Chapter 1: Safety and Quality Management: 11-01-2021 - Harley Rose Bautista, RMT RMT 2023

ANALYSIS OF URINE & BODY FLUIDS | MLS 111
CHAPTER 1: SAFETY AND QUALITY MANAGEMENT

11-01-2021 | HARLEY ROSE BAUTISTA, RMT RMT 2023
NATIONAL FIRE PROTECTION ASSOCIATION (NFPA) • Example:
HAZARDOUS MATERIALS CLASSIFICATION 150mg/dl 1.73m2
1. Yellow Quadrant → CCr = = X 1.73m2 = 150 mg per dl
→ Reactivity or Stability hazard. 150mg/dl
0 Stable
1 Unstable if heated COCKGRAFT-GAULT
2 Violent chemical change • Used to check the serum levels of blood urea nitrogen
3 Shock and heat may deteriorate (BUN) and creatinine.
4 May deteriorate • To determine whether renal insufficiency is present.
• Age, weight, gender, and sex.
2. White Quadrant • Formula:
→ Specific hazard. (140−age)(body weight in kg)
→ CCr =
OXY Oxidizer 72 x serum crea mg/dl
ACD Acid → If female = multiply by .85
ALK Alkaline → If male = none
COR Corrosive • Example:
W No water (140−25)(55kg)
Radiation → CCr = = 87
72 x 1mg/dl
3. Blue Quadrant Remember: The most common error in infiltration test is the
→ Health hazard. improper timed urine specimen (24 hours specimen).
0 Normal Material
1 Slightly Hazardous TUBULAR REABSORPTION TEST
2 Hazardous • Concentration test
3 Extremely Danger → To determine the ability of the tubules to reabsorb the
4 Deadly essential salts and water that have been nonselectively
filtered by glomerulus.
4. Red Quadrant • To evaluate tubular reabsorption.
→ Fire hazard (Flammability hazard).
0 Will not burn Absolute test:
1 Above 200 F 1) Fishberg test
2 Below 200 F → The patient will not drink water for 24 hours.
3 Below 100 F → After 24 hours, pag ihi niya, kukuhain yung specific
4 Below 73 F gravity.
→ Specific gravity = greater than or equal to 1.026.
2) Mosenthal test
→ Compare day and night urine volume and specific
gravity.
SAFETY HAZARDS
• CDC – Centers for Disease Control and Prevention
• OSHA – Occupational Safety and Health Administration
• CLSI – Clinical and Laboratory Standards Institute
BIOLOGICAL HAZARD
• Potentially harmful microorganisms.
• Bacillus anthracis
Terms to remember:
o Chain of infection – understanding how
microorganisms are transmitted.
o Infection control – To control and monitor infections
occurring within the facilities.
Types of Safety Hazards

“You Were Born Right” Type Source Possible injury
Infectious agents Bacterial, fungal, viral, or
CREATININE CLEARANCE Biological
parasitic infections.
• Most common test by glomerular formation. Needles, lancets, broken Cuts, punctures or
UC 1.73m2 Sharps glass exposure to bloodborne
• Formula: CCr = X 1.73m2 pathogens.
PC Preservatives and reagents Exposure to toxic,
→ Wherein: Chemical carcinogenic, or causative
o UC – Urine Creatinine agents.
o PC – Plasma Creatinine
CHAP 1 | GALLENO 1
Radioactive
Equipment and Exposure to radiation o At any time when hands have been knowingly
radioisotopes contaminated.
Ungrounded or wet Burns or shock o Before going to designated break areas.
Electrical
equipment; frayed cords o Before and after using bathroom facilities.
Fire or Open flames, organic Burn or dismemberment
→ Proper way:
Explosive chemicals
Wet floors, heavy boxes, Falls, sprains, or strains o Wet your hands with WARM water. Do not
Physical allow parts of your body to touch the sink.
patients
o Apply antimicrobial soap.
o Rub to form a lather, create friction, and
loosen debris.
o Thoroughly clean between fingers including
thumbs, under fingernails, and rinse up to 15-
20 seconds.
o Rinse your hands in a DOWNWARD position.
o Dry with a paper towel.
o Turn off faucet using a clean paper towel to
prevent contamination.
Note: Ang unang tamang sagot ang isasagot daw pag ang nasa
choices ay both 15 secs and 20 secs.
3. Disposal of biological waste

→ All biological hazards are disposed in a biological
waste except URINE.
→ Urine is disposed in the sink using Sodium
hypochlorite (1:10).
→ It must be properly labelled (red or yellow coding).
SHARP HAZARDS
• All sharp objects must be disposed in puncture-resistant,
leakproof container with biohazard symbol.
CHEMICAL HAZARDS
• Avoid getting these materials in or on bodies, clothes, or the
work area.
• Every chemical in the workplace should be presumed to be
hazardous.
• First aid is to flush area with large amounts

Chemical Spills and
of water for at least 15 minutes.
Exposure
• Seek medical assistance.
Chemical handling ACID should always be added to WATER.
Prevention: 1. Appropriate work practices
1. PPE (Personal Protective Equipment) 2. Standard operating procedures
Chemical Hygiene 3. PPE
→ Laboratory coats Plan 4. Engineering controls
- Fluid resistant gowns. 5. Employee training requirements
- To protect clothing and skin from exposure to 6. Medical consultation guidelines
patients’ body substances. Should be labeled with a description of the
Chemical Labeling
→ Gloves particular hazard.
- Should be worn when in contact with patients, • All chemicals and reagents containing
specimens, contaminated items, laboratory hazardous ingredients in a concentration
Safety Data Sheets
equipment. greater than 1%.
- Sterile, nonsterile, powdered, unpowdered. • Carcinogenic potential.
The Globally
→ Masks, Goggles, and Face Shields Harmonized System International effort to standardize both the
- The mucous membranes of the eyes, nose, and of Classification and classification of hazardous chemicals and the
mouth must be protected from specimen splashes Labeling of symbols used.
and aerosols. Chemicals.
2. Handwashing (Hand Hygiene) Chemical Waste
EPA – Environment Protection Agency.
→ The best way to break the chain of infection. Disposal
→ Lab personnel must always sanitize hands in the
following situations: RADIOACTIVE HAZARDS
o Before patient contact. • Encountered in the clinical laboratory when procedures
o After gloves are removed. using radioisotopes are performed.
o Before leaving the work area. • The amount of radiation exposure is related to a
combination of time, distance, and shielding.
CHAP 1 | GALLENO 2
• Exposure to radiation during pregnancy presents a danger → record keeping
to the fetus. → equipment maintenance
→ safety programs
ELECTRICAL HAZARDS → training
• The danger of water or fluid coming in contact with → education and competency assessment of personnel
equipment is greater in the laboratory setting. → review process that is scheduled and documented
• Equipment should not be operated with wet hands. • Laboratory accreditation agencies:
• When an accident involving electrical shock occurs, the → TJC
electrical source must be removed immediately. → CAP – College of American Pathologist
→ AABB – American Association of Blood Banks
FIRE OR EXPLOSIVE HAZARDS
→ AOA – American Osteopathic Association
• Joint Commission (JC) requires that all health-care
→ ASHI - American Society of Histocompatibility and
institutions post evacuation routes and detailed plans to
Immunogenetics
follow in the event of a fire.
→ COLA - Commission on Laboratory Assessment
• When a fire is discovered, all employees are expected to
take the actions in the acronym RACE:
URINALYSIS PROCEDURE MANUAL
→ Rescue - rescue anyone in immediate danger.
• Procedure manual containing all the procedures performed
→ Alarm - activate the institutional fire alarm system. in the urinalysis section must be available for reference in
→ Contain - close all doors to potentially affected areas. the working area and must comply with the CLSI guidelines.
→ Extinguish or Evacuate - attempt to extinguish the fire,
if possible or evacuate, closing the door. PRE-EXAMINATION (PREANALYTICAL) VARIABLES
• It is important to be able to operate the fire extinguishers. • Occur before the actual testing of the specimen and include
The acronym PASS can be used to remember the steps in test requests, patient preparation, timing, specimen
the operation: collection, handling, and storage.
→ Pull pin • Turnaround Time (TAT)
→ Aim at the base of the fire → defined as the amount of time required from the point
→ Squeeze handles at which a test is ordered by the health-care provider
→ Sweep nozzle side to side until the results are reported to the health-care
provider.
Types of Fires and Fire Extinguishers
Fire Type of Specimen Collection and Handling
Extinguishing Material Extinguisher
type Fire
Class A Wood, paper, clothing Class A Water • Information on specimen collection and handling should be
Flammable organic Dry chemicals, carbon stated at the beginning of each procedure listed in the
Class B Class B manual.
materials dioxide, foam, or halon
Dry chemicals, carbon • The form should include space for recording:
Class C Electrical Class C
dioxide, or halon 1) the actual date and time of specimen collection.
None Sand or dry powder 2) whether the specimen was refrigerated before
Class D Combustible metals
Class ABC Dry chemicals transporting.
Liquid to prevent 3) the time the specimen was received in the
Class K Grease, oils, fats Class K splashing and cool the laboratory and the time the test was performed.
fire
4) tests requested.
5) an area for specific instructions that might affect
PHYSICAL HAZARDS
the results of the analysis.
• General precautions to consider are to avoid running in 6) patient identification information.
rooms and hallways, watch for wet floors, bend the knees
• Criteria for specimen rejection for both physical
when lifting heavy objects, keep long hair pulled back, avoid
characteristics and labeling errors must be present.
dangling jewelry, and maintain a clean, organized work
area. Policy for Handling Mislabeled Specimens
• Do NOT assume any information about the specimen or patient.
QUALITY MANAGEMENT • Do NOT relabel an incorrectly labeled specimen.
• Refers to the overall process of guaranteeing quality patient • Do NOT discard the specimen until investigation is complete.
care and is regulated throughout the total testing system. • Leave specimen EXACTLY as you receive it; put in the refrigerator
• Quality management system for preservation until errors can be resolved.
→ refers to all of the laboratory’s policies, processes, • Notify floor, nursing station, doctor’s office, etc. of problem and why
procedures, and resources needed to achieve quality it must be corrected for analysis to continue.
testing. • Identify problem on specimen requisition with date, time, and your
initials.
• All of the following are included in a QMS:
• Make person responsible for specimen collection participate in
→ Internal quality control solution of problem(s). Any action taken should be documented on
→ external quality control the requisition slip.
→ electronic quality control • Report all mislabeled specimens to the appropriate supervisor.
→ calibration or calibration verification
→ standardization Criteria for Urine Specimen Rejection
→ proficiency testing (PT), more formally known as • Unlabeled containers.
external quality assessment (EQA) • Nonmatching labels and requisition forms.
• Contaminated specimens with feces or toilet paper.
CHAP 1 | GALLENO 3
• Containers with contaminated exteriors. → Reliability - ability to maintain both precision and
• Insufficient volume of urine. accuracy.
• Improperly transported or preserved specimens. • Analysis of two levels of control material is required.
• Delay between time of collection and receipt in the laboratory. • The concentration of controls should be at medically
significant levels and should be as much like the human
EXAMINATION (ANALYTICAL) VARIABLES specimen as possible.
• Processes that directly affect the testing of specimens.
Terms to remember:
Reagents o Control mean
• Manual should state the name and chemical formula of - average of all data points.
each reagent used, instructions for preparation, when o Standard Deviation (SD)
necessary, or company source of prepared materials, - measurement statistic that describes the average
storage requirements, and procedures for reagent QC. distance each data point in a normal distribution is
• CLRW (Clinical Laboratory Reagent Water) must be from the mean.
monitored regularly for microbial contamination. o Coefficient of Variation (CV)
• All reagents and reagent strips must be properly labeled - SD expressed as a percentage of the mean.
with the date of preparation or opening, purchase and - The CV indicates whether the distribution of
received date, expiration date, and appropriate safety values about the mean is in a narrow versus broad
information. range and should be less than 5%.
• Reagent strips should be checked against known negative o Control ranges
and positive control solutions on each shift. - Determined by setting confidence limits that are
within 2SD or 3SD of the mean.
Instrumentation and Equipment
• Procedure manual should clearly state the instructions Changes in accuracy of results are indicated by either:
regarding the operation, performance, and frequency of o Trend - gradual changing in the mean in one direction.
calibration. o Shift - abrupt change in the mean.
Calibrated daily or when used against deionized Internal Quality Control

