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06 Abnormal Constituents of Urine

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34 views4 pages

06 Abnormal Constituents of Urine

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rohannmandela0987
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© © All Rights Reserved
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ABNORMAL CONSTITUENTS OF URINE

Many Substances such as glucose, protein, aminoacids etc. are present in trace amounts
in normal urine. They escape detection due to the low sensitivity of the tests employed.
Concentration of these constituents is increased markedly in different pathological conditions.
When they are present in high concentration only they are detectable by the routine lab tests
and are said to be present in urine. Presence of these substances is suggestive of underlying
pathological conditions.

An increase in urinary output (polyurea) occurs in Diabetes mellitus, Diabetes insipidus


or after administration of certain drugs like digitalis, salicylates or diuretics.

A total suppression of urine formation (anuria) may occur during shock, acute nephritis,
incompatible blood transfusions, and mercury poisoning or bilateral renal stone formation.

PHYSICAL CHARECTERISTICS:

1.COLOUR: The urine appears smoky brown when blood is present, yellow when bilirubin is
present, black when melanins are present. Milky appearance as turbidity may be due to the
presence of bacteria or epithelial cells or lipids.

2.PH: significantly acidic urine is voided in fever or acidosis, alkali therapy or urinary retention
makes urine alkaline.

3. specific gravity: specific gravity is high in acute nephritis and fever when solute
concentration is high. It is low due to very dilute urine in Diabetes insipidus.

4. Odour: Fruity odour due to ketone bodies in uncontrolled diabetes mellitus, mousy odour in
phenyl ketonuria, or pungent odour in urinary infection.

CHEMICAL CONSTITUENTS:

The abnormal constituents which are routinely analyzed in urine are albumin, blood, glucose,
ketone bodies, bile salts and bilirubin.
TESTS FOR ABNORMAL CONSTITUENTS OF URINE
EXPERIMENT OBSERVATION INFERENCE
A coagulum is observed in the Albumin is present in urine
I.Tests For Albumin heated position
a) Heat coagulation
test:fill ¾th of test tube with
Urine. Hold the tube over the
flame in a slanting position
and boil the upper half
portion of urine. The lower
half serves as control. Cool,
add a few drops of 1% acetic
acid.
PRINCIPLE: Heating denaturates the protein and coagulates it. The lower portion of solution
acts as control. If the turbidity is due to phosphates or sulphates it disappears after addition of
1% acetic acid.
CLINICAL IMPORTANCE: Albumin excretion in urine is called albuminuria.
Albuminuria may be due to i). pre-renal, ii). renal or iii). post–renal conditions.
i).Pre-renal: dehydration resulting from pyloric stenosis, intestinal obstruction, diarrhea etc.,
congestive cardiac failure, fever, severe anemias.
ii).Renal: diseases of kidney either inflammatory, degenerative or destructive.
High amount of proteinuria is seen in nephrotic syndrome where ther is autoimmune
destruction of glomeruli.
iii).Post renal: inflammatory, degenerative or destructive diseases of ureter, bladder, prostate
or urethra.

b)Sulphosalicylic acid White precipitate is formed Confirms the presence of protein


in urine.
test:to 3ml of Sulphosalicylic
acid, add 1ml of urine.
II.TEST FOR BLOOD: Blue or green color forms, Blood is present in the urine
2)Benzidine Test : which is stable only for a few
Mix 1ml. of Benzidine solution seconds.
and 1ml. of H2O2. To this
mixture add 1ml. of urine.
PRINCIPLE: heating of urine destroys the peroxidase enzyme of leucocytes if present. Hemoglobin acts
like peroxidase on H2O2 and cleaves it to water and nascent oxygen which oxidizes benzidine to a blue
or green color complex.
CLINICAL IMPORTANCE:Hematuria (presence of RBC in urine) occurs due to bleeding in the urinary
tract due to trauma as in case of introduction of catheter through urethra etc.
When hemolysed blood is found in urine, the condition is called Hemoglobinuria. This occurs in severe
burns, chemical poisoning and incompatible blood transfusion.
Presence of protein and blood together is seen in infection, injury or malignancy of urinary tract.
III. TEST FOR REDUCING Presence of reducing sugars in
SUGARS: Yellow to brick red precipitate urine.
3)Benedict’s test: is formed.
To 5ml. of Benedicts reagent ,
add 8 drops of urine. Boil for
2min.

PRINCIPLE: presence of reducing sugar in general the glucose. The colour is suggestive of approximate
amount of glucose present in urine.
(Green = 0.5%, yellow = 1%, orange = 1.5%, Brick red =2%).
It is due to formation of enediols in alkaline medium which reduces Cu2+ to Cuprous hydroxide and then
to cuprous oxide(Cu2O)
CLINICAL IMPORTANCE:Positive Benedict’s test indicates reducing sugar excretion in urine.
Glycosuria (excretion of glucose in urine) seen in Diabetes mellitus and in renal diabetes. Lactosuria
seen in pregnancy and lactation. Excretion of pentoses is seen in pentosuria.
iv) TEST FOR KETONE BODIES: Permanganate Pink colored Indicates the presence of ketone
4).Rothera’sTest: ring is formed bodies in urine

Take 5ml of urine and


saturate it with solid
ammonium sulphate .Add 2
or 3 drops of freshly prepared
Sodiumnitroprusside solution.
Mix gently and add 1 ml. of
strong Ammonia (NH4OH)
drop wise along the side of
the test tube.
PRINCIPLE:Nitroprusside in alkaline medium reacts with ketone group to give Permanganate Pink
coloured ring.
CLINICAL IMPORTANCE:Acetone,Acetoacetic acid and β-hydroxy butyrate known as ketone
bodies and found in urine when fat metabolism is excessive as in case of severe uncontrolled
Diabetes mellitus and starvation. Both glycosuria and ketonuria are present in diabetic
ketoacidosis.
v) TEST FOR BILE SALTS: Sulphur sinks to the bottom Indicates the Presence of Bile
salts in urine.
5). Hay’s Test :
Take 2ml. of Urine in one Sulphur floats in water.
testtube which is marked as
Test(T), and take 2ml. of
water in another testtube
which is marked as
Control(C).sprinkle a little
sulphur powder in both tubes
and observe without mixing.
PRINCIPLE:Bile salts acts as emulsifying agents and decrease surface tension, hence
Sulphur sinks in presence of bile salts (Sodium taurocholate, sodium glycocholate etc.).
CLINICAL IMPORTANCE:Presence of Bile salts and Bile pigments in urine occurs in hepatocellular
jaundice due to intrahepatic biliary obstruction caused by inflammatory edema and also in
obstructive jaundice.
vi)TEST FOR BILE Green or Blue color is Indicates the Presence of Bile
PIGMENTS: developed on precipitate. pigments in urine.
6). Fouchet’s Test :To 5 ml
of Urine, add 1ml. of Glacial
acetic acid 5ml Bacl2 and
pinch of MgSO4. After 5
minutes, filter the solution.
Unfold the filter paper over a
dry filter paper, add a few
drops of “Fouchet’s” reagent
on dry precipitate.
PRINCIPLE:Fouchet’s reagent contains ferric chloride in trichloro acetic acid. Bile pigments
are observed on barium sulphate precipitate.Fouchet’s reagent oxidizes bilirubin to biliverdin
(green) or bilicyanin (blue).
vii). TEST FOR Purplish red colour is Indicates the presence of
UROBILINOGEN: observed urobilinogen.
7). Ehrlich’s test: To 1 ml
of urine add 2 ml of Ehrlich’s
reagent.

REPORT: The abnormal constituents present in the given urine sample are________________.

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