DAVAO DOCTORS COLLEGE

MEDICAL LABORATORY SCIENCE DEPARTMENT

STUDENT NOTES: AUBF

INTRODUCTION TO URINALYSIS

HISTORY • Reabsorption of water and filtered substances essential to

• Hippocrates
– Wrote a book on “uroscopy”
• 1140 CE
– Urine Color charts had been developed
– Chemical testing progressed from “ant testing”
and “taste testing” for glucose
• Frederik Dekkers (1694)
– Discover Albuminuria by boiling the urine
• Thomas Bryant (1627)
– - Published the book “Pisse Prophets”
– 17 centuries
• - Invention of the microscope
• - Led to the examination of urinary
sediment
• Thomas Addis
– - Developed the method for quantitating the
microscope sediment
• Richard Bright (1827)
– - Introduced the concept of urinalysis as part of a
doctor’s routine patient examination
• 1930s
– - Began to disappear from routine examination.
body function converts approximately 170,000 mL of filtered
plasma to the daily urine output of 1200 mL
URINE COMPOSITION
• Urine consist of urea and other organic and inorganic
chemicals dissolved in water
• Urine is normally 95% water and 5% solutes
• These solutes can occur owing to the
influence of factors such as dietary
intake, physical activity, body
metabolism and endocrine functions
• Other substances found in urine include
hormones, vitamins and medications
• May contain formed elements, such as
cells, casts, crystals, mucus and
bacteria (increase amount is often
indicative of disease)
INORGANIC AND ORGANIC CHEMICALS IN URINE

