Unit 4 Urinalysis Diane Perry 1.0.ppt

Urinalysis The study of urine 2.1.1, 2.3,3.1.6,3.3.1, 3.3.2,3.3.3,3.3.4 13a` Objectives Urinalysis  Objectives 1.Basic Definitions in Urinalysis 1.1 Define basic urinalysis terms 2. How muc...

Urinalysis The study of urine 2.1.1, 2.3,3.1.6,3.3.1, 3.3.2,3.3.3,3.3.4 13a` Objectives Urinalysis  Objectives 1.Basic Definitions in Urinalysis 1.1 Define basic urinalysis terms 2. How much water and solutes in urine 2.1 Describe how much water and solutes in urine 3. Causes in the color of urine 3.1 List some of the causes in the color of urine 4. Normal volume of urine 4.1 List the normal volume of urine 5. Different types of urine collections 5.1 List the different types of urine collections 5.2 Describe the different types of urine collection s 3  Objectives 6. Different types of urine preservations 6.1 List the different types of urine preservations 7. Steps in urinalysis 7.1 Describe step by step the procedure in urinalysis 7.2 Describe the physical examination 7.3 Describe the chemical examination 7.4 Describe the microscopic examination 8. Chlamydia Urine Collection 8.1 Describe the procedure in Chlamydia Urine Collection 9. Occult blood test 9.1 Describe the two methods in collect occult blood 4  Urinalysis It is the most common and oldest test order Urinalysis has used as a diagnostic tool over 6,000 years ago 5  Urinalysis 6  Urine composition Urine consists of urea and other organic and inorganic chemicals dissolve in water. Urea – is a metabolic waste product produced in the liver from breakdown of protein and amino acids. Urea accounts for almost half of the total dissolved solutes in urine. Other organic substances include creatine and uric acid. The major inorganic chemical is chloride, folloed by potassium and sodium 7  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 8  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 9  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 10  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 11  Kidneys Regulate the volume of fluid in the blood Keeps the chemical components of the blood at a constant level 12  Types of urine collection Random – collected at any time in a urine container. Collected for routine urinalysis First Morning Specimen - This is the specimen of choice for urinalysis and microscopic analysis, since the urine is generally more concentrated (due to the length of time the urine is allowed to remain in the bladder) and, therefore, contains relatively higher levels of cellular 13  Types of urine collection 24 hour collection – urine is collected for a 24 hour period. The patient discards the first morning void. All further voids are placed in the container, including the first morning specimen of the next day. A preservative may be added depending on the test ordered. Collected for chemistry testing. Normal volume of urine/24 hours is approx 750- 2000 ml. 14  Urine Collection Hat 15  24 hr. urine collection 16  Note : for 24 hr collection - Collect urine in a collection hat or plastic container. Do not void directly in the 24 hr container as it might contain a caustic preservative. Voiding directly in the container might cause splashing. After voiding in to collection hat, pour contents carefully into 24 hr container 17  Note : for 24 hr collection When measuring the volume of a 24 hr. urine specimen , use a graduated cylinder. Then record the volume 18  Types of urine collection Catheterized specimen - This specimen is collected under sterile conditions by passing a catheter ( hollow tube) through the urethra into the bladder. Urine from the bladder through the catheter into a plastic bag where it accumulates. Then a urine specimen is collected from the bag. 19  Types of urine collection Midstream clean catch –  Female- Sit on the toilet with your legs spread apart while voiding. Use two fingers to spread open your labia. Keeping your labia spread open, urinate a small amount into the toilet bowl, then stop the flow of urine. Hold the urine cup a few inches (or a few centimeters) from the urethra and urinate until the cup is about half full.  Male - Urinate a small amount into the toilet bowl, and then stop the flow of urine. Then collect a sample of urine into the clean or sterile cup, until it is half full. You may finish urinating into the toilet bowl. Collected for microbiology. You may be given a special clean-catch kit that 20 contains sterile wipes  Types of urine collection The BD Vacutainer® Urine Culture and Sensitivity tube Collect the specimen as a normal C&S. ( sterile container) After collection, insert holder ( this has the sterile straw). Next push in gray stopper tube After gray stopper tube is filled, put holder into sharps container. Preservative – Boric Acid 21 Mix tubes and label.  