Urinalysis Test: The things you need to know about your urine samples.

A urinalysis test, or urine test, is a medical examination of your urine to ascertain and diagnose infections, diabetes, kidney disease, liver disease, and pregnancy.

This is because the urinary system, in which urine sample is produced consists of the kidney, ureter, bladder, and urethra. Urine is produced basically after blood filtration in the kidney, the waste in the form of urine leaves through the ureters into the bladders where it is stored.

During urination or otherwise known as micturition, the urine passes through the urethra. If there is a high level of glucose in the blood, pyelonephritis, the presence of pathogens, hepatitis, or pregnancy (when HCG is released in the blood) will be detected when examining the urine.

How does my urine examine?

A urine sample is examined in three stages:

Physical examination of urine: This describes the appearance of the urine such as the color and whether it is cloudy or clear.

The color of a urine sample can be red, brown, yellow-brown, yellow-orange, pale, or amber. Each of these colors signifies if the urine is normal or likely to have bacterial urinary infections, urinary schistosomiasis, hepatitis, kidney disease, etc, and can make a urine sample look cloudy instead of clear. Normal urine is supposed to be clear except for infections or what the patient eats before the testing.

Chemical examination of urine: This is done using a commercially prepared dipstick with different parameters on it.

By dipping the dipstick into the urine container having a urine sample, and observing the color changes of the color chart. A color change in each of the parameters signifies the presence of the following:

Blood: Blood in the urine is called haematuria. This may be due to a sign of infection, menstruation, kidney or bladder-associated diseases, or blood disorders.
Urobilinogen: The presence of urobilinogen in a urine sample cannot be used to diagnose any specific medical condition. If the urine sample shows a little or higher-than-normal means a possible liver disease such as hepatitis, cirrhosis, hemolytic anemia, or liver damage due to medicine.
Bilirubin: Similar to urobilinogen, the breaking down of old red blood cells in the body produces bilirubin. The bilirubin enters the intestines and forms bile, a fluid that helps to digest food. The liver helps in removing the bilirubin from the body, which builds up in the blood and gets into the urine if there is a problem with the liver.
Protein: Proteinuria or albuminuria (protein in the urine) can be a sign of kidney damage, dehydration, or the presence of infection. Normally, proteins build muscles and bones and regulate body fluids, fight against infection, and repair tissue. As such, proteins are not supposed to leave the body unless when the kidneys are not functioning properly. Causes of kidney damage include diabetes, high blood pressure, and infections.
Ketone: Ketonuria (ketone in the urine) results when there are high levels of the ketone. It is common in diabetic patients, particularly in type1 diabetes mellitus. Ketone produced is a response to a shortage of glucose to serve as an alternative source of fuel from fatty acids. This process is normal.
Nitrite: Nitrate is a chemical element found in the body. The presence of bacteria converts it to nitrite. In most cases, it signifies the presence of infectious bacteria (UTIs).
Glucose: Glycosuria (glucose in the urine). This is a condition in which sugar is found in a urine sample. It is mostly seen in the urine samples of type 1 and types 2 diabetic patients or individuals with damaged kidney. Insulin assists in controlling the amount of glucose in the body, when it is damaged the glucose levels become too high, and the kidneys can’t filter and absorb it. Hence, it results in its presence in the urine.
pH: The normal pH of the body ranges from 4.6 to 7.0. The pH ranges from 1 to 14; from 1 to 6 is acidic while 8 to 14 is alkalinity, and 7.0 is neutral. Presence of infections and what you eat before the testing can alter the pH.

Microscopic examination of urine: After a successful physical and chemical examination of the urine sample, we proceed to the microscopic examination by viewing the urine sample under the microscope. The urine sample must first be centrifuged to have the deposit/sediment. While we examine the urine sample under the microscope, we look out for the following:

Epithelial cells: It is normal to see a few epithelial cells in urine. When large numbers are seen indicates inflammation of the urinary tract due to infections.
White blood cells: Pyuria results when many white blood cells are seen in a urine sample. It is seen in urinary infections. Few of it is normal.
Red blood cells: Hematuria (blood in the urine) may be due to glomerulonephritis, sickle cell diseases, menstruation, schistosomiasis, bacterial infections, hemorrhagic condition, etc.
Bacterial cells: Bacteriuria (bacteria in the urine) occurs in urinary tract infections (UTIs); protein and nitrite are sometimes found along with it.
Yeast cells: They are found in urine with vaginal candidiasis, mostly in women. A urine sample from diabetes and those with immunosuppression can have yeast cells.
Crystals: The finding of crystals has little importance as they are formed from normal urine, unless in rare cases. Cystine crystals, Calcium oxalate crystals, Tyrosine crystals, Cholesterol crystals, Tripe phosphate crystals, etc are different types of crystals.
Casts: Depending on the type of cast, they are formed in the kidney tubules. Hyaline casts may be seen when the glomerular filter membrane is damaged, waxy casts indicate tubular damage, then cellular and granular casts indicate hemorrhage in the renal tubules and renal damage respectively.