Urinalysis Explained
Summary
TLDRIn this video, Dr. Mike provides an insightful explanation of urinalysis, a cost-effective diagnostic tool used to assess health. He covers various aspects of what can be detected through urine tests, such as color, specific gravity, pH, glucose, ketones, blood, protein, nitrites, leukocytes, bilirubin, and urobilinogen. Each of these markers offers clues about hydration levels, infections, kidney health, metabolic issues like diabetes, and liver function. Dr. Mike highlights how urinalysis can serve as an important indicator for identifying diseases and disorders.
Takeaways
- 😀 Urinalysis is a fast, cost-effective diagnostic tool that helps identify diseases by analyzing substances present or absent in urine.
- 🟡 Urine color can vary from clear to cloudy, colorless to amber, and can indicate issues such as infections, blood presence, or dissolved proteins.
- 🌡️ Specific gravity measures the concentration of substances in urine, indicating hydration levels or conditions like diabetes if levels are too high or low.
- 🧪 pH levels in urine help assess acid-base imbalances, with normal ranges between 4.5 to 8, often around 5.5 to 6.5.
- 🍬 Glucose in urine may indicate diabetes, as kidneys normally reabsorb glucose. Excess glucose can overwhelm this process, leading to glycosuria.
- 🔋 Ketones in urine are associated with type 1 diabetes or low-carb diets, where the body uses fats as an energy source instead of glucose.
- 🩸 Blood in urine could signal damage to the filtration membrane or other parts of the urinary tract, with potential causes like infection or injury.
- 🧬 Protein in urine can be caused by short-term issues like heart failure or exercise, or long-term problems like glomerulonephritis (kidney damage).
- 🦠 Nitrites in urine indicate bacterial presence, converting nitrates into nitrites, often pointing to a urinary tract infection (UTI).
- 💊 Bilirubin and urobilinogen in urine may indicate hemolysis (breakdown of red blood cells) or liver dysfunction.
Q & A
What is urinalysis and why is it significant?
-Urinalysis is a diagnostic tool used to examine the contents of urine to identify what should or should not be present, which can indicate diseases or disorders.
How can the color of urine provide insights into health?
-The color of urine can range from clear to amber and can be influenced by factors like food, drugs, and the presence of blood or proteins. It can indicate infections or other health issues.
What is specific gravity in the context of urinalysis?
-Specific gravity measures the concentration of urine, specifically the osmolality, which is the concentration of solutes in the urine. It can indicate hydration status and potential conditions like dehydration or diabetes.
What does a high specific gravity in urine suggest?
-A high specific gravity, above 1.03, may suggest dehydration or the presence of substances like glucose or urea, which could indicate conditions such as diabetes.
Why is pH important in urinalysis?
-pH measures the concentration of hydrogen ions and can indicate acid-base imbalances in the body, such as acidosis or alkalosis, which can be related to respiratory or metabolic conditions.
What can the presence of glucose in urine indicate?
-The presence of glucose in urine can indicate an overload of sugar intake or a problem with glucose handling, such as diabetes, where the kidneys are unable to reabsorb all the glucose filtered from the blood.
How are ketones related to diabetes in the context of urinalysis?
-Ketones are an alternate energy source produced when glucose is not available. Their presence in urine can indicate type 1 diabetes, where insulin is not present to facilitate glucose use, or a very low carbohydrate diet.
What does the presence of blood or peroxidase activity in urine signify?
-The presence of blood or peroxidase activity in urine can indicate damage to the filtration membrane, infections, or damage to the tubules, ureters, bladder, or urethra.
Why is protein presence in urine a concern?
-Proteins are usually not present in urine due to their size, but their presence can indicate damage to the glomerulus, conditions like glomerulonephritis, or transient causes such as heart failure, exercise, or stress.
What does the presence of nitrites in urine indicate?
-The presence of nitrites in urine indicates the presence of bacteria, which can be a sign of a urinary tract infection, as bacteria convert nitrates to nitrites.
What can the presence of bilirubin and urobilinogen in urine suggest?
-The presence of bilirubin and urobilinogen in urine can suggest issues with red blood cell breakdown, liver dysfunction, or problems with the bile or biliary system.
