1. Pre-renal Causes
1.1. Bleeding Diathesis
1.2. Haemoglobinopathy
1.3. Malignant hypertension
2. Urine Examination
2.1. PHYSICAL EXAMINATION
2.1.1. VOLUME
2.1.1.1. Normal (1-2 L /day)
2.1.1.2. Polyuria (> 2.5L /day)
2.1.1.2.1. Causes
2.1.1.3. Oliguria ( < 400 ml / day)
2.1.1.3.1. Causes
2.1.1.4. Anuria ( < 100 ml / day )
2.1.1.4.1. Causes
2.1.1.5. Nocturia ( > 500 ml / night)
2.1.1.5.1. # Characteristic of Chronic Glomerulonephritis
2.1.2. COLOUR
2.1.2.1. Normal ( Clear, Pale yellow)
2.1.2.2. Colorless (Diluted urine)
2.1.2.2.1. Diabetes Mellitus
2.1.2.2.2. Diabetes Insipidus
2.1.2.2.3. Diuretics
2.1.2.3. Deep Yellow / Orange (Concentrated urine)
2.1.2.3.1. Fever
2.1.2.3.2. Excessive sweating
2.1.2.4. Red ( Blood)
2.1.2.4.1. Hematuria
2.1.2.4.2. Beetroot ingestion
2.1.2.5. Black / Brown
2.1.2.5.1. Melanin
2.1.2.5.2. Alkaptonuria
2.1.2.6. Milky / Purulent
2.1.2.6.1. Genito-urinary tract infection
2.1.2.6.2. Chyluria
2.1.3. ODOUR
2.1.3.1. Normal
2.1.3.1.1. Aromatic (due to aromatic fatty acids)
2.1.3.2. Ammonical
2.1.3.2.1. Bacterial action
2.1.3.3. Foul / Offensive
2.1.3.3.1. Pus Or Inflammation
2.1.3.4. Fruity
2.1.3.4.1. Ketonuria
2.1.3.5. Maple syrup Like
2.1.3.5.1. Maple syrup urine disease
2.1.3.6. Rancid
2.1.3.6.1. Tyrosinaemia
2.1.3.7. Rotten egg smell
2.1.3.7.1. Cystinuria
2.1.4. pH
2.1.4.1. Normal (pH = 4.6-8)
2.1.4.2. Acidic
2.1.4.2.1. Ketosis-acidosis
2.1.4.2.2. Starvation
2.1.4.2.3. Fever
2.1.4.2.4. Systemic acidosis
2.1.4.2.5. UTI - E.Coli
2.1.4.3. Alkaline
2.1.4.3.1. Strict vegetarian
2.1.4.3.2. Systemic Alkalosis
2.1.4.3.3. UTI - Proteus
2.1.4.3.4. New Topic
2.1.5. SPECIFIC GRAVITY
2.1.5.1. Normal (1.010 - 1.025)
2.1.5.2. High Specific gravity ( Hyperosthenuria)
2.1.5.2.1. Diabetes Mellitus
2.1.5.2.2. Dehydration
2.1.5.2.3. Fever
2.1.5.2.4. Heart failure
2.1.5.3. Low specific gravity (Hyposthenuria)
2.1.5.3.1. Diabetes Insipidus
2.1.5.4. Fixed specific gravity = 1.010 (Isosthenuria)
2.1.5.4.1. Chronic renal diseases
2.2. CHEMICAL EXAMINATION
2.2.1. Proteins
2.2.1.1. Tests
2.2.1.1.1. Heat and Acetic Acid test
2.2.1.1.2. Sulphosalicylic acid test
2.2.1.1.3. Dipsticks
2.2.1.1.4. Esbach's Albuniometer
2.2.1.2. Causes of Proteinuria
2.2.1.2.1. Functional Causes
2.2.1.2.2. Pre-renal Causes
2.2.1.2.3. Renal Causes
2.2.1.2.4. Post-renal Causes
2.2.2. Sugars
2.2.2.1. Tests
2.2.2.1.1. Benedict's test
2.2.2.1.2. Dipsticks (For glucose)
2.2.2.2. Causes of Glycosuria
2.2.2.2.1. Glycosuria with Hyperglycemia
2.2.2.2.2. Glycosuria without Hyperglycemia
