Reagent Strip

pH

General Info
pH measures degree of
acidity or alkalinity of
urine
Regulation of the
acid-base balance
in the body

First morning
urine:
slightly
acidic (pH 5.06.0)
Alkaline urine =
following a meal

Clinical Significance
Systemic acid-base disorders
(metabolic or respiratory origin)
Management
of
urinary
conditions
1.) Acidic: resp/metab acidosis
not related to renal fxn
2.) Alkaline: resp/metab acidosis
is present
3.) Promotion or inhibition of
Stone formation/ renal calculi
formation.
4.) Treatment of UTI (ureasplitting bacteria do not
multiply readily in acidic
urine.)
Acidic:
high
CHON
diet,
methanamine
mandelate
&
fosfomycin tromethamine
Alkaline: vegetarians
Does not reach pH 9 (associated
with unpreserved specimens)

Protein

The most indicative of

renal
disease(often
associated with early
renal disease)
Albumin:
major
serum
CHON
found in urine
Low
because:
Majority
of
albumin is not
filtered, much of
it is reabsorbed
Other
protein:
Tamm-Horsfall
protein
=
produced
by
tubules; proteins
from
prostatic

Prerenal Proteinuria: conditions affecting

plasma prior to reaching the kidney; not
indicative of renal disease

Hb, low MW plasma CHONs,

myoglobin, acute phase reactant
in inflammation and infection.
Bence Jones CHON: px with MM;
monoclonal Ig light chains turbid
at 40-60 C; clear at 100 C
Renal Proteinuria: true renal disease
(glomerular or tubular damage)
Glomerular: selective filtration is
impaired; serum CHONs/RBCs
pass through & excreted in urine;
increased mmHg may override
filtration
causing
increase
albumin in the filtrate; latter
parts
of
pregnancy

Reaction
Double
indicator
system
of
methyl red &
bromthymol
blue

Protein
error
of
indicators
(tetrabromphe
nol blue or
3,3,5,5tetrachlorophe
nol-3,4,5,6tetrabromosulf
onphthalein +
acid buffer)

Reference Value
pH 5.5-8.0

Negative or Trace

Very
minute amount in
urine <10mg/dL
or 100mg/ 24hrs)

Clinical
proteinuria:
>
30mg/dL
(300
mg/L)

fluid,
vaginal
secretions
Presence
does
not
always
signify
renal
disease

Glucose

The
most
frequent
chemical
analysis
on
urine
For the detection
&
diabetes
mellitus
monitoring.

(preeclampsia)
Tubular: affecting reabsorption
because the normally filtered
albumin is not reabsorbed; toxic
substances
exposure;
heavy
metals, viral infections & Fanconi
syndrome
Orthostatic/ Postural
Microalbuminuria:
devt
of
diabetic neuropathy leading to
reduced glomerular filtration &
eventual renal failure (type 1 & 2
DM);
onset
of
renal
complications; associated with
increased risk of CVD; requires
24-hr urine specimen.
Postrenal Proteinuria: added to urine as
it passes through the lower urinary tract
(ureters, bladder, urethra, prostate &
vagina)

Ketones

Represents
3
intermediate products of
fat metabolism: Acetone
(2%), acetoacetic acid

Almost all the glucose filtered by

the glomerulus is reabsorbed in
the PCT; urine contains minute
amount
Glucose reabsorption by active
transport
Fasting urine specimen
for
screening is recommended.
For diabetes monitoring: 2-hr
postprandial
Assessment
of
gestational
diabetes (Glucose crosses the
placenta, whereas insulin does
not)

Most valuable in management &

monitoring of type-1 DM
KETONURIA: a deficiency in insulin,
indicating the need to regulate dosage

Double
sequential
enzyme
reaction

Use
of
sodium
nitroprusside
(nitroferricyanide) to
measure ketones

Negative

Negative

Blood

(20%) & hydroxybutyric

acid (78%).
Acetone & betahydroxybutyric
acid:
produced
from acetoacetic
acid.

(insufficient insulin dosage).

Increased accumulation in blood
leads to:
1.) electrolyte imbalance
2.) dehydration
3.) if not corrected, acidosis &
eventual diabetic coma.

Hemoglobin
testing
provides
the
most
accurate
means
for
determining presence of
blood
Once blood has
been
detected,
the
microscopic
examination can
be
used
to
differentiate.

