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Questions and Answers
Which factor does NOT influence urine volume?
Which factor does NOT influence urine volume?
What is the typical range of urine volume voided by an adult each day?
What is the typical range of urine volume voided by an adult each day?
Which condition is associated with decreased urine output (oliguria)?
Which condition is associated with decreased urine output (oliguria)?
What is the appropriate capacity for routine urinalysis containers?
What is the appropriate capacity for routine urinalysis containers?
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What is the correct way to label a urine specimen container?
What is the correct way to label a urine specimen container?
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What is the correct order of steps for the clean-catch urine collection procedure for men?
What is the correct order of steps for the clean-catch urine collection procedure for men?
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Why is it important to touch only the outer surfaces of the container during the urine collection process?
Why is it important to touch only the outer surfaces of the container during the urine collection process?
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What method is used for obtaining a specimen through the abdomen into the bladder?
What method is used for obtaining a specimen through the abdomen into the bladder?
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When collecting pediatric specimens using plastic bags, what is the next step after enough urine has been collected?
When collecting pediatric specimens using plastic bags, what is the next step after enough urine has been collected?
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What is the recommended volume of urine to be collected during the clean-catch urine procedure?
What is the recommended volume of urine to be collected during the clean-catch urine procedure?
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What is a criterion that would lead to the rejection of a specimen?
What is a criterion that would lead to the rejection of a specimen?
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Which method is recommended for preserving specimens if testing cannot occur within two hours?
Which method is recommended for preserving specimens if testing cannot occur within two hours?
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What effect does increased bacterial multiplication have on urine composition?
What effect does increased bacterial multiplication have on urine composition?
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Which of the following could lead to specimen rejection due to improper handling?
Which of the following could lead to specimen rejection due to improper handling?
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What change occurs in urine when it is not preserved properly?
What change occurs in urine when it is not preserved properly?
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What happens to glucose levels in urine if it is not preserved appropriately?
What happens to glucose levels in urine if it is not preserved appropriately?
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Which of the following is NOT a method of preserving specimens?
Which of the following is NOT a method of preserving specimens?
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What is the primary cause of changes in urinalysis results if the sample is delayed beyond the recommended time frame?
What is the primary cause of changes in urinalysis results if the sample is delayed beyond the recommended time frame?
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What is a potential consequence of not emptying the bladder at the start of a 24-hour timed urine specimen collection?
What is a potential consequence of not emptying the bladder at the start of a 24-hour timed urine specimen collection?
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Which urine collection method typically provides the least contamination from epithelial cells and bacteria?
Which urine collection method typically provides the least contamination from epithelial cells and bacteria?
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How should specimens be treated during the collection period for a 24-hour timed specimen?
How should specimens be treated during the collection period for a 24-hour timed specimen?
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Which of the following is NOT a common error associated with timed urine collections?
Which of the following is NOT a common error associated with timed urine collections?
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What is the primary benefit of using a concentrated urine sample in tests?
What is the primary benefit of using a concentrated urine sample in tests?
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What is typically collected during a catheterized urine specimen procedure?
What is typically collected during a catheterized urine specimen procedure?
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What type of urine specimen collection is ideal for quantitating protein and electrolytes?
What type of urine specimen collection is ideal for quantitating protein and electrolytes?
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In a clean-catch urine collection, what is the purpose of discarding the first part of the urine stream?
In a clean-catch urine collection, what is the purpose of discarding the first part of the urine stream?
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What is the maximum duration for which specimens should be refrigerated before analysis or culturing?
What is the maximum duration for which specimens should be refrigerated before analysis or culturing?
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What is the primary reason specimens should be allowed to return to room temperature before chemical reagent strip testing?
What is the primary reason specimens should be allowed to return to room temperature before chemical reagent strip testing?
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Which of the following is NOT a characteristic of an ideal urine preservative?
Which of the following is NOT a characteristic of an ideal urine preservative?
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What is a disadvantage associated with using boric acid as a urine preservative?
What is a disadvantage associated with using boric acid as a urine preservative?
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What type of specimen is primarily known as a spot specimen?
What type of specimen is primarily known as a spot specimen?
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Which specimen type is best for urine pregnancy testing?
Which specimen type is best for urine pregnancy testing?
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What should NOT be used if the urine level in a Gray C&S tube is below the minimum fill line?
What should NOT be used if the urine level in a Gray C&S tube is below the minimum fill line?
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What is an advantage of refrigeration as a urine preservative?
What is an advantage of refrigeration as a urine preservative?
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Study Notes
Urine Composition
- Sodium is found primarily in salt.
- Potassium is combined with chloride and other salts.
- Trace amounts of phosphate, ammonium and calcium are also present.
- Phosphate combines with sodium to regulate blood pH (buffering).
- Ammonium helps regulate blood and tissue fluid acidity.
- Calcium combines with chloride sulfate and phosphate.
Urine Volume
- Normal urine volume is typically 600-2000 mL, with a common range of 1200-1500 mL.
- Volume is affected by fluid intake, fluid loss from nonrenal sources, and variations in the secretion of antidiuretic hormone (ADH).
Decreased Urine Volume
- Oliguria is a decrease in urine output, below 2.5 L/day.
- Oliguria can be associated with conditions like diabetes mellitus and diabetes insipidus.
- Substances like diuretics, caffeine, and alcohol can suppress ADH secretion, artificially inducing oliguria.
Diabetes Mellitus vs. Diabetes Insipidus
- Urine analysis can be used to differentiate between these types of diabetes.
