Urine analysis - Revision history

Danbot: Add Category:Labs

2026-03-22T06:44:05Z

← Older revision		Revision as of 06:44, 22 March 2026
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	[[Category:Renal]]		[[Category:Renal]]
	[[Category:Urology]]		[[Category:Urology]]
			[[Category:Labs]]

ClaireLewis at 18:13, 16 October 2019

2019-10-16T18:13:58Z

← Older revision		Revision as of 18:13, 16 October 2019
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	**Any acid-base abnormalities affects urinary pH		**Any acid-base abnormalities affects urinary pH
	**Diet can affect pH		**Diet can affect pH
	**Useful in evaluation stones, infection, RTA		**Useful in evaluation [[nephrolithiasis\|stones]], [[UTI\|infection]], [[renal tubular acidosis\|RTA]]
	***Stones: alkaline (calcium oxalate/calcium phosphate, magnesium-ammonium phosphate, staghorn) vs acidic (uric acid, cysteine)		***[[nephrolithiasis\|Stones]]: alkaline (calcium oxalate/calcium phosphate, magnesium-ammonium phosphate, staghorn) vs acidic (uric acid, cysteine)
	***UTI: proteus and klebsiella produce alkaline urine		***[[UTI]]: [[proteus]] and [[klebsiella]] produce alkaline urine

	*Specific gravity		*Specific gravity
	**Represents kidney's ability to concentrate urine; often reflective of hydration status		**Represents kidney's ability to concentrate urine; often reflective of hydration status
	**Low values can be seen in ~~pts~~ with impaired urinary concentrating ability (i.e. ~~diabetic insidious~~, sickle cell nephropathy, acute tubular necrosis)		**Low values can be seen in patients with impaired urinary concentrating ability (i.e. [[diabetes insipidus]], [[sickle cell]] nephropathy, acute tubular necrosis)
	**High values can be due to elevated protein or ketoacids		**High values can be due to elevated protein or ketoacids
	**Specific gravity should be considered in detection of pediatric UTI<ref>Chaudhari PP et al. The Importance of Urine Concentration on the Diagnostic Performance of the Urinalysis for Pediatric Urinary Tract Infection. Ann Emerg Med. 2017 Feb 3. pii: S0196-0644(16)31512-8.</ref>		**Specific gravity should be considered in detection of pediatric UTI<ref>Chaudhari PP et al. The Importance of Urine Concentration on the Diagnostic Performance of the Urinalysis for Pediatric Urinary Tract Infection. Ann Emerg Med. 2017 Feb 3. pii: S0196-0644(16)31512-8.</ref>
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	*Glucose		*Glucose
	**Glucosuria is due to high blood glucose or decreased kidney threshold concentration		**Glucosuria is due to [[hyperglycemia\|high blood glucose]] or decreased kidney threshold concentration
	**Typically seen in diabetics or pregnant patients		**Typically seen in [[diabetes\|diabetics]] or [[pregnancy\|pregnant]] patients

	*Ketones		*Ketones
	**Typically seen with uncontrolled diabetes, [[Diabetic ketoacidosis]], severe exercise, starvation, vomiting, pregnancy		**Typically seen with uncontrolled [[diabetes]], [[Diabetic ketoacidosis]], severe exercise, starvation, [[vomiting]], [[pregnancy]]

	*Nitrite		*Nitrite
	**90% specific but 50% sensitive in detecting gram ~~neg~~ bacteria that converts nitrate to nitrite		**90% specific but 50% sensitive in detecting [[gram negative]] bacteria that converts nitrate to nitrite
	**A positive test suggest bacteria but a negative test cannot rule out UTI		**A positive test suggest bacteria but a negative test cannot rule out UTI

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	*Bilirubin		*Bilirubin
	**Increased urobilirubin associated with excessive hemolysis, liver disease, constipation, intestinal bacterial overgrowth		**Increased urobilirubin associated with excessive [[hemolytic anemia\|hemolysis]], liver disease, [[constipation]], intestinal bacterial overgrowth
	**Decreased urobilirubin associated with obstructive biliary disease and severe cholestasis		**Decreased urobilirubin associated with obstructive [[biliary disease]] and severe cholestasis

