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{{SI}}
[[Image:Weewee.JPG|thumb|Human Urine Sample]]
{{CMG}}
{{SCC}} {{AE}} {{YD}}<br>
{{SK}} Urinary findings; Urinary abnormalities; Findings on urine exam; Urine; Urine composition; Urine output


==Overview==
'''Urine''' is a fluid produced by humans through the [[kidney]], collected in the [[Urinary bladder|bladder]], and excreted through the genital [[urethra]]. Urine formation helps to maintain the balance of minerals and other substances in the body. Urinary findings may be qualitative or quantitative. Qualitative urinary findings are often analyzed on urinalysis and urine culture. Quantitative urinary findings depends on urine output. A urinalysis (U) is an array of tests performed on urine and is one of the most common methods of medical diagnosis. A part of a urinalysis can be performed by using urine dipsticks, in which the test results can be read as color changes.
==Composition of Urine==
[[Image:Urea.png|thumb|left|150px|Urea structure]]<br><br><br><br><br><br><br><br>
The following is a list of normal urine constituents:


* '''Non-organic substances''': bicarbonate, chloride, phosphorus, sulphur, bromide, fluoride, iodide, rhodanide, potassium, natron, calcium, magnesium, iron, copper, zinc, cobalt, selenium, arsenium, lead, and mercury.
* '''Nitrogenous substances''': nitrogen, [[urea]], [[creatine]], [[creatinine]], [[guanidine]], [[choline]], [[carnitine]], [[piperidine]], [[spermidine]], [[dopamine]], [[epinephrine]], [[norepinephrine]], [[serotonin]], [[tryptamine]], levulinique amino-acid, and [[bilirubin]]
* '''Non-nitrogenous organic acids'''
* '''[[Amino acid]]s''': [[alanine]], [[carnosine]], [[glycine]], [[histidine]], [[leucine]], [[lysine]], [[methionine]], [[phenylalanine]], [[serine]], [[tyrosine]], [[valine]], hydroxyloproline, galactosylhydroxylyzine, xylosylserine, and others.
* '''Proteins:''' [[albumin]], [[haptoglobin]], [[transferrin]], immunoglobulins [[IgG]], [[IgA]], [[IgM]], and others.
* '''Enzymes''': lactadehydrogenase, [[gamma-glutamyl transferase]], alpha amylase, uropepsinogene, [[lysozyme]], beta-N-acetylglucosaminidase, [[urokinase]], [[protease]], and others.
* '''Carbohydrates''': [[arabinose]], xyloseribose, [[fucose]], rhammose, [[ketopentose]], [[glucose]], [[galactose]], [[mannose]], [[fructose]], [[lactose]], [[sucrose]], fucosylglucose, [[raffinose]], and others.
* '''[[Vitamins]]''': [[thiamine]] (vitamin B1), [[riboflavin]] (vitamin B2), [[vitamin B6]], 4-pyridoxique acid, [[nicotinic acid]], [[vitamin B12]], biopterine, [[ascorbic acid]] (vitamin C) and others.
* '''[[Hormones]]''': [[gonadotropin]], [[corticotropin]], [[prolactin]], lactogeniques hormones, [[oxytocin]], [[vasopressin]], [[thyroxine]], catecholamines ([[epinephrine]], [[norepinephrine]], [[dopamine]]), [[insulin]], [[erythropoietin]], corticosteroids ([[aldosterone]], [[corticosterone]], [[cortisone]]), [[testosterone]], [[progesterone]], [[estrogen]] and others.
* '''[[Agglutinin]]s and precipitines''': neutralizing action on the polio virus and other viruses.
* '''Antineoplaston''': selectively prevents the development of cancer cells without affecting healthy cells that
* '''Allantoin''': nitrogen crystalline substance that promotes healing, from the oxidation of uric acid.  It is used in the manufacture of many skin creams.
* '''DHEA (dehydroepiandrosterone)''': steroid secreted by the adrenal glands, present in large quantities in male urine.  It prevents obesity, prolongs the life of animals and is a possible treatment against anemia, diabetes and breast cancer. DHEA stimulates the development of the bone marrow and increases its production of red blood cells, monocytes, macrophages and lymphocytes. A low level of DHEA seems to be associated with aging.
* '''Gastric antisecretory products''': prevent the onset and development of stomach ulcers.
* '''[[Glucoronic acid]]''': produced by the liver, kidneys and intestines, it has a major secretory function.
* '''H-11''': inhibits the growth of cancer cells and reduces the existing tumors without disrupting the recovery process.
* '''H.U.D. HUD (Human’s urine derivative)''': demonstrates remarkable anticancer properties.
* '''Interleukin-1''': a positive influence on the auxiliary and inhibitory substances. Can send a signal to the hypothalamus to trigger fever.
* '''Trimethyl-glyoxal''': destroys cancer cells.
* '''Prostaglandine''': a hormonal substance that dilates the blood vessels, lowers tension, relaxes the muscle walls of the bronchi, stimulates contractions during labor, and many metabolic functions.
* '''Proteoglobulines''': plasma proteins containing anti-bodies against certain allergens, they are identical to the proteins of immoglobulines blood serum.
* '''Prosteoses''': immunological products assets allergic reactions.


