Nueva Ecija University of Science and Technology

College of Arts and Sciences

College of Nursing

Final Output in Biochemistry Lab

Urinalysis by Reagent Strips

CABRIDO, ALECSANDRA NICOLE

CABUDSAN, GENESIS

CUNANAN, CHARLES KEVIN

DATU, BEVERLY JANE L.

DELA CRUZ, DONNA

DELA VEGA, ELLA MAE M.

DOMINGO, MONALIZA C.

BSN I-A

December 05, 2019

 Abstract

Urinalysis is a test for urine used to detect and manage a wide range of disorders, such as urinary tract

infections, kidney disease and diabetes. A urinalysis involves checking the appearance, concentration, and

content of urine. Our urine donor was a cancer patient, diagnosed of acute myelogenous leukemia.

Three reagent’s strip was dipped into the urine with different interval. The result showed

noticeable increase of leukocytes and it indicates a positive result proving that her disease is characterized by

too many white blood cells in the body. Also her nitrite results tested positive indicating bacterial infection in

the urinary tract.

INTRODUCTION

 HISTORY OF THE DEVELOPMENT OF URINALYSIS

The ancient Babylonian and Sumerian physician first inscribes their evaluations of urine into clay tablets

as early as 4,000 B.C. Laboratory medicine began 600 years with the analysis of human urine, which was called

uroscopy and today is termed urinalysis. Uroscopy was the mirror of medicine for thousands of years. From a

liquid window through which physicians felt they could view the body's inner workings (Armstrong, 2014). As

a result, many chemical components now reported in metabolic profiles were first analyzed and identified in

urine during the first half of 18th century. Throughout most of history, and well into the 18th century, the

diagnosis of an illness was based on its presenting symptoms and examination of the afflicted individual

(Eknoyan, 2007).

 SIGNIFICANCE OF THE TEST

Urinalysis is the physical, chemical and microscopic examination of urine. It involves a numbers of tests

to detect and measure various compounds that pass through urine. It can be used to test for drugs, pregnancy or

diseases. Urinalysis is test for urine that will check your overall health may recommend a urinalysis as part of a

routine medical exams by your Doctor. Also to diagnose a medical condition and to monitor a medical

conditions (mayorclinic.org, 2018). Many illnesses and disorders affect how your body removes waste and

toxins. It involves checking the appearance, concentration and content of urine. Abnormal urinalysis results

may point to a disease or illness. It can help your doctor detect problems that may be shown by your urine.

The examination of urine is the most screening laboratory procedures for the early detection for renal or urinary

tract diseases as well as for the monitoring and evaluation for the systemic diseases of extra-genitourinary tract

system (Jong 2015). It may be used to screen for and/or help diagnose conditions such as urinary tract

infections, kidney disorders, liber problems, diabetes or other metabolic conditions.

 The diagnostic reagent strip, with 1 or more reagent pads adhered to a plastic handle, is one of the most

common testing technologies in routine clinical use. The key reason for its acceptance is ease of use. One of the

first reagent strips contained a reagent pad for glucose (Clinistix; Ames Co, Elkhart, IN; 1956) that could be

dipped into urine, was allowed to react for a minute, and read.1 This diagnostic method eliminated the necessity

of preparing liquid reagents and was easier to use than tablet reagents. During the next 40 years many products

were developed that offered the same ease of use and simplicity, benefits still valued today. After the urine

glucose strips, a series of reagents were developed, initially with diabetes mellitus as the disease focus (Pugia,

2000).

Most diagnostic reagent strips used to perform routine urinalysis in veterinary laboratory were designed

for human use. The result obtained with several diagnostic urine strips are unreliable. The urine pH meter to

determine pH results especially when trying to measure relatively small changes in urine pH. The glucose test

pads contains labile enzymes. If the enzymatic action of these proteinaceous enzymes is impaired, test result

will be unreliable (Osborne, 2009). And cost-effective, noninvasive test used as an indicator of health or disease

for metabolic and renal disorders, infection, drug use, pregnancy, and nutrition.

 APPLICATION IN CLINIC, HOSPITAL, COMMUNITY AND OTHER RELEVANT SETTING

A urinalysis is used to detect and manage a wide range of disorders, such as urinary tract infections, kidney

disease and diabetes. To check your overall health. Your doctor may recommend a urinalysis as part of a routine

medical exam, pregnancy checkup, pre-surgery preparation, or on hospital admission to screen for a variety of

disorders.

