Analysis Of Urine and other Body Fluids

Week 1 & 2 / Strasinger’s Urinalysis and Body Fluids 6th Edition

INTRODUCTION TO URINALYSIS  Urine contains information, which can be

obtained by inexpensive laboratory tests.
TOPIC OUTLINE
 According to CLSI, urinalysis define as “the
1 History
testing of urine with procedures commonly
2 Urine Composition performed in an expeditious, reliable,
3 Urine Volume accurate, safe, and cost- effective manner
4 Urine Specimen and Collection
5 Specimen Collection and Handling
NOTES
Ultrafiltrate of Plasma
HISTORY  Can be used to evaluate or monitor our
Hippocrates Wrote a book on “uroscopy” bodies homeostasis in Aldosterone system
(5th century
BC)
Frederik Discover albuminuria. Urine Composition
Dekkers
Normally 95% of water and 5 % of solutes
(1694)
Thomas Examination of urinary sediment by ORGANIC INORGANIC
Addis his method of quantitating the COMPONENTS COMPONENTS
microscopic sediment.  Urea- Major organic  Sodium Chloride-
Richard Introduced concept of urinalysis as component Major inorganic
Bright part of doctor’s routine patient  Creatinine- derived component;
(1827) examination from creatine Principal salt
 Uric acid- common  Potassium
NOTE component in  Sulfate- Derived
kidney stones; from amino acids
 1140 Common Era – developed color chart
derived from  Phosphate
 Albuminuria – protein in urine; discovered
from boiling urine
catabolism of  Ammonium
 Thomas Brian – reveal the contribution of
nucleic acid in food.  Magnesium
 Hippuric acid-  Calcium
early physician ; was first medical law’s in
benzoic acid is
England
eliminated in this
form, increases
with high vegetable
WHY WE STUDY URINE? diet. Other
 The kidney is the only organ with such a substances
noninvasive means by which to directly (carbohydrates,
evaluate its status. pigments, fatty
 Urine is an ULTRAFILTRATE of plasma. acids, enzymes etc).
 Urine is a readily available and easily collected
specimen.

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 IS THIS FLUID URINE?
 At times it is necessary to verify that the fluid
present in a urine container is in fact urine.
 The single most useful substance that
identifies a fluid as urine is its uniquely HIGH
CREATININE CONCENTRATION (approximately
50 times that of plasma)
 In addition, concentrations of urea, sodium
and chloride are significantly higher in urine
than in other body fluids.
URINE SPECIMEN & COLLECTION

URINE VOLUME
 Urine volume depends on the amount of water
that the kidney excrete. Amount excreted is
usually determined by the body’s state of
hydration.
 Normal Daily Urine Output: 1200 to 1500 mL a
range of 600 to 2000 mL is considered normal.
TYPES OF SPECIMEN
 The composition of urine depends on the
patient’s metabolic state and the timing and
procedure used for collection.
 Patients must be instructed when special
collection techniques are required.

1 FIRST MORNING SPECIMEN

OLIGURIA  Decrease in urine output
 Also known as the 8 hour specimen
 Result of excessive water loss
 The ideal screening specimen
from vomiting, diarrhea,
 It is a concentrated specimen thereby assuring
perspiration, or severe burn
detection of chemicals and formed elements
< 1ml/kg/hr → Infants
not seen in random specimen.
< 0.5 ml/kg/hr →Children
 Essential for preventing false- negative
< 400 ml/day → Adults
pregnancy tests and for evaluating orthostatic
ANURIA  Cessation of urine flow result
proteinuria.
from any serious damage to the
 The specimen must be collected immediately
kidney or decrease flow of blood
and deliver to the laboratory within 2 hours.
to the kidney
2 RANDOM SPECIMEN
NOCTURIA  Normally, kidneys excrete 2 or 3
times more urine during the day
 Can be collected at any time, usually during
 Increase nocturnal excretion of
daytime hours, and without prior patient
urine
preparation.
POLYURIA  Increase in daily urine volume
 The most commonly received specimen.
 Greater than 2.5 L/ day →Adults  Usually satisfactory for routine screening and
2.5- 3 mL/kg/day → Children
are capable of detecting abnormalities that
Associated with Diabetes mellitus
indicate disease process.
and Diabetes Insipidus
3 FASTING SPECIMEN (SECOND MORNING)
artificially induced by diuretics,
caffeine and alcohol

