| Urinalysis |
| Intervention |
|
White blood cells seen under a microscope from a urine sample.
|
| MeSH |
D016482 |
| Other codes |
LOINC Codes for Urinalysis panels |
| MedlinePlus |
003579 |
|
[edit on Wikidata]
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A urinalysis (UA), also known as routine and microscopy (R&M), is an array of tests performed on urine, and one of the most common methods of medical diagnosis.[1] The word is a portmanteau of the words urine and analysis.[2]
The target parameters that can be measured or quantified in urinalysis include naked-eye (gross) examination for color and smell plus analysis for many substances and cells, as well as other properties, such as specific gravity.
A part of a urinalysis can be performed by using urine test strips, in which the test results can be read as color changes. Another method is light microscopy of urine samples.
Contents
- 1 Target parameters
- 1.1 Color
- 1.2 Smell
- 1.3 Ions and trace metals
- 1.4 Proteins and enzymes
- 1.5 Blood cells
- 1.6 Other molecules
- 1.7 Other urine parameters
- 1.8 Drugs
- 2 Methods
- 2.1 Urine test strip
- 2.2 Microscopic examination
- 2.3 Other methods of urinalysis
- 3 See also
- 4 References
- 5 External links
Target parameters
Urine test results should always be interpreted using the reference range provided by the laboratory that performed the test, or using information provided by the test strip/device manufacturer.[3]
In addition to the substances mentioned in tables below, other tests include a description of color and appearance.
Color
See also: Urine § Color
Mayo Clinic has a nice review of urine color change causes.[4] The following are examples of color change causes and not a complete listing (if your urine is abnormal colored, web search the color for possible causes).
- Nearly colorless: excessive fluid intake for the conditions (such as habit polydipsia...quite common in the USA); &, if not, this could be a sign of untreated diabetes mellitus, diabetes insipidious, and certain types of nephritis
- Yellow: distinctly yellow may indicate riboflavin (vitamin B2) intake
- Yellow-amber: normal
- Orange: too little fluid intake for the conditions
- Red: may indicate leakage of red blood cells or their hemoglobin contents; intake of red substances
- Dark:
- Reddish-orange: intake of substances or medications
- Rusty-yellow to reddish-brown: intake of substances or medications
- Dark brown: intake of substances or medications ; damaged muscle (myoglobinuria) from extreme exercise or other widespread damage; altered blood; intake of phenolic (phenols) substances; a problem in porphyrin (porphyria) metabolism; and melanin from melanocytic tumors (melanoma)
- Brown black: intake of substances or medications; lots of altered blood; a problem with homogentisic acid metabolism (alkaptonuria) which can result in dark whites of the eyes and dark-colored internal organs and tissues (ochronosis); Lysol (the product with phenols) poisoning; much melanin from melanocytic (melanoma) tumors.
- Magenta to purple-red: phenolphthalein type of stimulant laxative (as in Ex-Lax)
- Green (or dark with greenish hue): possible problem with bile metabolism (bilirubinuria) and jaundice
- Other colors: always think of substances that you have eaten or taken in drinks in the past 48 hours.
Smell
See also: Urine § Odor
The odor (scent) of urine can normally vary from odorless (when very light colored and dilute) to a much stronger odor when the person is dehydrated and the urine is concentrated. Brief changes in odor are usually just interesting and not medically significant (example: the abnormal smell many can detect after eating asparagus. Diabetics in ketoacidosis (urine has lots of ketones) have a type of abnormal urine odor. Mayo Clinic has a nice discussion of urine odor and causes.[5]
Ions and trace metals
| Target |
Lower limit |
Upper limit |
Unit |
Comments |
LOINC Codes |
| Nitrite |
n/a |
0 / negative[6] |
|
The presence of nitrites in urine, termed nitrituria, indicates the presence of coliform bacteria.
