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Blood enters the capillaries > afferent arteriole> flows through

the glomerulus> efferent arteriole

Nephron - functional units (1 to 1.5 million) Sizes of these arterioles

 help to create the hydrostatic pressure differential
2 types of nephrons: important for glomerular filtration
 Cortical nephrons  maintain consistency of glomerular capillary pressure and
 approximately 85% of nephrons renal blood flow within the glomerulus
 cortex of the kidney
 responsible primarily for removal of waste Smaller size of the efferent arteriole
products  increases the glomerular capillary pressure
 reabsorption of nutrients
 Juxtamedullary nephrons (Before returning to the renal vein)
 longer loops of Henle blood from the efferent arteriole enters> peritubular capillaries>
 primary function is concentration of the urine vasa recta> cortex and medulla of the kidney close to the tubules

Kidney Peritubular capillaries

 clear waste products selectively from the blood  surround the proximal and distal convoluted tubules
 maintain the body’s essential water and electrolyte  reabsorption of essential substances from the fluid
balances (proximal convoluted tubule)
 final adjustment of the urinary composition (distal
Renal functions: convoluted tubule)
a. renal blood flow
b. glomerular filtration Vasa recta
c. tubular reabsorption  loops of Henle in juxtamedullary nephrons (adjacent to
d. tubular secretion ascending and descending)

Renal Blood Flow Osmotic gradient (salt concentration)

 renal artery supplies blood to the kidney  major exchanges of water and salts take place between the
 human kidneys (approximately 25% of the blood pumped blood and the medullary interstitium
through the heart)  necessary for renal concentration

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Average body size 3 glomerular filtration barrier cellular layers

 1.73 m2 of surface a. the capillary wall membrane
b. the basement membrane (basal lamina)
Total renal blood flow c. visceral epithelium of Bowman’s capsule
 1200 mL/min
Endothelial cells of the capillary wall
Total renal plasma flow  containing pores and are referred to as fenestrated (differs)
 600 to 700 mL/min  pores increase capillary permeability but do not allow the
passage of large molecules and blood cells
Glomerular filtration rate (GFR)
 calculated determine whether the observed measurements Basement membrane
represent normal function  restriction of large molecules occurs as the filtrate

Glomerular Filtration Thin membranes

 consists of a coil (eight capillary lobes)
Walls of Glomerular Filtration
 glomerular filtration barrier
 located within Bowman’s capsule
 serves as a nonselective filter of plasma substances
with molecular weights less than 70,000
Several factors influence the actual filtration process
 cellular structure of the capillary walls and Bowman’s
capsule
 hydrostatic pressure and oncotic pressure
 renin-angiotensin-aldosterone system (RAAS)
Cellular Structure of the Glomerulus
Plasma filtrate must pass through;
 covering the filtration slits formed by the intertwining foot
processes of the podocytes of the inner layer of Bowman’s
capsule
Structure of the glomerular filtration barrier
 contains a shield of negativity that repels molecules with a
positive charge
 shield is very important because albumin (the primary
protein associated with renal disease) has a positive charge
and would easily pass through the barrier
Glomerular Pressure
Hydrostatic pressure
 resulting from the smaller size of the efferent arteriole
 glomerular capillaries enhances filtration
(opposition of pressures from the fluid within Bowman’s capsule
and oncotic pressure of unfiltered plasma proteins in the glomerular
capillaries)

