What a little bit of urine can tell

Perhaps it was 40 years ago that a friend of mine came to my home late in the evening, very upset and concerned about his father. He had brought with him only a sample of his father’s darkly stained brown urine, which foamed with the slightest agitation. He was concerned that his father might be bleeding in the urine from some tumor of the bladder, prostate or kidney.

A few pertinent questions established that his father’s eyes and skin were deeply stained yellow but his bowel movements were almost colorless. It was my sad task to inform my friend that his father required hospitalization without delay. If he was lucky, his problem might be traced to a gallstone obstructing the flow of bile but unfortunately, cancer of the pancreas would have to be considered a more ominous cause.

Sorry to say, that was the diagnosis and the father succumbed to this illness soon thereafter. Foaming of the urine was the key; bile makes the urine foam. So a diagnosis was reached or at least strongly suspected just by examining the urine. Patients often ask why they’re asked to give a urine specimen before they are examined. So much information can be obtained from the proper examination of a patient’s urine specimen; it would be unthinkable for the urologist to reach a conclusion about a patient without first having done a complete urinalysis.

Even in ancient, Babylon, Egypt, India and particularly during the Roman and Byzantine Eras, doctors were skilled in making diagnoses simply by looking at the patient’s still warm urine specimen in a clear glass. This skill was known as “Uroscopy,” often included actually tasting the urine for sweetness or sugar and it has become the forerunner of modern urinalysis.

Today, a complete urinalysis requires not only the visual appreciation of the appearance of the urine specimen but a complete chemical and microscopic evaluation as well. Usually, the chemical testing is done by use of a “dipstick,” which rapidly and accurately gives the results to up to 10 different tests including sugar, protein, blood, ketones, bilirubin (bile), urobilinogen, nitrates, specific gravity, pH (acidity), and white blood cells (pus). That’s only part of the story however; microscopic examination of the centrifuged urinary sediment completes the urinalysis because white blood cells, red blood cells, bacteria, fungi, yeast, crystals, and casts, which are solidifications of certain proteins within the kidney tubules are easily seen.

Many different types of crystals, each one distinguishable under the microscope give valuable clues as to the cause of a patient’s kidney stone formation. Complete urinalysis remains an indispensable tool for the modern urologist to properly diagnose and treat every patient. The next time you are asked to give a urine specimen, be happy that so much information can be obtained “from just a little bit of urine.”

Have Questions? Call Dr. Okun at 718-241-6767

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