an increase in urinary albumin that is below the detectable range of
the standard protein dipstick test. It is not a different chemical form of albumin.
Microalbuminuria occurs long before clinical proteinuria becomes evident.
This test allows for the routine detection of low concentrations of albumin in the urine. This
test has become a standard for the screening, monitoring and detection of deteriorating
renal function in diabetic patients. Studies have shown that diabetic patients who progress
to renal failure first excrete micro amounts of albumin and that, at this stage, intervening
treatment can reverse the proteinuria and thus prevent progression to renal failure. This
test is also used to monitor compliance of blood pressure control, glucose control and
protein restriction. Its normal value is less than 30 mg/24 hours (<30 mg/day) or < 20 mg/L
(10-hour collection)
Increased microalbuminuria is associated with:
1. Diabetes with early diabetic nephropathy
2. Hypertension—heart disease
3. Generalized vascular disease
1. Strenuous exercise
2. Hematuria (menses)
3. High-protein diet or high salt levels
4- Urine Glucose (Glucosuria)

Glucose is present in glomerular filtrate and is
reabsorbed by the proximal convoluted tubule. If the
blood glucose level exceeds the reabsorption capacity of
the tubules, glucose will appear in the urine. Tubular
reabsorption of glucose is by active transport in response
to the body's need to maintain an adequate concentration
of glucose.
The blood level at which tubular reabsorption stops is termed the renal threshold, which for
glucose is between 160 and 180 mg/dl (9–10 mmol/l).
1. Increased glucose occurs in:
Diabetes mellitus
Endocrine disorders (thyrotoxicosis, Cushing's syndrome or acromegaly)
Liver and pancreatic disease
Central nervous system disorders (brain injury or stroke)
Impaired tubular reabsorption
Pregnancy with possible latent diabetes (gestational diabetes)
2. Increase of other sugars (react only with reduction tests, not dipstick tests):
Lactose: pregnancy, lactation and lactose intolerance
Galactose: hereditary galactosuria (severe enzyme deficiency in infants; must be
treated promptly)
Xylose: excessive ingestion of fruit
Fructose: hereditary fructose intolerance or hepatic disorders
Pentose: certain drug therapies and rare hereditary conditions
1. False-positive results:
Presence of non–sugar-reducing substances such as ascorbic acid, homogentisic
acid or creatinine
Tyrosine
Drugs: Nalidixic acid, cephalosporins, probenecid or penicillin
Large amounts of urine protein (slows reaction)
2. Stress, excitement, myocardial infarction, testing after a heavy meal and testing soon
after the administration of intravenous glucose may all cause false-positive results.
3. Contamination of the urine sample with bleach or hydrogen peroxide may invalidate
results.
4. False-negative results may occur if urine is left to sit at room temperature for an
extended period, owing to the rapid glycolysis of glucose.
5. High specific gravity depresses colour development, low specific gravity intensifies it.
5- Urine Ketones (Acetone; Ketone Bodies)

Ketones, which result from the metabolism of fatty acid and fat, consist mainly of three
substances: acetone, ß-hydroxybutyric acid and acetoacetic acid. The last two substances
readily convert to acetone, in essence making acetone the main substance being tested.
However, some testing products measure only acetoacetic acid.
In healthy persons, ketones are formed in the liver and are completely metabolized so that
only negligible amounts appear in the urine. However, when carbohydrate metabolism is
altered, an excessive amount of ketones is formed (acidosis) because fat becomes the
predominant body fuel instead of carbohydrates.
The excess presence of ketones in the urine (ketonuria) is associated with diabetes or
altered carbohydrate metabolism. Testing for urine ketones in patients with diabetes may
provide the clue to early diagnosis of ketoacidosis and diabetic coma.
Ketonuria signals a need for caution, rather than crisis intervention, in either a diabetic or a
nondiabetic patient. However, this condition should not be taken lightly:
In the diabetic patient, ketone bodies in the urine suggest that the diabetes is not
adequately controlled and that adjustments of either the medication or the diet
should be made promptly.
In the nondiabetic patient, ketone bodies indicate a reduced carbohydrate
metabolism and excessive fat metabolism.
Positive urine ketones in a child younger than 2 years of age is a critical alert.
1. Drugs that may cause a false-positive result include: Levodopa, Phenothiazines, Ether,
Insulin, Isopropyl alcohol, Metformin, Penicillamine, Phenazopyridine (Pyridium) and
Captopril
2. False-negative results occur if urine stands too long, owing to loss of ketones into the
air.
6- Urine Nitrite (Bacteria)