Outlines
💉 Introduction to Urinalysis
Dr. Mike introduces the topic of urinalysis, describing it as an affordable and effective diagnostic tool to analyze urine. He explains that urinalysis can reveal diseases or disorders by assessing what should or should not be present in the urine. The first factor to consider is the color, which can range from clear to amber, depending on factors like food, drugs, or the presence of blood. Cloudiness may indicate proteins or infections.
🔬 Specific Gravity and its Importance
Specific gravity is discussed as a test that measures the concentration of substances in the urine. It provides information about the osmolality, or the amount of dissolved particles, with normal values ranging between 1.003 and 1.03. High specific gravity can suggest dehydration, glucose in the urine (potentially indicating diabetes), or syndrome of inappropriate antidiuretic hormone (SIADH). Low values may indicate overhydration or diabetes insipidus, a condition where too much dilute urine is produced.
⚖️ Understanding pH Levels in Urine
The pH level of urine, which ranges from 4.5 to 8, reflects the acidity or alkalinity of the body. Typically, urine has a slightly acidic pH of 5.5 to 6.5. A more acidic pH can be caused by protein-rich diets, while an alkaline pH may indicate a urinary tract infection (UTI). Dr. Mike discusses how pH levels can also signal metabolic or respiratory imbalances, such as acidosis or alkalosis, depending on the retention or loss of hydrogen ions and bicarbonates.
🍬 Glucose and Ketones in Urinalysis
Glucose should not be present in urine, as it is normally reabsorbed by the kidneys. If glucose appears, it could indicate excessive sugar intake or diabetes. Dr. Mike explains the link between glucose and diabetes, particularly the role of insulin in glucose metabolism. Additionally, he highlights that ketones, another energy source, can appear in urine during uncontrolled type 1 diabetes or low-carb diets. Ketones are produced when the body switches to fat metabolism due to the absence of insulin.
💪 Blood, Hemoglobin, and Myoglobin in Urine
The presence of blood in urine is typically linked to peroxidase activity, which detects hemoglobin, myoglobin, and erythrocytes. While erythrocytes are usually too large to pass through the glomerulus, myoglobin and hemoglobin may appear due to muscle damage or intense physical activity. Elevated levels of these proteins can also signal kidney damage or infections. Dr. Mike discusses conditions such as crush injuries and intense exercise as potential causes of these abnormalities.
🧪 Protein and Nitrites in Urinalysis
Proteins larger than 20,000 Daltons do not typically filter through the kidneys, but smaller proteins like albumin may appear in urine. Proteinuria can indicate heart failure, fever, stress, or kidney damage. Nitrites, which should not be present in urine, are produced by bacteria converting nitrates, signaling a bacterial infection, such as a UTI. Dr. Mike discusses how both short-term and long-term factors can contribute to protein or nitrite presence in urine.
🦠 Leukocytes and Bilirubin in Urine
Leukocytes (white blood cells) in the urine indicate an infection or inflammation in the urinary tract or kidneys. Bilirubin, a breakdown product of red blood cells, can appear in urine if too many red blood cells are breaking down (hemolysis) or if there's liver dysfunction or bile duct obstruction. Bilirubin gets processed by the liver and either excreted in bile or reabsorbed, contributing to urobilinogen in the urine, which is another marker of red blood cell breakdown or liver issues.
Mindmap
Keywords
💡Urinalysis
💡Specific Gravity
💡pH
💡Glucose
💡Ketones
💡Nitrites
💡Leukocytes
💡Bilirubin
💡Hemoglobin
💡Glomerulus
Highlights
Urinalysis is a cost-effective diagnostic tool for disease or disorder detection.
Urine color can range from clear to amber and can indicate various health conditions.
Specific gravity measures urine concentration and can signal dehydration or overhydration.
High specific gravity may indicate diabetes or syndrome of inappropriate antidiuretic hormone.
Low specific gravity could suggest diabetes insipidus or overhydration.
pH levels in urine can reflect acid-base imbalances in the body.
Urine pH can vary from 4.5 to 8, with normal levels between 5.5 and 6.5.
Glucose in urine can be a sign of diabetes or excessive sugar intake.
Ketones in urine are an indicator of type 1 diabetes or very low carbohydrate diets.
Presence of blood or peroxidase activity can signal damage to the filtration membrane or infections.
