Unit 4. Urinalysis and Urine Composition
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Questions and Answers

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?

  • Nocturia (correct)
  • Polyuria
  • Oliguria
  • Anuria

    • 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?

    <p>Clorets</p> Signup and view all the answers

    What is the normal volume of urine for a 10-year-old?

    <p>750-1500 ml/24 hours</p> Signup and view all the answers

    What is the function of the kidneys?

    <p>Regulate the volume of fluid in the blood</p> Signup and view all the answers

    What is the term for the absence of urine production?

    <p>Anuria</p> Signup and view all the answers

    What can cause urine to turn brown or black?

    <p>Methyldopa</p> Signup and view all the answers

    What type of urine collection involves collecting urine at any time in a urine container?

    <p>Random</p> Signup and view all the answers

    What is the specimen of choice for urinalysis and microscopic analysis?

    <p>First Morning Specimen</p> Signup and view all the answers

    What is the normal volume of urine collected in a 24-hour period?

    <p>750-2000 ml</p> Signup and view all the answers

    Why should urine not be voided directly into the 24-hour collection container?

    <p>It might cause splashing and contaminate the container</p> Signup and view all the answers

    What type of urine collection is used for microbiology testing?

    <p>Midstream clean catch</p> Signup and view all the answers

    What is the purpose of the BD Vacutainer® Urine Culture and Sensitivity tube?

    <p>To collect a sterile urine specimen for culture and sensitivity testing</p> Signup and view all the answers

    Why is it important to process urine specimens promptly?

    <p>To prevent all of the above</p> Signup and view all the answers

    What preservative is commonly used to prevent bacterial growth in urine specimens?

    <p>Boric acid</p> Signup and view all the answers

    What happens to urine glucose levels when microorganisms grow in the specimen?

    <p>They decrease</p> Signup and view all the answers

    What is the consequence of not refrigerating unpreserved urine specimens for chemical urinalysis?

    <p>All of the above</p> Signup and view all the answers

    Why is the first morning specimen considered the best for urinalysis?

    <p>It is the most concentrated</p> Signup and view all the answers

    What is the primary purpose of measuring specific gravity in urinalysis?

    <p>To measure the weight of the urine compared to water</p> Signup and view all the answers

    What is the significance of the presence of nitrites in urine?

    <p>It indicates the presence of bacteria</p> Signup and view all the answers

    What is the purpose of microscopy in urinalysis?

    <p>To examine the sediment of centrifuged urine</p> Signup and view all the answers

    What is the primary component of a cast?

    <p>A type of protein</p> Signup and view all the answers

    What is a factor that can lead to the formation of a cast?

    <p>Decreased urine flow</p> Signup and view all the answers

    What is the purpose of centrifuging urine ?

    <p>To remove the supernatant</p> Signup and view all the answers

    What is the significance of the presence of ketones in urine?

    <p>It indicates the presence of diabetes or starvation</p> Signup and view all the answers

    What is the purpose of measuring pH in urinalysis?

    <p>To test the acidity or alkalinity of the urine</p> Signup and view all the answers

    Where should you place the test card, brush kit, return envelope, and label?

    <p>In the bathroom</p> Signup and view all the answers

    How many times should you flush the toilet before collecting your sample?

    <p>2 to 3 times</p> Signup and view all the answers

    How should you wash your hands after completing the test?

    <p>Wet your hands with warm water, then rub them with soap for at least 20 seconds</p> Signup and view all the answers

    What should you check before placing the label on the test card?

    <p>The information on the label your healthcare provider gave you</p> Signup and view all the answers

    Where should you write the date and time of your collection?

    <p>On the specimen bag</p> Signup and view all the answers

    What should you do with the test card after completing the test?

    <p>Place it in the specimen bag</p> Signup and view all the answers

    What should you do with the specimen bag after placing the test card in it?

    <p>Place it in the pre-paid envelope</p> Signup and view all the answers

    What is the most important aid in identifying urine crystals?

    <p>pH of the urine</p> Signup and view all the answers

    Which type of crystal forms in alkaline urine?

    <p>Triple phosphate</p> Signup and view all the answers

    What is the name of the test that detects red blood cells in stool?