This test is a rapid, indirect method for detecting bacteria in the urine. Significant UTI may
be present in a patient who does not experience any symptoms. Common gram-negative
organisms contain enzymes that reduce the nitrate in the urine to nitrite.
Clinicians frequently request the urine nitrate test to screen high-risk patients: pregnant
women, school-aged children (especially girls), diabetic patients, elderly patients and
patients with a history of recurrent infections. The nitrate test can also be used to evaluate
the success of antibiotic therapy.
1. Under the light microscope, the presence of > 20 bacteria per high-power field (hpf)
may indicate a UTI. Untreated bacteriuria can lead to serious kidney disease.
2. The presence of a few bacteria suggests a UTI that cannot be confirmed or excluded
until more definitive studies, such as culture and sensitivity tests, are performed.
3. A positive nitrate test is a reliable indicator of significant bacteriuria and is a cue for
performing urine culture.
4. A negative result should never be interpreted as indicating absence of bacteriuria, for
the following reasons:
If an overnight urine sample is not used, there may not have been enough time for
the nitrate to convert to nitrite in the bladder.
Some UTIs are caused by organisms that do not convert nitrate to nitrite (eg,
staphylococci and streptococci).
Sufficient dietary nitrate may not be present for the nitrate-to-nitrite reaction to
occur.
1. Azo dye metabolites and bilirubin can produce false-positive results.
2. Ascorbic acid can produce false-negative results.
3. False-positive results can be obtained if the urine sits too long at room temperature,
allowing contaminant bacteria to multiply.
4. High specific gravity will reduce the sensitivity.
7- Urine Bilirubin
Bilirubin is formed in the reticuloendothelial cells of the spleen and bone marrow because
of the breakdown of hemoglobin; it is then transported to the liver. Urinary bilirubin levels
are increased to significant levels in the presence of any disease process that increases
the amount of conjugated bilirubin in the bloodstream. Elevated amounts appear when the
normal degradation cycle is disrupted by obstruction of the bile duct or when the integrity
of the liver is damaged.
Urine bilirubin aids in the diagnosis and monitoring of treatment for hepatitis and liver
damage. Urine bilirubin is an early sign of hepatocellular disease or intrahepatic or
extrahepatic biliary obstruction. It should be a part of every UA because bilirubin often
appears in the urine before other signs of liver dysfunction (eg, jaundice or weakness)
become apparent.
1. Even trace amounts of bilirubin are abnormal and warrant further investigation.
Normally, there is no detectable bilirubin in the urine.
2. Increased bilirubin occurs in:
Hepatitis and liver diseases caused by infections or exposure to toxic agents
(cirrhosis)
Obstructive biliary tract disease
Liver or biliary tract tumors
Septicemia
Hyperthyroidism
1. Bilirubin rapidly decomposes when exposed to light; therefore, urine should be tested
immediately.
2. High concentrations of ascorbic acid or nitrate cause decreased sensitivity.
8- Urine Urobilinogen
Bilirubin, which is formed from the degradation of hemoglobin, is transformed through the
action of bacterial enzymes into urobilinogen after it enters the intestines. Some of the
urobilinogen formed in the intestine is excreted as part of the feces, where it is oxidized to
urobilin; another portion is absorbed into the portal bloodstream and carried to the liver,
where it is metabolized and excreted in the bile. Traces of urobilinogen in the blood that
escape removal by the liver are carried to the kidneys and excreted in the urine. This is the
basis of the urine urobilinogen test. Unlike bilirubin, urobilinogen is colourless.
Urine urobilinogen is one of the most sensitive tests available to determine impaired liver
function. Urinary urobilinogen is increased by any condition that causes an increase in the
production of bilirubin and by any disease that prevents the liver from normally removing
the reabsorbed urobilinogen from the portal circulation. An increased urobilinogen level is
one of the earliest signs of liver disease and hemolytic disorders.
Reference Values:
Random specimen: <1 mg/dl
2-hour specimen: <1 mg/2 hours
24-hour specimen: 0.5–4.0 mg/day
1. Urine urobilinogen is increased when there is:
Increased destruction of RBCs: Hemolytic anemias, Pernicious anemia
(megaloblastic) and Malaria
Hemorrhage into tissues: Pulmonary infarction and Excessive bruising
Hepatic damage: Biliary disease, Cirrhosis (viral and chemical) and Acute hepatitis
2. Urine urobilinogen is decreased or absent when normal amounts of bilirubin are not
excreted into the intestinal tract. This usually indicates partial or complete obstruction
of the bile ducts. The stool is pale in colour. Decreased urinary urobilinogen is
associated with Cholelithiasis, Severe inflammation of the biliary ducts or Cancer of the
head of the pancreas
3. During antibiotic therapy, suppression of normal gut flora may prevent the breakdown
of bilirubin to urobilinogen; therefore, urine levels will be decreased or absent
1. Drugs that may affect urobilinogen levels include those that cause cholestasis and
those that reduce the bacterial flora in the gastrointestinal tract.
2. Peak excretion is known to occur from noon to 4:00 p.m. The amount of urobilinogen in
the urine is subject to diurnal variation.
3. Strongly alkaline urine shows a higher urobilinogen level, and strongly acidic urine
shows a lower urobilinogen level.
4. Drugs that may cause increased urobilinogen include drugs that cause hemolysis.
5. If the urine is highly coloured, the strip will be difficult to read.
Microscopic examination of urine sediment

