10 PARAMATERS OF URINE REAGENT STRIP TEST

Parameter Principle Sensitivity Reading Related tests Reagent Reactions Interference/ Source of Clinical Significance Other important
Time Error info about the
parameter
Double indicator Multistix: (Henry’s,  Methyl red *No known interfering  Respiratory / Metabolic Acidosis= Acidic Kidney= major
reaction 5.0-8.5 in 0.5 Graff’s)  Bromthymo substances* urine body’s regulator of
increments Immediate l Blue  Respiratory / Metabolic Alkalosis= Alkaline acid and base
*It use 2 indicators: (pH 4-6) ly – 60  Improper preserved urine (excretion of H+)
>methyl red cover pH 4-6 seconds urine= pH ↑ 8.5 ** Urine pH that does not conform in this
(red to yellow color Chemstrip: manner can rule out possible defect in renal First morning urine:
change as it progress) 5.0-9.0 in 1.0 Standard:  Run over from adjacent tubular secretions &reabsorption (acid, base) 5.0-6.0 pH
> bromthymol blue cover increments 60 seconds pads  Renal Calculi formation (Calcium oxalates

pH pH 6-9 (yellow-blue color

change as it progress
(pH6-9) (Highly acidic protein testing
area= false acidic urine in
ppt in acidic urine) & Prevention (maintain
alkaline urine)
After meal:
↑Alkaline (alk tide)
= pH 5 to 9 alk urine)  Precipitation/ Identification of crystals
 Treatment of UTI (maintain acidic urine) Normal Random spx:
 Determination of unsatisfactory specimen 4.5-8.0 pH
(Alkaline urine= (+) bacteria due to prolong
sitting in unpreserved manner)
Protein error of pH Multistix: (Henry’s) *SSA Multistix: False (+)  Clinical proteinuria= >30 mg /dl  Most indicative
P indicators 15-30 mg/dL 30-60 protein ↑= ↑tubidity Tetrabromop  ↑ buffered alkaline urine Prerenal (not usually detected in routine of renal dse.
seconds degree  Pigmented spx urinalysis)  Normal value:
R *Reagent strip is Chemstrip:
henol blue
 Loss of buffer due to  Multiple myeloma- ↑ serum protein= <10mg/dl or 100
impregnated with either 6mg/ dL Standard: *Micral Test Chemstrip: prolonged stay of strip in excretion of Bence Jones protein (susp: mg/ 24 hr
O Multistix or Chemstrip 60 seconds As the albumin ↑ 3’3”,5’5”- spx reagent turbid= 40-60C, clear =100C)  Albumin- Major
reagent and an acid color progress from  ↑ Specific gravity  Muscle injury serum protein
T buffer. white to red
tetrachlorophe
nol,3,4,5,6,-  Contaminated container  Acute phase reactant found in urine
No protein= both yellow False (-) Renal - Primarily
E However as protein *Immunodip
tetrabromosulf
onphthalein  Proteins other than  Glomerular proteinuria (Glomerular damage, detected in
concentration ↑ color ↑albumin= ↑ albumin strenuous exercise, Dehydration, reagent strip
I progress into various location and color  Microalbuminuria Hypertension, Pre-eclampsia, High fever, due to ↑
shades of green to final of band (dark blue)  Blood Exposure to cold, Pre-eclampsia) amino group
N blue  Microalbuminuria (onset of renal accepting H+
For Albumin: complication, ↑ risk of cardiovascular dse)  No creatinine
*Acid buffer is added to  Dye Binding  Tubular proteinuria (Fanconi Syndrome, level is
maintain pH constant level method Heavy/ Toxic metals exposure, Severe viral considered

