ASPEK KLINIS

PEMERIKSAAN URINALISA
dr. Torajasa Achamar, Sp.PK, M.Biomed
PATELKI DPC KABUPATEN GORONTALO
10 MARET 2019
Urine Composition
Urine

95% water 5% solutes

Organic Inorganic

• Urea • NaCl
• Creatinine • K+
• Uric acid • SO42-
• Hippuric acid • PO43-
• Other substances • NH4+
• Mg2+
• Ca2+

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 Urine Volume
• Normal daily output : 1200-1500 ml
a range 600 – 2000 ml is considered normal

Oliguria < 1 ml/kg/hr (infants)

< 0.5 ml/kg/hr (children)
< 400 ml/day (adults)
Anuria Cessation of urine flow
Nocturia Increase in nocturnal excretion of urine
Polyuria > 2.5 – 3 ml/kg/day (children)
> 2.5 L/day (adults)

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Specimen Collection
– First morning (Urin Lebih terkonsentrasi)
– Catat Waktu Pengambilan
– Cara Pengambilan Paling Baik ( “clean
catch”)
– Harus Diperiksa paling lama 2 jam
setelah pengambilan
– Bebas dari Debris atau secret Vagina,
atau sperma misalnya
Clean Catch
Specimen Collection
Supra-pubic Needle Aspiration
Analisa Urin

−Makroskopik
−Kimia (Urine Dipstick)
−Mikroskopik 10x, 40x
−Culture (not covered in this lecture)
−Pemeriksaan Sitologi
Pemeriksaan Fisik
(Makroskopik)

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Warna, Kejernihan, dan Bau
• Urin normal :
Tidak Bewarna – Kuning muda dihasilkan oleh zat warna
urin namanya urochrome
Normal : Jernih
Bau normal
• Bagus dilihat pada Keadaan :
Kontainer/Tempat urin jernih
Dilihat dengan background warna putihView through a
clear container
Cahaya ruangan harus bagus

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Warna:
• Banyak hal yang mempengaruhi : Balance cairan, diet, obat2an,
penyakit
• Amber yellow : Urochrome (derivative of urobilin, produce
from bilirubin degradation, is pigment found in normal urine).
• Susu Pus, bacteria

• Coklat Blood (Hemoglobin).

• Orange, blue or red medications.
• Green Infeksi Pseudomonas
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Odour (Bau)

Mempunyai peran kecil dalam mendiagnosis penyakit diurin

1.Aromatic odour------> Normal urine mempunyai aroma asam
2.Ammonia odour------> infeksi.
3.Fruity odour--------> Diabetes due to the presence of ketones.
Chemical Examination

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Semi-Quantitative

Substances Tests
Protein Sulfosalicylic Acid
Heat & Acetic Acid
Glucose Benedict’s
Ketone Rothera’s
Gerhardt’s
Bilirubin Harrison’s
Urobilin Schlesinger’s

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Protein: Sulfosalicylic Acid

8 tetes 20% sulfosalicylic acid  mix

bandingkan 1 dan 2
@ 2 mL urine

• 1 = 2: (-)
• Tabung satu lebih keruh dari tabung 2: Panaskan tabung 1 sampai mendidih,
dinginkan dengan air mengalir  Masih keruh: (+)

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Protein: Interpretation

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Glucose: Benedict’s
Masukan 5 mL of
Benedict’s reagent

Taruh dalam water

Masukan 5 – 8
Bath selama 5 menit
tetes urine  mix

- Jernh atau biru

1+ Hijau Green color, green or yellow precipitate
2+ Kuningellow to green color, yellow precipitate
3+ Kuning Keorangenan
4+ Merah bata

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Ketone: Rothera’s

Add 5 mL of urine

Overlay with 1 mL of
Add 1 g of Rothera’s
concentrated
reagent  mix
ammonium hydroxide