Specimen Collection Containers
- Urine must be collected in clean, dry, leak-proof containers.
- Containers should be disposable, with screw-top lids to prevent leakage.
- For routine urinalysis, wide mouth and wide bottom containers are preferred.
- Clear material allows for color and clarity assessment.
- Sterile containers are necessary for microbiology testing.
Specimen Collection Labelling and Requisitions
- Specimen labels should include patient name, healthcare number, and date & time of collection.
- Labels must be attached to the container, not the lid.
- A requisition with matching information must accompany the specimen.
Specimen Rejection Criteria
- Unlabeled containers.
- Mismatched patient information on specimen label and requisition.
- Specimens contaminated with feces or toilet paper.
- Containers with contaminated exteriors or leakage.
- Insufficient specimen quantity.
- Improperly transported or > 24 hours old specimens.
- Specimens that were not properly preserved.
- Urine cultures collected in non-sterile containers.
- Inappropriate collection for the required testing.
- Laboratories should have written policies regarding specimen rejection.
Specimen Handling
- Specimen collection, handling, processing, and reporting should meet laboratory standards.
- Ideal testing time for urinalysis is within 2 hours.
- Refrigeration or preservative use is recommended for delayed testing.
- Improper preservation can alter urine composition due to bacterial growth.
Changes in Unpreserved Urine
- Color: Modified or darkened due to oxidation or reduction of metabolites.
- Clarity: Decreased due to bacterial growth and precipitation.
- Odor: Increased due to bacterial breakdown of urea to ammonia.
- pH: Increased due to urea breakdown and loss of CO2.
- Glucose: Decreased due to glycolysis and bacterial utilization.
- Ketones: Decreased due to volatilization and bacterial metabolism.
- Bilirubin: Decreased due to exposure to light and photooxidation.
- Urobilinogen: Decreased due to oxidation.
- Nitrite: Increased due to nitrate-reducing bacteria multiplication.
- RBCs, WBCs, casts: Decreased due to disintegration in alkaline urine.
- Bacteria: Increased due to multiplication.
- Trichomonas: Decreased due to loss of motility and death.
Urine Preservatives
- Refrigeration at 2-8°C is the most common preservation method for up to 24 hours.
- Specimens should be allowed to return to room temperature before reagent strip testing.
- Chemical preservatives can be used for transport if refrigeration is unavailable.
- The ideal preservative should be bactericidal, inhibit urease, preserve formed elements, and not interfere with chemical tests.
- The choice of preservative should depend on the specific test ordered.
Types of Urine Specimens
- Random
- First Morning
- 24-hour (or timed)
- Catheterized
- Midstream Clean-Catch
- Suprapubic Aspiration
- Pediatric
Random Specimen
- Most common type of specimen.
- Collected at any time.
- Suitable for routine testing (physical, chemical, microscopic).
First Morning Specimen
- More concentrated than random urines.
- Recommended for nitrite, protein, and microscopic examination.
- Preferable for urine pregnancy testing to avoid false negatives.
- Helpful for evaluating orthostatic proteinuria.
- May have deteriorated casts.
- Bacteria can impact glucose analysis (decreased glucose).
24-Hour or Timed Specimen
- Collect all voidings over a specific period (2, 12, or 24 hours).
- Produces quantitative results for protein, creatinine, and electrolytes.
- Specimens should be refrigerated during collection and mixed well before analysis.
- Preservatives may be required.
Common Errors with Timed Urines
- Loss of urine specimens.
- Inclusion of two first morning specimens.
- Inaccurate total volume measurement.
- Inadequate or incorrect preservative use.
- Transcription errors.
Catheterized Specimen
- Collected under sterile conditions.
- A hollow tube is inserted through the urethra into the bladder.
- Commonly requested for bacterial cultures.
Midstream Clean-Catch Specimen
- Patient cleanses the genital area with wipes before mid-urination collection.
- Reduces contamination with epithelial cells and bacteria.
Clean-Catch Urine Collection Procedures for Women
- Wash hands thoroughly.
- Remove container lid without touching the inside.
- Squat over the toilet.
- Separate the folds of skin around the urinary opening.
- Cleanse from front to back with wipes.
- Void into the toilet for a few seconds.
- Hold the container in the urine stream.
- Finish voiding into the toilet.
- Secure the lid without touching the inside.
- Clean the exterior with an antiseptic wipe.
Clean-Catch Urine Collection Procedures for Men
- Wash hands thoroughly.
- Remove container lid without touching the inside.
- Wash the end of the penis with a wipe, starting at the urethral opening and working away in a circular motion (retract foreskin if present).
- Void into the toilet for a few seconds.
- Hold the container in the urine stream.
- Finish voiding into the toilet.
- Secure the lid without touching the inside.
- Clean the exterior with an antiseptic wipe.
Suprapubic Aspiration
- Needle is inserted through the abdomen into the bladder.
- Provides a contamination-free sample for bacterial culture and cytologic examination.
Pediatric Specimens
- Collected using soft, clear plastic bags attached to the infant's genital area.
- Once sufficient urine is collected, the bag is removed and the specimen poured into a container.
- Catheterization or suprapubic aspiration can also be used.
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Description
Test your knowledge on the composition and volume of urine in this quiz. Explore concepts like normal urine volume, the effects of various substances on urine output, and the differences between diabetes mellitus and diabetes insipidus. Challenge yourself and deepen your understanding of renal physiology.