Note: Delay in urine processing and prolonged exposure at room temperature may result in microbial growth with changes in the pH (shift to alkaline), which may cause false positive protein and blood results.  Also, urine glucose may decrease as growing microorganisms utilize the sugar. 22  Types of urine collection Suprapubic aspiration – This specimen is collected by inserting a needle through the abdomen into the bladder. 23  Chart of urine collection Type of specimen Purpose Random Routine screening First morning Routine screening, Pregnancy test 24 hr Quantitive chemical tests Catharized Bacterial cultures Midstream, clean catch Routine screening, Bacterial cultures Suprapubic Bacterial culture 24  Preservatives for urines When a decision to use a preservative is made – for any type of testing, potential interference with assay methods should be considered. Laboratories should validate all test procedures intended to be used for preserved specimens. Specimens may need to be split if various tests requiring different preservatives are requested. 25  Examples of preservatives for urines Refrigeration Tartaric acid, Boric acid Sodium carbonate Hydrochloric acid, , Acetic acid 26  Routine Urinalysis For chemical urinalysis, unpreserved specimens exceeding the two hour limit that have not been refrigerated should not be accepted for analysis due to potential bacterial overgrowth leading to disintegration of cells and casts and errors in chemical urinalysis. The best specimen is first morning specimen This is because it is the most concentrated 27  Routine Urinalysis Should be done within 2 hours after collection. Consists of three parts: Physical examination Chemical testing Microscopic examination (microscopy) - in some labs microscopic examination is only done if the chemical testing is abnormal or if it specifically requested 28  Physical examination Color – yellow, brown, red Turbidity – clear, turbid, slightly turbid, mod turbid or very turbid. Specific gravity (SG) – measures the weight of urine compared to the weight of water. SG of 1.000 is very dilute, SG of 1.030 is very concentrated. 29  Physical examination Specific gravity is now done on the chemical step Specific gravity is done at the physical step , only when the chemical strip does not have specific gravity on the strip 30  Physical examination  Note. We usually do not do odor or volume in routine urinalysis Odor is unsafe and unreliable Volume is done in other special collections 31  Urine color & turbidity 32  Urine turbidity 33  Specfic Gravity Refractometer 34  Chemical examination PH – tests the acidity or alkalinity of the urine Protein - ↑ indicates kidney disease Glucose – presence in urine indicates ↑ blood glucose ( diabetes) Ketones - ↑ in diabetics or starvation Bilirubin – to test for liver disease Blood – present during infection, trauma, cancer, kidney stones or other bleeding Nitrites – indicates the presence of bacteria 35  Urobilinogen – test for jaundice and other liver disorders Leukocytes- found in kidney disease and UTI Also Specific Gravity 36 37  Urine Strip Reader 38  Microscopy Urine microscopy will only be performed when Urinalysis Renal Workup is ordered. Renal workup is dipstick plus reflex to microscopy only if positive for blood, protein or leukocyte esterase.  The Urine Renal Workup will provide information on the presence of casts, cells and other formed elements. Urinary Crystals will no longer be reported as part of the urine microscopic examination 39  Microscopy Done on the sediment of centrifuged urine Procedure: Pour urine into test tubes Centrifuge Pour off supernatant Mix sediment Place a small amount of sediment on a slide Cover with a coverslip Examine under high power ( 400X) 40  Cells that may be found in urine 41  Red Blood Cells 42  White Blood Cells 43  White and Red blood cells normal 1-3/HPF 44 45  CASTS Casts- formed in the kidney tubules and expelled during kidney damage. The main component of a cast is a gel – like protein 46  4 factors that can lead to the formation of a cast; - Decreased urine flow - Increased acidity ( low ph) - Increased concentration ( high SG) - Increased plasma proteins 47  Examples of Casts Red cell casts 48  WBC Cast 49  Hyaline Cast 50  Granular Cast 51  Waxy Cast 52  Crystals Crystals are formed by the precipitation of urine salts when changes occur in the ph, temperature( crystal form at low temperatures) or concentration of the urine. The most important aid in identification of urine crystals is the ph of the urine 53  There are 2 kinds of crystals; - Crystals that form in acid urine - Crystals that form in alkaline urine 54  Calcium Oxalate Crystals Acid ph 55  Cystine Crystals Acid ph 56  Triple phosphate crystals Alkaline ph 57  Urine may also contain Yeast ( Candida albicans) 58  Bacteria 59  Trichomonas vaginalis 60  Trichomonas vaginalis https://youtu.be/8SNDtKfhPg4 61  Sperm 62  Mucous 63  Oil or Air Debris 64  Debris from fibre 65  Fat Droplets 66  Chlamydia Urine Collection Chlamydia is a very common and curable sexually transmitted disease (STD). It's caused by a kind of bacteria called the chlamydia trachomatis bacteria and can be passed from person to person during vaginal, oral and anal sex. 67  In women, untreated infections can lead to chronic pelvic pain, pelvic inflammatory disease (PID), infertility,. It can also cause prenatal problems for an unborn baby including pneumonia.  