Urine Analysis Report PDF

Chemical Analysis INTRODUCTION URINALYSIS is a simple non-invasive diagnostic test which can provide a glimpse into a person’s health The urinary system Organs of the urinary system  Kidneys  Ureters  Urinary bladder  Urethra KIDNEY nephron Components of urine Collection...

Chemical Analysis INTRODUCTION URINALYSIS is a simple non-invasive diagnostic test which can provide a glimpse into a person’s health The urinary system Organs of the urinary system  Kidneys  Ureters  Urinary bladder  Urethra KIDNEY nephron Components of urine Collection requirements  Containers – white/red/green topped.  Mid stream  Early morning  Sample storage < 2hrs or kept at 4c out of direct sunlight - Types of testing  Physical  Chemical  Microscopic Chemical testing of urine  Usually done with reagent strips.  Used to determine body processes such as carbohydrate metabolism, liver or kidney function.  Used to determine infection.  Can be used to determine presence of drug or toxic environmental substances.  Some chemicals that can be found in urine (not normal components)  Ketones.  pH – acid/alkaline balance.  Blood  Bilirubin (urobilinogen)  Glucose  Protein  Nitrates  Leukocytes The manual dipstick test  Do’s and don’ts DO  Follow manufacturers instruction.  Ensure the sample is in the correct container for the test required (red/white top).  Ensure correct reagent strips are selected for the required test..  Always check and record the appearance of the urine sample.  Return the top on the reagent strip bottle.  TIMING IS ESSENTIAL for reliable results.  Do’s and don’ts DON’T  Remove the desiccant from the reagant strip bottle.  Touch the test areas of the strip.  Take out more strips than are required for immediate use. Sample requirements  Patients should instructed on how to collect the sample.  Sterile containers should be used to collect the sample  All samples must be properly labelled with the patient ID.  Ensure the sample is in the correct container for the test required.  The first sample on waking should be used for microalbumInuria as other samples may be less concentrated. Patient instruction ‘ To collect a clean urine sample: label the container with your name, date of birth and the date wash your hands  Cleaning the area to be taken from the sample startto urinate but don’t collect the first part of urine that comes out collect a sample of urine ‘mid-stream’ in a sterile screw-top container screw the lid of the container shut wash your hands thoroughly Materials/equipment required for dipstick testing  Reagent/test strips – in-date and stored correctly  Watch  Urine sample in suitable container  Gloves  Good lighting  Access to hand washing and drying  Suitable room (sluice) for testing  Suitable waste disposal - Urine Dipstick Glucose Bilirubin Ketones Specific Gravity Blood pH Protein Urobilinogen Nitrite Leukocyte Esterase Manual Test procedure ① Wear gloves. ② Ensure the sample is in the correct container. ③ Check the appearance of the sample and record results. ④ Ensure the strips have been stored properly & are in-date. ⑤ Remove the cap, take out strip and replace the cap on the bottle.  Sources of error  Incorrect dipping of reagent strip.  Incomplete wetting of strip.  Incorrect storage of strips – always check manufacturers instructions.  Sample error – sample must be allowed to return to room temperature, non sterile containers; sample needs to be fresh for best results.  Contamination of the reagent pad by handling or non sterile container.  pH may be falsely elevated if the urine is stale.  Some medication can affect some of the reagents on the strips (e.g. cephalosporins; L-dopa; high levels of salicylates; chlorhexadine; ferrous sulphate)  Strips out of date.  Vegetarians may have a urine pH >8.  Clinical significance of test results  Glucose - is found when its concentration in plasma exceed the renal threshold (may indicate diabetes)  Bilirubin/urobilinogen – indicates an excess in the plasma. Commonest cause of positive results is liver cell injury e.g. hepatitis, paracetamol overdose, late-stage cirrhosis.  Ketones – due to excessive breakdown of body fat. Common in fasting, may indicate low carbohydrate diet, vomiting & fever, present in starvation  Clinical significance of test results (cont.)  Specific gravity – a measure of solute concentration. High values can be found in dehydration. Low values found in high fluid intake. Diabetes insipidus; chronic renal failure; hypercalcaemia; hypokalaemia.  Blood – menstruation, kidney disorders; urinary tract disorders (e.g. tumours, prostatic enlargement).  pH – high values - commonest cause of high vales is stale urine; large intake of antacids;UTI with ammonia forming organisms. Low values – acidosis (diabetic & lactic); starvation; potassium depletion.  Clinical significance of test results (cont.)  Protein – excess albumen in the urine is unusually due increased permeability in the glomeruli. Positive results in acute and chronic kidney disease, pre-eclampsia.  Nitrite – UTI – most of the organisms which infect the urinary tract contains an enzyme that convers nitrate (normally found in urine) to nitrite which is not found in urine in the absence of infection. Some organisms do not convert nitrate to nitrite (false negative).  Leucocytes – leucocytes enter inflamed tissue from the blood and are shed into the urine. UTI is commonest cause of positive results.