Table Of ContentUrinalysis
in
Clinical Laboratory
Practice
Authors:
Alfred H. Free, Ph.D. Helen M. Free, M.A.
Vice President Director
Technical Services and Scientific Relations Clinical Specialties
Ames Division Research Products Division
Miles Laboratories Miles Laboratories
Elkhart, Indiana Elkhart, Indiana
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
First published 1975 by CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
Reissued 2018 by CRC Press
© 1975 by CRC Press, Inc.
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish
reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the
consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this
publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has
not been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form
by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording,
or in any information storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.
com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a
not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a
photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and
explanation without intent to infringe.
Library of Congress Cataloging in Publication Data
Free, Alfred H. 1913–
Urinalysis in clinical laboratory practice.
Bibliography: p.
Includes index.
1. Urine – Analysis and pathology. I. Free, Helen
M., joint author. II. Title. [DNLM: 1. Urine – Anal-
ysis. QY185 F853ua]
RB53.F83 616.07’566 75-29484
ISBN 0-8493-5104-9
Publisher’s Note
The publisher has gone to great lengths to ensure the quality of this reprint but points out that some imperfections in the original copies
may be apparent.
Disclaimer
The publisher has made every effort to trace copyright holders and welcomes correspondence from those they have been unable to
contact.
ISBN 13: 978-1-315-89836-0 (hbk)
ISBN 13: 978-1-351-07746-0 (ebk)
Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the
CRC Press Web site at http://www.crcpress.com
PREFACE
This book was conceived in the offices of Mr. of articles or table of contents (admittedly, a few
Bernie Starkoff, President, and Mr. Gerry Becker of the most exotic non-English references are
of CRC one autumn afternoon. Probably at the based mainly on the English abstracts!). They have
suggestion of our good friend, Dr. Irving Sunshine, been chosen from the most recent books and
we were asked if we would expand the article, journals. There may be some important references
"Urinalysis, Critical Discipline of Clinical which we have omitted. This was entirely uninten-
Science," from the December, 1972, Critical tional and was caused by the fact that we could
Reviews of Laboratory Science into a full book. It only read and absorb so much in the year of
sounded a lot easier than it turned out to be, and preparation.
there are a lot of things we'd do differently the The chapter titles have been chosen to divide
second time — and we may! Much of the material the field into a series of ready reference categories.
written has evolved through the quarter of a We recognize that there is overlap, but no matter
century or so that we have been actively involved what kind of divisions are made, there must
in the field of urinalysis. All of it is entirely our necessarily be some overlap. We have tried not to
own thinking if it is not attributed to someone refer to the same publications too many times.
else. The two of us agree on most of it. It has long We have deliberately not included a series of
been our philosophy that the study of urine procedures and methods with precise directions.
provides a wealth of clinical information which is The book is not meant to be a laboratory manual.
not appreciated by the scientific community as It is intended as an information book for those
much as it should be. We have repeatedly stated interested in the study, the teaching, the practice,
that the task of analyzing urine often falls to the the interpretation, or the review of urinalysis. We
youngest, newest, and least experienced person in would appreciate comments on how this book can
the laboratory. One of our goals has always been be improved, changed, or upgraded. We recognize
to upgrade the status of urinalysis in the clinical that the text is not able to fulfill the requirements
laboratory. We hope that this book will help to of all laboratory workers and clinicians, but we
accomplish this goal. hope that it will contribute in some small way to
The references we have quoted have all been raising the status of urinalysis to that of a discipline
read — they are not simply references from a list on a level with others in the clinical laboratory.
Helen M. Free
Alfred H. Free
THE AUTHORS
Helen M. Free graduated from the College of Wooster in Woostei, Ohio with a major and honors in
chemistry. She began her career at Miles Laboratories in Quality Control and has contributed her
talents to the research, development, and technical services laboratory activities of the Ames Division.
While she was New Products Manager for Chemical Test Systems, the Ames Division marketed about
25 new products in a 5-year period. She is now Director, Specialty Systems for Ames. She is also
active in many scientific societies, particularly the American Chemical Society (past Chairperson and
present Councilor of the St. Joseph Valley Section, member of several Council committees, including
Nominations and Elections, Chairperson of Public Relations and former Chairperson of the Women
Chemists Committee) and the American Society for Medical Technology (presently Chairperson of
the Nuclear Medical Technology Section of the Scientific Assembly).