URINE
• 2 unique characteristics of urine specimen
• Urine is a readily available and easy collected specimen
• Urine contains information, w/c can be obtained by
inexpensive laboratory tests, about many of the body’s
major metabolic functions.
• Clinical and Laboratory Standards Institute (CLSI)
– Defines urinalysis as “the testing of urine with
procedures commonly performed in an
expeditious, reliable, accurate, safe, and cost- URINE VOLUME
effective manner.”
• Depends on the amount of water that the kidneys excrete
– URINE
• Fountain of information • Water is a major body constituent
• Liquid tissue biopsy of the urinary tract • Amount excreted is usually determined by the body’s state
• Painlessly obtained (EASY) of hydration
• Factors that influence urine volume
• Yields a great deal of information quickly and economically
include fluid intake, fluid loss from
• Tests need to be carefully performed and properly controlled
nonrenal sources, variations in the
secretion of antidiuretic hormone and
URINE FORMATION need to excrete dissolved solids
• Main determinant of urine volume is water
• The kidneys continuously form urine as an ultrafiltrate of • Normal daily urine output is usually 1200-1500 mL
plasma. • range of 600 to 2000 mL
 • Night urine generally not in
excess of 400 mL
• Pregnancy: diurnal variation may be reversed
• Young children: 3-4x as much urine per kilogram of body
weight than adults
• Measurement of the urine output during timed intervals may
be valuable in clinical diagnosis
SPECIMEN COLLECTION
Urine is a biohazardous substance that requires the
observance of Standard Precautions.
CONTAINERS
• Specimens must be collected in clean, dry, leak-
proof containers
• Disposable containers should be used
• Including bags with adhesive for the
collection of pediatric specimens
• Large containers for 24-hour specimens
• Screw-top lids, wide mouth and made up of clear
material
• 50mL - Capacity of the container
• Allow 12 mL specimen needed for
microscopic analysis
• Additional specimen for repeat analysis
• Enough room for the specimen to be
mixed by swirling the container.
• MICROBIOLOGY - Individually packaged sterile
containers with secure closures should be used
LABELS
• All specimens must be labeled properly with
patient’s name and identification number, the date
and time of collection
• Additional information such as the patients age
and location and the healthcare provider’s name
• Labels must be attached to the container, not to
the lid
REQUISITIONS
• A requisition form (manual or computerized) must
accompany specimens delivered to the laboratory
• The information on the form must match the
information on the specimen label
• Additional information on the form can include
method of collection or type of specimen, possible
interfering medications and the patient’s clinical
information
SPECIMEN REJECTION
• Improperly labeled and collected specimens should be
rejected by the laboratory, and appropriate personnel should
be notified to collect a new specimen.
• Unacceptable Situations:
1. Specimens in unlabeled containers
2. Nonmatching labels and requisition forms
3. Specimens contaminated with feces or toilet paper
4. Containers with contaminated exteriors
5. Specimens of insufficient quantity
6. Specimens that have been improperly transported
SPECIMEN HANDLING
SPECIMEN INTEGRITY
• Specimens should be delivered to the laboratory
promptly and tested within 2 HOURS
• A specimen that cannot be delivered and tested
within 2 hours should be refrigerated or have an
appropriate chemical preservative added.
• Improper preservation can seriously affect the
results of a routine urinalysis
CHNAGES IN UNPRESERVED URINE
SPECIMEN PRESERVATION
• Most routinely used method of preservation is
refrigeration at 2 °C to 8 °C
• The specimen must return to
room temperature before
chemical testing by reagent
strips.
• If the urine is to be cultured, it should be
refrigerated during transit and kept refrigerated
until cultured up to 24 hours
• CHEMICAL PRESERVATIVES – transported over
a long distance
• Ideal preservative should be bactericidal,
preserved formed elements and should not
interfere with chemical tests.
TYPES OF SPECIMEN
RANDOMSPECIMEN
(occasional/single)
• This is the most commonly received specimen
• It may be collected anytime but the actual time of
voiding should be recorded on the container
• It is use for ROUTINE SCREENING TEST
FIRST MORNING SPECIMEN
 • IDEAL SPECIMEN FOR ROUTINE URINALYSIS • FOR BACTERIAL CULTURE AND URINE
and Pregnancy Test CYTOLOGY
• Most concentrated specimen • Provides a sample that is free of extraneous
• It is use for evaluation of orthostatic proteinuria contamination
GLUCOSE TOLERANCE SPECIMENS THREE-GLASS COLLECTION
• The urine is tested for glucose and ketones • FOR PROSTATIC INFECTION
• The results reported along with the blood test 1. First portion of voided urine
results 2. Middle portion of voided urine
• Correlated with renal threshold for glucose 3. Urine after prostatic massage
• FASTING URINE, 2-HOUR POSTPRANDIAL, • Examine the 1st and 3rd specimen microscopically,
GLUCOSE TELERANCE, FRACTIONAL then compare the no. of WBC and bacteria
SPECIMEN • PROSTATIC INFETION- If the no. of WBC and
• These specimens is an INSTITUTIONAL OPTION bacteria in the 3rd specimen is 10x GREATER than
24- hour (or Timed) Specimen that of the 1st.
• Measuring the exact amount of a urine chemical • 2nd specimen – CONTROL for bladder & kidney
(Quantitative Chemical Tests) infection. If POSITIVE for WBC and bacteria, the
• Begin and end the collection period with an 3rd specimen is considered invalid.
EMPTY BLADDER 1. PEDIATRIC SPECIMENS
• It should be refrigerated or keep on ice during the • SOFT, CLEAR PLASTIC BAGS WITH
collection HYPOALLERGENIC SKIN ADHESIVE TO
• It must be thoroughly mixed, and the volume ATTACH TO THE GENITAL AREA
accurately measured and recorded • Care must be taken not touch the inside of the bag
• 12-HOUR SPECIMEN, 4-HOUR SPECIMEN, when applying it
AFTERNOON SPECIMEN (2PM-4PM) • ROUTINE SPECIMEN- ensure the area is free of
CATHETERIZED SPECIMEN contamination
• FOR BACTERIAL CULTURE • MICROBIOLOGY SPECIMEN- clean the area
• It is collected under sterile conditions by passing a with soap and water and sterilely dry the area,
hollow tube(catheter) through the urethra into the sterilely transfer collected specimen
bladder. DRUG SPECIMEN COLLECTION
MIDSTREAM CLEAN-CATCH SPECIMEN • CHAIN OF CUSTODY (COC)
• FOR ROUTINE SCREENING AND BACTERIAL 1. Process that provides documentation of
CULTURE proper sample identification from time of
• Alternative to the catheterized specimen collection to the receipt of the laboratory
• Provides a safer, less traumatic method • Required urine volume – 30-45 ml
• Provides a specimen that is less contaminated by • Temperature (with in 4 min) – 32.5- 37.7 °C
epithelial cells and bacteria • Bluing Agent (dye) is added to the toilet water
• It is more representative of the actual urine sample reservoir to prevent specimen adulteration
SUPRAPUBIC ASPIRATION

REFERENCES:
Strasinger, S.K, Di Lorenzo, M.S (2014). Urinalysis and Body Fluids (6th ed.) Philadelphia: F.A Daviss Company