FERRER, DOREEN NIZZA CAMIGLA BSMT-L2 10/27/2021

 (DIDNTB) infection) abnormal
↑ albumin= pale Postrenal  Abnormal A:C
green- aqua blue  Lower urinary tract structures ratio: 30-300
For Creatinine  UTI mg/g
 Pseudoperoxidase  Menstruation  Protein high=
activity of copper  Prostatic fluid protein error of
creatinine  Spermatozoa indicator
complex  Protein low= dye
↑ creatinine= binding (A:C
orange to blue ratio)
Double Sequential Multistix: (Henry’s) *Copper Multistix: False (+) (+) Galactose in newborn urine= Inborn error of  Most frequently
Enzyme Reaction 75–125 Multistix: Reduction Test Glucose  Contamination by metabolism performed
mg/dL 30 seconds (Clintest/ oxidase oxidizing agents and (+) Lactose in urine= common to be seen at chemical analysis
*This method is specific for Benedict’s Test) Peroxidase detergents nursing mother on urine
glucose and is based on the Chemstrip: Chemtrip: ~ This test is based Glycosuria  All glucose is
G rxn of the products of 40 mg/dL 60 seconds on the fact that only
Potassium
iodide (green
False (-)
 High levels of ascorbic Hyperglycemia Related almost all reabsorb
glucose oxidase and in the presence of  DM (reached 160-180 mg/dL threshold) in the PCT
L peroxidase method thus the strong alkali
to brown) acid
 High levels of ketones  Gestational Diabetes (normal at 6 mos or  Iodate is
name double sequential Standard: solutions and heat Chemstrip: earlier- placental hormones blocks insulin incorporated on test
U enzyme rxn. The testing
area is impregnated with
30 seconds reducing sugars Glucose
 High specifific gravity
 Low temperatures fxn) pads to prevent
(inc. glucose) are  Cushing Syndrome, hyperthyroidism, interference action
C glucose oxidase,
peroxidase, chromogen
able to reduce
oxidase
Peroxidase
 Improperly preserved
specimens pheochromocytoma, thyrotoxicosis, severe of ascorbic acid
copper sulfate into stress (glucagon, epinephrine*, cortisol,  Clinitest
O (differs on manufacturer of
reagent strip), and buffer.
cuprous oxide.
Tetramethyl
benzidine thyroxine, growth hormone= blocks insulin - not confirmatory test
Upon reduction, fxn) for glucose
S Glucose oxidase reacts with
O2 to form peroxide which color change from
(yellow-green)
Renal-Associated - hygroscopic
blue through green  Compromised renal tubules (end-stage renal - Subject to
E will then be use by
peroxidase to react in to orange red will dse, cystinosis, Fanconi syndrome) interference from
combination with be observed, other reducing
chromagen forming an depending on the sugars
oxidized colored compound amount of reducing - Use 2 drops instead
which is ∝ to glucose sugar is present of 5 drops to avoid
concentration “pass through”
Sodium nitroprusside Multistix: (Henry’s)  Acetest tablets  Chemstrip: False (+)  Vomiting (↑ loss of carbs) Ketone compound:
(nitroferricyanide) *5–10 mg/dL Multistix: ~Perform in cases Sodium  Phthalein dyes  DM (inability to metabolize carbs)  Acetone (2%)

FERRER, DOREEN NIZZA CAMIGLA BSMT-L2 10/27/2021

 reaction acetoacetic 15 seconds of severe ketosis. nitroprusside  Highly pigmented red  Starvation & Malabsorption (inadequate carbs  Acetoacetic acid
K *Sodium nitroprusside acid This tablet has an Glycine urine in body) (20%)
and glycine reacts with Chemstrip: additional  Levodopa  Insufficient insulin dosage B-hydroxybutyrate
E acetoacetate and acetone Chemstrip: 60 seconds component of  Medications containing  Strenuous exercise (overuse of carbs) (78%)
in an alkaline medium *9 mg/dL lactose which gives free sulfhydryl groups= Ketonuria= electrolyte imbalance, dehydration, =constant in all spx
T forming a violet dye acetoacetic a better color atypical color reaction acidosis, diabetic coma  Only appear
complex. acid; differentiation.  Improperly timed reading
O *+ result = color change *70 mg/dL Standard:  False (-)
when
carbohydrates
(beige to violet) acetone 40 seconds  Improperly preserved
N specimens
(major source of
energy) is