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  The second voided specimen after a period of
fasting.
 This specimen will not contain any metabolites
from food ingested before the beginning of
the fasting period.
 Recommended for glucose monitoring.
4 2 HOUR- POSTPRANDIAL SPECIMEN
 The patient is instructed to void shortly before
consuming a routine meal and to collect a
specimen 2 hours after eating.
 Specimen is tested for glucose
 Results are used primarily for insulin therapy
monitoring for persons with diabetes mellitus
5 GLUCOSE TOLERANCE SPECIMEN
 Collected correspond with blood samples
drawn during glucose tolerance test (GTT).
 Number of specimens varies with the length of
the test.
 Urine is tested for glucose and ketones
6 24 HOUR (TIMED) SPECIMEN
 Specimen used for urine quantitative assay.
 Many solutes exhibit diurnal variation.
 Catecholamines, 17- hydroxysteroids,
electrolytes
 The patient must begin and end the collection
period with empty bladder.
 On its arrival in the laboratory, the specimen
must be thoroughly mixed and the volume
accurately measured and recorded.
 All specimen should be refrigerated or kept on
ice during the collection period.
 The most common error encountered are
related to specimen collection or to handling
problems.
7 MIDSTREAM “CLEAN CATCH” SPECIMEN
 Less traumatic method for obtaining urine for
bacterial culture and routine urinalysis.
 Used to avoid contamination (ex. Vaginal
discharge)
 Before collection, the glans penis or urethral
meatus are thoroughly cleansed and rinsed.
 After cleansing, midstream specimen is
obtained when the px passes some urine in
the toilet and then stops and urinate the mid
portion to the container.
 Care should be taken not to contaminate the
specimen container.
8 CATHETERIZED SPECIMEN
 Obtained following catheterization of the
patient, that is insertion of a sterile catheter
through urethra into the bladder.
 Urine flows directly from the bladder through
the indwelling catheter and accumulates in a
plastic reservoir bag.
 Most often these specimen are sent for
bacterial culture.
 Involves collecting urine directly from the
bladder by puncturing the abdominal wall and
distended bladder using needle and syringe.
 This procedure is used principally for bacterial
cultures, especially for anaerobic microbes and
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 in infants, in whom specimen contamination is
often unavoidable
9 SUPRAPUBIC ASPIRATION
 Completely free of contamination for bacterial
culture and cytology
 External needle aspiration from the bladder
 Possible pediatric specimen
10 PEDIATRIC COLLECTION
 Pediatric and newborn infants pose a challenge
in collecting an appropriate urine specimen.
 Commercially available plastic urine collection
bags with hypoallergenic skin adhesive are
used.
 The bag is placed over the penis in the male
and around the vagina (excluding the anus) in
the female, and the adhesive is firmly attached
to the perineum.
11 DRUG SPECIMEN COLLECTION
 Chain of custody
 Provides this documentation of proper sample
identification from the time of collection to
the receipt of laboratory results
 withstand legal scrutiny
 No tampering of spx
 Spx must be handled securely
 Proper ID is required
 30-45ml (60ml in PHL)
 Urine tempt must be checked within 4 mins
(32.5-37.7C)
12 PROSTATITIS SPECIMEN
Also known as “three glass collection”
• 1 st container → first passed urine
• 2 nd container → midstream portion of urine
• 3 rd container → urine with prostatic fluid
• 4 th container → post prostatic massage urine
specimen (Stamey –Mears)
IMPORTANCE:
• 1 st container → Urethral infection or
inflammation
• 2 nd container → urinary bladder infection
• 3 rd and 4th container → Prostatic infection (+
WBC and 10x bacteria compared to 1st container)