In health, the urine contains small numbers of cells and other formed elements from the
entire genitourinary tract. Urinary sediment provides information useful for both diagnosis
and prognosis. It provides a direct sampling or urinary tract morphology.
Procedure for Microscopic Urine Examination:

1. Collect a random urine specimen. Transport the specimen to the laboratory as soon as
possible.
2. Urinary sediment is microscopically examined under both the low-power field (lpf) and
the high-power field (hpf). Low power is used to find and count casts; RBCs, WBCs
and bacteria show up and are counted under high power. Amounts present are defined
in the following terms: few, moderate, packed and packed solid; or 1+, 2+, 3+ and 4+.
Crystals and other elements are also noted.
3. Microscopic results should be correlated with the physical and chemical findings to
ensure the accuracy of the report as shown in the following table:
Microscopic Elements Physical Examination Dipstick Measurement

Red blood cells Turbidity, red to brown colour Blood
White blood cells Turbidity Protein – Nitrite – Leukocytes
Epithelial cast cells Turbidity Protein
Bacteria Turbidity, odour pH – Nitrite – Leukocytes
Crystals Turbidity, odour pH
1- Urine Crystals
A variety of crystals may appear in the urine. They can be identified by their specific
appearance and solubility characteristics. Crystals in the urine may present no symptoms
or they may be associated with the formation of urinary tract calculi and give rise to clinical
manifestations associated with partial or complete obstruction of urine flow.
A number of in vivo and in vitro factors influence the types and numbers of urinary crystals
in a given sample.
In vivo factors include:
1. Concentration and solubility of crystallogenic substances contained in the specimen
2. Urine pH
3. Excretion of diagnostic and therapeutic agents
In vitro factors include:

1. Temperature (solubility decreases with temperature)
2. Evaporation (increases solute concentration)
3. Urine pH (changes with standing and bacterial overgrowth)
Most common crystals:

Struvite: Struvite crystals (magnesium ammonium
phosphate, triple phosphate) usually appear as colourless,
3-dimensional, prism-like crystals ("coffin lids").
Occasionally, they instead resemble (vaguely) an old-
fashioned double-edged razor blade (lower frame).
Bilirubin: Bilirubin crystals tend to precipitate onto other

formed elements in the urine. In the top picture, fine needle-
like crystals have formed on an underlying cell. This is the
most common appearance of bilirubin crystals. In the lower
two pictures, cylindrical bilirubin crystals have formed in
association with droplets of fat, resulting in a "flashlight"
appearance. This form is less commonly seen.
Calcium Carbonate: Calcium carbonate crystals usually

appear as large yellow-brown or colourless spheroids with
radial striations. They can also be seen as smaller crystals
with round, ovoid or dumbbell shapes.
Calcium Oxalate Dihydrate: Calcium oxalate dihydrate

crystals typically are seen as colourless squares whose
corners are connected by intersecting lines (resembling an
envelope). They can occur in urine of any pH. The crystals
vary in size from quite large to very small. In some cases,
large numbers of tiny oxalates may appear as amorphous
unless examined at high magnification.
Uric acid crystals: They exhibit extreme pleomorphism in

