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Unit #5A – Clinical Laboratory Testing - Urinalysis. Cecile Sanders, M.Ed., MLS(ASCP). Unit #5A – Clinical Laboratory Testing - Urinalysis. Urinary system is an excretory system Renal System (reproduced with permission from Baylor College of Medicine).

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unit 5a clinical laboratory testing urinalysis1
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Urinary system is an excretory system
  • Renal System

(reproduced with permission from Baylor College of Medicine)

unit 5a clinical laboratory testing urinalysis2
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Collection and Preservation of Urine
    • Urinalysis performed for two purposes
      • Check for metabolic by-products
      • Observe physical, chemical and microscopic characteristics
    • Types of Specimens
      • First morning urine specimen is preferred
      • Mid-stream (urine caught from middle of urine stream)
      • Clean catch (patient must cleanse urethral opening prior to urinating and catching urine)
unit 5a clinical laboratory testing urinalysis3
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Handling and preserving specimens
    • Examine within 1 hour of collection OR
    • Refrigerate at 4-6° C for up to 8 hours
    • Preservatives (least ideal)
    • When urine sits at room temperature
      • Bacteria multiply
      • Glucose decreases
      • Casts and cellular elements decompose
unit 5a clinical laboratory testing urinalysis4
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Color of urine
    • Yellow – dilute urine is usually lighter in color; concentrated urine is usually dark
    • Red – may have blood present
    • Brown/black – may be associated with melanoma
    • Yellow-brown or green-brown – may be associated with liver conditions such as hepatitis or cirrhosis
unit 5a clinical laboratory testing urinalysis5
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Light yellow, brown, and dark yellow urines
unit 5a clinical laboratory testing urinalysis6
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Transparency
    • Urine normally transparent
    • Turbid – may be associated with crystals that settle out of urine at room or refrigerator temperature
    • Cloudy – may be associated with UTI OR crystals
unit 5a clinical laboratory testing urinalysis7
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Specific gravity is the ratio of the weight of a given volume of the solution (urine) to the weight of an equal volume of water
    • Indicates concentrations of dissolved chemicals such as glucose, salts, etc.
    • The result of the kidneys’ ability to concentrate urine
    • Normal values – 1.005-1.030 (Ave = 1.015)
    • Usually measured by dip stick or refractometer
unit 5a clinical laboratory testing urinalysis8
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Chemical Examination of Urine
    • Reagent strips
      • Test pads are for pH, protein, glucose, ketone, bilirubin, blood, urobilinogen, specific gravity, leukocytes and bacteria
      • Used only once and discarded
      • Performing the chemical tests by reagent strip
        • Perform within 1 hour after collection OR
        • Allow refrigerated specimens to return to room temperature
        • Dip strip in fresh urine and compare color of pads to the color chart after appropriate time period
        • Instruments are available which detect color changes electronically
unit 5a clinical laboratory testing urinalysis9
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Urine Multistix – reading dipstick results manually; colors are matched to those on the bottle label; timing is critical for each pad.
unit 5a clinical laboratory testing urinalysis11
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Bayer Clinitek automatically reads a urine dipstick and prints out results
unit 5a clinical laboratory testing urinalysis12
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Principle of chemical tests
    • pH measures degree of acidity or alkalinity of urine
    • Presence of protein (proteinuria) is an important indicator of renal disease, such as pyleonephritis
    • Presence of glucose (glycosuria) indicates that the blood glucose level has exceeded the renal threshold, such as in diabetes
unit 5a clinical laboratory testing urinalysis13
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Ketones are excreted when the body metabolizes fats incompletely (ketonuria), such as in diabetes
  • Bilirubin is a byproduct of the breakdown of hemoglobin. Its presence may be an indication of liver disease, bile duct obstruction or hepatitis
  • Presence of blood may indicate infection, trauma to the urinary tract or bleeding in the kidneys
  • Urobilinogen is a degradation product of bilirubin formed by intestinal bacteria. It may be increased in hepatic disease or hemolytic disease
unit 5a clinical laboratory testing urinalysis14
Unit #5A – Clinical Laboratory Testing - Urinalysis
    • Nitrite formed by gram negative bacteria converting urinary nitrate to nitrite. Presence of nitrites in fresh urine can indicate infection – in an old urine, nitrites can be positive without an infection
    • Leukocytes usually indicate infection
    • Specific gravity reflects kidney's ability to concentrate urine
  • Normal values
    • Negative results for glucose, ketones, bilirubin, nitrites, leukocyte esterase and blood
    • Protein negative or trace
    • pH 5.5-8.0
    • Urobilinogen 0.2-1.0 Ehrlich units
unit 5a clinical laboratory testing urinalysis15
Unit #5A – Clinical Laboratory Testing - Urinalysis
  • Resources
    • Basic Clinical Laboratory Techniques, Estridge and Reynolds, Thomson/Delmar Learning, Fifth Edition, 2008