Urine Analysis (1/3): Sediment and Dipstick Examination

Urine Analysis (1/3): sediment and dipstick
Urine Analysis (2/3): urine culture
Urine Analysis (3/3): 24-hour urine test

Urine Sediment: Microscopic Examination

Preparing the Specimen

12 ml of midstream urine is centrifuged with 2000 rpm for 5 minutes. The supernatant is discarded (around 11.5 ml) and the rest is resuspended by manual shaking of the centrifuge tube. One drop of the fluid is placed on a microscope slide and covered with a slip. The urine sediment specimen is viewed with 400× magnification.

Differential Diagnosis of the Urine Sediment

Abnormal urine color:

Cloudy urine: pyuria
Red color of urine: hematuria, food (beetroot, blueberry, blackberry), myoglobinuria, hemoglobinuria, chronic lead poisoning
Dark yellow to orange color of urine: bilirubinuria (urobilinogen), medication with rifampicin
Brown color of urine: hemorrhage, myoglobinuria, medication with nitrofurantoin, metronidazole or L-Doa, porphyria
Green color or urine: bilirubinuria (biliverdin)

Hematuria and Microhematuria

Hematuria is defined as visible blood in urine; microhematuria is defined with more than 5 erythrocytes per high power field. More than 20 erythrocytes per high power field is a strong microhematuria. Please see section hematuria for differential diagnosis.

Leukocyturia

Leukocyturia is more than 15 leukocytes per high power field. Differential diagnoses include urinary tract infections, urogenital tuberculosis (sterile leucocyturia), nephrolithiasis and foreign bodies.

Urine Casts

Urine casts are cylindrical mucoprotein structures, which are formed in the distal nephron and passed into the urine. Depending on the luminal content of the distal nephron, casts are acellular or contain cells (erythrocytes, leukocytes or tubular cells). Cellular casts in the urine sediment suggest a renal inflammatory disease (e.g. glomerulonephritis, pyelonephritis). Degeneration of cellular casts results in granular casts and waxy casts. Acellular casts (e.g. hyaline casts) may have no pathologic significance or are an indication for a reduced fluid intake.

Urine Crystals

Many different crystal types can be identified in patients with stone disease and in normal urine. Only the identification of cystine crystals (hexagonal crystals) is important to establish the diagnosis of cystinuria.

Bacteria

Visible bacteria in the freshly processed midstream urine are diagnostic for a urinary tract infection. 5 bacteria per high power field correspond to a colony count of 100000/ml.

Urine Analysis with Dipsticks

Standard values for urine dipstick analysis are shown in Table dipstick standard values. In screening for urological diseases, the urine analysis with dipsticks is superior to the urine sediment. The dipstick analysis provides important information about the urinary pH, specific gravity, proteinuria, bilirubinuria, glucosuria, ketonuria and nitrite test. False positive and negative results are common in urinary specific weight of >1020 g/ml or urine with abnormal color.

**Urine dipstick standard values.**
	Standard value
Erythrocytes	<5
Leukocytes	<15
Urinary pH	5.5–6.5
Glucose	<15 mg/dl (0.84 mmol/l)
Protein	<30 mg/dl
Specific Gravity	1.003–1.030 g/ml
Nitrite test	negativ

Differential Diagnosis of Dipstick Urine Analysis

Hematuria:

Please see section hematuria for differential diagnosis.

Leukocyturia:

Differential diagnoses include urinary tract infections, urogenital tuberculosis (sterile leukocyturia), nephrolithiasis and foreign bodies.

Alkaline urine:

Alkaline urine is a sign for infection with urea-splitting bacteria (e.g. Proteus), renal tubular acidosis, after a big meal, old urine.

Acid urine:

Acid urine is a sign for uric acid or cystine urolithiasis.

Glucosuria:

Glucosuria is always suspicious of diabetes mellitus, since the dipstick reacts only >50 mg/dl glucose in urine. Seldom differential diagnoses: renal glucosuria.

Proteinuria:

The urinary protein concentration should be <30 mg/ml: differential diagnosis of proteinuria.

Nitrite test:

The nitrite test should be negative. A positive test corresponds to a colony count of >100000/ml. False negative nitrite tests are obtained with non-nitrite-producing bacteria such as Enterococcus, high vitamin C intake or urine storage time in the bladder <4 h.

Examinations

Index

Urine culture

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

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References

Deutsche Version: Urinuntersuchung: Sediment und Teststreifen

Last update:

Dr. med. Dirk Manski (E-Mail)