==Overview==
==Algorithm of Common Urinary Findings==
{{familytree/start |summary=Common Urinary Findings}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |A01=Urinary Findings}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | B02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |B01=Quality (Composition) |B02=Quantity (Volume)}}
{{familytree | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | C01 | | | | C02 | | | | | | | | | | | | | | C03 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |C01=[[#Urine Odor|Urinalysis]] |C02=[[Urine culture]] |C03=[[Urine output]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | |,|-|^|-|-|-|-|.| | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | |,|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|.| | | E01 | | | | | E02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |E01=[[High urine output]] |E02=[[Low urine output]]}}
{{familytree | D12 | | D11 | | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | | D08 | | |!| | | | |,|-|^|-|.| | | | | | | | | | | | | | | | | | | | | | | | |D12=[[#Urine Odor|Urine odor]] | D11=[[#Urine Color and Turbidity|Color]] and [[#Urine Color and Turbidity|Turbidity]] |D01=[[#Urine Specific Gravity and Osmolality|Specific gravity]] or [[#Urine Specific Gravity and Osmolality|osmolality]] |D02=[[#Urinary pH|Urinary pH]]| D03=[[Hematuria]] |D04=[[Pyuria]] |D05=[[Proteinuria]] |D06=[[#Cells|Cells]] |D07=[[Urinary casts|Casts]] and [[#Casts and Crystals|Crystals]] |D08=[[#Other|Other]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | F01 | | | F02 | | F03 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |F01=[[Polyuria]] |F02=[[Oliguria]] |F03=[[Anuria]]}}
{{familytree/end}}


'''Urine''' is a liquid produced by animals through the [[kidney]], and is collected in the [[Urinary bladder|bladder]] and excreted through the [[urethra]].  
==Urine Odor==
Urine is usually odorless but can produce pungent smells following the consumption of certain foods (e.g. asparagus)


Urine formation helps to maintain the balance of minerals and other substances in the body. For example, excess of calcium is normally eliminated through the urine. Urine also excretes [[ammonia]], the build-up of which is harmful to the body. In addition, urine is the result of a mechanism that maintains the appropriate amount of water in the body.  
==Urine Color and Turbidity==
===Color===
Below is a table that lists common urine discolorations and their associated conditions.


A range of substances, including ethanol and artificial sweeteners, are also eliminated from the body through the urine.
{|class="wikitable"
| bgcolor="#C0C0C0"|'''Urine Color'''
| bgcolor="#C0C0C0"| '''Associated Conditions'''
|-
|'''Clear or Light Yellow'''
|Normal urine color
|-
| '''Dark Yellow'''
| Dehydration, [[vitamin B12]] administration
|-
|'''Greenish/Yellow'''
|[[Vitamin B]] administration
|-
| '''Yellow-Red'''
| Laxatives
|-
| '''Orange'''
| [[Rifampicin]], [[nitrofurantoin]], [[pyridium]]
|-
| '''Dark / Black'''
| [[Alkaptonuria]], [[porphyria]], [[sarcoma]]
|-
| '''Milky'''
| Lymphatic fistulas
|-
| '''Opaque'''
| [[Bacteria]], [[Cell]]s
|-
| '''Dark Red/Pink'''
| Concentrated, [[hematuria]], [[hemoglobinuria]], [[myoglobinuria]], Ingestion of certain foods (colored candy, berries, or beets)
|-
| '''Yellowish-Brown'''
| [[Hyperbilirubinemia]]
|-
| '''Pale'''
| [[Polyuria]], [[chronic kidney disease]]
|-
| '''Foamy or Frothy'''
| [[Proteinuria]]
|-
| '''With sediment'''
| Precipitation of urate salts
|-
| '''Cloudy'''
| [[Pyuria]], tissue components
|-
| '''With intestinal contents'''
| Intestinal fistulas
|}