size and in shape. They appear readily in acid urine allowed
to stand at room temperature.
Cystine: Cystine crystals are flat colourless plates and have
a characteristic hexagonal shape with equal or unequal
sides. They often aggregate in layers. Their formation is
favored in acidic urine.
Drug Crystals: Many drugs excreted in the urine have the

potential to form crystals. Hence, a review of the patients
drug history is prudent when faced with unidentified urine
crystals. Most common among these are the sulfa drugs.
Both panels on the right are from patients receiving
trimethoprim-sulfadiazine. The differing appearance may
relate to variation in drug concentration, urine pH and other
factors. The inset in the lower panel shows the crystals as
they appeared when polarized.
Type Colour Shape Clinical Implications

Acid Urine
Uric acid Yellow-brown rhombohedral prisms Normal; increased purine metabolism, gout or
Lesch-Nyhan syndrome
Cystine Colourless, Flat hexagonal plates Cystinuria; cystinosis—cystine stones in kidney or
highly with well-defined edges, crystals also in spleen and eyes
refractile singly or in clusters
Cholesterol Colourless “Broken window panes” Nephritis, nephrotic syndrome or chyluria
with notched corners
Bilirubin Reddish- Cubes, rhombic plates, Elevated bilirubin
brown amorphous needles
Acid, Neutral, or Slightly Alkaline Urine

Calcium Colourless Octahedral dumbbells, Normal; large amounts in fresh urine may indicate
oxalate often small—use high severe chronic renal disease, liver disease,
power ethylene glycol poisoning, diabetes mellitus or
large doses of vitamin C
Alkaline Urine
Calcium Colourless Needles, spheres, Normal
carbonate dumbbells
Calcium Colourless Prisms, plates, needles Normal
phosphate
1. Refrigerated urine will precipitate out many crystals because the solubility properties of
the compound are altered.
2. Urine left standing at room temperature will also cause precipitation of crystals or the
dissolving of the crystals.
3. Radiographic dye can cause crystals in improperly hydrated patients. These resemble
uric acid crystals and can be suspected in specimens that have an abnormally high
specific gravity (>1.030).
2- Urinary Casts
Casts are cylindrical structures composed mainly of mucoprotein, which is secreted by
epithelial cells lining the loops of Henle, the distal tubules and the collecting ducts. The
factors responsible for the precipitation of this mucoprotein are not fully understood, but
may relate to the concentration and pH of urine in these areas. Casts may form in the
presence or absence of cells in the tubular lumen. If cells (epithelial cells, WBC) are
present as a cast forms, they may adhere to, and subsequently be surrounded by, the
fibrillar protein network.
The appearance of a cast observed in a urine sediment depends largely upon the length
of time it remained in situ in the tubules prior to being shed into the urine. A cast
recognizable as "cellular", for example, was shed shortly after it was formed. A waxy cast,
in contrast, was retained longer in the tubular system prior to being released.
General Interpretation of casts:
Casts are quantified for reporting as the number seen per low power field (10x objective)
and classified as to type (e.g., waxy casts, 5-10/LPF). Casts in urine from normal
individuals are few or none.
1. An absence of casts does not rule out renal disease. Casts may be absent or very few
in cases of chronic, progressive, generalized nephritis. Furthermore, casts are unstable
in urine and are prone to dissolution with time, especially in dilute and/or alkaline urine.
2. Although the presence of numerous casts is solid evidence of generalized (usually
acute) renal disease, it is not a reliable indicator of prognosis.
Types of cast:
Hyaline Casts: Hyaline casts are formed in the absence of
cells in the tubular lumen. They have a smooth texture and a
refractive index very close to that of the surrounding fluid.
Reduced lighting is essential to see hyaline casts. Lower the
substage condenser. When present in low numbers (0-
1/LPF) in concentrated urine of otherwise normal patients,
hyaline casts are not always indicative of clinically significant
renal disease.
Cellular Casts: Cellular casts most commonly result when

disease processes such as ischemia, infarction, or
nephrotoxicity cause degeneration and necrosis of tubular
epithelial cells. The presence of these casts indicates acute
tubular injury but does not indicate the extent or reversibility
of the injury. A common scenario is the patient with
decreased renal perfusion and oliguria secondary to severe
dehydration.
Granular Casts: Granular casts, as the name implies, have

