Week #3: Introduction to Urinalysis

3. Uric Acid
- Product of nucleic acid breakdown in
OUTLINE food and cells

a. Urine Composition 4. Chloride

b. Urine Volume - Major inorganic component
c. Urine Container - Found together with sodium and
d. Types of Specimens many other inorganic substances
e. Specimen Integrity
5. Sodium
- Primarily from salt
- Varies by intake
MAIN TOPIC - Low intake of sodium = low excretion
SUB TOPIC of sodium (vice versa)
SUB-SUBTOPIC - Note: Sodium and chloride
concentrations are significantly
URINE COMPOSITION higher in urine than in other body
fluids.
● Water - accounts for 95% of urine
composition 6. Potassium
● Solids - accounts for 5% of urine - Combines with chloride and other
composition salts
○ Organic solids
○ Inorganic solids 7. Phosphate
○ - Combines with sodium to buffer the
Primary Components in Normal Urine blood
● Urea - Maintains the neutrality of urine’s pH
● Creatinine
● Uric acid 8. Ammonium
● Chloride - Regulates blood and tissue fluid
● Sodium acidity
● Potassium
● Phosphate 9. Calcium
● Ammonium - Combines with chloride, sulfate, and
● Calcium phosphate
URINE VOLUME
1. Urea
- major organic component of urine - It depends on the amount of water
- Product of protein and amino acid that the kidney excretes
metabolism - The amount excreted is determined
by the body’s state of hydration
2. Creatinine
- Product of creatine metabolism by Factors the influence urine volume:
muscles
- Note: Urine has a definitive ● Fluid intake
characteristic of having a high ● Fluid loss from nonrenal source
concentration of creatinine and ○ kidney is not involved
urea as compared to other body ○ e.g., vomiting, diarrhea,
fluids. excessive sweating, and
burns

