UrinalysisBy Jenny Bellen Bo RMT,AMT

UrinalysisA urinalysis is a laboratory test that can help your doctor diagnose the problems with your body that may be indicated by your urine.Many illnesses and disorders affect how your body removes waste and toxins. The excretory system includes your lungs, kidneys, urinary tract, skin, and bladder. Problems with any of these body parts can affect the appearance, concentration, and content of your urine.Urinalysis is not the same as a drug screening or pregnancy test, although all three tests involve a urine sample.

screening for surgery, pregnancy or routine check up

Suspect of diabetes, kidney or liver disease, urinary tract infection

check progress of treatment or progression of diseases

if there is symptoms of abdominal pain, back pain, blood in the urine or painful urination

Why urinalysis is done

Urinalysis ProceduresSample • collection

• labelling

Examination•macroscopic•microscopic•dipstick/automated

Reporting

Quality Control

Maintenance

SAMPLES

Random

Early morning collection

Clean-catch mid stream

Catheterization of the bladder

Suprapubic transabdominal

Methods of collection

Significance of time interval of urine collection and examination in the laboratory.

Decreased clarity due to

crystallization of solutes

Increasing pH

Loss of ketone bodies

Overgrowth of contaminating

microorganisms

Loss of bilirubin

Generally, urinalysis may not reflect the findings of absolutely fresh urine if the sample is > 1 hour old. Therefore, urine sample should be delivered in the laboratory as soon as possible.

Sample Labelling

Check if you receive the

correct urine sample

Match the information on both the request

and the sample if there is any differences, and

please do double check to be sure you did not miss any thing

Number the sample and the request according to the

serial number on the instrument (CLINITEK -500) or if you run the samples manually

volume (min. of 10ml)

turbidity

MACROSCOPIC URINALYSIS

Put on gloves and protective eyewear.( it should be)

Check expiry. Remove one reagent strip from bottle, and replace cap tightly.

A fresh urine specimen is collected in a clean, dry container. A Multistix strip is briefly immersed in the urine specimen, covering all reagent areas.

The edge of the Multistix strip is run against the rim of the urine container to remove excess urine. The strip is held in a horizontal position.

The reactions are read visually or automatically with a Clinitek reflection photometer. If the strip is evaluated visually, the strip test areas are compared to those on the Multistix color chart at the specified times. The results are recorded, and the strip is discarded.

Manual testing of patient’s samples (with Multistix 10SG):

CHEMICALThe common chemical testing of urine utilizes commercial disposable test strips. Siemens Multistix 10 SG test strips test for Glucose, Bilirubin, Ketone, Specific Gravity, Blood, pH, Protein, Urobilinogen, Nitrite, and Leukocyte Esterase. The result of this testing is regarded as semi quantitative.

Procedure in Testing patient samples in CLINITEK-500

sample

dip and drag

load

Manual ProcedureRoutine / Dipstick examination

Place the strip with reagent area up in strip loading table close to the push bar.

Do not pull or push table, the analyzer table is automatically drawn into the read area to be read.

The instrument continues to move the strips across the read area until the last strip is moved to the waste bin.

A new strip can be placed on the loading station or table at any time.

The results will be printed as soon as all the reagent areas on the strip have been read.

When the test is finished, discard strips into biohazardous waste.

METHODOLOGIES AND INTERPRETATIONS

Diabetes is the most common cause of elevated glucose levels. In some cases a high amount of glucose in urine can be due to pregnancy.N.V. = NEGATIVE

Ketones can make your blood acidic. Acidic blood can cause DKA ( Diabetic ketoacidosis). The most serious effects of DKA include: POSITIVE:

Swelling in your brain A loss of consciousnessDiabetic coma Death

N.V. NEGATIVE

Specific gravity is a measure of concentration of particles in the urine. Specific gravity testing is useful if your doctor thinks any of the following conditions:

Dehydration or over hydration Diabetes insipidusHeart failure Shock Kidney failure Kidney infectionLower/Elevated sodium levels Urinary tract infection

N.V. 1.002 – 1.030

pH is the level indicator of acidity in the urine. Abnormal level of pH may indicates conditions such as:

Acidosis Dehydration Diarrhea DKA Starvation Gastric Suctioning UTI Kidney stones Kidney Failure Vomiting Pyloric obstruction

Blood in the urine may be a sign of Kidney damage Infection Trauma Kidney or bladder stoneKidney or Bladder Cancer Blood disorders

N.V. NEGATIVE

Bilirubin in the urine indicates the presence of liver disease or biliary obstruction. Very low amounts of bilirubin can be detected in the urine, even when serum levels are below the clinical detection of jaundice. N.V. = 0.02 mg/dL

Protein levels in urine will increase due toExcessive heat or cold, Fever, Stress both physical and emotional and excessive exercise

But abnormally high levels of protein in urine can be a sign of underlying issues that can lead to kidney disease such as

Diabetes Lupus Rheumatoid arthritis Heart conditions LeukemiaHypertension Sickle cell anemia

Elevated Urobilinogen may indicate hemolytic anemia or excessive breakdown of RBC, overburdening of the liver, hepatic infection or liver cirrhosis.N.V. 0.2 – 1.00 mg/dL

The presence of nitrites in urine most commonly means there is a bacterial infection in the urinary tract. This is an indicator of UTI.

Bacteriuria caused by some Gram negative bacteria which produce the nitrate reductase enzyme give a positive test.

False positive results can be caused by colored substances in the urine and prolonged storage at room temperature that allows proliferation of contaminating bacteria.