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Autoregulatory mechanism (juxtaglomerular apparatus)
 maintains the glomerular blood pressure at a relatively
constant rate regardless of fluctuations in systemic blood
pressure
Dilation of the afferent arterioles and constriction of the
efferent arterioles when blood pressure drops;
 decrease in blood flowing through the kidney
preventing an increase in the blood level of toxic waste
products.
 increase in blood pressure
results in constriction of the afferent arterioles to prevent
overfiltration or damage to the glomerulus
Renin-Angiotensin-Aldosterone System
 flow of blood to and within the glomerulus
 system responds to changes in blood pressure and plasma
sodium content
Juxtaglomerular apparatus
 consists of the juxtaglomerular cells
 macula densa
Low plasma sodium content
 resulting in a decreased overall blood volume and
subsequent decrease in blood pressure
 macula densa senses such changes, a cascade of reactions
within the RAAS occurs
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Renin
 an enzyme produced by the juxtaglomerular cells
 secreted and reacts with the blood-borne substrate
angiotensinogen to produce the inert hormone
angiotensin I
angiotensin I (passes through the alveoli of the lungs)> angiotensin-
converting enzyme ACE (change) > angiotensin II (active form)>
corrects renal blood flow in the following ways:
a. causing vasodilation of the afferent arterioles and
constriction of the efferent arterioles
b. stimulating reabsorption of sodium and water in the
proximal convoluted tubules, and
c. triggering the release of the sodium-retaining hormone
aldosterone by the adrenal cortex
d. antidiuretic hormone by the hypothalamus
 systemic blood pressure and plasma sodium content
increase, the secretion of renin decreases
 the actions of angiotensin II produce a constant pressure
within the nephron.
 every minute approximately two to three million glomeruli
filter
 approximately 120 mL of water-containing low-molecular-
weight substances
 filtration is nonselective
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Difference between the compositions of the filtrate and the Electrochemical energy
plasma  this interaction transfers the substance across the cell
membranes and back into the bloodstream
 absence of plasma protein, any protein-bound substances,
and cells Passive transport
 differences in their concentration or electrical potential on
Analysis of the fluid
opposite sides of the membrane.
 shows the filtrate to have a specific gravity of 1.010  These physical differences are called gradients
 chemically an ultrafiltrate of plasma
Passive reabsorption of water
 all parts of the nephron except the ascending loop of Henle
Tubular Reabsorption  the walls of which are impermeable to water.

 the body cannot lose 120 mL of water-containing essential Urea

substances every minute  passively reabsorbed in the proximal convoluted tubule and
 plasma ultrafiltrate enters the proximal convoluted tubule the ascending loop of Henle, and
through cellular transport mechanisms (begin reabsorbing
these essential substances and water) Passive reabsorption of sodium
 accompanies the active transport of chloride in the
Reabsorption Mechanisms ascending loop

The cellular mechanisms are termed; plasma concentration

 active transport  a substance that is normally completely reabsorbed reaches
 passive transport an abnormally high level
 the filtrate concentration exceeds the maximal
Active transport reabsorptive capacity (Tm)
 the substance to be reabsorbed must combine with a carrier  the substance begins appearing in the urine.
protein
 responsible for the reabsorption of glucose, amino acids plasma concentration
and salts in the proximal convoluted tubule, chloride in the  active transport stops is termed the renal threshold
ascending loop of Henle, and sodium in the distal
convoluted tubule

