| | Falak Khan GEMP I 2017

Urinalysis

This station will require you to do a urine dipstick test and make appropriate comments
based on the patient history and results. Actual procedure steps are bolded and extra info is
added to assist you with interpretation.

Step by Step Process

You need a watch for this station!

1. Walk in, greet the examiner and patient (if there is one) and introduce yourself.
2. Clean hands
3. Put on gloves
4. Tell the patient what you will be doing and get consent.
5. Start with and comment on the Macroscopic Examination of the Urine
a. Volume
b. Colour & Appearance
c. Odour
6. Check the expiry date on the dipstick bottle and comment on it
7. Take out a stick and submerge the entirety of the coloured strips into the urine
sample and remove
8. Hold the stick horizontally while waiting for the colours to develop
9. State that all markers must be read after 30 seconds except for leukocytes which
will be read after 2 minutes.
10. Read and comment on each marker based on the colour change compared to the
references on the bottle and mention possible reasons for why there is a change
while keeping your patient history in mind. To impress the marker, it is useful to
mention if expected changes are not noticed on the strip i.e if there are no ketones
in a diabetic patient.
11. Explain to the patient what your findings are and what your next step will be and
thank them for their time.
 | | Falak Khan GEMP I 2017

Remember to relate your comments to the clinical history of the patient and be confident in
you commenting!

Explanations & Interpretation

1. Walk in, greet the examiner and patient (if there is one) and introduce yourself.
2. Clean hands
3. Put on gloves
4. Tell the patient what you will be doing and get consent.

e.g. “You have mentioned that you have XYZ symptoms and I would just like to test
your urine to see if we can find anything that explains these. I will just be looking at
your urine and putting a strip into this urine sample that you have provided me with
and based on the results of the strip we may be able to see what is in your urine. Do I
have your permission to do this?”

5. Start with and comment on the Macroscopic Examination of the Urine

a. Volume
Normal urine volume is 750 – 2000 milliliters in a 24 hour period.
Polyuria > 2000ml
Causes: Diabetes (Mellitus and Insipidus)
Polycystic Kidney
Chronic Renal Failure
Medication: Diuretics
IV saline/glucose
Oliguria < 400ml
Causes: Dehydration – vomiting, diarrhea, sweating
Renal ischaemia
Acute tubular necrosis
Obstruction to the urinary tract
Acute renal failure
 | | Falak Khan GEMP I 2017

Anuria < 200ml

Nocturia = > 500ml urine with a specific gravity <1.018 excreted at night by
an adult. Think Glomerular Nephritis

b. Colour & Appearance

Normal fresh urine is pale yellow and clear
Colourless urine
Due to dilution: Diabetes mellitus & insipidus
Diuretics
Milky urine
Causes: Purulent genitourinary infection
Chyluria (fat in urine)
Orange/dark urine
Causes: Excessive sweating
Obstructive jaundice
Fever
Red urine
Causes: Beetroot consumption
Haematuria (Blood in urine)
Foamy urine
Causes: Proteinuria
Brown/Black urine
Causes: Melanin
Alkaptonuria (inherited genetic disorder in
which the body cannot process the amino acids
phenylalanine and tyrosine)

c. Odour
Normal odour is aromatic due to volatile fatty acids
Ammonia-like odour is due to bacterial infection
Fruity odour is due to ketones in the urine

6. Check the expiry date on the dipstick bottle and comment on it

 | | Falak Khan GEMP I 2017

7. Take out a stick and submerge the entirety of the coloured portions into the urine
sample and remove
8. Hold the stick horizontally while waiting for the colours to develop
9. State that all markers must be read after 30 seconds except for leukocytes which
will be read after 2 minutes.
10. Read and comment on each marker based on the colour change compared to the
references on the bottle and mention possible reasons for why there is a change
while keeping your patient history in mind. To impress the marker, it is useful to
mention if expected changes are not noticed on the strip i.e if there are no ketones
in a diabetic patient.
a. Specific Gravity
High specific gravity (hyperosthenuria) i.e. >1.022
Causes: All causes of Oliguria
Glycosuria (glucose in urine)
Elevated protein levels ( 1 – 7.5 g/litre)
Low specific gravity (hyposthenuria) i.e. <1.016
Causes: All causes of polyuria EXCEPT glycosuria
Fixed specific gravity (isosthenuria) i.e. = 1.010
Cause: Chronic renal disease

b. pH
Normal range from 4.6 – 8.5
Acidic urine i.e. < 4.6
Causes: Ketosis (diabetes, starvation, fever)
Systemic acidosis
UTI – E.coli
Acidification therapy
Alkaline urine i.e. > 8.5
Causes: Strict vegetarian
Systemic alkalosis
UTI: Proteus
 | | Falak Khan GEMP I 2017

c. Proteins
Strip test is sensitive to albumin
Negative result does not rule out presence of haemoglobin or globulins
Normal = no protein in urine
Greater than 0.3 g/litre is clinically significant
Causes: Pre-Renal: heavy exercise
Fever
Hypertension
Multiple myeloma
Eclampsia
Renal: Glomerulonephritis (acute & chronic)
Tubular dysfunction
Polycystic kidney
Nephrotic syndrome
Post-Renal Cystitis (acute and chronic)
TB cystitis
Microalbuminuria cannot be detected by strip test

d. Sugars
Small amounts of glucose are normally present in urine but these are below
the sensitivity of the test.
Glycosuria i.e. >6mmol/litre is clinically significant
Causes: With hyperglycaemia: Diabetes
Acromegaly
Cushing’s disease
Hyperthyroidism
Corticosteroid use
Without hyperglycaemia: Renal tubular dysfunction

e. Ketones
Detects acetoacetic acid in the urine
Normal urine is negative for this test
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Positive
Causes: Low level: Physiological stress
Higher level: Starvation/diabtets
Abnormal carbohydrate or lipid
metabolism

f. Bilirubin
Normally no bilirubin in urine
Even trace amounts are clinically significant
Causes: Liver disease (injury, hepatitis)
Biliary tract obstruction

g. Bile salts
Normal range = 3 to 17 mol/litre
Greater than 34 mol/litre is abnormal
Causes: Haemolytic anaemias
Obstructive jaundice

h. Urobilinogen
Normal range = 3 to 17 mol/litre
Greater than 34 mol/litre is abnormal
Causes: Haemolytic anaemias
Obstructive jaundice
i. Blood
Test detects myoglobin and haemoglobin
Even trace amounts may be clinically significant
Can be present in menstruating females
UTI can lead to false positives
Haematuria
Causes: Pre-Renal: Bleeding diathesis
Heamoglobinopathies
Malignant hypertension
 | | Falak Khan GEMP I 2017

Renal: Trauma
Calculi
Glomerulonephritis (acute and chronic)
Renal TB
Renal tumours
Post-Renal: Severe UTI
Calculi
Trauma
Urinary tract tumours

j. Nitrites
Presence indicates the presence of large amounts of bacteria in urine
Gram negative rods such as E.coli more likely to give a positive result
k. Leukocytes
Normally no leukocytes in blood
Positive test (pyuria) indicates presence of WBC in urine – clinically significant

11. Explain to the patient what your findings are and what your next step will be and
thank them for their time.