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Urine history, Urine Composition, Normal Finding, Advantages of Urine Analysis

March 22, 2021Lab TestsUrine Analysis

History of the urine examination

  1. The analysis of the urine is actually the beginning of the laboratory medicines.
  2. At that time, the physicians checked the urine’s gross appearance, like color, turbidity, odor, and volume.
    Urine physical character

    Urine physical character

  3. They were testing the viscosity and even the sweetness. For sweetness, they were observing the attraction of the ants to urine.
    Urine sugar test in the old days

    Urine sugar test in the old days

  4. The modern urine examination includes physical as well as chemical and microscopic examination.
  5. Hippocrates wrote a book on urine examination as uroscopy in 5th BC.
  6. In 1140 AD, color char was developed, describing the significance of 20 different colors of the urine.
  7. Chemical testing progressed after the ant gathering around the diabetic urine.
  8. Later on, taste testing was also started.
  9. In 1694, Frederick Dekkers discovered the protein, Albuminuria by boiling the urine.
  10. Pisse prophets by the Charlatans became the subject of the book published by  Thomas Bryant in 1627.
  11. The advent of the microscope in the 17th century led to the examination of urine sediments.
  12. Richard Bright, in 1827 made the urine examination a routine for the patients.
  13. In 1930 the number and the complexity of urine examination made urine examination impractical.
  14. With modern facilities, the urine examination is the routine part of the patient’s doctor’s office visit.
  15. Now urine examination is popular due to:
    • Easily available sample.
    • Urine gives many of the body metabolism information.
    • This information from the urine is cheap.
  16. The National Committee for clinical laboratory standards (NCCLS) define the urine analysis procedure is reliable, accurate, safe, and cost-effective.

Urine definition

  1. Urine is a liquid biopsy obtained without pain or cost to the patient, but it provides a wealth of diagnostic information.
  2. Urine is the main source of information from a sick (damaged) kidneys to the physicians.
  3. Urine is the fluid excreted through the kidneys, passes through the ureter, and is stored in the urinary bladder. When the urinary bladder is full, then discharged through the urethra.

In a normal healthy person, urine is:

  1. Sterile.
  2. Clear.
  3. Amber color.
  4. It is slightly acidic (pH 5 to 6).
  5. Specific gravity is 1.024
  6. It has a characteristic odor.
  7. The daily output is 500 mL.
    1. Anuria when the urine volume is <100 mL/24 hours.
    2. Oliguria when the urine volume is <400 mL/24 hours.
    3. Polyuria when the urine volume is > 2000 mL/24 hours.

Urine Composition

The kidneys continuously form the urine as an ultrafiltrate of the plasma. Reabsorption of the water and filtered substances essential to the body function converts roughly 170,000 mL of filtered plasma to the average daily urine output of 1200 mL.

  1. Urine consists of:
    1. Urea. It is produced in the liver by the breakdown of proteins and amino acids.
      1. This is 50% of the dissolved solid substances in the urine.
    2. Organic substances like creatinine and uric acid.
    3. Inorganic substances. The major substance is chloride (CL¯), followed by Na+ and K+.
      1. The dietary intake makes it difficult to decide on the normal level.
    4. Water.
    5. Other substances found are:
      1. Hormones.
      2. Drugs.
      3. Vitamins.
      4. Cells.
      5. Cast.
      6. Crystals
      7. Bacteria.
        Urine formation and changes in the kidney

        Urine formation and changes in the kidney

  2. Urine constituents depend upon:
    1. Physical activity.
    2. Dietary intake.
    3. Body metabolism.
    4. Endocrine functions.
  3. To confirm the urine sample:
    1. Advise urea and creatinine; these are present in high concentrations than any other body fluids and confirm that the specimen is urine.

The Urine analysis includes:

Physical properties include:

  1. Color
  2. Appearance (opaque or colorless)
  3. Odor

Chemical Tests include:

  1. pH
  2. Specific gravity
  3. Protein
  4. Glucose
  5. Ketones
  6. Bilirubin
  7. Urobilinogen
  8. Blood
  9. Nitrite
  10. Leukocyte esterase

Microscopic Examination includes:

  1. Red blood cells
  2. White cells (WBC)
  3. Casts
  4. Crystals
  5. Epithelial cells
  6. Bacteria and another microorganism

Normal Urine findings are :

Characteristic Normal
Appearance  Pale or yellow
Transparency Clear
Volume 1200 to 2000 ml/24 hours
pH  5 to 7
Specific gravity 1.001 to 1.035
Cast (hyaline) 0 to 5 / HPF
Red blood cells ≤ 3 / HPF
Blood

