Usa ne Aoolyre 10 + Rurinalysis is a laboratory test. It can help your doctor detect problems that may be shown by your urine. Why Get Tested? To screen for, help diagnose and/or monitor several diseases and conditions, such as kidney disorders or urinary tract infections (UTIs) When is it ordered? ALE pale Fas When you have symptoms, such as abdominal pain, back pain, frequent or painful urination; blood in urine, sometimes as part of a health eaamnination, pregnancy check-up, hospital admission, or pre-surgical work-up. $ What is being tested? ‘Acomplete urinalysis consists of * Visual examination, which e clarity * Chemical ex three distinct testing phases: yyaluates the urine’s color and amination, which tests chemically for about 9 substances that provide valuable information about health and disease and determines the concentration of the urine « Microscopic examination, which identifies and counts the type of cells, casts, crystals, and other components such as bacteria and mucus that can be present in urine $ How is the sample * One to two ounces 0! sufficient sample is req + Urine for a urinalysis can a first morning sample ma concentrated and more lik + Sometimes, you may be asked to c sample. For this, it is important to c! collecting the urine. Bacteria and cells collected for testing? * urine is collected in a clean container. A uired for accurate results. be collected at any time. In some cases, y be requested because it is more ely to detect abnormalities. collect a “clean-catch” urine jean the genital area before from the surrounding skincan contaminate the sample and interfere with the interpretation of test results. ‘Aurine sample will only be useful for a urinalysis if taken to the healthcare provider's office or laboratory for processing within a short period of time. $s Visual Exam During the visual examination of the urine, the laboratorian observes the urine’s color and clarity. These can be signs of what substances may be present in the urine. + Urine color Urine can be a variety of colors, most often shades of yellow, from very pale or colorless to very dark or amber. Unusual or abnormal urine colors can be the result of a disease process, several medications (e.8-, multivitamins can turn urine bright yellow), or the result of eating certain foods. + Urine clarity Urine clarity refers to how clear the urine is. Usually, laboratorians report the clarity of the urine using one of the following terms: clear, slightly cloudy, cloudy, or turbid. “Normal” urine can be clear or cloudy. $ Chemical Exam To perform the chemical examination, most clinical laboratories use commercially prepared test strips with test pads that have chemicals impregnated into them. The laboratorian dips the strip into urine, chemical reactions change the colors of the pads within seconds to minutes, and the laboratorian determines the result for each test. To reduce timing errors and eliminate variations in color interpretation, automated instruments are frequently used to “read” the results of the test strip. $ A dipstick test checks forSpecific gravity «Urine specific gravity is a measure of urine concentration. This test show how concentrated particles are your in urine. If there were no Substances present, the specific gravity of the urine would be 1.000 (the same as pure water). Since all urine has some substances in it, a urine SG of 1.000 is not possible. If a person drinks excessive quantities of water in a short period of time or gets an intra (IV) infusion of large volumes of fluid, then the urine specific gravity may be very close to that of water. The upper limit of the test pad, a specific gravity of 1.035, indicates concentrated urine, one with many substances in a limited amount of water. S$ Acidity (pH) The pH level indicates the amount of acid in urine. Abnormal pH levels may indicate a kidney or urinary tract disorder. The urine is usually slightly acidic, about pH 6, but can range from 4.5- 8. The kidneys play an important role in maintaining the acid-base balance of the body. enous Protein + The protein test pad provides a rough estimate of the amount of albumin in the urine. Normally, there will be no protein or a small amount of protein in the urine. When urine protein is elevated, a person has a condition called proteinuria. ( Larger amounts may indicate a kidney problem) Proteinuria may occasionally be seen in healthy individuals. Healthy people can have temporary or persistent proteinuria due to stress, exercise, fever, aspirin therapy, of exposure to cold. Repeat testing may be done once these conditions have resolved to determine whether the proteinuria is persistent. $ GlucoseNormally the amount of sugar (glucose) in urine is too low to be detected. When glucose is present, the condition is called glucosuria. Some other conditions that can cause glucosuria include hormonal disorders, jiver” disease, medications, and pregnancy. Bilirubin + This test screens for bilirubin in the urine. Bilirubin is not present in the urine of normal, healthy individuals. It is a waste product that is produced by the liver from the hemoglobin ‘of RBCs that are broken down and removed from circulation. It becomes 2 component of bile, a fluid that is released into the intestines to aid in food digestion. + Incertain liver diseases, such as biliary obstruction or hepatitis, excess bilirubin can build up in the blood and is eliminated in urine. The presence of bilirubin in urine is an early indicator of liver disease and can occur before clinical symptoms such as jaundice develop $ Ketones As with sugar, any amount of ketones detected in voor urine, could be 2 sign of diabetes and requires follow-up testing, Exposure to cold, frequent, prolonged vomiting, and several digestive system diseases can ice increase fat metabolism, resulting in ketonuria. Urobilinogen + This test screens for urobilinogen in the urine. 