Further information: Nitrite test
|
5802-4 |
| Sodium (Na) – per day |
150[7] |
300[7] |
mmol / 24 h |
A urinalysis is frequently ordered during the workup of acute renal failure. Full kidney function can be detected through the simple dipstick method. |
2956-1 |
| Potassium (K) – per day |
40[7] |
90[7] |
mmol / 24 h |
Urine K may be ordered in the workup of hypokalemia. In case of gastrointestinal loss of K, the urine K will be low. In case of renal loss of K, the urine K levels will be high. Decreased levels of urine K are also seen in hypoaldosteronism and adrenal insufficiency. |
2829-0 |
| Urinary calcium (Ca) – per day |
15[8] |
20[8] |
mmol / 24 h |
An abnormally high level is called hypercalciuria and an abnormally low rate is called hypocalciuria.
Further information: Urinary calcium
|
14637-3 |
| 100[8] |
250[8] |
mg / 24 hours |
6874-2 |
| Phosphate (P) – per day |
n/a[7] |
38[7] |
mmol / 24 h |
Phosphaturia is the hyperexcretion of phosphate in the urine. This condition is divided into primary and secondary types. Primary hypophosphaturia is characterized by direct excess excretion of phosphate by the kidneys, as from primary renal dysfunction, and also the direct action of many classes of diuretics on the kidneys. Additionally, secondary causes, including both types of hyperparathyroidism, cause hyperexcretion of phosphate in the urine. |
14881-7 |
A sodium-related parameter is fractional sodium excretion, which is the percentage of the sodium filtered by the kidney which is excreted in the urine. It is a useful parameter in acute renal failure and oliguria, with a value below 1% indicating a prerenal disease and a value above 3%[9] indicating acute tubular necrosis or other kidney damage.
Proteins and enzymes
| Target |
Lower limit |
Upper limit |
Unit |
Comments |
| Protein |
0 |
trace amounts[6]
/ 20 |
mg/dl |
Proteins may be measured with the Albustix test. Since proteins are very large molecules (macromolecules), they are not normally present in measurable amounts in the glomerular filtrate or in the urine. The detection of protein in urine, called proteinuria, may indicate the permeability of the glomerulus is increased. This may be caused by renal infections or by other diseases that have secondarily affected the kidneys, such as hypertension, diabetes mellitus, jaundice, or hyperthyroidism.
Further information: Proteinuria
|
| Human chorionic gonadotropin |hCG |
– |
50[10] |
U/l |
This hormone appears in the urine of pregnant women.And also in case of testicular cancer in male. Home pregnancy tests commonly detect this substance. |
Blood cells
| Target |
Lower limit |
Upper limit |
Unit |
Comments |
Red blood cells (RBCs) /
erythrocytes |
0[6][11] |
2[6] – 3[11] |
per
High Power Field
(HPF) |
May be present as intact RBCs, which indicate bleeding. Even trace amount of blood is enough to give the entire urine sample a red/pink hue, and it is difficult to judge the amount of bleeding from a gross examination. Hematuria may be due to a generalized bleeding diathesis or a urinary tract-specific problem (trauma, stone, infection, malignancy, etc.) or artefact of catheterization in case the sample is taken from a collection bag, in which case a fresh urine sample should be sent for a repeat test.
If the RBCs are of renal or glomerular origin (due to glomerulonephritis), the RBCs incur mechanical damage during the glomerular passage, and then osmotic damage along the tubules, so get dysmorphic features. The dysmorphic RBCs in urine which are most characteristic of glomerular origin are called "G1 cells", which are doughnut-shaped rings with protruding round blebs sometimes looking like Mickey Mouse's head (with ears).
Painless hematuria of nonglomerular origin may be a sign of urinary tract malignancy, which may warrant a more thorough cytological investigation.
