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Urinalysis
| Positive Result | Significance | Cause | Action |
|---|---|---|---|
| Glucose (raised BS) | Found when concentration exceeds renal threshhold. | Diabetes Mellitus or glucose infusion | Blood glucose. Further action may follow. |
| Bilirubin | Indicates excess of conjugated bilirubin in plasma. Stale urine may give false -ve. | Liver cell injury (viral/drug Hep, paracetamol o/d, late stage cirrhosis) Biliary tract obstruction (gallstones, carcinoma of head of pancreas, biliary atresia in infants) | Always report for further investigations |
| Glucose (no raised BS) | Not normally detectable in urine. Found when concentration exceeds renal threshhold. | Pregnancy or renal glycosuria | Perform BS. Further action may be needed. |
| Ketones | Indicates accumulation of acetoacetate secondary to excessive breakdown of body fat. Some drugs e.g. L-dopa may give false +ve. | Fasting, particularly with fever and/or vomiting. Most often in children. Diabetic ketoacidosis. Ketotic hypoglycaemia in young children. | Urgent action if known diabetic. |
| Specific Gravity | Measure of total solute concentration in urine. In health varies widely according to the need to excrete water and solutes. | High: dehydration, impaired kidney function e.g. chronic renal failure Low: high fluid intake, diabetes insipidus, chronic renal failure, hypercalcaemia, hypokalaemia. | |
| Blood | May be haematuria (intact blood cells) or haemoglobinuria (excreted from plasma or liberated from red cells in urine) | Haematuria: kidney disorder e.g. glomerulonephritis, polycystic kidneys, tumours, infection, benign prostatic enlargement. Haemoglobinuria: severe haemolysis e.g. sickle cell crisis. | Report. Follow up pending tests and clinical picture. |
| pH | 4.5 - 8.0 healthy. | Low: Diabetic ketoacidosis, starvation, potassium depletion. High: Stale urine, alkalaemia e.g. vomiting and over-consumption of antacids, renal tubular acidosis, UTI with ammonia-forming organisms. | Depends on other results. |
| Protein | Test most sensitive to albumin. -ve doesn't rule out other proteins. | Acute/chronic glomerulonephritis, UTI, glomerular involvement in systemic lupus, erythematosus, nephrotic syndrome, pre-eclampsia, fever, heart failure, postural (orthostatic) proteinuria. | Persistent +ve needs investigation. Consider other tests and clinical picture. |
| Urobilinogen | Combined effects of bilirubin production, its conversion to urobilinogen in gut, and its reabsorption into blood stream. Stale urine gives false -ve | Increase: increased production (e.g. sickle cell), decreased uptake by liver (e.g. viral Hepatitis and cirrhosis) Decrease: biliary tract obstruction (e.g. gall stones, pancreatic carcinoma, sterilization of colon by unabsorbable antibiotics e.g neomycin | Urgent investigation. |
| Nitrite | Converted from dietary nitrate by UTI enzymes. | UTI by nitrite-producing organisms. Absense doesn't exclude UTI. | Send specimen for microscopy and culture. |
| Leucocytes | Leucocytes from inflamed tissue are shed in urine. | UTI, especially when acute inflammation of UT. | Send specimen for microscopy and culture. |
Created by:
kuc
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