Urinalysis - Department of Pathology

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Presentation Transcript

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Course: IDPT 5005 School of Medicine, UCDHSCUrinalysisFrancisco G. La Rosa, MD Francisco.LaRosa@ucdenver.edu Associate Professor, Department of Pathology University of Colorado Denver Health Sciences Programs, Denver, Colorado 80045

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Specimen CollectionFirst morning voiding (most concentrated) Record collection time Type of specimen (e.g. “clean catch”) Analyzed within 2 hours of collection Free of debris or vaginal secretions

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Clean Catch

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Specimen CollectionSupra-pubic Needle Aspiration

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Macroscopic Examination Chemical Analysis (Urine Dipstick) Microscopic Examination Culture (not covered in this lecture) Cytological ExaminationTypes of Analysis

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Macroscopic ExaminationOdor: Ammonia-like: (Urea-splitting bacteria) Foul, offensive: Old specimen, pus or inflammation Sweet: Glucose Fruity: Ketones Maple syrup-like: Maple Syrup Urine DiseaseColor: Colorless Diluted urine Deep Yellow Concentrated Urine, Riboflavin Yellow-Green Bilirubin / Biliverdin Red Blood / Hemoglobin Brownish-red Acidified Blood (Actute GN) Brownish-black Homogentisic acid (Melanin)

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Turbidity: Typically cells or crystals. Cellular elements and bacteria will clear by centrifugation. Crystals dissolved by a variety of methods (acid or base). Microscopic examination will determine which is present.Macroscopic Examination

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Chemical Analysis

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Chemical AnalysisUrine Dipstick

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The Urine Dipstick:GlucoseGlucose + 2 H2O + O2 ---> Gluconic Acid + 2 H2O2Glucose Oxidase3 H2O2 + KI ---> KIO3 + 3 H2OHorseradish PeroxidaseChemical PrincipleRead at 30 seconds RR: Negative

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Significance Diabetes mellitus. Renal glycosuria. Limitations Interference: reducing agents, ketones. Only measures glucose and not other sugars. Renal threshold must be passed in order for glucose to spill into the urine. Other Tests CuSO4 test for reducing sugars.Uses and Limitations of Urine Glucose Detection

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Sugar Disease(s) - Galactose Galactosemias - Fructose Fructosuria, Fructose Intolerance, etc. - Lactose Lactase Deficiency - Pentoses Essential Pentosuria - Maltose Non-pathogenic * NOT Sucrose because it is not a reducing sugarDetection of Reducing Sugars* by CuSO4

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+++trace4006008001000200Urinalysis Glucose ResultBlood Glucose (mg/dL)Urine versus Blood GlucoseNegative

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Preservation - Cells and casts begin to disintegrate in 1 - 3 hrs. at room temp. - Refrigeration for up to 48 hours (little loss of cells). Specimen concentration - Ten to twenty-fold concentration by centrifugation. Types of microscopy - Phase contrast microscopy - Polarized microscopy - Bright field microscopy with special staining (e.g., Sternheimer-Malbin stain)Microscopic ExaminationGeneral Aspects

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Microscopic ExaminationPer High Power Field (HPF) (400x) > 3 erythrocytes > 5 leukocytes > 2 renal tubular cells > 10 bacteria Per Low Power Field (LPF) (200x) > 3 hyaline casts or > 1 granular cast > 10 squamous cells (indicative of contaminated specimen) Any other cast (RBCs, WBCs) Presence of: Fungal hyphae or yeast, parasite, viral inclusions Pathological crystals (cystine, leucine, tyrosine) Large number of uric acid or calcium oxalate crystalsAbnormal Findings

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Erythrocytes - “Dysmorphic” vs. “normal” (> 10 per HPF) Leukocytes - Neutrophils (glitter cells) More than 1 per 3 HPF - Eosinophils Hansel test (special stain) Epithelial Cells - Squamous cells Indicate level of contamination - Renal tubular epithelial cells Few are normal - Transitional epithelial cells Few are normal - Oval fat bodies Abnormal, indicate NephrosisMicroscopic ExaminationCells

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Microscopic ExaminationRBCs

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Microscopic ExaminationRBCs

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Microscopic ExaminationWBCs

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Microscopic ExaminationSquamous Cells

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Microscopic ExaminationTubular Epithelial Cells

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Microscopic ExaminationTransitional Cells

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Microscopic ExaminationTransitional Cells

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Microscopic ExaminationOval Fat Body

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Microscopic ExaminationLE Cell

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Bacteria - Bacteriuria More than 10 per HPF Yeasts - Candidiasis Most likely a contaminant but should correlate with clinical picture. Viruses - CMV inclusions Probable viral cystitis.Microscopic ExaminationBacteria & Yeasts

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Last Updated: 8th March 2018

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