Abnormal urinalysis

🔍 Urine analysis (urinalysis) is a fundamental diagnostic tool that provides valuable information about a patient's health. It involves the physical, chemical, and microscopic examination of urine to detect disorders such as urinary tract infections (UTIs), kidney disease, and diabetes.

🧩 Components of Urine Analysis

1️⃣ Physical Examination

• 💧 Colour: Normal urine ranges from pale yellow to amber.
  • 🔴 Red/Pink → Hematuria (blood), beetroot, medications.
  • 🤎 Brown/Black → Myoglobinuria, liver disease, drugs.
• 🌫️ Clarity: Should be clear. Cloudiness may mean bacteria, blood, sperm, crystals, or mucus.
• 👃 Odor: Normal = mild. Strong/foul can indicate infection, metabolic disorders, or dietary causes (e.g., asparagus).
• ⚖️ Specific Gravity: 1.005–1.030. ↑ suggests dehydration, ↓ suggests overhydration or renal impairment.

2️⃣ Chemical Examination

🧪 A urine dipstick is used to detect key substances:

• pH 📏: Normal 4.5–8. Abnormal → renal disease, UTI, metabolic derangements.
• Protein 🧬: Proteinuria may indicate kidney disease, HTN, or diabetes.
• Glucose 🍬: Glycosuria suggests diabetes mellitus.
• Ketones ⚡: Ketonuria suggests uncontrolled diabetes, starvation, or keto diet.
• Bilirubin & Urobilinogen 💛: May indicate liver disease or haemolysis.
• Blood 🩸: From infection, stones, trauma, or glomerular disease.
• Leukocyte Esterase 🦠: WBCs present → UTI.
• Nitrites 🔄: Suggest bacterial infection (Gram-negative organisms).

3️⃣ Microscopic Examination

🔬 Urine sediment examined for cells, casts, crystals, and organisms:

• Red Blood Cells 🩸: Infection, stones, or glomerular disease.
• White Blood Cells ⚪: Suggest infection/inflammation.
• Epithelial Cells 🧫: Few = normal; ↑ = contamination or pathology.
• Casts 🧱:
  • Hyaline = often normal (post-exercise).
  • Red Cell = glomerulonephritis.
  • White Cell = pyelonephritis, interstitial nephritis.
• Crystals 💎: Indicate stone risk or metabolic disorders.
  • Uric Acid = gout, chemotherapy.
  • Calcium Oxalate = kidney stones, ethylene glycol poisoning.
• Bacteria 🦠: With WBCs → infection.
• Yeast 🍞: May indicate fungal UTI (e.g., diabetics).
• Parasites 🪱: Rare, e.g., schistosomiasis.

📊 Table of Key Findings

✅ Conclusion

💡 Urine analysis is a quick, inexpensive, and valuable diagnostic tool. It can detect conditions ranging from simple UTIs to serious systemic disease. Mastery of this skill is essential for all clinicians.