Urinalysis PDF

CHRISTINE A. AGBUNAG, RMT  Formed in the kidneys as an ultrafiltrate of plasma. It is the most analyzed body fluid in the body. Reasons for using urine as specimen: It is readily available and easily collected. It contains information about the body’s major metabolic functions....

CHRISTINE A. AGBUNAG, RMT  Formed in the kidneys as an ultrafiltrate of plasma. It is the most analyzed body fluid in the body. Reasons for using urine as specimen: It is readily available and easily collected. It contains information about the body’s major metabolic functions. Inexpensive laboratory testing can be performed. It is most useful in ascertaining evidence of disease or disturbing function of the kidneys. Testing of urine with procedures commonly performed in an expeditious, reliable, safe and cost-effective manner. REASONS FOR URINALYSIS Diagnosis of disease. Screening asymptomatic populations for undetected disorders. Monitoring progress of disease and effectiveness of therapy. Diagnosing and treating urinary tract infections. 1 Ease of collection and convenience for the patient. Most commonly received in the laboratory Collected at anytime but the time of collection should be recorded. 2 Collected immediately after waking up from 8 hours of sleep. CONCENTRATED SPECIMEN Ideal screening specimen. Prevent false-negative pregnancy tests and is used for evaluating orthostatic proteinuria. 3 A second morning or second specimen voided after fasting (glucose monitoring). 4 1. Tolerance test - fasting, 1/2 hour, 1 hour, etc. 2. 2-hour post prandial - two hours after meal. 3. Double voided - waiting time of approximately 30 minutes after emptying the bladder. 4. 24-hour urine specimen.  Used to produce accurate quantitative results. When the concentration of the substance to be measured changes with diurnal variations and with daily activities, such as exercise, meals, and body metabolism, 24-hour collection is required. To obtain an accurate timed specimen, the patient must begin and end the collection period with an empty bladder.  24-hour specimen Procedure 1. Empty the bladder upon waking up. 2. Affix the label on the container and write down the time and date of the specimen collection. Start timing. 3. Discard line output at the first hour of collection and collect all the urine that has been passed for the next 24 hours. 4. If instructed, refrigerate the specimen collected all throughout the collection period. 5. Collect urine prior to bowel movement. 6. Drink fluid as needed to avoid dehydration. 7. Take one last void at the end of the 24-hour collection period. 8. Make sure the container is sealed before placing it in the cooler. Arrange to transport the specimen to the laboratory at the soonest possible time. 5 Specimen is collected under sterile conditions by passing a hollow tube (catheter) through the urethra into the bladder. Test requested most commonly on a catheterized specimen is a bacterial culture. 6 Safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis. Alternative to the catheterized specimen. More representative of the actual urine than the routinely voided specimen. It is less contaminated by epithelial cells and bacteria. 7 Collected by external introduction of a needle through the abdomen into the bladder. Bacterial culture and cytology examinations. 8 1. Three-Glass Collection 2. Pre- and Postmassage Test 3. Stamey-Meares Test for Prostatitis 9 Soft, clear plastic bags that are hypoallergenic are available for collecting routine specimens. These bags have hypoallergenic skin adhesive to attach to the cleaned genital area of both boys and girls. Sterile specimens may be obtained by catheterization or by suprapubic aspiration.  Regular voided The patient voids or urinates into a clean container. The patient voids or urinates into the toilet first, interrupts the urination Midstream for a while, and then restarts into the container with the last urine flow voided in the toilet. Midstream clean- Special cleaning is performed on the genital area of the patient before catch collection. Urine of patient is collected from a sterile catheter inserted through the Catheterized urethra into the bladder. Suprapubic Urine of patient is collected by inserting needle directly into bladder and aspiration aspirating the urine by the use of a sterile syringe. When the patient is a child who is not potty-trained, urine is collected in a Pediatric plastic bag and checked every 15 minutes until the required volume is collected.  Varies from almost colorless to black. Variations may be due to normal metabolic functions, physical activity, ingested materials or pathologic conditions. Normal color: pale yellow, yellow, dark yellow. The yellow color of urine is caused by the presence of a pigment, UROCHROME. product of endogenous metabolism. Examination of urine color should be under a good light source, looking down through the container against a white background. Dark Yellow or amber Presence of the abnormal pigment bilirubin. Administration of phenazopyridine (Pyridium) or Yellow-orange azo-gantrisin compounds to persons with urinary tract infections. Red presence of blood Brown urine containing glomerular bleeding blood Melanin or homogentisic acid, levodopa, methyldopa, Brown or black phenol derivatives, and metronidazole (Flagyl). Bacterial infections, including urinary tract infection Blue/green by Pseudomonas species and intestinal tract infections resulting in increased urinary indican  General term that refers to transparency or turbidity of urine. Common terminologies used  Clear  Hazy  Cloudy  Turbid  Milky  URINE CLARITY DETERMINATION No visible particulates, CLEAR transparent Few particulates, print easily seen HAZY through urine Many particulates, print blurred CLOUDY through urine Print cannot be seen through TURBID urine MILKY Many precipitate or be clotted 1. Use a well-mixed specimen 2. View through a clear container 3. View against a white background 4. Maintain adequate room lighting 5. Evaluate a consistent volume of specimen 6. Determine color and clarity  Not part of routine urinalysis Freshly voided urine: faint aromatic odor ODOR POSSIBLE CAUSES Aromatic Normal Foul-ammonia-like UTI, bacterial decomposition Fruity, sweet Diabetes mellitus, starvation, vomiting Maple syrup Maple syrup urine disease Mousy Phenylketonuria Rancid Tyrosinemia Sweaty feet Isovaleric acidemia Cabbage Methionine malabsorption Bleach Contamination  Consists of chemical-impregnated absorbent pads attached to a plastic strip. Color-producing chemical reaction takes place when the absorbent pad comes in contact with urine. The reactions are interpreted by comparing the color produced on the pad with a chart supplied by the manufacturer.  