To diagnose a medical condition. Your doctor may suggest a urinalysis if you're experiencing abdominal pain,

back pain, frequent or painful urination, blood in your urine, or other urinary problems. A urinalysis may help

diagnose the cause of these symptoms.

To monitor a medical condition. If you've been diagnosed with a medical condition, such as kidney disease or a

urinary tract disease, your doctor may recommend a urinalysis on a regular basis to monitor your condition and

treatment.

 INFORMATION ON THE DEVELOPMENT OF THE REAGENT STRIP FOR URINALYSIS

Glucose: 16.3%w/w glucose oxidase (Aspergillus niger, 1.3IU); 0.6%w/w peroxidase (horseradish, 3300 IU);

7.0% w/w potassium iodide; 76.1% w/w buffer and non-reactive ingredients.

Bilirubin: 0.4% w/w 2,4-dichloroaniline diazonium salt, balanced with buffer and non-reactive ingredients.

Ketone: 7.7% w/w sodium nitroprusside balanced with buffer and non-reactive ingredients.
Specific Gravity: 2.8% w/w bromothymol blue, 69.0%; poly (methyl vinyl ether/maleic anhydride); 28.2%

sodium hydroxide

Blood: 6.6% w/w cumene hydroperoxide; 4.0% w/w 3, 3’, 5, 5’-tetramethylbenzidine; 89.4% w/w buffer and

nonreactive ingredients.

pH: 0.2% w/w methyl red; 2.8% w/w bromothymol blue; 97% w/w nonreactive ingredients.

Protein: 0.3% w/w tetrabromophenol blue; 99.7% w/w buffer and

nonreactive ingredients.

Urobilinogen: 2.9% w/w p-diethylaminobenzaldehyde balanced with buffer and nonreactive ingredients.

Nitrite: 1.4% w/w p-arsanilic acid, balanced with buffer and nonreactive ingredients.

Leukocytes: 0.4% w/w indoxyl ester derivative; 0.2%w/w diazonium salt; 99.4% w/w buffer and nonreactive

ingredients.

 LIMITATIONS OF REAGENT STRIP

Comparison to the color chart is dependent on the interpretation of the individual. It is therefore, recommended

that all laboratory personnel interpreting the results of these strips be tested for color blindness. As with all

laboratory tests, definitive diagnostic or therapeutic

decisions should not be based on any single test result or method.

Glucose: Moderate amounts of ketone bodies (40mg/dL orgreater) may decrease color development in urine

containing small amounts of glucose (75-125 mg/dl). However, such concentration of ketone simultaneously

with such glucose concentration is metabolically improbable in screening. The reactivity of the glucose test

decreases as the SG and/or ascorbic acid of the urine increases. Reactivity may also vary with temperature.

Bilirubin: Reactions may occur with urine containing large doses of chlorpromazine or rafampen that might be

mistaken for positive bilirubin. Indican (indoxyl sulfate) and metabolites of Lodine may cause false positive

or atypical color; ascorbic acid (25mg/dL or

greater) may cause false negative results.

Ketone: Color reaction that could be interpreted as “positive” maybe obtained with urine specimens containing

MESNA or large amounts of phenylketones or L-dopa metabolites.3

Specific Gravity: The chemical nature of the specific gravity test may cause slightly different results from

those obtained with the specific gravity methods when elevated amounts of certain urine constituents are

present. Highly buffered alkaline urine may cause

low readings relative to other methods. Elevated specific gravity readings may be obtained in the presence of

moderate quantities
(100-750 mg/dl) of protein.

Blood: The sensitivity of the blood test is reduced in urine with high specific gravity and/or high ascorbic acid

content. Microbial peroxidase, associated with urinary tract infection may cause false positive reactions.

pH: If proper procedure is not followed and excess urine remains on the strip, a phenomenon known as

“running over” may occur, in which the acid buffer from the protein reagent area run onto the pH area, causing

a false lowering in the pH result.

Protein: False positive results may be obtained with highly alkaline urine. Contamination of the urine specimen

with quarternary ammonium compounds may also produce false positive results.4

Urobilinogen: The test area will react with interfering substances known to react with Ehrlich’s reagent, such

as porphobilinogen and p-aminosalicyclic acid.

This test is not a reliable method for the detection of porphobilinogen. Drugs containing azo-dyes (e.g. Azo

Gantrisin) may give a masking golden color. The absence of urobilinogen cannot be determined with this test.

Nitrite: The pink color is not quantitative in relation to the number of bacteria present. Any degree of pink

coloration should be interpreted as a positive nitrite test suggestive of 105

or more organisms/ml. There are occasional urinary tract infections from organisms, which do not contain

reductase to convert nitrate to nitrite.

