Urinalysis: Difference between revisions

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+<section begin="urology" />'''Urinalysis''', also called '''urine analysis''' refers to any analysis of the urine.
 A '''urine dipstick test''', sometimes abbreviated as '''urinary stick''' or '''u-stix''' is a point-of-care test which is used to analyse certain parametres of the urine. It's quick and cheap, and can be read off manually or by automatic machines. They're used in the diagnosis and follow-up of many disorders, like [[urinary tract infection]], [[diabetes mellitus]], and [[chronic kidney disease]]. A normal dipstick evaluates the following parametres in the urine:
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 == Procedure ==
 [[File:Urinary dipstick.png|thumb|This shows the urinary dipstick and the standard with which the result is compared to.<ref>https://www.onecaremedical.com.sg/urine-dipstick-tests/</ref>]]
-The patient provides a urinary sample. A single-use paper strip is dipped into the urine. The strip contains multiple squares covered with different reagents, each of which change colour when coming into contact with certain compounds in the urine. The degree of colour change is compared to a standard which is usually printed on the bottle.
+The patient provides a urinary sample. If the urine is to be analysed at a lab, the sample is sent to the lab.
+If the urine is to be analysed with a dipstick, a single-use paper strip is dipped into the urine. The strip contains multiple squares covered with different reagents, each of which change colour when coming into contact with certain compounds in the urine. The degree of colour change is compared to a standard which is usually printed on the bottle.
 == Leukocytes ==
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 The urine dipstick can be helpful in diagnosing microscopic [[haematuria]]. This can be useful in the evaluation of urinary tract pathologies like stones and cancer. Urinary tract infection can also cause microhaematuria. In case of gross [[haematuria]], the urinary dipstick result has no clinical utility.
-== References ==
+== pH ==
+Some dipsticks may measure urine pH. It's normally 4 - 8. Acidic urine may be a response to respiratory acidosis and increase the risk for uric acid stone or cysteine stone. Alkaline urine may be due to UTIs caused by urease-producing bacteria (Proteus spp.). Measurement of pH doesn't add much clinical value.
+== Macrosopic evaluation ==
+* Amount
+** 500 – 2500 mL/day = normal
+** 100 – 500 mL/day = oliguria
+** < 100 mL/day = anuria
+* Colour
+** Colourless
+*** Very dilute urine, overhydration
+** Yellow
+*** Normal
+** Cloudy/turbid
+*** Pyuria
+*** Phosphaturia
+*** Chyluria
+** Red
+*** Haematuria
+*** Haemoglobinuria/myoglobinuria
+*** Phenolphthalein (previously used in laxatives)
+** Orange
+*** Dehydration
+*** Rifampin
+** Brown
+*** Urobilinogen
+*** Porphyria
+** Drugs like metronidazole, chloroquine, nitrofurantoin, amitriptyline, methyldopa, sulphasalazine, etc. can cause abnormal colour of urine
+== Urine microscopy ==
+* Procedure
+** Centrifugation -> removal of supernatant -> add solution or some drops of supernatant -> add to slide -> 10x, 40x, 400x magnification
+* Epithelial cells
+** Squamous cells -> contamination
+** Transitional cells -> urothelial malignancy
+* Bacteria
+** Detection of bacteria on microscopy is not reliable -> culture must be performed
+* Leukocytes
+** Pyuria if >5 WBCs per field of view at 400x
+** See topic 6
+* RBCs
+** Haematuria if >3 RBCs per field of view at 400x
+** See topic 7
+* Casts – tubule-shaped structures
+** WBC casts -> pyelonephritis
+** RBC casts -> glomerulonephritis
+** Epithelial casts -> acute tubular necrosis
+* Crystals are of low clinical significance
+== References ==<section end="urology" />
+[[Category:Urology]]
 [[Category:Laboratory Medicine]]