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 For glucose, the plasma renal threshold is 160 to 180 mg/dL,
and glucose appears in the urine when the plasma
concentration reaches this level.
Renal threshold and the plasma concentration
 can be used to distinguish between excess solute filtration
and renal tubular damage
Active transport of more than two-thirds of the filtered sodium out
of the proximal convoluted tubule
 accompanied by the passive reabsorption of an equal
amount of water
 the fluid leaving the proximal convoluted tubule still
maintains the same concentration as the ultrafiltrate
Tubular Concentration
Renal concentration
 begins in the descending and ascending loops of Henle,
where
 the filtrate is exposed to the high osmotic gradient of the
renal medulla
Water (removed by osmosis in the descending loop of Henle)>
sodium and chloride (reabsorbed in the ascending loop)> Excessive
reabsorption of water ( filtrate passes through the highly
concentrated medulla is prevented by the water-impermeable walls
of the ascending loop)
selective reabsorption process
 called the countercurrent mechanism
 serves to maintain the osmotic gradient of the medulla
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The sodium and chloride leaving the filtrate in the ascending loop
prevent dilution of the medullary interstitium by the water
reabsorbed
from the descending loop.
 Maintenance of this osmotic gradient is essential for the
final concentration of the filtrate when it reaches the
collecting duct
Concentration of the filtrate leaving the ascending loop is
 quite low owing to the reabsorption of salt and not water in
that part of the tubule
 Reabsorption of sodium continues in the distal convoluted
tubule, but it is now under the control of the hormone
aldosterone, which regulates reabsorption in response to
the body’s need for sodium
Collecting Duct Concentration
The final concentration of the filtrate through the reabsorption
of water begins in the late distal convoluted tubule and continues in
the collecting duct
 Reabsorption depends on the osmotic gradient in the
medulla and the hormone vasopressin (antidiuretic
hormone [ADH])
 the dilute filtrate in the collecting duct comes in contact
with the higher osmotic concentration of the medullary
interstitium, passive reabsorption of water would occurthe
process is controlled by the presence or absence of ADH
 A high level of ADH increases permeability, resulting in
increased reabsorption of water, and a low-volume
concentrated urine
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 absence of ADH renders the walls impermeable to water,
resulting in a large volume of dilute urine
 production of aldosterone is controlled by the body’s
sodium concentration
 production of ADH is determined by the state of body
hydration
 the chemical balance in the body is actually the final
determinant of urine volume and concentration
The concept of ADH control can be summarized in the following
manner:
↑Body Hydration = ↓ADH = ↑Urine Volume
↓Body Hydration = ↑ADH = ↓Urine Volume
Tubular Secretion
 involves the passage of substances from the blood in the
peritubular capillaries to the tubular filtrate
2 major functions:
 eliminating waste products not filtered by the glomerulus
 regulating the acid–base balance in the body through the
secretion of hydrogen ions.
Foreign substances (medications)
 cannot be filtered by the glomerulus because they are
bound to plasma proteins
When these protein-bound substances enter the peritubular
capillaries
 develop a stronger affinity for the tubular cells
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 dissociate from their carrier proteins, which results in their
transport into the filtrate by the tubular cells
 The major site for removal of these nonfiltered substances
is the proximal convoluted tubule
Acid–Base Balance
 blood pH of 7.4,the blood must buffer and eliminate the
 excess acid formed by dietary intake and body metabolism
(maintain n.ph)
buffering capacity of the blood
 depends on bicarbonate (HCO3 –) readily filtered by the
 glomerulus returned to the blood to maintain the proper pH
secretion of hydrogen ions (H+)
 prevents the filtered bicarbonate from being excreted in the
urine
 causes the return of a bicarbonate ion to the plasma
 provides for almost 100% reabsorption of filtered
bicarbonate and occurs primarily in the proximal convoluted
tubule
 As a result of their small molecular size, hydrogen ions are
readily filtered and reabsorbed. the actual excretion of
excess hydrogen ions also depends on tubular secretion.
ammonia reacts with the H+
 to form the ammonium ion (NH4 +)
 The resulting ammonium ion is excreted in the urine
 A disruption in these secretory functions can result in
metabolic acidosis or renal tubular acidosis, the inability to
produce an acid urine
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cleared of a substance per minute.

Standard test measuring:

Glomerular Filtration Tests
 used to measure the filtering capacity of the glomeruli termed
as clearance tests
 About 1200 mL of blood (650 mL plasma) passes through the
kidneys, every minute
 About 120-125 mL is filtered per minute by the kidneys & this
is referred to as glomerular filtration rate (GFR)
 With a normal GFR (120-125 mL/min), the glomerular filtrate
formed in an adult is about 175-180 litres/day, out of
which only 1.5 litres is excreted as urine.
a. Filtering capacity of the glomeruli
b. Measures rate at which kidneys are able to remove
filterable substances from the blood
RENAL FUNCTION TESTS
• U = Concentration of the substance in urine.
• V = Volume of urine in ml excreted per minute.
• P = Concentration of the substance in plasma.

Clearance test Primary substances used in clearance tests

 measures the rate at which the kidneys are able to remove (to 1. Creatinine
clear) a filterable substance from the blood 2. beta2-microglobulin
3. cystatin C
To test accuracy of the substance being measured: 4. radioisotopes
1) Substance analyzed must be neither
reabsorbed nor secreted by the tubules Exogenous procedure
2) Stable in a 24-hour collected urine A test that requires an infused substance
3) Consistent in the plasma level
4) Availability of the substance in the body Endogenous procedure
5) availability of the tests for chemical analysis seldom the method of choice if a suitable test substance is already
of the substance present in the body