Refractometers water (1.000), and a known control such as 5% saline • Internal quality control consists of internal monitoring
or 9% sucrose. systems built into the test system and are called:
Osmometers
→ Internal controls
Urine reagent
strip tests - Monitor the sufficient addition of a patient
All control values must be recorded. specimen or reagent, the instruments, or reagents.
Human Chronic
Gonadotropin → Procedural controls
(hCG) kit tests
Automated Electronic Controls
urinalysis system Calibrated using manufacturer-supplied calibration • External quality control (EQC) uses a mechanical or
Reagent strip materials. electrical device in place of a liquid QC specimen.
readers
• Verifies the functional ability of a testing device, but it does
Refrigerators
Water baths
Temperatures should be taken daily. not verify the integrity of the testing supplies.
Calibration should be customarily performed every 3
Centrifuges Proficiency Testing (External Quality Assessment)
months.
Should be kept clean at all times and have an annual • Testing of unknown samples received from an outside
Microscopes
professional cleaning. agency and provides unbiased validation of the quality of
Automated Periodically checked for accuracy and reproducibility. patient test results.
pipettes • Personnel in subscribing laboratories test these proficiency
Used for reagent preparation is quality controlled by survey specimens in the same manner as patient
Deionized water checking pH and purity meter resistance on a weekly specimens.
basis and bacterial count on a monthly schedule.
• NO COMMUNICATION WITH OTHER LABORATORIES IS
PERMITTED.
Testing Procedure
• Corrective action must be taken for unacceptable results.
• Detailed, concise testing instructions are written in a step-
• The Clinical Laboratory Improvement Amendments (CLIA)
by-step manner.
mandates comparison testing for laboratory accreditation.
• Instructions should begin with specimen preparation.
Individualized Quality Control Plan
Quality Control
• Alternative CLIA QC option that provides equivalent
• Refers to the materials, procedures, and techniques that quality testing to meet the CLIA regulations for moderate
monitor the accuracy, precision, and reliability of a and high complexity tests and provider-performed
laboratory test. microscopy procedures (PPMP) tests.
• It requires:
External Quality Control
→ RA – Risk Assessment
• Used to verify the:
- Identifies and evaluates potential problems that
→ Accuracy - ability to obtain the expected result.
may occur in the entire testing process.
→ Precision - ability to obtain the same result on the
→ QCP – Quality Control Plan
same specimen.
CHAP 1 | GALLENO 4
- Establishes control procedures to reduce the Critical Results
possibility of reporting an inaccurate patient test • Written procedures available for the reporting of critical
result. values.
→ QA – Quality Assessment → Critical values are test results that are significantly
- Involves QC records, PT records, review of patient lower or higher than the normal reference range.
results, specimen rejection logs, TAT reports, • They can be life-threatening and must be relayed to the
record of preventive measures, personnel health-care provider immediately.
competency records.
Interpreting Results
Personnel and Facilities • Sensitivity
• Quality control is only as good as the personnel performing → Lowest level of an analyte that a test can detect.
and monitoring it. • Specificity
→ Likelihood of measuring the analyte desired.
POST-EXAMINATION VARIABLES • A well-documented QM program ensures quality test
• Processes that affect the reporting of results and correct results and patient care data.
interpretation of data.
• Efficient and accurate manner is essential to quality patient Quality Management Errors
care. ✓ Patient misidentification
✓ Wrong test ordered
Laboratory reports must be present in the patient’s record. ✓ Incorrect urine specimen type collected
Pre-examination
Required information includes: ✓ Insufficient urine volume
• Patient’s first and last name. ✓ Delayed transport of urine to the laboratory
• Patient’s unique information number. ✓ Incorrect storage or preservation of urine
• Specimen collection date and time. ✓ Sample misidentification
• Specimen source. ✓ Erroneous instrument calibration
• Condition of unsatisfactory. ✓ Reagent deterioration
• Test performed, the results, and the reference ranges of the tests. Examination ✓ Poor testing technique
✓ Instrument malfunction
• Date and time of the final results generated.
✓ Interfering substances present
• Facility where the test was performed.
✓ Misinterpretation of OC data
✓ Patient misidentification
Written Reports ✓ Poor handwriting
• There must be a written procedure for reporting, reviewing, ✓ Transcription error
and correcting errors. Post-examination ✓ Poor quality of instrument printer
• Should provide adequate space for writing and should ✓ Failure to send report
✓ Failure to call critical values
present the information in a logical sequence.
✓ Inability to identify interfering substances
Electronic Results
• Most common method for reporting results.
• Many urinalysis instruments have the capability for the
operator to transmit results directly from the instrument to
the designated health-care provider.
• It is essential that the operator carefully review results
before transmittal.
Telephone (Verbal) Results

• Frequently used to transmit results of stat results and critical
values.
• When telephoning results, confirm that the results are being
reported to the appropriate person.
→ Time of the call, name of the person receiving the
results must be documented according to the facility’s
policy.
Results Errors
• Errors may be discovered in the laboratory through a QM
procedure known as DATA CHECK.
→ DATA CHECK compares a patient’s test results with
the previous results.
• Many laboratory analyzers now have autoverification.
→ An automated comparison of patient results with the
predetermined preapproved criteria, programmed into
them.
• Patient’s record should be corrected as soon as the error is
detected.
CHAP 1 | GALLENO 5
CHAPTER 3: INTRODUCTION TO URINALYSIS
HISTORY AND IMPORTANCE → additional information such as the patient’s age
and location.
→ healthcare provider’s name, as required by
5th Wrote a book on uroscopy.
institutional.
Century Hippocrates
BCE • Labels must be attached to the container, not to the
1140 CE Color charts had been developed. lid.
The information on the form must match the information on
• “Ant testing” and “taste Requisitions
the specimen label.
1694 Frederik Dekkers testing” for glucose.
• Albuminuria by boiling urine.
17th Examination of urinary sediment.
Century
Concept of urinalysis as part of a
1827 Richard Bright doctor’s routine patient
examination.
Two unique characteristics of a urine specimen account for

this continued popularity:
• Urine is a readily available and easily collected
specimen.
• Urine contains information, which can be obtained by
inexpensive laboratory tests, about many of the body’s
major metabolic functions.
CLINICAL AND LABORATORY STANDARDS INSTITUTE