Further information: Hematuria
|
| RBC casts |
n/a |
0 / negative[6] |
|
White blood cells (WBCs) /
leukocytes /
(pus cells) |
0[6] |
2[6] / negative[6] |
Further information: Pyuria
|
| – |
10 |
per µl or
mm3 |
"Significant pyuria" at greater than or equal to 10 leucocytes per microlitre (µl) or cubic millimeter (mm3) |
"Blood" /
(actually hemoglobin) |
n/a |
0 / negative[6] |
dip-stick qualitative scale of 0 to 4+ |
Hemoglobinuria is suggestive of in vivo hemolysis, but must be distinguished from hematuria. In case of hemoglobinuria, a urine dipstick shows presence of blood, but no RBCs are seen on microscopic examination. If hematuria is followed by artefactual ex vivo or in vitro hemolysis in the collected urine, then the dipstick test also will be positive for hemoglobin and will be difficult to interpret. The urine color may also be red due to excretion of reddish pigments or drugs. |
Other molecules
| Target |
Lower limit |
Upper limit |
Unit |
Comments |
| Glucose |
n/a |
0 / negative[6] |
|
Glucose can be measured with Benedict's test. Although glucose is easily filtered in the glomerulus, it is not present in the urine because all of the glucose filtered is normally reabsorbed from the renal tubules back into the blood. Presence of glucose in the urine is called glucosuria.
Further information: Glucosuria
|
| Ketone bodies |
n/a |
0 / negative[6] |
|
With carbohydrate deprivation, such as starvation or high-protein diets, the body relies increasingly on the metabolism of fats for energy. This pattern is also seen in people with diabetes mellitus, when a lack of the hormone insulin prevents the body cells from using the large amounts of glucose available in the blood. This happens because insulin is necessary for the transport of glucose from the blood into the body cells. The metabolism of fat proceeds in a series of steps. First, triglycerides are hydrolyzed to fatty acids and glycerol. Second, the fatty acids are hydrolyzed into smaller intermediate compounds (acetoacetic acid, betahydroxybutyric acid, and acetone). Thirdly, the intermediate products are used in aerobic cellular respiration. When the production of the intermediate products of fatty acid metabolism (collectively known as ketone bodies) exceeds the ability of the body to metabolize these compounds, they accumulate in the blood and some end up in the urine (ketonuria).
Further information: Ketonuria
|
| Bilirubin |
n/a |
0 / negative[6] |
|
The fixed phagocytic cells of the spleen and bone marrow destroy old red blood cells and convert the heme groups of hemoglobin to the pigment bilirubin. The bilirubin is secreted into the blood and carried to the liver, where it is bonded to (conjugated with) glucuronic acid, a derivative of glucose. Some of the conjugated bilirubin is secreted into the blood and the rest is excreted in the bile as bile pigment that passes into the small intestine. The blood normally contains a small amount of free and conjugated bilirubin. An abnormally high level of blood bilirubin may result from an increased rate of red blood cell destruction, liver damage (as in hepatitis and cirrhosis), and obstruction of the common bile duct as with gallstones. An increase in blood bilirubin results in jaundice, a condition characterized by a brownish-yellow pigmentation of the skin and of the sclera of the eyes.
Further information: Bilirubinuria
|
| Urobilinogen |
0.2[6] |
1.0 [6] |
Ehrlich units
or mg/dL |
| Creatinine – per day |
4.8[7] |
19[7] |
mmol / 24 h |
|
Free catecholamines,
dopamine – per day |
90 [12] |
420 [12] |
μg / 24 hours |
|
| Free cortisol |
28[13] or 30[14] |
280[13] or 490[14] |
nmol/24 h |
Values below threshold indicate Addison's disease, while values above indicate Cushing's syndrome. A value smaller than 200 nmol/24 h (72 µg/24 h[15]) strongly indicates absence of Cushing's syndrome.[14] |
| 10[16] or 11[15] |
100[16] or 176[15] |
µg/24 h |
| Phenylalanine |
|
30.0 |
mg/L[17] |
In neonatal screening, a value above the upper limit defines phenylketonuria.[17] |
Other urine parameters
| Test |
Lower limit |
Upper limit |
Unit |
Comments |
| Urine specific gravity |
1.003 [1][6] |
1.030[1][6] |
no unit |
This test detects the ion concentration of urine. Small amounts of protein or ketoacidosis tend to elevate the urine's specific gravity (SG). This value is measured using a urinometer and indicates hydration or dehydration. If the SG is under 1.010, the patient is hydrated; an SG value above 1.020 indicates dehydration. |
| Osmolality |
400[7] |
n/a[7] |
mOsm/kg |
|
| pH |
5[6] |
7[6] |
(unitless) |
|
| Bacterial cultures |
by urination |
– |
100,000 |
colony forming units per millilitre (CFU/mL) |
Bacteriuria can be confirmed if a single bacterial species is isolated in a concentration greater than 100,000 CFU/ml of urine in clean-catch midstream urine specimens (one for men, two consecutive specimens with the same bacterium for women).