Clearance Tests Creatinine Clearance

 A variety of substances have been used to measure the GFR  a waste product of muscle metabolism that is produced
 measures the rate at which the kidneys are able to remove (to enzymatically by creatine phosphokinase from creatine, which
clear) a filterable substance from the blood links with ATP to produce ADP and energy
 defined as the volume of plasma that would be completely

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 Newer methods that do not require the collection of timed (24-

hour) urine specimens have been developed using just the serum 6. Cystatin C
creatinine, cystatin C, or beta2-microglobulin values. The results of  Low molecular weight
these tests are reported as estimated glomerular filtration rate (eGFR)  Potential marker for long-term monitoring of renal function
 Constant in serum levels
Clearance Test Substance  Independent of age, gender, and muscle mass
 Higher analysis cost
1. Urea
 Present in all urine specimen but replaced by other
substances Calculations (Creatinine Clearance)

2. Inulin 1. Greatest source of error: improper timed specimen

 Polymer of fructose 2. GFR reported in mL/min.
 Extremely stable substance not reabsorbed nor secreted by the 3.
tubules
U = urine creatinine in mg/dL
 Not a normal body constituent and infused at a constant rate
throughout the testing period V = urine volume in mL/min.
 Seldom choice if suitable substance is already present in the body P = plasma creatinine in mg/dL

3. Radionucleotides Ex #1. Calculate the urine volume for a 4-hour specimen measuring
 Measures plasma disappearance of infused substances thus 1L:
eliminating need for urine collection 4 hours X 60 minutes = 240 minutes
 Injection of radionucleotides to:
1000mL
 visualize plasma disappearance of radioactive material
 enable visualization of the filtration of one or both kidneys 240 minutes
= 4.17 mL/min (volume)
4. β2microglobulin
 Dissociates from human leukocyte antigen and removed from the Standard Formula to calculate millilitres of plasma cleared
plasma by glomerular filtration per minute (C) is:
 Increased in patients with inflammatory conditions, autoimmune
disorders, viral infections, multiple myeloma
 Beta2-microglobulin (molecular weight 11,800)
Ex #2. Using urine creatinine of 400 mg/dL (U), plasma creatinine
5. Creatinine of 5.0 mg/dL (P), and urine volume of 2500 mL obtained from a
 Waste product of muscle metabolism and found at a constant 24-hour specimen (V), calculate the glomerular filtration rate.
rate in the blood
V = 2500 mL = 1.74 mL/min.

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60 minutes X 24 hours = 1440 minutes Renal Threshold Of A Substance

C = 400 mg/dL (U) X 1.74 mL/min. (V) = 139.2 mL/min.  is defined as its concentration in blood (or plasma) beyond
5.0 mg/dL (P) which it is excreted into urine.

Reference values: a. Glucose is 180 mg/dL

• The normal range of creatinine clearance is around 120-145 b. Ketone bodies 3 mg/dL
mL/min. c. Calcium 10 mg/dL
• These values are slightly lower in women. d. Bicarbonate 30 mEq/L
Men (107 to 139 mL/min.)
Women (87 to 107 mL/min.) Tubular maximum (Tm):
 The maximum capacity of the kidneys to absorb a particular
Serum creatinine normal range: substance.
Adult male: 0.7-1.4 mg/dl a. Glucose: 350 mg/min
Adult female: 0.6-1.3 mg/dl
Children: 0.5-1.2 mg/dl 2. Tubular Reabsorption Test
 Also known as Concentration tests
Clinical Significance in the interpretation of results for
Creatinine Clearance: Water Deprivation Tests
1. Determines the number of functioning nephrons 1. Fishberg Test - patients deprived of fluid for
2. Functional capacity of the nephrons 24 hours prior to measuring the specific
gravity
Results may be used to: 2. Mosenthal Test – compared the volume of
 Measure extent of nephron damage day and night urine samples to evaluate
 Monitor effectiveness of treatment in the prevention of further concentrating ability
nephron damage
 Determine feasibility of administering medications Free Water Clearance
a. How much water must be cleared each minute to produce a urine
Renal Threshold Substances with the same osmolarity as with the plasma
• certain substances in the blood have excretion rate in urine b. Determines the ability of the kidney to respond to the state of
dependent on their concentration. body hydration
• At a normal concentration in the blood, they are completely
reabsorbed by the kidneys.