== Characteristics ==
To view a complete comprehensive list of causes that are are associated with urine discoloration, click [[Urine discoloration|here]]


The typical bright yellow colour of urine is caused by the pigment [[urochrome]], but also from the degradation products of [[bilirubin]] and [[urobilin]]. Clear colors are a sign of hydration and are the preferred colors of urine.
===Turbidity===
*Normal urine is usually clear
*Turbid urine may be a manifestation of urinary bacterial infection, hematuria, proteinuria, pyuria, or presence of crystals and casts.


===Unusual colouration===
==Urine Specific Gravity and Osmolality==
===Urine Specific Gravity===
*Normal urine [[specific gravity]] (density) ranges between 1.003 and 1.035 g.cm<sup>-3</sup>.
*Specific gravity outside the normal range may sometimes be associated with urinary disorders.
===Urine Osmolality===
*In healthy individuals with restricted fluid intake, urine osmolality should be > than 800mOsm/kg.
*24-hour urine osmolality normally ranges between 500 and 800 mOsm/kg.
*Random urine osmolality normally ranges between 50 and 1400 mOsm/kg.


*Yellowing/light Orange may be caused by removal of excess [[B vitamin]]s from the bloodstream.
====''Increased urine osmolality''====
*Certain medications such as [[rifampin]] and [[pyridium]] can cause orange urine.
*[[Acidosis]]
*Bloody urine is termed [[hematuria]], potentially a sign of a bladder infection.
*[[Addison's Disease]]
*Consumption of beets can cause urine to have a pinkish tint; the condition is harmless and temporary.
*[[Congestive Heart Failure]]
*Dark orange to brown urine can be a symptom of [[jaundice]] or [[Gilbert's syndrome]].
*[[Cirrhosis|Hepatic cirrhosis]]
*Black or dark-colored urine is referred to as [[melanuria]] and may be caused by a [[melanoma]].
*[[Hypernatremia]]
*Reddish or brown urine may be caused by [[porphyria]]. Again, the consumption of beets can cause the urine to have a harmless, temporary pink or reddish tint.
*[[Shock]]
*Fluorescent Yellow / Greenish urine may be caused by dietary supplemental vitamins, especially the B vitamins.
*[[SIADH|Syndrome of Inappropriate Anti Diuretic Hormone]] ([[SIADH]])
*Dark yellow urine is usually indicative of dehydration.


===Odor===
====''Decreased urine osmolality''====
Usually odorless, urine can produce pungent smells after the consumption of certain foods. Eating asparagus is known to produce a strong odor in human urine. This is due to the body's break down of [[asparagusic acid]]. Although odorous urine is a universal consequence of eating asparagus, the odour is not universally detectable.<ref>{{cite journal | journal=Br Med J | volume=281 | pages=1676 | year= 1980 | author=Lison M, Blondheim SH, Melmed RN. | title=A polymorphism of the ability to smell urinary metabolites of asparagus | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=7448566 | pmid=7448566 | doi =  }}</ref>
*[[Aldosteronism]]
*[[Amyloidosis]]
*Chronic [[Interstitial Nephritis]]
*[[Chronic pyelonephritis]]
*[[Diabetes Insipidus]]
*Primary [[polydypsia]]
*[[Glomerulonephritis]]
*[[Hypercalcemia]]
*[[Hypokalemia]]
*[[Lithium]] nephrotoxicity
*Nephrogenic diabetes insipidus
*[[Polycystic kidneys]]
*[[Renal Tubular Necrosis]]


