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ROUTINE URINALYSIS

A routine analysis is one of the most common laboratory examinations used in the
diagnosis and treatment of disease. It can be easily and quickly performed. The results of the
routine urinalysis can reveal diseases of the bladder or kidneys, systematic metabolic or
endocrine disorders such as diabetes, and diseases of the liver, such as hepatitis, cirrhosis, or
obstruction of the bile ducts. Urinalysis is routine performed on all patients undergoing physical
examinations and on those entering the hospital for treatment.
Analysis of the urine includes physical, chemical, and microscopic examinations.

EXERCISES 1
PHYSICAL EXAMINATION OF URINE
Physical examination is the first stage of routine urinalysis. The physical examination of
urine includes the determination of the urine color, clarity or transparency, and specific gravity.
Other physical characteristics but which are not tested routinely includes volume and odor.
Observation of these characteristics provides preliminary information concerning disorders
such as glomerular bleeding, liver disease, inborn errors of metabolism, and urinary tract
infection.
PROCEDURE
1. Wash and dry your hands. Follow the universal blood fluid precautions. Protect yourselves
by wearing the laboratory gowns, gloves, and masks.
2. Allow the specimen to come to room temperature if it was refrigerated.
3. Use a well-mixed specimen. Mix the urine by swirling.
4. Label the containers with the name of the patient or their assigned numbers.
5. View through a clear container. Pour the specimen into a standard-size tube (10-15 ml
sample).
6. View against a white background and maintain adequate room lighting.
7. Evaluate a consistent volume of specimen. Determine color and clarity.
8. Clean the work area and wash your hands.

EXERCISES 1-A
COLOR
Visually observe the color of the samples. Compare the samples with one another and
record your readings. The color of urine varies from almost colorless to black. These variations

may be due to normal metabolic functions, physical activity, ingested materials, or pathologic
conditions. A noticeable change in urine color is often the reason a patient seeks medical
advice; it then becomes the responsibility of the laboratory to determine whether this color
change is normal or pathologic. The normal color of urine is from straw (colorless) to amber
(dark yellow orange). This is due to the major pigment UROCHROME and the minor pigments
urobilin, uroerythrin and hematoporphin. The color of the urine is also influenced by its
concentration such that concentrated urine is dark and less concentrated urine is lighter in color.
Color is also related to turine volume in that large volumes of urine are voided out is normally
light in color while urine in small volumes is normally dark.
For normal urine, report as: straw, pale/light yellow, yellow, yellow orange, orange, and
amber. Deviations from the normal are termed as abnormal. Pathologic (associated with
diseases) or non-pathologic (not associated with disease).

REPORT
Specimen number
1.

Name of Patient

Age

Sex

Color

Significance

2.
3.
4.
5.

______________________
Examiners signature
EXERCISE 1-B
TRANSPARENCY

_____________
Date

Examine the sample in the previous activity. Hold each test tube with the urine
against a lighted ground. Shake the tube gently and observe for the presence of suspended
material or particles.
Clarity (character) is a general term that refers to the transparency/turbidity of a urine
specimen. In routine urinalysis, clarity is determined in the same manner that ancient physicians
used: by visually examining the mixed specimen while holding it front from the light source. The
specimen should be in clear container. Color and clarity are routinely determined at the same
time.
Record result as:
CLEAR
HAZY
SLIGHTLY TURBID
TURBID

- no cloudiness
- can see light print through tube
- can see only dark print through tube
- cannot see through tube

Normally, freshly voided urine is clear or transparent. Cloudiness or slight turbidity of


urine upon long stand at room temperature is considered normal. This is due to settling down of
mucus threads, crystals, leukocytes, epithelial cell and bacteria. This cloudiness upon long
standing is termed as tubercula. Other causes of cloudiness must be viewed as abnormal.
REPORT
Specimen number