	*Proteins		*Proteins
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	***4+ - >1000mg/dl		***4+ - >1000mg/dl
	**Etiology		**Etiology
	***Transient proteinuria: CHF, fever, exercise, seizure, stress		***Transient [[proteinuria]]: [[CHF]], [[fever]], exercise, [[seizure]], stress
	***Persistent proteinuria: nephrotic syndrome, glomerulonephritis, ATN, AIN, Falcon syndrome, multiple myeloma, myoglobinuria		***Persistent [[proteinuria]]: [[nephrotic syndrome]], [[glomerulonephritis]], ATN, AIN, Falcon syndrome, [[multiple myeloma]], myoglobinuria

	*Blood		*Blood
	**If more than 3RBCs, urine dipstick is positive for blood		**If more than 3RBCs, urine dipstick is positive for blood
	**Does not detect where the blood is coming from		**Does not detect where the blood is coming from
	***Can be due to hematuria, hemoglobinuria, myoglobinuria, contamination		***Can be due to [[hematuria]], hemoglobinuria, myoglobinuria, contamination
	***Blood+/RBC+ → hematuria		***Blood+/RBC+ → [[hematuria]]
	***Blood+/RBC- → myoglobinuria (rhabdomyolysis, renal failure) or hemoglobinuria (infection, transfusion-related reaction, paroxysmal nocturnal hemoglobinuria)		***Blood+/RBC- → myoglobinuria ([[rhabdomyolysis]], [[renal failure]]) or hemoglobinuria (infection, [[transfusion reaction\|transfusion-related reaction]], [[paroxysmal nocturnal hemoglobinuria]])

	===Microscopic Examination===		===Microscopic Examination===
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	*RBCs		*RBCs
	**Microscopic hematuria defined as 3RBCs/hpf or more		**Microscopic [[hematuria]] defined as 3RBCs/hpf or more
	**Transient hematuria in young patients is typically benign. In older patients >50yo, warrants further work-up for underlying malignancy		**Transient [[hematuria]] in young patients is typically benign. In older patients >50yo, warrants further work-up for underlying malignancy
	**Persistent hematuria always warrants further work-up		**Persistent [[hematuria]] always warrants further work-up
	***Renal: glomerular (proteinuria, RBC casts, dysmorphic RBCs) vs nonglomerular (no RBC casts or dysmorphic RBCs)		***Renal: glomerular ([[proteinuria]], RBC casts, dysmorphic RBCs) vs nonglomerular (no RBC casts or dysmorphic RBCs)
	***Extrarenal: tumors, stones, BPH, infections (pyelonephritis, cystitis, prostatitis, urethritis), schistosomiasis, foley trauma, anticoagulants, chemotherapy		***Extrarenal: tumors, [[nephrolithiasis\|stones]], BPH, infections ([[pyelonephritis]], [[cystitis]], [[prostatitis]], [[urethritis]]), [[schistosomiasis]], foley trauma, [[anticoagulants]], chemotherapy

	*Epithelial Cells		*Epithelial Cells
	**Generally, 15-20 squamous cells or more indicates contamination		**Generally, 15-20 squamous cells or more indicates contamination
	**Hyaline casts - nonspecific		**Hyaline casts - nonspecific
	**Red cell casts - nearly diagnostic of glomerulonephritis or vasculitis		**Red cell casts - nearly diagnostic of [[glomerulonephritis]] or [[vasculitis]]
	**White cell casts - tubulointerstitial nephritis, acute pyelonephritis, renal tuberculosis, vaginal infection		**White cell casts - tubulointerstitial nephritis, acute pyelonephritis, renal tuberculosis, vaginal infection
	**Muddy-brown granular casts - diagnostic of acute tubular necrosis		**Muddy-brown granular casts - diagnostic of acute tubular necrosis
	**Waxy and broad casts - advanced renal failure		**Waxy and broad casts - advanced [[renal failure]]
	**Fatty casts - nephrotic syndrome		**Fatty casts - [[nephrotic syndrome]]

	*Crystals		*Crystals
	**May be normal		**May be normal
	**Calcium oxalate crystals - ethylene glycol ingestion		**Calcium oxalate crystals - [[ethylene glycol]] ingestion
	**Uric acid crystals - tumor lysis syndrome, gout		**Uric acid crystals - [[tumor lysis syndrome]], [[gout]]
	**Cystine crystals - cystinuria		**Cystine crystals - cystinuria
	**Magnesium ammonium phosphate and triple phosphate crystals - UTI caused by Proteus, Klebsiella		**Magnesium ammonium phosphate and triple phosphate crystals - [[UTI]] caused by [[Proteus]], [[Klebsiella]]

