Urine examination/cosmetic dentistry courses

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

Biochemistry by U. Satyanarayana
Clinical diagnosis and management by lab methods.
A handbook of medical lab technology by V.H. Talib.
Medical lab technology by S. Kwathilkar

At the end of the seminar, the learner should be able
to -
1. Understand Objectives of urine analysis
2. Describe the process of urine formation
3. Illustrate different types of urine tests

A significant amount of information can be obtained through the
examination of urine.
1. Careful examination enables the detection of disease processes
intrinsic to the urinary system, both functional and structural.
2. The progression or regression of various lesions.
3. Furthermore, systemic disease processes, such as endocrine or
metabolic abnormalities, can be detected through the recognition of
abnormal amounts of disease specific metabolites excreted in the
urine.

 Three main types of urinalysis are currently performed.
 These include –
1. The dipstick urinalysis
2. The basic urinalysis
3. The specialized cytopathological urine sediment examination.

 The routine urine analysis consists of two major components-
1. Physiochemical determinants
2. A brightfield or phase contrast microscopic examination of urine
sediment for evidence of hematuria, pyuria, etc.

 In the normal adult, approximately
1200 ml of blood perfuse the kidney each
minute, which accounts for about 25% of
the cardiac output.
 The glomeruli receives blood through afferent arterioles, and an
ultrafiltrate of the plasma passes through each glomerulus into
Bowman’s space.
 From here the filtrate is passed through the tubules and collecting duct
where reabsorption or secretion of various substances occur.
 Ultimately, the original glomerular filtrate volume of 1-2 L is formed.

– First morning voiding (most concentrated)First morning voiding (most concentrated)
– Record collection timeRecord collection time
– Analyzed within 2 hours of collectionAnalyzed within 2 hours of collection
– Free of debris or vaginal secretionsFree of debris or vaginal secretions

SpecimenSpecimen
CollectionCollection
Suprapubic Needle AspirationSuprapubic Needle Aspiration

1. Macroscopic Examination
2. Chemical Analysis (Urine Dipstick)
3. Microscopic Examination
4. Culture
5. Cytological Examination
Types of AnalysisTypes of Analysis

Gross examination
1) Appearance
Color
Character
Odor
Volume

ColorlessColorless Diluted urineDiluted urine
Deep Yellow Conc. Urine, RiboflavinDeep Yellow Conc. Urine, Riboflavin
Yellow-GreenYellow-Green Bilirubin / BiliverdinBilirubin / Biliverdin
RedRed Blood / HemoglobinBlood / Hemoglobin
Brownish-redBrownish-red Acidified Blood (Acute GN)Acidified Blood (Acute GN)
Brownish-blackBrownish-black Homogentisic acid (Melanin)Homogentisic acid (Melanin)

Volume:
Normal 700 ml – 2500 ml
Polyuria >2500ml in 24 hrs
Oligouria < 500ml in 24 hrs
Anuria < 150ml in 24 hrs

1. Dehydration
2. Acute Glomerulonephritis
3. Shock
4. Toxic Nephropathy
5. Obstruction
6. Chronic glomerulonephritis
7. Addison’s disease
8. Hyperparathyroidism

1. Polydipsia
2. Diabetes mellitus
3. Diabetes insipidus
4. Caffeine
5. Alcohol
6. Diuretic agent

 Ammonia-like:Ammonia-like: Urea-splitting bacteriaUrea-splitting bacteria
 Foul, offensive:Foul, offensive: Old specimen, pus or inflammationOld specimen, pus or inflammation
 Sweet:Sweet: GlucoseGlucose
 Fruity:Fruity: KetonesKetones
 Maple syrup-like:Maple syrup-like: Maple Syrup Urine DiseaseMaple Syrup Urine Disease
 Mousy PhenylketonuriaMousy Phenylketonuria

The specific gravity of a specimen indicates the relative
proportion of dissolved solid components to total volume of the
specimen.
Osmolality on the other hand indicates the no. of particles of
solute per unit of solution.

Urea (20%), sodium chloride (25%), sulfate and phosphate
contributes most to specific gravity of normal urine.
Normal adult urine specific gravity is 1.016 – 1.022 over a
period of 24 hrs.
Urine with low specific gravity is known as hyposthenuric, the
S.P < 1.007.

1. Urinometer
2. Refractometer
3. Falling drop method
4. Reagent strip method

Low specific gravity:
Excess water intake
Diabetes insipidus
High specific gravity:
Dehydration
Albuminuria
Glycosuria
Fixed Specific gravity
ADH Deficiency
Chronic nephritis

Normal adult urine osmolality – 500-850 mOsm/kg water.
Dehydration – 800- 1400 mOsm/kg water.
Diuresis – 40 – 80,Osm/kg water.