Provide a simple, rapid means for performing medically significant chemical analysis of urine It includes:  pH  Specific gravity  Ascorbic acid  Protein  Ketones  Creatinine  Blood  Glucose  Urobilinogen  Bilirubin  Nitrite  Leukocyte Principle: Reflectance Photometry REAGENT STRIP HANDLING AND STORAGE: Store with desiccant in an opaque, tightly closed container Stored below 30°C Bottle should not be open in the presence of volatile fumes Do not use expired reagent strips Causes of reagent strip deterioration:  Moisture  Volatile chemicals  Heat  Light REAGENT STRIP TECHNIQUE: MIX DIP REMOVE BLOT COMPARE Improper techniques:  Unmixed specimens  Allowing the strip to remain in the urine for extended period  Excess urine remaining on the strip Specimens that have been refrigerated must be allowed to return to room temperature before reagent strip technique 4-Parameter Urine Reagent strip 10-Parameter Urine Reagent strip 12-Parameter Urine Reagent strip TIME (seconds) PARAMETER PRINCIPLE GLUCOSE Double sequential enzymatic reaction 30 BILIRUBIN Diazo reaction 40 KETONE Sodium nitroprusside reaction SPECIFIC pKa change of a polyelectrolyte 45 GRAVITY PROTEIN Protein error of indicators pH Double indicator system BLOOD Pseudoperoxidase activity of 60 hemoglobin UROBILINOGEN Ehrlich reaction NITRITE Greiss reaction 120 LEUKOCYTES Leukocyte esterase  Remarks Result Derived from the metabolism of Formation of N2 gas Urea amino acids into ammonia From catabolism of nucleic acid Formation of crystals Uric acid in food and cell destruction Creatinine: Jaffe Derived from creatine, Yellow/Orange picric acid nitrogenous substance in reaction muscle tissue Component of principal salt Drops until the Chloride: Fantus (NaCl) formation of red brown method color Phosphates Buffers in the blood Bright yellow precipitate  Principle Positive Clinical Significance Result Purple ring at the Purple ring or Diabetes mellitus, junction is produced in purple tinge propanol toxicity, Acetone: Rothera’s presence of acetone severe starvation, Nitroprusside Test fasting, fever, prolonged vomiting In a hot alkaline Green Blood sugar is elevated Glucose: Benedict’s solution, glucose Yellow Renal tubular Test reduces copper salts to Orange absorption is impaired cuprous oxide Red Denaturation of White ring at Proteinuria Albumin: Heller precipitated proteins the junction of Glomerular damage Ring’s test the solution Defect in reabsorption of tubules.  Principle Positive Clinical Result Significance Peroxidase Green Hematuria activity of Blue Hemoglobinuria Blood: Benzidine Hemoglobin Myoglobinuria Oxidation of bile Blue, green, Jaundice, liver disease, Bile pigments: pigments violet ring bilirubinuria, Gmelin’s Test gallstones Formation of red Red ring or red Hyperlipidemia Bile acid and color upon solution Cholestasis salts: addition of Gallstones Pettenkofer’s Test sucrose and sulfuric acid Normal Crystals Uric Acid Ca oxalate Hippuric Ca phosphate Triple phosphate Ca carbonate Ammonium biurate Abnormal Crystals Bilirubin Cholesterol Cystine Leucine Tyrosine 1. Check request and specimen labels as to: Name of Patient Age Sex Birthday Requesting Physician Ward Examination Desired Specimen Submitted Time received 2. Label the request and the specimen container with the corresponding assigned number. 3. Examine the physical characteristics of urine sample grossly or macroscopically as to COLOR AND TRANSPARENCY/CLARITY. 4. Pour about 3ml to 5 ml of urine sample into a test tube labeled with the corresponding assigned number. 5. Remove one urine dip strip from the bottle and replace cap. 6. Completely immerse reagent areas of the strip in fresh urine and remove immediately to avoid dissolving out reagents. 7. While removing, run edge of the entire length of the strip against the rim of the urine container to remove excess urine. 8. Hold the strip in a horizontal position to prevent possible mixing of chemicals from adjacent reagent areas and/or contaminating the hands with urine. 9. If reading visually, compare reagent areas to corresponding Colour Chart on the bottle label at time specified. 10.Hold strip close to colour blocks and match carefully. Avoid laying the strip on the Colour Chart, as this will result in the soiling of colour chart. 11.For optimal results read result within the time specified on the bottle label. 12.Centrifuge sample for about 5 minutes at 1500rpm. 13.Decant supernatant fluid and examine sediments under the microscope. Red Blood Cells, Pus cells and Casts: Reported as count per HPO Epithelial cells and other components: Reported as cell seen per LPO OCCASIONAL 1-4 FEW 5-10 MODERATE 11-25 MANY OVER 25 14.Write results on official urinalysis form and logbook. 15.Official reports are signed by the Medical Technologist and Pathologist before releasing to the general receiving and releasing area. Strasinger, S. K., & Di Lorenzo, M. S. (2021). Urinalysis and body fluids. Seventh edition. Philadelphia, PA, F.A. Davis Company. Learning Guide for Principles of Medical Laboratory Science 2 1st Edition · Author(s). Bernard U. Ebuen, Nini F. · Publisher. C&E Publishing, Inc.  Any questions? Email me at [email protected]