Podcast
Questions and Answers
What percentage of total dissolved solutes in urine is accounted for by urea?
What percentage of total dissolved solutes in urine is accounted for by urea?
- 25%
- 75%
- 40%
- 50% (correct)
What is the term for excessive urination at night?
What is the term for excessive urination at night?
- Nocturia (correct)
- Polyuria
- Oliguria
- Anuria
What is the yellow pigment that gives urine its color?
What is the yellow pigment that gives urine its color?
- Bilirubin
- Urochrome (correct)
- Urea
- Hemoglobin
Which of the following can cause urine to turn green or blue-green?
Which of the following can cause urine to turn green or blue-green?
What is the normal volume of urine for a 10-year-old?
What is the normal volume of urine for a 10-year-old?
What is the function of the kidneys?
What is the function of the kidneys?
What is the term for the absence of urine production?
What is the term for the absence of urine production?
What can cause urine to turn brown or black?
What can cause urine to turn brown or black?
What type of urine collection involves collecting urine at any time in a urine container?
What type of urine collection involves collecting urine at any time in a urine container?
What is the specimen of choice for urinalysis and microscopic analysis?
What is the specimen of choice for urinalysis and microscopic analysis?
What is the normal volume of urine collected in a 24-hour period?
What is the normal volume of urine collected in a 24-hour period?
Why should urine not be voided directly into the 24-hour collection container?
Why should urine not be voided directly into the 24-hour collection container?
What type of urine collection is used for microbiology testing?
What type of urine collection is used for microbiology testing?
What is the purpose of the BD Vacutainer® Urine Culture and Sensitivity tube?
What is the purpose of the BD Vacutainer® Urine Culture and Sensitivity tube?
Why is it important to process urine specimens promptly?
Why is it important to process urine specimens promptly?
What preservative is commonly used to prevent bacterial growth in urine specimens?
What preservative is commonly used to prevent bacterial growth in urine specimens?
What happens to urine glucose levels when microorganisms grow in the specimen?
What happens to urine glucose levels when microorganisms grow in the specimen?
What is the consequence of not refrigerating unpreserved urine specimens for chemical urinalysis?
What is the consequence of not refrigerating unpreserved urine specimens for chemical urinalysis?
Why is the first morning specimen considered the best for urinalysis?
Why is the first morning specimen considered the best for urinalysis?
What is the primary purpose of measuring specific gravity in urinalysis?
What is the primary purpose of measuring specific gravity in urinalysis?
What is the significance of the presence of nitrites in urine?
What is the significance of the presence of nitrites in urine?
What is the purpose of microscopy in urinalysis?
What is the purpose of microscopy in urinalysis?
What is the primary component of a cast?
What is the primary component of a cast?
What is a factor that can lead to the formation of a cast?
What is a factor that can lead to the formation of a cast?
What is the purpose of centrifuging urine ?
What is the purpose of centrifuging urine ?
What is the significance of the presence of ketones in urine?
What is the significance of the presence of ketones in urine?
What is the purpose of measuring pH in urinalysis?
What is the purpose of measuring pH in urinalysis?
Where should you place the test card, brush kit, return envelope, and label?
Where should you place the test card, brush kit, return envelope, and label?
How many times should you flush the toilet before collecting your sample?
How many times should you flush the toilet before collecting your sample?
How should you wash your hands after completing the test?
How should you wash your hands after completing the test?
What should you check before placing the label on the test card?
What should you check before placing the label on the test card?
Where should you write the date and time of your collection?
Where should you write the date and time of your collection?
What should you do with the test card after completing the test?
What should you do with the test card after completing the test?
What should you do with the specimen bag after placing the test card in it?
What should you do with the specimen bag after placing the test card in it?
What is the most important aid in identifying urine crystals?
What is the most important aid in identifying urine crystals?
Which type of crystal forms in alkaline urine?
Which type of crystal forms in alkaline urine?
What is the name of the test that detects red blood cells in stool?
What is the name of the test that detects red blood cells in stool?