Leukocytes: Highly colored urine and the presence of the drugs cephalexin (Keflex) and gentamicin have

been found to interfere with this test. High urinary protein of 500 mg/dl or above diminishes the intensity of the

reaction color. Elevated glucose concentration or high specific gravity may cause decreased results.

OBJECTIVES

1. To execute urinalysis using reagent strips

2. To distinguish the diversity of the cancer patient’s urine in contrast to normal baseline level of each

panel.

3. To determine the importance of the urinalysis results of the urine sample and its relationship to certain

diseases.

MATERIAL and METHODS

BACKGROUND OF THE MEDICAL CONDITION

Treatment for leukemia can be complex — depending on the type of leukemia and other factors. But the patient

undergo in chemo therapy and blood transfusion because Leukemia is cancer of the body's blood-forming
tissues, including the bone marrow and the lymphatic system. Leukemia usually involves the white blood cells.

Your white blood cells are potent infection fighters — they normally grow and divide in an orderly way, as your

body needs them. But in people with leukemia, the bone marrow produces abnormal white blood cells, which

don't function properly. Scientists don't understand the exact causes of leukemia. It seems to develop from a

combination of genetic and environmental factors. She was diagnosed when a blood test showing an abnormal

white cell count may suggest the diagnosis. To confirm the diagnosis and identify the specific type of leukemia,

a needle biopsy and aspiration of bone marrow from a pelvic bone will need to be done to test for leukemic

cells, DNA markers, and chromosome changes in the bone marrow. And until now the patient was still fighting

and she was continuously undergoing in her treatments.

PRINCIPLES BEHIND THE DIFFERENT PANELS FOUND IN THE REAGENT STRIP

Almost of the panels were positive in reagent strip except on ketone and glucose because the urinary tract

cytology has a long history of utilization for the diagnosis and follow‐up of tumors involving the urothelial

tract. As expected, the most common tumor encountered in exfoliative urine cytology is urothelial carcinoma.

While the sensitivity of urinary tract cytology for the diagnosis of low‐grade urothelial carcinomas is low, its

sensitivity and accuracy for high grade urothelial carcinomas is much higher. However, nonurothelial

malignancies, such as hematopoietic malignancies, can also be encountered in urine specimens. Leukemic cells

in urine can be diagnosed readily by cytological examination in cases where more invasive procedures are

difficult to perform. Additionally, cell block sections can be utilized to determine the immunocytochemical

profile of the tumor cells to confirm the diagnosis.

BRIEF MEDICAL HISTORY OF THE PATIENT

Our donor was a female adult, 34 years old and was diagnosed of Acute Myelogenous Leukemia – a

cancer of the blood and bone marrow. She was diagnosed at the age of 33 last September 2018.

According to her some symptoms and experiences she felt was dizziness and sometimes headache. She

also noticed bruises around her body. These experiences brought her to hospital and undergone check-up

which later revealed that she has a cancer that was denoted “acute” meaning the disease is in rapid

progression. She does not have any other medical condition.

  ONGOING TREATMENTS

1. Chemoteraphy with monthly intervals

2. Blood transfusion

 MEDICATION

1. Folic Acid

2. Vitamin B complex

DIAGNOSTIC RELEVANCE OF EACH PANEL

Leukocytes -type of blood cell that is made in the bone marrow and found in the blood and lymph tissue.

Leukocytes are part of the body’s immune system. They help the body fight infection and other diseases. Types

of leukocytes are granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (T cells

and B cells). Checking the number of leukocytes in the blood is usually part of a complete blood cell (CBC)

test. It may be used to look for conditions such as infection, inflammation, allergies, and leukemia. Also called

WBC and white blood cell. An unusually high number of leukocytes in the urine indicates inflammation or

infection along the urinary tract, often in the bladder or kidney. ... An absence of leukocyte esterase in the urine

means that the urine is not likely to contain white blood cells, so it is not likely to be carrying infectious agents.

Nitrite-Nitrite tests detect the products of nitrate reductase, an enzyme produced by many bacterial species.

These products are not present normally unless a UTI exists. This test has a sensitivity and specificity of 22%

and 94-100%, respectively. The low sensitivity has been attributed to enzyme-deficient bacteria causing

infection or low-grade bacteriuria.

