Urinalysis Overview

• Diet (Vegetarian, low carbohydrate diet, lots of citrus fruit)
• Systemic alkalosis (metabolic or respiratory)
• RTA I, Fanconi, UTI (most)
• Salicylate OD, antibiotics, acetazolomide

• Diet (high protein, cranberries)
• Systemic acidosis
• DM, DKA, starvation, COPD, diarrhoea, malabsorption
• Phenylketonuria, renal TB, alkaptonuria

1.010 – CRF, chronic GN

>1.030 – Ddehydration, SIADH, adrenal insufficiencyAlkaline urine

• Proteinuria
• Glucosuria
• IV contrast
• Colloid

• Renal: Increased renal tubular secretion, increased glomerular filtration (glomerular disease), nephrotic syndrome, pyelonephritis, glomerulonephritis, malignant hypertension
• CVS: Benign HT, CCF, SBE
• Other: Pre-eclampsia, gout, orthostatic proteinuria, increased plasma protein (myeloma), electric current injury, K+ depletion, Cushing’s syndrome
• Drugs: Aminoglycosides, gold, amphotericin, NSAID, sulphonamides, penicillins

• Concentrated urine (UO<2.5L/day)
• Alkaline urine (pH >7.5)
• Trace residue of bleach
• Aceazolomide, cephalosporins, NaHCO3

• Dilute urine (UO >5.0 litres/day)
• Acidic urine (pH <5)
• Bence Jones globulin associated with multiple myeloma, lymphoma and macroglobulinaemia is NOT detected by dipstick urinalysis

• Contaminated specime
• Ttrichomonas vaginalis,
• Drugs or foods that colour the urine red

• Intercurrent antibiotic therapy (e.g. gentamicin, tetracycline and cephalosporins)
• Gglycosuria
• Proteinuria,
• High specific gravity.
• Low bacteria count UTI (especially in women)

• Ascorbic acid
• Certain bacteria such as S. saprophyticus, acinetobacter and most enterococci

• Haematuria: trauma, infection, inflammation, infarction, calculi, neoplasia, clotting disorders or chronic infection.
• Haemaglobinuria (intravascular haemolysis)
• Myoglobinuria (crush injury, electrocution, rhabdomyolysis)

• Ketonuria is associated with low carbohydrate (high fat/protein) diets, starvation, diabetes, alcoholism, eclampsia and hyperthyroidism.
• Overdose of insulin, isoniazid and isopropyl alcohol

• Raised conjugated bilirubinaemia (with bilirubinuria) is associated with hepatocellular disease, cirrhosis, viral and drug induced hepatitis, biliary tract obstruction (e.g. choledocholithiasis), pancreatic causes of obstructive jaundice (e.g. carcinoma of the head of the pancreas) and recurrent idiopathic jaundice of pregnancy
• Inherited condition: Dubin-Johnsons syndrome, Rotor’s syndrome

• Ascorbic acid (vitamin C)
• Aged sample (conjugated bilirubin hydrolses to unconjugated bilirubin at room temperature)
• Rifampicin
• Exposure to UV light (converts bilrubin to biliverdin)

• Increased: cirrhosis, infective hepatitis, extravascular haemolysis, haemolytic anaemia, pernicious anaemia, malaria, and hepatitis secondary to infectious mononucleosis
• Decreased: or absent in obstructive jaundice and elevated levels of bilirubinuria

• Hyperglycaemia associated with diabetes, cystinosis, Cushings syndrome or thyrotoxicosis. Liver disease (e.g. Wilsons disease)
• Renal: Reduced ‘renal threshold’, renal tubular disease and pregnancy
• Drugs: cephalosporins, penicillins, nitrofurantoin, methyldopa, tetracycline, lithium, carbemazepine, phenothiazines, steroids and thiazides