E compromised

S
Pseudoperoxidase action Multistix: (Henry’s) Ammonium Sulfate o Multistix: False (+) Clinical Significant= >5 RBC /uL of urine  Seen in urine as
of Hgb 5–20 60 seconds Test Diisopropyl  Strong oxidizing agents (+) blood reagent strip=_+ RBC, hgb, myoglobin either:
RBCs/mL, ~This is used to  Bacterial peroxidases Hematuria (closely related to renal/genitourinary
B *This is based on the
catalytic activity of
0.015– differentiate
benzene
dehydro  Menstrual contamination origin disorders)
*intact- Hematuria
(cloudy, red)
0.062 mg/dL myoglobin and hgb Pathologic
L hemoglobin and
myoglobin in the oxidation
hemoglobin in the urine by
peroxide
tetramethyl
False (-)
 High specific gravity/  Renal calculi
*lyse RBC-
Hemoglobinuria
adding ammonium  Glomerulonephritis
O reaction of chromogen by
an organic peroxide. This
Chemstrip: sulfate into urine
benzidine  crenated cells
 Formalin  Pyelonephritis
(clear, red)
✓ microscopic exam
5 RBCs/mL, then centrifugated. o Chemstrip:
O reaction leads produced
an oxidized chromogen
hemoglobin This is based on the Dimethyl
 Hypertension
medications
 Tumors
 Trauma
✘ visual examination
 Hemoglobin
corresponding fact that larger hgb dihydro
D which has the following
end products:
to 10 molecule are ppt by peroxyhexane
 High concentrations of
nitrite
Non-pathologic
 Strenuous exercise
chemical test
provides most
RBCs/mL ammonium sulfate Tetramethyl
+ intact RBC= green  Unmixed specimens  Menstruation accurate
thus: benzidine
spots on yellow/ orange Hemoglobinuria determination of
+ myoglobin=
background  Intravascular hemolysis (no RBC) presence of blood
supernatant
+ free hgb= uniform  Hemolytic anemia, transfusion rxn, severe  Myoglobinuria=
remains its red
green or green to dark burns, brown recluse spider bites, infxn, clear, red-brown
color
blue color  strenuous exercise (= ↑ hemoglobin than urine
+hgb= red ppt, -
haptoglobin= filtration of hgb) *Heme portion= toxic
supernatant blood.
*Reabsorption of hgb= hemosiderin (denature to renal tubule. ↑

FERRER, DOREEN NIZZA CAMIGLA BSMT-L2 10/27/2021

 ferritin) in renal tubular EC and urine sediment concentration= acute
 ↑ in hemolytic transfusion renal failure*
Myoglobinuria > Hemoglobin-
 Rhabdomyolysis(muscle destruction; susp) haptoglobin
- It may cause a cola drink color urine complex- prevents
filtration of
hemoglobin.
Diazo reaction Multistix: (Henry’s) Ictotest  Multistix: False (+) (+) bilirubin in urine= excess blood conjugated  Provide an early
0.4–0.8 Multistix- ~ This test makes 2,4-  Highly pigmented urines bilirubin due to: indication of liver
*In this reaction an acid mg/dL 20 seconds use of specialized bile duct obstruction cause by:
B medium is impregnated bilirubin mats that retain the
dichloroaniline
diazonium
(phenazopyridine- yellow-
orange/ reddish= mistaken  Gallstone
dse
 Degradation
with diazonium salt (0.8 mg/dL- Chemstrip bilirubin while the  Pancreatic cancer (head)
I (depends on manufacturer Henry’s) - 30-60 urine is being
salt as bilirubin)
 Medications (rifampin,
product of
hemoglobin
type) to which bilirubin seconds absorb. Chemical  Chemstrip:
L will combine. The Chemstrip: reaction take place 2,6-
indicant, iodine,
chlorpromazine
Liver damage
= inability to sufficiently excrete conjugated
(conversion of
protoporphyrin)
coupling of bilirubin and 0.5 mg/dL and color
I diazonium salt produced bilirubin appearing blue to
dichlorobenzen
e-diazonium
metabolites)
False (-)
bilirubin in bile caused by:
 Hepatitis
 Unconjugated B=
water
an azodye with color Standard: purple indicates
R ranging from degrees of 30 seconds presence of
salt  Specimen exposure to light
(oxidation of bilirubin-
 Cirrhosis insolubleunfilter
ed by glomerulus
tan or pink to violet. bilirubin. Color
U other than this=
>biliverdin= does not react
with diazo)
Bilirubinuria= yellow-brown to greenish brown
urine, possible yellow foam
 Conjugated
B(conjugated in
- bilirubin
B  High concentrations of
Nitrite & ascorbic acid (+) urinary bilirubin (-) urobilinogen =
liver w/
glucuronic acid)=
I 25mg/dL (combine with
diazonium
intrahepatic/ extra hepatic biliary obstruction water
solublefiltered
N by glomerulus but
is usually excreted
in bile not urine
 Ictotest tablet-
confirmatory test
(blue to purple
color on mat)