    <p>Occult Blood Test (FOCT)</p> Signup and view all the answers

    What is the primary purpose of the Chlamydia Nucleic Acid Amplification (NAA) Test?

    <p>To detect chlamydia</p> Signup and view all the answers

    What is the recommended duration of time before specimen collection for the Chlamydia NAA Test?

    <p>At least 1 hour</p> Signup and view all the answers

    What is the purpose of the special diet for 48 hours before the Occult Blood Test (FOCT)?

    <p>To increase the amount of fiber in the stool</p> Signup and view all the answers

    What is the limitation of the Chlamydia Nucleic Acid Amplification (NAA) Test?

    <p>It can only be used with the GEN-PROBE APTIMA Assays</p> Signup and view all the answers

    What is the primary advantage of the Fecal Immunochemical Test (FIT) over other tests?

    <p>Medicines and food do not interfere with the test</p> Signup and view all the answers

    What is the purpose of the Fecal Immunochemical Test (FIT)?

    <p>To detect colon cancer</p> Signup and view all the answers

    The suprapubic aspiration method of urine collection involves inserting a needle through the abdomen into the kidney.

    <p>False</p> Signup and view all the answers

    A 24-hour urine collection is used for routine screening and pregnancy tests.

    <p>False</p> Signup and view all the answers

    Boric acid is a preservative used to prevent bacterial growth in urine specimens for routine urinalysis.

    <p>True</p> Signup and view all the answers

    Delay in urine processing can result in a decrease in pH levels.

    <p>False</p> Signup and view all the answers

    Midstream, clean catch urine collection is used for bacterial cultures.

    <p>True</p> Signup and view all the answers

    Urine glucose levels increase when microorganisms grow in the specimen.

    <p>False</p> Signup and view all the answers

    Laboratories are not required to validate test procedures for preserved specimens.

    <p>False</p> Signup and view all the answers

    Random urine collection is used for quantitative chemical tests.

    <p>False</p> Signup and view all the answers

    Unpreserved urine specimens can be accepted for analysis after 2 hours if they have been refrigerated.

    <p>True</p> Signup and view all the answers

    The first morning specimen is the best for urinalysis because it is the most diluted.

    <p>False</p> Signup and view all the answers

    Tartaric acid is not commonly used as a preservative for urine specimens.

    <p>True</p> Signup and view all the answers

    Specific gravity is always measured at the physical examination step.

    <p>False</p> Signup and view all the answers

    Boric acid is not suitable for preserving urine specimens for chemical urinalysis.

    <p>False</p> Signup and view all the answers

    Microscopic examination is always done as part of the routine urinalysis procedure.

    <p>False</p> Signup and view all the answers

    Refrigeration is not a suitable method for preserving urine specimens.

    <p>False</p> Signup and view all the answers

    Urine collection for a 24-hour period involves discarding the first morning void in the first day.

    <p>False</p> Signup and view all the answers

    First morning specimen is not preferred for urinalysis and microscopic analysis.

    <p>False</p> Signup and view all the answers

    Random urine collection is used for microbiology testing.

    <p>False</p> Signup and view all the answers

    Urine for routine urinalysis is best collected between 2-4 pm.

    <p>False</p> Signup and view all the answers

    Urine collections for microbiology testing should be refrigerated immediately.

    <p>False</p> Signup and view all the answers

    Urochrome is responsible for the red color of urine.

    <p>False</p> Signup and view all the answers

    The physical examination of urine includes observing its color, clarity, and volume.

    <p>True</p> Signup and view all the answers

    A preservative is must added to the 24-hour urine collection container.

    <p>False</p> Signup and view all the answers

    The chemical examination of urine includes testing for pH, protein, and glucose.

    <p>True</p> Signup and view all the answers

    Kidneys regulate the pH of the blood.

    <p>True</p> Signup and view all the answers

    Oliguria is a term used to describe excessive urination at night.

    <p>False</p> Signup and view all the answers

    Urine specimens for urinalysis should be processed within 2 hours of collection.

    <p>True</p> Signup and view all the answers

    Chloride is the minor inorganic chemical in urine.

    <p>False</p> Signup and view all the answers

    The microscopic examination of urine includes examining for casts, crystals, and bacteria.