Together, the Frees were recipients of the Honor Scroll Award of the Chicago Section of the
American Institute of Chemists.
Alfred H. Free, Ph.D., graduated magna cum laude from Miami University at Oxford, Ohio and
obtained his doctorate in biochemistry at Western Reserve University, Cleveland, Ohio. He has served
the scientific community as a member of academia — professor of Biochemistry of the Medical School
at Western Reserve - and as a member of industry. He first joined Miles Laboratories as head of the
Biochemistry Section of the Miles-Ames Research Laboratories, then served as Director of the Ames
Research Laboratory, and is now Vice-President of Technical Services and Scientific Relations for the
Ames Division of Miles Laboratories. He has actively participated in the field of urinalysis testing in
clinical laboratories throughout the world. He holds several patents and is active in many scientific
societies, particularly the American Association of Clinical Chemists, Association of Clinical Scientists
(of which he is a past president), American Institute of Chemists, the American Institute of Nutrition,
and the American Society of Biological Chemists.
ACKNOWLEDGMENTS
We are very grateful to many people for the and to E. M. Knights, Jr., M.D., for serving as
contributions they have made to this book. We referee for the book.
would like to thank Roland F. Beers, M.D., Ph.D.,
We owe a debt of gratitude to Margaret Helfrick
Vice-President of Research, Miles Laboratories,
and to Mary Jackson for their unstinting help in
Mr. Joseph Schwalbach, Director, Patents,
obtaining library references, to our daughter,
Trademarks, Licences, Miles Laboratories, and J.
Penny and Victoria Van Patten-Green for the
M. Botero, M.D., Vice-President, Medical Affairs,
artwork, and to Willye Coley and Karen Dieball
Ames Division, Miles Laboratories for their helpful
for their unstinting devotion to the typing of this
comments. We would also like to thank our
manuscript.
colleagues all over the world for answering our
questionnaire on Chapter 49. Finally, we truly appreciate the gentle
We are particularly grateful to two friends reminders and never ending patience as well as the
and colleagues: to Jack R. Leonards, Ph.D., excellent editorial capabilities of Gayle Tavens and
M.D., for refereeing the original article Marci Peck of CRC Press.
DEDICATION
In appreciation for their patience and understanding,
this book is dedicated to our family and colleagues.
TABLE OF CONTENTS
1. Introduction 1
2. History 3
3. Process of Urine Formation 7
4. Nature and Composition of Urine from Healthy Subjects 13
5. Urine Collection 21
6. Good Handling Practices (Getting Good Results) 27
7. Physical Properties - Color, Turbidity, Odor 31
8. Urine Volume, Density or Specific Gravity, and Osmolality 35
9. Glucose and Other Reducing Substances 39
10. Protein 51
11. Ketone Bodies 57
12. Gross and Occult Blood 63
13. Myoglobin 69
14. Bilirubin 73
15. Urobilinogen 77
16. Porphyrins and Related Compounds 85
17. Microscopic Examination of Urine Sediment 91
18. Exfoliative Urinary Cytology 97
19. Bacteriuria 103
20. Phenylketonuria 113
21. Other Inborn Errors of Metabolism 117
22. Enzymes 123
23. Pregnancy Tests 129
24. Hormones 135
25. Sodium and Chloride 143
26. Potassium, Calcium, Magnesium, and Phosphate 149
27. pH and Buffers 155
28. Trace Elements 161
29. Toxicological Studies 167
30. Drugs of Abuse 175
31. Therapeutic Drugs 181
32. Catecholamines 185
33. Urine Studies Relating to Nutrition 191
34. Special Urine Tests 197
35. Clearance Studies 201
36. Routine Urinalysis 205
37. Urine Controls 211
38. Automated Urinalysis and Special Instrumentation 217
39. Urinalysis on Infants and Small Children 221
40. Urinalysis in Geriatrics 225
41. Radionuclides 229
42. Radioimmunoassays 231
43. Urine Preservatives 235
44. Renal Lithiasis 239
45. Relationship of Urine to Amniotic Fluid 245
46. Hemodialysis and Renal Transplantation 249
47. Creative Approaches to Teaching Urinalysis 253
48. Urinalysis in Animals 265
49. Urinalysis Around the World 269
50. Future Potentialities of Urine Study 273
Index 277
