|
|
Urine discoloration /
Urinalysis
|
 |
|
Urine discoloration |
|
Dark / Brown |
| Cascara | Chloroquine |
| ferrous salts/ iron dextran | Levodopa |
| methocarbamol | methyldopa |
| metronidazole | nitrates |
| nitrofurantoin | quinine |
| Senna | sulfonamides |
| Yellow-brown |
| Bismuth | Chloroquine |
| Cascara | Metronidazole |
| Nitrofurantoin | Primaquine |
| Senna | Sulfonamides |
| Blue or blue
green |
| amitriptyline | methylene blue |
| triamterene | Methocarbamol |
| Orange/yellow |
| Chlorzoxazone | Dihydroergotamine |
| heparin | phenazopyridine |
| rifampin | sulfasalazine |
| warfarin | |
| Red / Pink |
| daunorubicin or doxorubicin | heparin |
| ibuprofen | methyldopa |
| phenothiazines | phenytoin |
| phenylbutazone | rifampin |
| Salicylates | senna |
|
Urinalysis |
Normal urine output (minimum): 0.5 to
1 ml/kg/hr daily
Oliguria: < 500 ml urine/ 24 hours
Anuria: < 100 ml urine/ 24 hours.
|
Low urine output: potential
causes |
| Prerenal: |
heart
failure, shock, volume depletion, third spacing fluids, renal
artery compromise |
| Renal: |
acute
tubular necrosis, end-stage renal disease, interstitial disease,
glomerular disease, drug induced: (Aminoglycosides, amphotericin B, cisplatin, colistin, cyclosporin, dextran, gallium, hydroxyurea, lithium,
methicillin, methotrexate, methoxyflurane, nitrofurantoin,
pentamidime, plicamycin, streptozocin, and vancomycin.), bilateral cortical necrosis |
| Post-renal: |
neurogenic
bladder, obstruction of ureter, bladder neck, or urethra. |
|
Differential
diagnosis |
| Lab |
pre-renal |
renal |
| Urine/serum creatinine |
>40 |
<20 |
fractional excreted
sodium:
[UNa/serum Na] / [Ucr/ serum creatinine] x 100 |
<1 |
>1 |
| Urine osmolality |
>500 |
<350 |
| Urinary sodium |
<20 |
>40 |
|
Normal values:
|
| Appearance |
straw or yellow colored
/ clear |
| Specific gravity: |
infant: 1.002 - 1.006
child and adult: 1.001 - 1.035 |
| pH |
Child and adult: 4.6 - 8 |
| Following substances
should be negative: |
acetone, bilirubin,
blood, glucose, nitrite, protein, leukocyte esterase. |
| WBC |
0 - 4/HPF |
| RBC |
Male: 0 - 3/HPF
female: 0 - 5/HPF |
| Epithelial |
Occasional |
| Hyaline casts |
Occasional |
| Bacteria |
None |
| Differential
diagnosis: |
|
Bilirubin |
| Positive |
hepatitis, obstructive
jaundice |
|
Blood |
| Positive |
tumors, infection,
trauma, hemolytic anemia, coagulopathy, interstitial nephritis,
polycystic kidneys, kidney stones, burns, cystitis, prostatitis,
pyelonephritis |
| Epithelial
cells |
| Positive |
acute tubular necrosis,
necrotizing papillitis |
|
Glucose |
| Positive |
diabetes, cushing's
disease, burns, steroids, hyperthyroidism, pancreatitis,
pancreatic carcinoma, shock |
|
Ketones |
| Positive |
diarrhea, vomiting, DKA,
starvation, high fat diet, hyperthyroidism, pregnancy, febrile
states. |
|
Leukocyte esterase
(detects 5 or > WBC).
Used along with test for nitrites to detect UTI (predictive
capacity: approximately 74 %). If both nitrites and
leukocyte esterase are negative, there is a 97% chance that a UTI
is not present. |
| Positive |
Infection |
| Nitrite |
| Positive |
Infection present.
Nitrates are converted to nitrites by many strains of bacteria. |
|
Protein |
| Positive |
glomerulonephritis,
pyelonephritis, nephrotic syndrome, pre-eclampsia, malignancies,
heavy exercise, stress, CHF, malignant hypertension |
|
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