    <p>True</p> Signup and view all the answers

    Urinalysis is a diagnostic tool that has been used for less than 100 years.

    <p>False</p> Signup and view all the answers

    A 24-hour urine collection container can directly receive urine without a collection hat or plastic container.

    <p>False</p> Signup and view all the answers

    The midstream clean catch urine collection method is used for microbiology testing.

    <p>True</p> Signup and view all the answers

    The normal volume of urine for a 24-hour collection is approximately 750-1000 ml.

    <p>False</p> Signup and view all the answers

    The BD Vacutainer Urine Culture and Sensitivity tube is used for routine urinalysis.

    <p>False</p> Signup and view all the answers

    Catheterized specimen collection is a type of midstream clean catch collection.

    <p>False</p> Signup and view all the answers

    A graduated cylinder is used to measure the volume of a 24-hour urine specimen.

    <p>True</p> Signup and view all the answers

    Urine collection hats or plastic containers are not necessary for 24-hour urine collection.

    <p>False</p> Signup and view all the answers

    The BD Vacutainer Urine Culture and Sensitivity tube is used to collect a specimen for chemical urinalysis.

    <p>False</p> Signup and view all the answers

    Match the following types of urine crystals with their pH levels:

    <p>Calcium Oxalate Crystals = Acid pH Cystine Crystals = Acid pH Triple phosphate crystals = Alkaline pH Hyaline Casts = None</p> Signup and view all the answers

    Match the following types of casts with their characteristics:

    <p>Red cell casts = Indicate glomerular damage WBC Cast = Indicate inflammation Hyaline Cast = Indicate normal kidney function Granular Cast = Indicate chronic kidney disease</p> Signup and view all the answers

    Match the following factors that can lead to the formation of a cast:

    <p>Decreased urine flow = Increased concentration of urine Increased acidity (low pH) = Increased plasma proteins Increased plasma proteins = Increased concentration of urine Increased concentration of urine = Decreased urine flow</p> Signup and view all the answers

    Match the following urine components with their characteristics:

    <p>Mucous = Normal finding in urine Yeast (Candida albicans) = Infection Fat Droplets = Abnormal finding in urine Oil or Air Debris = Contamination</p> Signup and view all the answers

    Match the following sexually transmitted diseases with their characteristics:

    <p>Chlamydia = Caused by viruses Trichomonas vaginalis = Caused by bacteria</p> Signup and view all the answers

    Match the following complications with the disease that can cause them:

    <p>Chronic pelvic pain = Chlamydia Pelvic inflammatory disease (PID) = Chlamydia Prenatal problems = Chlamydia Pneumonia = Trichomonas vaginalis</p> Signup and view all the answers

    Match the following types of urine collections with their uses:

    <p>24-hour urine collection = Routine screening and pregnancy tests Midstream, clean catch urine collection = Bacterial cultures Suprapubic aspiration method = Urine collection in children Random urine collection = Urine collection for urinalysis</p> Signup and view all the answers

    Match the following preservatives with their uses in urinalysis:

    <p>Boric acid = Prevent bacterial growth Formalin = Preserve urine for microscopy None = Preserve urine for urinalysis Acetic acid = Preserve urine for bacterial cultures</p> Signup and view all the answers

    Match the following components of urine with their significance in urinalysis:

    <p>pH = Tests the acidity or alkalinity of the urine Protein = Indicates kidney disease Glucose = Presence in urine indicates increased blood glucose (diabetes) Bilirubin = Tests for liver disease</p> Signup and view all the answers

    Match the following components of urine with their significance in urinalysis:

    <p>Ketones = Indicates diabetes or starvation Nitrites = Indicates the presence of bacteria Urobilinogen = Tests for jaundice and liver disorders Leukocytes = Found in kidney disease and UTI</p> Signup and view all the answers

    Match the following procedures with their descriptions in urinalysis:

    <p>Microscopy = Done on the sediment of centrifuged urine Refractometer = Measures specific gravity Urine Strip Reader = Used for chemical examination Centrifuge = Used to separate supernatant from sediment</p> Signup and view all the answers

    Match the following characteristics of urine with their possible descriptions:

    <p>Yellow = Color of urine Turbid = Clarity of urine 1.000 = Specific gravity of very dilute urine 1.030 = Specific gravity of very concentrated urine</p> Signup and view all the answers

    Match the following components of urine with their significance in kidney disease:

    <p>Casts = Formed in kidney tubules and expelled during kidney damage Red Blood Cells = Present during infection, trauma, or cancer White Blood Cells = Found in kidney disease and UTI Urobilinogen = Tests for jaundice and liver disorders</p> Signup and view all the answers

    Match the following types of urinalysis with their descriptions:

    <p>Physical examination = Examines color, turbidity, and specific gravity of urine Chemical testing = Tests for various substances in urine Microscopic examination = Examines urine under a microscope for cells, casts, and crystals</p> Signup and view all the answers

    Match the following components of urine with their significance in urinalysis:

    <p>Urine Color = Indicates the presence of bilirubin Urine Turbidity = Indicates the presence of cells or casts Specific Gravity = Measures the concentration of solutes pH = Tests the acidity or alkalinity of the urine</p> Signup and view all the answers

    Match the following preservatives with their uses in urinalysis:

    <p>Tartaric acid = Preservative for urine specimens Boric acid = Preservative for urine specimens Acetic acid = Preservative for urine specimens Hydrochloric acid = Preservative for urine specimens</p> Signup and view all the answers

    Match the following procedures with their descriptions in urinalysis:

    <p>Renal Workup = Dipstick plus reflex to microscopy only if positive for blood, protein, or leukocyte esterase Urine Strip Reader = Used for chemical examination Microscopy = Done on the sediment of centrifuged urine Centrifuge = Used to separate supernatant from sediment</p> Signup and view all the answers

    Match the following steps in urinalysis with their descriptions:

    <p>Routine urinalysis = Tests performed on urine samples Physical examination = Examines physical characteristics of urine Chemical testing = Tests for various substances in urine Microscopic examination = Examines urine under a microscope for cells, casts, and crystals</p> Signup and view all the answers

    Match the following components of urine with their significance in urinalysis:

    <p>Blood = Present during infection, trauma, or cancer Leukocytes = Found in kidney disease and UTI Protein = Indicates kidney disease Glucose = Presence in urine indicates increased blood glucose (diabetes)</p> Signup and view all the answers

    Match the following components of urine with their significance in kidney disease:

    <p>Casts = Formed in kidney tubules and expelled during kidney damage Red Blood Cells = Present during infection, trauma, or cancer White Blood Cells = Found in kidney disease and UTI Urobilinogen = Tests for jaundice and liver disorders</p> Signup and view all the answers

    Match the following conditions with their effects on urine specimens:

    <p>Refrigeration = Prevents bacterial growth in urine specimens Bacterial overgrowth = Leads to disintegration of cells and casts in urine specimens Delay in processing = Causes errors in chemical urinalysis First morning specimen = Best specimen for urinalysis due to high concentration</p> Signup and view all the answers

    Match the following types of urine specimens with their characteristics:

    <p>First morning specimen = Most concentrated urine specimen Unpreserved specimen = Not suitable for chemical urinalysis if not refrigerated Preserved specimen = Suitable for chemical urinalysis Refrigerated specimen = Prevents bacterial growth in urine specimens</p> Signup and view all the answers

    Match the following tests in urinalysis with their purposes:

    <p>Physical examination = Examines physical characteristics of urine Chemical testing = Tests for various substances in urine Microscopic examination = Examines urine under a microscope for cells, casts, and crystals</p> Signup and view all the answers

    Match the following characteristics of urine casts with their descriptions:

    <p>Physical component = Primary component of a cast Factor leading to formation = Factor that can lead to the formation of a cast Presence in urine = Significance of the presence of casts in urine</p> Signup and view all the answers

    Match the following types of urine collection with their primary purposes:

    <p>Random = Routine screening First morning = Pregnancy test 24 hr = Quantitative chemical tests Catharized = Bacterial cultures</p> Signup and view all the answers

    Match the following urine collection methods with their descriptions:

    <p>Suprapubic aspiration = Inserting a needle through the abdomen into the bladder Midstream, clean catch = Collecting urine at any time in a urine container Catharized = Routine screening, Bacterial cultures 24 hr = Collecting urine over a 24-hour period</p> Signup and view all the answers