Ehrlich aldehyde Multistix: (Henry’s) Multistix: Multistix: ↑ Urobilinogen (>1mg/dL) due to: 
U reaction (Multistix) 0.2-1 mg/dL Chemstrip p-dimethyl False (+) Hepatocellular damage caused by:
Product of
bacterial

FERRER, DOREEN NIZZA CAMIGLA BSMT-L2 10/27/2021

R urobilinogen - 10-30 aminobenzalde Ehlrich-reactive compounds:  Viral hepatitis conversion of
*Urobilinogen reacts with seconds hyde (Indican ,p-aminosalicylic  Toxic substances conjugated
O p-
dimethylaminobenzaldehy
Chemstrip:
0.4 mg/dL Chemstrip:
acidSulfonamides,
Methyldopa, Procaine
 Cirrhosis bilirubin in the
intestine.
*Liver damageimpaired removal of reabsorbed
B de (Ehrlich
reagent)=light-dark pink
urobilinogen Standard:
60 seconds
 4-
methoxybenze
,Chlorpromazine)
Highly-pigmented urine
urobilinogen in blood ↑kidney filtration=
 Only conjugated
urobilin is
I (not specific to ne- diazonium False (-)
appearance in urine
Hemolytic Disorders
excreted in the
urobilinogen tetraflfluorobor Old specimens urine
L ate Preservation in formalin
(+) urine urobilinogen, (-) urine bilirubin
*Ruptured RBC =↑ Hgb release = more  Reabsorbed
Azo-coupling (diazo)
I reaction (Chemstrip) Chemstrip:
degradation= ↑ unconjugated bilirubin ↑ liver (blood),
recirculated
workload (conjugation)↑ circulated
N *Urobilinogen reacts with
False (+)
Highly-pigmented urine
urobilinogen↓ liver processing reabsorbed (liver) reexcreted
& unconjugated
urobilinogen (overworked) ↑kidney filtration=
O 4-methoxybenzene-
diazonium
False(-)
Old specimens
appearance in urine (bile duct)
 Normal value in
G Tetrafluoroborate= white-
pink (specific for
Preservation in formalin
High concentrations of nitrate
Bile duct obstruction urine: 0.5- 2.5
mg/ 24 hrs
E urobilinogen)
Detected not by reagent strip but through:
Persistent absence in urine and feces (pale stool) (henry’s)
↑=alk urine
N ↓= acd urine

Greiss Reaction Multistix: (Henry’s) Multistix: False (+) Pathogenic bacteria reduce nitratenitrite= + > Nitrate= normal
N 0.06–0.1 Multistix- p-arsanilic  Improperly preserved urine nitrite if: urine constituent
*In this reaction, the mg/dL nitrite 40 seconds >10^5 to 10^6/ml bladder urine > Nitrite= should not
I testing area is ion
acid
Tetrahydroben
specimens
 Highly pigmented urine appear in urine
impregnated with an (0.075 mg/dL- Chemstrip + urine nitrite, culture must be considered with a > First morning urine
T aromatic amine (para- Henry’s) - 30
zo(h)- quinolin
-3-ol
False (-)
 Nonreductase-containing first morning clean-voided midstream spx spx or if the urine has
arasanilic or seconds remained in the
R sulfanilamide), if nitrite is Chemstrip: Chemstrip:
bacteria (inability to
reduce nitrate-nitrite= not  Nitrite testing provides: bladder for 4 hours.
present in urine (acidic) it 0.05 mg/dL
I will form diazonium salt. nitrite ion
Sulfanilamid
e, hydroxyl
detected in nitrite test)
 Insufficient contact time
*screening test for UTI
*detecting initial bladder infection
This compound is then
T added with Standard:
tetrahydro
benzoquinoline
between bacteria and
urinary nitrate (atleast
*evaluate the success of antibiotic therapy
* detection of bacteriuria= prevents serious
tetrahydrobenzoquinolin 60 seconds
E thereby a pink-colored
4hrs)
 Lack of dietary nitrate
complication of pyelonephritis
* determination for performing urine cultures ( in