Name of Patient

Transparency

1
2
3
4
5

______________________
Examiners signature
EXERCISE 1-C
SPECIFIC GRAVITY

_____________
Date

The specific gravity of urine indicated the relative proportions of dissolved solid
components to the total volume of the specimen. Specific gravity is also a reflection of the ability
of the kidney to dilute or concentrate urine.
The ability of the kidneys to selectively reabsorb essential chemicals and water
from the glomerular filtrate is one of the bodys most important functions. The intricate process
of reabsorption is often the first renal function to routine urinalysis. This evaluation can be
performed by measuring the specific gravity of the specimen. Specific gravity also detects
possible dehydration or abnormalities in antidiluteric hormone and can be used to determine
whether specimen concentration is adequate to ensure the accuracy of chemical tests. Specific
gravity may be tested through various methods to ensure the accuracy of chemical tests.
Specific gravity may be tested through various methods using different instruments. Two of
these instruments are the urinometer and refractometer.
The Urinometer
The urinometer is a weighted, bulb-shaped instrument that has a cylindrical stem
which contains a scale calibrated in specific readings. The instrument is floated in cylindrical
containing urine. The depth to which it sinks in the urine indicated the specific gravity of the
urine.
Test for the reliability of Urinometer:
Place the urinometer in distilled water (similar to the urine procedure).
This is because the urinometer is calibrated with the use of distilled water.
The reading must be 1.000.
Requirement:
Each pair must bring to the laboratory at least 5 urine samples. As mush
as possible, specimens must have varied degrees of transparency.
PROCEDURE
Calibration of the urinometer
1. Wash and dry your hands. Follow the universal blood and body-fluid precautions. Wear
laboratory gowns, gloves and mask.
2. Fill the glass cylinder two-thirds full with distilled water at room temperature.
3. Read the specific gravity of the distilled water by inserting the urinometer into the
cylinder in a spinning motion. Be sure that the urinometer is not touching the sides or the
bottom of the cylinder, If the urinometer does not read 1.000, a correction factor or a new
urinometer is necessary.
Specimen
1. Allow the specimen to come at room temperature if it was refrigerated.
2. Mix the specimen by swirling.
3. Pour the specimen into the clean glass cylinder to two- thirds full.
4. Read the specific gravity of the urine. For accurate result, the urinometer must be read
at eye level.
5. Obtain duplicate readings. Duplication of test results is a means of quality control of the
procedure.
6. Record your readings and make the necessary corrections.
7. Clean and dry the equipment used, clean the work area and wash your hands.

How to get the corrected Specific Gravity


1. Get the specific gravity of the urine specimens.
2. Get the temperature of the urinometer for which it was standardized and at a room
temperature.
3. Subtract the lower temperature from which the higher temperature of get the difference
between the two temperatures. (Rule: For every 3 degrees centigrade rise from the
standard temp., add 0.001 and for every e degrees centigrade fall from the standard
temperature, subtract 0.001).
4. Divide the difference by 3 (to find out how many 3s are there in the difference).
5. Multiply the quotient by 0.001.
6. Add or subtract the product to or from the last two digits of the urinometers actual SG
reading of the specimen.
If the urine is not sufficient and determination is not possible, as well as it is not
an urgent test, write in your report QNS quantity not sufficient.
If the quantity is not sufficient but it is necessary that you have to get the specific
gravity of the specimen (e.g. in urgent cases where results of the tests is needed), then dilute it
with distilled water before reading. If urine is diluted 1:2, multiply the last two digits of the actual
SG by 2; if diluted 1:3, multiply the last two digits by 3. After which temperature correction is
made to get the final corrected SG.
Corrections are made for specimens that contain glucose and proteins as these
affect the specific gravity of the urine. For every 1g/100 ml urine specimens, subtract 0.003 for
every 1g/100 ml urine specimen subtract 0.004.

(Figure.4-2. Urinometer representing various specific gravity)

Results of the test:


Name of the patient
1.
2.
3.

Age

Sex

Actual SG Reading

Corrected SG Reading

4.