	*Bacteria		*[[Bacteria]]
	**Generally due to infection or contamination		**Generally due to infection or contamination
	**If positive for nitrites, leukocyte esterase and bacteria - highly suggestive of UTI		**If positive for nitrites, leukocyte esterase and bacteria - highly suggestive of [[UTI]]
	**If significant amount of squamous epithelial cells - may indicate contamination		**If significant amount of squamous epithelial cells - may indicate contamination
	**Urine culture should be obtained if UTI suspected		**Urine culture should be obtained if UTI suspected
	***Generally, >100K/mL of a single organism reflects significant bacteriuria		***Generally, >100K/mL of a single organism reflects significant bacteriuria

	*Yeast		*[[candiduria\|Yeast]]
	**Generally due to infection or contamination		**Generally due to infection or contamination

Kearny89: /* Chemical Examination */

2019-06-05T01:52:51Z

Chemical Examination

← Older revision		Revision as of 01:52, 5 June 2019
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	**Diet can affect pH		**Diet can affect pH
	**Useful in evaluation stones, infection, RTA		**Useful in evaluation stones, infection, RTA
	***Stones: alkaline (calcium/oxalate/calcium phosphate, magnesium-ammonium phosphate, staghorn) vs acidic (uric acid, cysteine)		***Stones: alkaline (calcium oxalate/calcium phosphate, magnesium-ammonium phosphate, staghorn) vs acidic (uric acid, cysteine)
	***UTI: proteus and klebsiella produce alkaline urine		***UTI: proteus and klebsiella produce alkaline urine

Mholtz at 17:28, 28 June 2017

2017-06-28T17:28:39Z

← Older revision		Revision as of 17:28, 28 June 2017
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	==Reference Range==		==Reference Range==
	{\| {{table}}		{\| {{table}}
	\| Color\|\|Yellow		\| '''Color'''\|\|Yellow
	\|-		\|-
	\| Clarity/turbidity\|\|Clear		\| '''Clarity/turbidity'''\|\|Clear
	\|-		\|-
	\| pH\|\|4.5-8.0		\| '''pH'''\|\|4.5-8.0
	\|-		\|-
	\| Specific gravity\|\|1.005-1.025		\| '''Specific gravity'''\|\|1.005-1.025
	\|-		\|-
	\| Glucose\|\|<130 mg/d		\| '''Glucose'''\|\|<130 mg/d
	\|-		\|-
	\| Ketones\|\|None		\| '''Ketones'''\|\|None
	\|-		\|-
	\| Nitrites\|\|Negative		\| '''Nitrites'''\|\|Negative
	\|-		\|-
	\| Leukocyte esterase\|\|Negative		\| '''Leukocyte esterase'''\|\|Negative
	\|-		\|-
	\| Bilirubin\|\|Negative		\| '''Bilirubin'''\|\|Negative
	\|-		\|-
	\| Urobilirubin\|\|Small amount (0.5-1mg/dL)		\| '''Urobilirubin'''\|\|Small amount (0.5-1mg/dL)
	\|-		\|-
	\| Blood\|\|<3 RBCs		\| '''Blood'''\|\|<3 RBCs
	\|-		\|-
	\| Protein\|\|<150mg/d		\| '''Protein'''\|\|<150mg/d
	\|-		\|-
	\| RBCs\|\|<2 RBCs/hpf		\| '''RBCs'''\|\|<2 RBCs/hpf
	\|-		\|-
	\| WBCs\|\|<2-5 WBCs/hpf		\| '''WBCs'''\|\|<2-5 WBCs/hpf
	\|-		\|-
	\| Squamous epithelial cells\|\|<15-20 per hpf		\| '''Squamous epithelial cells'''\|\|<15-20 per hpf
	\|-		\|-
	\| Casts\|\|0-5 hyaline casts/hpf		\| '''Casts'''\|\|0-5 hyaline casts/hpf
	\|-		\|-
	\| Crystals\|\|Occasionally		\| '''Crystals'''\|\|Occasionally
	\|-		\|-
	\| Bacteria\|\|None		\| '''Bacteria'''\|\|None
	\|-		\|-
	\| Yeast \|\|None		\| '''Yeast'''\|\|None
	\|}		\|}