• Defines urinalysis as
→ the testing of urine with procedures commonly
performed in an expeditious, reliable, accurate, safe,
and cost-effective manner.
• Reasons for performing urinalysis
→ identified by CLSI include aiding in the diagnosis of
disease, screening asymptomatic populations for
undetected disorders, and monitoring the progress of
disease and the effectiveness of therapy.
URINE FORMATION
• Kidneys continuously form urine
→ ultrafiltrate of plasma.
SPECIMEN REJECTION
→ approximately 170,000 mL of filtered plasma to the
• Unacceptable situations include:
average daily urine output of 1200 mL.
→ Specimens in unlabeled containers.
URINE COMPOSITION → Nonmatching labels and requisition forms.
→ Specimens contaminated with feces or toilet paper.
Primary Components in Normal Urine → Containers with contaminated exteriors.
Primary organic component. Product of protein and → Specimens of insufficient quantity.
Urea
amino acid metabolism. → Specimens that have been improperly transported.
Creatinine Product of creatine metabolism by muscles.
Uric acid Product of nucleic acid breakdown in food and cells. SPECIMEN HANDLING
Primary inorganic component. Found in combination with
Chloride
sodium (table salt) and many other inorganic substances. • Specimens should be delivered to the
Sodium Primarily from salt, varies by intake. laboratory promptly and tested within 2
Potassium Combined with chloride and other salts. hours.
Phosphate Combines with sodium to buffer the blood. Specimen Integrity • A specimen that cannot be delivered and
Ammonium Regulates blood and tissue fluid acidity. tested within 2 hours should be
Calcium Combines with chloride, sulfate, and phosphate. refrigerated or have an appropriate
chemical preservative added.
SPECIMEN COLLECTION • Refrigerate at 2°C to 8°C
→ decreases bacterial growth and
• Collected in clean, dry, leak-proof containers. metabolism.
• The recommended capacity of the container is 50 mL, • Urine is to be cultured
which allows 12 mL of specimen needed for → it should be refrigerated during
Containers Specimen Preservation
microscopic analysis. transit.
• A lid with a transfer device that can be assessed with → kept refrigerated until cultured up to
a device called a transfer straw. 24 hours.
• All specimens must be labeled properly with: • The specimen must return to room
Labels → patient’s name and identification number. temperature before chemical testing by
→ the date and time of collection. reagent strips.
CHAPTER 3 | GALLENO 1
Changes in Unpreserved Urine Use on automated Must refrigerate Round or
Analyte Change Cause Yellow UA instruments. within 2 hours. conical bottom,
Color Modified Oxidation or reduction of metabolites. Plus tube no
Decreased Bacterial growth and precipitation of preservative.
Clarity Cherry red or Stable for 72 hours Must be filled to Preservative is
amorphous material.
Increased Bacterial multiplication causing breakdown Yellow at RT; instrument- minimum sodium
Odor preservative compatible. fill line. propionate.
of urea to ammonia.
Breakdown of urea to ammonia by urease- plus tube
pH
producing bacteria or loss of CO2.
Glucose Decreased Glycolysis and bacterial use. URINE COLLECTION
Ketones Volatilization and bacterial metabolism. • Midtstream
Bilirubin
Exposure to light or photo oxidation to → Void yung unang patak ng wiwi.
biliverdin.
→ Middle wiwi.
Urobilinogen Oxidation to urobilin.
Nitrite Increased Multiplication of nitrate-reducing bacteria.
• First morning urine
RBC and Decreased Disintegration in dilute alkaline urine. → Concentrated.
WBC Casts → Also used for pregnancy test.
Bacteria Increased Multiplication.
Trichomonas Decreased Loss of motility, death. Remember:
✓ Urine volume: 15-30 mL
Urine Preservatives ✓ Dalhin agad sa lab 1 hour after mag wiwi.
Preservatives Advantages Disadvantages Add Info
Does not interfere Precipitates Prevents TYPES OF URINE COLLECTION
with chemical tests. amorphous bacterial
Refrigeration
phosphates and growth Random Specimen
urates. for 24 hours.
Preserves glucose Interferes with • For routine and qualitative UA.
and sediments well. acid • Anytime.
Thymol
precipitation
test for protein. First Morning
Prevents bacterial Interferes with Keeps pH at
• BEST FOR UA.
growth and drug and about 6.0.
Boric acid Metabolism. hormone Can be used • Ideal specimen for routine UA and pregnancy test (hCG).
analyses. for urine culture • Most concentrated; most acidic: for well preservation of
transport. cells and casts.
Excellent sediment Acts as a Rinse • For evaluation of orthostatic proteinuria.
preservative. reducing agent. specimen
container with Second Morning
Formalin
formalin to
preserve cells • 2nd voided urine after a period of fasting.
and casts. • FASTING SPECIMEN.
Is a good Inhibits reagent May use • Glucose urine determination.
preservative for strip tests for sodium
drug glucose, blood, benzoate Note: Wala dapat glucose sa urine. Kapag higher than 120-180
Sodium
Analyses. and instead of mg/dl sign na yun na diabetic ka.
fluoride
Leukocytes. fluoride for
reagent strip
testing. 2 hours Postprandial Specimen
Does not interfere Causes an odor Use 1 drop or • Diabetic monitoring.
Phenol with routine test. change. ounce of
specimen. Glucose Tolerance
• Convenient Check tablet
• Optional with blood samples in glucose tolerance test.
when composition
refrigeration to determine
Commercial not possible. possible effects Fractional Specimen
preservative • Have on desired • At least 2 voided collections.
tablets controlled tests. • Series of blood & urine samples are collected at specific
concentration time intervals to compare the concentration of a substance
to minimize
in urine with its concentration in the blood (used in the dx of
interference.
diabetes).
Contains collection
cup, transfer straw,
Urine Median Clean Cut
culture and
collection
kits
sensitivity (C&S) • Void yung first wiwi.
preservative • Ideal for Urine culture (OPD patient).
tube, or UA tube.
• For routine screening and bacterial culture.
Sample stable at Do not use if Preservative is
room temperature urine is below boric acid.
Light gray Suprapubic Aspirate
(RT) for 48 hours; minimum fill
and gray
C&S tube
prevents bacterial line. Keeps pH at • Recommended for Anaerobic bacterial culture.
growth and about 6.0. • Urine cytology study.
metabolism.
Pediatric Specimen
• Use of soft, clear plastic bag with adhesive.
• Sterile specimen obtained by catheterization or suprapubic
aspiration.
3 Glass Specimen Technique

• For prostatic infection.
1) First portion of voided urine.
2) Middle portion of voided urine.
3) Urine after prostatic massage.
Remember:
✓ 2nd specimen serves as a control.
✓ Examine the 1st and 3rd specimen microscopically,
then compare the no of WBC & bacteria.
Rule: If the number of WBC and bacteria in the 3rd specimen is

greater than 10x in the 1st specimen, it means it has prostatic
infection.
Remember:
✓ If the 2nd specimen is positive in WBC and bacteria, DO
NOT CONSIDER THE RESULT (Result Invalid). Test
should be repeated.
Specimen (Tube)
Result
1 2 3
+ + + Considered as UTI.
- + + Possible contamination
Timed Specimen
• Renal function.
• Creatinine, 24hr Na, Urine
Potassium.
24 hours (8am-8am)
• Begin and end the collection period
with and empty bladder.
• Requires preservative.
12 hours (8am-8pm) Addis count
• Nitrite test
4 hours • Urine remains in the bladder for at
least 4hrs before being collected.
Afternoon (2pm-5=4pm) Urobilinogen determination.
Drug Specimen Collection

• Medical technologist must take DRUG PROFIENCY TEST
to perform this type of collection.
Take note:
• Chain of custody
→ Documented simula pag wiwi hanggang sa result.
→ process that provides documentation of proper sample
identification from the time of collection to the receipt
of laboratory report.
Required volume 30-45 mL

Temperature 32.5 to 37.7 deg cel.
Container Parang lalagyan daw ng enervon.
Remember:
✓ Walang tubig dun sa banyo kasi baka haluaan ng tubig
yung wiwi (izza no no).
✓ Blue dye agent in the toilet to PREVENT
ADULTERATION.
✓ Hindi nisasara ang pinto raw.
✓ ASC (Assistant Specimen Collector).
CHAPTER 4: RENAL FUNCTION
RENAL PHYSIOLOGY Note: PCT, LH, DCT, CD alter urine concentration. The
• Nephron ascending LH is highly impermeable to water.
→ Basic structural and functional unit of the kidney.
→ Each kidney has 1-1.5 million nephrons. (2-2.5 million Urinary Filtrate Flow:
sabi ni ma’am sa lecture hehe) 1. Bowman capsule
→ Consists of glomerulus and renal tubule. 2. Proximal convoluted tubule
3. Descending loop of Henle
Two types of nephrons 4. Ascending loop of Henle
Cortical nephrons Juxtamedullary nephrons 5. Distal convoluted tubule
• Make up approximately 85% • Have longer loops of Henle. 6. Collecting duct
7. Renal calyces
of nephrons. • Its primary function is
8. Ureter
• Cortex of the kidney. concentration of urine.
9. Bladder
• Responsible for removal if
10. Urethra
waste products and
reabsorption of nutrients.
Renal Plasma Flow
URINE FORMATION • Amount of plasma moving towards the kidney per minute.
1. Glomerulus • Normal value of RPF: half of the RBF (600-700 mL/min).
→ First organ.
Glomerular Filtration
→ Glomerular filtration.
2. Proximal convoluted tubule (PCT) • Glomerulus (salaan-like ganon).
→ Tubular reabsorption. → Consists of a coil approximately 8 capillary lobes.
3. Loop of Henle → Within the Bowman’s capsule.
4. Distal convoluted tubule (DCT) → Non-selective filter of plasma substances.
→ Tubular secretion. → Molecular weight: < 70,000 Daltons.
5. Collecting duct
→ Reabsorption of water. Why hindi na-fifilter ni glomerulus si albumin?
6. Calyx o MW of albumin: 66,000-70,000.
7. Renal pelvis o Because of its shield of negativity.
→ Excretion. - It repels molecules with a negative charge.
RENAL FUNCTIONS Technical tip: If it were not for the shield of negativity, all routine
urines would have positive reagent strip readings for protein or
Renal Blood Flow albumin.
• Amount of blood moving towards the kidney per minute.
Remember:
• The human kidneys receive approximately 25% of the blood
✓ Presence of albumin in the urine indicates that you
pumped through the heart at all times.
have renal problem.
• Normal value RBF: 1,200 mL/min.
Tubular Reabsorption
Order of Blood Flow:
1. Renal artery (blood in) • First one to be affected if renal disease occurs.
2. Afferent arteriole
3. Glomerulus Remember:
4. Efferent arteriole ✓ Renal threshold of glucose: 160-180 mg/dl.
5. Peritubular capillaries - Glucose appears in the urine when the plasma
6. Vasa recta concentration reaches this level.
7. Renal vein (blood out)
Proximal Major site (65%) of reabsorption of plasma
Convoluted Tubule substances.
Regulates SWAG-U, in the DCT and C.
o Sodium
Anti-Diuretic
o Water
Hormone (ADH or
o Amino acid
Vasopressin)
o Glucose
o Urea
Aldosterone Regulates Sodium reabsorption.
REMEMBER!!!
Body Hydration ADH Urine volume
Increase Decrease Increase
Decrease Increase Decrease
Note: If you have DIABETES INSIPIDUS

