General Urine Examination (GUE) Or Urinalysis

General Urine Examination (GUE)
Or Urinalysis

GUE is the important screening procedure in clinical medicin because it gives diagnostically important information about the presence of disease inside and outside the urinary tract by urine analysis screen for renal or urinary tract disease and help detect metabolic and systemic disease , because they don’t apeare clear symptoms.
Urine composition is affected mainly by three factors, they are:
1. Nutritional status.
2. State of metabolic processes.
3. Ability of kidney to selectively handle the material presented to it.

Methods of urine collection:
Urin collected in clean, dry container and should examined fresh, bacterial contamination causes alkaline of urine due to conversion of urea to ammonia and loss of glucose.

Macroscopic urinalysis:
*Appearance:
Normal urine is clear and pale yellow (straw) in color. Table No.1 shows the
types of abnormal urine color and their causes:

Table No.1: Abnormal urine color and its causes:
Color Causes
Colorless Dilution, D.M (Diabetes milletus),D.I (Diabetes Insebetes)
Milky Pus from genitor-urinary tract disease, chyluria.
Orange Urobilinogenuria
Red Beet root ingestion, haematuria , haemoglobinuria , phenolphthalein
Greenish Jaundice , phenol poisoning (tea color)
Dirty blue or green Putrefying urine in typhus or cholera
Dark brown Brown red or yallow very contaminated urine, acute febrile disease, bilirubinurine
















* Volum:
The average 24 hours urinary output in an adult is around 1200 – 1500 ml.

Table NO.2 Shows the abnormal urine volume and its causes:
Urine type Volume Causes
Polyuria More than 2000 ml • D.M or D.I
• Chronic renal failure
• Intravenous saline / glucose
Oligouria Less than 500 ml • Dehydration due to vomiting, diarrhea and excessive sweating
• Renal ischemia
• Obstruction to urinary flow
Anuria Complete cessation
Nocturia Excreation by an adult of urine more than 500ml at night • Chronic glomerulonephritis

*Specific Gravity (SG):
Specific gravity measures urine density, or the ability of the kidney to concentrate or dilute the urine . It depends upon the concentration of various solutes in the urine. SG measured by:

A.Urinometer:
Procedure /
1. Transfer urine (about 80ml) into the urinometer container.
2. Left the urinometer float freely without touching the sides or the bottom of the container.
3. Read the graduation.

B. Refractometer.

Urine of low SG is called Hyposthenuric (< 1.007) happen in :
1. Excessive water uptake
2. Chronic nephritis
3. DI
4. All causes of polyuria except DM.

Urine of high SG is called Hypersthenuric (< 1.010) happen in :
1. Excessive sweating
2. Glycouria
3. Albominuria
4. All causes of oligouria.

Urine with fixed SG of about (1.010 - 1.012) called isothenuria.

* Reaction(PH):
Urine PH measured by litmus paper or by PH meter.
Among the urinary tract infection (UTI), E.coli caused
acidic urine, while Proteus caused alkalin urine. Meat
protein diat cause acidification of urine consumption
of citrus fruits makes the urine alkaline.
Urinary PH may range from as low as 4.6 to as high as 8.0.

Table No.3: Acidic an alkaline urine cases
Urine PH condition Causes
Acidic Kotosis • D.M
• Starvation
• Fibrile illness
Acidification therapy Used in UTI treatment
Alkaline Post prandial
Vagetarianism
UTI

Proteus, Pseudomonas infection




Chemical analysis

A. Protein test
1) Heat & acetic acid
Urine is putting in a test tube, heating the upper part of specimen (the lower part not heating for comparison). If the heated part of specimen cloudiness or turbid that may be indicate for protein presence. Add few drops of (10%) acetic acid prove the presence of protein if the cloudiness permanent, and when the cloudiness absent that mean the cloudiness as a result of presence the phosphate or carbonate.
Results:
No cloudiness -
Definite cloudiness, but no granularity +
Granular cloudiness in upper part, dense and transparence ++
High dense and opaque cloudiness +++
Dense precipitation and often it is solid ++++

2) Sulphosalicylic acid test:
In the case of clear and acidic urine specimen add 3 drops of (20%) Sulphosalicylic acid to 1 ml of specimen then heating the specimen. If the cloudiness continue means positive result (presence of protein).
3) Detecting the protein by strips.

B-Glucose test (Benedict s test)
In this method the (Cu) ions redact to the (Cu2O) by the glucose if present. If the glucose concentration 0.1% or less there are no precipitate was seen after cooling specimen.

Procedure:
Add 8 drops of urine to 5ml of benedict, heating the tube until boiling and examinant.

Results
Blue color , Negative result -
Green Green (<0.5% glucose) +
Greenish yellow (0.5-1% glucose) ++
Yellow (1-2% glucose) +++
Orange to red (over 2% glucose) ++++
C- Ketone bodies
Ketone bodies are product of incomplete fat metabolism and their presence is indicative of acidosis.
There are three ketone bodies that can be detected in urine:
1. Aciton
2. Acetoacetic acid
3. ?-hydroxybutyric acid

Ketone bodies test (Rothera s test)

Procedure:
1. Saturate 5ml of urine with annonium sulphate.
2. Add small crystals of sodium nitropruside and shake.
3. Add ammonia in amount equal to sodium nitropruside at the side of the test tube.
Results: Formation of purple ring indicate (+ve) refer to Ketoneuria .

D- Bile pigment test (Harrison test)
The normal value of bile pigment in urine specimen less than or equal to 0.02 mg%.
Procedure:
1. Add 5 ml of 10% Barium chloride to 5 ml of urine in a test tube.
2. Filter the sample by filter paper, and let the filter paper to dry.
3. Add 1-2 drop of Fouchet s reagent to the dried precipitate.
Results: Green color indicate +ve test.

*Causes of hyperbilirubinuria:
1. Moderate to severe hepatocellular damage
2. Obstruction of bile ducts

E- Urobilinogen test (Ehrlich s test)

Procedure:
1. Add 1 ml of Ehrlich s reagent to 10 ml of urine.
2. Invert the tube several times and let it stand fro 5 minutes.
Results: Pink color is normal, while another color is +ve test.

*Causes of urobilinogenuria:
1. Hemolytic anemia.
2. Early, moderate and severe hepatocellular damage. It is not raised in obstruction jaundice.