Introduction to Urinalysis

Nicole S. Rivera, RMT

Learning Objectives
At the end of the discussion each student is expected to: Understand and appreciate the history and importance of urinalysis Be able to define urinalysis and different terms related to it Be able to enumerate and understand the different factors that affect urine composition and volume Know the proper collection, preservation and handling of urine specimen Name and differentiate the types of urine specimens

History and Importance

 Hippocrates in 5th century BC uroscopy

In Middle Ages, instruction in urine examination

1140 AD: color charts

 17th century invention of microscope Examination of urinary sediment Thomas Addis methods for quantitating microscopic sediment 1827: Richard Bright concept of urinalysis as routine exam 1930s: impractical, disappear from routine examinations Development of modern testing techniques

Why has urine specimen remained popular as a part of patient examination?

Readily available and easily collected Contains information about many of the bodys major metabolic functions

Urinalysis

According to Clinical and Laboratory Standards Institute (CLSI):

the testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe and cost-effective manner

Reasons for performing Urinalysis

As identified by CLSI:
Aids in diagnosis of disease Screening asymptomatic populations for undetected disorders Monitoring the progress of disease Effectiveness of therapy

Urine Formation
Kidneys Urine ultrafiltrate of plasma Approximately 170,000 mL plasma

Average daily urine output of 1200 mL

Urine Composition
Urine 95% water 5% solutes
UREA metabolic waste product Other organic solutes: creatinine and uric acid Major inorganic solute: Chloride Formed elements

Test for urea and creatinine

Factors that influence urine composition

Body positions

Urine Volume
Factors that influence urine volume: Fluid intake Fluid loss from non-renal sources Variation in secretion of Antidiuretic hormone Need to excrete increased amounts of dissolved solids

 1200 1500 mL

600 2000 mL

 Oliguria
Decrease in urine output
dehydration

Anuria
Cessation of urine flow
Serious kidney damage Decrease flow of blood to kidneys

Nocturia
Increased nocturnal excretion of urine
2-3 times greater during the day

 Polyuria
Increased in daily urine volume More than 2.5 L / day in adults 2.5-3 mL/kg/day in children Artificially induced by:
Diuretics, caffeine, alcohol

Polydipsia

Polyuria
Specific gravity

Decreased SG

Increased SG
Decreased insulin or decreased function of insulin Increased glucose

Decreased production or function of ADH

Diabetes insipidus
Diabetes mellitus

Specimen Collection
Specimen container
clean, dry, leak-proof Disposable Wide mouth Wide, flat bottom Clear 50 mL Sterile (cultures)

 Proper labelling Requisition form Reject specimens when:

Not properly labelled Contaminated specimen Insufficient quantity Improper transport

Specimen Handling
Analyte Color Clarity Odor Change Modified/darkened Decreased Increased Cause Oxidation or reduction of metabolites Bacterial growth, pption of amorphous materials Bacterial multiplication, breakdown of urea to ammonia Breakdown of urea to ammonia by ureaseproducing bacteria Glycolysis and bacterial use Volatilization

pH

Increased

Glucose Ketones

Decreased Decreased

Analyte Bilirubin

Change Decreased

Cause Exposure to light

Urobilinogen
Nitrite

Decreased
Increased

Oxidation to urobilin
Multiplication of nitrate-reducing bacteria Disintegration in dilute alkaline urine

Red and white cells and casts

Decreased

Bacteria

Increased

Multiplication

Specimen Preservation
Refrigeration 2C to 8C Chemical preservatives Unfortunately, an ideal chemical preservative does not exist Example: Thymol preserves glucose and sediments but interferes with acid precipitation tests for protein

Types of Specimen
Random specimen Any time Affected by diet and physical activity

First Morning specimen Ideal screening specimen Prevents false-negative pregnancy Orthostatic proteinuria Concentrated

Fasting specimen (Second Morning) Second voided specimen after fasting Glucose monitoring 2-Hour Postprandial specimen Void before meal then collect 2 hours after meal Glucose monitoring insulin therapy Glucose Tolerance specimen Collected to correspond with GTT

24-Hour or Timed specimen Patient must begin and end with an empty bladder Provide patient with written instruction
Catheterized specimen Sterile conditions Bacterial culture Midstream Clean-Catch specimen Alternative to catheterized specimen Male: clean the glans Female: separate the labia, clean urinary meatus

Suprapubic aspiration
External introduction of needle through the abdomen into the bladder Bacterial culture, cytologic examination

Prostatitis specimen
Three-glass collection Prostatic infection Cultures on all specimen First and third specimens microscopically Second specimen control

Pediatric specimen Soft, clear plastic bags with hypoallergenic adhesive Sterile specimens suprapubic or catheterized

THANK YOU!