Urobilinogen in urine test measures the amount of urobilinogen in a urine sample. Urobilinogen is formed

from the reduction of bilirubin. Bilirubin is a yellowish substance found in your liver that helps break down red

blood cells. Normal urine contains some urobilinogen. If there is little or no urobilinogen in urine, it can mean

your liver isn't working correctly. Too much urobilinogen in urine can indicate a liver disease such as hepatitis

or cirrhosis.

Protein- the analysis of urinary protein composition is an important step in the evaluation and monitoring of

kidney diseases. Among the various approaches, the determination of urinary-specific proteins makes it possible

to non-invasively detect a preferentially tubular or glomerular injury, to orientate towards a pathological

process, to guide the indication of a kidney biopsy, and to follow the evolution of the disease and the

effectiveness of a therapy. No study systematically evaluated the performance of urinary-specific proteins for

the diagnosis of a renal disease. We conducted this retrospective study to perform an exhaustive analysis of the

correlations that may exist between histologically proven kidney disease and the corresponding specific urinary
protein composition it in order to evaluate the diagnostic value of each of its components. Urinary

concentrations of total protein, albumin, transferrin, alpha1microglobulin, beta2microglobulin, retinol binding

protein, and immunoglobulin G were analyzed in more than 500 patients who underwent renal biopsy and

concomitant urine specific protein analysis.

pH is the measurement of how acidic or alkaline a person's urine is. Doctors often test the urine pH, and

they may perform other diagnostic tests, when a person has symptoms that may be related to a problem in the

urinary tract.

Blood test is simple for you—with the exception of feeling "a little pinch"—the actual diagnostic process

behind the scenes is quite complex, requiring specialized equipment and technicians. Even before your blood is

tested, it needs to be properly prepared for the analyzer. It might be spun very fast to separate the blood cells

from the fluid portion of the blood, creating a serum or plasma sample. Then the blood analyzer device counts

and identifies the shape and size of blood cells, or measures chemical reactions to detect concentrations of

certain molecules in blood. Finally, the results are verified by a trained lab professional and returned to your

doctor.

Specific gravity- measurement of specific gravity provides information regarding a patient's state of

hydration or dehydration. It also can be used to determine loss of renal tubular concentrating ability. There are

no "abnormal" specific gravity values. This test simply indicates urine concentration.

Ketone- the presence of ketones in the urine probably indicates that the body is using fats rather than

carbohydrates for energy. High levels of ketones may be present in the urine of individuals with uncontrolled

diabetes because the body's ability to metabolize carbohydrates is defective. A preferable blood level of

ketones for dietary ketosis is 1.5–3.0 mmol/L (15–300 mg/dL) ( 11 ). Summary Measuring the ketones in your

blood is a more accurate but also more expensive way of measuring ketosis.

Bilirubin test is used to detect an increased level in the blood. It may be used to help determine the cause of

jaundice and/or help diagnose conditions such as liver disease, hemolytic anemia, and blockage of the bile

ducts. ... Heme is a component of hemoglobin, which is found in red blood cells

Glucose- blood glucose test measures the glucose levels in your blood. Glucose is a type of sugar. It is your

body's main source of energy. A hormone called insulin helps move glucose from your bloodstream into your

cells. Too much or too little glucose in the blood can be a sign of a serious medical condition. High blood

glucose levels (hyperglycemia) may be a sign of diabetes, a disorder that can cause heart disease, blindness,

kidney failure and other complications. Low blood glucose levels (hypoglycemia) can also lead to major health

problems, including brain damage, if not treated.

Panels: Leucocytes, nitrite, urobilinogen, protein pH, blood,specific gravity, ketone, bilirubin, glucose.

REAGENT COMPOSITION OF THE PANEL

The performance characteristics of the Urine Reagent Strips have been determined in both laboratory and

clinical tests. Parameters of importance to the user are sensitivity, specificity, accuracy and precision.

Generally, this test has been developed to be specific for the parameters to be measured with the exceptions of

the interferences listed:

Glucose (GLU) 30 seconds 1.5% w/w glucose oxidase; 0.5% w/w peroxidase; 10.0% w/w potassium iodide .