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. Positive test results may indicate liver diseases such as viral hepatitis, cimhosis, liver damage due to drugs or toxic substances, or conditions associated with increased RBC destruction (hemolytic anemia). When urine urobilinogen is low or absent in a person with urine bilirubin and/or signs of liver dysfunction, it can indicate the presence of hepatic or biliary obstruction. $ Blood (Hemoglobin) and Myoglobin + This test is used to detect hemoglobin in the urine (hemoglobinuria)+ Its presence in the urine indicates blood in the urine (known, as hematuria). « A-small number of RBCs are normally present in urine and usually result in a “negative” chemical test. An increased amount of hemoglobin and/or increased number of RBCs are detected as a “positive” chemical test 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. $ Leukocyte esterase is an enzyme present in most white blood cells (WBCs). A few white blood cells are normally present in urine and usually give a negative chemical test result. When the number of WBCs in urine increases significantly, this screening test will become positive. Results of this test will be considered along with a microscopic examination for WBCs in the urine. + When this test is positive and/or the WBC count in urine is high, it may indicate that there is inflammation in the urinary tract or kidneys. The most common cause for WBCs in urine (leukocyturia) is a bacterial urinary tract infection (UTI $ Nitrite + This test detects nitrite and is based upon the fact that many bacteria can convert nitrate (a normal substance in urine) to nitrite. Normally, the urinary tract and urine are free of bacteria and nitrite. When bacteria enter the urinary tract, they can cause a urinary tract infection. However, since not all bacteria are capable of converting nitrate to nitrite, the results of this test will be considered along, with the leukocyte esterase (above) and a microscopic examination. Ascorbic Acid (Vitamin C) + Occasionally, people taking vitamin C or multivitamins may have large amounts of ascorbic acid in their urine.$ Microscopic Exam The microscopic exam is performed on urine sediment — urine that has been centrifuged to concentrate the substances in it at the bottom of a tube. The fluid at the top of the tube is then discarded and the drops of fluid remaining are examined under a microscope. It will typically be done when there are abnormal findings on the physical or chemical examination and the results from all will be taken into account for interpretation $ Red blood cells (RBCs) * Normally, a few RBCs are present in urine sediment (0-5 RBCs per high power field). Some causes of hematuria are benign, temporary states that do no lasting harm and resolve with little or no specific treatment, but may be a sign of kidney disease, a blood disorder or another underlying medical condition, such as bladder cancer. S$ White blood cells (WBCs) +» The number of WBCs in urine sediment is normally low (0-5 WBCs per high power field). WBCs can be a contaminant, such as those from vaginal secretions. An increased number of WBCs seen in the urine under a microscope and/or positive test for leukocyte esterase may indicate an infection or inflammation somewhere in the urinary tract. Epithelial cells + Epithelial cells are usually reported as “few,” “moderate,” or “many” present per low power field (LPF). Normally, in men and women, a few epithelial cells can be found in the urine sediment. In urinary tract conditions such as infections, inflammation, and malignancies, an increased number of epithelial cells are present. $ Bacteria, yeast+ in healthy people, the urinary tract is sterile and, if the urine sample is collected as a “clean-catch” sample, there will be no microbes seen in the urine sediment under the microscope. + Urinary tract infections are caused by microorganisms — usually bacteria — that enter the urethra and bladder, causing 4 inflammation and infection. Though a UTI most commonly happens in the urethra and bladder, bacteria can also travel up the ureters and infect your kidneys, + In women (and rarely in men), yeast can also be present in urine. They are most often present in women who have a vaginal yeast. infection because the urine has been contaminated with vaginal secretions during collection, Casts Casts are cylindrical particles sometimes found in urine that are formed from coagulated protein released by kidney cells, They are formed in the long, thin, hollow tubes of the kidneys known as tubules and usually take the shape of the tubule. Under the microscope, they often look like the shape of a “hot dog” and in healthy people they appear nearly clear. This type of cast is called a “hyaline” cast. Normally, healthy people may have a few (0-5) hyaline casts per low power field. + Other types of casts are associated with different kidney diseases, and the type of casts found in the urine may give clues as to which disorder is affecting the kidney, * Fatty casts are seen in people who have lipids in urine. This is most often a complication of nephrotic syndrome. Granular casts are a sign of many types of kidney diseases. + Red blood cell casts mean there is a microscopic amount of bleeding from the kidney. + Renal tubular epithelial cell casts reflect damage to tubule cells in the kidney. These casts are seen in conditions such as renal tubular necrosis, viral disease such as cytomegalovirus nephritis and kidney transplant rejection. : + Waxy casts can be found in people with advanced kidney disease and long term (chronic) kidney and long-term (chronic) kidney failure. (a—_——— * + White blood cell (WBC) casts are common with acute kidney infections and interstitial nephritis $ Crystals + Urine contains a large number of different chemicals. Under some circumstances, these chemicals may solidify into salt crystals. This is called crystaluria. Crystals are considered “normal” if they are from solutes that are typically found in the urine: * Amorphous urates + Crystalline uric acid * Calcium oxalates + Amorphous phosphates If the crystals are from substances that are not normally in the urine, they are considered “abnormal.” Abnormal crystals may indicate an abnormal metabolic process. Some of these include: + Calcium carbonate * Cystine + Tyrosine + Leucine Normal or abnormal crystals can form within the kidneys as urine is being made and may group together to form kidney “stones” or calculi. These stones can become lodged in the kidney itself or in the ureters, tubes that pass the urine from kidney to the bladder, causing extreme pain