BSMT- SEC 2 OMUGTONG | LADIA | MACALAGUIM | MADEJA | MANLA | MARQUEZ | PEÑAFRANDA | PONCE
1
 ● Variations in the secretion of
antidiuretic hormone (ADH)
● Need to excrete increased amounts
of dissolved solids, such as glucose
or salts.
● Normal daily urine output is usually
1200 to 1500 mL, a range of 600 to
2000 mL is considered normal.
Oliguria
- a decrease in urine output
- (less than 1 mL/kg/hr in infants, less
than 0.5 mL/kg/hr in children, and
less than 400 mL/day in adults
- - Acid preservatives can be added
Nocturia
- an increase in the nocturnal excretion
of urine is termed nocturia.
Polyuria
- an increase in daily urine volume
(greater than 2.5 L/ day in adults and
2.5 to 3 mL/kg/day in children
- associated with diabetes mellitus and
diabetes insipidus
- more solutes results to frequent
urination
- induced artificially by diuretics,
caffeine, and alcohol (suppresses the
secretion of ADH)
Anuria
- total cessation of urine output
Nocturia
- increased excretion of urine during
nighttime (2 to 3 times more than the
urine excretion at morning)
URINE CONTAINER
For Routine Urinalysis
- Ideal container: wide mouth, flat
bottom (prevent overturning), clear
(allow the determination of color and
clarity)
Capacity
- 50 mL capacity, which allows for the
collection of 12 mL of specimen
needed for microscopic analysis
- Collect urine at capacity to avoid
BSMT- SEC 2 OMUGTONG | LADIA | MACALAGUIM | MADEJA | MANLA | MARQUEZ | PEÑAFRANDA | PONCE
repeat urinalysis
- Swirl the container to avoid the
settlement of sediments at the
bottom, especially RBCs and WBCs
For Urine Culture
- Individually packed, sterile
containers, with secure closure
12/ 24 Hr Urine Sample
- Large containers for quantitative
analysis
- 3,000 mL capacity, wide mouth, leak
proof screw cap, brown opaque
plastic (prevents the specimen from
being exposed UV and white light)
Label:
● Last and first name
● Identification number
● Date and time of collection
Additional Information:
● Patient’s age
● Patient’s gender
● Patient’s middle name
● Healthcare provider’s name /
Requesting physician
● Preservative used
Note: Labels must be attached to the
container, not to the lid, and should not be
detached when the container is refrigerated
or frozen.
Note: All demographics of the patient should
be filled in. Do not accept lacking information.
Laboratory ID - Put the accession number
TYPES OF SPECIMENS
2
1. Random
2. First morning
3. 24-hour urine
4. Catheterized
5. Midstream clean-catch
6. Suprapubic aspiration
7. Prostatitis
8. Pediatric
9. Drug specimen
Random
- Most commonly received specimen
- Collected at any time
- For routine urine testing
- May lead to erroneous results due
to food and dietary intake
First Morning Specimen
- Ideal specimen / specimen of choice
- Concentrated and acidic specimen
- Collected immediately on arising of
the patient
- Ideal for routine urinalysis
- Used for pregnancy tests to prevent
false negatives (concentrated levels
of HCG)
- For the evaluation of orthostatic
proteinuria
- Preferred for cytology studies
(number of epithelial cells can be
significant)
Second Morning Specimen
- Used for glucose determination
- Collected after a period of fasting
2-Hour Postprandial Specimen
- Used for diabetic screening or
monitoring
- e.g., The patient started eating at
9:00 AM and finished by 9:30 AM.
Hence, the urine should be collected
at 11:30 AM (2 hours after the patient
finished his meal), not 11:00 AM (2
hours after the patient started eating
his meal).
Fractional Specimen
- Used for diabetic screening or
monitoring
BSMT- SEC 2 OMUGTONG | LADIA | MACALAGUIM | MADEJA | MANLA | MARQUEZ | PEÑAFRANDA | PONCE
Midstream Clean Catch Specimen
- Alternative to catheterized specimen
- Safer and less traumatic method of
urine collection
- Used for bacterial culture and routine
urinalysis
- Less contaminated with epithelial
cells and bacteria
- Representative of actual urine
- Has cleansing agents that can be
used for the patient
- e.g., hexachlorine and
povidone iodine (not
recommended because it
can impart dark color to the
urine)
- Allows passage of the initial urine
that contains any urethral washing
- e.g., normal flora of the distal
urethra
- Allows the collection of specimen that
represents elements and analytes
from the bladder, ureters, and kidney
Catheterized Specimen
- Collected in sterile conditions
- A hollow tube is passed through the
urethra into the bladder
- Balloon is inflated inside the bladder
to anchor the tube and avoid being
detached
- Commonly requested for bacterial
culture
- Way longer in males than in females
- Disease associated with
catheterization:
- Pseudomonas spp. (imparts
green color to the urine)
- Klebsiella spp. (imparts violet
color to the urine)
Suprapubic Aspiration
- Collected by the external introduction
of a needle through the abdomen into
the bladder
- Used for bacterial culture
(anaerobic) and cytologic
examinations
- Performed by physicians only
Pediatric Specimen
3
 - Use soft, clear plastic bags with
hypoallergenic skin adhesive
- Commonly called as “wee bag”
- For microbiology specimens, clean
the area with soap and water and
sterilely dry the area, removing any
residual soap residue. Firmly apply a
sterile bag. Sterilely transfer the
collected specimen into a sterile
container and label the container.
- Put by nurses and physicians only,
not medical technologists (to avoid
being sanctioned)
- Medical technologists should
carefully instruct guardians on how to
clean the pediatric patient’s
reproductive area
- Must be cleaned with soap
and water and allow to dry
- Do not use wet wipes and
tissues to avoid urine
contamination
- Must not have fecal
contamination
- Check the applied bag for
approximately every 15 minutes until
the needed amount of sample has
been collected (at least 20 mL should
be collected, safest is 30 mL)
Prostatitis Specimen:
a) Three glass collection
i. Collect a MIDSTREAM clean catch
specimen
● Collect the first urine passed → sterile
container 1
● Collect midstream portion → sterile
container 2
ii. Massage the prostate and collect urine
sample → sterile container 3
- Performed by physicians through
rectal examination
- If the third specimen’s WBC count
and bacterial count is 10 times
greater than your first specimen, it
is indicative of prostatic infection
- If the positive result of the third
specimen is invalid, infected urine
BSMT- SEC 2 OMUGTONG | LADIA | MACALAGUIM | MADEJA | MANLA | MARQUEZ | PEÑAFRANDA | PONCE
has contaminated it.
iii. Perform quantitative cultures on all three
specimens
iv. Examine 1st and 3rd specimen
microscopically
- Check for the WBC count and
bacterial count
b) Pre- and Post-Massage Test
i. Collect a midstream clean catch specimen
ii. Massage the prostate and collect a urine
sample
STAMEY-MEARS TEST FOR PROSTATITIS
Timed Specimen/24-Hour Specimen
- Used for quantitative evaluation of a
urine chemical
- Collection period must begin and end
with a patient's empty bladder
- During collection, specimen must be
refrigerated or kept on ice
*discard the first collection; start with an
empty bladder
* kung sa bahay nag-cocollect, put a label on
the urine container
- The required amount of urine
(approximately 50 mL) is aliquoted
for testing
Drug Specimen Collection
- Correct collection procedures and
documentation must be strictly
followed
- Chain of Custody (COC) must be
observed
- process that provides documentation
of proper sample identification from
4
 the time of collection to the receipt of Preservative Advantages Disadvantages
laboratory results
*there must be no tampering of specimen Refrigeration Does not interfere Precipitates
with chemical amorphous
*accompanied by accessioner (every step, tests phosphates and
may pinipirmahan siya) urates
- 30-45 mL of urine sample must be
Thymol Preserves Interferes with
obtained for the testing glucose & acid precipitation
*dapat puno agad, bawal dagdagan kapag sediments well test for protein
kulang
- Urine temperature must also be Boric Acid Prevents bacterial Interferes with
growth and drug and hormone
noted within 4 minutes from metabolism analyses
collection (32.5°C to 37.7°C)
*temperature of urine should be close to body Formalin Excellent Acts as a
sediment reducing agent,
temperature preservative interfering with
SPECIMEN INTEGRITY chemical tests for
glucose, blood,
leukocyte
Specimen must be transported and tested esterase, and
copper reduction
within 2 hours from collection
Toluene Does not interfere Floats on urine
*specimen should be refrigerated or lagyan with routine tests surface; clings to
ng chemical preservative pipettes and
testing materials

