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 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
Causes of Hydronephrosis
Diagnosis of Hydronephrosis
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.
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Bibliography / Reference
Collection of Pages - Last revised Date: December 5, 2023