URINALYSIS – A SIMPLE WAY TO ASSESS PATIENTS

URINALYSIS – A SIMPLE WAY TO ASSESS PATIENTS
Every person that takes care of the sick should use urinalysis – a simple test to check his patients. Combi 9 Dip Stixs that can check various parameters in the urine are available and should be used by all health care providers.
Urinalysis is a very important investigation used to depict the state of health of a pregnant mother or any other sick person. It can draw attention of a health worker to the possibility of the following health concerns
 Diabetes
 Pregnancy - induced hypertension
 Urinary treat infection
 Hepatitis (inflammation of the liver)
 Chronic Renal (Kidney) disease
 Malaria.
DIABETES MELLITUS
When there is glucose in the urine further tests can now be performed to establish the diagnosis of diabetes in pregnancy. Such tests include fasting blood sugar and oral glucose tolerance test (OGTT).
PREGNANCY INDUCED HYPERTENSION
Protein in urine may mean pregnancy – induced hypertension in a pregnant woman if her blood pressure is also high. It protein in urine is up to three to four pluses (+++ or ++++) and the woman’s blood pressure is high coupled with swelling of the hands and legs the woman has severe pregnancy – induced hypertension. Such women need immediate specialist care. If the woman’s blood pressure is normal, urine – microscopy, culture and sensitivity should be done to rule out urinary tract infection which is another reason for protein in urine.
URINARY TRACT INFECTION
This disease can show in urine as:
 Protein in urine
 Presence of pus cells or white blood cells
 Presence of bacteria
 Nitrites positive in urinalysis.
When there indices are seen in urine, a microscopy, culture and sensitivity should be done to discover the organism responsible for the infection and the drugs that can kill such organisms. This helps the health care provider give the appropriate medications that can lead to a cure.
KIDNEY DISEASES
Excessive protein in the urine like three or four pluses, (+++ or ++++) can be a signal of a serious kidney disease like renal failure or Nephrotic syndrome. In nephrotic syndrome the patient is swollen all over.
Red blood cell casts seen on urine microscopy, is a signal of intrinsic kidney disease.
Red Cell Casts, leucocytes (white blood cells) and epithelial casts are found in acute glomerolonephritis (inflammation of the glomeruli (filtering apparatus) of the kidneys).
Hyaline Casts consist of coagulated (congelled) protein without cellular elements. They are found in glomerolonephritis and occasionally in small numbers in normal urine especially after vigorous exercise.
Epithelial and Granular Casts are indicative of inflammation and degeneration of renal (Kidney) tubules. Granular Casts are formed by degeneration of the impressed cells.
In such cases in order to assess the kidney function further tests are required like kidney scan and serum urea and creatinine estimation.
HEPATITIS
Inflammation of the liver known as hepatitis can cause the following symptoms:
 Severe fatigue or weakness
 Loss of appetite
 Headaches
 Jaundice [Yellowness of the skin and conjunctiva (white of the eyes)]
 Dark urine
 Muscle or general body aches
 Joint pains
It can be caused by hepatitis viruses A,B,C,D, or E. Some poisons or toxins can also damage the liver and cause hepatitis.
Hepatitis can cheaply be detected in the urine. Bilirubin seen in the urine is a sign of hepatitis. This will alert a health care provider of its presence.
MALARIA
Can even be suspected by doing a urinalysis. The presence of urobilinogen in significant quantity in urine can be a sign of malaria. During acute malarial attacks red blood cells that carry oxygen are haemolyzed (broken down) by the malaria parasites.
These broken down fragment of red blood cells can be seen in the urine as urobilinogen.
KIDNEY STONES (RENAL CALCULUS)
Crystals (e.g Calcium oxalate, cysteine (an amino acid) or urate (derived from nucleic acid metabolism) may be seen in renal calculus (stone in the kidney or urinary tract). The patient with renal calculus can have episodic or severe colicky pain in the flanks, some times radiating towards the tip of the penis in males.
Red blood cells can also be noted in the urine of people with renal calculus.
NB: It is important to note that the fact that some body is passing urine frequently is not synonymous with a diagnosis of diabetes mellitus. It can also mean urinary tract infection. It is only a urinalysis and microscopy, culture and sensitivity that can settle the issue and give a sense of direction of treatment. Even though frequent urination can be a symptom of diabetes mellitus, health care providers should not give patients with such complaints drugs for diabetes when they have not confirmed the diagnosis through the relevant tests already mentioned.
FASTING STATE OR MATERNAL DISTRESS FOR A WOMAN IN LABOUR
The presence of acetone in the urine of a pregnant woman indicates a fasting state and in a woman in labour can mean maternal distress following prolonged labour, which has depleted her energy reserve.
Acetone is a product of fat metabolism. Fat is usually called in to provide energy when glucose the primary energy provider is exhausted. Such a woman will benefit from an intravenous infusion of dextrose or energy giving food intake if not contraindicated.
A comprehensive examination of the urine of a pregnant woman is therefore very useful to assess her baseline state of health or make accurate diagnosis of any body sick that needs medical attention. Every health care provider should know the enormous information that can be got from checking the urine of a client. It is also important to note that people who take care of the sick can easily carry out urinalysis on their patients using a dip stix like combi 9. they can also send the urine of their clients to the laboratory using sterile urine bottles for microscopy, culture and sensitivity. These will make a lot of information available to them for the correct handling of their patients. It will also enable them refer patients with serious problems like kidney diseases, diabetes mellitus, hepatitis to specialists that can handle them instead of delaying such patients.