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b. turbidity
3. Tubular Secretion and Renal Blood Flow Tests c. Odor
 Test to measure tubular secretion of nonfiltered substances d. Volume
and renal blood flow e. Viscosity
1. ρ-amino hippuric acid test (PAH) using the dye f. Sweetness
phenolsulfonphthalein
a. test substance easily removed from the blood each time it Modern urinalysis basic observation
comes in contact with a functional renal Tissue a. physical examination of urine
b. does not combine with plasma proteins b. chemical analysis
c. removed completely from the blood c. microscopic examination of urinary sediment
d. not anymore performed especially using the dye PSP because
of concern over interference of medications and elevated History of medicine (well-known names)
waste products in patient’s serum  Hippocrates
e. possible anaphylactic shock Who wrote a book on “uroscopy” 5th century BCE
 Frederik Dekkers’
2. Titratable Acidity & Urinary Ammonia Discovery in 1694 of albuminuria by boiling urine (Chemical testing
a. Ability of kidney to produce acid urine depends on tubular progressed from “ant testing” and “taste testing” for glucose)
excretion of ammonia by the cells of the DCT  Thomas Bryant
b. Inability to produce acid urine: Renal Tubular Acidosis The Charlatans called “pisse prophets,” became the subject of a
c. Measurement of total hydrogen ion excretion in urine book published in 1627
 Thomas Addis
Quantitating the microscopic sediment
 Richard Bright
Introduced the concept of urinalysis as part of a doctor’s routine
patient examination in 1827
History and Importance
Two unique characteristics of a urine specimen account
References study of urine
for this continued popularity:
 found in drawings of cavemen and in Egyptian hieroglyphics
1. Urine is a readily available and easily collected
(Edwin Smith Surgical Papyrus)
specimen
 bladder-shaped flask of urine
2. Urine contains information, which can be obtained by
inexpensive laboratory tests, about many of the body’s
Basic observations
major metabolic functions.
a. color

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Clinical and Laboratory Standards Institute (CLSI) Major inorganic substances solid dissolved in urine
Defines urinalysis as “the testing of urine with procedures a. Chloride
commonly performed in an expeditious, reliable, accurate, safe, b. Sodium
c. Potassium
and cost-effective manner”
Dietary intake
Urine Formation  influences the concentrations of these inorganic
 Kidneys continuously form urine as an ultrafiltrate of Plasma compounds, making it difficult to establish normal levels
 Re-absorption of water and filtered substances essential
to body function converts approximately 170,000 mL of Other substances found in urine include:
a. Hormones
filtered plasma to the average daily urine output of 1200 mL.
b. Vitamins
c. medications
Urine Composition
Urine Urine Volume
 consists of urea and other organic and inorganic chemicals Water
dissolved in water  A major body constituent
 It may contain formed elements, such as cells, casts, crystals,  It determined by the body’s state of hydration.
mucus, and bacteria (↑ indicative of disease)
 95% water Factors that influence urine volume
 5% solutes a. fluid intake
Influence factors of solute b. fluid loss from non renal sources
a. dietary intake c. variations in the secretion of antidiuretic hormone
b. physical activity d. to excrete increased amounts of dissolved solids glucose or
c. body metabolism salts
d. endocrine functions
The normal daily urine
Urea  1200 to 1500 mL
 a metabolic waste product produced in the liver from
the breakdown of protein and amino acids
It range of
 600 to 2000 mL considered normal
Other organic substances
a. Creatinine Oliguria
b. Uric acid  a decrease in urine output
less than 1 mL/kg/hr in infants

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less than 0.5 mL/kg/hr in children  Although appearing to be dilute, a urine specimen from a
less than 400 mL/day in adults patient with diabetes mellitus has a high specific gravity because
of the in creased glucose content
- commonly seen when the body enters a state of dehydration as a
result of excessive water loss from vomiting, diarrhea, perspiration, Diabetes insipidus
 results from a decrease in the production or function of
or severe burns
antidiuretic hormone (ADH)
Anuria  the water necessary for adequate body hydration is not
reabsorbed from the plasma filtrate
 Day time
 the urine is truly dilute and has a low specific gravity. Fluid loss in
 cessation of urine flow both diseases is compensated by increased ingestion of water
 may result from any serious damage to the kidneys or (polydipsia), producing an even greater urine volume. Polyuria
decrease in the flow of blood to the kidneys accompanied by increased fluid intake is often the first symptom
of either disease
Nocturia
 An increase in the nocturnal excretion of urine

Polyuria
 an increase in daily urine volume
2.5 L/day in adults (greater than normal value)
2.5 to 3 mL/kg/day in children

- is often associated with diabetes mellitus and diabetes insipidus

however, it may be artificially induced by diuretics, caffeine, or
alcohol, all of which suppress the secretion of antidiuretic hormone.

