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{{SK}} Urinary findings; Urinary abnormalities; Findings on urine exam; Urine; Urine composition; Urine output




==Overview==
==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.  
'''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.  
 
== Characteristics ==
 
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.


===Unusual colouration===
==Urinary Findings Algorithm==
{{familytree/start |summary=Urinary Findings}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |A01=Urinary Findings}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | B02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |B01=Quality (Composition) |B02=Quantity}}
{{familytree | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | C01 | | | | C02 | | | | | | | | | | | | | | C03 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |C01=[[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 | D11=Urine color and turbidity |D01=[[Specific gravity]]/[[osmolality]] |D02=[[Urinary pH]]| D03=[[Hematuria]] |D04=[[Pyuria]] |D05=[[Proteinuria]] |D06=[[Cells]] |D07=[[Casts]] and [[Crystals]] |D08=Other}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | F01 | | | F02 | | F03 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |F01=[[Polyuria]] |F02=[[Oliguria]] |F03=[[Anuria]]}}
{{familytree/end}}


*Yellowing/light Orange may be caused by removal of excess [[B vitamin]]s from the bloodstream.
==Urine Composition (Quality)==
*Certain medications such as [[rifampin]] and [[pyridium]] can cause orange urine.
===Urine Odor===
*Bloody urine is termed [[hematuria]], potentially a sign of a bladder infection.
Urine is usually odorless but can produce pungent smells following the consumption of certain foods (e.g. asparagus)
*Consumption of beets can cause urine to have a pinkish tint; the condition is harmless and temporary.
*Dark orange to brown urine can be a symptom of [[jaundice]] or [[Gilbert's syndrome]].
*Black or dark-colored urine is referred to as [[melanuria]] and may be caused by a [[melanoma]].
*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.
*Fluorescent Yellow / Greenish urine may be caused by dietary supplemental vitamins, especially the B vitamins.
*Dark yellow urine is usually indicative of dehydration.


===Odor===
===Urine Color and Turbidity===
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>
====Color====
Below is a list of common urine discolorations and their associated diseases.
*Clear or light yellow
**Normal urine color (caused by the pigment [[urochrome]] and degradation of [[bilirubin]] and [[urobilin]] products)
*Dark yellow
**Dehydration
*Greenish yellow color
**Vitamin B ingestion
*Orange color
**Excess urinary losses of vitamin B
**Medication-induced: [[rifampin]] and [[pyridium]]
*Dark red color
**Hematuria
**Myoglobinuria
**Ingestion of certain foods: berries, colored candy, and beets
*Brown color
**Hematuria
**Myoglobinuria
**Porphyria
**Hyperbilirubinemia
*Black (melanuria)
**Sarcoma
**Alkaptonuria
====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.


===Turbidity===
===Urine Specific Gravity and Osmolality===
[[Turbidity|Turbid]] urine may be a symptom of a bacterial infection, but can also be due to crystallisation of salts such as [[calcium phosphate]].
====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.


===pH===
===Urinary pH===
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>
*The [[pH]] of urine is normally close to neutral pH=6-7 (Range: 4.5 to 8.2).
*Strongly acidic or alkaline urine may be manifestations of diseases.


===Volume===
===Hematuria===
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.
*Microscopic hematuria
*Gross hematuria


===Density or specific gravity===
===Pyuria===
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.
*Microscopic pyuria
*Gross pyuria


==Composition==
===Proteinuria===
*Albuminuria
**Microalbuminuria
**Macroalbuminuria
*Paraproteinuria


===Nitrogen===
===Cells===
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.
*Benign
*Malignant


===pH===
===Casts and Crystals===
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.
''Acellular casts''
*Hyaline casts
*Granular casts
*Waxy casts
*Fatty casts
*Pigment casts
*Crystal casts


The decay of urea into carbon dioxide is catalyzed by [[urease]]:
''Cellular casts''
*RBC casts
*WBC casts
*Bacterial casts
*Epithelial cell casts


[[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>]]
''Crystals''
*Struvite crystals (magnesium-ammonium-phosphate)
*Bilirubin crystals
*Calcium carbonate crystals
*Amorphous crystals
*Calcium oxalate dihydrate crystals
*Cystine crystals


===Dissolved heavy metals===
===Other===*Urinary beta-HCG (urinary pregnancy test)
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>
*Myoglobinuria
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>
*Glucosuria
*[[Copper]]: 67
*Ketonuria
*[[Zinc]]: 30
*Catecholamines
*[[Chromium]]: 5
*Bacterial antigens
*[[Lead]]: 1
*Sperm
*[[Cadmium]]: 0
*Urinary drug concentration
*Dissolved heavy metals (e.g. copper, zinc, chromium, lead, cadmium)


===Bacteria===
===Urine Culture===
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
Normal urine is sterile. Presence of microorganisms in urine may be associated with urinary infections.
for it may feed the infecting bacteria.
*Fungi
*Bacteria


===Demographics of composition===
==Urine Quantity (Volume)==
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.  
*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.


==Urinalysis==
===High Output===
{{main|Urinalysis}}
*Polyuria: Excessive urinary production > 2.5 L per 24 hours
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.
 
==Uses==
===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===
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.
 
===Textiles===
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.
 
===Hormone Replacement Therapy===
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.
 
===Jelly Fish Stings===
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.


===Low Output===
*Oliguria: Urine production < 400 mL / 24 hours
*Anuria: Urine production < 100 mL / 24 hours
== References ==
== References ==
<references/>
==See also==
* [[Human urine]]
<br>


[[Category:Physiology]]
[[Category:Neprhology]]
[[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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Revision as of 18:46, 6 April 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] 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.

Urinary Findings Algorithm

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

Urine Composition (Quality)

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 list of common urine discolorations and their associated diseases.

  • Clear or light yellow
  • Dark yellow
    • Dehydration
  • Greenish yellow color
    • Vitamin B ingestion
  • Orange color
  • Dark red color
    • Hematuria
    • Myoglobinuria
    • Ingestion of certain foods: berries, colored candy, and beets
  • Brown color
    • Hematuria
    • Myoglobinuria
    • Porphyria
    • Hyperbilirubinemia
  • Black (melanuria)
    • Sarcoma
    • Alkaptonuria

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.

Urinary pH

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

Hematuria

  • Microscopic hematuria
  • Gross hematuria

Pyuria

  • Microscopic pyuria
  • Gross pyuria

Proteinuria

  • Albuminuria
    • Microalbuminuria
    • Macroalbuminuria
  • Paraproteinuria

Cells

  • Benign
  • Malignant

Casts and Crystals

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
  • Catecholamines
  • Bacterial antigens
  • Sperm
  • Urinary drug concentration
  • Dissolved heavy metals (e.g. copper, zinc, chromium, lead, cadmium)

Urine Culture

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

  • Fungi
  • Bacteria

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 Output

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

Low Output

  • Oliguria: Urine production < 400 mL / 24 hours
  • Anuria: Urine production < 100 mL / 24 hours

References


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