Urinalysis Interpretation

Why do we need to be able to interpret urinalysis?

Accurate assessment is important

Why do we attend Urinalysis?.

As it provides health professionals with valuable information about a patients health status. Urinalysis can detect indications of renal, urological and liver disease, diabetes mellitus, urinary tract infection and general hydration. It is an important part of patient assessment and could potentially indicate the presence of a serious disease. Accurate interpretation is vital to eliminate or substantiate an active illness or disease. 



 

Course Introduction: Module structure

Course Introduction: Module structure

Urinalysis  Modules

1 what's normal? What's not?

2 Interpreting urinalysis

3 Assessment Quiz

4 Course completion

AIMS:


Students will broadly examine these topics throughout the resource. The  learning activities will provide education to enable students to  accurately interpret urinalysis . 

The resource takes approximately 30 minutes to complete. 

Learning Outcomes:

After completing theses modules students will be able to:

Identify normal urinalysis ranges

Interpret abnormal results

Identify urinary tract infection with urinalysis

Relate abnormal ranges to disease processes



After completing each module press the home button to enter the next resource. 









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Module 1: A review of urinalysis, What's normal??

What's normal in the healthy person? : Urinalysis summary

Parameter                     Normal  Value

specific gravity            1.010 - 1.025

pH                                       4.5  -  8.0

Ketones                          Negative

Leukocytes                    Negative

Nitrite                             Negative

Protein                            Negative

Glucose                           Negative

Blood                               Negative

Urobilinogen                 Negative

Bilirubin                         Negative


Now you know what's normal, we can move to interpreting abnormal results!

Module 1: What's abnormal in these samples?.

S.G 1.015, pH 6.0, protein +, Blood +

  • S.G, pH
  • pH, blood
  • Blood, protein
  • S.G, blood

S.G 1.020, pH 7.0, Leukocytes +, glucose+

  • S.G, Leukocytes
  • pH, glucose
  • S.G, glucose
  • Leukocytes, glucose

S.G 1.030, pH 7.0, bilirubin +

  • S.G, bilirubin
  • S.G, pH
  • pH, bilirubin

Module 2: Interpreting Urinary analysis

Understanding the urinalysis parameters: Interpreting the results

Urine contains many components that are assessable.

Specific Gravity (S.G)

Is an indicator of urine concentration or the amount of solutes ( metabolic wastes & electrolytes) present in urine.

S.G normally ranges from 1.010 - 1.025.

As urine becomes more concentrated, it's S.G increases. A high S.G may indicate fluid deficit or dehydration.

Excess fluid intake or diseases affecting the ability of the kidneys  to concentrate urine can result in low S.G.


Urinary pH

Is measured to determine the relative acidity or alkalinity of urine.

Urine is slightly acidic, with an average pH of 6.

 7 is neutral, less than 7 is acidic, greater than 7 is alkaline.

Normal ranges 4.5 - 8.

The kidneys play a role in regulating acid-base balance, therefore assessment of urine pH can be useful in determining wether the kidneys are responding appropriately to acid -base imbalances.

In metabolic acidosis, pH decreases as the kidneys excrete hydrogen ions.

The pH increases with metabolic alkalosis.

Ketones

Are normally not present in the urine.

Ketones are a product of the breakdown of fatty acids, or from insufficient ingestion of carbohydrates.

Are found in urine of patients with poorly controlled diabetes. 

Effective to evaluate ketoacidosis in patients whom are alcoholic, fasting, or  consuming high protein diets.




Protein 

There should be no detectable quantities in the urine, as protein molecules are too large to escape from glomerular capillaries into the filtrate. 

If the glomerular membrane is damaged, it can become leaky allowing proteins to escape. This is known as proteinuria.

Albumin is one of the smaller proteins, and if the kidneys begin to show dysfunction it may show an early sign of kidney disease.

Injury to the urinary tract, bladder or urethra can illicit protein in the urine.


Leukocytes

Aren't a normal component of urine.

Leukocytes determine the presence of whole or lysed white blood cells in the urine this is termed pyuria.

Infection is possible when leukocytes are detected in the urine. However, leukocytes alone is not conclusive for urinary tract infection.

This requires a mid stream urine (MSU) sample for culture and sensitivity to definitively determine. 

False positives can occur from contaminated specimens, or recent antibiotic therapy. 