Urine pH
Protein
Glucose and other sugars
Ketones
Blood, Hb, hemosiderin and myoglobin
Bilirubin
Urobilinogen
Miscellaneous chemical screening test (ascorbic acid,melanin)

Chemical AnalysisChemical Analysis
Urine DipstickUrine Dipstick
Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protein
Urobilinogen
Nitrite
Leukocyte Esterasewww.indiandentalacademy.com

 Normal urine pH may vary from 4.6-8.
 Acidic pH:
 High protien / acid fruit juice
 Respiratory and metabolic acidosis
 UTI by E.coli
 Alkaline pH:
 Citrus fruits / vegetables
 Respiratory and metabolic alkalosis
 UTI proteus , Pseudomonas

1. Reagent strip
2. Ph electrode
3. Titratable acidity of urine

5.05.0
6.06.0
6.56.5
7.07.0
7.57.5
8.08.0
8.58.5
The UrineThe Urine
Dipstick:Dipstick: pHpH
HH++
interacts with:interacts with:
Methyl Red (at high concentration; low pH) andMethyl Red (at high concentration; low pH) and
Bromthymol Blue (at low concentration; highBromthymol Blue (at low concentration; high
pH), to form a colored complexespH), to form a colored complexes
(dual indicator system)(dual indicator system)
Chemical PrincipleChemical Principle

Normally up to 15o mg of protein is excreted in urine daily,
with the average urine protein concentration varying from 2 –
10 ml/dl.
Detection of an abnormal amount of protein in urine is an
important indicator of renal disease because protein has a very
low maximal threshold rate of reabsorption.

Protein % of Total Daily Maximum
Albumin 40% 60 mg
Tamm-Horsfall 40% 60 mg
Immunoglobulins 12% 24 mg
Secretary IgA 3% 6 mg
Other 5% 10 mg
TOTAL 100% 150 mg
Proteins in “Normal” UrineProteins in “Normal” Urine

Heavy proteinuria
(.4gm/dl)
Moderate
proteinuria(1.0 –
4.0gm/dl)
Minimal proteinuria
(,1.0gm/dl)
Nephrotic syndrome Multiple myeloma Chronic
pyelonephritis
Congestive
pericarditis
Nephrosclerosis Medullary cystic
disease
Renal vein thrombosis Toxic nephropathies

1. Heat Acetic acid Test
2. Sulphosalicylic acid test
3. Protein reagent strip
4. Bence Jones proteinuria determination
5. Quantative determination

Principle:
Test is based on heating the proteins which results in their
coagulation and as a result protein is visible as a white
coagulum.

 Fill 3/4th
test tube with Urine
 Heat tube on the top (upper edge of sample urine)
 In case proteins are present in the urine , they will coagulate
with heat giving a white coagulum on the upper part.
 Add Acetic Acid if the coagulum dissolves then it is not due to
proteins (due to Phosphates)

It precipitates at temperature between 40 – 60 degree Celsius,
and redissolves near 100 degree Celsius.
It represents single sharp peak of either the kappa or lambda
immunoglobulin light chain presence

It is colorimetric in nature.
Sulfosalicylic acid or trichloroacetate acids are commonly
used precipitants, the resultant turbidity can be measured by a
photometer.

Various sugars may be found in urine.
These includes glucose, fructose, galactose, lactose, maltose,
pentose and sucrose.
Glucose appears in urine when the blood level of glucose is
more than 180mg/dl.

1. Diabetes mellitus
2. Cushing’s syndrome
3. Hyperthyroidism
4. Pheochromocytoma
5. Acromegaly
6. Hyperadrenocorticism

Sugar Disease(s)
- Galactose Galactosemias
- Fructose Fructosuria, Fructose Intolerance, etc.
- Lactose Lactase Deficiency
- Pentoses Essential Pentosuria
- Maltose Non-pathogenic

Methods of detecting glycosuria
1. Benedict’s method/ copper reduction test
2. Fehling’smethod
3. Glucose Oxidase method
4. Osazone test
5. Reagent strip

Principle:
Copper Sulphate is reduced to cupric sulphate which shows a
play of colors when heated in alkaline environment in
presence of a reducing substance.

5ml Benedict's solution
8 drops of urine (0.5ml) into the Benedict's solution.
Heat the test tube
Play of colors Blue to Green to Yellow to Red to Orange
depending on the quantity of reducing substance present in
this case glucose

Whenever there is defect in carbohydrate metabolism or
absorption or an inadequate amount of carbohydrate in the
diet, the body compensates by metabolizing increasing amount
of fatty acids.
When this increase is large, ketone bodies, the product of
incomplete fat metabolism, begin to appear in blood and then
in urine.

Three ketone bodies-
1. Acetoacetic acid 20%
2. Acetone 2%
3. 3-hydroxybutyrate 78%
Total ketone bodies can range from 17-42mg/dl

Uncontrolled Diabetes Mellitus
Chronic starvation
Pregnancy toxemia
Prolonged vomiting
Severe Diarrhea with dehydration
Glycogen storage disease

1. Rothera’s test/ nitroprusside tablet test
2. Gerhardt’s test
3. Keto test strip Method/ reagent strip test

Rothera test: Principle- Acetone develops magenta colored
complex with Na Nitroprusside in an alkaline environment.

The presence of an abnormal no. of blood cells in urine is
known as hematuria - relatively common.
Presence of free Hb in urine refers to hemoglobinuria- rare
Presence of myoglobin – myoglobinuria – rare.

Hematuria Hemoglobinuria Hemosiderin Myoglobinuri
a
Neoplastic
renal
disease
Intravascular
hemolysis
Acute
hemolytic
episode
rhabdomyolysi
s
Calculi Extensive burn

Other tests-
Ortho Toulidine test
Aminophenazonetest
Dip stick test
Immunochemical method (Nephlometry)

Urine examination/cosmetic dentistry courses

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