If this test is positive or the WBC count in urine is high, it may indicate that there is inflammation in the urinary tract or kidneys. The most common cause for WBCs in urine is a bacterial UTI such as a bladder or kidney infection.N.V. NEGATIVE

Precautions for sample collection and handling Collect (10 - 15ml)clearly label with the patient's name, hospital file number, address, and date

Test the urine sample as soon as possible, do not centrifuge. The use of urine preservatives is not recommended

If testing cannot be done within an hour after voiding, refrigerate the specimen immediately and let it return to room temperature before testing

Nitrite results are optimized by using a first morning specimen or one that has incubated in the bladder for four hours or more

Prolonged exposure to room temperature may result in microbial proliferation with the resultant changes in pH. A shift to alkaline pH may cause false positive results with the protein test area. Urine containing glucose may decrease in pH as organisms metabolize the glucose

Bacterial growth from contaminating organisms may cause false positive blood reactions from the peroxidases produced. In random urine specimens from females.' a positive result for leukocytes may be due to a source external to the urinary tract.

MICROSCOPIC URINALYSIS

A microscopic exam is performed if blood, protein, or leukocyte esterase results are abnormal or if a microscopic exam is specifically requested. The urine is centrifuged and examined microscopically for WBC, RBC, crystals, casts, bacteria and yeast. Both dipstick and microscopic exam should be performed for patient populations with a high incidence of genitourinary tract disease

Methodology

Pour a sample of well-mixed urine (usually 10-15 ml) into a test tube. Conical bottom test tubes are preferred because they allow for better pellet formation

Remove the tube and decant the supernatant into the sink and a volume of 0.2 to 0.5 ml is left inside the tube. The sediment is suspended in the remaining supernatant by tapping the tube against a hard surface several times.. A drop of resuspended sediment is poured onto a glass slide using a pipette or by holding the tube upside down and carefully tapping it the slide until one drop falls onto the slide

Place a cover slip over the drop and place under the microscope. Although commercial stains are available to highlight cellular elements, examination of unstained urine is usually adequate.

Examination The sediment is first examined under low power

to identify most crystals, casts, squamous cells, and other large objects. Be sure to use a low light source (adjust iris and condenser). Too much light makes the cellular and crystalline elements harder to see. Scan the slide under low power to locate areas of interest. Look for casts just inside the perimeter of the cover slip. The numbers of casts seen are usually reported as number of each type found per low power field (LPF). Example: 5-10 hyaline casts/L casts/LPF. Since

the number of elements found in each field may vary considerably from one field to another, several fields are averaged.

Next, examination is carried out at high power and examines ten random fields in the central part of the cover slip to identify crystals, cells, and bacteria. The various types of cells are usually described as the number of each type found per average high power field (HPF). Example: 1-5 WBC/HPF.

Clinical Significance of Microscopic Examination In healthy people, the urine contains small numbers of cells and other formed elements

from the entire urinary tract, and epithelial cells from the kidney, ureter, bladder, and urethra. In renal disease, the urine often contains increased numbers of substances discharged from an organ that is otherwise accessible only by biopsy or surgery. A microscopic examination of urine sediment detects the presence and amounts of:

Red blood cells

White blood cells

Bacteria and yeast

Casts

Epithelial cells

Crystals

RED BLOOD CELLS

Hematuria is the presence of abnormal numbers of red cells in urine due to: glomerular damage, tumor's which erode the urinary tract anywhere along its length, kidney trauma, urinary tract stones, renal infarcts, acute tubular necrosis, upper and lower urinary tract infections, nephrotoxins, and physical stress. Red cells may also contaminate the urine from the vagina in menstruating women or from trauma produced by bladder catheterization. Theoretically, no red cells should be found, but some find their way into the urine even in very healthy individuals. However, if one or more red cells can be found in every high power field, and if contamination can be ruled out, the specimen is probably abnormal.

N..V. 0 – 4 /HPF

WHITE BLOOD CELLS

Pyuria refers to the presence of abnormal numbers of leukocytes that may appear with infection in either the upper or lower urinary tract or with acute glomerulonephritis. Usually, the WBC's are granulocytes. White cells from the vagina, especially in the presence of vaginal and cervical infections, or the external urethral meatus in men and women may contaminate the urine.

If two or more leukocytes per each high power field appear in non-contaminated urine, the specimen is probably abnormal. Leukocytes have lobed nuclei and granular cytoplasm.

These white blood cells in urine have lobed nuclei and refractile cytoplasmic granules.

N.V. 0 – 5/HPF

Epithelial cells

Squamous epithelial cells in urine

Hyaline casts, which appear very pale and slightly refractile, are common

findings in urine.

This is a broad, and there are "cracks" in this cast

CASTS

White blood cells cast (HPF, unstained)

Red blood cells cast (HPF, unstained

CRYSTALS

Calcium oxalates

Uric acid crystals

Triple phosphate

Calcium phosphate crystals

Cystine

Leucine Tyrosine

Bilirubin Cholesterol

Microorganisms and other element

Yeast

Trichomonas vaginalis

Starch or talc powder in urine

Fiber in urine

Fecal material in urine

REPORTING AND RELEASING OF REPORTS

Record results on the registration book or in the computer. notify the doctor or nurse in charge if there is any abnormal results that may help in patient’s treatment.

As with all laboratory tests, definitive diagnostic or therapeutic decisions should not be based on any single result or method

MAINTENANCE OF CLINITEK ADVANTUSSerial No………………………….. Month / Year…………………………..

Date

DIALY CLEANINGChanging

printer paper

Performing a Decontamination( once a month)

Periodic Maintenance Comments

push bar fixed platform

moving table

reagent strip hold

down plate123456789

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References: healthline.com.health Medscape.com Micribiology SOP

Photo credits: Rawan Jawad & Yasmin Hamdan