75.0% w/w buffer; 13.0% w/w non-reactive ingredients

Ketone (KET) 40 seconds 5% w/w sodium nitroprusside; 95% w/w buffer

Bilirubin (BIL) 30 seconds 0.5 % w/w 2, 4-dichloroaniline diazonium salt; 99.5% w/w buffer and non-reactive

ingredients

Blood (BLO) 60 seconds 4% w/w 3,3’,5,5’-tetramet hylbenzidine (TMB); 6% w/w cumene hydroperoxide; 90%

w/w buffer and non-reactive ingredients

Specific Gravity (SG) 45 seconds 2.5% w/w bromthymol blue indicator; 17.5% w/w buffer and non-reactive

ingredients; 55% poly (methyl vinyl ether/maleic anhydride); 25% sodium hydroxide

Protein (PRO) 60 seconds 0.3% w/w tetrabromophen ol blue; 99.7% w/w buffer and non-reactive ingredients

Urobilinogen (URO) 60 seconds 2.5% w/w p-diethylaminob enzaldehyde; 97.5% w/w buffer and non-reactive

ingredients

Nitrite (NIT) 60 seconds 4.5% w/w p-arsanilic acid; 95.5% w/w non-reactive ingredients

pH 60 seconds 0.5% w/w methyl red sodium salt; 5% w/w bromthymol blue; 94.5% w/w non-r eactive

ingredients

Leukocytes (LEU) 120 seconds 0.5% w/w derivatized pyrrole amino acid ester; 0.4% w/w diazonium salt; 32%

w/w buffer; 67.1% w/w non-reactive ingredients

SENSITIVITY OF EACH PANEL

Glucose: This test is specific for glucose; no substances excreted in urine other than glucose is known to give a

positive result. The reagent area does not react with lactose, galactose, fructose, or reducing metabolites of

drugs; e.g. salicylates and nalidixic acid. This test may be used to determine whether the reducing substances

found in urine is glucose. Approximately 100 mg/dl glucose in urine is detectable.

Bilirubin: The test has a sensitivity of 0.4-0.8 mg/dl bilirubin in urine. The test is considered specific for

bilirubin in urine.
Ketone: The ketone test area provides semi-quantitative results and reacts with acetoacetic acid in urine. This

test does not react with beta-hydroxybutyric acid or acetone. The reagent area detects as little as 5-10 mg/dl

acetoacetic acid in urine.

Specific Gravity: The specific gravity test permits determination of urine specific gravity between 1.000 and

1.030. In general, the specific gravity test correlates within 0.005 with values obtained with the reflective index

method.

Blood: At the time of reagent manufacture, this test when read as instructed has a sensitivity to free hemoglobin

of 0.015 mg/dl or 5- 10 intact red blood cells/μL urine. This test is slightly more sensitive to free hemoglobin

and myoglobin than to intact erythrocytes.

pH: The pH test area permits quantitative differentiation of pH values to one unit within the range of 5-9. pH

reading is not affected by variation in the urinary buffer concentration.

Protein: The test area is more sensitive to albumin than to globulin, hemoglobin, Bence-Jones proteins, and

mucoprotein; a negative result does not rule out the presence of these other proteins. The test area is sensitive to

15 mg/dl albumin. Depending on the inherent variability in clinical urine lesser concentration may be detected

under certain conditions.

Urobilinogen: This test will detect urobilinogen in concentrations as low as 0.2 EU/dl in urine. The absence of

urobilinogen in the specimen being tested cannot be determined with this test.

Nitrite: At the time of reagent manufacture, this test has sensitivity to sodium nitrite of 0.075 mg/dl.

Comparison of the reacted reagent area on a white background may aid in the detection of low levels of nitrite

ion, which may otherwise be missed. This test is specific for nitrite and will not react with substances normally

excreted in the urine.

Leukocytes: This test can detect as low as 10-15 WBC/μL. This test will not react with erythrocytes or bacteria

common in urine.

NORMAL/ACCEPTED LEVELS FOR EACH PANEL

Urobilinogen: in this test, the normal range of urobilinogen is 0.1 to 1.0 mg/dl. If results exceed a 2.0 mg/dl

concentration, the patient and/or urine sample should be further evaluated. Glucose: normally, glucose is not

detected in urine, although a small amount is excreted by the normal kidney. This test detects approximately

100 mg/dl. This concentration may be considered as abnormal if found consistently.

Ketones: with this reagent, ketonic bodies should not be detected in normal urines. Ketonic bodies may appear

in urine if vomit, diarrhea, digestive disorders, pregnancy or intense physical exercise are present.
Bilirubin: bilirubin is not detectable in urine of healthy individuals, even with the most sensitive methods. An

increase in its levels indicates disease and is the earliest sign of cellular disease and/or bile obstruction. The

appearance of bilirubin traces is enough evidence to justify a subsequent test.

Proteins: normal urine samples usually contain some proteins (0-4 mg/dl). Therefore, only highly persistent

levels of urine proteins indicate kidney or urinary tract disease. Protein results in traces or higher quantities

indicate significant proteinuria, and thus further clinical testing is required. Pathologic proteinuria usually yields

results above 30 mg/dl and is persistent.