Nitrites

Not normal in the healthy person. 

When the urine becomes infected, most species of bacteria are able to colonise in the urine producing nitrates that are then converted to nitrites. This determines the presence of gram-negative bacteria such as ecoli.

The absence of nitrites does not exclude urinary tract infection  as most gram positive organisms like enterococcus do not produce nitrites. 

Therefore, Nitrite alone is not conclusive in determining urinary tract infections.

False positives can occur from contaminated specimens.


Blood

Is not normally present in the urine, any detected on dipstick testing is abnormal.

Termed Haematuria, it's usually asymptomatic. Positive results may indicate trauma, urinary tract infection, inflammation, clotting disorders chronic infection, or  kidney damage.

Ensure patient's aren't menstruating or experiencing rectal bleeding before assessing urine.

  


Bilirubin

Not normally present in the urine of healthy individuals.

Termed bilirubinuria, may be an early indicator of liver disease.

Occurs from biliary obstruction, and the inability of conjugated bilirubin to reach the intestines.   

Only conjugated bilirubin can be excreted as biliruninuria.

Bilirubin is formed as a by-product of red blood cell degradation (breakdown) in the liver.

The presence of bilirubinuria may be an early indicator of liver disease, or bile duct obstruction.


.


Urobilinogen 

Normally present in urine in low concentrations, however any detected on dipstick testing is abnormal

Bilirubin is conjugated by the liver and passed to the bowel in bile, where it is converted to urobilinogen. Most urobilinogen is excreted in the faeces or transported back to the liver and converted to bile.

Increased concentrations in the urine indicate cirrhosis, infective hepatitis, and haemolytic anaemia.

Urinalysis is very sensitive but non-specific in determining cause.

increased bilirubin turnover indicates haemolytic anaemia. Decreased indicates bile tract obstruction.

Match the following terms with their normal parameters

  • A normal specific gravity is
    1.010-01.025
  • Nitrite
    Negative. A positive result is indicative of infection with the presence of gram-negative bacteria .
  • pH
    4.5 - 8.0
  • Ketones
    Negative. A positive result indicates the breakdown of fatty acids, due to inadequate carbohydrate intake.
  • Leukocyte
    Negative. A positive result determines the presence of whole or lysed white blood cells in the urine.
  • Blood
    Negative. A positive result could be indicative of  trauma,  urinary tract infection, inflammation, clotting disorders chronic infection, or kidney damage
  • Bilirubin
    Negative. A positive result is indicative of biliary obstruction.
  • Urobilinogen
    Negative. A positive result is Indicative  of cirrhosis, and infective hepatitis,
  • Protein
    Negative. A positive result is associated with glomerular membrane  damage, which allows proteins to escape

Module 3: Quiz time

How would you identify if a patient has kidney disease with urinalysis?.

Select the correct response:


  • Assess protein
  • Assess specific gravity
  • Assess Leukocytes
  • Assess Bilirubin

What disease/s is associated with inadequate carbohydrate intake and ketones?

Select all that apply


  • Arthritis
  • Cancers of the urinary tract
  • Alcoholism
  • diabetes mellitus

A specific gravity of 1.030 indicates?

Select the correct answer:

  • Fluid excess
  • Urinary tract infection
  • Dehydration
  • liver disease

What components of urinalysis identify urinary tract infection?

Select all that apply:



  • glucose
  • Nitrite
  • leucocytes
  • urobilinogen

A low  Urinary pH could be

Select the correct answer:

  • metabolic acidosis
  • due to urinary tract infection
  • From fluid excess
  • From fluid deficit associated with dehydration

Bilirubin is positive for which disease process?.

Select the correct response:

  • kidney disease
  • urinary tract infection
  • Liver disease
  • Nephritis

A positive result for blood could indicate

Select all that apply.

  • trauma to the urinary tract
  • menstruation
  • Kidney infection
  • Anti-coagulant medications

Urobilinogen is usually positive in the urine?,

  • True
  • False

A S.G of 1.005 indicates the inability of the kidneys to concentrate urine correctly

  • true
  • false

Biliary obstruction will cause a positive result in?

  • Bilirubin
  • leukocytes

Module 4: Course completion

Well done you've reached the conclusion of the resource.

Well Done! 

You've achieved mastery in urinalysis interpretation.

Print for your record of achievement.