Urinalysis: Physical Examination and Urine Volume

600 to 2,000 mL.

1,200 to 1,500 mL.

< 400 mL.

2–3:1.

50 mL.

10 to 15 mL (Average: 12 mL for urinometry and reagent strip testing).

Increased urine volume exceeding: > 2,000 mL/24 hrs (in adults — Henry), > 2.5 L/day (in adults — Strasinger), 2.5–3.0 mL/kg/day (in children)

Increased fluid intake, Diuretics, Nervousness, Diabetes mellitus (associated with high Specific Gravity / ↑ SG), Diabetes insipidus (associated with low Specific Gravity / ↓ SG)

Decreased urine volume under: < 500 mL/24 hrs (in adults — Henry), < 400 mL/day (in adults — Strasinger), < 1 mL/kg/hr (in infants), < 0.5 mL/kg/hr (in children)

Dehydration, Renal diseases, Renal calculi or tumor

Complete cessation of urine flow

- Complete obstruction

Excretion of more than 500 mL of

- Pregnancy , - Renal diseases, bladder

Any increase in urine excretion

- Excessive water intake

The degree of hydration (should correlate with urine Specific Gravity).

Normal: Colorless to deep yellow; Abnormal: Red / Red-brown (most common).

Examine the specimen under a good light source, looking down through the container against a white background.

Color: Major pigment (Yellow); Properties: Lipid-soluble product of endogenous metabolism, production is directly proportional to metabolic rate; Clinical Increase: Increased in thyrotoxicosis, fever, and starvation.

Color: Pink (or red); Origin: Derived from melanin metabolism; Deposition: May deposit on amorphous urates and uric acid crystals.

Color: Dark yellow / orange-brown; Origin: Derived from the oxidation of colorless urobilinogen; Sample Context: Present in old specimens.

Recent fluid consumption, polyuria, and dilute random specimens.

Normal urine color.

Concentrated specimens (strenuous exercise, dehydration, fever, burns), first morning specimens, excessive urobilin, bilirubin, and carotene.

Bilirubin (tea-colored urine with yellow foam), Phenazopyridine / Pyridium (orange and viscous urine with orange foam), acriflavin, nitrofurantoin, and phenindione.

Bilirubin oxidized to biliverdin.

Pseudomonas infection.

Amitriptyline, methocarbamol, Clorets, methylene blue, chlorophyll, phenol (initially brown, turns green when oxidized), and indican.

RBCs (cloudy/smoky red: hematuria), Hemoglobin (clear red), Myoglobin (clear rededdish-brown/cola-colored/tea-colored), porphobilin (derived from porphobilinogen), beets, menstrual contamination, fuchsin (aniline dye from foods and candy), and Rifampin (all body fluids are red).

Porphyrins.

Methemoglobin (acidic urine), homogentisic acid (alkaline urine: alkaptonuria), melanin (upon air exposure), phenol derivatives, Argyrol, methyldopa/levodopa, and metronidazole (Flagyl).

Pyuria/leukocyturia (increased WBCs).

Ethyl alcohol (diuresis).

Levodopa (treatment for Parkinsonism: red then brown, alkaline).

Nitrofurantoin (treatment for UTI).

Mepacrine / Atabrine (antimalarial, treatment for Giardiasis).

Methyldopa / Aldomet (anti-hypertensive).

Metronidazole / Flagyl (treatment for Trichomoniasis).

Phenazopyridine / Pyridium (treatment for UTI).

Phenol poisoning.

Rifampin (treatment for TB).

Riboflavin (multivitamins).

Thoroughly mix the specimen, examine the specimen while holding in front of a light source, and view through a newspaper print.

No visible particulates, transparent.

Few particulates, print easily seen through urine.

Many particulates, print blurred through urine.

Print cannot be seen through urine.

May precipitate or be clotted.

Squamous epithelial cells (females), amorphous urates (pink sediment), amorphous phosphates and carbonates (white or beige precipitate), vaginal cream, semen, fecal contamination, radiographic contrast media, and talcum powder.

RBCs, WBCs, bacteria (uniform turbidity not cleared by acidification or filtration), yeasts (increased in diabetes mellitus), non-squamous epithelial cells, abnormal crystals, lymph fluid (chyluria), and lipids.

Amorphous urates, and radiographic contrast media.

Amorphous phosphates, and carbonates.

Amorphous urates, and uric acid crystals.

RBCs, amorphous phosphates, and carbonates.

WBCs, bacteria, yeast, and spermatozoa.

Lipids, lymphatic fluid, and chyle.

Normal urine, due to the presence of volatile acids from food.

Acute tubular necrosis (acute renal failure).

Urinary tract infection (e.g., Proteus vulgaris), and old urine.

Ketones (due to Diabetes Mellitus, starvation, and vomiting).

Maple syrup urine disease (MSUD).

Phenylketonuria (PKU).

Tyrosinemia.

Isovaleric acidemia, and glutaric acidemia.

Phenol-containing medications.

Methionine malabsorption (Oasthouse syndrome).

Specimen adulteration, or container contamination.

Cystine disorder.

Trimethylaminuria.

Ingestion of onions, garlic, and asparagus (methylmercaptan), and UTI (Brunzel).

Hawkinsinuria.

3-hydroxy-3-methylglutaric aciduria.

Multiple carboxylase deficiency.