Further information: Bacteriuria
|
| by bladder catheterisation |
– |
100 |
For urine collected via bladder catheterisation, the threshold is 100 CFU/ml of a single species.
Further information: Bacteriuria
|
Drugs
Main article: Drug test
Urine may be tested to determine whether an individual has engaged in recreational drug use. In this case, the urinalysis would be designed to detect whatever marker indicates drug use.
Methods
When doctors order a urinalysis, they will request either a routine urinalysis or a routine and microscopy (R&M) urinalysis, with the difference being a routine urinalysis does not include microscopy or culture.
Urine test strip
A urine test strip can quantify:
- Leukocytes – with presence in urine known as leukocyturia
- Nitrite – with presence in urine known as nitrituria
- Protein – with presence in urine known as proteinuria, albuminuria, or microalbuminuria
- Blood – with presence in urine known as hematuria
- specific gravity
Microscopic examination
A urine sample is about to be examined under a phase-contrast microscope using a Neubauer counting chamber. The urine is under the cover slide, in the upper segment formed by the H-shaped grooves.
The numbers and types of cells and/or material such as urinary casts can yield a great detail of information and may suggest a specific diagnosis.
- Hematuria – associated with kidney stones, infections, tumors and other conditions
- Pyuria – associated with urinary infections
- Eosinophiluria – associated with allergic interstitial nephritis, atheroembolic disease
- Red blood cell casts – associated with glomerulonephritis, vasculitis, or malignant hypertension
- White blood cell casts – associated with acute interstitial nephritis, exudative glomerulonephritis, or severe pyelonephritis
- (Heme) granular casts – associated with acute tubular necrosis
- Crystalluria – associated with acute urate nephropathy (or acute uric acid nephropathy, AUAN)
- Calcium oxalatin – associated with ethylene glycol
- Waxy casts – associated with chronic renal disease
Other methods of urinalysis
- Urine culture – a microbiological culture of urine samples, detecting bacteriuria, is indicated when a urinary tract infection is suspected.
- Ictotest – this test is used to detect the destruction of old red blood cells in the urine.
- Hemoglobin test – this tests for hemolysis in the blood vessels, a rupture in the capillaries of the glomerulus, or hemorrhage in the urinary system, which cause hemoglobin to appear in the urine.
See also
- Blood test
- Uroscopy, the ancient form of this analysis
- Medical technologist
- Urinary casts
- Proteinuria
- Urine test strip
- Urine collection device
- Pregnancy test, measures hCG levels in urine
- Blood lead level
References
- ^ a b c Simerville JA, Maxted WC, Pahira JJ (March 2005). "Urinalysis: a comprehensive review". American Family Physician 71 (6): 1153–62. PMID 15791892.
- ^ Harper, Douglas. "Urinalysis". Online Etymology Dictionary. Retrieved 26 September 2011.
- ^ "Reference Ranges and What They Mean". Lab Tests Online (USA). Retrieved 22 June 2013.
- ^ http://www.mayoclinic.org/diseases-conditions/urine-color/basics/causes/con-20032831
- ^ http://www.mayoclinic.org/symptoms/urine-odor/basics/causes/sym-20050704
- ^ a b c d e f g h i j k l m n o p q r Normal Reference Range Table from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease.
- ^ a b c d e f g h i j Reference range list from Uppsala University Hospital ("Laborationslista"). Artnr 40284 Sj74a. Issued on April 22, 2008
- ^ a b c d medscape.com - Urine Calcium: Laboratory Measurement and Clinical Utility By Kevin F. Foley, PhD, DABCC; Lorenzo Boccuzzi, DO. Posted: 12/26/2010; Laboratory Medicine. 2010;41(11):683–686. © 2010 American Society for Clinical Pathology. In turn citing:
- Wu HBA. Tietz Guide to Clinical Laboratory Tests. 4th ed. St. Louis, MO: Saunders, Elsevier; 2006.