Note: Please show solutions in correcting the SG readings.

______________________
Examiners signature

_____________
Date

Refractometer

1. Put one or two drops of sample on the prism.


gently.

2. Close the daylight plate

3. The sample must spread all over the prism surface.


through the

4. Look at the scale


eyepiece.

5. Read the scale where the boundary line intercepts it.


the prism
water.

5. Wipe the sample from


clean with a tissue and

STUDY GUIDE QUESTIONS


1. What is a normal urine:
a. Color

b. transparency

c. specific gravity

2. What is the relationship between urine color and:


a. volume
b. specific gravity

3. List down 5 abnormal pathologic and 5 abnormal non-pathologic colors of the urine.

4. What causes cloudiness or slight turbidity of a normal urine specimen upon long standing?

5. List down 5 causes of cloudiness of urine.

6. What is the significance of examining urine color and transparency?

7. List down the common causes of urine odor

8. What is the significance of measuring the specific gravity of urine?

9. Compare the urinometer from the refractometer.

Case Study
1) A concerned male athlete brings a clear, red urine specimen to the physicians office.
a) Would you expect to see RBCs in the microscopic examination? Why or why not?
b) Name two pathologic causes of clear, red urine. Under what conditions do these
substances appear in the urine?
c) The patient reported that the urine appeared cloudy when he collected it the previous
evening, but it was clear in the morning. Is this possible? Explain your answer.
d) If the urine is chemically negative for blood, what questions should the physician ask the
patient?
2) Upon the arriving at work, a technologist notices that a urine specimen is left beside the sink
by personnel in the nightshift has a black color. The initial report describes the specimen as
yellow.
a) Should the technologist be concerned about this specimen? Explain your answer.
b) if the specimen had an initial ph of 6.0 and now has a ph of 8.0, what is the most
probable cause of the black color?
c) If the specimen has a ph of 6.0 and was sitting uncapped, what is the most probable
cause of the black color?
d) If the original specimen was reported to be red and to contain RBCs what is the possible
cause of the black color?
3) While performing a routine urinalysis on a specimen collected from a patient in the urology
clinic, the technician finds a specific gravity reading that exceeds the 1.035 scale on the
refractometer.
a) If the urinalysis report has a 1+ protein and a negative glucose, what is the most
probable cause of this finding?
b) The technician makes a 1:4 dilution of the specimen, repeats the specific gravity, and
gets a reading of 1.015. What is the actual specific gravity?
c) Using 1 ml of urine, how would the technician make the above dilution?
d) How could a specific gravity be obtained from the specimen without diluting it?
4) Mrs. Smith frequently shops at the farmers market near her home. She notices her urine
has a red color and brings a sample to her physician. The specimen tests negative for blood.
a) What is a probable cause of Mrs. Smiths red urine?
b) Mrs. Smith collects a specimen at the physicians office. The color is yellow and the ph is
5.5. Is this consistent with the previous answer? Why or why not?
5) A urinalysis supervisor requests a new specimen in each of the following situations. Support
or
disagree with the decisions.

a)
b)
c)
d)

A green-yellow specimen with negative teat results for glucose and bilirubin.
A dark yellow specimen that produces a large amount of white foam.
A cloudy urine with a string odor of ammonia.
A hazy specimen with a specific gravity.

CLINICAL MICROSCOPY LABORATORY EFFICIENCY RATING TOOL


Name of Student: _____________________Inclusive Dates: ______Over-all Rating:________

Rating:

4.0= excellent
3.5= superior
3.0= very good
2.5= good

2.0= fair
1.5= poor
1.0= needs improvement

EVALUATION PARAMETERS
I.
Knowledge on the subject matter (30%)
RATING
REMARKS
1. Recalls previously learned theories and concepts
___________
related to the performance of test procedures.
___________
2. States principles relevant to performance of steps in
___________
the procedure.
3. Identified normal from abnormal results of tests or
___________
examinations done.
4. Discuss the clinical significance of the test results obtained.
___________
II.
Skills (50%)
1. Demonstrate skills and techniques in whatever tests
___________
he/she performs.
2. Observe proper aseptic technique and standard
___________
operating procedures.
3. Perform laboratory tests with
a. promptness
___________
b. speed without sacrificing efficiency
___________
c. ease and confidence
___________
4. Record and report results neatly and completely.
___________
III.

