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Urinalysis Continued

The Macroscopic Exam

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Introduction

The macroscopic exam determines the physical properties of urine, such as volume, color, clarity, and odor. The process is performed without instruments, using only the unaided eyes and nose.

Urine volume

Urine volume is the urine produced over 24 hours, which usually ranges from 0.8 Liters (800 ml) to 2 Liters (2000 ml). Low urine volume or oliguria (less than 400ml) can indicate possible chronic kidney disease. High urine volume or polyuria (more than 3000 ml) can indicate diabetes, increased fluid intake, or possible kidney disease.

24-Hour Urine Volume Chart

24 hour urine volume chart

Urine color

Usually, the color of urine is pale yellow. However, color changes can result from particular foods, dehydration, infections, organ dysfunction, and medications.

Pale Yellow

Urine color: pale yellow (normal)

Normal Color

Amber

Urine color: amber

Due to concentrated urine resulting from dehydration.

Pink

Urine color: pink

Due to blood in the urine (hematuria) resulting from urinary tract infection (UTI), kidney stones, or certain foods.

Orange

Urine color: orange

Due to medications, carotene (carrots), B vitamins, or bilirubin (resulting from liver or bile duct disease).

Blue

Urine color: blue

Due to food coloring, medications, or urinary tract infections.

Brown

Urine color: brown

Due to fava beans, medications, kidney disease, or muscle breakdown.

Urine clarity

Urine clarity refers to its turbidity or transparency. Urine is usually translucent (clear) but can become increasingly opaque or cloudy as the number of solid particles in the urine increases. A high concentration of crystals (related to dehydration, certain foods, or urine pH), white blood cells (related to urinary tract infections), or elevated glucose (related to diabetes) can cause the urine to become cloudy.

Clear

Urine clarity: clear

Cloudy

Urine clarity: cloudy

Urine odor

Normal urine has a slight odor produced by the chemical compounds usually released. Urine odor, however, can vary significantly with dehydration, diabetes, medications, infections, and particular foods. A sweet or fruity aroma can result from elevated glucose or ketones in the urine due to diabetes. An ammonia (NH₃) smell can result from dehydration, which increases urine concentration. A pungent or foul odor can result from urinary tract infections, medications, or certain foods.

Normal (Slight)

Urine odor: normal (slight)

Sweet or Fruity

Urine odor: sweet or fruity

Ammonia

Urine odor: ammonia

Pungent or Foul

Urine odor: pungent or foul

Macroscopic Exam Procedures

Collect the Subject’s Urine
for 24 Hours

Before visiting your clinic, have the subject collect her urine for 24 hours.

To hold the urine, provide a 3-liter plastic container labeled on the outer surface with volume increments. Instruct the subject to urinate in an ordinary glass jar and transfer the contents to the plastic container.

On her arrival at the clinic, have the plastic container delivered to your team for evaluation.


Prepare a Fresh Urine Sample for Examination

Have the subject submit a fresh urine sample upon her arrival at the clinic and examine it for clarity, color, and odor.


Macroscopic Exam Results

Determine 24-Hour Urine Volume

Move the slider bar to increase the transparency of the container and view the urine volume.


Determine Urine Color

Move the slider bar to determine the color of the urine sample.


Determine Urine Clarity

Move the slider bar to determine the clarity of the urine sample.


Determine Urine Odor

Move the slider bar to determine the odor of the urine sample.

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References and Attributions

Clevland Clinic – Crystals in Urine

Kidney Support and Protection – Can You Prevent Kidney Stones

Labpedia – Urine Analysis: Physical Examination, and Interpretation

NIH National Library of Medicine – Urinary pH and Stone Formation

University of California at San Diego Health – 10 Colors that Suggest Urine Troubles

University of Utah – Urinalysis

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