Diabetes mellitus
 caused by a defect either in the pancreatic production of insulin
or in the function of insulin (↑ results of body glucose
concentration)
 The kidneys do not reabsorb excess glucose, necessitating
excretion of increased amounts of water to remove the
dissolved glucose from the body

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Specimen Collection straw. The transfer straw has a needle and an evacuated tube
 urine is a biohazardous substance that requires the observance holder
of Standard Precautions
 Gloves should be worn at all times when in contact with the Labels
specimen Patient’s name
Identification number
Containers Date and time of collection
Specimens must be collected in
a. Clean Additional information
b. dry Patient’s age
c. leak-proof containers Location
d. screw-top lids Healthcare provider’s name
e. wide mouthand flat bottom to facilitate collection (female
patients) - Labels must be attached to the container, not to thelid, and should
f. Disposable containers should be use not become detached if the container is refrigerated or frozen
g. variety of sizes and shapes
h. bags with adhesive for the collection of pediatric specimens Requisitions
i. large containers for 24-hour specimens Requisition form (manual or computerized)
 accompany specimens delivered to the laboratory
 match the information on the specimen label
Capacity of the container
 50 mL
Additional information on the form
 allows 12 mL of specimen needed for microscopic analysis
a. method of collection or type of specimen
and repeat analysis
b. possible interfering medications
c. patient’s clinical information
Packaged sterile containers with secure
closures should beused for microbiologic urine studies
- The time the specimen is received in the laboratory should be
recorded on the form
- Sterile containers are also suggested if more than 2 hours elapse
between specimen collection and analysis.
-A designed sterile containers are available that have a lid with a
transfer device that can be assessed with a device called a transfer

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Specimen Rejection Specimen Preservation

Improperly labeled and collected specimens should be rejected by Most routinely used method of preservation
the laboratory, and appropriate personnel should be notified to  refrigeration at 2°C to 8°C (decreases bacterial growth and
collect a new specimen. Unacceptable situations include: metabolism)
1. Specimens in unlabeled containers
2. Nonmatching labels and requisition forms - If the urine is to be cultured, it should be refrigerated
3. Specimens contaminated with feces or toilet paper during transit and kept refrigerated until cultured up to
4. Containers with contaminated exteriors 24 hours
5. Specimens of insufficient quantity
6. Specimens that have been improperly transported Types of Specimens
Laboratories should have a written policy detailing their  To obtain a specimen that is representative of a patient’s
conditions for specimen rejection. metabolic state, regulation of certain aspects of specimen
collection is often necessary.
Specimen Handling
 a urine specimen is so readily available and easily collected Special conditions may include
often leads to laxity in the treatment of specimen after its time
collection length
 Changes in urine composition take place not only in vivo but method of collection
also in vitro, thus requiring correct handling procedures patient’s dietary and medicinal intake

Specimen Integrity Random Specimen

Specimen
 delivered to the laboratory promptly and tested within 2 hours
 A specimen that cannot be delivered and tested within 2 hours
should be refrigerated or have an appropriate chemical
preservative
 most commonly received specimen
 may be collected at any time but the actual time of voiding
should be recorded on the container
 useful for routine screening tests to detect obvious
abnormalities

- Most significant changes that may occur in a specimen allowed to - it may also show erroneous results resulting from dietary intake or
 unpreserved at room temperature for longer than 2 hours physical activity just before collection.
(presence and growth of bacteria)
First Morning Specimen
ideal screening specimen