✓ ADH = decrease
✓ Urine volume = increase Normal value:
• Male: 107-139 mL/min.
Active transport Passive transport • Female: 87-107 mL/min.
Substance Location Substance Location
Glucose, Cockgroft & Gault
PCT, descending
amino acids, PCT Water
LH, CD
salts (140−age)(body weight in kg)
Ascending Formula: CCr =
Chloride
LH
Urea PCT, ascending LH 72 x serum crea mg/dl
PCT and
Sodium Sodium Ascending LH Variables:
DCT
• Age
Note: • Sex
✓ Transport is the movement of a substance across cell → Female: multiply by 0.85
membranes into the bloodstream by electrochemical → Male: none
energy. • Weight
✓ Passive transport is the movement of molecules
across a membrane by diffusion because of a physical Tubular reabsorption test
gradient • Used to evaluate tubular reabsorption.
*yung RAAS sa last part ko na lang ilalagay, haba kase lol* • Patient is deprived of fluid for 24 hours.
Fishberg • Urine SG is then measured.
Tubular Secretion • Specific gravity = 1.026
Compare day and night urine in terms of
Mosenthal test
2 MAJOR FUNCTIONS: volume and specific gravity.
• Elimination of waste products not filtered by the glomerulus. Influenced by the number of particles in a
Osmolality
• Regulation of the acid-base balance in the body through solution.
secretion of hydrogen ion. Influenced by the number and density of
Specific gravity
particles in a solution.
RENAL TUBULAR ACIDOSIS
1) Inability to produce an acid urine. Tubular secretion test
2) Hydrogen ions are not excreted in the urine. 1) PAH (p-aminohippuric acid) test
2) PSP (phenosulfonphthalein) test = obsolete results are
RENAL FUNCTION TESTS hard to interpret.
Glomerular filtration tests
Clearance tests Terms to remember:
• Used to evaluate glomerular filtration. ✓ Exogenous procedure
• Rate in milliliters per minute (mL/min). - Test that requires an infused substance.
✓ Endogenous procedure
Urea clearance Old and obsolete - Suitable test substance is already present in the
Creatinine body.
Most common ✓ Renin
clearance
Inulin clearance Gold standard - Enzyme produced by juxtaglomerular cells
Beta- Used to distinguished kidney
microglobulin disorders. Hi! Wag niyo kalimutan basahin pa rin yung book hehe payting!
Measure the viability of transplanted
Radioisotopes Action of the RAAS:
kidney.
Small protein produced at constant 1) Dilates the afferent arteriole and constricts the efferent
Cystatin C arteriole.
rate.
2) Stimulates sodium reabsorption in the proximal
Creatinine Clearance convoluted tubule.
3) Triggers the adrenal cortex to release the sodium
2 retaining hormone aldosterone to cause sodium
UV
Formula: CCr =
P
X 1.73m
A
reabsorption and potassium excretion in the distal
convoluted tubule and collecting duct.
4) Triggers antidiuretic hormone release by the
Which: hypothalamus to stimulate water reabsorption in the
Ccr = creatinine clearance collecting duct.
U = urine creatinine (mg/dl)
P = plasma creatinine
V = volume
A = body surface area
*Check niyo na lang example ni ma’am dun sa vid lec*
CHAPTER 5: PHYSICAL EXAMINATION OF URINE
PHYSICAL EXAMINATION OF URINE → Imparts an orange-brown color to a urine that is not
UREA – major organic substance. fresh.
URINE VOLUME LABORATORY CORRELATION OF URINE COLOR

• Normal range (24hrs) = 600-1,200 mL/min (Routine UA). Color Cause
• Average range (24hrs) = 1,200-1,500 mL/min. Colorless Recent fluid consumption
• Night-Day ratio = 1:2 or 1:3 (for uranometry and reagent • Polyuria
Pale yellow
strip). • dilute random specimen.
• Concentrated specimen: Strenuous exercise
Definition Production of Causes Dark yellow
• First morning specimen: carotene
• Increased fluid
Amber Dehydration: fever, burns
intake.
Increased
Henry:
• Diuretics. • Bilirubin (yellow foam)
>2000mL/24hrs. • Phenazopyridine (Pyridium): orange and
POLYURIA urine • Diabetes Orange
Strasinger:
volume. mellitus. viscous urine with orange foam
>2.5L/day
• Diabetes • Acriflavin, Nitrofurantoin, Phenindione
insipidus. Yellow-green, Bilirubin – (oxidize)
Henry: • Dehydration. yellow brown → Biliverdin
Decreased
OLIGURIA urine
500mL/24hrs. • Renal calculi or
Strasinger: Green Pseudomonas infection
tumor.
volume.
400mL/day. • Indican
• Complete • Amitriptyline
obstruction • Methocarbamol
Complete (stones, Blue green • Clorets
ANURIA cessation of <100mL/24hrs. carcinomas).
• Methylene blue
urine flow. • Toxic agents.
• Decreased renal
• Phenol
blood flow. • Chlorophyll
>500mL of urine at Pregnancy • RBCs (cloudy/smoky red): Hematuria
Excessive night. • Hemoglobin (clear red): intravascular
NOCTURIA urination at hemolysis
night. Specific Gravity: Pink, red
• Myoglobin (clear red or reddish-brown or cola
<1.018
colored); muscle damage (rhadomyolysis)
• Beets, menstrual contamination, Rifampin
DIABETES MELLITUS
Burgundy or
• High specific gravity (concentrated).
purplish red, Porphysis
portwine
DIABETES INSIPIDUS
• Low specific gravity (diluted). • Methemoglobin (acidic urine)
• Homogentisic acid (alkaline urine):
URINE COLOR Alkaptonuria
• Important indicator of dehydration. • Melanin (upon air exposure)
Brown, black
• Phenol derivatives,
• Increase color (pale). • Agryrol,
Increase fluid
• Diluted • Methyldopa or Levodopa,
intake
• Low specific gravity • Metronidazole (Flagyl)
• Decrease color (dark)
Decrease fluid URINE COLOR CHANGES WITH COMMONLY USED DRUGS
• Concentrated
intake Drug Disease Cause
• High specific gravity
Cola colored (red
Urine Color Determination: Levodopa Parkinson’s then brown,
alkaline).
• Examine the specimen under a good light source.
Mepacrine Antimalarial, intestinal
• Look down through the container against a white Yellow
(Atabrine) worms, giardiasis
background.
Methyldopa Green brown
Anti-hypertensive
(Adomet)
PIGMENTS
Metronidazole Darkening,
1) Urochrome Trichomoniasis
(Flagyl) reddish brown.
→ Yellow.
Phemazopyridine Orange red, acid
→ Major pigment. (Pyridium)
UTI
pH
→ Production is directly proportional to metabolic rate. Rifampin TR Bright orange red
→ Thyrotoxicosis, fever, and starvation. Riboflavin Bright yellow
2) Uroerythrin (Multivitamins
→ Pink.
→ May deposit in amorphous urate and uric acid crystals.
3) Urobilin
→ Dark yellow or orange.
CHAPTER 5: PHYSICAL EXAMINATION OF URINE
URINE CLARITY OR TRANSPARENCY (TURBIDITY) Methionine malabsroption, oasthouse
Hops
urine disease
Remember: What a CLEAR HAZY CLOUDY Tur to a MILKY Bleach Contamination
way. Sulfur Cystine disorder
Rotting fish
Clarity Term Pungent Ingestion of onions, garlic, and asparagus
Clear No visible particles, transparent. Swimming pool Hawkinsinuria
Hazy Few particles, print easily seen through urine. Cat urine 3-hyroxy-3-methylglutaric aciduria
Cloudy Many particles, print blurred through urine. Tomcat urine Multiple carboxylase deficiency
Turbid Print cannot be seen through urine.
Milky May precipitate or be clotted.
Urine Clarity Determination:

• Thoroughly mix the specimen.
• Examine the specimen while holding in front of a light
source.
• View through a newspaper print.
Non pathologic causes of Pathologic causes of urine

urine turbidity turbidity
• Squamous epithelial cells. • Rbcs, wbc
• Amorphous urates • Bacteria = uniform turbidity
• Amorphous phosphates not cleared by acidification
• Carbonates or filtration.
• Vaginal cream • Yeast
• Semen • Non squamous epithelial
• Spermatozoa cells
• fecal contamination • Abnormal crystals lymph
• Radiographic contrast media fluid
• Talcum powder • Lipid
LABORATORY CORRELATION IN URINE TURBIDITY

(ARC)
• Amorphous urates
Acidic urine
• Radiographic
• Contrast media
(AMPC)
• Amorphous
Alkaline urine
• Phosphates
• Carbonates
(RAPC)
• RBCs
Soluble in Dilute Acetic
• Amorphous
Acid
• Phosphates
• Carbonates
Insoluble in Dilute Acidic WBCs, bacteria, yeast,
Acid spermatozoa
Soluble in Ether Lipids, lymphatic fluid, chyle
URINE ODOR
Odor Cause
Normal (due to presence of volatile acids
Aromatic
from blood)
Foul, ammoniacal UTI (Proteus vulgaris)
Ketones (Diabetes Mellitus, starvation,
Fruity, sweet
vomiting)
Caramelized sugar, Maple syrup urine (MSUD)
curry, maple syrup
Mousy, musty Phenylketonuria (PKU)
Rancid buttery Tyrosinemia
Sweet feet, acid Isovaleric acidemia, glutaric acidemia
Cabbage
CHAPTER 6: CHEMICAL EXAMINATION OF URINE
REAGENT STRIP TECHNIQUE (Manual) Urinometry (Urinometer or Hydrometer)
• Calibration of temperature: 20 degcel.
Reading Urine
Principle Positive color • Requires temperature correction.
time parameter
→ Below 20 degcel (for every 3 degcel) = minus 0.001
Double sequential
Glucose
enzyme reaction
Green to brown → Above 20 degcel (for every 3 degcel) = plus 0.001
30 secs
Tan or pink to • Requires correction for glucose and protein.
Bilirubin Diazo Reaction
violet → Per gram of glucose (1g /dl) = minus 0.004
40 secs Ketones
Sodium nitroprusside
Purple → Per gram of protein (1g / dl) = minus 0.003
reaction (Legal’s test) • Urine volume required = 10-15ml
Blue (SG:
Specific pKa change of a • Calibration
45 secs 1.000) to yellow
gravity polyelectrolyte
(SG: 1.030) → Potassium sulfate (K2S04) solution (20.29g K2S04 to
Protein (Sorensen’s) 1 L I20)
Protein Blue → SG reading should be 1.015
error of indicators
Double indicator Orange (pH 5.0)
pH
system to blue (pH 9.0) Refractometry (Refractometer or TS Meter)
Uniform green • Indirect method based on refractive index (RI)
60 secs or blue (Hgb or
Pseudoperoxidase
Blood Mb) Speckled or
activity of hemoglobin RI = Light velocity in air
spotted (intact
RBCs) Light velocity in solution
Urobilinogen Ehrlich reaction Red
Nitrite Greiss reaction Uniform pink • Compensated to temp (15-38c).
120 secs Leukocytes Leukocyte esterase Purple • No need for temp correction.
• Requires correction for glucose and protein.
Procedures • Calibration
1) Dip the reagent strip briefly (no longer than 1 second) → distilled water = 1.000
into a well-mixed uncentrifuged urine specimen at RT. → 5% NaCl = 1.022 + 0.001
2) Remove excess urine by touching the edge of the strip → 9% Sucrose = 1.034 + 0.001
to the container as the strip withdrawn.
• Specific Gravity Dilution
3) Blot the edge of the strip on a disposable absorbent
→ Specimens with very high SG reading can be diluted
pad.
and retested.
4) Wait the specified amount of time for the reaction to
→ To obtain the actual SG; multiply the decimal portion of
occur.
SG by the dilution factor.
5) Compare the color reaction of the strip pads to the
manufacturer’s color chart in good lighting. → Example:
o Urine specimens dilute 1:4 has a reading of 1.014.
Care of Reagent Strips What is the actual SG reading?
1) Store with desiccant in an opaque, tightly closed
container. Remember:
2) Store below 30C (room temp) do not freeze. ✓ Both refractometer (Rf) and urinometer (U) require
3) Do no expose to volatile fumes. corrections for glucose and protein.
4) Do not use past the expiration date. ✓ Refractometry reading is lower than the urinometer
5) Do not use if chemical pads become discolored. reading by 0.002 (Rf< U by 0.002).
6) Remove strips immediately prior to use.
Reagent Strip Reaction for Specific Gravity
AUTOMATED REAGENT STRIP READERS Time 45 seconds
• Principle = Change of pKa polyelectrolytes
• Light reflection from the test pads decreases in proportion
to the intensity of color produced by the concentration of the Blue [1.000] > green > yellow [ 1.030] > H
test substance. (arrow up) > H+ > H+
SPECIFIC GRAVITY (SG) Principle • The polyelectrolyte ionizes, releasing

