Urinalysis Continued
The Macroscopic Exam
Macroscopic Exam Background
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
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
Normal Color
Amber
Due to concentrated urine resulting from dehydration.
Pink
Due to blood in the urine (hematuria) resulting from urinary tract infection (UTI), kidney stones, or certain foods.
Orange
Due to medications, carotene (carrots), B vitamins, or bilirubin (resulting from liver or bile duct disease).
Blue
Due to food coloring, medications, or urinary tract infections.
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
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)
Sweet or Fruity
Ammonia
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 when she arrives at the clinic.
Prepare the sample to be examined 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