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require the patient to make an additional trip to the laboratory
essential for preventing false-negative pregnancy tests
and for evaluating orthostatic proteinuria
first morning specimen is a concentrated specimen
- The patient should be instructed to collect the specimen
immediately on arising and to deliver it to the laboratory within 2
hours or keep it refrigerated.
24-Hour (or Timed) Specimen
 A carefully timed specimen must be used to produce accurate
quantitative results
 The patient must begin and end the collection period with an
empty bladder
 lowest concentration is in the early morning
 highest concentration occurs in the afternoon
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Many solutes exhibit diurnal variations
a. catecholamines
b. 17- hydroxysteroids
c. electrolytes
- When the concentration of the substance to be measured changes
with diurnal variations and with daily activities such as exercise,
meals, and body metabolism, 24-hour collection is required If the
concentration of a particular substance remains constant, the
specimen may be collected over a shorter period.
- The concentration of a substance in a particular period must be
calculated from the urine volume produced during that time.
On its arrival in the laboratory, a 24-hour specimen must be
thoroughly mixed and the volume accurately measured and
recorded.
- All specimens should be refrigerated or kept on ice during the
collection period and may also require addition of a chemical
preservative.
Catheterized Specimen
 collected under sterile conditions by passing a hollow tube
(catheter) through the urethra into the bladder
Most commonly requested test in C.S
 bacterial culture
Midstream Clean-Catch Specimen
 an alternative to the catheterized specimen
 provides a safer, less traumatic method for obtaining urine for
bacterial culture and routine urinalysis
 It provides a specimen that is less contaminated by epithelial
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cells and bacteria Second specimen

 representative of the actual urine than the routinely voided  used as a control for bladder and kidney infection If it is
specimen positive, the results from the third specimen are invalid
because infected urine has contaminated the specimen
Suprapubic Aspiration
 collected by external introduction of a needle through the Pre- and Post-Massage Test
abdomen into the bladder  a clean-catch mid stream urine specimen is collected
 provides a sample for bacterial culture that is completely  a second urine sample is collected after the prostate is
free of extraneous contamination massaged
 The specimen can also be used for cytologic examination  a positive result is significant bacteriuria in the post-massage
specimen of greater than 10 times the premassage count
Prostatitis Specimen Pediatric Specimens
 Several methods are available to detect the presence of  Soft, clear plastic bags with hypoallergenic skin adhesive to
prostatitis attach to the genital area of both boys and girls
Three-Glass Collection  Sterile specimens may be obtained by catheterization or by
 Male mid stream clean-catch procedure suprapubic aspiration
1. the first urine passed, it is collected in a sterile container
2. the midstream portion is collected in another sterile container Routine specimen analysis
3. the prostate is then massaged so that prostate fluid will be 1. ensure the area is free of contamination
passed with the remaining urine into a third sterile container 2. Attach the bag firmly over the genital area avoiding the anus
3. When enough specimen has been collected, remove the bag
Quantitative cultures and label it or pour the specimen into container and label the
performed on all specimens container following institutional policy
First and third specimens Microbiology specimens
examined microscopically 1. clean the area with soap and water and sterilely dry the area,
In prostatic infection removing any residual soap residue
Third specimen 2. Firmly apply a sterile bag
 will have a white blood cell/ high-power field count and a 3. Sterilely transfer collected specimen into a sterile container
bacterial count 10 times that of the first specimen and label the container
 macrophages containing lipids may also be present.
Drug Specimen Collection
 Urine specimen collection is the most vulnerable part of
a drug-testing program.

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 The chain of custody (COC) is the process that provides this

documentation of proper sample identification from the time
of collection to the receipt of laboratory results
 For urine specimens to withstand legal scrutiny, it is necessary
to prove that no tampering of the specimen occurred, such as
substitution, adulteration, or dilution.
 Proper identification of the individual whose information is
indicated on the label is required. Either photo identification or
positive identification by an employer representative with
photo ID is acceptable
 Urine specimen collections may be “witnessed” or “un
witnessed.”
 The urine temperature must be taken within 4 minutes
from the time of collection
 The temperature should read within the range of 32.5°C to
37.7°C. The urine color is also inspected to identify any signs of
contaminants

Bsmls- 3c l Catalan, Jean C.

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PRE-LIM
Urinalysis and Body Fluids Romans 8:28

Bsmls- 3c l Catalan, Jean C.