Test

Appearance
and Color

Normal Values
Normal specimen should be
clear/straw colored (pale yellow to
amber b/c of pigment urochrome
product of bilirubin metabolism)

Test
Specific
Gravity

Urine
Osmolality

Abnormal Color
- Pathologic condition or ingestion of
certain foods
- Cloudy presence of WBCs, RBCs,
bacteria
- Red bleeding (dark red from kidney,
bright red from bladder); eating beets
- Dark yellow bilirubin or
urobilinogen
- Green pseudomonas infection
- Brown eating rhubarb
- Certain drugs can change urine color

Indications

Normal Values

Abnormal Increase

Measure
kidneys ability
to concentrate
urine (remove
wastes)
Weight of urine
is compared to
the weight of
distilled water
(1.000)
Value affected
by amount of
solutes and
volume,
hydration
status
Evaluate fluid
and electrolyte
abnormalities
Determination

Adult: 1.005
1.030 (usually,
1.010 1.025)
Elderly: values
decrease with
age
Newborn: 1.001
1.020
(qualitative test)

- high
concentration =
high specific
gravity
- Diabetes Mellitus
- Excessive water
loss; dehydration
- Increased
secretion of
antidiuretic
hormone

Abnormal
Decrease
- low
concentrati
on = low
specific
gravity
- Diabetes
Insipidus
- Chronic
Renal
Diseases
diminished
concentrati
ng ability

50 1200
mOsm/kg
random
(quantitative

- high
concentration =
high specific
gravity

- low
concentrati
on = low
specific

Interfering
Factors
-Different
medications
(Table on p. 959)
-Urine refrigerated
longer than 1 hr
(cloudy)
-Certain foods
-Darkens upon
standing
(oxidation of
bilirubin)
Interfering
Factors
-Recent use of
radiographic
dyes SG
-Cold
temperatures
SG
-Drugs may
SG (dextran,
mannitol,
sucrose)

Drugs such as
aminosalicylic acid,
barbiturates,
chloral hydrate,

Test
pH

Indications

Protein

of kidneys
concentration
capabilities
Investigate
antidiuretic
hormone
abnormalites

acid/base
Tubules ability
to maintain H+
in plasma and
extracellular
fluid
Tubule secretes
hydrogen as
sodium is
reabsorbed in
proximal
convoluted
tubule and
distal
convoluted
tubule
Indicator of
kidney function
Normally
protein not in
urine spaces
in glomerular

test)

- Diabetes Mellitus
- Excessive water
loss; dehydration
- Increased
secretion of
antidiuretic
hormone

gravity
- Diabetes
Insipidus
- Chronic
Renal
Diseases
diminished
concentrating
ability
Abnormal
Decrease

chlorpropamide,
ethyl alcohol,
griseofulvin,
morphine, oral
contraceptives,
procaine,
sulfonamides

Normal Values

Abnormal Increase

4.6 8.0
(average 6.0)

- Acidemia
- Diets high in
cranberries,
metabolic or
respiratory
acidosis
- Associated with
xanthine, cysteine,
uric acid, and
calcium oxalate
stones
- Metabolic or
respiratory
acidosis,
starvation,
dehydration

- Bacteria
- UTIs
- alkalemia
- Associated
with calcium
carbonate,
calcium
phosphate,
and
magnesium
phosphate
stones.
- Renal tubular
acidosis

-Becomes alkalne on
standing (ureasplitting bacteria
produce ammonia)
-Uncovered
specimen become
alkaline (CO2
vaporizes from urine)
-Dietary factors
-Certain drugs pH
(acetazolamide,
bicarbonate
antacids) and pH
(ammonium chloride,
chlorothiazide)

negative
0 8 mg/dL

- Proteinuria
- Preeclampsia
HTN, edema
- Eclampsia
preeclampsia with
seizures
- Complications of

n/a

-Severe emotional
stress, excessive
exercise, and cold
baths
-Radiopaque
contrast media
administered 3

Interfering
Factors

membrane too
small to allow
passage

diabetes
decreased renal
blood flow
Glomerulonephritis
glomerular
membrane damage
- Amyloidosis
- Multiple myeloma

Test

Indications

Normal Values

Abnormal Increase

Blood

-Any disruptions in
the blood-urine
barrier will cause
RBCs to enter the
urine.

Negative
(RBCs 2)

- Hematuria
- Cystitis bladder,
lower UTI
- Glomerulonephritis
glomerular
membrane damage
- Cancer
- Tumors, trauma,
stones, infection
that involve the
mucous membranes
in the collecting
system

Glucose

- Indicates possible Fresh specimen:

diabetes
Negative

- Familial
hyperglucagonemi

days prior (falsepositive)

-Diet high in
protein
-Concentrated
urine
-Hemoglobin
-Drugs protein
(penicillin,
vancomycin,
griseofulvin,
methicillin,
polymixin B,
sulfonamides)
Abnormal
Decrease
n/a

n/a

Interfering
Factors
-Strenuous physical
exercise RBC
casts
-Traumatic urethral
catherization may
cause RBCs in
urine
-Overaggressive
anticoagulation
therapy or bleeding
disorders tend to
cause RBCs in
urine without
concomitant
disease
-Radioactive scan
within previous 48