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	==See Also==		==See Also==


	==References==		==References==
	<references/>		<references/>
	*Edgar, L. emedicine.medscape.com/article/2074001

	[[Category:Renal]] [[Category:Urology]]		[[Category:Renal]]
			[[Category:Urology]]

Alvarez13: /* Chemical Examination */

2017-05-25T14:22:04Z

Chemical Examination

← Older revision		Revision as of 14:22, 25 May 2017
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	*Nitrite		*Nitrite
	**~~Specific~~ but ~~not~~ sensitive in detecting ~~[[Acute cystitis]]~~		**90% specific but 50% sensitive in detecting gram neg bacteria that converts nitrate to nitrite
	***A positive test suggest ~~UTI~~ but a negative test cannot rule out UTI		**A positive test suggest bacteria but a negative test cannot rule out UTI

	*Leukocyte Esterase		*Leukocyte Esterase
	**Enzyme within WBC that is released when WBCs lyse		**Enzyme within WBC that is released when WBCs lyse
	**~~Typically implies [[Acute cystitis]]~~		**70% sensitive and 50% specific for detecting WBCs (pyuria)

	*Bilirubin		*Bilirubin

Kxl328: /* Chemical Examination */

2017-03-14T06:38:01Z

Chemical Examination

← Older revision		Revision as of 06:38, 14 March 2017
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	**Low values can be seen in pts with impaired urinary concentrating ability (i.e. diabetic insidious, sickle cell nephropathy, acute tubular necrosis)		**Low values can be seen in pts with impaired urinary concentrating ability (i.e. diabetic insidious, sickle cell nephropathy, acute tubular necrosis)
	**High values can be due to elevated protein or ketoacids		**High values can be due to elevated protein or ketoacids
			**Specific gravity should be considered in detection of pediatric UTI<ref>Chaudhari PP et al. The Importance of Urine Concentration on the Diagnostic Performance of the Urinalysis for Pediatric Urinary Tract Infection. Ann Emerg Med. 2017 Feb 3. pii: S0196-0644(16)31512-8.</ref>
			***The higher the concentration of the urine, when in the presence of negative LE, the higher the negative predictive value of [[UTI]]
			***At threshold of greater than or equal to 5 WBCs per HPF in microscopic UA

	*Glucose		*Glucose

Mholtz: Text replacement - "-->" to "→"

2017-02-08T22:27:34Z

Text replacement - "-->" to "→"

← Older revision		Revision as of 22:27, 8 February 2017
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	**Does not detect where the blood is coming from		**Does not detect where the blood is coming from
	***Can be due to hematuria, hemoglobinuria, myoglobinuria, contamination		***Can be due to hematuria, hemoglobinuria, myoglobinuria, contamination
	***Blood+/RBC+ ~~-->~~ hematuria		***Blood+/RBC+ → hematuria
	***Blood+/RBC- ~~-->~~ myoglobinuria (rhabdomyolysis, renal failure) or hemoglobinuria (infection, transfusion-related reaction, paroxysmal nocturnal hemoglobinuria)		***Blood+/RBC- → myoglobinuria (rhabdomyolysis, renal failure) or hemoglobinuria (infection, transfusion-related reaction, paroxysmal nocturnal hemoglobinuria)

	===Microscopic Examination===		===Microscopic Examination===

ClaireLewis: /* References */

2016-10-04T20:11:50Z

References

← Older revision		Revision as of 20:11, 4 October 2016
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	<references/>		<references/>
	*Edgar, L. emedicine.medscape.com/article/2074001		*Edgar, L. emedicine.medscape.com/article/2074001

			[[Category:Renal]] [[Category:Urology]]

Rossdonaldson1: /* References */

2016-09-29T01:19:06Z

References

← Older revision		Revision as of 01:19, 29 September 2016
Line 144:		Line 144:
	==See Also==		==See Also==

	===References===		==References==
	<references/>		<references/>
	*Edgar, L. emedicine.medscape.com/article/2074001		*Edgar, L. emedicine.medscape.com/article/2074001

Rossdonaldson1: /* See Also */

2016-09-29T01:18:54Z

← Older revision		Revision as of 01:18, 29 September 2016
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	**Generally due to infection or contamination		**Generally due to infection or contamination

	===See Also===		==See Also==

	===References===		===References===
	<references/>		<references/>
	*Edgar, L. emedicine.medscape.com/article/2074001		*Edgar, L. emedicine.medscape.com/article/2074001