- ^ "MedlinePlus Medical Encyclopedia: Fractional excretion of sodium". Retrieved 2009-05-02.
- ^ Ajubi NE, Nijholt N, Wolthuis A (2005). "Quantitative automated human chorionic gonadotropin measurement in urine using the Modular Analytics E170 module (Roche)". Clinical Chemistry and Laboratory Medicine 43 (1): 68–70. doi:10.1515/CCLM.2005.010. PMID 15653445.
- ^ a b "medical.history.interview: Lab Values". Retrieved 2008-10-21.
- ^ a b "University of Colorado Laboratory Reference Ranges". Retrieved 2008-10-21.
- ^ a b Converted from µg/24 h, using molar mass of 362.460 g/mol
- ^ a b c Görges R, Knappe G, Gerl H, Ventz M, Stahl F (1999). "Diagnosis of Cushing's syndrome: Re-evaluation of midnight plasma cortisol vs urinary free cortisol and low-dose dexamethasone suppression test in a large patient group". Journal of endocrinological investigation 22 (4): 241–249. doi:10.1007/bf03343551. PMID 10342356.
- ^ a b c Converted from nmol/24h, using molar mass of 362.460 g/mol
- ^ a b MedlinePlus - Cortisol – urine. Update Date: 11/23/2009. Updated by: Ari S. Eckman. Also reviewed by David Zieve.
- ^ a b Kim NH, Jeong JS, Kwon HJ, Lee YM, Yoon HR, Lee KR, Hong SP (2010). "Simultaneous diagnostic method for phenylketonuria and galactosemia from dried blood spots using high-performance liquid chromatography-pulsed amperometric detection". Journal of Chromatography B 878 (21): 1860–1864. doi:10.1016/j.jchromb.2010.04.038. PMID 20494631.
External links
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Wikimedia Commons has media related to Urinalysis. |
- Lab Tests Online: Urinalysis
- Different Types of Urinalysis
- Instructions How to Use with Reader and Without By Color Comparison
- Conoximent de las Orines, an early book about analyzing urine for medical purposes. Estimated date 1466.
‹ The template below (Urine tests) is being considered for merging. See templates for discussion to help reach a consensus.›
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Components and results of urine tests (CPT 81000–81099)
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| Protein |
- Albumin
- Myoglobin
- hCG
- Leukocyte esterase
- Urine pregnancy test
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| Small molecules |
- Ketone bodies
- Glucose
- Urobilinogen
- Bilirubin
- Creatinine
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| Blood cells |
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| Chemical properties |
- Urine specific gravity
- Urine osmolality
- Urine pH
- Urine anion gap
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| Other |
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‹ The template below (Abnormal clinical and laboratory findings for urine) is being considered for merging. See templates for discussion to help reach a consensus.›
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Abnormal clinical and laboratory findings from a urine test (R80–R82, 791)
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| Red blood cells |
- Hematuria (Microscopic hematuria)
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| White blood cells |
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| Proteinuria |
- Albuminuria/Microalbuminuria
- Myoglobinuria
- Hemoglobinuria
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| Small molecules |
- Glycosuria
- Ketonuria
- Bilirubinuria
- Hyperuricosuria/Hypouricosuria
- Aminoaciduria
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| Pathogens |
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| Other |
- Chyluria
- Crystalluria
- osmolality (Isosthenuria, Hypersthenuria)
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尿検査は尿試験紙法を用いる。採取した尿に試験紙を浸し、試験紙の色の変化を目視によりサンプルと照らし合わせて決定する。尿沈渣は染色し、顕微鏡にて観察する。また、フローサイトメトリーにて成分を分け数量を決定する。
試験紙法は人が目視で行っているので、人がかわると結果も異なってくる可能性を考慮しておく。沈渣も個数はフローサイトメトリーによりだいたい正確に決定されているが、沈渣の円柱の分類などは人の目で決めているので、人による誤差があることを理解しておく。
