MT305 LEC - Week 1 Intro to Urinalysis PDF

MT305 LEC WEEK 1: INTRODUCTION TO URINALYSIS (TRANSCRIPT) BSMLS HISTORY & IMPORTANCE  Analyzing urine was actually the beginning of laboratory medicine...

MT305 LEC WEEK 1: INTRODUCTION TO URINALYSIS (TRANSCRIPT) BSMLS HISTORY & IMPORTANCE  Analyzing urine was actually the beginning of laboratory medicine  References to the study of urine can be found in the drawings of cavemen and in Egyptian hieroglyphics, such as the Edwin Smith Surgical Papyrus  Although these physicians lacked the sophisticated testing mechanisms now available, they were able to obtain diagnostic information from such basic observations as o Color o Turbidity o Odor o Volume o Viscosity o Sweetness - By noting that certain specimens attracted ants or tasted sweet  Hippocrates - In the 5th century BCE, wrote a book on “uroscop.”  Middle Ages - Physicians concentrated their efforts very intensively on the art of uroscopy, receiving instruction in urine examination as part of their training  Frederik Dekkers - Discovery in 1694 of albuminuria by boiling urine o Type of protein; Dapat walang albumin sa urine  Charlatans without medical credentials URINE VOLUME began offering their predictions to the  Normal Daily Urine Output - 1200-1500 mL public for a healthy fee. These  A range of 600 to 2000 mL - considered normal charlatans, called “pisse prophets,” became the subject of a book  Oliguria - Decrease in urine output published by Thomas Bryant in 1627 o Infants - Less than 1 mL/kg/hr  Galen (A.D.) – “Diarrhea of Urine” o Children - Less than 0.5 mL/kg/hr  Medieval Period - Period of water casting o Adults - Less than 400 mL/day o By the late middle ages, the study of urine had solidified into  Anuria - Cessation (wala) of urine flow the practice known as uroscopy  Nocturia - Increase in the nocturnal excretion of urine (Madalas o Medieval doctors associated nearly every known disease with umihi sa gabi) urinary characteristics , and some would diagnose patients  Polyuria - Increase in daily urine volume – associated with DI and without even meeting them just by examining a bottle of their DM urine o Diabetes Insipidus - Kulang production ng vasopressin/ADH  The invention of the microscope in the 17th century led to the o Diabetes Mellitus examination of urinary sediment  Can’t produce insulin  Thomas Addis - Methods for quantitating the microscopic  Type I - Insulin dependent sediment  Type II - Insulin independent; Acquired through lifestyle,  Richard Bright - Introduced the concept of urinalysis as part of a environment doctor’s routine patient examination in 1827 o Adults - >2.5 L/day  By the 1930s, however, the number and complexity of the tests o Children - 2.5 to 3 mL/kg/day performed in a urinalysis had reached a point of impracticality, and urinalysis began to disappear from routine examinations  Fortunately, development of modern testing techniques rescued routine urinalysis, which has remained an integral part of the patient examination  2 Unique Characteristics of a Urine Specimen Account for this Continued Popularity o Urine is a readily available and easily collected specimen o Urine contains information, which can be obtained by inexpensive laboratory tests, about many of the body’s major metabolic functions URINE FORMATION  An ultrafiltrate of plasma  Reabsorption of water and filtered substances essential to body function converts  Specific Gravity – Gaano kabigat ung ihi approximately 170,000 mL of filtered plasma SPECIMEN COLLECTION  Containers - Clean, dry, leak-proof containers often disposable  1200 mL - Average daily urine  50mL - Recommended capacity of the container output  12 mL - Specimen needed for microscopic analysis URINE COMPOSITION  Sterile Container - Microbiology and if more than 2 hours will  Consists of urea and other organic and inorganic chemicals elapse before reading the urine (Within 1 hour after collection) dissolved in water o 95% water LABELS o 5% solutes  Patient’s name o Urea – half  Identification number o Creatinine  The date and time of collection, and additional information such as o Uric acids the patient’s age and location and the healthcare provider’s name. o Chloride – major inorganic compound (depends on the protocol) o Na, K REQUISITION o Hormones  Manual or computerized o Vitamins  Can include method of collection o Formed elements, such as cells, casts  Type of specimen, possible interfering medications, and the o Crystals, mucus, and bacteria patient’s clinical information  The time the specimen is received in the laboratory