===Turbidity===
==Urinary pH==
[[Turbidity|Turbid]] urine may be a symptom of a bacterial infection, but can also be due to crystallisation of salts such as [[calcium phosphate]].
*The [[pH]] of urine is normally close to neutral pH = 6 to 7 (Range: 4.5 to 8.2).
*Strongly acidic or alkaline urine may be manifestations of the following:


===pH===
===''Renal and urologic diseases''===
The [[pH]] of urine is close to neutral (7) but can normally vary between 4.5 and 8. Strongly acidic or alkaline urine may be symptomatic of disease.<ref>[http://www.rnceus.com/ua/uaph.html Urine pH<!-- Bot generated title -->]</ref>
*Urinary tract infection
*Acute kidney injury
*Chronic kindey disease
*Renal tubular acidosis


===Volume===
===''Systemic diseases''===
The amount of urine produced depends on numerous factors including state of hydration, activities, environmental factors, size, and health. In adult humans the average production is about 1 - 2 L per day. Producing too much or too little urine needs medical attention: [[Polyuria]] is a condition of excessive production of urine (> 2.5 L/day), in contrast to [[oliguria]] where < 400 mL are produced per day, or [[anuria]] with a production of < 100 mL per day.
*[[Diabetes Mellitus]]
*[[Diarrhea]]
*[[Vomiting]]
*[[Fanconi's Syndrome]]
*Increased [[protein catabolism]]
*[[Lupus erythematosus]]
*Metabolic/respiratory alkalosis or acidosis
*Protein rich diet


===Density or specific gravity===
===''Drug administration''===
Normal urine density or [[specific gravity]] values vary between 1.003-1.035 (g.cm<sup>-3</sup>) , and any deviations may or may not be associated with urinary disorders.
*[[Acetazolamide]]
*[[Aldosteronism]]
*[[Amyloidosis]]
*[[Antibiotic]]s
*[[Sodium acetate]]
*[[Sodium bicarbonate]]
*Sodium lactate


==Composition==
==Hematuria==
*Microscopic [[hematuria]]
*Gross [[hematuria]]


===Nitrogen===
==Pyuria==
Urine production and excretion is the body's primary method for removal of [[nitrogen]]. In human urine, this is mainly in the form of [[urea]], a protein metabolic byproduct. Aquatic organisms such as fish, alternatively excrete [[ammonia]]. Birds and reptiles excrete [[uric acid]], as a protein metabolic byproduct, instead of urea or ammonia. There are some exceptions to these excretion patterns.
Pyuria is defined as the presence of 10 or more white cells per cubic millimeter in a urine specimen, 3 or more white cells per high-power field of unspun urine, a positive result on Gram’s stain of an unspun urine specimen, or a urinary dipstick test that is positive for leukocyte esterase<ref>{{Cite journal| doi = 10.1016/j.ajic.2008.03.002| issn = 1527-3296| volume = 36| issue = 5| pages = 309–332| last1 = Horan| first1 = Teresa C.| last2 = Andrus| first2 = Mary| last3 = Dudeck| first3 = Margaret A.| title = CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting| journal = American Journal of Infection Control| date = 2008-06| pmid = 18538699}}</ref>


===pH===
Pyuria may first be classified based on gross/microscopic examination
When it leaves the body, urine is usually around [[pH]] 6, though it may be as low as 4.5 or as high as 8.2. As [[urea]]--the compound which accounts for 75-90% of the [[nitrogen]] in urine--begins to decay,  [[hydroxide]] ions form, raising the pH as high as 9-9.3.
*Microscopic [[pyuria]]
*Gross [[pyuria]]
Pyuria may also be classified based on the presence/absence of detectable infection
*[[Bacteriuria]] (detectable bacteria in urine)
*[[Pyuria#Sterile pyuria|Sterile pyuria]] (non-infectious cause or an infection that is undetected on regular gram-stain and urine culture)


The decay of urea into carbon dioxide is catalyzed by [[urease]]:
==Proteinuria==
*Albuminuria
**Microalbuminuria
**Macroalbuminuria
*Paraproteinuria


[[Urea|(NH<sub>2</sub>)<sub>2</sub>CO]] + H<sub>2</sub>O → [[carbon dioxide|CO<sub>2</sub>]] + 2[[ammonia|NH<sub>3</sub>]]
==Cells==
*Benign
*Malignant