Ketones

Test
Bilirubin

- Direct measure of (positive results

glucose in the
reported as 100
urine
2000 mg/dL)
24-hour
specimen: 50300 mg/24 hr or
0.3 1.7
mmol/day

a
- Diabetes Mellitus
- Chronic renal
failure
- Severe stress
- Acromegaly

- Byproduct of fatty

- Poorly controlled
diabetes,
hyperglycemia
- Diabetic
ketoacidosis
- Alcoholic
ketoacidosis
- Starvation
- High protein Diet
- Isopropanol
ingestion
- Acute febrile
illnesses
Abnormal Increase

n/a

- Disease affecting
bilirubin
metabolism or
excretion after
conjugation
- Obstruction of
bile duct;
gallstones

n/a

acid catabolism
- Used as energy
source when glucose
cannot be utilized
-provide energy
source when glucose
cannot be
transferred into the
cell due to insulin
insufficiency

Indications
- Major constituent
of bile
- Breakdown of
hemoglobin
- Conjugated in
liver and excreted
in bile, which is
metabolized in

Negative
(positive
reported as 1+
to 4+)

Normal Values
None/negative

Abnormal
Decrease

hrs and glucagon

measured by RIA.
Administration of
radionuclides
-Prolonged fasting,
stress, or moderate
to intense exercise
-Drugs (amino
acids, gastrin,
insulin,
glucocorticoids)
- Special diet (carbfree, high-protein,
high-fat) may
cause ketonuria
- Drugs cause
(isoniazid,
isopropanol,
paraldehyde)

Interfering
Factors
-Not stable when
exposed to light

Urobilinogen

Leukocyte
Esterase

Test
Nitrites

small intestine by
bacteria to
urobilinogen
- Unconjugated fat
soluble (difficult to
excrete)
- Conjugated water
soluble (easily
excreted) can go
thru kidneys
- Bilirubin
transformed by
action of bacteria
(in intestines)
- Portion of
urobilinogen
absorbed and
carried to liver and
excreted in bile
and urine
- Detect
leukocytes in urine

Indications

- Certain drugs
oral contraceptives
- Conjugated
hyperbilirubin
- Turns urine dark
yellow or orange

0.01 -1 Ehrlich
unit/mL
(Results usually
normal some
always in urine)
Abnormal
results reported
numerically if >
0.2mg/dL

- Overproduction
(hemolytic anemia)

- If you dont
see
urobilinogen,
bilirubin did
not get
changed into
urobilinogen
in the small
intestines

- pH levels; alkaline
levels; acidic
levels
- Phenazopyridine
turns urine orange
(false impression of
jaundice)
- Cholestatic drugs
levels
- Antibiotics reduce
intestinal flora,
levels

negative

- Positive tests
indicates UTI
- MOST reliable
rest for UTI (90%
accurate)

n/a

- False +:
contaminated by
vaginal secretions that
contain WBCs
- False -: contain high
levels of protein or
ascorbic acid

Normal Values

- Screening test for None

identification of UTI
- Bacteria (gram
neg. only) produce
enzyme reductase,

Abnormal
Increase
- Positive test
indicates UTI, with
positive leukocyte
esterase

Abnormal
Decrease
n/a

Interfering
Factors
n/a

Crystals

can reduce urinary

nitrates to nitrites.
- Microscopic
examination
- Indicate that
renal stone
formation is
imminent, if not
already present
- Type of crystals
varies with disease
and pH of urine

None

- Crystals in acidic
urine
Uric acid
crystals
(gout)
Calcium
oxalate
(envelopes
compose
most kidney
stones)
- Crystals in
alkaline urine
Calcium
phosphate
(little clinical
significance)
Triple
phosphate
(coffin lids
a/w stones,
chronic
cystitis)
- Phosphate and
calcium oxalate
crystals occur with
parathyroid
abnormalities or
malabsorption
states
- Some crystals
observed when SG

n/a

- Radiographic
contrast media
may cause
precipitation of
urinary crystals

Test
Casts

Indications

Normal Values Abnormal Increase

- Casts formed only None

in distal
convoluted tubule
or collecting duct
- Formation
favored by
decreased urine
flow, increased
sodium
concentration and
acidic pH
- Associated with
some degree of
proteinuria and
stasis within renal
tubules
- Exact picture of
tubule it came
from

- Hyaline Casts
Made of
protein
Composed
primarily of
mucoprotein
called TammHorsfall
protein
secreted by
tubule cells
Can be seen
in normal
patients,
especially
after
strenuous
exercise,
dehydration
- Cellular Casts
Made up of
cells
When cellular
casts remain
in nephron
long time,
may
degenerate
into coarsely
granular

Abnormal
Decrease
n/a

Interfering
Factors
n/a

casts, then
finely
granular
casts and
ultimately
broad waxy
casts

Epithelial cells are found during microscopic examination and are found in patients who have
contamination (contaminated sample)
Cellular Casts
o Granular Casts
Result from degeneration of cellular material into granular particles within WBC or
epithelial cell cast
Found after exercise and in renal disease
o Fatty Casts
Fat within epithelial cell casts becomes incorporated with protein into casts of coalesce
to large droplets called oval fat bodies
Hallmark of nephrotic syndrome
o Waxy Casts
May be cell casts or hyaline casts
Occur when flow through tubule diminished and granular casts degenerate
A/w chronic renal diseases and chronic renal failure, diabetic nephropathy, malignant
HTN
o Epithelial Cell Casts
May be squamous of renal tubule
May be shed into urine from bladder as result of tumor, infection, polyps
Squamous epithelial cell casts can be normal
Renal tubular cell casts indicate glomerulonephritis

o White Blood Cell Casts

Found in infections, mostly pyelonephritis, inflammatory nephritis (lupus)
o Red Blood Cell Casts
Found with disruption of blood/urine barrier at any level of tract, usually bladder,
ureteral, urethral diseases
Casts indicate membrane damage glomerulonephritis