2.2.3. Billirubin
2.2.3.1. Test
2.2.3.1.1. Fouchet's test
2.2.3.2. Causes
2.2.3.2.1. Liver disease (Injury/hepatitis)
2.2.3.2.2. Biliary tract obstruction
2.2.4. Bile salts
2.2.4.1. Test
2.2.4.1.1. Hay's test
2.2.4.2. Causes
2.2.4.2.1. Obstructive Jaundice
2.2.5. Urobilinogen
2.2.5.1. Test
2.2.5.1.1. Ehrlich test
2.2.5.2. Causes
2.2.5.2.1. Hemolytic Anaemia
2.2.6. Blood
2.2.6.1. Test
2.2.6.1.1. Benzidine test
2.2.6.2. Types
2.2.6.2.1. Hematuria
2.2.6.2.2. Hemoglobinuria
2.2.6.2.3. Myoglobinuria
2.3. Ketone bodies
2.3.1. Types
2.3.1.1. Acetone
2.3.1.2. Acetoacetoic acid
2.3.1.3. Beta-hydroxy butyric acid
2.3.2. Test
2.3.2.1. Rothera's test
2.3.3. Causes of Ketonuria
2.3.3.1. Diabetic
2.3.3.2. Non-diabetic
2.3.3.2.1. High-fever
2.3.3.2.2. Starvation
2.3.3.2.3. Severe vomiting/diarrhea
2.4. MICROSCOPIC EXAMINATION
2.4.1. RBCs (Hematuria)
2.4.1.1. Renal Causes
2.4.1.1.1. Trauma
2.4.1.1.2. Calculi
2.4.1.1.3. Acute & Chronic glomerulonephritis
2.4.1.1.4. Renal TB
2.4.1.1.5. Renal tumor
2.4.1.2. Post-renal Causes
2.4.1.2.1. Severe UTIs
2.4.1.2.2. Calculi
2.4.1.2.3. Trauma
2.4.1.2.4. Tumors of urinary tract
2.4.2. WBCs (Pyuria)
2.4.2.1. Urinary tract infection
2.4.2.2. Indwelling urinary catheter
2.4.2.3. Urological malignancy
2.4.2.4. Chronic Interstitial nephritis
2.4.2.5. Intestinal cystitis
2.4.3. Bacteria
2.4.3.1. UTIs
2.4.4. Crystals
2.4.4.1. Crystals in acidic urine
2.4.4.1.1. Uric acid
2.4.4.1.2. Calcium oxalate
2.4.4.1.3. Cysteine
2.4.4.1.4. Leucine
2.4.4.2. Crystals in alkaline urine
2.4.4.2.1. Ammonium phosphate
2.4.4.2.2. Magnesium phosphate
2.4.4.2.3. Calcium carbonate
2.4.5. CASTS
2.4.5.1. Acellular Casts
2.4.5.1.1. Hyaline casts
2.4.5.1.2. Granular casts
2.4.5.1.3. Waxy casts
2.4.5.1.4. Fatty casts
2.4.5.1.5. Pigment casts
2.4.5.1.6. Crystal casts
2.4.5.2. Cellular Casts
2.4.5.2.1. Red cell casts
2.4.5.2.2. White cell casts
2.4.5.2.3. Epithelial cell casts
3. Types of Urine Samples
3.1. Random specimen
3.1.1. Most common
3.1.2. Taken anytime
3.1.3. Purpose : • Routine screening • Chemical tests
3.2. Morning sample
3.2.1. 1st urine in morning
3.2.2. Most concentrated
3.2.3. Purpose : • Pregnancy test • Microscopic test
3.3. Clean Catch Midstream
3.3.1. Purpose : • Culture • UTI
3.4. 24 hours
3.4.1. Quantitative and Qualitative analysis
3.4.2. Analysis of ° Proteins ° AFB ° Microalbuminuria
3.5. Post prandial
3.5.1. 2 hrs after meal
3.5.2. Purpose : • Diabetes Mellitus
3.6. Supra Pubic Aspirate
3.6.1. Purpose : To obtain sterile urine