Negative

Rarely 2 to 3 RBCs/HPF

White blood cells

 ≤2 to 5 HPF

Male = 1 to 2 /HPF

Female = 0 to 5 /HPF

Squamous epithelial cells ≤ 15 to 20 / HPF
Yeast Negative
Bacteria Negative
Protein  Negative
Glucose (Source 4)
  1.  Random sample = Negative
  2. Qualitative = 0 (negative)
  3. 24 hours sample = 1 to 15 mg/dL
Ketones (Source 4)  Urine = Negative
Bilirubin (Source 4)

 Negative

(o to 0.02 mg/dL)

Urobilinogen (Source 4)

 Negative

Random sample= ≤1 mg/dL (0 to 4 mg/24 hours)

2-hour sample = <1 mg /2 hours

24- hours sample = 0.5 to 4.0 mg/dL

Another source = 0.2 to 4.0 mg/24 hours

Porphyrins <300 µg/24 hours
Nitrite  Negative
Albumin 10 to 100 mg /24 hours
Amylase 260 to 950 smogi units/24 hours
Protein (Source 4)

Quantitative = negative

Urine 24 hours sample

  • Adult male = 1 to 14 mg/dL
  • Adult female = 3 to 10 mg/dL
  • Child <10 years = 1 to 10 mg/dL
Calcium (Source 4)

Normal diet = 100 to 300 mg/24 hours

Low-calcium diet = 50 to 150 mg/24 hours

(Another source = 0.3 g/24 hours)

Sodium chloride

average 10 g /24 hours

Patient with moderate to severe salt depletion = <10 mmol/L or <20 mmol/L /24 hours

(Another source = 15.0 g/24 hours)

Sodium (Source 4)

Adult = 40 to 220 meq/24 hours

Child = 41 to 115 meq/24 hours

Potassium (Source 4)

Adult = 25 to 125 meq/ 24 hours

Child = 10 to 60 meq/24 hours

(Another source = 3.3 g/24 hours)

Magnesium (Source 4)

75 to 150 mg/24 hours

(Another source = 0.1  g/24 hours)

Bicarbonate Negative
Creatinine

Male = 20 to 28 mg/Kg/24 hours

Female = 15 to 21 mg/Kg/24 hours

(Another source = 1.5 g/24 hours)

1.0 to 1.6 gm/24 hours

Creatine <100 mg/24 hours (higher value in children and pregnancy)
Urea nitrogen 5 to 15 g/24 hours
Nitrogen 7 to 20 g/24 hours
Urea

10 to 35 g/24 hours

(Another source = 25.0 to 35.0 g/24 hours)

Uric acid (Source 4)

With normal diet =  250 to 750 mg/24 hours

With purine-free diet = <400 mg/24 hours

With high-purine diet = <1000 mg/24 hours

(Another source = 0.4 to 1.0 g/24 hours)

Chloride (Source 4)

Adult = 110 to 250 meq/24 hours

Child  <6 years = 15 to 40 meq/24 hours

Child 10 to 16 years = 64 to 176 meq/24 hours

Ammonium NH4+ 0.7 g/24 hours
Phosphate PO4¯ 2.5 g/24 hours
Lead <0.08 µg/mL or 120 µg/24 hours
Cystine Negative  (0)
Homogentisic acid Negative (0)
δ-aminolevulinic acid 1.3 to 7.0 mg/24 hours
Phenyl pyruvic acid Negative (0)
Hemoglobin /myoglobin Negative (0)
Addis count
  1. RBC = up to 1000,000/24 hours
  2. WBC + epithelial cells= up to 2000,000/24 hours
  3. Casts = up to 100,000/24 hours

Advantages of the routine urine analysis:

Parameter Advantages of the test
Appearance Due to the presence of pigments, concentrated or diluted urine
pH To identify the crystals and acid-base balance
Glucose and ketone bodies Useful in the diabetics
Bilirubin Indicates liver disease and jaundice
Urobilinogen Help in the hemolytic anemia and obstructive jaundice
Presence of hemoglobin Indicates hemoglobinuria, I/V hemolysis
Presence of myoglobin Seen in rhabdomy0lysis
Presence of light-chain proteins Help to diagnose multiple myeloma
Porphobilinogen Diagnose porphyrias

 

Summary of the urine analysis

Summary of the urine analysis

  • Please see the details in Urine analysis Part 2.

Possible References Used
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