FERRER, DOREEN NIZZA CAMIGLA BSMT-L2 10/27/2021

 azodye.  Large quantities of combination w/ leukocyte esterase)
bacteria converting nitrite
to nitrogen
 Presence of antibiotics
(inhibits bacterial
metabolism)
 High concentrations of
ascorbic acid (compete
for nitrite in combining
with diazonium salt)
 High specific gravity (↓
sensitivity)
L Leukocyte Esterase + Multistix: 120  Multistix: False(+) Normal Value= 0 to 5/hpf ↑urinary leukocytes=
Diazo reaction 5–15 seconds Derivatized  Contaminated container Women > Men subject to
E WBC/hpf pyrrole amino (Strong oxidizing agents, ↑= UTI indicator microscopic
U *LE catalyzes hydrolysis acid ester Formalin) Bacterial UTI examination
of acid ester forming an Chemstrip: Diazonium salt  Highly pigmented urine,  (+) Neutrophils & Monocytes  Quantitation is
K aromatic compound and 10–25 nitrofurantoin (Obscure Non Bacteriuria UTI caused by: done by
O acid. The aromatic WBC/hpf  Chemstrip: color rxn)  Trichomonas, Chlamydia, yeasts, renal tissue microscopic
compound combines with False(-) inflammation examination
C diazonium salt
Indoxylcarb
 ↑ concentrations of LE
onic acid ester
Y impregnated on pad Diazonium salt protein, glucose, oxalic -able to detect even
thereby producing a acid, ascorbic acid, the lysed WBC
T purple azodye. gentamicin, (except
E Color intensity ∝ enzyme cephalosporins, lymphocytes)
present (related to tetracycline (↓ rxn -more reliable than
Esterase leukocyte present) sensitivity) nitrite test
 Inaccurate timing

FERRER, DOREEN NIZZA CAMIGLA BSMT-L2 10/27/2021

Specific pKa change (dissociation 1.000-1.030 Standard:  Multistix: False(+) ↑Specific Gravity may due to:
constant 45 seconds Poly (methyl  High concentrations of  Dehydration
Gravity *The polyelectrolyte vinyl protein  UTI
ionizes, release H+ in ether/maleic
 Excessive sweating
proportion to # of ions anhydride) False(-)
bromthymol  Diabetes Mellitus
present in sol’n thus:  Highly alkaline urines ( 6.5) ↓Specific gravity may due to:
blue
↑ urine concent.=↑ H+  Diabetes Insipidus
released  Loss of renal tubular concentrating ability
↑ H+ = ↓pH
 Chemstrip:
Ethylene  Intake of diuretics (ex. Coffee)
As specific gravity ↑,
glycol
added indicator changes diaminoethyl
from blue (alk) to yellow ether tetraacetic
(acd) acid,
bromthymol
blue

Sources:

 McPherson, R., & Pincus, M. (2017). Henry’s Clinical diagnosis and management by laboratory methods (23rd ed., pp. 446–458) [Review of Henry’s Clinical diagnosis and management by laboratory methods]. Elsevier.

 Strasinger, S. K. (2014). Urinalysis and Body Fluids (6th ed., pp. 72–92) [Review of Urinalysis and Body Fluids]. F.A. Davis Company.

 Strasinger, S. K. (2014). Urinalysis and Body Fluids (5th ed., pp. 54–75) [Review of Urinalysis and Body Fluids]. F.A. Davis Company.
 Mundt, L. (2011). Graff’s textbook of routine urinalysis and body fluids (2nd ed.). Wolters Kluwer.

FERRER, DOREEN NIZZA CAMIGLA BSMT-L2 10/27/2021

FERRER, DOREEN NIZZA CAMIGLA BSMT-L2 10/27/2021