===Dissolved heavy metals===
==Casts and Crystals==
Because urine is a liquid collection of metabolic byproducts (whereas [[feces]] contains both metabolized and unmetabolized compounds), and because the concentration of heavy metals is low in metabolized compounds, this translates into a low concentration in urine.<ref name=SLU>http://www.ecosanres.org/pdf_files/SEI_Publications_2004/ESR2web.pdf</ref>
===Casts===
Studies of urine in organic cattle farms in Sweden in 1999 and 2002 yielded the following concentrations of heavy metals (all in μg/kg wet weight):<ref name=SEI>http://www.ecosanres.org/pdf_files/ESR_Publications_2004/ESR2web.pdf</ref>
''To view a comprehensive list of urinary cast types and the characteristics of each cast type, click [[Urinary casts|here]]''
*[[Copper]]: 67
====''Acellular casts''====
*[[Zinc]]: 30
*Hyaline casts
*[[Chromium]]: 5
*Granular casts
*[[Lead]]: 1
*Waxy casts
*[[Cadmium]]: 0
*Fatty casts
*Pigment casts
*Crystal casts


===Bacteria===
====''Cellular casts''====
Urine is generally considered to be [[sterile]]. When it leaves the body, however, the urine can pick up bacteria from the surrounding skin, which would contaminate it. However, it is not generally advisable to use urine to clean open wounds
*RBC casts
for it may feed the infecting bacteria.
*WBC casts
*Bacterial casts
*Epithelial cell casts


===Demographics of composition===
===Crystals===
The presence of macronutrients in urine varies significantly from one region of the world to another. However, the amount of nutrients which is lost in the urine, in proportion to the amount of nutrients one consumes, remains relatively constant.
*Struvite crystals (magnesium-ammonium-phosphate)
*Bilirubin crystals
*Calcium carbonate crystals
*Amorphous crystals
*Calcium oxalate dihydrate crystals
*Cystine crystals


==Urinalysis==
==Other==
{{main|Urinalysis}}
===Urinary beta-HCG (urinary pregnancy test)===
Many [[drug test]]s and other clinical chemical analyses are done on urine. These tests are used to find whether individuals are pregnant, drug users, or other hormone and substance usage questions. There are normal levels for things in urine as well.
===Myoglobinuria===
===Glucosuria===
===Ketonuria===
===Bilirubinuria===
===Eosinophiluria===
*[[Acute interstitial nephritis]]
*[[Cholesterol embolism | Atheroembolic renal disease]]
*[[Rapidly progressive glomerulonephritis]]
*[[Urinary tract infection]]


==Uses==
''To view a comprehensive list of causes of eosinophiluria, click [[eosinophiluria|here]]''
===Animal repellent===
Taking advantage of the scents of male animals' urine, some companies sell animal urine, usually coyote or fox, to cities and other organizations to prevent their trees from being stolen for use as Christmas trees. The scents of carnivore urine (bobcat, mountain lion, and wolf, in addition to coyote and fox) are also sold to the public in pelletized form to repel garden browsing by herbivores such as squirrels and rabbits, as well as deterring domestic or feral cats from marking territory, or catching birds, in gardens. When the pellets are sprinkled on a target area, the intruding animal will instinctively recognize the territorial urinary scent of its predators and avoid the area.


===Munitions===
===Bacterial antigens===
In historical times, urine was collected and used in the manufacture of gunpowder.  Stale urine was filtered through a barrel full of straw and allowed to continue to sour for a year or more.  After this period of time, water was used to wash the resulting chemical salts from the straw.  This slurry was filtered through wood ashes and allowed to dry in the sun.  [[Potassium nitrate|Saltpeter]] crystals were then collected and added to brimstone and charcoal to create black powder.
===Sperm===
===Urinary drug concentration===
*Drug testing uses urinalysis to test for certain chemicals which are typically present in the urine only after recreational drug use.
* These tests must be requested specifically or as part of a toxicology screen, and are not part of a routine urinalysis.
===Dissolved electrolytes or heavy metals===
Calciuria (urinary calcium) differential diagnosis:
*[[Bone]] [[metastases]]
*Diets low in [[calcium]]
*[[Hypervitaminosis]]
*Idiopathic [[hypercalciuria]]
*Increased [[calcium]] intake
*[[Multiple Myeloma]]
*[[Paget's Disease]]
*[[Primary hyperparathyroidism]]
*Prolonged immobilization
*[[Pseudoparahypothyroidism]]
*[[Renal Tubular Acidosis]]
*[[Renal osteodystrophy]]
*[[Sarcoidosis]]
*[[Steroids]]
*[[Vitamin D deficiency]]
*[[Vitamin D]] resistant [[ricketts]]