SPECIMEN HANDLING Sodium Fluoride Is a good Inhibits reagent

preservative for strip tests for
drug analyses glucose, blood,
and leukocytes
Changes in Unpreserved Urine
Phenol Does not interfere Causes odor
with routine test change
Decrease ↓ Increase ↑
Commercial Convenient when Check tablet
Preservative refrigeration not composition to
Tablets possible determine
Clarity Odor possible effects
Have controlled on desired tests
Glucose pH concentration to
minimize
interference
Ketones Nitrite
Urine Collection Contains -
Kits collection cup,
Bilirubin Bacteria transfer straw,
culture and
Urobilinogen sensitivity (C&S)
preservative tube,
or UA tube
RBC, WBC, & Casts
Light Gray and Sample stable at Do not use if urine
gray C&S tube room temperature is below minimum
Trichomonas (RT) for 48 hours; fill line
prevents bacterial
Neither Decrease nor Increase: growth and
metabolism

Yellow UA Plus Use on automated Must refrigerate

Color Tube instruments within 2 hours

Cherry Red/ Stable for 72 Must be filled to

Yellow hours at minimum fill line.
SPECIMEN PRESERVATION Preservative RT; instrument-
Plus Tube compatible Bilirubin and

BSMT- SEC 2 OMUGTONG | LADIA | MACALAGUIM | MADEJA | MANLA | MARQUEZ | PEÑAFRANDA | PONCE
5
 urobilinogen may
be decreased if
specimen is
exposed to light
and left at RT

Saccomanno Preserves cellular -

Fixative elements well

BSMT- SEC 2 OMUGTONG | LADIA | MACALAGUIM | MADEJA | MANLA | MARQUEZ | PEÑAFRANDA | PONCE
6
BSMT- SEC 2 OMUGTONG | LADIA | MACALAGUIM | MADEJA | MANLA | MARQUEZ | PEÑAFRANDA | PONCE
7