What is the primary purpose of the Chlamydia Nucleic Acid Amplification (NAA) Test?
What is the primary purpose of the Chlamydia Nucleic Acid Amplification (NAA) Test?
What is the recommended duration of time before specimen collection for the Chlamydia NAA Test?
What is the recommended duration of time before specimen collection for the Chlamydia NAA Test?
What is the purpose of the special diet for 48 hours before the Occult Blood Test (FOCT)?
What is the purpose of the special diet for 48 hours before the Occult Blood Test (FOCT)?
What is the limitation of the Chlamydia Nucleic Acid Amplification (NAA) Test?
What is the limitation of the Chlamydia Nucleic Acid Amplification (NAA) Test?
What is the primary advantage of the Fecal Immunochemical Test (FIT) over other tests?
What is the primary advantage of the Fecal Immunochemical Test (FIT) over other tests?
What is the purpose of the Fecal Immunochemical Test (FIT)?
What is the purpose of the Fecal Immunochemical Test (FIT)?
The suprapubic aspiration method of urine collection involves inserting a needle through the abdomen into the kidney.
The suprapubic aspiration method of urine collection involves inserting a needle through the abdomen into the kidney.
A 24-hour urine collection is used for routine screening and pregnancy tests.
A 24-hour urine collection is used for routine screening and pregnancy tests.
Boric acid is a preservative used to prevent bacterial growth in urine specimens for routine urinalysis.
Boric acid is a preservative used to prevent bacterial growth in urine specimens for routine urinalysis.
Delay in urine processing can result in a decrease in pH levels.
Delay in urine processing can result in a decrease in pH levels.
Midstream, clean catch urine collection is used for bacterial cultures.
Midstream, clean catch urine collection is used for bacterial cultures.
Urine glucose levels increase when microorganisms grow in the specimen.
Urine glucose levels increase when microorganisms grow in the specimen.
Laboratories are not required to validate test procedures for preserved specimens.
Laboratories are not required to validate test procedures for preserved specimens.
Random urine collection is used for quantitative chemical tests.
Random urine collection is used for quantitative chemical tests.
Unpreserved urine specimens can be accepted for analysis after 2 hours if they have been refrigerated.
Unpreserved urine specimens can be accepted for analysis after 2 hours if they have been refrigerated.
The first morning specimen is the best for urinalysis because it is the most diluted.
The first morning specimen is the best for urinalysis because it is the most diluted.
Tartaric acid is not commonly used as a preservative for urine specimens.
Tartaric acid is not commonly used as a preservative for urine specimens.
Specific gravity is always measured at the physical examination step.
Specific gravity is always measured at the physical examination step.
Boric acid is not suitable for preserving urine specimens for chemical urinalysis.
Boric acid is not suitable for preserving urine specimens for chemical urinalysis.
Microscopic examination is always done as part of the routine urinalysis procedure.
Microscopic examination is always done as part of the routine urinalysis procedure.
Refrigeration is not a suitable method for preserving urine specimens.
Refrigeration is not a suitable method for preserving urine specimens.
Urine collection for a 24-hour period involves discarding the first morning void in the first day.
Urine collection for a 24-hour period involves discarding the first morning void in the first day.
First morning specimen is not preferred for urinalysis and microscopic analysis.
First morning specimen is not preferred for urinalysis and microscopic analysis.
Random urine collection is used for microbiology testing.
Random urine collection is used for microbiology testing.
Urine for routine urinalysis is best collected between 2-4 pm.
Urine for routine urinalysis is best collected between 2-4 pm.
Urine collections for microbiology testing should be refrigerated immediately.
Urine collections for microbiology testing should be refrigerated immediately.
Urochrome is responsible for the red color of urine.
Urochrome is responsible for the red color of urine.
The physical examination of urine includes observing its color, clarity, and volume.
The physical examination of urine includes observing its color, clarity, and volume.
A preservative is must added to the 24-hour urine collection container.
A preservative is must added to the 24-hour urine collection container.
The chemical examination of urine includes testing for pH, protein, and glucose.