===Textiles===
===Catecholamines===
Urine has often been used as a [[mordant]] to help prepare textiles, especially wool, for dyeing. Urine was used for dyes such as indigo where the urea in the urine reacted with the insoluble dye to form a soluble solution.
{|class="wikitable"
| '''Parameter'''|| '''Upper reference range in the urine per 24 hours'''
|-


===Hormone Replacement Therapy===
| '''[[Norepinephrine]]'''
Steroid hormones extracted from the urine of pregnant mares are used in a drug sold under the trade name [[Premarin]]. The drug, manufactured and sold by [[Wyeth]] Pharmaceuticals, is an estrogen replacement therapy used in the treatment of [[menopause]] symptoms.
| 23-105 micrograms/24 hours
|-
| '''[[Dopamine]]'''
| 190-450 micrograms/24 hours
|-
| '''[[Metanephrine]]'''
| 74-297 micrograms/24 hours
|-
| '''[[Normetanephrine]]'''
| 105-354 micrograms/24 hours
|-
| '''[[Vanillic acid]]'''
| 3.3-6.5 mg/24 hours
|-
| '''[[Vanillyl mandelic acid]]'''
| 17-33 micromol/liter (3.3-6.5 mg/24 hour)
|}


===Jelly Fish Stings===
====''Differential Diagnosis of urinary catecholamines''====  
Contrary to popular belief, urine should not be applied to Jellyfish stings.  The urine could actually cause the release of more of the poisonous [[venom]] from the sting.
*[[Medication-induced]]
*[[Ganglioma]]
*[[Multiple endocrine neoplasia]] type 2
*[[Neuroblastoma]]
*[[Pheochromocytoma]]
*[[Stress]]


== References ==
==Urine Culture==
<references/>
Normal urine is sterile. Presence of microorganisms in [[urine culture]] may be associated with urinary infections or colonization.
*Bacteria: [[Bacteriuria]]
*Fungi: [[Funguria]]


==See also==
==Urine Quantity (Volume)==
* [[Human urine]]
*The amount of urine produced depends on hydration (volume of fluid intake), physical activity, environmental factors, body surface area, and general health condition.
*In adult humans, the average urine production is approximately 1 L to  2 L per 24 hours.


<br>
===High Urine Output===
*Polyuria: Excessive urinary production > 2.5 L per 24 hours


===Low Urine Output===
[[Low urine output]] may be either [[oliguria]] or [[anuria]]:
*[[Oliguria]]: Urine production < 400 mL / 24 hours in adults. A more specific definition includes the following:
**Infants: oliguria is defined as urine output < 1 mL/kg/hr<ref name=klahr>{{cite journal | author = Klahr S, Miller S | title = Acute oliguria | journal = N Engl J Med | volume = 338 | issue = 10 | pages = 671–5 | year = 1998 | pmid = 9486997 | doi = 10.1056/NEJM199803053381007}} [http://content.nejm.org/cgi/content/full/338/10/671 Free Full Text].</ref>
**Children: Oliguria is defined as urine output < 0.5 mL/kg/hr.
**Aduults: Oliguria is defined as urine output < 17 to 21 ml/hr.
'''''For a detailed explanation of oliguria, click [[Oliguria|here]].'''''
<br><br>
*[[Anuria]]: Urine production < 100 mL / 24 hr in adults.
'''''For a detailed explanation of anuria, click [[Anuria|here]].'''''