Personal and Interpersonal Relationships (20%)


1. Shows respect and courtesy to superiors and peers
___________
2. Punctual in reporting to class and other required
___________
activities including submission of requirements.
3. Treats any information acquired with strict
confidentiality.
___________
4. Maintains good grooming and bearing at all times
___________
5. Manifest Christian values at all times
___________
6. Evaluate self objectively.
___________
Computation:
I. __________ X 30% = __________
II. __________
X 50% = __________
III. __________X 20% = __________
Total: _________
______________________ ______________________
Students signature
Instructors signature

EXERCISES II
RAPID CHEMICAL TEST (DIPSTICKS STRIPS)

Routine chemical examination of urine has changed dramatically since the early days of
urine testing, owing to the development of the reagent strip method for chemical analysis.
Reagents strips currently provide a simple, rapid means for performing medically significant
chemical analysis of urine, including ph, protein, glucose, ketones, blood, bilirubin, urobilinogen,
nitrite, leukocytes, and specific gravity. The two major types of reagent strips are manufactured
under the tradenames Multistix (Siemens Medical Solutions Diagnostics, Tarrytown, N.Y) and
Chemstrip (Roche Diagnostics, Indianapolis, Ind).
The use of reagent strip is a rapid means of measuring the chemical constituents of
urine. It will take seconds to get the desired results.
In routine urinalysis, the following chemicals are assayed: glucose, protein, ketone
bodies and blood. Although ph reaction of the physical; properties of urine, it is included in the
reagent strip.

PROCEDURE
1. Pour at least 10 ml of urine into the corresponding labeled tube.
2. Dip the reagent strip into the specimen for approximately one second, making sure that
all the teat areas are well-moistened. Draw the back of the reagent strip across the rim
of the test tube to remove excess urine.
3. Hold the bottle with the color scale and the reagent strip in a horizontal position so not to
have cross-reactions. Compare the strip with the color scale after the specified time
interval. Color changes after 2 minutes are of no clinical significance.
4. Record the results.
Report
Name of Patient
Urobilinogen Nitrite
1.
2.
3.
4.
5.

Age/Sex Glucose Bilirubin Ketone

SG ph Blood Protein

______________________ ______________________
Students signature
Date
GENERAL PRECAUTIONS
1. Protect reagent strips from moisture and excessive heat to prevent loss of sensitivity. Store
reagent strips in a cool, dry area, but not in the refrigerator. Urine should be at room
temperature when tested with reagent strips.
2. Avoid contamination of reagent strips. Do not touch test areas. Do not lay reagents strip on
a bench surface. Do not use reagent strips in the presence of volatile acids or alkalis.
3. Properly moisten reagent strip in well-mixed urine. Avoid prolonged dipping as is this may
cause leeching of the test reagent.
4. Exercise care in reading reagent strips. Observe the proper time elements. Hold reagent
strip close to the appropriate color chart when reading, Read only under good lighting
conditions.
Summary of Reagent Strip Testing
Care of reagent Strips

Store with desiccant in an opaque, tightly closed container.


Store below 30 C; do not freeze.
Do not expose to volatile fumes.
Does not use past the expiration date.
Do not use if chemical pads become discolored.
Remove strips immediately prior to use.

