Urinalysis Explained

Summary

In 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

00:00

💉 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.

05:02

🔬 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.

10:02

⚖️ 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.

15:04

🍬 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.

Keywords

💡Urinalysis

Urinalysis is a diagnostic tool used to analyze the content of urine to detect signs of disease or disorder. In the video, it is highlighted as a cost-effective, fast method to assess what should or shouldn't be present in the urine, providing valuable indicators for medical conditions such as infections, diabetes, or dehydration.

💡Specific Gravity

Specific gravity measures the concentration of particles in urine. It indicates the balance of substances like ions, proteins, or glucose in relation to fluid levels. In the video, it's used to assess hydration levels, with a high specific gravity potentially indicating dehydration or glucose presence (as seen in diabetes), and a low value indicating overhydration.

💡pH

pH in urinalysis reflects the acidity or alkalinity of urine, ranging from 4.5 to 8. A normal pH typically falls between 5.5 and 6.5, indicating slightly acidic urine. Deviations in pH can signal underlying issues like infections (alkaline pH in UTIs) or dietary effects (more acidic with high-protein diets).

💡Glucose

Glucose in urine, known as glucosuria, should not normally be present, as glucose is reabsorbed by the kidneys. The presence of glucose can indicate excessive sugar intake or a medical condition like diabetes. The video discusses how diabetes, especially type 1 and type 2, can overwhelm the kidney's ability to reabsorb glucose, leading to its appearance in urine.

💡Ketones

Ketones are an alternative energy source produced when the body breaks down fats instead of glucose. In urinalysis, ketones can be an indicator of type 1 diabetes, where the body produces little to no insulin. Ketones are also produced in low-carbohydrate diets, as the body switches from glucose to fat metabolism for energy.

💡Nitrites

Nitrites in urine typically indicate the presence of bacteria, which convert nitrates (naturally present in the body) into nitrites. This is a common marker of bacterial infections such as urinary tract infections (UTIs). In the video, nitrites are discussed as an indicator of bacterial activity in the urinary tract.

💡Leukocytes

Leukocytes, or white blood cells, in the urine suggest inflammation or infection within the urinary system, such as a UTI. While leukocytes are normally not found in urine, their presence can signal an immune response to infection or inflammation in the kidneys, bladder, or urethra, as discussed in the video.

💡Bilirubin

Bilirubin is a byproduct of the breakdown of red blood cells. In the video, it's explained that bilirubin in urine can indicate liver dysfunction or hemolysis, where red blood cells break down at an accelerated rate. Bilirubin is typically processed by the liver and excreted in bile, so its presence in urine suggests an abnormality in this process.

💡Hemoglobin

Hemoglobin is the protein in red blood cells responsible for carrying oxygen. In urinalysis, hemoglobin presence may indicate hemolysis, muscle damage, or intense exercise. In the video, the detection of hemoglobin, myoglobin, or erythrocytes in urine suggests possible damage to the filtration membrane or physical trauma.

💡Glomerulus

The glomerulus is part of the kidney responsible for filtering blood to form urine. It acts as a sieve, allowing small molecules like glucose to pass while retaining larger molecules like proteins and blood cells. The video references the glomerulus when discussing how various substances, like glucose and proteins, are either reabsorbed or passed into urine, depending on kidney function.

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