Chapter 2: Introduction to Urinalysis  Formed elements in the urine

History and Importance 1. Cells

 Analyzing urine 2. Casts
- Beginning of laboratory medicine 3. Red Blood Cells
 Edwin Smith Surgical Papyrus 4. White Blood Cells
- Egyptian hieroglyphics 5. Crystals
- Physicians with bladder-shaped flask 6. Bacteria
 Basic Observations: 7. Mucus threads
1. Color
2. Turbidity  Primary Components in Normal Urine
3. Odor
4. Volume  Organic compounds
5. Viscosity 1. Urea – primary organic component
6. Sweetness  Metabolic waste product of breakdown of protein and AA
a. Taste test  Accounts for nearly half of total dissolved solids in urine
b. Attraction of Ants ** To identify fluid as urine: High Urea and High Creatinine
 Hippocrates (5th Century BCE) 2. Creatinine – product of creatine metabolism
- Book on uroscoppy 3. Uric acid – product of nucleic acid breakdown
 1140 CE
- Color charts  Inorganic compounds
- Significance of 20 different colors 1. Chloride – primary inorganic component
 Frederick Dekkers (1694) 2. Sodium
- Albuminuria by boiling urine 3. Potassion – combines with chloride
 Charlatans (Pisse prophets) 4. Phosphate – combines with sodium to buffer blood
- Offer predictions to public for healthy fee 5. Ammonium – regulates acidity
 Thomas Bryan (1627) 6. Calcium – combines with chloride, sulfate, phosphate
- Published book about Charlatans Urine Volume
- Inspired passing of 1st medical licensure laws in England  Urine Volume depends on the amount of water that the kidneys
 Thomas Addis excrete.
- Methods of quantitating microscopic sediments * Water is a major body constituent; amount excreted is
 Richard Bright determined by the body’s state of hydration.
- Concept of urinalysis as part of doctor’s routine patient
exam  Factors that influence urine volume
1. Fluid intake
 Two (2) unique characteristics of urine 2. Fluid loss
1. Readily available and easily collected 3. Variations in secretion of ADH
2. Contains information about body’s major metabolic 4. Need to excrete increased amounts of dissolve solids
function (glucose or salts)
 Oliguria
 Urinalysis (CLSI) - Decreased in urine output
- Testing of urine procedures commonly performed in an o Infants – -Less than 1 mL/kg/hr
expeditious, reliable, accurate, sage, & cost-effective o Children – Less than 0.5 mL/kg/hr
manner. o Adults – Less than 400 mL/day
CLSI – Clinical & Laboratory Standards Institute - Leads to anura
 Reasons for performing urinalysis - It is commonly seen when the body enters a state of