Technique
Mix specimen well.
Let refrigerated specimens warm to room temperature before testing.
Dip the strip completely, but briefly into the specimen.
Remove excess urine by withdrawing the strip against the rim of the container and
by blotting the edge of the strip.
Compare reaction colors with the manufacturers chart under a good light source
at the specified time.
Perform backup test when indicated.
Be alert for the presence of interfering substances.
Understand the principles and significance of the test, read package inserts.
Relate chemical findings to each other and to the physical and microscopic
urinalysis results.
Quality Control
Test open bottles of reagent strips with known positive and negative controls
every 24 hr.
Resolve control results that are out of range by further testing.
Test reagents used in backup test with positive and negative controls.
Perform positive and negative controls on new reagents and newly opened bottles
of reagent strips.
Record all control results and reagent lot numbers.
STUDY GUIDE QUESTIONS
1. What are the tests assayed using reagent strips?
2. For each test determination, give the following:
a. reagents impregnated in the patch or the reagent area
b. principle of the test
c. range of color change
d. normal result

3. The reagents impregnated in the patch for protein determination is the most sensitive
to what
type of protein?

4. Why should extra care be observed in NOT letting the urine from the protein patch run
into the
ph patch?
5. Enumerate at least 2 causes of FALSE POSITIVE glucose test and briefly discuss how
it affects
the chemical reaction.
it

6. Give at least once causes of a FALSE NEGATIVE glucose test and briefly discuss how
affects the chemical reaction.

7. What is the renal threshold for glucose? What is the excessive secretion of glucose in
the urine
by diabetic patient?
Case Studies and Clinical Situations
1. A patient taken to the emergency room following an episode of syncope has a fasting blood
glucose level of 450 mg/dl. Result of the routine urinalysis are as follows:
COLOR: Pale Yellow
KETONES: Negative
CLARITY: Clear
BLOOD: Negative
SP GRAVITY: 1.020
BILIRUBIN: Negative
ph: 5.0
UROBILINOGEN: Normal
PROTEIN: 1+
NITRITE: Negative
GLUCOSE: 250 mg/dL
LEUKOCYTES: Negative
a. Explain the correlation between the patients blood and urine glucose result.
b. What is the most probable metabolic disorder associated with his patient?
c. Considering the patients condition, what is the significance of the patients protein
result?
d. What could have been done to delay the onset of proteinuria in his patient?
e. If the patient in his study had a normal blood glucose level, to what would the
urinary glucose be attributed?
2. A female patient arrives at the outpatient clinic with symptoms of lower back pain and
urinary
frequency with a burning sensation. She is a firm believer in the curative power of vitamins.
She has tripled her usual dosage of vitamins in an effort to alleviate her symptoms; however,
the symptoms have persisted. She is given a sterile container and asked to collect a
midstream clean-catch urine specimen. Results of this routine urinalysis are as follows:
COLOR: Dark Yellow
KETONES: Negative
CLARITY: Hazy
BLOOD: Negative
SP GRAVITY: 1.012
BILIRUBIN: Negative
ph: 7.0
UROBILINOGEN: Normal
PROTEIN: Trace
NITRITE: Negative
GLUCOSE: Negative
LEUKOCYTES: 1+
Microscopic
8 to 12 RBC/HPF Heavy Bacteria
40 to 50 WBC/HPF Moderate squamous epithelial cells

a. What discrepancies between the chemical and microscopic test results are present?
State and explain a possible reason for each discrepancy.
b. What additional chemical tests could be affected by the patients vitamin dosage?
Explain the principle of the interference.
c. Discuss the urine color and specific gravity results with regard to correlation and give
a possible cause for any discrepancy.
d. State three additional reasons not previously given for a negative nitrite test in the
presence of increased bacteria.

3. Considering the correct procedures for care, techniques, and quality control for reagent
strips, state a possible cause for each of the following scenarios:
a. The urinalysis supervisor notices that an unusual large number of reagent strips are
becoming
discolored before the expiration date has been reached.
b. A physicians office is consistently reporting positive nitrite test results with negative
LE test
results.
c. A students result for reagent strip blood and LE are consistently lower than those of
the
laboratory staff.