• Density of solution compared with density of similar volume hydrogen ions in proportion to the number
of distilled water at a similar temperature. of ions in the solutions.
• Influenced by number and size of particles in a solution. • Reagent is sensitive to the no f ions in
urine; indicator changes color in relation to
Normal SG (random) 1.003-1.005 ionic concentration
When SG is <1.003 Not urine, except Diabetes insipidus Multisix = poly (methyl vinyl ether or maleic
When SG >1.040 Radiographic dye or Plasma expander anhydride) bromothymol blue
Isosthenuria 1.010
Reagents
Hyposthenuria <1.010 Chemstrip=
Hypersthenuria >1.010 ethyleneglycoldiaminoethylethertetraacetic
acid bromothymol blue
DETERMINATION False (+) = high concentration of protein
Interferences
False (-) = highly alkaline urines (>6.5)
• Add 0.005 to SG reading when pH is >6.5 → 450mg/24 hrs • Protein derived from prostatic and
due to interference with the bromothymol vaginal secretion
Notes blue indicator.
• Not affected by glucose, protein, and
radiographic dye. Pre-Renal (Before) or Overflow Proteinuria
• Caused by conditions that affect the plasma prior to it
Harmonic Oscillation Densitometry reaching the kidney:
• Based in frequency of a soundwave entering a solution → Intravascular hemolysis = hemoglobin
change in proportion to the density of the solution. → Muscle injury = myoglobin
• Ex: yellow IRIS (International Remote Imaging System → Severe infection and inflammation = high APRS
→ IRIS Diagnostics → Multiple myeloma = proliferation of immunoglobulin-
o Models 300 to 500 workstations. producing plasma cells (Bence-Jones protein)
- 6ml = required urine volume. o BJP = immunoglobulin light chains.
- 4ml (of 6ml) = for IRIS Slide less microscope. o Tests = serum electrolytes, immunofixation
- 2ml (of 6ml) = for IRIS Mass Gravity Meter (for electrophoresis.
specific gravity determination by using o Urine = precipitates at 40-60C (cloudy) and
harmonic oscillation). dissolves at 100C (clear).
pH Renal Proteinuria (True Renal Disease)

• Important in the identification of crystals and determination A. Glomerular Proteinuria
of unsatisfactory specimens.
• Normal pH: 1) Diabetic nephropathy
→ random = 5.0-8.0 → Decreased glomerular filtration.
→ 1st morning = 5.0-6.0 (concentrated) → May lead to renal failure.
• pH of 9.0 = older spx; reject. → Indicator: Microalbuminuria = proteinuria undetectable
• Alkaline tide occurs after meals due to withdrawal of by routine reagent strip.
hydrogen ions for the purpose of secretions of HCl. → Albumin Excretion Rate (AER) = in ug/min or in mg or
24 hours.
Causes of acid urine Causes of alkaline urine o Normal AER = 0-20 ug/min.
• Diabetes mellitus • Renal tubular acidosis o Microalbuminuria = 20-200ug or min (or 30-
• Starvation • Vegetarian diet 300mg or 24hrs).
• High protein diet • After meal o Clinical albuminuria = 7200 ug or min.
• Cranberry juice • Vomiting Old specimens
• Emphysema • Hyperventilation 2) Orthostatic or Cadet or Postural Proteinuria
• Dehydration • Presence of urease producing → Proteinuria when standing due to increased pressure
• Diarrhea bacteria to renal veins.
• Presence of acid producing
bacteria (E. Coli)
Orthostatic Clinical
• Medications.
Proteinuria Proteinuria
First morning Negative Positive
Reagent Strip Reaction for pH 2 hours after standing Positive Positive
Time 60 seconds
Double indicator system Micral Test
• Test for microalbuminuria.
pH (H+) ————-----——--------—— pH (H+) • A strip employing antibody-enzyme conjugate that binds
Principle
Methyl Red. Bromothymol Blue albumin.
pH 4.0-6.0 pH 6.0-9.0 • Principle: Enzyme immunoassay.
(Red to yellow). (Yellow to blue) • Reagents:
Reagents Methyl red, Bromothymol blue → Gold labeled antibody.
→ B-galactosidase.
• No known interfering substances.
→ Chlorophenol red galactoside
• Remover from adjacent pads, old specimens. • Sensitivity: 0-10mg/dl
Interferences
• Correlations with other tests = Nitrite, • Interference: dilute urine = false (-)
Leukocytes, Microscopic
B. Tubular Proteinuria
Protein → Normally filtered albumin can no longer be reabsorbed.
• Most indicative disease. o Fanconi’s syndrome.
• Produces white foam in urine when shaken. o Toxic agents or heavy metals.
o Severe viral infections.
Remember: White foam indicates that there is a presence of
protein. Post-Renal Proteinuria (After)
• Lower UTI or Inflammations.
Albumin Other proteins
• Injury or Trauma.
• Major serum protein. • Serum and tubular micro globulins.
• Menstrual Contamination.
• Normal values: • Tamm-horsfall protein (uromodulin).
→ 400 or 40mg/L • Prostatic fluid or spermatozoa.
• Vaginal secretions. → Sucrose (Glu + Fru) - Intestinal disorders, sucrose
intolerance, (-) Copper reduction test [non-reducing
Reagent Strip Reaction for Protein sugar].
Time 60 seconds • Effect of diabetes.
Sorensen’s Error of indicators
Clinical Significance of Urine Glucose
Principles
Indicator + Protein ——-----—-> (+) blue green • Hyperglycemia associated
(Yellow). (-) yellow → ___ blood glucose = ___ urine glucose
Multistix = tetrabromphenol blue → Causes:
Reagents Chemstrip = tetrachloropheno o DM
tetrabromosulfonphtalein o Cushing’s syndrome
False (+) o Pheochromocytoma
• highly buffered alkaline urine o Acromegaly
• pigmented specimen o Hyperthyroidism
• Phenazopyridine • Renal Associated
• Quaternary ammonium compounds → ___ blood glucose = ___ urine glucose
(detergents) → Impaired tubular reabsorption of glucose
• Antiseptics → Causes:
Interferences
• Chlorhexidine o Fanconi syndrome - Defective tubular
• Loss of buffer from prolonged exposure of reabsorption of glucose and amino acid.
the reagent strip to the specimen
• High SG Reagent Strip Reaction for Glucose
False (-) Time 30 seconds
• Proteins other than albumin Double Sequential Enzyme Reaction
• Microalbuminuria
• Indicator is SENSITIVE to albumin Glucose oxidase
Notes • Correlations with other tests = blood nitrite, Glucose + 02 ------——-> Gluconic acid + h20
Principle
leukocytes, microscopic
Peroxidase
H20 + Chromogen —-> Oxidase chromogen +
Sulfosalicylic Acid (SSA) Precipitation Test
H20
• A cold precipitation test that reacts equally with all forms of
Multistix = Glucose oxidase, Peroxidase,
protein.
Potassium Iodine (blue to green to brown)
SSA GRADING
Reagents
Protein Chemstrip = Glucose oxidase, Peroxidase,
Grade Turbidity range Tetramethylbenzine (yellow to green)
(mg/dL) False (+)
Negative No increase in turbidity <6 • Oxidizing agents
Trace Noticeable 6-30 • Detergents
1+ Distinct with no granulations 30-100 False (-)
2+ With granulation but no flocculation 100-200 Interferences • High levels of ascorbic acid
3+ With granulation and flocculation 200-400
• Ketones
4+ Clumps of protein > 400
• High SG
SSA Procedure • Low temp
3ml of 3% SSA • Improperly preserved spx
+ Sensitivity = 100mg/dL
3ml of centrifuged urine
+ Other chromogens:
(+) cloudiness • Aminopropylcarbazole (yellow > orange-
Notes
brown)
Glucose (Dextrose) • o-toluidine (pink to purple)
• Most frequently tested in urine.
• Renal threshold = plasma concentration of a substance at Correlations with other tests = ketones, protein
which tubular reabsorption stops.
• Renal threshold for glucose – 160-180 mg/dl. Copper Reduction Test (Clinical or Benedict’s Test)
Test Nonspecific test for reducing sugars
• Other sugars in urine (identified by TLC):
Copper reduction test
→ Fructose (Levulose) - Fruits, honey, syrup, fructose
intolerance. Principles Reducing substance:
→ Galactose - Infants with galactosemia. CuS04 ————> (+) Cu20
→ Lactose (Glu + Gal) - During pregnancy, lactation, Blue Brick red
strict milk diet, lactose intolerance. CuS04 ——————————> Cu20.
False positive
→ Pentose - Benign essential penosuria (Xylulose, Ascorbic Acid
CuS04 ——————————> Cu20
Arabinose). False negative
Oxidizing agents, detergents
• Brown recluse to the renal
• Clinitest Procedure spider bites. tubules.
→ 5gtts urine + 10gtts H20 + Clinitest tablet
• Pass-through phenomenon Hemoglobin vs. Myoglobin
Test Hemoglobin Myoglobin
→ Occurs when > 2 g/dL sugar is present
Plasma examination Hemolyze Pale yellow
→ Blue > Green > Yellow > Brick red >>> blue or green Blondheim’s test Precipitated Not precipitate
brown (Ammonium sulfate)
• The tablets contain:
→ CuS04 = main reacting agent. Procedure:
→ NaC03 = eliminates interfering 02. Urine + 2.8g
→ Na citrate = for heat production. NH4Sulfate (80% satd)
Filter or centrifuged
Summary of Glucose Oxidase and Clinitest Reaction Test supernatant for
Glucose Oxidase Clinitest Interpretation blood with a reagent
1+ Positive Negative Small amount of glucose strip
4+ Positive Negative Oxidizing
Possible interfering substance for
Negative Positive Reagent Strip for Blood
reagent strip
Time 60 seconds
Ketones Pseudoperoxidase of Hgb
• Result from increased fat metabolism due to inability to
Principle Hemoglobin
metabolize carbohydrates.
H20 + chromogen —> oxidized chromogen + H20
• Seen in:
Yellow Pseudoperoxidase. (Green to blue)
→ Type 1 Diabetes Mellitus
Multisix = diisopropylhenzene dehydroperoxide
→ Vomiting tetramethylhenzidine
→ Starvation Reagents
→ Malabsorption Chemstrip = dimethydihydroperoxyhexane
• Ketone Bodies tetramethyohenzidine
→ 78% Beta-hydroxybutyric acid False (+)
- major ketone but not detected in reagent strip • strong oxidizing agents
→ 20% Acetoacetic Acid (AAA) / Diabetic acid • bacterial peroxides
- parent ketone • menstrual contamination
→ 2% Acetone False (-)
• high SG
Reagent Strip for Ketones Interferences
• crenated cells
Time 40 seconds • formalin
Sodium Nitroprusside reaction • captopril
Principle • high concentrations of nitrite
Acetoacetic acid + Na nitroprusside —> (+) Purple
• ascorbic acid ( > 25 mg/dL) unmixed
Acetone. Glycerin
specimens
Reagents Chemstrip = Sodium nitroprusside, Glycerin
• Uniform green or blue color = hemoglobin or
False (+)
myoglobin
• Phthalein dyes
• Speckled or spotted = hematuria (intact
• highly pigment red urine Notes
RBC’s
Interferences • levodopa medications during containing
• Correlations with other tests = protein,
sulfhydryl groups
microscopic
False (-)
• improperly preserved specimens
Bilirubin
• Acetone is detected only when glycine is • Conjugated bilirubin (CB) – water soluble.
Notes present.
• Early indication of liver disease.
• Correlations with other tests = glucose.
• Amber urine with yellow foam.
• Clinical significance – liver disorders: hepatitis, cirrhosis,
Blood
biliary obstruction (gallstones, carcinoma).
• Ictotest (tablet)
Hematuria Hemoglobinuria Myoglobinuria
Cloudy red urine Clear red urine Clear red (reddish-brow) → More sensitive than reagent strip with less interference.
urine. → Contains:
Seen in: Seen in: Seen in: o P-nitrohenzene p-oluensesulfonate
• Glomerulonephritis. • intravascular • Rhabdomyolysis o SSA
• Renal calculi. hemolysis. • Muscular trauma o Sodium carbonate
• Tumors. • Transfusion • crush syndromes o Boric Acid
• Strenuous exercise reactions. • Extensive exertion → (+) blue to purple color
• Trauma. • Hemolytic • Ileme portion of the
• Microscopic – intact anemia. myoglobin is toxic
RBC. • Severe burns.
Reagent Strip for Bilirubin
Time 30 seconds Nitrite
Diazo Reaction • Rapid screening test for UTI or bacteriuria.
• Specimen 1st morning or 4-hour urine.
Principle Bilirubin diglucuronide (CB)
+ Reagent Strip Reaction for Nitrite
Diazonium salt ——> Azodye Time 60 seconds
Multisix = 2,4-dichloroanilline diazonium salt Griess Reaction
Reagents
Chemstrip = 2,6-dichlorobenzene diazonium salt
False (+) P-arsanilic acid (or sulfanilamide)
• highly pigmented urines +
• phenazopyridine Principle nitrite -——> Diazonium salt
• indicant
Interferences • metabolites of Iodine Diazonium salt
False (-) +
• Specimen exposure to light tetrahydrobenzoquinolin —> (+) uniform pink
• high concentrations of nitrite Multisix = p-arsanilic acid, tetrahydrobenzo
(h)-quinolin-3-ol
• ascorbic acid ( > 25 mg/dl)
Reagents
• (+) tan to pink to violet
Notes Chemstrip = sulfanilamide,hydroxytetrahydro
• Correlations with other tests = Urobilinogen benzoquinoline
False (+)
• improperly preserved specimens
• highly pigmented urine
False (-)
• non-reductase-containing bacteria,
• insufficient contact time bet
Interferences • bacteria and urinary nitrate
• lack of urinary nitrate
• large quantities of bacteria converting
nitrite to nitrogen
• presence of antibiotics
• high concentration of ascorbic acid
• high SG
• Pink spots or edges is considered as
NEGATIVE.
• (+) Nitrite corresponds to 100,000
Notes
organisms per mL
• Correlations with other tests = protein,
leukocytes, microscopic
Leukocytes
• Significance:
→ UTI
→ Screening for urine culture specimen
Reagent Strip Reaction for Leukocytes