- No ring or a brown ring

1+ Narrow lavender-purple ring
2+ Narrow dark purple ring
3+ Wide dark purple ring

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Bilirubin : Harrison’s

Masukan 5 mL urine

Spread the precipitate

Masukan 5 mL 10% Barium out on another filter
chloride solution paper, allow to dry
Mixed well & filter to remove ↓
the precipitate Add 2 – 3 drops
Fouchet’s reagent

• Green or Blue-green color: (+)

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Ph : Principles

Reagents Methyl red, bromthymol blue

Sensitivity 5–9
Interference Negatif
Korelasi dengan test lain Nitrite, leukocytes, microscopic

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Berat Jenis

Reagents Poly (methyl vinyl ether/maleic anhydride)

bromthymol blue
Sensitivity 1.000 – 1.030
Correlations with other tests False (+): Protein >>>
False (-): Alkaline urines (>6.5)

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Protein

• Proteinuria sangat penting berhubungan dengan

fungsi ginjal
• Normal : < 10 mg/dL atau 100 mg/dL dalam 24
urin
• Clinical proteinuria : ≥ 30 mg/dL 300 mg/L)
• Caused by pre renal, renal, post renal

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Principles

Reagents Tetrabromphenol blue

Sensitivity 15 – 30 mg/dL albumin
Interference False (+): Urin Alkali>>, pigmented specimens,
detergents, antiseptics,
False (-): other proteins, microalbuminuria

Correlations with other tests Blood, nitrite, leukocytes, microscopic

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Glucose
• Hampir semua Glukosa diabsorbsi di proksimal
tubulus
• Renal threshold : 160 – 180 mg/dl

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Principles

Reagents Glucose oxidase, peroxidase, potassium iodide

Sensitivity 75 – 125 mg/dL
Interference False (+): kontaminasi oleh oxidizing agents &
detergents
False (-): ascorbic acid , ketones , specific gravity
>>, low temp., improperly preserved specimens
(urin Lama)
Correlations with other tests Ketones, protein

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Ketones
• Products : • Clinical significance :
• Acetone • Starvation
• Acetoacetic acid • Vomiting
• Beta-hydroxybutyric
acid

• Increased ketones in
blood :
• Hiperemesis
Gravidarum
• Ketoasidosis Diabetes
• Acidosis/diabetic coma
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Principles

Reagents Sodium nitroprusside

Sensitivity 5 – 10 mg/dL acetoacetic acid
Interference False (+): phtalein dyes, pigmented red urine >>,
Obat levodopa, Obat2an sulfhydryl groups
(antibiotic golongan sulfa)
False (-): improperly preserved specimens (urin
Lama)
Correlations with other tests Glucose

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Nitrite
• Clinical significance :
• ISK dimana bakteri mengubah ammonia
• Principles :

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Nitrite Reagent Strip
Reagents P-arsanilic acid, tetrahydrobenzo(h)-quinolin-3-ol
Sensitivity 0.06 – 0.1 mg/dL nitrite ion
Interference False (+): improperly preserved specimens (urin
lama), pigmented urine >> (termasuk urin yang
terpapar lama sinar matahari
False (-): Bakteri yang tidak mereduksi amonia,
Banyak bakteri large mengkonversi nitrite to
nitrogen, pemakaian antibiotic, ascorbic acid >>,
Berat Jenis >>
Correlations with other tests Protein, leukocytes, microscopic

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Bilirubin
• Clinical significance
• Hepatitis
• Cirrhosis
• Biliary obstruction
• Gallstone
• Carcinoma

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Principles

Reagents 2,4-dichloroaniline diazonium salt

Sensitivity 0.4 – 0.8 mg/dL bilirubin
Interference False (+): pigmented urines >>, phenazopyridine,
indican,
False (-): specimen terpapar Cahaya matahari,
ascorbic acid > 25 mg/dL, nitrites concentration
>>
Correlations with other tests Urobilinogen