1. Aiding in the diagnosis of disease dehydration as a result of excessive water loss from
2. Screening asymptomatic population for undetected vomiting, diarrhea, perspiration, or severe burns.
disorders  Anuria
3. Monitoring progress of disease & effectiveness of therapy - Cessation of urine flow
Urine Formation - Causes:
 Formed by the kidneys o Kidney damage
 Ultrafiltrate of plasma o Decrease blood flow to kidneys
 Average daily urine output = 1,200 – 1,500 mL (1.2-1.5 L) ** Kidney excrete 2 or 3 times more in the day than in the night
* Range of 600 to 2000 mL is considered normal.  Nocturia
Urine Composition - increased nocturnal urination
 Polyuria
 95% water, 5% solute
- Increased daily urine volume
o Children – 2.5 – 3 mL kg/day
 Causes of variations in solutes
o Greater than 2.5 L/day in adults
1. Dietary intake – influences conc. of inorganic solutes
- Often associated with diabetes mellitus and diabetes
2. Physical activity
insipidus; may be artificially induced by diuretics, caffeine,
3. Body metabolism
or alcohol, all of which suppress the secretion of ADH
4. Endocrine function

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 Diabetes Mellitus (DM) Specimen Handling
- Defect in pancreatic production of insulin Specimen Integrity
- kidneys do not reabsorb excess glucose, necessitating - Specimens should be delivered within 2 hours
excretion of increased amounts of water - If not:
- High glucose = increased specific gravity of urine - Refrigerate
Chemical Preservatives
 Diabetes Insipidus (DI) **Most changes are related to bacterial growth
- Decrease in production/ function of ADH  Changes in Unpreserved Urine
- the water is not reabsorbed from the plasma filtrate. 1. Modified / Darkened – Color
- urine is truly dilute and has a low specific gravity. 2. Increased:
 polydipsia - increased ingestion of water or excessive thirst a. Nitrite
 polyuria – excessive urination b. Bacteria
 polyphagia – excessive hunger c. Odor
d. pH
Specimen Collection e. Turbidity
Containers 3. Decreased:
- Clean, dry, leak-proof a. Clarity
 Container for Routine Urinalysis b. Glucose
1. Wide mouth – for female patients c. Ketones
2. Wide flat bottom – prevent overturning d. Bilirubin – photo-oxidation to biliverdin
3. Made of clear material – for color and clarity e. Urobilinogen
Recommended capacity: 50 mL (12 mL for microscopic analysis) f. RBC, WBC, Casts
 Sterile Containers g. Trichomonas
- Microbiologic urine studies Specimen Preservation
- Suggested if more than 2 hours elapse time between 1. Refrigeration
specimen collection and analysis - Most routinely used method of preservation
- Has a: - 2-8 °C
- Lid and Transfer device (with transfer straw) - If urine cultured it is refrigerated until 24 hours.The
 Transfer straw specimen must return to room temperature before
- Has an eedle and evacuated tube holder chemical testing by reagent strips
- Tubes: 2. Boric Acid
- w/ preservatives – microbiologic testing - Prevent bacterial growth and metabolism
- w/ conical bottom – sediment analysis - Interferes with drug and hormone analysis
- w/ round bottom – reagent strip testing - Keeps 6.0 pH; urine culture transport
Labels 3. Formalin
- Must be attached to the container NOT on the lid - Preserves sediments
- Should NOT be detached if container is refrigerated or - Reducing agent
frozen - Interferes with chemical tests for glucose, blood,
- with the patient’s name and identification number, the leukocyte esterase and copper reduction
date and time of collection, and additional information 4. Sodium fluoride
such as the patient’s age and location and the physician’s - Preservative for drug analysis
name, - Inhibits reagent strip tests for glucose, blood,
Requisitions leukocyte
- A requisition form (manual or computerized) must 5. Commercial Preservative Tablets
accompany specimens delivered to the laboratory. 6. Urine Collection Kits
- Test requisitions must match the information on the 7. Light gray & gray C & S tube
specimen label - Stable at RT for 48 hours
8. Yellow UA Plus tube
- Can include: - For automated instruments
- Method of collection 9. Cherry Red/Yellow Preservative Plus tube
- Interfering medications - Stable at RT for 72 hours
- Clinical information 10. Sacommano Fixative
- Time the specimen is received - Preserves cellular elements
Specimen Rejection 11. Toluene & Phenol
 Unacceptable situations: - Does not interfere with routine tests
1. Unlabeled containers 12. Thymol
2. Requisition and label nonmatching - Preserves glucose and sediments
3. Contaminated with feces or toilet paper
4. Contaminated exterior
5. QNS
6. Improperly transported
** NEVER discard BEFORE asking the SUPERVISOR.
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 Types of Specimens
1. Random Specimen 8. Midstream Clean-Catch Specimen
- Most commonly received - Alternative to catheterized specimen
- May be collected any time - It provides a specimen that is less contaminated by
o Time voiding should be recorded epithelial cells and bacteria and, therefore, is more
- Routine screening representative of the actual urine than the routinely
- may show erroneous results resulting from dietary intake voided specimen.
or physical activity just before collection. - Safer, less traumatic
- - For bacterial culture & routine analysis
2. 1st Morning Specimen
- the ideal screening specimen 9. Suprapubic Aspiration
- an 8-hour specimen, is a concentrated specimen and - collected by external introduction of a needle through the
should be deliver it to the laboratory within 2 hours. abdomen into the bladder.