Protein in urine can be due to heart failure, exercise, or long-term conditions like glomerulonephritis.
Nitrites in urine indicate bacterial presence and potential urinary tract infections.
Leukocytes in urine suggest inflammation or infection in the urinary system.
Bilirubin and urobilinogen in urine can indicate liver dysfunction or issues with the biliary system.
Transcripts
hi everybody dr mike here in this video
we're going to take a look at urinalysis
[Music]
now urinalysis is a cheap fast and
cost-effective diagnostic tool
to have a look at what should or should
not be present in the urine and can be a
great indicator
for disease or disorder so let's go
through
what we can check in a urinalysis one by
one
so first thing is let's have a look at
color so color is something you can
obviously just take and look at
it can be something that's clear
or it can be cloudy or anything in
between
it could be colorless
or it could be amber for example
and anything in between now what can
change the color of our urine can be
anything from
food to drugs for example it could be
the presence of
blood what about from clear to cloudy it
could be the presence of
proteins or anything dissolved in the
urine or maybe an indication of an
infection
so just by looking at the urine can give
you a great indication as to what
may be going on specific gravity this is
the first
test that we can actually perform using
the urinalysis or the dipstick for
example
and specific gravity is simply looking
at the concentration
of the urine it's looking at the stuff
in the urine
now specifically what it's looking at is
something called the
osmolality
and the osmolality is that concentration
of stuff in the urine so for example
if i were to check the specific gravity
of water it's going to be
one because there's nothing in water
it's just water itself so
it's the reference point specific
gravity of one anytime you put
anything into that water so let's say we
start to dissolve some ions or maybe
some proteins or maybe some sugar or
glucose for example
it's going to increase the concentration
of stuff in there or the osmolality
now this is going to increase the
specific gravity so if we take urine
it's obviously not going to be
a void of particulates or particles
dissolved in it like water is so it's
going to be a value
greater than 1. what you're going to
find is for
urine the specific gravity is usually
between 1.003
and 1.03 so
what this indicates is that for example
if something's
above 1.03 it may be an indication of
dehydration
so more stuff dissolved in the urine
itself or
not enough fluid and so the relative
proportion of stuff dissolved in
is greater compared to the fluid if it's
below 1.003
it's going to be an indication of
hydration
maybe an indication of over hydration
what can specific gravity tell us well
again apart from
the relative hydration status it can be
an indication of the presence of other
things so for example
if it's above 1.03 so
looking as though dehydrated could be
the presence of glucose in the urine so
glycose or glucose urea
which is an indication potentially of
diabetes for example
it could be an indication of something
called syndrome of inappropriate
anti-diuretic
hormone what does that mean so
anti-diuretic hormone
anti-diuresis to stop urinating
so adh anti-diuretic hormone pulls water
back into the body
so syndrome of inappropriate
antidiuretic hormone means it's pulling
too much water back into the body
so the urine you produce is concentrated
so they can be just
two potential reasons glucosuria or
syndrome of inappropriate adh
can be an indication if the specific
gravity is too high if it's
too low for an exam for example it could
be an indication of something called
diabetes
insipidus now diabetes mellitus mellitus
means sweet
sweet like sugar because there's glucose
or sugar in the urine
diabetes insipidus it's not sweet
there's no glucose in that urine it's
actually a problem
up in the brain with not enough
antidiuretic hormone being produced
so too much dilute urine is being
produced and that could be an indication
of a low specific gravity again they're
all just indicators
so ph ph is looking at the concentration
of hydrogen ions
and obviously looking at ph can be a
great way of looking at whether there's
any acid base
imbalances so for example somebody can
have respiratory or metabolic acidosis
or alkalosis so that means too much or
too little hydrogen ions
respiratory based means it has to have
something to do with the breathing so
maybe if you're
retaining too much carbon dioxide that
turns to hydrogen ions and your blood
becomes too acidic
maybe you're breathing off or
hyperventilating and you're getting rid
of too much carbon dioxide
that could be an indication of alkalosis
okay so your ph starts to go up acidosis
ph goes down alkalosis pass goes up
metabolic means there's something going
on in the body usually at the kidneys
and it's retaining too much hydrogen
ions or getting rid of too much
bicarbonate for example
this can bear out in the ph test of the
urinalysis
but what you should know is what the
normal ph
is so for example the ph can vary from
4.5 to 8.