Nitrite: any pink coloration degree after 30 seconds indicates clinically significant bacteriuria, usually due to

kidney, ureters, bladder or urethra infections.

pH: normal urine is slightly acid with a pH of 6, that can range from 5 to 8. It is an important indicator of

kidney, gastrointestinal, respiratory and metabolic factors.

Blood: the appearance of hemoglobin in urine indicates kidney or urinary tract disease. The test is highly

sensitive to hemoglobin and intact erythrocytes, thus complementing the microscopic examination.

Specific gravity: adults random urines have a specific gravity ranging from 1.003 to 1.040. Twenty four hour

urines from normal adults, with balanced diets and normal fluid intake, have a specific gravity of 1.016-1.022.

This test detects values between 1.000 and 1.030.

Leukocytes: normally no leukocytes are detectable in urine. Individually observed trace results may have

questionable clinical significance. If positive results are observed, a subsequent study of the patient should be

performed. Occasionally, in women urine, it is possible to find leukocytes due to vaginal contamination.

LIMITATION OF EACH PANEL

Glucose: This test is highly specific for glucose. No substance excreted in urine other than glucose is known to

give a positive result. The reagent area does not react with ketones, lactose, galactose, fructose or other

metabolic substances with reducing metabolites of drugs (e.g. salicylates and nalidixic acid).

• Ketone: The test does not react with acetone or β-hydroxybutyrate. Urine specimens of high pigment, and

other substances containing sulfhydryl groups occasionally give reactions up and including trace (+).

• Bilirubin: Bilirubin is absent in normal urine, so any positive result, including a trace positive, indicates an

underlying pathological condition and requires further investigation. Reactions may occur with urine containing

large doses of chlorpromazine or rifampen that might be mistaken for positive bilirubin.The presence of

bilirubin-derived bile pigments may mask the bilirubin reaction. This phenomenon is characterized by color
development on the test patch that does not correlate with the colors on the color chart. Large concentrations of

ascorbic acid may decrease sensitivity.

• Blood: A uniform blue color indicates the presence of myoglobin, hemoglobin or hemolyzed erythrocytes.

Scattered or compacted blue spots indicate intact erythrocytes. To enhance accuracy, separate color scales are

provided for hemoglobin and for erythrocytes. Positive results with this test are often seen with urine from

menstruating females. It has been reported that urine of high pH reduces sensitivity, while moderate to high

concentration of ascorbic acid may inhibit color formation. Microbial peroxidase, associated with urinary tract

infection, may cause a false positive reaction. The test is slightly more sensitive to free hemoglobin and

myoglobin than to intact erythrocytes.

• Specific Gravity: Ketoacidosis or protein higher more than 100 mg/dL may cause elevated results. Results are

not affected by non-ionic urine components such as glucose. If the urine has a pH of 7 or greater, add 0.005 to

the specific gravity reading indicated on the color chart.

Protein: Any green color indicates the presence of protein in the urine. This test is highly sensitive for albumin,

and less sensitive to hemoglobin, globulin and mucoprotein. A negative result does not rule out the presence of

these other proteins. False positive results may be obtained with highly buffered or alkaline urine.

Contamination of urine specimens with quaternary ammonium compounds or skin cleansers containing

chlorhexidine produce false positive results. The urine specimens with high specific gravity may give false

negative results.

• Urobilinogen: All results lower than 1 mg/dL urobilinogen should be interpreted as normal. A negative result

does not at any time preclude the absence of urobilinogen. The reagent area may react with interfering

substances known to react with Ehrlich’s reagent, such as p-aminosalicylic acid and sulfonamides. False

negative results may be obtained if formalin is present. The test cannot be used to detect porphobilinogen.

• Nitrite: The test is specific for nitrite and will not react with any other substance normally excreted in urine.

Any degree of uniform pink to red color should be interpreted as a positive result, suggesting the presence of

nitrite. Color intensityis not proportional to the number of bacteria present in the urine specimen. Pink spots or

pink edges should not be interpreted as a positive result. Comparing the reacted reagent area on a white

background may aid in the detection of low nitrite levels, which might otherwise be missed. Ascorbic acid

above 30 mg/dL may cause false negatives in urine containing less than 0.05 mg/dL nitrite ions. The sensitivity

of this test is reduced for urine specimens with highly buffered alkaline urine. For accurate results, antibiotics

should be discontinued for at least 3 days before the test is performed. A negative result does not at any time

preclude the possibility of bacteruria. Negative results may occur in urinary tract infections from organisms that
do not contain reductase to convert nitrate to nitrite; when urine has not been retained in the bladder for a

sufficient length of time (at least 4 hours) for reduction of nitrate to nitrite to occur; or when dietary nitrate is

absent.