- preventing false-negative pregnancy tests and for - sample for bacterial culture that is completely free of
evaluating orthostatic proteinuria extraneous contamination.
- for cytologic examination.
3. Fasting Specimen (2nd Morning)
- the second voided specimen after a period of fasting. 10. Prostatitis Specimen
- will not contain any metabolites from food ingested before  3-glass collection
the beginning of the fasting period. - used to determine prostatic infection.
- It is recommended for glucose monitoring.  Glass 1 – First urine
 Glass 2 – Midstream urine
4. 2-Hour Postprandial Specimen  Glass 3 – Urine with prostate fluid
- void shortly before consuming routine meal and collect o Glass 1 to 3
specimen 2 hours after eating. - Quantitative culture
- tested for glucose o Glass 3
- primarily for monitoring insulin therapy in persons with - Microscopic exam
diabetes mellitus. - Contains WBC/HPF and bacterial count of 10x > than
1st specimen
5. Glucose Tolerance Specimens o Glass 2
- Collected to correspond with the blood samples drawn - Control for bladder and kidney infection
during a glucose tolerance test (GTT). - If positive for bladder & kidney infection; glass 3 is
- The number of specimens varies with the length of the invalid.
test.  Pre & Post Massage Test (PPMT)
tested for glucose and ketones,  clean-catch midstream urine specimen is collected.
- the results are reported along with the blood test results (1)
are correlated with the renal threshold for glucose.  Massage prostate
 Collect urine (2)
6. 24- Hour Specimen (Timed Specimen)  Massage prostate
- Accurate quantitative results  Collect urine (3)
- the lowest concentration is in the early morning and the o (+) for Bacteruria if bacterial count is 10x > in 2 than in 3
highest concentration occurs in the afternoon.  Stamey Mears Test for Prostatities (4-glass method)
- If the concentration of a particular substance remains  VB1 – Initial voided urine
constant, the specimen may be collected over a shorter  VB2 – Midstream clean-catch
period.  EPS – expressed prostatic secretion
- All specimen should be refrigerated or kept on ice  VB3 – Post prostatic massage urine
- Quantitative chemical tests o VB1
- Tested for Urethral infection or inflammation
 Solutes with diurnal variations (Low in early morning; High in o VB2
afternoon) - Tested for Urinary bladder infection
a. Cathecholamines o EPS
b. 17- hydroxyl steroids - > 10-20 WBC/HPF = abnormal
c. Electrolytes 11. Pediatric Specimen
7. Catheterized Specimen - Soft, clear plastic bags with hypoallergenic skin
- For bacterial culture adhesive toattach to the genital area of both boys
- specimen is collected under sterile conditions by passing a and girls are available for collecting routine
hollow tube (catheter) through the urethra into the specimens.
bladder. - Sterile specimens may be obtained by catheterization
- measures functions in the individual kidneys. or by suprapubic aspiration.
- Specimens for culture also may be obtained using a
clean-catch cleansing procedure and a sterile
collection bag.
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 Drug Specimen Collection
 Urine specimen collection is the most vulnerable part of a drug-testing program. Correct collection procedures and documentation are
necessary to ensure that the results are those of the specific individual submitting the specimen.
 Chain of Custody (COC)
- Process that provides of proper sample identification from time of collection to the receipt of labor story results
- is a standardized form that must document and accompany every step of drug testing.
 Drug Specimen Collection
- May be witnessed or unwitnessed
- If witnessed:
o Witness/ Collector = Same gender
o Collect 30-45 mL of urine
** Urine temperature must be taken within 4 minutes; temperature should be 32.5-37.7°C.

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