Time 120 seconds
Leukocyte Esterase
Indoxyl carbonic acid ester———— > indoxyl

Urobilinogen
Principle +
• Bile pigment that results from hemoglobin degradation.
Acid indoxyl
• Normal Volume = < 1 mg/L or Ehrlich unit.
+
• Specimen: Afternoon urine (2-4 PM). Diazonium salt —-> (+) Purple
Multisix = derivatized pyrrole amino acid ester,
Urine
Condition Blood Bilirubin
Urine Diazonium salt.
Urobilinogen Reagents
(Conjugated)
Extravascular hemolytic Chemstrip = Indoxyl carbonic acid ester,
UB Negative +++ Diazonium sat.
disease
Liver damage (hepatic Negative or False (+)
UB or CB ++
jaundice) Positive • strong oxidizing agents
Interferences
Bile duct obstruction • formalin
(post-hepatic or CB +++ - or v
• highly pigmented urine
obstructive jaundice)
• nitrofurantoin
False (-)
• high concentrations of protein
• glucose
• oxalic acid
• gentamicin
• cephalosporins
• tetracyclines
• inaccurate timing.
• Contain esterase: Neutrophils,
Eosinophils, Basophils, Monocytes,
Histiocytes, Trichomonas.
Notes • No esterase: lymphocytes -Strip can detect
even lysed WBC’s.
• Correlations with other test = protein,
nitrate, microscoping
Ascorbic Acid
• A reducing agent that causes false-negative reaction:
→ Acronym: BBLNG (blood, bacteria, leukocytes, nitrite,
and glucose)
• 11th reagent pad:
→ Ascorbic acid (> 5 mg/dl) = Phosphomolybdate ——>
(+) molybdenum blue
• GC-MS = more accurate quantitative method.
CHAPTER 7: MICROSCOPIC EXAMINATION
MICROSCOPIC EXAMINATION OF URINE WBC (Pyuria or Leukocytes)
• Urine Sediment Preparation • NV: 0.5 or 0.8 / HPF
→ 10-15mL urine (average 12mL) • Increased number indicates the presence of an infection or
→ Centrifuge at 400 RCF for 5mins. inflammation.
→ Decant urine (0.5ml or 1.0m remains). • Neutrophils (predominant)
→ Transfer 20 uL (0.02ml) sediment to glass slide with 22 → Granulated and multi-lobed.
x 22 mm coverslip. → In hypotonic urine, granules swell and undergo
→ Examine microscopically (10 LPF, 10 HPF under Brownian movement, producing a sparkling
reduced light). appearance (glitter cells) no pathologic significance
• Addis Count • Eosinophils
→ Quantitative measure of formed element of urine using → Normal value: 4%
hemacytometer. → Significant: >1% (associated with drug induced
→ Specimen = 12-hour urine. interstitial nephritis.
→ Preservative = formalin • Mononuclear cells (lymphocytes, monocytes,
• Normal Values: macrophages, histiocytes) – in small number
→ RBC: 0-500,000/ 12-hour urine.
→ WBC: 0-1,000,000 12-hour urine Epithelial Cells
→ Hyaline casts: 0-5,000 or 12-hour urine. 1) Squamous epithelial cells.
• LARGE CELL with abundant, irregular cytoplasm and
MICROSCOPIC TECHNIQUES prominent nucleus.
Technique Function • From linings of vagina, female urethra, and lower portion of
Bright-field microscopy For routine UA. male urethra
Enhances visualization of translucent
Phase-contrast microscopy → Variation = clue cells.
elements (with low refractive indices).
Identification of cholesterol in oval fat → Squamous epithelial cell covered with Gardnerella
Polarizing microscopy vaginalis.
bodies, fatty casts, and crystals.
Dark-field microscopy Identification of treponema palladium. → Associate with bacterial vaginosis.
Visualization of fluorescent microorganism
Fluorescence microscopy
or those stained by a fluorescent dye. 2) Transitional epithelial (urothelial) cells.
Interference-contrast 3-D microscopy-image and layer by layer • Spherical, or polyhedral or caudate with centrally located
microscopy imaging of a specimen. Bright-filed nucleus.
A. Nomarski (differential) microscopes can be adapted
• Derived from the linings of renal pelvis, ureter, urinary
B. Hoffman (modulation)
bladder, and upper portion of male urethra.
SEDIMENT STAINS
• Increased numbers are seen following catheterization.
Stain Action Function
Delineates structure Identifies WBCs, 3) Renal tubular epithelial (RTE) cell.
Sternheimer-Malbin • Reporting of Epithelial cells - rare, few, moderate, many.
and contrasting colors epithelial cells, and casts.
(Crystal violet +
Safranin O)
of the nucleus and • Most clinically significant epithelial cell.
cytoplasm • Origin: renal tubular
Enhances nuclear Differentiates WBCs and → Squamous (LPF).
Toluidine blue
detail; supravital stain RTE cells.
Lyses RBCs enhances Distinguishes RBCs from
→ Transitional (HPF).
2% acetic acid nuclei of WBCs. WBCs, yeast, oil, → Rectangular, polyhedral, cuboidal, or columnar.
droplets, and crystals. → Average number per HPF with an eccentric nucleus.
Lipid stains (Oil Red
Stains triglycerides Identifies free fat droplets → RTE cell.
O and Sudan III)
and neutral fas orange and lipid containing cells → Oval fat body.
red and cast.
→ 2 RTE / HPF indicates tubular injury.
Differentiates Gram- Identifies bacterial casts.
Gram stain positive and negative
bacteria. RTE CELL VARIATIONS
Hansel stain (Eosin Y Stains eosinophilic Identifies urinary Oval Fat Bodies Bubble Cells
+ Methylene blue) granules. eosinophils. RTE cells with non-lipid-filled
Lipid containing RE cell
vacuoles
Seen in lipiduria Seen in acute tubular necrosis.
SPECIFIC CONSTITUENTS
Identifies by:
CELLS • lipid stains (G and neutral
fats).
RBCs (hematuria) • polar zone microscope
• Normal volume: 0-2 or 0-3 / HPF. (Cholesterol – Maltese
• Smooth, non-nucleated, biconcave disks cross).
• Hypertonic urine = crenate cell.
• Hypotonic urine = swell hemolyze or ghost cell. Bacteria
• Glomerular membrane damage = dysmorphic RBC. • Reporting of Bacteria (few, moderate or many per HPF).
• Sources of error: yeasts, oil droplet, air bubbles, calcium • UTI = bacteria + WBC’s.
oxalate crystals. • Enterobacteriaceae (ex. E. Coli) = most common.
• Remedy: add 2% acetic acid, it will lyse the RBCs but not • Staphylococcus, Enterococcus
the others.
Yeast • Prototype cast. Physiologic:
• Reporting of Yeasts (rare, few, moderate or many per HPF). • Beginning of all types of • Stress
casts. • strenuous exercise
• True yeast infection = WBC + Yeast; Yeast alone contains Hyaline
• Normal value = 0-2 LPF. Pathologic:
with normal flora. cast
• Glomerulonephritis
• Small, refractile oval structures that may or may not bud. • Pyelonephritis
• Candida albicans = seen in DM and vaginal moniliasis • CHF
Bleeding within the nephron. Glomerulonephritis,
RBC cast
Parasites strenuous exercise.
• Inflammation within the
• Most frequent parasite encountered in the urine. nephron.
• Pear shaped flagellate with jerky motility. • May be confused with
Trichomonas Pyelonephritis, Acute
• Agent of Ping-pong base. WBC cast epithelial cell casts.
interstitial nephritis.
vaginalis
• Usually reported as rare, few, moderate, or many • To differentiate:
per HPF. → Phase microscopy
• Blood fluke with terminal spine. → Supravital stain
Schistosoma Epithelial Advance tubular
• Causes hematuria.
haematobium (RTE) cell destruction, Renal tubular
• Associated with bladder cancer.
ova cast damage.
• Specimen 24-hour urine preserved.
Bacterial Identified by performing
Enterobius Pyelonephritis.
cast Gram stain.
vermicularis Most common fecal contaminant
Granules are derived from
ova Glomerulonephritis,
Granular the lysosomes of RTE cell
Pyelonephritis, Stress,
cast during normal metabolism
Spermatozoa Strenuous exercise.
(non-pathologic).
• Reporting = present, based on lab protocol. • Not stained with
• After sexual intercourse. Sternheimer-Maibin
stain.
Nephrotic syndrome
Mucus Threads Fatty cast • Identification:
(lipiduria).
→ TAG and neutral
• Reporting = rare, few, moderate or many per LPF. facts
• Major constituent = Tamm Horsfall. → Cholesterol
Final degenerative form of all
Stasis of urine flow
Note: Waxy cast types of casts: Brittle, highly
Chronic renal failure.
✓ Quantitative and average of 10 representative fields. refractile with jagged ends
Do not quantitate budding yeast, mycelia elements. • A.k.a. Renal failure
✓ Trichomonas or sperm but do note their presence with cast.
the appropriate LIS code. • Indicates destruction
Broad Extreme urine stasis
(widening) of the tubular
cast Renal failure.
walls.
CASTS (CYLINDRUDRIA)
• Any type of cast can be
• Unique to the kidney. broad.
• Formed in the DCT and CD.
• Major constituent = Tamm Horsfall. CRYSTALS (CRYSTALLURIA)
→ Produced by RTE cells. • Formed by precipitation of urine solutes (salts, organic
• Performed along the edges of the coverslip with subdued compounds, medication).
light. • Factors that contribute to crystal formation:
→ Temperature
Formation of Casts → Solute conc
1) Aggregation of Tamm Horsfall protein into individual protein → pH
fibrils attached to the RTE cells. • Usually reported as rare, few, moderate or many per HPF.
2) Interweaving of protein fibrils to form a loose fibrillar • Abnormal crystals may be averaged and reported HPF.
network.
3) Further protein fibril interweaving to form a solid structure. NORMAL URINARY CRYSTALS (ACIDIC)
4) Possible attachment of urinary constituents to the solid Crystal Information Significance Solubility
matrix. Brick/dust yellow
5) Detachment of protein fibrils from the epithelial cells. Amorphous
brown granules Alkali and
urates
6) Excretion of the casts. (pH:acid)
Pink sediment heat.
(uroerythrin)
SEQUENCE: • Product of
• Hyaline purine • Lesch-Nyhan
metabolism. syndrome.
• Cellular •
• Rhombic, Chemotherapy
• Coarsely Granular Uric acid
wedge, (increased Alkali
(pH:acid)
• Finely Granular hexagonal, four- metabolism of
• Waxy sided flat plate cell nuclei).
(whetstone), • Gout
URINARY CASTS lemon shaped.
Cast Information Clinical Significance
• Can be • Colorless to Possible Acetone
mistaken as yellow-brown tubular
cystine crystals. needles, sheaves damage (may
Forms: Food high in of wheat, rosettes, deposit in
Calcium • Dihydrate ascorbic acid arrowheads, nephrons
oxalate (Wheddelite) (tomato or petals, and round
(pH:acid or envelope. asparagus) Dilute forms.
neutral or • Monohydrate HCl • May be mistake as Lignin test for
rarely or (Wheddelite) calcium Sulfonamides
Sulfonamide Newspaper:
alkaline oval or phosphate
(pH:acid or urine + 25%
dumbbell shape crystals, to
neutral) HCL -> (+)
Calcium Cigarette-butt in differentiate:
Acetic → calcium YELLOW
sulfate appearance.
acid. phosphate:
(pH:acidic)
Hippuric Yellow-brown or soluble inn
H20, acetic acid.
acid colorless elongated
ether → Sulfonamide
(pH:acid) prisms.
NORMAL URINARY CRYSTALS (ALKALINE) = (+) Lignin
Amorphous Granular in test, Diazo
Dilute reaction.
phosphate appearance
Acetic Ampicillin Colorless needles that Massive Refrigeration
(pH: White precipitate.
acid (pH:acid or tend to form bundles doses of form
alkaline)
Yellow-brown “horny neutral) following refrigeration. penicillin. bundles.
Ammonium apple”. Acetic
biurate acid with URIC ACID VS. CYSTINE
(pH:alkaline) Seen in old heat Uric acid Cystine
specimens Yellow Colorless
Triple Colorless, prism- presence of urea- Color
brown
phosphate shape or “coffin-lid” splitting bacteria Solubility in ammonia Sol Sol
or (urea > ammonia) Solubility in dilute HCl Insol Sol
Dilute
Magnesium Feathery appearance Birefringence (ability to refract light n 2 Positive Negative
acetic
ammonium when they directions)
acid
phosphate disintegrate Cyabide-nitropusside reaction Negative Positive
