Urinalysis

Overview:

A urinalysis is a test to analyse the urine to detect and treat a wide range of diseases. It helps to detect infections, kidney diseases, metabolic diseases like diabetes, and various other diseases. It checks the visual appearance, chemical concentration, and microscopic content of urine. It was the first laboratory test developed in medicine to diagnose a disease by analysing the urine. It is a safe, effective, and cost-effective diagnostic test. 

Indications:

It is a commonly prescribed diagnostic test. It is used for 

• Routine medical examination to assess the overall health 
• As a part of the pregnancy test 
• Pre-surgical evaluation to screen for various diseases 
• Diagnoses and Monitor diseases like Kidney diseases, Urinary tract infections, and liver diseases
• When an individual is admitted to the hospital 

Clinical symptoms that necessitate the urinalysis include

• Frequent abdominal and back pain
• Pain and blood while urinating 
• Frequent urination 

Urinalysis test procedure:

There is not much preparation to be done before a urinalysis test. One can do this test at home or at a diagnostic center. Collect a container the day before doing urinalysis. The first urine in the morning should be sent to the test. 

Clean the tip of the penis in males and labia in the females before passing the urine. Start urinating and collect the mid-stream of the urine into the container. Collect at least 30-60ml of urine. The collected urine has to be sent to the lab in an hour. 

Interpretation of urinalysis:

The three components of urinalysis include urine color and appearance, chemical findings, and microscopic findings. 

• Color: This is detected by the naked eye. The normal color of urine ranges from colorless or pale yellow to deep amber. Certain abnormalities change the color of urine. These include 
• Amber color – Bile pigments 
• Brown/black – bile pigments, medications, fava beans, senna, and diseases like alkaptonuria
• Dark yellow – concentrated specimen due to dehydration or exercise 
• Green/blue – Medications, asparagus, dyes like methylene blue, infections caused by pseudomonas
• Orange – carrots, bile pigments, medications
• Pink/red – beetroots, medications, dyes, diseases like hematuria, hemoglobinuria, 
• Appearance: This is detected by the naked eye. The normal appearance of urine ranges from clear or translucent. Certain abnormalities change the appearance of urine. These include bacteria, blood clots, contrast agents, contamination by poop, lymph, presence of red or white blood cells, and semen 
• Odor: This is detected by smelling the urine. The normal odor of the urine is urinated. The altered odor of the urine is found in:
• Honey odor – Diabetes 
• Fruity – diabetic ketoacidosis 
• Poopy odor – an abnormal connection between the digestive system and the bladder 
• Pungent – urinary tract infection
• Garlic smell – medications 
• Specific gravity: urinary specific gravity indicates the kidney's capacity to dilute or concentrate the urine. Abnormal specific gravity is seen in altered diet, health, hydration, and physical activity. 
• Urine volume: less urine production is seen in kidney diseases, obstruction in the kidney, heart failure causing kidney dysfunction, and severe dehydration. Excess urine output is seen in diabetes, alcohol intake, saline or glucose infusion, and increased water intake. 
• Chemical examination: 
• Urine pH – indicates kidney tubule function and measures the acid-base levels. An increased acidic nature is seen in kidney dysfunction, diabetes, medications, protein diet, and stones in the kidneys. Alkaline urine is seen in bacterial growth, diarrhea, and vomiting. 
• Proteins – These are present only in trace amounts in urine. Their detection can be temporary or persistent. These can appear in urine due to abnormal filtration, inability to reabsorb, and when excess proteins are produced beyond the filtration capacity of the kidneys. This can occur is diseases like kidney diseases, injury to the kidney tubules, progressive kidney disease, cancers like multiple myeloma, heart diseases, and also in physiological conditions due to exercise, dehydration, and distress. 
• Blood cells – normally these are not present in the urine. But conditions like trauma, kidney stones, transfusion reactions, blood thinner medications, severe exercise, burns, and infections can cause blood cells to appear in the urine. Prolonged coma, seizures, drug abuse, and muscle-wasting diseases cause myoglobin to be released in the urine. 
• Glucose – When there is excess glucose (sugar) in the body that is beyond the reabsorption capacity of the kidneys, then glucose is released in the urine. Increased glucose in urine is seen in diabetes, pregnancy, infusion of glucose, and diseases like Cushing and Fanconi syndrome. 
• Bilirubin – Normally bilirubin pigments produced by the liver are not seen in urine. Their presence indicates liver diseases, obstruction of bile ducts, hepatitis, and cirrhosis of the liver. 
• Nitrates – These are also not found in urine. The presence of nitrates in urine indicates a urinary tract infection. 
• Ketone bodies – these are produced by the metabolism of fat and fatty acids and are not present in urine in normal health. They are seen in uncontrolled diabetes, pregnancy, carb-free diet, and starvation. 
• Leukocyte esterase – This is an enzyme present in white blood cells and not normally secreted in urine. This is secreted in diseases like urinary tract inflammation, fever, sterile pyuria conditions caused by infections, tumors, foreign bodies, and pelvic diseases. 
• Microscopic examination:
• Casts – tube-like particles that appear in some conditions. They can be due to the accumulation of red/white blood cells, epithelial cells, granular casts, waxy casts, hyaline casts, or fatty casts that are formed in the kidney tubules. These are mainly secreted in kidney diseases, infections, strenuous exercises, diabetes, trauma, and advanced kidney diseases. 
• Cells – Sometimes few red or white blood cells are present in the urine. However, excess cells indicate inflammation of the kidneys or urinary tract infections. The presence of eosinophils in the urine indicates necrosis, infections, and transplant diseases. 
• Microbes – Presence of bacteria. Fungi or parasites indicate urinary tract infections 
• Crystals – These are the end products of metabolism and are not normally secreted in urine. These include uric acid, calcium oxalate, amorphous phosphate, triple phosphate, sulfur, and cysteine. Secretion of these crystals indicates a defect in the metabolism and disease. 

Conclusion:

Urinalysis is a basic test that detects various diseases based on the different factors analyzed using urine. It is a safe, simple, and effective test to detect various diseases. It can help in detecting and monitoring the diseases. 

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