a textured appearance which ranges from fine to coarse in
character.
Fatty Casts: Fatty casts are identified by the presence of

refractile lipid droplets. The background matrix of the cast
may be hyaline or granular in nature. Often, they are seen in
urines in which free lipid droplets are present as well.
Pictured here is a fatty cast with a hyaline matrix. Also notice
the free lipid droplets in the background. As an isolated
finding, lipiduria is seldom of clinical significance.
Waxy Casts: Waxy casts have a smooth consistency but

are more refractile and therefore easier to see compared to
hyaline casts. They commonly have squared off ends, as if
brittle and easily broken. Waxy casts indicate tubular injury
of a more chronic nature than granular or cellular casts and
are always of pathologic significance.
3- Infectious Agents in Urine Sediment

Infectious agents of various classes can be observed in urine sediments. In most cases,
their significance can be properly assessed only in light of the clinical signs, method of
collection, post-collection interval, and other findings in the urinalysis.
Types of infectious agents:

Candida: Yeasts in unstained urine sediments are round to
oval in shape, colourless, and may have obvious budding.
They often represent contaminants, and are especially
suspect if the sample is voided and/or old. In other
circumstances, however, their significance should not be
discounted. The pictures shows pseudohyphae formation by
the yeasts, which were identified on culture as Candida
albicans.
Bacteria: Bacteria can be identified in unstained urine

sediments when present in sufficient numbers. Rod-shaped
bacteria and chains of cocci are often readily identifiable. If
there is any doubt about the presence of bacteria, a Gram-
stained smear of urine sediment should be examined. The
lower panel at the right shows a neutrophil containing
phagocytized bacteria. Notice that the nucleus in this cell is
round; nuclei tend to become round as neutrophils age in
urine.
Fungi: Fungal hyphae in urine sediment preps most

commonly represent overgrowth of contaminants in samples
where analysis was delayed. If seen in a fresh sample,
fungal infection of the kidneys and/or bladder should be
suspected.
4- Cells in Urine Sediment

Urine is a hostile environment for cells since they encounter abnormal osmotic pressures,
pH changes and exposure to toxic metabolites. For these reasons, post-collection delay of
examination should be minimized. If delay is unavoidable, refrigeration will slow
degeneration of cells.
For routine purposes, cells are examined as unstained wet-mounts of sedimented urine.
Under some circumstances, air-dried smears are prepared and stained with hematologic
stains. Red blood cells and leukocytes are quantified as cells/HPF (High Power Field - 40x
objective). Other cell types are usually subjectively listed as "few, moderate, or many".
Types of cells:
Red Blood Cells: The appearance RBCs in urine depends
largely on the concentration of the specimen and the length
of time the red cells have been exposed. Fresh red cells
tend to have a red or yellow colour (lower panel). Prolonged
exposure results in a pale or colourless appearance as
hemoglobin may be lost from the cells (upper panel).
In fresh samples with S.G. of 1.010-1.020, RBC may retain
the normal disc shape (upper panel). In more concentrated
urines (>1.025), red cells tend to shrink and appear as small,
crenated cells (lower panel). In more dilute samples, they
tend to swell. At urine S.G. <1.008 and/or highly alkaline pH,
red cell lysis is likely. Lysed red cells appear as very faint
"ghosts", or may be virtually invisible.
Red blood cells up to 5/HPF are commonly accepted as normal. Increased red cells in
urine is termed hematuria, which can be due to hemorrhage, inflammation, necrosis,
trauma or neoplasia somewhere along the urinary tract. The method of collection must
be considered because catheterization can induce hemorrhage.
White Blood Cells: WBCs in unstained urine sediments
typically appear as round, granular cells which are1.5-2.0
times the diameter of RBC. The details of nuclear shape
often are difficult to discern, especially if the specimen is not
fresh. WBC in urine are most commonly neutrophils.
Staining of air-dried sediment smears with a hematologic
stain sometimes is useful for more specific identification.
Like erythrocytes, WBC may lyse in very dilute or highly
alkaline urine. WBC up to 5/HPF are commonly accepted as
normal. Greater numbers (pyuria) generally indicate the
presence of an inflammatory process somewhere along the
course of the urinary tract.
Pyuria often is caused by urinary tract infection, and many times bacteria can be seen in
the sediments. Depending on clinical signs, pyuria may be an indication for culture of urine
even if no bacteria are seen.
Squames: Squamous epithelial cells are the largest cells