so that's quite significant usually it's
sitting for urine
between 5.5 and 6.5 now what's that
telling you it's telling you it's
slightly
acidic now you can change the acid base
through food for example so
ingesting proteins proteins are made up
of amino
acids right the acid portion gives you
an indication
when we break down proteins and amino
acids we turn it into ammonia our body
doesn't like handling ammonia so it
turns it into urea
that comes out in our urine and urea is
acidic so if you have more proteins in
your diet your urine will be more acidic
now if the urine is more basic it could
be an indication that there's bacteria
present
that eat up or split the urea so a uti
could be an indication of an
alkaline based or a basic urine because
it's breaking up that urea
but it could also be an indication of a
number of other things like i said
food for example so ph again just an
indicator
glucose all right so glucose is small
enough for our kidneys to filter
remember there's a filtration membrane
called the glomerulus
so if i were to drop the filtration unit
of the kidney
called the nephron there's different
aspects of it
so right here is where you actually
filter the blood so the blood is going
to come
in turn into something called a
glomerulus
and then the blood is going to go out
and if it's small enough it gets
filtered through this sieve or this
filtration membrane
called the glomerular filtration
membrane glucose is small enough to get
filtered
into this tube into this nephron and
these tubules
but what should normally happen is all
the glucose
that gets filtered should be thrown back
into the blood of the body so what that
means is anything that ends up
at the other end of this tube that comes
out in our urine
so that means all the glucose that gets
filtered actually gets thrown back into
the body
and doesn't come out in our urine so
urine shouldn't actually have glucose in
it
but if it does have glucose in it what
can be it be an indication of so maybe
somebody has ingested
far too much sugar far too much glucose
and the transport molecules that bring
it back into the body of being
overwhelmed
and it can't bring it all back so
there's an overload of glucose and it
just carries out into the urine
or it could be an indication of diabetes
so remember diabetes is a problem with
handling glucose so type 1 diabetes
you don't produce the insulin type 2 you
produce it
it just doesn't really work and insulin
is that key to tell the cells of the
body
like muscle cells for example and fat
cells to take the glucose
and bring it in from the blood but if
that insulin isn't there or doesn't work
the glucose stays in the blood
and overwhelms this filtration and it
comes out in the urine and as we know
with
diabetics wherever the glucose goes it
pulls water with it that's osmotic
that's an osmotic effect and it can lead
to
increasing urine production as well
polyuria more urine being produced over
time
so glucose good indicator of diabetes
ketones
also a good indicator of diabetes but
more specifically
type 1 diabetes now
why what is ketones so ketones usually
aren't present in the urine ketones are
an alternate energy source
alternate from glucose that's our
primary energy source ketones are an
alternate
energy source what happens is this
glucose
turns into energy through a process
known as glycolysis
glucose goes to pyruvate pyruvate jumps
into the krebs cycle of the mitochondria
that creates products that jump into the
electron transport chain that produces
about 36 odd atp molecules
glucose can only do this if insulin is
present
if insulin is not present the body tries
to make
glucose it makes it from
non-glucose-based sources like
fats and proteins and what happens is
all these fats
come in get broken down and they start
to back up
and when they back up they go through an
alternate pathway of energy source
production
and that's the pathway of ketones now so
type 1 diabetics
they have they produce zero insulin
right
no insulin that means no glucose being
produced no glucose being utilized for
energy
so all these ketones being produced type
2 diabetics they do produce
the insulin which means the glucose is
undergoing whatever glucose gets into
the cells is undergoing
this glycolytic process so the ketone
production
will be minimal right so that's why type
1 diabetes
producing ketones is a good indicator
but ketones are also produced when
somebody is on a very low carbohydrate
diet so somebody could be producing
ketones
if they're not ingesting much glucose at
all in the first place
so the only option is to produce the
ketones for energy take the fatty acids
break it down to produce ketones all
right
blood now blood is probably not the
right term to use
here but what we're referring to in this
test is actually
it measures something called peroxidase
activity and peroxidase activity is
actually an indicator
of hemoglobin
myoglobin and
erythrocyte function
so hemoglobin myoglobin erythrocyte
function that's actually what this
aspect of the test picks
up not just blood now hemoglobin carries
oxygen around the body myoglobin carries
