MLSC 3054 Clinical Fluid Analysis
Charity Accurso, PhD
MLS Program
University of Cincinnati
Color
Clarity
Odor
Taste
Specific gravity
Normal = yellow (light, dark, amber)
Due to presence of urochrome
Other pigments: uroerthyrin and urobilin
Table 6.1
Charity Accurso, PhD, MT(ASCP) 1
MLSC 3054 Clinical Fluid Analysis
• Remember: colors may or may not change in the
presence of a pathologic conditions.
• RBCs and red color
• Brown color
• Bilirubin
• Highly pigmented foods: beets, breath fresheners
• Medications: Table 6.2
• Normal: white foam the rapidly dissipates
• Albumin/Protein: white, thick foam that persists
• Bilirubin: yellow foam
• Foam is not usually reported out, but may be noted.
• Not diagnostic, but could be supportive
• Transparency/turbidity of urine
• Terms:
▫ Clear – no visible particulates, transparent
▫ Hazy – few particulates, print easily seen through
urine
▫ Cloudy – many particulates, print blurred through
urine
▫ Turbid – print cannot be seen through urine
▫ Milky – may precipitate or be clotted
Charity Accurso, PhD, MT(ASCP) 2
MLSC 3054 Clinical Fluid Analysis
• Normal urine – aromatic odor
• Urinary tract infections –
• strong ammonia odor
• Increase ketone output
• Aminoacidopathies
• Food – asparagus, garlic,
onions
• Medications
• Density of a solution compared with density of a
similar volume of distilled water at a similar temp
• Clinical Utility
▫ Measures kidney’s ability to reabsorb chemicals
and water
▫ Detect possible dehydration
▫ Abnormalities in ADH hormone
▫ Determine if conc is adequate for chemical test
accuracy
▫ Urine is usually 94% water and 6% solutes
▫ Changes in the solute concentration may be
pathologic
Direct vs. Indirect methods
Indirect methods - molecular size of solutes does
not affect measurement
Refractometry
Reagent strip method
Direct methods – true density of urine, regardless
of solutes present
Charity Accurso, PhD, MT(ASCP) 3
MLSC 3054 Clinical Fluid Analysis
Indirect method
Three factors affect refractive
Based on refractive index of light index
When light enters a solution, it Wavelength of light used
refracts and slows the beam
Temperature of the solution
Increase in solutes causes a
Concentration of the solution
decrease in light velocity
Refractive index ratio of light All solutes present are
refraction in two differing media measured, including protein
and glucose
Figure 4.3
Calibrate using:
Distilled water – 1.000
5% NaCl – 1.022 ± 0.001
9% Sucrose – 1.034 ± 0.001
Controls – Low, Medium and High
Charity Accurso, PhD, MT(ASCP) 4
MLSC 3054 Clinical Fluid Analysis
Indirect colorimetric estimation of concentration
Based on the quantity of ionic and charged solutes
Na+, Cl-, K+, NH4+
Non-ionic solutes are not measured
Glucose, urea, protein or radiographic dye
Not a true assessment of urine specific gravity, but
does reflect renal concentrating ability
Pad impregnated with a polyelectrolyte and a pH
indicator at an alkaline pH
After exposure to urine, the protons from the
polyelectrolyte will be released in proportion to the
ionic concentration.
End result – change in pH causing color change
Clinical utility Urine range: 275-900 mOsm/kg
Evaluate renal concentrating Serum range: 275-300
ability mOsm/kg
Monitor renal disease
Monitor fluid and electrolyte
balance Serum levels constant
Differentially diagnose cause of Urine changes due to diet, fluid
polyuria intake, activity
Concentration of a solution
expressed in terms of Osm/kg Measured as a colligative
property
Freezing point osmometry or
vapor pressure depression
Charity Accurso, PhD, MT(ASCP) 5
MLSC 3054 Clinical Fluid Analysis
Useful for specimens that may
include volatile solutes or are
lipemic
Specimen is supercooled
Heat released as crystals form
is measured
Pure water freezes at 0°C
1 Osm of solute particles
decreases freezing point by
1.86°C
Reported as mOsm
Not as common
Cannot measure volatile
substances
Increase in solutes causes a
decrease in vapor pressure
and decrease in dew point
temperature
Rarely assess just volume alone
Normal volume: 600-1800 ml/day
Less than 400 ml at night
More than >500 ml at night = nocturia
Polyuria = >2.5-3 L/day
Diuresis = any increase in urine excretion
Medications, caffeine, hormone imbalance, increased in intake
Oligura = <400 ml per day
Water deprivation, sweating, decreased blood supply to kidneys,
other conditions
Anuria = lack of urine
Charity Accurso, PhD, MT(ASCP) 6