which can be present in normal urine samples. They are
thin, flat cells, usually with an angular or irregular outline and
a small round nucleus. They may be present as single cells
or in variably-sized clusters. Those shown in the upper panel
are unstained; that in the lower panel was prepared using
Sedi-Stain. Their main significance is as an indicator of such
contamination.
Neoplastic Cells: Neoplastic cells may be seen in urine

sediments of patients with tumors of the urinary tract. The
pictures shown are from a case of transitional cell carcinoma
in the bladder. Though the presence of neoplastic cells may
be suspected on examination of unstained wet-mounts
(upper panel), evaluation of air-dried sediment smears or
cytocentrifuge preps stained with hematologic stains (lower
panel) is necessary for confirmation.
5- Contaminants in Urine Sediment
Extraneous contaminating materials of many types can make their way into urine
specimens. Striving for optimal collection and transport of specimens will help maximize
useful results and minimize confusing findings.
Types of cells:
Overgrowth of Microbes: Specimens mailed to laboratories
without refrigeration or preservatives are subject to
overgrowth of microbes, whether contaminants or
pathogens. Shown here is a dense mat of fungal hyphae.
Bacteria, whether pathogens or contaminants, also can
multiply when analysis is delayed. This often clouds the
interpretation of both sediment examination and culture
results. Refrigeration is perhaps the best all-around method
for preserving a specimen.
Fibers: Cotton, plant and paper fibers may be confused for

parasite larvae or urinary casts. Care in sample collection
and handling will minimize the presence of such material.
Starch Granules: Granular starch is used as powder on

surgical and exam gloves. These granules are commonly
encountered as contaminants not only in urine sediments,
but also in cytology smears of various types. They are
variable in size, round to polygonal in shape, colourless and
usually have a circular or Y-shaped "dot" in the center.
Urine Chemistry
Urine Pregnancy Test; Human Chorionic Gonadotropin (hCG) Test
From the earliest stage of development, the placenta produces hormones, either on its
own or in conjunction with the fetus. The very young placental trophoblast produces
appreciable amounts of the hormone human chorionic gonadotropin (hCG), which is
excreted in the urine. This hormone is not found in the urine of men or of normal, young,
nonpregnant women.
Increased urinary hCG levels form the basis of the tests for pregnancy; hCG is present in
blood and urine whenever there is living chorionic/placental tissue. hCG is made up of α-
and β-subunits. The β-subunit is the most sensitive and specific test for early pregnancy.
hCG can be detected in the urine of pregnant women 26 to 36 days after the first day of
the last menstrual period (ie, 5 to 7 days after conception). Pregnancy tests should return
to negative 3 to 4 days after delivery.
1. False-negative test results and falsely low levels of hCG may be caused by dilute urine
(low SG) or by using a specimen obtained too early in pregnancy.
2. False-positive tests are associated with:
Proteinuria
Hematuria
The presence of excess pituitary gonadotropin
Certain drugs (eg, chlorpromazine, phenothiazines or methadone)
Put 2 drops of urine in the sample well
Only one coloured band appears. Result - Negative
Two coloured bands appear (C & T). Result - Positive
No band appears. Test – Invalid. Test again with new Test Kit.
Urine Drug Investigation Specimens

When screening for unknown drugs, the most valuable samples are obtained from urine,
gastric contents and blood. Urine drug screening is preferred for several reasons:
1. Specimens are easily procured.
2. It is not an invasive procedure (unless bladder catheterization is involved).
3. Drug concentrations are more elevated in urine or may not be detectable in blood.
4. Drug metabolites are excreted for a longer period (days or weeks) through urine,
indicating past drug use.
5. Urine test procedures are more easily done and are more economical.
Common Urine Drug Tests:

Alcohol, Amphetamines, Analgesics, Barbiturates, Benzodiazepines, Cocaine, Cyanide,
Lysergic acid diethylamide (LSD), Major tranquilizers, Marijuana, Opiates, Phencyclidine
(PCP), Sedatives, Stimulants and Sympathomimetics.
Factors associated with incorrect test results for urine drug screens include:
1. Detergents
2. Sodium chloride (table salt) (NaCl)
3. Low SG (dilute urine)
4. High pH (acid urine)
5. Low pH (alkaline urine)
6. Blood in the urine
Personal Urine Drug Test Multi-Line 6 Drug Urine Screen Test
Timed Urine Test

