Basic Examination of Urine

‡ examination of urine provides info regarding diseases of the kidney and lower urinary tract ‡ clinical lab disciplines involved in urinalysis: chemistry, microbiology, routine wet urinalysis, cytology, and other specialty sections ‡ new technologies include immunochemistry, molecular and genetic biology, DNA ploidy, and cell cycle analysis
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3 TYPES OF URINALYSIS
1. reagent strip (dipstick) urinalysis
± for screening laboratories, physician offices, and patient home testing ± remains a valuable frontline test for the early detection and monitoring of px for chemical abnormalities ± encompasses the physiochemical analysis of urine ± requires less sophisticated training of personnel ± esily performed on multiple settings ± provides accurate information in several clinical situations

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3 TYPES OF URINALYSIS
2. screening wet analysis ‡ referred to as a routine or basic urinalysis ‡ has 2 components:
± macroscopic urinalysis or physiochemical determinations (appearance, sp gr, and multiparameter reagent strip measurements of several chemical constituents) ± brightfield or phase-contrast examination of urine segment for evidence of hematuria, pyuria, cylinduria (casts), and crystalluria
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3 TYPES OF URINALYSIS
3. cytodiagnostic urinalysis ‡ specialized urinalysis ‡ cytologic approach to the urine sediment ‡ more sensitive test pathologic test for evaluating urine sediment in several renal and lower urinary tract disorders ‡ this specialized urine cytology test has replaced the quantitative Addis count method ‡ provides sequential info regarding the progression or regression of many urinary system conditions
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Types of urine specimens
‡ ‡ random specimen
± ± ±
most commonly received specimen the ideal screening specimen used for routine screening, pregnancy tests and for determining orthostatic proteinuria

‡ ‡

First morning urine

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Fasting Specimen (Second Morning Specimen)
±
second voided urine specimen used for glucose monitoring timed specimen is used to determine concentration of a particular substance Instruction:
‡ Day 1 7am
± ± patient voids and discards specimen patient collects all urine for the next 24 hours patient voids and adds this urine to the previously collected urine

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24-hour specimen
± ±

‡

‡

Day 2 7am
±

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Catheterized Specimen ± used for bacterial culture Midstream Clean-Catch Specimen ± an ideal specimen for routine screening and for bacterial culture ± patient is instructed to cleanse thoroughly the genitalia and is asked to collect the midstream portion of urine. When collecting, patient should be instructed to separate the labia in females or retract the foreskin in uncircumcised males. Suprapubic Aspiration ± used for bacterial culture and cytology sterile needle is introduced into the bladder to collect sample that is free of contaminants Pediatric Specimen ± soft, clear plastic bag w/ adhesive is attached to the genital portion
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COMPONENTS OF BASIC (ROUTINE) URINALYSIS
‡ ‡ ‡ ‡ specimen evaluation gross/physical examination chemical screening sediment examination

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Specimen Evaluation
‡ urine specimen must be evaluated in terms of acceptability ‡ Considerations: proper labeling, proper specimen for requested test, proper receptacle, storage conditions (time, temperature) and preservative, visible signs of contamination, and any transportation delays in moving the specimen to the lab ‡ a properly labeled specimen must have the patient s full name, and the date and time of collection
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Gross/physical examination
‡ Appearance and Color
APPEARANCE Colorless Cloudy REMARKS Very dilute urine Polyuria, diabetes insipidus Phosphates, carbonates, urates, uric acid Phosphates, oxalates Leukocytes, Red cells ( smoky ) bacteria, Rectovesical fistula yeasts, spermatozoa, prostatic fluid, In acid urine mucin, mucous threads, calculi, gravel clumps, pus, tissue, fecal contamination radiographic dye Many neutrophils (pyuria) Nephrosis, crush injury soluble Fat in ether Lipiduria,opalascent Lymphatic obstruction soluble Chyluria, milky in ether Emulsified paraffin Vaginal creams Acriflavine Green Fluorescence CAUSE

Milky

Yellow

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Yellow-orange Concentrated urine Urobilin in excess Bilirubin Yellow-green Bilirubin-biliverdin

Dehydration, fever No yellow foam Yellow foam, if sufficient bilirubin Yellow foam beer brown, yellow foam Positive reagent strip for blood Positive reagent strip for blood Positive reagent strip for blood May be colorless Foods, candy Yellow alkaline, genetic Clots, mucus

Yellow-brown Bilirubin-biliverdin Red Hemoglobin Erythrocytes Myoglobin Porphyrin Fuscin, aniline dye Beets Menstrual contamination

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Red-purple Red-brown

Porphyrins Erythrocytes Hemoglobin on standing Methemoglobin Myoglobin Bilifuscin (dipyrrole) Methemoglobin Homogentisic acid Melanin Indicans Pseudomonas infections Chlorophyll

May be colorless

Acid pH Muscle injury Result of unstable hemoglobin

Brown-black

Blood, acid pH On standing, alkaline On standing, rare Small intestine infection Mouth deodorants

Blue-green

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Color
‡ Normal urine color Yellow (due to urochrome)
Color Orange Dark Yellow Green Pathologic Bilirubin Bilirubin Urobilin Oxidized bilirubin Biliverdin Pseudomonas RBCs Hemoglobin Myoglobin Porphyrins Biliary pigments Melanin Hmogentisic acid Diabetes mellitus Diabetes insipidus NonPatho Rhubarb Carrots Carrots Concentrated Vit B complx Drugs Phenazopyridine Fluorescein Dithiazanine Nitorfurans Phenol Benzene Acetophenetidin Phenindione Phenol derivatives Methyldopa Levodopa Diuretics
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Red or Pink

Beets

Brown or Black

Rhubarb

Pale Yellow

Large fluid intake

Odor
‡ usually not a part of routine urinalysis ‡ ammoniacal odor of urine is due to breakdown of urea
Odor Ammonia Sweet Mousy Maple syrup Distinctive Pathologic UTI Diabetes mellitus Phenylketonuria Maple syrup disease Garlic, onions, asparagus Nonpathologic Old urine Starvation, dieting, strenuous exercise, vomiting, diarrhea

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Transparency (clarity)
‡ Normal appearance:
± freshly voided urine is usually clear

‡ white cloudiness may be caused by precipitation of amorphous phosphates and carbonates ‡ Causes of turbidity:
± presence of phosphates, carbonates, crystals, red blood cells, leukocytes, epithelial cells, etc.
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Specific Gravity
‡ density of a substance compared with the density of a similar volume of distilled water at a similar temperature ‡ used to assess kidney s ability for reabsorption ‡ Normal values = 1.015-1.025

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ROUTINE URINALYSIS PROCEDURE
Urine in specimen container Transfer urine in a clean tube

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