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Urinalysis

Urinalysis refers to a group of tests conducted on urine sample to determine the various chemical components of the urine. Urine analysis is an examination of the urine sample that gives useful information regarding the renal and metabolic disorders, kidney or urinary tract infections, diabetes and host of other diseases. Urinalysis does not diagnose the disease itself, rather the presence of abnormal substances in the urine that will help direct the course of further evaluation and diagnosis. Depending upon the symptoms reported, urinalysis is conducted in three different phases.


1. Visual analysis or physical examination
2. Chemical analysis
3. Microscopic analysis


Physical examination of urine

Color: Normally urine looks pale yellow; any change in the color of the urine indicates some abnormality, for example dark yellow urine indicates dehydration whereas bile pigments cause brown urine. Urine turns red when there is blood in the urine. Sometimes consumption of certain foods such as blackberries, rhubarb and beets turns the urine red.

Clarity: Normal urine is usually clear, cloudy urine indicates the presence of bacteria, blood, sperm, crystals, or mucus. Odor: Normal urine has a nutty odor to it whereas diabetes gives urine a fruity odor and bacterial infections lead to bad odor of the urine.

Chemical analysis of urine

Chemical examination is normally conducted with the help of the dipstick. The change in the colors of the different pads on the dipstick indicates varied health conditions.

pH balance: pH balance measures the acidic and alkaline balance of the urine. The lower or higher pH indicates kidney disorders. pH balance can be changed by consuming the appropriate diet.

Protein: Protein test normally involves examining the albumin levels in the urine. The elevated albumin level is the initial symptom of kidney disorder.

Glucose: Higher glucose levels in the urine is associated with diabetes and other conditions like hormonal disorders, liver disease and pregnancy.

Ketones: When the body does not get enough carbohydrates, it starts metabolizing the fats to gather energy and in process releases ketones into the urine, thus indicating the low levels of insulin.

Blood: Urine is also tested for the presence of red blood cells. Various kidney and urinary tract diseases and trauma, injury, medications, smoking, or strenuous exercise lead to the contamination of urine with the blood.

Nitrites: UTI or urinary tract infection changes the urinary nitrates into nitrites. Therefore the presence of nitrites indicates the presence of UTI. Likewise urine is also tested for Leukocytes as they too indicate the presence of UTI.

Microscopic urine analysis

This test involves collection of urine in centrifuge to be spun for few minutes, so that sediments settle at the bottom. The sediment substance is then spread on the slide and examined under microscope. The urine is tested for the following:

If the urine shows red or white blood cells, it signals an inflammation, kidney disease or an injury of the ureters, bladder, or urethra. Microscopic examination of urine also reveals the presence of crystals. Large number of Crystals in the urine indicates dehydration, pH imbalance, UTI or a condition called Urolithiasis, signifying kidney stone or bladder stones. Urine is also tested for bacteria, yeast cells, or parasites, as any of these organisms in the urine signals infection. Increased quantity of epithelial cells in urine could indicate some health problems.


Lithotripsy

Lithotripsy is a medical procedure wherein shock waves are used to break up kidney stones, ureter or bladder. Extra corporeal shock wave lithotripsy is the most commonly used type. The shock wave is termed extra corporeal as the shock wave is generated outside the body. It is a non-invasive technique. This procedure is used when the stone is too large to pass out on its own or if the stone is stuck in the ureter.


Lithotripsy Procedure

Prior to the treatment the following is followed:

  • Complete physical examination
  • Urine analysis
  • Blood test
  • IVP: intravenous pyelogram is used to locate the stone and understand the extent of blockage
  • ECG for people with history of heart problems

Patient is made to lie down on a comfortable cushion/bed (usually water-filled). A mild sedative, pain killer and antibiotics are administered before the procedure so as to prevent any kind of discomfort, pain or infection. High energy sound waves pass through the body until they hit upon the kidney stone. The machine through which the waves is passed is called as the lithotripter. The kidney stone is broken into several pieces by the wave. The broken stone debris is called gravel. This gravel passes out while urinating. Usually there is no damage to skin or other internal organs as the shock waves are not focused on them. Generally after lithotripsy, people tend to bleed while urinating. This is common and will stop on its own. People who have undergone the procedure should drink plenty of water so as to flush the gravel out. A few patients may report abdominal pain which subsides on its own after a few days. If the symptoms persist, it is suggested that the patient visit the physician.


Lithotripsy should not be performed on people with skeletal deformities, persons with uncontrolled bleeding and pregnant women. Some of the possible side-effects include:

  • Kidney infection
  • Ulcers in the stomach or small intestine.
  • Pieces of the stone may block free urine passage.
  • Pieces of stone might be left behind in the body.
  • Bleeding (internal)
  • Very rarely stones do not get completely fragmented during the first time and so the procedure might have to be repeated again.

Leptospirosis

Leptospirosis is a bacterial infection caused by Leptospira interrogans bacterium. This is also known as infectious jaundice, swamp fever and hemorrhagic jaundice . Leptospirosis is more prevalent in tropical areas especially in areas where there are animals or rodents in urban dwellings. This infection spreads through contact with water, food, or soil containing urine from infected animals. It usually does not spread from person to person.


Typical symptoms of Leptospirosis include high fever, muscle aches, vomiting and jaundice. The patient might suffer chills and headache. Other symptoms of leptospirosis are diarrhea, abdominal pain and skin rash. Left untreated, leptospirosis can lead to meningitis, kidney failure and liver failure. Since the symptoms are not very specific, this disease is likely to be neglected. A blood test for Leptospirosis is done to diagnose the infection. This will show increased liver enzymes and WBC count of less than 10,000. A urine analysis will show abnormality. Leptospirosis is treated with antibiotics, such as doxycycline or penicillin.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 11, 2019