Prostatic Infection
 higher WBC/hpf count in specimen 3 than
specimen 1
 bacterial count in specimen 3 is 10 times higher
than specimen 1
Specimen 2 is a control for bladder or kidney
infection
 Positive culture in specimen 2 invalidates
positive culture in specimen 3 (cannot
differentiate urinary tract infection from
prostate infection)
Prostate specimen variations
Stamey-Mears: 4-glass collection
 Initial voided (VB1)
 Midstream (VB2)
 Massaged Prostate Excretions (EPS)
 Post-massage urine (VB3)
Cultures on all specimens
 VB1 and VB2 positive = urinary infection
 EPS examined for WBCs >10-20/ hpf:abnormal
Negative cultures on VB1 and VB2 and positive on
EPS and VB3 show prostatitis
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Pre-and Post-Massage Test:
 Specimen 1 – midstream clean-catch
specimen
 Specimen 2 – post-massage specimen
Prostatitis is indicated by a quantitative culture
result in the second glass that is 10 times higher
than specimen 1
SPECIMEN COLLECTION & HANDLING
A SPECIMEN COLLECTION
 Gloves should be worn at all times
 Routine urinalysis protocols typically require
10 to 15 ml of urine. Less than 12 ml hinder
performance of microscopic examination.
 Containers for urine collection must be
clean, dry and made of clear or translucent
disposable material such as plastic or glass.
 The container should stand upright have an
opening of at least 4-5 cm and have a
capacity of 50 to 100 mL.
 All specimen containers must be labelled
before or immediately after collection.
Patient identification label is always placed
directly on the container holding the
specimen.
 Specimens should be delivered to the
laboratory promptly and tested within 2
hours.
NOTE
 Delivered within 2 hrs
 Accurate time for reading of result
 must be 1hr
 labelled on container not on lid
B SPECIMEN LABELING
Information on label:
 Patient’s Name, ID Number, Date, Time
 Additional information: Age, Location,
Physician
PLACE LABEL ON CONTAINER, NOT LID
Requisition form: Must accompany specimen
 Information must match label
 Time of receipt is stamped on requisition
 Other info: Type of specimen, Interfering
meds
C URINE SPECIMEN REJECTION
 Unlabeled urine specimen container
Mislabeled urine specimen
 Names or identification number on container
label and request slip do not match
 Inappropriate urine collection technique or
specimen type for test requested
 Specimen not properly preserved during a
time of delay or inappropriate preservative
used
 Visibly contaminated urine (fecal material,
toilet tissue)
 Insufficient volume of urine for test/s
requested
D SPECIMEN INTEGRITY
 Test within 2 hours of collection
 Refrigerate if testing is delayed
 Most problems are caused by bacterial
multiplication
 Increased: Color, Turbidity, pH, Nitrite,
Bacteria, Odor
 Decreased: Glucose, Ketones, Bilirubin,
Urobilinogen, RBCs, WBCs, Casts
E CHANGES IN UNPRESERVED URINE
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F SPECIMEN PRESERVATION

 Most routinely used method of preservation

is refrigeration at 2ºC to 8ºC

 When a specimen must be transported over

a long distance and refrigeration is
impossible, chemical preservatives may be
added.

Examples of chemical preservatives:

 Thymol
 Formalin
 Saccomanno’s Fixative
 Acids (HCl, glacial acetic acid, Boric acid)
Sodium Carbonate
 Sodium Fluoride
 Toluene
NOTE
 Phenol
 Trichomonads: parasitic infection
(tumbling, can see under urine
IDEAL PRESERVATIVE
microscopy)
 Bactericidal
 Precipitation of Protein: Sulfosalicylic
 Inhibit urease
Acid is the reagent for confirmatory of
 Able to preserve formed elements
presence of protein in urine
 Must not interfere with chemical tests  Porphyrins and Porphobilinogen:
chemicals that help to make
Ideal preservative does not exist as of the hemoglobin
moment
G URINE PRESERVATIVE