or Struvite Fern-leaf (Harr).
(pH:alkaline)
AMINOACIDURIA
Overflow Type Renal Type
ABNORMAL URINARY CRYSTALS Amino acid in blood = Amino acid in blood =
Crystal Information Significance Solubility Amino acid in urine = Amino acid in urine =
Colorless hexagonal Due to defective tubular
plates. Crystinuria reabsorption of amino acid.
Cystine Ammonia,
and
(pH:acid) dilute HCl Examples: PKU, MSUD. Examples: Crystinuria,
Mistaken as uric acid Crystinosis
Fanconi’s syndrome.
crystals.
Rectangular plates with
a notch in one or more Urinary Sediment Artifacts
Cholesterol
corners (staircase
Nephrotic
• Starch granules.
(pH:acid)
pattern).
syndrome
Chloroform → Spheres with dimple center.
→ Maltese cross‖ formation on polarizing microscope.
Resemble crystals of
radiographic dye. • Oil droplets.
• Similar to • Air bubbles.
cholesterol • Pollen grains = spheres with a cell wall and concentric
crystals. circles.
• To differentiate • Hair and fibers = mistaken for casts.
cholesterol and • Fecal contamination.
radiographic dye
Radiographic
crystals:
dye 10% NaOH URINE SCREENING FOR METABOLIC DISORDERS
→ patient hx
(pH:acid)
→ correlation • Inborn Error of Metabolism (IEM).
with other UA → Failure to inherit a gene that codes for a particular
results enzyme.
→ Radiographic
dye = SG PHENYLALANINE TYROSINE DISORDERS
>1.040 Other
Tyrosine Colorless to yellow Liver disease Alkali or (-) Gene those
Disorder informati Tests
(pH:acid or needles in clumps or (more heat. codes for
on
neutral) rosettes. common). “Mousy” Screening:
Clumped needles or Acetic acid, odor of • FeCl3 tube =
Leucine granules with bright HCl, NaOH, Phenylketonu Phenylalanine urine. (+) blue-
Liver disease
(pH:acid) yellow color. ether, ria hydroxylase. green color.
chloroform May lead • Phenistix strip
to severe + (+) gray to
mental gray-green TRYPTOPHAN DISORDERS
retardatio color (30 Disorder Information Tests
n. seconds Indigo blue color of urine Obermayer’s test
reading time). (upon air exposure) seen
• Guthrie Indicanuria in: FeCl3 + urine +
bacterial A. Intestinal disorder chloroform = (+) violet
inhibition test B. Hartnup disease color
Confirmatory: Ion • Carcinoid tumor of FeCl3 tube = (+) blue-
exchange HPLC argentaffin or green
GUTHRIE BACTERIAL enterochromaffin
INHIBITION TEST cells. Nitrosonaphthol with
• Bacillus subtilis is cultured Argentaffinoma • Produced 5-HIAA nitrous acid = () violet
with beta2-thienylalanine. (5-
• Beta2-thienylalanine hydroxyindoleacetic Px.avoid eating
inhibits the growth of B. acid) a metabolite of banana, pineapple and
subtulis. serotonin. tomatoes
• Phylalanine counteracts the
action of Beta2- CYSTINE DISORDERS
thienylalanine Disorder Information Tests
Type 1: “Rancid Screening: Renal type of aminoaciduria Brand‖s
Fumarylacetoace Butter” • FeCl3 tube = Defective tubular modification of
tate hydrolase odor if (+) transient reabsorption of cystine, Legal’s
(FAH) urine green color. Cystinuria lysine, arginine, ornithine. nitroprusside rgt:
• Nitroso- cyanide
Tyrosyluria Type 2: naphtol = (+) Nitroprusside
or Tyrosine orange-red (+) red-purple color
Tyrosinemia Aminotransferase Confirmatory: Inborn error of metabolism Brand’s
• Chromatogra (-) gene that codes from an modification of
Type 3: phy. enzyme responsible for Legal’s
p-hydroxyphenl- • Quantitative cystine metabolism nitroprusside (+)
pyruvic acid serum assay Cystinosis red-purple color
dioxygenase of tyrosine. Cystine deposits in many
Urine Screening: areas of the body (bone
darkens • FeCl3 tube = marrow, cornea, lymph
after (+) transient nodes, and internal organs)
becoming blue color. Defects in the metabolism of Silver-nitroprusside
alkaline • Clinitest = (+) Homocystinuria
homocysteine (-) gene that test = (+) red color.
from yellow codes for cystathionine B-
standing precipitate. synthase.
at room • Alkalinization
Homogentisic temperatu
Alkaptonuira of fresh urine MUCOPOLYSACCHARIDE DISORDERS
acid oxidase re Confirmatory: (MUCOPOLYSACCHARIDOSIS)
• paper or thin-
layer • Impaired metabolism of mucopolysaccharides or
chromatograp glycosaminoglycans (protein + polysaccharides, located in
hy. connective tissues.
• Capillary Disorder Information Tests
electrophores Mucopolysaccharides
is. accumulate in the cornea of
Use to • FeCl3 tube = the eye.
Hurler Acid albumin test = (+)
over (+) gray or
syndrome white turbidity
proliferatio black ppt There are skeletal
Cetyltrimethylammonium
n of • Sodium abnormalities and mental
bromide (CTAB) = white
melanocyt nitroprusside retardation
Melanuria turbidity.
es test + (+) red Sex-inked recessive, rarely
Urine • Ehrlich test = Hunter
seen in females.
Mucopolysaccharide
darkens (+) Red There are skeletal
syndrome (MPS) paper test = blue
upon air abnormalities and mental
color
exposure retardation
Sanfilippo Mental retardation is the
Disorder Information Tests syndrome only abnormality.
Leucine, Isoleucine and 2,4-
Maple Syrup Valine in blood and urine Dinitrophenylhydrazine PURINE DISORDERS
Urine “Caramelized” sugar or (DNPH) test Disorder (-) Gene those codes for Other information
Disease Maple syrup‖ odor of (+) yellow turbidity or Hypoxanthine-gunine High Uric acid in the
urine+ precipitate Lesch – Nyhan
phosphoribosyltransferase blood urine.
• Isovaleric = “sweaty disease
Organic (HRPT).
feet” odor of urine.
Acidemias
• Propionic acidemia PORPHYRIN DISORDERS (PORPHYRIAS)
Methylmalonic acidemia p-nitroaniline test = (+) • Disorders of porphyrin metabolism.
Emerald green
• Urine color =
• Colorless in =
Disorder (-) Gene those codes for damage precipitated by Cellular and granular
ALA hydratase deficiency Amibolevulic acid (ALA) synthetase other renal disorders. casts
porphyria Waxy and broad casts
Acute intermittent porphyria Uroporphyrinogen synthase Progression to renal
Congenital erythropoietic Uropophyrinogen cosynthase failure.
porphyria Deposition of IgA on Early stages:
Porphyria cutanea tarda Uroporphyrinogen decarboxylase the glomerular Macroscopic/
Hereditary coproporphyria Coproporphyrinogen oxidase membrane resulting microscopic
IgA Nephropathy
Variegate porphyria Protoporphyrinogen oxidase from increases levels hematuria
(Berger’s disease)
of IgA. Late sages:
SCREENING TESTS Same as chronic
glomerulonephritis.
Specimen = urine, stool, blood, bile
Disruption of electrical Serum =
Ehrlich’s Detects -ALA porphobilinogen
charges that produce
reaction
the tightly fitting
Tests for:
Nephrotic syndrome podocyte barrier Urine =
• uroporphyrin,
Fluorescence a resulting in massive
• coproporphyrin loss of protein and
550-600mm
• protoporphyrin lipids.
(+) violet or pink or red fluorescence Little cellular changes Heavy proteinuria
FEP CC = recommended test for lead poisoning. Minimal charge in the glomerulus. Transient hematuria
disease (lipoid Fat droplets
RENAL DISEASE Nephrosis, Nil Disruption of
disease) podocytes primarily in
GLOMERULAR DISEASE children following.
Disorder Etiology Findings Most common cause of Microalbuminuria
complex, formed in Macroscopic ESRD. (+) micral test
conjunction of Group A hematuria
Acute post- Deposition of
Streptococcus infection Proteinuria
streptococcal Focal segmental glycosylated proteins
on the glomerular Dysmorphic RBCs
glomerulonephritis glomerulosclerosis on the glomerular
membranes. RBC casts
(APGN) basement membranes
Granular casts
(+) ASO titer caused by poorly
Deposition of immune controlled blood
complexes from glucose levels.
systemic immune Genetic disorder See nephrotic
disorders (ex: SLE) on showing lamellate and syndrome
Rapidly Progressive Alport syndrome
the glomerular thinning of glomerular
(Crescentic) basement membrane.
membrane Cellular
Glomerulonephritis
proliferation of
epithelial cells inside TUBULAR DISORDERS
Bowman’s capsule Disorder Etiology Findings
from “crescents”. Damage to renal tubular cells Microscopic hematuria
Deposition of anti- caused by ischemia or toxic proteinuria
glomerular basement Acute tubular
agents. RTE cells, RTE casts
Goodpasture membrane antibody to necrosis
Hyaline, granular,
Syndrome glomerular and Macroscopic waxy, broad cast
alveolar basement hematuria Generalized failure of tubular Glycosuria
membranes. Proteinuria Fanconi
reabsorption in the proximal Possible cystine
Anti-neutrophilic RBC casts Syndrome
convoluted tubule. crystals
cytoplasmic A. Neurogenic DI = failure of the
autoantibody (ANCA) hypothalamus o produce ADH.
Wegener’s binds to neutrophils in Diabetes Low specific gravity
granulomatosis vascular walls Insipidus Polyuria (> 15 L/day)
B. Nephrogenic DI = renal
producing damage to tubules fail to respond to ADH.
small vessels in the Blood glucose:
lungs an glomerulus. Urine glucose:
Occurs in children Renal
Glycosuria
following viral glycosuria
Due to defective tubular
Hemoch Scholein respiratory infections reabsorption of glucose.
Purpura Decrease in platelets
disrupts vascular
• RENAL FAILURE
integrity.
Cellular proliferation → Low glomerular filtration rate ( < 25 mL/min).
affecting the capillary → Azotemia (high BUN and Crea).
Membranoproliferative walls or the glomerular Hematuria → Electrolyte imbalance.
Glomerulonephritis basement membrane, Proteinuria → (-) renal concentrating ability > isosthenuria.
possibly immune- → Proteinuria and renal glycosuria.
mediated.
→ High telescoped sediment.
Marked decrease in Hematuria
Chronic
renal function resulting Proteinuria • TELESCOPED SEDIMENT
glomerulonephritis
from glomerular Glycosuria
→ Simultaneous appearance of the elements of • Sulfonamide calculi.
acute/chronic glomerulonephritis and nephrotic • Silica calculi = ingestion of silica over a long period of time.
syndrome. • Triamterene calculi = insoluble diuretic; mustard-colored stones.
→ Increase cells and casts (RBC, granular, waxy, broad, • Adenine calculi = associated with inherited enzyme deficiency
fatty) lipid droplets, oval fat bodes. and hyperuricemia.
• Xanthine calculi = associated with a genetic disorder with
absence of xanthine oxidase.
RENAL CALULI or RENAL LITHIASIS
• Conditions Favoring the Formation of Renal Calculi:
→ pH
→ Chemical conc
→ Urinary stasis
PRIMARY URINALYSIS
FINDINGS:
• Renal Calculi
→ Information or Description.
• Caox
→ Major constituent of renal calculi.
INTERSTITIAL DISORDERS
Disorder Etiology Findings
Ascending bacterial infection of • WBCs
urinary bladder. • Bacteria
• Microscopic
Cystitis hematuria
(Lower UTI) • Mild
proteinuria
• increased pH
• NO CAST
Infection of the renal tubules and • WBCs
interstitium related to interference • Bacteria
of urine flow to the bladder, reflux • WBC casts,
Acute of urine forms the bladder • bacterial
pyelonephritis (vesicoureteral reflux) and casts
(Upper UTI) untreated cystitis. • Microscopic
hematuria
• proteinuria
Recurrent infection of the renal • WBCs
tubules and interstitium caused by • Bacteria
structural abnormalities affecting • WBC casts
the flow of urine • bacterial
Chronic casts
pyelonephritis • Granular,
waxy, broad
casts
• Hematuria
• proteinuria
Allergic inflammation of the renal • Hematuria
inerstitium in response to certain • Proteinuria
Acute medications. • WBC (high
interstitial eosinophils)
nephritis • WBC casts
• NO
BACTERIA
Very hard, dark in color with rough surface.

