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 Course Outline
I. Introduction to Urinalysis
I. History and Importance of Urinalysis
II. Urine Composition
III. Urine Volume
IV. Specimen Collection V. Specimen
Rejection
VI. Specimen Handling
VII. Type of Specimen
URINE ANALYSIS
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-
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
HISTORY AND IMPORTANCE
“Analyzing urine was actually the beginning of
laboratory medicine.”
Ancient drawing of cavemen and hieroglyphics
- Pictures of early physicians showing
pictures of early physicians examining a
bladder-shaped flask of urine
- E.g. Edwin Smith Surgical Papyrus
“Although these physicians lacked the
sophisticated testing mechanisms now available,
they were able to obtain diagnostic information
from such basic observations as color, turbidity,
odor, volume, viscosity, and even sweetness (by
noting that certain specimens attracted ants or
tasted sweet).”
First Methods used in the first days of Urine
Analysis
- Ant Testing
- Taste Testing
Modern urinalysis expanded beyond physical
examination (e.g. Ant testing and Taste testing)
to chemical analysis and microscopic examination
of urinary sediment.
Well-known names and Notable Ages in Urine
Analysis
Hippocrates
- Wrote a book on “uroscopy”
- 5th century BCE
Middle Ages
- Physicians studied the art of uroscopy
- Urine examination became part of training
as a physician
Frederik Dekkers
- Discovery in 1694 of albuminuria
- Albuminuria was detected by boiling urine
Thomas Bryant
- Published a book about “charlatans” or
quack doctors
- Charlatans are self-proclaimed physicians
that are without medical credentials who
are offering their “service” to the public
for a healthy fee
- His book inspired the passing of the first
medical licensure laws in England
Invention of Microscope
- 17th Century
- Dutch spectacle maker Zacharias Janssen
is credited with making one of the earliest
compound microscope
- Examination of urinary sediment began
- Thomas Addis began quantitating
microscopic sediment
- Richard Bright introduced the concept of
urinalysis as part of a doctor’s routine
patient examination in 1827
1930s
- Number and complexity of urinalysis tests
reached a point of impracticality
- Urinalysis began to disappear from routine
examinations
- But later on, it was rescued by modern
testing techniques
Why is urine specimen continually popular?
1. Urine is readily available and easily
collected
2. Urine contains information, which can be
obtained by inexpensive laboratory tests,
about many of the body’s major metabolic
functions
URINE FORMATION
- The Kidneys is the main organ for urine
production
- It forms urine as an ultrafiltrate of plasma
 - Reabsorption of water and filtered
substances essential to body function
converts approximately 170,000 mL of compound. Found in
filtered plasma to the average daily urine combination with
output of 1200 mL. sodium and other
inorganic substances
URINE COMPOSITION
Sodium Primarily from salt,
Consisting of: varies by intake.
- Urea
Potassium Combined with
- Organic and Inorganic chemicals dissolved
in, chloride and other
- Primarily creatinine and uric acid salts
- Water Phosphate Combines with sodium
Solute concentration in the urine can vary to buffer the blood
according to: Ammonium Regulates blood and
- Dietary intake
tissue fluid acidity
- Physical activity
- Body metabolism Calcium Combines with
- Endocrine functions chloride, sulfate, and
phosphate
Urea
- A metabolic waste product
- Factors that
Formed from the breakdown of influence
protein urine volumes:
and amino acids - Fluid intake
- Fluid loss from nonrenal sources
Possible formed elements that- canVariations
be foundininthe secretion of antidiuretic
hormone
the urine (that are often indicative of disease):
- Cells - Need to excrete increased amounts of
- Casts dissolved solids, such as glucose or salts
- Crystals
- Mucus Normal daily urine output
- Bacteria - 1200 to 1500 mL
- 600 to 2000 mL is considered normal

URINE VOLUME
Diseases or conditions that may affect urine
volume
Urine volume depends on the amount of water
that the kidneys excrete. Oliguria
- This is why hydration is- one of the body
Decrease in urine output
states that determines-theLess
value
than urine
of 1mL/kg/hr in infants
volume - Less than 0.5mL/kg/hr in children
- Less than 400mL/day in adults
Primary Components of Normal - Urine
Commonly happens when the body is in
the state of dehydration
Component
Anuria
Urea - Cessation of urine flow
- May result from any serious damage to the
kidneys or
Creatinine
- From a decrease in the flow of blood to
the kidneys
Uric acid Nocturia
- Increase in the nocturnal excretion of
urine

Chloride Polyuria
- INcrease in daily urine volume (greater
 than 2.5 L/day in adults and 2.5 to 3
mL/kg/day in children
- Often associated with diabetes mellitus
and diabetes insipidus
- Can be artificially induced by diuretics,
caffeine, or alcohol
- Which suppresses secretion of
antidiuretic hormone
SPECIMEN COLLECTION
Containers
- Must be clean, dry, and leak-proof
- Disposable containers are advisable
- Applied screw top lids are less likely to
leak compared to snap-on lids
- Should have a wide mouth
- Should be made of clear material to
allow for determination of color and
clarity
- Recommended capacity is 50 mL
- 12mL for microscopic analysis
- Extra for repeat analysis
- Enough room for the specimen to be
mixed by swirling the container
Individually packaged sterile containers