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Urobilinogen

• Clinical significance :
• Early detection of liver disease
• Liver disorders, hepatitis, cirrhosis, carcinoma
• Hemolytic disorders
• Increased urine urobilinogen : > 1 mg/dL
Urine Urine Urobilinogen
Bilirubin
Bile duct obstruction +++ Normal
Liver damage + or - ++
Hemolytic disease Negative +++

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Principles

Reagents P-dimethylaminobenzaldehyde
Sensitivity 0.2 mg/dL urobilinogen
Interference False (+): porphobilinogen, indican, p-
aminosalicylic acid, sulfonamides, methyldopa,
procaine, chlorpromazine, pigmented urine >>
False (-): old specimens, preservation in formalin,
nitrate concentration >>
Correlations with other tests Bilirubin

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Blood
• Intact red blood cells (hematuria) : cloudy red
• Hemoglobinuria : clear red
• Myoglobinuria : clear red-brown

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 Principles

Reagents Diisopropylbenzene dehydroperoxide

tetramethylbenzidine
Sensitivity 5 – 20 RBCs/mL, 0.015 – 0.062 mg/dL Hb
Interference False (+): strong oxidizing agents, bacterial
peroxidases, menstrual contamination
False (-): specific gravity /crenated cells >>, formalin,
captopril, nitrite concentration >>, ascorbic acid >
25 mg/dL, unmixed specimens
Correlations with other tests Protein, microscopic

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Leukocyte Esterase

• Positif pada :
• Infeksi Bakterial
• Perempuan > Laki

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Principles

Reagents Derivatized pyrrole amino acid ester, diazonium salt

Sensitivity 5 – 15 WBC/hpf
Interference False (+): strong oxidizing agents, formalin,
pigmented urine >>, nitrofurantoin
False (-): protein, glucose, asam oksalat, asam
askorbat, gentamicin, cephalosporins, tetracyclines,
Terlalu lama
Correlations with other tests Protein, nitrite, microscopic

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Microscopic Examination

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 PROSEDUR PEMERIKSAAN SEDIMEN URINE

Hitung
TORAK

KRISTAL ABNORMAL
PEMBESARAN
10 X

SEL EPITEL

MUKUS

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 PROSEDUR PEMERIKSAAN SEDIMEN URINE

ERITROSIT

LEKOSIT

KRISTAL NORMAL

PEMBESARAN SEL EPITEL

40 X
SPERMATOZOA

IDENTIFIKASI TORAK

LAIN LAIN : BAKTERI, SEL RAGI,

TRICHOMONAS, DLL

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 Biasanya pada pasien dengan penyakit
Dismorphic red Blood ginjal yang menyerang bagian Glomerulus
Cells in urine contoh : GNA,SLE
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Bagaimana Cast terbentuk

Protein Tamm Horsfall

Stasis Urin (Urin tertampung Lama)

Perubahan PH

Excretion of the cast

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 Silinder/Cast

Erythrocyte Casts: Glomerular diseases (GN,GNA,SLE)

Leukocyte Casts: Pyuria, Infeksi saluran Kencing

Degenerating Casts:
- Granular casts Nonspecific (Tamm-Horsfall protein)
- Hyaline casts Nonspecific (Tamm-Horsfall protein)
- Waxy casts Nonspecific
- Fatty casts Nephrotic syndrome
(oval fat body casts)
Microscopic Examination
WBCs Cast
Microscopic Examination
Granular Cast
Microscopic Examination
Hyaline Cast
Microscopic Examination
Waxy Cast
Microscopic Examination
Fatty Cast
Urinary
Crystals

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 Reference

• Strasinger SK, Di Lorenzo MS. 2008. Urinalysis and Body

Fluids. 5th ed. Philadelphia: FA Davis.
• Gandasoebrata R. 2004.Penuntun Laboratorium Klinik.
Jakarta: Dian Rakyat.

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