    Match the following preservatives with their uses in urine specimens:

    <p>Boric acid = Preventing bacterial growth in urine specimens for routine urinalysis Antimicrobial agents = Preventing microbial growth in urine specimens for culture Acidic preservatives = Preventing protein denaturation in urine specimens for protein analysis Gel preservatives = Preventing clotting in urine specimens for coagulation studies</p> Signup and view all the answers

    Match the following consequences with the effects of delayed urine processing:

    <p>Microbial growth = Shift to alkaline pH and false positive protein and blood results Protein denaturation = Decrease in urine glucose levels Urine acidification = Increase in urine specific gravity Cast formation = Decrease in renal function</p> Signup and view all the answers

    Match the following types of urine specimens with their preparation requirements:

    <p>Random = No preparation required First morning = Discard the initial stream and collect the midstream 24 hr = Collect urine in a sterile container and refrigerate Catharized = Use a sterile catheter and collect urine directly into a sterile container</p> Signup and view all the answers

    Match the following types of urine analysis with their primary purposes:

    <p>Pregnancy test = Detecting human chorionic gonadotropin (hCG) Chemical urinalysis = Measuring pH, protein, and glucose levels Microscopic analysis = Examining urine sediment for casts, cells, and crystals Culture = Detecting bacterial growth and identifying pathogens</p> Signup and view all the answers

    Match the following types of casts with their compositions:

    <p>Hyaline casts = Protein and cellular debris Granular casts = Protein and cellular debris with granular appearance Red blood cell casts = Red blood cells and protein Waxy casts = Protein and cellular debris with waxy appearance</p> Signup and view all the answers

    Match the following types of urine crystals with their associated conditions:

    <p>Uric acid crystals = Gout and kidney stones Cystine crystals = Cystinuria and kidney stones Oxalate crystals = Hyperoxaluria and kidney stones Phosphate crystals = Kidney damage and chronic kidney disease</p> Signup and view all the answers

    Match the following terms related to urine production with their definitions:

    <p>Anuria = increased production of urine Oliguria = absence of urine production Polyuria = decreased production of urine Nocturia = excessive urination at night</p> Signup and view all the answers

    Match the following substances with their effects on urine color:

    <p>Beets = yellow-orange urine Rhubarb = red urine Carrots = green-blue urine Clorets = brown-black urine</p> Signup and view all the answers

    Match the following types of urine collection with their descriptions:

    <p>Random = collected for a 24-hour period First Morning Specimen = collected at any time in a urine container 24-hour collection = collected for routine urinalysis Midstream, clean catch = specimen of choice for urinalysis and microscopic analysis</p> Signup and view all the answers

    Match the following kidney functions with their descriptions:

    <p>Regulating the volume of fluid in the blood = keeping the chemical components of the blood at a constant level Keeping the chemical components of the blood at a constant level = regulating the volume of fluid in the blood Producing urine = regulating the volume of fluid in the blood Maintaining blood pH = keeping the chemical components of the blood at a constant level</p> Signup and view all the answers

    Match the following terms related to urine casts with their definitions:

    <p>Casts = formed from excess protein in the urine Hematuria = the presence of blood in the urine Urochrome = a type of urine cast Melanin = a pigment that gives urine its yellow color</p> Signup and view all the answers

    Match the following types of urine crystals with their formations:

    <p>Uric acid crystals = alkaline urine Triple phosphate crystals = acidic urine Calcium oxalate crystals = alkaline urine Cystine crystals = acidic urine</p> Signup and view all the answers

    Match the following terms related to renal workup with their descriptions:

    <p>Bilirubin = a pigment that gives urine its yellow color Nitrites = a sign of bacterial infection in the urine Ketones = a sign of diabetes in the urine Glucose = a sign of kidney damage in the urine</p> Signup and view all the answers

    Match the following types of urine analysis with their purposes:

    <p>Microscopy = measuring the specific gravity of urine Chemical urinalysis = detecting red blood cells in the urine Urinalysis = measuring the pH of urine Culture and sensitivity = detecting bacterial growth in the urine</p> Signup and view all the answers

    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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