The chemical examination of urine includes testing for pH, protein, and glucose.
Kidneys regulate the pH of the blood.
Kidneys regulate the pH of the blood.
Oliguria is a term used to describe excessive urination at night.
Oliguria is a term used to describe excessive urination at night.
Urine specimens for urinalysis should be processed within 2 hours of collection.
Urine specimens for urinalysis should be processed within 2 hours of collection.
Chloride is the minor inorganic chemical in urine.
Chloride is the minor inorganic chemical in urine.
The microscopic examination of urine includes examining for casts, crystals, and bacteria.
The microscopic examination of urine includes examining for casts, crystals, and bacteria.
Urinalysis is a diagnostic tool that has been used for less than 100 years.
Urinalysis is a diagnostic tool that has been used for less than 100 years.
A 24-hour urine collection container can directly receive urine without a collection hat or plastic container.
A 24-hour urine collection container can directly receive urine without a collection hat or plastic container.
The midstream clean catch urine collection method is used for microbiology testing.
The midstream clean catch urine collection method is used for microbiology testing.
The normal volume of urine for a 24-hour collection is approximately 750-1000 ml.
The normal volume of urine for a 24-hour collection is approximately 750-1000 ml.
The BD Vacutainer Urine Culture and Sensitivity tube is used for routine urinalysis.
The BD Vacutainer Urine Culture and Sensitivity tube is used for routine urinalysis.
Catheterized specimen collection is a type of midstream clean catch collection.
Catheterized specimen collection is a type of midstream clean catch collection.
A graduated cylinder is used to measure the volume of a 24-hour urine specimen.
A graduated cylinder is used to measure the volume of a 24-hour urine specimen.
Urine collection hats or plastic containers are not necessary for 24-hour urine collection.
Urine collection hats or plastic containers are not necessary for 24-hour urine collection.
The BD Vacutainer Urine Culture and Sensitivity tube is used to collect a specimen for chemical urinalysis.
The BD Vacutainer Urine Culture and Sensitivity tube is used to collect a specimen for chemical urinalysis.
Match the following types of urine crystals with their pH levels:
Match the following types of urine crystals with their pH levels:
Match the following types of casts with their characteristics:
Match the following types of casts with their characteristics:
Match the following factors that can lead to the formation of a cast:
Match the following factors that can lead to the formation of a cast:
Match the following urine components with their characteristics:
Match the following urine components with their characteristics:
Match the following sexually transmitted diseases with their characteristics:
Match the following sexually transmitted diseases with their characteristics:
Match the following complications with the disease that can cause them:
Match the following complications with the disease that can cause them:
Match the following types of urine collections with their uses:
Match the following types of urine collections with their uses:
Match the following preservatives with their uses in urinalysis:
Match the following preservatives with their uses in urinalysis:
Match the following components of urine with their significance in urinalysis:
Match the following components of urine with their significance in urinalysis:
Match the following components of urine with their significance in urinalysis:
Match the following components of urine with their significance in urinalysis:
Match the following procedures with their descriptions in urinalysis:
Match the following procedures with their descriptions in urinalysis:
Match the following characteristics of urine with their possible descriptions:
Match the following characteristics of urine with their possible descriptions:
Match the following components of urine with their significance in kidney disease:
Match the following components of urine with their significance in kidney disease:
Match the following types of urinalysis with their descriptions:
Match the following types of urinalysis with their descriptions:
Match the following components of urine with their significance in urinalysis:
Match the following components of urine with their significance in urinalysis:
Match the following preservatives with their uses in urinalysis:
Match the following preservatives with their uses in urinalysis:
Match the following procedures with their descriptions in urinalysis:
Match the following procedures with their descriptions in urinalysis:
Match the following steps in urinalysis with their descriptions:
Match the following steps in urinalysis with their descriptions:
Match the following components of urine with their significance in urinalysis:
Match the following components of urine with their significance in urinalysis:
Match the following components of urine with their significance in kidney disease:
Match the following components of urine with their significance in kidney disease:
Match the following conditions with their effects on urine specimens:
Match the following conditions with their effects on urine specimens:
Match the following types of urine specimens with their characteristics:
Match the following types of urine specimens with their characteristics:
Match the following tests in urinalysis with their purposes:
Match the following tests in urinalysis with their purposes:
Match the following characteristics of urine casts with their descriptions:
Match the following characteristics of urine casts with their descriptions:
Match the following types of urine collection with their primary purposes:
Match the following types of urine collection with their primary purposes:
Match the following urine collection methods with their descriptions:
Match the following urine collection methods with their descriptions:
Match the following preservatives with their uses in urine specimens:
Match the following preservatives with their uses in urine specimens:
Match the following consequences with the effects of delayed urine processing:
Match the following consequences with the effects of delayed urine processing:
Match the following types of urine specimens with their preparation requirements:
Match the following types of urine specimens with their preparation requirements:
Match the following types of urine analysis with their primary purposes:
Match the following types of urine analysis with their primary purposes:
Match the following types of casts with their compositions:
Match the following types of casts with their compositions:
Match the following types of urine crystals with their associated conditions:
Match the following types of urine crystals with their associated conditions:
Match the following terms related to urine production with their definitions:
Match the following terms related to urine production with their definitions:
Match the following substances with their effects on urine color:
Match the following substances with their effects on urine color:
Match the following types of urine collection with their descriptions:
Match the following types of urine collection with their descriptions:
Match the following kidney functions with their descriptions:
Match the following kidney functions with their descriptions:
Match the following terms related to urine casts with their definitions:
Match the following terms related to urine casts with their definitions:
Match the following types of urine crystals with their formations:
Match the following types of urine crystals with their formations:
Match the following terms related to renal workup with their descriptions:
Match the following terms related to renal workup with their descriptions:
Match the following types of urine analysis with their purposes:
Match the following types of urine analysis with their purposes:
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Study Notes
Urinalysis
- Most common and oldest diagnostic test, used for over 6,000 years
- Urine composition:
- Urea (metabolic waste product produced in the liver from breakdown of protein and amino acids)
- Other organic substances: creatine, uric acid
- Major inorganic chemicals: chloride, potassium, sodium
- Definitions:
- Anuria: absence of urine production
- Nocturia: excessive urination at night
- Oliguria: decreased production of urine
- Polyuria: increased production of urine
- Hematuria: blood in the urine
- Urochrome: yellow pigment that gives urine its color
Colors of Urine
- Caused by food or medication:
- Red: beets, rhubarb (in alkaline urine)
- Yellow-orange: carrots, some antibiotics
- Green, blue-green: clorets, amitryptiline
- Brown-black: Methyldopa, metronidazole
- Caused by disease states:
- Red, red-brown: RBCs, hgb, myoglobin
- Wine-red: blood
- Brown-black: melanin, hgb in acid urine
- Dark yellow, green-brown: bilirubin
Normal Volume of Urine
- Varies by age:
- Newborn: 25-350 ml/24 hours
- One year: 300-600 ml/24 hours
- Ten years: 750-1500 ml/24 hours
- Adult: 750-2000 ml/24 hours
Kidneys
- Regulate volume of fluid in blood
- Keep chemical components of blood at a constant level
Types of Urine Collection
- Random: collected at any time for routine urinalysis
- First Morning Specimen: collected for urinalysis and microscopic analysis
- 24-hour collection:
- Collect urine for 24 hours, discarding first morning void
- Add preservative if necessary
- Measure volume of urine
- Catheterized specimen: collected under sterile conditions using a catheter
- Midstream clean catch:
- Collected for microbiology
- Special clean-catch kit with sterile wipes may be provided
- Procedure: urinate a small amount, then stop and collect a sample, finishing urination into the toilet bowl
Routine Urinalysis
- Physical examination:
- Color
- Turbidity
- Specific gravity (measures weight of urine compared to water)
- Chemical examination:
- pH (acidity or alkalinity of urine)
- Protein
- Glucose (presence indicates diabetes)
- Ketones (increased in diabetics or starvation)
- Bilirubin (tests for liver disease)
- Blood (present during infection, trauma, cancer, or kidney stones)
- Nitrites (indicates presence of bacteria)
- Microscopic examination:
- Done on sediment of centrifuged urine
- Examines for:
- Red blood cells
- White blood cells
- Casts (formed in kidney tubules and expelled during kidney damage)
- Crystals (formed by precipitation of urine salts)
Microscopy
- Procedure:
- Pour urine into test tubes
- Centrifuge
- Pour off supernatant
- Mix sediment
- Place small amount of sediment on a slide
- Cover with a coverslip
- Examine under high power (400X)
- Casts are formed in the kidney tubules and expelled during kidney damage
- Factors leading to cast formation:
- Decreased urine flow
- Increased acidity (low pH)
- Increased concentration (high SG)
- Increased plasma proteins
Crystals
- Formed by precipitation of urine salts when changes occur in pH, temperature, or concentration of urine
- Identification aided by pH of the urine
- Two kinds of crystals:
- Formed in acid urine
- Formed in alkaline urine
- Examples of crystals:
- Calcium oxalate crystals
- Cystine crystals
- Triple phosphate crystals
Other Components of Urine
- May contain:
- Yeast (Candida albicans)
- Bacteria
- Trichomonas vaginalis
- Sperm
- Mucous
- Oil or air debris
- Debris from fiber
- Fat droplets
Urine Collection and Urinalysis
- After collection, insert the holder with the sterile straw, then push in the gray stopper tube, and finally put the holder into the sharps container.
- Preservative used in urine collection is Boric Acid.
- Delay in urine processing and prolonged exposure at room temperature may result in microbial growth, leading to false positive protein and blood results.
- Urine glucose may decrease as growing microorganisms utilize the sugar.
Types of Urine Collection
- Suprapubic aspiration: collected by inserting a needle through the abdomen into the bladder.
- Random: collected at any time in a urine container, used for routine urinalysis.
- First Morning Specimen: the specimen of choice for urinalysis and microscopic analysis, collected for routine screening and pregnancy tests.
- 24 hour collection: collected for a 24 hour period, used for quantitative chemical tests.
- Catheterized: collected under sterile conditions, used for bacterial cultures.
- Midstream, clean catch: collected for routine screening, bacterial cultures, and microbiology.
Preservatives for Urine
- Refrigeration, Tartaric acid, Boric acid, Sodium carbonate, Hydrochloric acid, and Acetic acid are examples of preservatives used for urine.
- Preservatives should be considered when deciding whether to use them, as they may interfere with assay methods.
Routine Urinalysis
- Unpreserved specimens exceeding the two-hour limit that have not been refrigerated should not be accepted for analysis due to potential bacterial overgrowth.
- The best specimen is the first morning specimen, which is the most concentrated.
- Routine urinalysis should be done within 2 hours after collection and consists of three parts: physical examination, chemical testing, and microscopic examination.
Physical Examination
- Color: yellow, brown, red
- Turbidity: clear, turbid, slightly turbid, moderately turbid, or very turbid
- Specific gravity (SG): measures the weight of urine compared to the weight of water, with a range of 1.000 (very dilute) to 1.030 (very concentrated)
Objectives
- Define basic urinalysis terms
- Describe how much water and solutes are in urine
- List the causes of color changes in urine
- List the normal volume of urine
- Describe the different types of urine collections
- List the different types of urine preservations
- Describe the steps in urinalysis, including physical, chemical, and microscopic examinations
Urinalysis
- Urinalysis is the most common and oldest test ordered
- It has been used as a diagnostic tool for over 6,000 years
- Urine composition consists of urea and other organic and inorganic chemicals dissolved in water
- Urea is a metabolic waste product produced in the liver from the breakdown of protein and amino acids
Definitions
- Anuria: absence of urine production
- Nocturia: excessive urination at night
- Oliguria: decreased production of urine
- Polyuria: increased production of urine
- Hematuria: blood in the urine
- Urochrome: the yellow pigment that gives urine its color
Colors of Urine
- Red: caused by beets, rhubarb (in alkaline urine), RBCs, hgb, myoglobin
- Yellow-orange: caused by carrots, some antibiotics
- Green, blue-green: caused by clorets, amitryptiline
- Brown-black: caused by Methyldopa, metronidazole, melanin, hgb in acid urine
- Dark yellow, green-brown: caused by bilirubin
Normal Volume of Urine
- Newborn: 25-350 ml/24 hours
- One year: 300-600 ml/24 hours
- Ten years: 750-1500 ml/24 hours
- Adult: 750-2000 ml/24 hours
Urinalysis
- The main component of a cast is a gel-like protein.
