PHYSICAL EXAMINATION OF URINE Flashcards
memorization
Normal volume range (24 hours)
600 to 2,000 mL (0.6 to 2 L)
Average volume range (24 hours)
1,200 to 1,600 mL (1.2 to 1.6 L)
Night urine output
<400 mL
Day:Night ratio
2-3:1
Container capacity (UA)
50 mL
The volume required for routine UA
10 - 15 mL (Average: 12 mL)
Increased urine volume
Polyuria
Volume considered to be polyuria
> 2,000 mL/24 hours (in adults - Henry)
2.5 L/Day (in adults - Strasinger)
2.5 - 3.0 mL/kg/day (in children)
Decreased urine volume
Oliguria
Volume considered to be oliguria
<500 mL/24 hours (in adults - Henry)
<400 mL/Day (in adults - Strasinger)
<1 mL/kg/hr (in infants)
<0.5 mL/kg/hr (in children)
Complete cessation of urine flow
Anuria
Volume considered to be anuria
<100 mL/24 hours (Graff)
Excretion of more than 500 mL of urine at night
Nocturia
Any increase in urine excretion
Diuresis
Difference of polyuria in Diabetes Insipidus and Diabetes mellitus
Diabetes insipidus - low specific gravity
Diabetes mellitus - high specific gravity
Roiugh indicator of the degree of hydration; should correlate with urine S.G.
Urine color
Best way to examine urine color:
- Examine the specimen under a good light source
- Look down through the container against a white background
Major pigment of urine
Urochrome
Derived form melanin metabolism; May deposit in amorphous urates and uric acid crystals; gives the urine a pink color
Uroerythrin
Dark yellow/ orange-brown; derived from oxidation of colorless urobilinogen; Present in old specimens
Urobilin (Dark yellow/orange-brown
lab correlation of urine color:
Pale yellow
Polyuria (DM, DI) dilute random specimen
lab correlation of urine color:
Dark yellow/ Amber
Concentrated specimen: strenuous exercise, dehydration, fever, burns
First morning specimen
Excessive urobilin, bilirubin, CAROTENE
lab correlation of urine color:
Orange
Orange-yellow
Bilirubin (yellow foam)
Phenazopyridine (Pyridium) - used to treat UTI
“tea-colored urine”
Bilirubin (yellow foam)
lab correlation of urine color:
Green
Pseudomonas infection
asparagus
B vitamins
PHENOL
lab correlation of urine color:
Blue-green
Chlorophyll
Clorets, PHENOL
Indican, Blue-diaper syndrome
lab correlation of urine color:
Pink
Red
RBCs
Hemoglobin
Myoglobin
porphobilin
RIFAMPIN
FUCHSIN
Beets
Menstrual contamination
lab correlation of urine color:
Cloudy/smokey red urine
presence of RBCs (hematuria)
lab correlation of urine color:
Clear red urine
Hemoglobin
Myoglobin
lab correlation of urine color:
Portwine
Porphyria
lab correlation of urine color:
Brown
Black
Methemoglobin (acidic urine)
Homogentesic acid (alkaline urine): Alkaptoniuria
Melanin (upon exposure to air)
lab correlation of urine color:
Milky white
Pyuria/Leukocyturia (increased WBCs)
What should the MT do before determining the urine clarity?
Thoroughly mix the specimen
Best way to determine urine clarity
Examine the specimen while holding in front of a light source and mus be viewed through a NEWSPAPER PRINT
Few particulates, print easily seen through urine
Hazy
Many particulates, print blurred through urine
Cloudy
Print cannot be seen through urine
Turbid
May precipitate or be clotted
Milky
Nonpathologic causes of urine:
- Squamous epithelial cells (increased in females)
- Amorphous urates (pink sediment)
- Amorphous phosphates & carbonates (white or beige precipitate)
- Vaginal cream, semen, fecal contamination, radiographic contrast media, talcum powder
Pathologic causes of urine:
- RBCs, WBCs
- Bacteria (uniform turbidity not cleared by acidification or filtration)
- Yeasts (increased in DM)
- Nonsquamous epithelial cells
- Abnormal crystals, Lymph fluid (chyluria), lipids
Laboratory correlations in urine turbidity:
Acidic urine
Amorphous urates
Radiographic contrast media
Laboratory correlations in urine turbidity:
Alkaline urine
Amorphous phosphates
Carbonates
Laboratory correlations in urine turbidity:
Soluble in heat
Amorphous urates
Uric acid Crystals
Laboratory correlations in urine turbidity:
Soluble in Dilute Acetic Acid
RBCs
Amorphous phosphates
Carbonates
Laboratory correlations in urine turbidity:
Insoluble in Dilute Acetic Acid
WBCs
Bacteria
Yeast
Spermatozoa
Laboratory correlations in urine turbidity:
Soluble in Ether
Lipids
Lymphatic fluid
Chyle
Normal urine odor
Aromatic, faintly, distinct/fragrant
Acute tubular necrosis urine odor (acute renal failure)
Odorless
UTI urine odor
Foul, ammoniacal, pungent
Fruity, sweet urine odor
Ketones( Diabetes Mellitus, starvation, vomiting)
Caramelized sugar, curry, maple syrup
Maple syrup urine disease (MSUD)
Mousy, musty, barny
Phenylketonuria (PKU)
Rancid butter
Tyrosinemia
Sweaty feet, acrid
Isovaleric acidemia, glutaric acidemia
Menthol-like
Phenol-containing medications
Bleach
Specimen adulteration or container contamination
Cabbage hops
Methionine malabsorption (Oasthouse disease)
Sulfur, rotten egg
Cystine disorder
Rotting fish
Trimethylaminuria
Pungent, fetid
Ingestions of onions, garlic & asparagus (methyl mercaptan), UTI (Brunzel)
Swimming pool
Hawkinsinuria
Cat urine
3-hydroxy-3-methylglutaric aciduria
Tomcat urine
Multiple carboxylase deficiency