In men, untreated infection can spread to other parts of the penis, prostate and testicles and cause pain and inflammation. Untreated, chlamydia can also lead to sterility in men. 68  Chlamydia Urine Collection Until recently, testing patients for chlamydia and gonorrhea involved collecting samples from the cervix or urethra and sending them for cultures. The discomfort and embarrassment associated with sampling these sites may deter some high-risk patients from seeking testing for these treatable infections. There is an alternate method 69  The Chlamydia Nucleic Acid Amplification (NAA) Test is a urine test, This test is highly recommended by the CDC for its accuracy. There's no swabbing - all you do is pee in a cup. 70  Chlamydia Urine Collection ( Gen Probe)  Specimen Collection and Handling: 1. The patient should not have urinated for at least 1 hour prior to specimen collection. 2. Direct patient to provide a first-catch urine (approximately 20 to 30 mL of the initial urine stream) into a urine collection cup free of any preservatives. Collection of larger volumes of urine may result in specimen dilution that may reduce test sensitivity. Female patients should not cleanse the labial area prior to providing the specimen. 71   3. Remove the cap and transfer 2 mL of urine into the urine specimen transport tube using the disposable pipette provided. The correct volume of urine has been added when the fluid level is between the black fill lines on the urine specimen transport tube label.  4. Re-cap the urine specimen transport tube tightly. This is now known as the processed urine specimen. Transport specimen as soon as possible. LIMITATIONS 1. Use this collection kit only with the GEN-PROBE® APTIMA® Assays. 72  Occult Blood Test (FOCT) 73  Stool for Occult Blood This is a rapid method for the detection of red blood cells in stool. This test is also called fecal guaiac test Used for the detection of colorectal cancer The patient is instructed to follow a special diet that is high in fiber for 48 hours before the test 74  Fecal Immunochemical Test (FIT) The fecal immunochemical test (FIT) is a screening test for colon cancer. It tests for hidden blood in the stool, which can be an early sign of cancer. FIT only detects human blood from the lower intestines. Medicines and food do not interfere with the test. So it tends to be more accurate and have fewer false positive results than other tests. 75  Fecal Immunochemical Test (FIT) Follow these steps to collect your stool sample and do your FIT: Gather your supplies. Place them in the bathroom where you can reach them easily. You will need your: Test card Brush kit with 2 brushes and 1 waste bag Return envelope Label 76  Fecal Immunochemical Test (FIT) Specimen bag Trash can Flush the toilet 2 to 3 times before you collect your sample. Sit on the toilet to have a bowel movement (poop) as usual. Don’t flush the toilet after your bowel movement. 77  Fecal Immunochemical Test (FIT) 78  Fecal Immunochemical Test (FIT) Using one of the brushes from your brush kit, gently brush the surface of your stool for about 5 seconds (see Figure 2). If your stool is loose, stir the water around the stool with your brush for 5 seconds. Figure 2. Brush the surface of your stool 79  Fecal Immunochemical Test (FIT) 80  Fecal Immunochemical Test (FIT) Remove the brush from the water. Gently shake it over the toilet to remove extra water and any clumps of stool. Rub the brush inside the square marked “1” on your test card (see Figure 3). Place the brush in the waste bag. 81  Fecal Immunochemical Test (FIT) Using the other brush, repeat. Then, rub the brush inside the square marked “2” on your test card. Place the brush in the waste bag and throw it away. Flush the toilet. Wash your hands. Wet your hands with warm water, then rub them with soap for at least 20 seconds. Rinse your hands well under warm running water. 82  Fecal Immunochemical Test (FIT) Close the flap of the test card. Check that the information on the label your healthcare provider gave you is correct. Place the label on the test card. Make sure to place it within the dotted lines so the flap doesn’t open. Write the date and time of your collection on the label on the specimen bag. Place your test card in the specimen bag. Then, place the specimen bag in the pre-paid envelope your healthcare provider gave you. The mailing address is on the envelope. 83