• pH: pH readings are not affected by variations in urinary buffer concentration.

• Leukocytes: The result should be read between 60-120 seconds to allow for complete color development. The

intensity of the color that develops is proportional to the number of leukocytes present in the urine specimen.

High specific gravity or elevated glucose concentrations (≥ 500 mg/dL) may cause test results to be artificially

low. The presence of cephalexin, cephalothin, or high concentrations of oxalic acid may also cause test results

to be artificially low. Tetracycline may cause decreased reactivity, and high levels of the drug may cause a false

negative reaction. High urinary protein (≥ 500 mg/dL) may diminish the intensity of the reaction color. This test

will not react with erythrocytes or bacteria common in urine.

II. FLOW CHART DESCRIBING THE STEPS UNDERTAKEN

Students described the urinalysis test to the donor and asked for a urine
SPECIMEN sample that were placed inside a new urine bottle.
COLLECTION

The donor were interviewed about her background medical condition.

HISTORY (symptoms, diagnosis and treatment)
TAKING

Upon the collection of urine, a timer was start for the interval of
FINDINGS readings. 3 reagent strip were then dip into the urine sample after AND
READING OF 5mins, 30mins and 1hour. These strips were placed into the printed
RESULTS urinalysis test directions after 2mins and students note the results.

CONCLUSION

FIGURE 1. URINALYSIS TEST DIRECTION

This test direction was used to detect the values obtained from the three readings performed.

TABLE 1: URINALYSIS RESULT OF THE TWO SAMPLES COLLECTED

Panels NORMAL/BASELINE CANCER PATIENT‘S URINE

LEVEL

1st reading 2ndreading 3rd reading

(2-10 mins (30 mins after (1 hour after

urination) urination)
after urination)

Leucocytes Negative Small 70 Small 70 Moderate 125

Nitrite Negative Positive Positive Positive

Urobilinogen Less than 17 µmol/l 16 µmol/l 16 µmol/l 16 µmol/l

Protein 0 trace or Negative Trace ± Negative Trace ±

pH 4.5 to 8.00 6.0 6.0 6.5

Blood Negative Non hemolyzed Non hemolyzed Non hemolyzed

10 Trace 10 Trace 10 Trace

Specific gravity 1.005 to 1.025 1.010 1.010 1.005

Ketone Negative Negative Negative Negative

Bilirubin Negative Small 17 Small 17 Small 17

Glucose Negative 5 Trace Negative Negative

 LEUKOCYTES

The expected result should be negative but the patient’s 1st and 2nd reading resulted to a same

value which is small 70 and after 1 hour her last reading obtained a Moderate 125 value. It shows

that the leukemia patient’s WBCs in urine increases significantly and it indicates a positive result

wherein the detection of white blood cells (WBC's) in the urine suggests a possible Urinary Tract

Infection (UTI) somewhere in the urinary tract such as the bladder, or the urethra. This result just

proves that the patient is suffering from a cancer called leukemia, a disease characterized by

having too many white blood cells in the body.

 NITRITE

The urine sample tested positive in all three readings despite the different time interval. A

positive nitrite test result can indicate a UTI which means bacteria enters the urinary tract.

 UROBILINOGEN

The normal baseline for this test was Less than 17 µmol/l and patient’s result tested negative for

all three readings performed, she only have 16 µmol/l. Urobilinogen is normally present in urine

in low concentrations. It is formed in the intestine from bilirubin, and a portion of it is absorbed

back into the blood. Patient’s results are normal and no indication of liver failure.

 PROTEIN

The protein test pad provides a rough estimate of the amount of albumin in the urine. Albumin

makes up about 60% of the total protein in the blood. Normally, there will be no protein or a

small amount of protein in the urine, with this statement, the patient’s result for protein is

normal. 1st read indicates a trace ± value and if trace amounts of protein are detected, and

depending on the person's signs, symptoms and medical history, 2nd dip of strip was performed to

see if there is still protein in the urine and it has dropped back to undetectable levels negative and

back to trace ± after 1 hour.

 pH

The urine is usually slightly acidic, about pH 6, but can range from 4.5-8. Patient’s result has

steady pH value of 6 until the 2nd reading and slightly changed on the 3rd reading with only 6.5

pH values. The kidneys play an important role in maintaining the acid-base balance of the body

and by having a normal result for this test we can infer that her kidneys are functioning normally

too.