- Used of microbiologic urine studies
- Sterile containers are suggested if more
than 2 hours elapsed between specimen
collection and analysis
Specially designed sterile containers
- Usually comes with a transfer straw -
Transfer straw has a needle and an
evacuated tube holder
Labels
- Labeled properly with:
- Patient's name
- Identification number
- Date and time of collection
- Patient’s age and location
- Healthcare’s provider’s name
- Must be attached on the container NOT
THE LID
- The label should not become detached if
the container is refrigerated or frozen
Requisitions
- Can either be manual or computerized
- Must accompany specimens delivered to
the laboratory
- Information on the form must match the
information on the specimen label
- The time the specimen is received by the
laboratory must be recorded on the form
SPECIMEN REJECTION
Possible reasons for rejection:
- Specimens in unlabeled containers
- Non Matching labels and requisition forms
- Specimens contaminated with feces or
toilet paper
- Containers with contaminated exteriors
- Specimens of insufficient quantity
- Specimens that have been improperly
transported
SPECIMEN HANDLING
Specimen Integrity
- Should be delivered to the laboratory
promptly and tested within 2 hours
- Specimens not delivered and tested
within 2 hours must be refrigerated or
have a chemical preservative
Specimen Preservation
- Refrigeration at 2C to 8C
- These temperature decreases bacterial
growth and metabolism
- If the urine is to be cultured, it should be
refrigerated during transit and kept
refrigerated until cultured up to 24 hours
- Chemical preservatives is the alternative
if there is no refrigeration
TYPES OF SPECIMEN
- Time
Special conditions that determine specimen
- Leng
type:
th
-
- Method of collection
Patient’s dietary and medicinal intake
1. Rand
o m Specimen
○ Most commonly received specimen
○ Collected at any time
○ Useful for routine screening tests
to detect obvious abnormalities
○ But may show erroneous results
resulting from dietary intake or
physical activity just before
collection
2. First orning Specimen
M Ideal screening program
○ Requires patient to make an
○ additional trip to the
laboratory It is a concentrated
○ specimen, thereby assuring
detection of chemicals and
formed elements that may not
be present in dilute random
specimen
○ The specimen should be collected
and delivered to the laboratory
within 2 hours
Essential for preventing false-
○
 negative pregnancy tests and for
evaluating orthostatic proteinuria
3. 24-Hour (or Timed) Specimen
0 A carefully timed specimen must be
used to produce accurate quantitative
results. Many solutes exhibit diurnal
variations such as catecholamines, 17-
hydroxysteroids, and electrolytes in
which the lowest concentration is in
the early morning and the highest
concentration occurs in the afternoon
○ Patient must begin and end the
collection period with an empty
bladder
4. Catheterized Specimen
0 Collected under sterile conditions by
passing a catheter through the urethra
into the bladder
○ Usually use for bacterial culture
5. Midstream Clean-Catch Specimen
0 Alternative to catheterized specimen
○ Safer, less traumatic method for
obtaining urine for bacterial culture
and routine urinalysis
○ Less contaminated by epithelial cells
and bacteria
6. Subprapubic Aspiration
0 Collected by external introduction of a
needle through the abdomen into the
bladder
○ Provides a sample for bacterial culture
that is completely free of extraneous
contamination
○ Also used for cytologic examination
7. Prostatitis Specimen
0 Three-Glass collection
i. Prior to collection the area
is cleansed using the male midstream
clean-catch procedure. Then instead
of discarding the first urine passed,
it is collected in a sterile container.
ii. Next, the midstream portion is
collected in another sterile
container. iii. The prostate is then
massaged so that prostate fluid will
be passed with the remaining urine
into a third sterile container.
iv. Quantitative cultures are
performed on all specimens,
and the first and third
specimens are examined
microscopically
v. In prostatic infection, the third
specimen will have a white
blood cell/ highpower field
count and a bacterial count 10
times that of the first
specimen. Macrophages
containing lipids may also be
present.
vi. The second specimen is
used as a control for bladder
and kidney infection. If it is
positive, the results from the
third specimen are invalid
because infected urine has
contaminated the specimen.
○ Pre-and Post-Massage Test
i. Clean catch midstream urine
specimen is collected
ii. A second urine sample is
collected after the prostate is
massaged iii. POsitive
result is significant
bacteriuria in the postmassage
specimen of greater than to
times the premassage count
8. Pediatric Specimens
0 Soft, clear plastic bags with
hypoallergenic skin adhesive to attach
to the genital area of both boys and
girls are available for collecting
routine specimens
○ Sterile specimens may be obtained by
catheterization or by suprapubic
aspiration. Care must be taken not to
touch the inside of the bag when
applying it.
9. Drug Specimen Collection
0 Most vulnerable part of a drugtesting
program
○ Correct collection procedures and
documentation are necessary to ensure
that the results are those of the
specific individual submitting the
specimen.
○ The chain of custody (COC) is the
process that provides this
documentation of proper sample
identification from the time of
collection to the receipt of laboratory
results.