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.

Hydronephrosis

Hydronephrosis refers to the swelling of one or both of the kidneys that occurs due to accumulation of urine in it. The urine goes through the ureter and is excreted by the urethra. If the outward flow of urine is blocked for some reason, it passes back to the kidneys, causing pressure and swelling. This condition is called as Hydronephrosis. It is not a disease in itself but occurs due to other underlying conditions. Reasons such as obstruction in urinary flow, kidney stones, reflux of urine from bladder to kidney lead to Hydronephrosis.

Symptoms of Hydronephrosis

• Sudden or intense pain in the back or sides
  
  
• Dull pain in the groin area
  
  
• Nausea and Vomiting
  
  
• Reduced urine output
  
  
• Frequent or painful urination
  
  
• Blood in the urine
  
  
• Weakness or malaise
  
  
• Fever due to urinary tract infection
  

Causes of Hydronephrosis

• Urinary stone
  
  
• Blood clots in the kidney or ureter
  
  
• Kidney tumor or Tumors in the bladder, prostate gland
  
  
• Urinary scarring
  
  
• Renal enlargement
  
  
• Renal failure
  
  
• Uterine prolapse
  

Congenital Hydronephrosis

• Hydronephrosis can also occur in infants. Such congenital cases are noticed either at prenatal or antenatal stage.
  
  
• Hydronephrotic in infants is normally due to Vesico-ureteral reflux in which urine, instead of flowing from the kidneys to the bladder, abnormally flows back in the ureter.
  
  
• Another common cause is congenital Hydronephrosis obstruction either at uretero-pelvic junction or at ureter-bladder junction.
  
  
• The condition is also caused due to Ureterocele wherein the ureter does not develop properly and causes a small pouch into the bladder.
  
  
• Pregnant women also experience gestational Hydronephrosis due to mechanical compression of the ureter blocking the urine flow.
  

Diagnosis of Hydronephrosis

• Early diagnosis is very important; the longer hydronephrosis remains untreated, the more kidney function is lost.
  
  
• Diagnosis may begin by a thorough physical examination of the patient where the enlarged kidneys would be palpable due to swelling.
  
  
• After noting down the symptoms and the medical history of the patient, doctor may order few blood and urine tests to check the level of infection.
  
  
• Ultrasound scan is normally taken to confirm the diagnosis.
  
  
• Imaging tests like CT scan and MRI of abdomen and kidneys may be required to understand the underlying condition and the exact location of the blockage which helps in deciding the course of the treatment.
  

Hydronephrosis Treatment

• The first step in treating the condition would be to drain the accumulated urine through catheterization.
  
  
• Once the fluid is drained off, the underlying condition that resulted in Hydronephrosis needs to be addressed.
  
  
• If there is a blockage in the ureters, a stent can be placed to bypass the block for smooth flow of urine.
  
  
• Kidney stones are normally treated with lithotripsy, a shock wave treatment that fragments the stones into tiny pieces, to excrete easily.
  
  
• Enlarged prostate is treated with medication or surgery to remove part or whole of the prostate.
  
  
• If Hydronephrosis is caused due to kidney tumors, the same is treated with surgery, chemotherapy and radiation.
  
  
• Hydronephrosis in infants often resolves on its own and does not require any aggressive treatment except for some mild antibiotics to prevent infection.
  

Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus, also known as Acquired Nephrogenic Diabetes Insipidus (ANDI) and Congenital Diabetes Insipidus is a form of diabetes insipidus which is due to the pathology of the kidney. This is in contrast to the central and Neurogenic DI which are due to insufficient levels of ADH or Anti diuretic hormone. Nephrogenic diabetes insipidus is caused by improper response of the kidneys to ADH and this leads to disability of the kidney to concentrate the urine by removing the water. Defect in the small tubes or tubules in the kidneys causes the patient to pass large amounts of urine. In normal persons, the tubules allow water to be removed from the kidneys and returned into the blood, without leaking the urine.

Causes of Nephrogenic Diabetes Insipidus

NDI occurs when the kidney tubules do not respond to a chemical in the body called ADH, also called vasopressin. It is ADH which tells the kidneys to make the urine more concentrated. Due to this, the kidneys release excessive amount of water into the urine and produce large quantity of very dilute urine. NDI is rare. Congenital diabetes insipidus is present during birth. Women can also pass this gene to their children. Other possible reasons of NDI are blockage in the urinary tract, low potassium levels, high calcium levels and use of certain drugs like lithium, demeclocycline, and amphotericin B.

Signs and symptoms of NDI

Intense and uncontrollable thirst and craving to drink ice water.
Large amounts of urine, usually 3 to 15 liters a day.
If sufficient intake of water is not done this could result in dehydration, dry mucous membranes, dry skin, sunken appearance of eyes, and sunken soft spot in infants. Other symptoms of inadequate fluids intake include fatigue, muscle pains, rapid heart rate weight loss.

A physical examination by a doctor would reveal low blood pressure, rapid pulse, shock and signs of dehydration. Diagnostic tests would reveal:

Osmolality of high serum
High urine output
Kidneys do not concentrate when the person is given ADH
Low urine osmolality and
Normal or high ADH levels.

Other diagnostic tests that are done include Serum sodium, 24-hour urine volume, Urine concentration test and Urine specific gravity

Treatment for Nephrogenic Diabetes Insipidus

Patients are normally given large amounts of fluids as the goal of treatment is to control the body's fluid levels. Amount of fluid given is equal to the amount of urine produced. Not keeping up with the fluid can lead to dehydration or electrolyte imbalance. Sometimes NDI is caused due to certain medication, and therefore stopping the medicines may improve symptoms. Hydrochlorothiazide may improve symptoms. This is prescribed alone or in combination with other medications. Although hydrochlorothiazide is a diuretic, it can actually reduce urine output for people with NDI. Some treatments which can reduce the symptom of nephrogenic diabetes insipidus are low salt, low protein diet and NSAIDs.