 BLOOD

Patient’s result was consistent throughout the three readings with a value of Non hemolyzed 10

Trace, quite close to negative result. Results of this test are typically interpreted along with those

from the microscopic examination of the urine to determine whether RBCs are present in the

urine. A positive result on this test with no RBCs present may indicate the presence of

hemoglobin in the urine (which can occur when RBCs have broken apart) or myoglobin from

muscle injury.
  SPECIFIC GRAVITY

From a normal range of 1.005 to 1.025, the patient’s result was 1.010, 1.010, and 1.005 meaning

these three readings were normal. This test simply indicates how concentrated the urine is.

Specific gravity measurements are a comparison of the amount of substances dissolved in urine

as compared to pure water. Her results shows that little amount of substances were included in

the urine.

 KETONE

Patient has a steady result of negative to ketones throughout the three readings. Ketones are not

normally found in the urine. They are intermediate products of fat metabolism. They are

produced when glucose is not available to the body's cells as an energy source. They can form

when a person does not eat enough carbohydrates or when a person's body cannot use

carbohydrates properly.

 BILIRUBIN

Patient’s urine revealed a value of small 17 from 1st reading until to 2nd reading.

Bilirubin is a highly pigmented compound (yellow in color), a waste product that is produced by

the liver from the hemoglobin of RBCs that are broken down and removed from circulation. It

becomes a component of bile, a fluid that is released into the intestines to aid in food digestion.

Her small detection of Bilirubin in the urine is an early indication of liver disease such as

hepatitis, a blockage in the structures that carry bile from liver, or a problem with general liver

function.

 GLUCOSE

Glucose is normally not present in urine thus the patient’s glucose level of trace 5 and two

negative results indicate that her sugar level are normal. The donor was then interviewed before

the collection of urine and she said that throughout her day she only eat boiled egg and small

cup of rice, her lack of food can be the reason of her negative glucose level.

References:
https://www.sciencedirect.com/science/article/pii/S0085253815523806

https://www.mayoclinic.org/tests-precedures/urinalysis/about/pac-20384907

https://www.annlabmed.org/journal/view.html?uid=163vmd=Full

https://www.bioscience.com.pk/topics/biochemistry/item/213-urine-strip-test-understanding-its-limitations

https://www.ajkd.org/article/S0272-6386(07)00697-X/fulltext

https://vetirinarynews.dvm360.com/urine-strips-maximizing-diagnos-value

https://www.mayoclinic.org/tests-procedures/urinalysis/about/pac-20384907

https://www.cliawaived.com/web/items/pdf/TCURS_Urinalysis_Reagent_Testing~644file1.pdf https://

www.disabled-world.com/calculators-charts/urinalysis.php

https://labtestsonline.org/tests/urinalysis

https://bpac.org.nz/BT/2013/June/urine-tests.aspx

DOCUMENTATION

Collection of Donor’s Urine

First Reading after 2-10 mins

Second reading after 30 mins

Third reading after 1 hour

 All three reagent strip was read after 2 mins.

TASK ALLOTMENT

NAME OF MEMBER TASK ASSIGNED DATE ASSIGNED DATE COMPLETED

CABRIDO,  In charge of writing Nov. 29 2019 Dec. 02, 2019

ALECSANDRA the objectives.

NICOLE S.  Perform the reading

of results.

CABUDSAN,  In charge in the 1st half of Nov. 29 2019 Dec. 02, 2019

GENESIS S. Materials and Method.

CUNANAN,  In charge of buying the Nov. 29 2019 Dec. 02, 2019

CHARLES KEVIN materials needed (gloves

and urine bottle)

 In charge of the Part II flow

chart.

DATU, BEVERLY  In charge of the 2nd half of Nov. 29 2019 Dec. 02, 2019

JANE L. Materials and Method

 Perform the reading of

results
 DELA CRUZ,  In charge of the 1st half of Nov. 29 2019 Dec. 02, 2019

DONNA R. introduction.

 In charge of history taking.

DELA VEGA, ELLA  In charge of history taking. Nov. 29 2019 Dec. 02, 2019

MAE M.  In charge of writing the

abstract, finding and

conclusions.

DOMINGO,  In charge of writing the 2nd Nov. 29 2019 Dec. 02, 2019

MONALIZA M. half of introduction

 Perform the reading of

results.