URINALYSIS 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 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.

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.

Ions and trace metals Lower limit Upper limit

Target

Unit

Comments

LOINCCodes

Nitrite

n/a

0/ negative[4]

The presence of nitrites in urine, termed nitrituria, indicates the presence of coliform bacteria. Further information: Nitrite test

5802-4

Sodium(Na) 150[5] 300[5] per day

A urinalysis is frequently ordered during the workup of acute renal mmol failure. Full kidney function can be / 24 h detected through the simple dipstick method.

2956-1

Potassium(K) 40[5] per day

90[5]

Urine K may be ordered in the workup of hypokalemia. In case of gastrointestinal loss of K, the urine K mmol will be low. In case of renal loss of K, 2829-0 / 24 h the urine K levels will be high. Decreased levels of urine K are also seen in hypoaldosteronism and adrenal insufficiency.

15[6] Urinary calcium(Ca) per day

20[6]

mmol An abnormally high level is / 24 h called hypercalciuria and an abnormally low rate is mg / calledhypocalciuria.

14637-3

100[6] 250[6]

24 6874-2 Further information: Urinary calcium hours

Phosphate(P) n/a[5] per day

38[5]

Phosphaturia is the hyperexcretion of phosphate in the urine. This condition is divided into primary and secondary types. Primary hypophosphatemia is characterized by direct excess excretion of phosphate mmol by the kidneys, as from primary renal 14881-7 / 24 h 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.

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%[7] indicating acute tubular necrosis or other kidney damage

Proteins and enzymes Lower limit Upper limit

Target

Unit

Comments

Protein

trace amounts[4] / 20

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 mg/dl thepermeability of the glomerulus is abnormally increased. This may be caused by renal infections or by other diseases that have secondarily affected the kidneys, such ashypertension, diabetes mellitus, jaundice, or hyperthyroidism. Further information: Proteinuria

Human chorionic gonadotropin|hCG Blood cells[edit]

50

[8]

U/l

This hormone appears in the urine of pregnant women. Home pregnancy tests commonly detect this substance.

Target

Lower limit

Upper limit

Unit

Comments

Red blood cells (RBCs) /

0[4][9]

2[4] 3[9]

per High Power

May be present as intact RBCs, which indicate bleeding. Even trace amount of blood is enough to give the entire urine

erythrocytes

Field (HPF)

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 (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[4] 2[4] / negative[4] 10 per l or

White blood cells(WBCs) / leukocytes /

0[4]

Further information: Pyuria

"Significant pyuria" at greater than or

(pus cells)

mm3

equal to 10 leucocytes per microlitre (l) or cubic millimeter (mm3)

"Blood" / n/a (actuallyhemoglobin)

0/ negative[4]

Hemoglobinuria is suggestive of in vivo hemolysis, but must be distinguished fromhematuria. In case of hemoglobinuria, a urine dipstick shows presence of blood, but no RBCs are seen dip-stick on microscopic examination. If hematuria qualitative is followed by artefactual ex vivoor in scale of 0 vitro hemolysis in the collected urine, to 4+ 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 Lower limit Upper limit

Target

Unit

Comments

Glucose

n/a

0/ negative[4]

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[4]

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[4]

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 brownishyellow pigmentation of the skin and of the scleraof the eyes. Further information: Bilirubinuria

Urobilinogen

0.2[4]

1.0 [4]

Ehrlich units or mg/dL

Creatinine per day 4.8[5]

19[5]

mmol / 24 h

Freecatecholamines, 90 [10] dopamine per day

420 [10]

g / 24 hours

Free cortisol

28[11]or 280[11] or nmol/24 Values below threshold indicate Addison's 30[12] 490[12] h disease, while values above indicateCushing's syndrome. A value smaller than 200 nmol/24 h (72 g/24 h[13]) strongly indicates absence 10[14]or 100[14] or g/24 h of Cushing's syndrome.[12] 11[13] 176[13]

Phenylalanine

30.0

mg/L[15]

In neonatal screening, a value above the upper limit defines phenylketonuria.[15]

Other urine parameters

Test

Lower limit

Upper limit

Unit

Comments

Urine specific gravity

1.003[1][4] 1.030[1][4] no unit

This test detects the ion concentration of urine. Small amounts of protein orketoacidosis 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 indicatesdehydration.

Osmolality

400[5]

n/a[5]

mOsm/kg

pH

5[4]

7[4]

(unitless)

by urination Bacterial cultures

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 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