== References ==
{{Reflist|2}}


[[Category:Physiology]]
[[Category:Nephrology]]
[[Category:Urology]]
[[Category:Body fluids]]
[[Category:Body fluids]]
[[Category:Urine| ]]
[[Category:Urine]]
 
[[ar:بول]]
[[cs:Moč]]
[[da:Urin]]
[[de:Urin]]
[[es:Orina]]
[[eo:Urino]]
[[fa:ادرار]]
[[fr:Urine]]
[[gd:Mùn]]
[[id:Urin]]
[[it:Urina]]
[[he:שתן]]
[[lt:Šlapimas]]
[[ml:മൂത്രം]]
[[nl:Urine]]
[[ja:尿]]
[[pl:Mocz]]
[[pt:Urina]]
[[ru:Моча]]
[[sk:Moč]]
[[fi:Virtsa]]
[[sv:Urin]]
[[ta:சிறுநீர்]]
[[tr:İdrar]]
[[yi:יורינע]]
[[zh:尿]]


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Latest revision as of 14:58, 6 October 2015

Human Urine Sample

Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.
Synonyms and keywords: Urinary findings; Urinary abnormalities; Findings on urine exam; Urine; Urine composition; Urine output

Overview

Urine is a fluid produced by humans through the kidney, collected in the bladder, and excreted through the genital urethra. Urine formation helps to maintain the balance of minerals and other substances in the body. Urinary findings may be qualitative or quantitative. Qualitative urinary findings are often analyzed on urinalysis and urine culture. Quantitative urinary findings depends on urine output. A urinalysis (U) is an array of tests performed on urine and is one of the most common methods of medical diagnosis. A part of a urinalysis can be performed by using urine dipsticks, in which the test results can be read as color changes.

Composition of Urine

Urea structure









The following is a list of normal urine constituents:

Algorithm of Common Urinary Findings

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urinary Findings
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Quality (Composition)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Quantity (Volume)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urinalysis
 
 
 
Urine culture
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine output
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
High urine output
 
 
 
 
Low urine output
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine odor
 
Color and Turbidity
 
Specific gravity or osmolality
 
Urinary pH
 
Hematuria
 
Pyuria
 
Proteinuria
 
Cells
 
Casts and Crystals
 
Other
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Polyuria
 
 
Oliguria
 
Anuria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Urine Odor

Urine is usually odorless but can produce pungent smells following the consumption of certain foods (e.g. asparagus)

Urine Color and Turbidity

Color

Below is a table that lists common urine discolorations and their associated conditions.

Urine Color Associated Conditions
Clear or Light Yellow Normal urine color
Dark Yellow Dehydration, vitamin B12 administration
Greenish/Yellow Vitamin B administration
Yellow-Red Laxatives
Orange Rifampicin, nitrofurantoin, pyridium
Dark / Black Alkaptonuria, porphyria, sarcoma
Milky Lymphatic fistulas
Opaque Bacteria, Cells
Dark Red/Pink Concentrated, hematuria, hemoglobinuria, myoglobinuria, Ingestion of certain foods (colored candy, berries, or beets)
Yellowish-Brown Hyperbilirubinemia
Pale Polyuria, chronic kidney disease
Foamy or Frothy Proteinuria
With sediment Precipitation of urate salts
Cloudy Pyuria, tissue components
With intestinal contents Intestinal fistulas

To view a complete comprehensive list of causes that are are associated with urine discoloration, click here

Turbidity

  • Normal urine is usually clear
  • Turbid urine may be a manifestation of urinary bacterial infection, hematuria, proteinuria, pyuria, or presence of crystals and casts.

Urine Specific Gravity and Osmolality

Urine Specific Gravity

  • Normal urine specific gravity (density) ranges between 1.003 and 1.035 g.cm-3.
  • Specific gravity outside the normal range may sometimes be associated with urinary disorders.

Urine Osmolality

  • In healthy individuals with restricted fluid intake, urine osmolality should be > than 800mOsm/kg.
  • 24-hour urine osmolality normally ranges between 500 and 800 mOsm/kg.
  • Random urine osmolality normally ranges between 50 and 1400 mOsm/kg.