should be recorded on the form SPECIMEN REJECTION  Specimens in unlabeled containers  Nonmatching labels and requisition forms  Specimens contaminated with feces or toilet paper  Containers with contaminated exteriors  Specimens of insufficient quantity  Specimens that have been improperly transported BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE SXIA  MT305 LEC WEEK 1: INTRODUCTION TO URINALYSIS (TRANSCRIPT) BSMLS SPECIMEN INTEGRITY  Transport - May ice ung lagayan  Specimens should be delivered to the laboratory promptly and CATHETERIZED SPECIMEN tested within 2 hours  Collected under sterile  > 2 Hours Reading Time - Refrigerate and add chemical conditions by passing a preservative hollow tube (catheter) CHANGES IN UNPRESERVED URINE through the urethra into the bladder  Bacterial Culture - Most commonly requested test on a catheterized specimen MIDSTREAM CLEAN-CATCH SPECIMEN  Alternative to the catheterized  Provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis  Representative of the actual urine than the routinely voided specimen  1st Urine - Contaminated with epithelial cells  Increased pH - Alkaline  2nd Urine - Actual representation of urine  Decreased pH - Acidic  Nitrite - Some bacteria produce nitrite  Trichomonas - Parasite SPECIMEN REJECTION  Most routinely used method of preservation is refrigeration at 2°C to 8°C, which decreases bacterial growth and metabolism  Use of chemical preservatives (if prolong transport and refrigeration is unavailable) URINE PRESERVATIVE  Refrigeration - Mostly used  Sediment - Material get from centrifuge urine TYPES OF SPECIMENS RANDOM SPECIMEN  Most commonly received specimen because of its ease of collection and convenience for the patient  Are be collected at any time  Commonly performed FIRST MORNING SPECIMEN  Ideal screening specimen  Essential for preventing false-negative pregnancy tests  Evaluating orthostatic proteinuria  Concentrated specimen SUPRAPUBIC ASPIRATION  Collected by external  Mas concentrated introduction of a needle  Orthostatic Proteinuria - Releasing high amount of protein due to through the abdomen into the upright position (Ex. Security guards ) bladder 24-HOUR (TIMED) SPECIMEN  Sample for bacterial culture  Used to produce accurate quantitative results that is completely free of  Falsely Elevate Results - Addition of urine formed before the start extraneous contamination of the collection period -  Used for cytologic examination  Falsely Decrease Results - Failure to include urine produced at the  Mas free from contamination end of the collection period than catheter PROSTATIC SPECIMEN  Detects the presence of prostatitis  3-Glass Collection - Collection of 3 parts of urine o 1st (Urine Passed) - Collected in the sterile container (Urethral infection / inflammation) o 2nd (Midstream Portion) - Collected on another sterile container (Urinary bladder infection) o 3rd Urine Passed (Remaining Urine) - Will also be collected to another sterile container after doing prostate massage-4th container (Prostatic infection; mostly for male)  All Specimens Collected - Subjected to quantitative urine culture  1st and 3rd Urine Sample - Examined microscopically  In Prostatic Infection o 3rd Urine Specimen - + WBC and 10x more bacteria present BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE SXIA  MT305 LEC WEEK 1: INTRODUCTION TO URINALYSIS (TRANSCRIPT) BSMLS o 2nd Urine Specimen - Used as a control for bladder and kidney infection  If + for Wbc and Bacteria, 3rd urine is invalid due to infected urine (UTI) contamination PRE- & POST-MASSAGE TEST  Pre- and Post-Massage Test (PPMT) - Clean-catch midstream urine specimen is collected  A second urine sample is collected after the prostate is massaged  Positive Result - Significant bacteriuria in the post-massage specimen of greater than 10 times the pre massage count PEDIATRIC SPECIMENS  Soft, clear plastic bags with hypoallergenic skin adhesive to attach to the genital area  Sterile Specimens - Obtained by catheterization or by suprapubic aspiration DRUG SPECIMEN COLLECTION  Urine Specimen Collection - Most vulnerable part of a drug-testing program  Chain of Custody (COC) - Process that provides this documentation of proper sample identification from the time of collection to the receipt of laboratory results  Tampering of Specimen - Via Substitution, Adulteration and Dilution  Urine Volume o 30-45ml (Strasinger) o DOH Manual  60 ml - Single collection  30 ml - Split collection  Temperature - 32.5-37.7 degrees BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE SXIA