- Four factors that can lead to the formation of a cast:
- Decreased urine flow
- Increased acidity (low pH)
- Increased concentration (high SG)
- Increased plasma proteins
Types of Casts
- Red cell casts
- WBC casts
- Hyaline casts
- Granular casts
- Waxy casts
Crystals
- Formed by the precipitation of urine salts when changes occur in pH, temperature, or concentration of the urine.
- The most important aid in identification of urine crystals is the pH of the urine.
- Two kinds of crystals:
- Crystals that form in acid urine
- Crystals that form in alkaline urine
- Examples of crystals:
- Calcium oxalate crystals (acid pH)
- Cystine crystals (acid pH)
- Triple phosphate crystals (alkaline pH)
Urine Components
- Yeast (Candida albicans)
- Bacteria
- Trichomonas vaginalis
- Sperm
- Mucous
- Oil or air debris
- Debris from fiber
- Fat droplets
Chlamydia Urine Collection
- Chlamydia is a common and curable STD caused by the chlamydia trachomatis bacteria.
- In women, untreated infections can lead to chronic pelvic pain, PID, infertility, and prenatal problems.
- In men, untreated infection can spread to other parts of the penis, prostate, and testicles, causing pain and inflammation.
Urine Examination
- Urine color and turbidity
- Specific gravity (SG) measured using a refractometer
- Chemical examination:
- pH tests acidity or alkalinity of the urine
- Protein indicates kidney disease
- Glucose presence indicates high blood glucose (diabetes)
- Ketones increase in diabetics or starvation
- Bilirubin tests for liver disease
- Blood present during infection, trauma, cancer, kidney stones, or other bleeding
- Nitrites indicate presence of bacteria
- Urobilinogen tests for jaundice and other liver disorders
- Leukocytes found in kidney disease and UTI
Urine Strip Reader
- Used to analyze urine chemically
Microscopy
- Urine microscopy performed only when Urinalysis Renal Workup is ordered
- Provides information on presence of casts, cells, and other formed elements
- Urinary crystals no longer reported as part of urine microscopic examination
Urine Collection and Processing
- Types of urine collection:
- Suprapubic aspiration
- Random
- First morning
- 24-hour collection
- Catharized
- Midstream, clean catch
- Preservatives for urines:
- Refrigeration
- Tartaric acid
- Boric acid
- Sodium carbonate
- Hydrochloric acid
- Acetic acid
- Note: Delay in urine processing and prolonged exposure at room temperature may result in microbial growth, leading to changes in pH and false positive protein and blood results.
Definitions
- Anuria: absence of urine production
- Nocturia: excessive urination at night
- Oliguria: decreased production of urine
- Polyuria: increased production of urine
- Hematuria: blood in the urine
- Urochrome: the yellow pigment that gives urine its color
Colors Caused by Food or Medication
- Red: beets, rhubarb (in alkaline urine)
- Yellow-orange: carrots, some antibiotics
- Green, blue-green: clorets, amitryptiline
- Brown-black: Methyldopa, metronidazole
Colors Caused by Disease States
- Red, red-brown: RBCs, hgb, myoglobin
- Wine-red: blood
- Brown-black: melanin, hgb in acid urine
- Dark yellow, green-brown: bilirubin
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