oxygen in the muscle that's what the
myers refer to
erythrocyte is the red blood cell which
obviously carries hemoglobin
now generally speaking erythrocytes do
not get filtered they're too big
cells don't get filtered here at the
glomerulus so
if you've got erythrocytes present could
be an indication that there's damage
at this membrane or there's some sort of
infection or some sort of damage
to the tubules itself or something lower
down lower down could be the ureters
it could be the bladder it could be the
urethra for example
what about myoglobin and hemoglobin well
they could be present
they do get filtered right but usually
they get reabsorbed back in so their
presence in the urine is very low
so again it's an overabundance that's
going to lead to their presence in the
urine
overproduction so for example it could
be
somebody doing exercise so marathon
runners or some somebody performing
intense exercise
may find that their hemoglobin globin
levels in their urine goes up
but it should be transient so it should
obviously fix itself within 48 72 hours
or it could be a crush injury so if
something crushes the muscle it's going
to release all this myoglobin
and again that's going to come out in
the urine so it could be an indicator of
that but again
could also be an indicator that there's
damage to
the filtration membrane itself
or the nephrons or the tubules for
example or something lower down
so an infection could actually increase
those numbers
protein so the only types of proteins
that can get filtered are proteins that
are less than 20 000
daltons in size that's the molecular
weight so anything that's smaller than
that gets
filtered at the glomerulus some proteins
are greater than that some proteins are
smaller some proteins that are smaller
than that that get filtered include
albumin
and some globulins they're usually
carrier
molecules so sometimes they're going to
be carrying insoluble substances
and they get filtered through again a
lot of it gets reabsorbed
back into the body some of it does come
out so what can increase the presence
of protein well it can happen
transiently or long term so transiently
things like
heart failure can do it increasing that
pressure that's happening
it could be damage to the glomerulus so
glomerulonephritis
can can cause this as well so that's
usually a long-term
cause so it could be short-term or
long-term short-term
heart failure exercise fever stress
long-term usually some sort of
nephropathy such as glomerulonephritis
can increase the presence of proteins
nitrites all right you usually should
have
zero nitrites in your urine you
shouldn't have any at all you have
nitrates but no nitrites
but what happens is we can have the
presence of bacteria
and these bacteria can turn the nitrates
with the a into nitrites
with the eye and so the presence of
nitrites tell you there is bacteria
present
which can be an indication of a
urinary tract effect infection wherever
that infection may
be leukocytes white blood cells
good indication of infection so this
infection again could be a great
indicator of uti
but usually you'd need to do some sort
of culture to say that bacteria is
present
for a uti if not no bacteria present
could be just
some type of itis right some sort of
oops inflammatory response that's
happening
so it could be inflammation of the
nephron itself
of the kidney something of the ureter
bladder urethra
so this could also increase the amount
of leukocytes present all right last one
bilirubin and urabilinogen your red
blood cells when they
die they go to the spleen so you've got
red blood cells
they go to the spleen the spleen breaks
up hemoglobin and globin and the heme
goes to the liver
and the liver turns it into bilirubin
that's the first thing bilirubin now
bilirubin
can be unconjugated or conjugated the
liver conjugates it what that means is
it makes it water-soluble so it can
float around
in the water of our body if it's
water-soluble it can be filtered
so some conjugated bilirubin can be
present
in the urine some what usually happens
is this the liver that makes the
bilirubin
conjugates it and sends it to
the bile right which is the gall bladder
and the gallbladder releases it into the
small intestines
and so this can come out in our fecal
material or it can get
reabsorbed back to the liver
all right now here's the thing when it's
in the ball as
in the small intestines this is where it
turns into urobilinogen
bilinogen okay and again this can go
to the liver for reabsorption so
what is all this telling you this is all
telling you that
the presence of bilirubin and
urobilinogen in the urine
can be an indication that too many red
blood cells are breaking down this is
known as
hemolysis it could be an indicator that
liver is dysfunctional
all right so some sort of hepatic
disease or maybe some sort of
hepatocellular disease or it can be an
indication that there's a problem with
the bile
or bile ducts so the biliary system
that's what it's telling you that's what
it's an indicator of so this is a quick
run through of your analysis
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