1- Quantitative Urine Uric Acid (24-Hour)
Uric acid is formed from the metabolic breakdown of nucleic acids composed of purines.
Excessive uric acid relates to excessive dietary intake of purines or to endogenous uric
acid production in certain disorders. Normally, one third of the uric acid formed is degraded
by bacteria in the intestines.
This test evaluates uric acid metabolism in gout and renal calculus formation. Evaluation of
excess uric acid excretion is important to aid in evaluating stone formation and
nephrolithiasis. It also reflects the effects of treatment with uricosuric agents by measuring
the total amount of uric acid excreted within a 24-hour period.
Reference Values:
With normal diet: 250–750 mg/24 hours or 1.48–4.43 mmol/day
With purine-free diet: <400 mg/24 hours or <2.48 mmol/day
With high-purine diet: <1000 mg/24 hours or <5.90 mmol/day
1. Many drugs increase uric acid levels, including:
Salicylates (aspirin) and other anti-inflammatory drugs
Diuretics
Vitamin C (ascorbic acid)
Warfarin
Cytotoxic drugs used to treat lymphoma and leukemia
2. Other factors increasing uric acid urine levels include:
X-ray contrast media
Strenuous exercise
Diet high in purines (eg, kidney and sweetbreads)
3. Allopurinol decreases uric acid levels
2- Quantitative Urine Calcium (24-Hour)

Calcium hemostasis is maintained by the parathyroid hormone. The bulk of calcium
excreted is eliminated in the stool. However, a small quantity of calcium is normally
excreted in the urine. This amount varies with the quantity of dietary calcium ingested.
Increased calcium in urine results from an increase in intestinal calcium absorption, a lack
of renal tubule reabsorption of calcium, resorption or loss of calcium from bone or a
combination of these mechanisms.
The urine calcium test is used for evaluation of calcium intake and/or the rate of intestinal
absorption, bone resorption and renal loss. Urine calcium is high in 30% to 80% of cases
of primary hyperparathyroidism but does not reliably diagnose this disease. Urine calcium
test does not have much value in a differential diagnosis.
Reference Values:
Normal diet: 100–300 mg/24 hours or 2.50–7.50 mmol/day
Low-calcium diet: 50–150 mg/24 hours or 1.25–3.75 mmol/day
Interfering Factors
1. Falsely elevated levels may be caused by:
Some drugs (eg, calcitonin; vitamins A, K, and C; and corticosteroids)
Urine procured immediately after meals in which high calcium intake has occurred
(eg, milk)
Increased exposure to sunlight
Immobilization (especially in children)
2. Falsely decreased levels may be found with:
Increased ingestion of phosphate, bicarbonate or antacids
Alkaline urine
Thiazide diuretics (can be used to lower calcium levels therapeutically)
Oral contraceptives or estrogens
Lithium
3- Urine Creatinine; Creatinine Clearance (Timed Urine and Blood)

Creatinine is a substance that, in health, is easily excreted by the kidney. It is the
byproduct of muscle energy metabolism and is produced at a constant rate according to
the muscle mass of the individual. Endogenous creatinine production is constant as long
as the muscle mass remains constant. Because all creatinine filtered by the kidneys in a
given time interval is excreted into the urine, creatinine levels are equivalent to the
glomerular filtration rate (GFR). Disorders of kidney function prevent maximum excretion of
creatinine. The creatinine clearance test is part of most batteries of quantitative urine tests.
Creatinine clearance is measured together with other urinary components in order to
interpret the overall excretion rate of the various urinary components.
The creatinine clearance test is a specific measurement of kidney function, primarily
glomerular filtration. It measures the rate at which the kidneys clear creatinine from the
blood. In a broad sense, clearance of a substance may be defined as the imaginary
volume (in milliliters) of plasma from which the substance would have to be completely
extracted in order for the kidney to excrete that amount in 1 minute. In addition to
estimating the GFR, this test is used to evaluate renal function in patients.
Because the excretion of creatinine in a given person is relatively constant, the 24-hour
urine creatinine level is used as a check on the completeness of a 24-hour urine collection.
It is of no help in the evaluation of renal function unless it is done as part of a creatinine
clearance test.
Reference Values:
Urine creatinine, men: 14–26 mg/kg/24 hours or 124–230 µmol/kg/day
Urine creatinine, women: 11–20 mg/kg/24 hours or 97–177 µmol/kg/day
Blood creatinine: 0.8–1.2 mg/dL or 71–106 µmol/L ( Table 3.12)
1. Exercise may increase creatinine clearance and urine creatinine.
2. Pregnancy substantially increases creatinine clearance.
3. Many drugs decrease creatinine clearance.
4. The creatinine clearance overestimates the GFR when there is severe renal
impairment. The serum creatinine is more indicative of the GFR in this situation.
5. A diet high in meat may elevate the urine creatinine concentration.
6. Proteinuria and advanced renal failure make creatinine clearance an unreliable method
for determining GFR.