Associated with increase intake of foods with high
purine content.
Uric Acid
Yellow to brownish red and moderately hard.
Seen in hereditary disorders of cystine metabolism.
Cystine
Yellow-brown, greasy and resembles an old soap;
least common calculi (1-2%).
Phosphate Pale and friable.
Triple Accompanied by urinary infections involving urea-
phosphate splitting bacteria.
Renal calculi:

Chapter 1: Safety and Quality Management: 11-01-2021 - Harley Rose Bautista, RMT RMT 2023

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ANALYSIS OF URINE & BODY FLUIDS | MLS 111

CHAPTER 1: SAFETY AND QUALITY MANAGEMENT

Types of Safety Hazards

3. Disposal of biological waste

• First aid is to flush area with large amounts

Calibrated daily or when used against deionized Internal Quality Control

Telephone (Verbal) Results

Two unique characteristics of a urine specimen account for

CLINICAL AND LABORATORY STANDARDS INSTITUTE

3 Glass Specimen Technique

Rule: If the number of WBC and bacteria in the 3rd specimen is

Drug Specimen Collection

Required volume 30-45 mL

Note: If you have DIABETES INSIPIDUS

*Check niyo na lang example ni ma’am dun sa vid lec*

URINE VOLUME LABORATORY CORRELATION OF URINE COLOR

Urine Clarity Determination:

Non pathologic causes of Pathologic causes of urine

LABORATORY CORRELATION IN URINE TURBIDITY

SPECIFIC GRAVITY (SG) Principle • The polyelectrolyte ionizes, releasing

pH Renal Proteinuria (True Renal Disease)

Reagent Strip Reaction for Leukocytes

Indoxyl carbonic acid ester———— > indoxyl

Very hard, dark in color with rough surface.

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Check niyo na lang example ni ma’am dun sa vid lec