HEMATURIA
Most closely related to disorders
of renal or genitourinary origin in
which bleeding is the result of
trauma or damage to the organs.
HEMOGLOBINURIA
May result from the lysis of RBCs
produced in the urinary tract.
No RBCs seen in cases of
intravascular hemolysis
Under normal conditions, the
formation
of
large
Hbhaptoglobin complexes prevents
the glomerular filtration of Hb.
When the amount of free Hb
present exceed that of the
haptoglobin (hemolytic anemias,
transfusion rxns, severe burns,
spider
bites,
infections
&
strenous exercise) Hb is available
for glomerular filtration.
MYOGLOBIN
Heme-containing protein found
in muscle tissue.
Produces also clear red-brown
urine.
In conditions associated with
muscle
destruction
like
rhabdomyolysis ( side effect in
intake of cholesterol- lowering
statin medications)
The heme portion is toxic to the

Peroxidase activity of
Hb to catalyze a
reaction between
hydrogen peroxide &
the
chromogen
tetramethylbenzidine
to
produce an oxidized
chromogen
(greenblue color)

Negative

>5
RBCs
per
microliter
of urine is
considered
clinically
significant.

renal
tubules;
high
concentrations can cause acute
renal failure.
Bilirubin

Urobilinogen

By
product
of
the
breakdown
of
hemoglobin
Since the bilirubin
in
samples
is
sensitive to light,
exposure of the
urine samples to
light for a long
period of time
may result in a
false
negative
test result.
Valuable in detection of
early liver disease
When conjugated
bilirubin
is
excreted through
the bile duct into
the intestine, the
intestinal bacteria
convert it to a
combination
of
urobilinogen and
stercobilinogen.
Some
of
the
urobilinogen
is
reabsorbed from
the instestine into
the
blood,
recirculates to the
liver & is excreted
back
into
the
intestine through
the bile duct.

Conjugated bilirubin appears in

the urine when:
1.) the normal degradation cycle is
disrupted by obstruction the bile
duct (gallstones/cancer)
2.) the integrity of the liver is
damaged, allowing leakage of
conjugated bilirubin
Common examples
hepatitis & cirrhosis

of

Diazo Reaction

Negative

Ehrlichs
reaction
coupling
reaction.

0.2-1.0
Ehrlich
units
Increased
amounts
(>1mg/dL)
is seen in
liver
disease &
hemolytic
disorders.

bilirubinemia:

Liver impairment decreases the

livers
ability
to
process
urobilinogen recirculated from
the instestines. The excess of
which remaining in blood is
filtered by the kidneys & appears
in the urine.

aldehyde
and azo(diazo)

Nitrite

Leukocyte
Esterase

Stercobilinogen
cannot
be
reasbsorbed
&
remains in the
instestine where
it is oxidized to
urobilin.
Urobilin is the
pigment
responsible
for
the characteristic
brown color of
feces.
Urobilinogen
appears in the
urine because as
it circulates in the
blood en route to
the liver, it passes
through
the
kidney
&
is
filtered by the
glomerulus

Provides
a
rapid
screening test for the
presence of UTI
to detect cases in
which urine CS
may
not
be
apparent
(not
intended
to
replace urine CS)

Leukocytes (white
blood
cells)
usually
indicate
infection.

Primary test for dx, monitoring

bacterial infection & evaluate the
success of antibiotic therapy. The
ability of bacteria to reduce
nitrate (normal constituent of
urine) to nitrite, which does not
appear in urine
Complications: bladder infection
(cystitis), pyelonephritis

LE is also present in Trichomonas

& histiocytes.
Lymphocytes, RBCs, bacteria &
renal tissue do not contain LE.

Greiss
reaction:
nitrite in urine in
acidic pH reacts with
an aromatic amine
(para-arsanilic
acid/sulfanilamide) to
form
diazonium
compd that reacts
with
tetrahydrobenzoquin
olin
cmpds
pink
azodye

Negative

Negative
Normal
values for
WBCs are

Specific
Gravity

Leukocyte
esterase activity
is
due
to
presence of WBCs
in urine.
Detection
of
increased urinary
WBCs
required
microscopic
examination
of
the
sediments
(granulocytic
WBCs
neutrophils,
eosinophils
&
basophils)
Offers a more
standardized
means
for
detection
of
WBCs
Not designed to
measure
leukocyte
concentration

It detects the
presence
of
leukocytes
that
have been lysed,
particularly
in
dilute
alkaline
specimens.
(Requires the longest
time of all the reagent
strip reaction (2
minutes)

Screening urine specimens using

LE & nitrite chemical reactions to
determine the necessity of
performing urine cultures can be
a cost-effective measure.

Specific gravity reflects

kidney's
ability
to
concentrate.

Monitoring
px
hydration
&
dehydration
Loss
of
renal
tubular

based on
the
microscopi
c sediment
examinatio
n 0-2-5/hpf

pKa change

Ascorbic Acid

ANALYTE: Ascorbic Acid

Principle:
Tillmans
Reaction
Reagent:
Tillmans
Reagent
(2,6-dichloroindophenol
sodium)
Color: blue to green

concentrating ability

Diabetes insipidus
Significance:
high levels indicate possible
interference with blood, glucose, nitrite
& leukocyte