Urine Analysis

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Urine Analysis

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Urine Analysis Diploma of Biochemical Analysis 2007/2008

Some normal urine constituents excreted (in g/24 hours)

Mohammed Al-Gayyar -1-

Mohammed Al-Gayyar -2-

Mohammed Al-Gayyar -3-

Routine urinalysis (UA) and related tests

General characteristics Chemical determinations Microscopic examination

Mohammed Al-Gayyar -4-

Mohammed Al-Gayyar -5-

Mohammed Al-Gayyar -6-

Mohammed Al-Gayyar -7-

Mohammed Al-Gayyar -8-

6- Specific gravity (SG)

2- Urine Protein (Albumin)

Interfering Factors for Qualitative Protein Test:

4- Urine Glucose (Glucosuria)

5- Urine Ketones (Acetone; Ketone Bodies)

6- Urine Nitrite (Bacteria)

Microscopic examination of urine sediment

Procedure for Microscopic Urine Examination:

Microscopic Elements Physical Examination Dipstick Measurement

In vitro factors include:

Most common crystals:

 Bilirubin: Bilirubin crystals tend to precipitate onto other

 Calcium Carbonate: Calcium carbonate crystals usually

 Calcium Oxalate Dihydrate: Calcium oxalate dihydrate

 Uric acid crystals: They exhibit extreme pleomorphism in

 Drug Crystals: Many drugs excreted in the urine have the

Type Colour Shape Clinical Implications

Acid, Neutral, or Slightly Alkaline Urine

 Cellular Casts: Cellular casts most commonly result when

 Granular Casts: Granular casts, as the name implies, have

 Fatty Casts: Fatty casts are identified by the presence of

 Waxy Casts: Waxy casts have a smooth consistency but

3- Infectious Agents in Urine Sediment

Types of infectious agents:

 Bacteria: Bacteria can be identified in unstained urine

 Fungi: Fungal hyphae in urine sediment preps most

4- Cells in Urine Sediment

 Squames: Squamous epithelial cells are the largest cells

 Neoplastic Cells: Neoplastic cells may be seen in urine

 Fibers: Cotton, plant and paper fibers may be confused for

 Starch Granules: Granular starch is used as powder on

Put 2 drops of urine in the sample well

Only one coloured band appears. Result - Negative

Two coloured bands appear (C & T). Result - Positive

Urine Drug Investigation Specimens

Common Urine Drug Tests:

Personal Urine Drug Test Multi-Line 6 Drug Urine Screen Test

Timed Urine Test

2- Quantitative Urine Calcium (24-Hour)

3- Urine Creatinine; Creatinine Clearance (Timed Urine and Blood)

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Bilirubin: Bilirubin crystals tend to precipitate onto other

Calcium Carbonate: Calcium carbonate crystals usually

Calcium Oxalate Dihydrate: Calcium oxalate dihydrate

Uric acid crystals: They exhibit extreme pleomorphism in

Drug Crystals: Many drugs excreted in the urine have the

Cellular Casts: Cellular casts most commonly result when

Granular Casts: Granular casts, as the name implies, have

Fatty Casts: Fatty casts are identified by the presence of

Waxy Casts: Waxy casts have a smooth consistency but

Bacteria: Bacteria can be identified in unstained urine

Fungi: Fungal hyphae in urine sediment preps most

Squames: Squamous epithelial cells are the largest cells

Neoplastic Cells: Neoplastic cells may be seen in urine

Fibers: Cotton, plant and paper fibers may be confused for

Starch Granules: Granular starch is used as powder on