Increased urine osmolality

Decreased urine osmolality

Urinary pH

  • The pH of urine is normally close to neutral pH = 6 to 7 (Range: 4.5 to 8.2).
  • Strongly acidic or alkaline urine may be manifestations of the following:

Renal and urologic diseases

  • Urinary tract infection
  • Acute kidney injury
  • Chronic kindey disease
  • Renal tubular acidosis

Systemic diseases

Drug administration

Hematuria

Pyuria

Pyuria is defined as the presence of 10 or more white cells per cubic millimeter in a urine specimen, 3 or more white cells per high-power field of unspun urine, a positive result on Gram’s stain of an unspun urine specimen, or a urinary dipstick test that is positive for leukocyte esterase[1]

Pyuria may first be classified based on gross/microscopic examination

Pyuria may also be classified based on the presence/absence of detectable infection

  • Bacteriuria (detectable bacteria in urine)
  • Sterile pyuria (non-infectious cause or an infection that is undetected on regular gram-stain and urine culture)

Proteinuria

  • Albuminuria
    • Microalbuminuria
    • Macroalbuminuria
  • Paraproteinuria

Cells

  • Benign
  • Malignant

Casts and Crystals

Casts

To view a comprehensive list of urinary cast types and the characteristics of each cast type, click here

Acellular casts

  • Hyaline casts
  • Granular casts
  • Waxy casts
  • Fatty casts
  • Pigment casts
  • Crystal casts

Cellular casts

  • RBC casts
  • WBC casts
  • Bacterial casts
  • Epithelial cell casts

Crystals

  • Struvite crystals (magnesium-ammonium-phosphate)
  • Bilirubin crystals
  • Calcium carbonate crystals
  • Amorphous crystals
  • Calcium oxalate dihydrate crystals
  • Cystine crystals

Other

Urinary beta-HCG (urinary pregnancy test)

Myoglobinuria

Glucosuria

Ketonuria

Bilirubinuria

Eosinophiluria

To view a comprehensive list of causes of eosinophiluria, click here

Bacterial antigens

Sperm

Urinary drug concentration

  • Drug testing uses urinalysis to test for certain chemicals which are typically present in the urine only after recreational drug use.
  • These tests must be requested specifically or as part of a toxicology screen, and are not part of a routine urinalysis.

Dissolved electrolytes or heavy metals

Calciuria (urinary calcium) differential diagnosis:

Catecholamines

Parameter Upper reference range in the urine per 24 hours
Norepinephrine 23-105 micrograms/24 hours
Dopamine 190-450 micrograms/24 hours
Metanephrine 74-297 micrograms/24 hours
Normetanephrine 105-354 micrograms/24 hours
Vanillic acid 3.3-6.5 mg/24 hours
Vanillyl mandelic acid 17-33 micromol/liter (3.3-6.5 mg/24 hour)

Differential Diagnosis of urinary catecholamines

Urine Culture

Normal urine is sterile. Presence of microorganisms in urine culture may be associated with urinary infections or colonization.

Urine Quantity (Volume)

  • The amount of urine produced depends on hydration (volume of fluid intake), physical activity, environmental factors, body surface area, and general health condition.
  • In adult humans, the average urine production is approximately 1 L to 2 L per 24 hours.

High Urine Output

  • Polyuria: Excessive urinary production > 2.5 L per 24 hours

Low Urine Output

Low urine output may be either oliguria or anuria:

  • Oliguria: Urine production < 400 mL / 24 hours in adults. A more specific definition includes the following:
    • Infants: oliguria is defined as urine output < 1 mL/kg/hr[2]
    • Children: Oliguria is defined as urine output < 0.5 mL/kg/hr.
    • Aduults: Oliguria is defined as urine output < 17 to 21 ml/hr.

For a detailed explanation of oliguria, click here.

  • Anuria: Urine production < 100 mL / 24 hr in adults.

For a detailed explanation of anuria, click here.

References

  1. ↑ Horan, Teresa C.; Andrus, Mary; Dudeck, Margaret A. (2008-06). "CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting". American Journal of Infection Control. 36 (5): 309–332. doi:10.1016/j.ajic.2008.03.002. ISSN 1527-3296. PMID 18538699. Check date values in: |date= (help)
  2. ↑ Klahr S, Miller S (1998). "Acute oliguria". N Engl J Med. 338 (10): 671–5. doi:10.1056/NEJM199803053381007. PMID 9486997. Free Full Text.


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