RLE 1M - Urine Testing (Part 2)

Urine

a fluid waste produced by your kidneys to eliminate excess fluids and waste materials from your system

Urine testing/ Urinalysis

a series of tests performed on urine. It looks at the physical, chemical, and microscopic characteristics of urine

Enuresis

The condition is characterized by involuntary urination during sleep for 3 months in children older than 5 and is commonly known as bedwetting

Diuretics

or water pills is a medication designed to pit or increase extra salt and water expelled from the body as urine

Ketone Bodies

Are substances produced by the liver and used peripherally as an energy source when glucose is not readily available.

Hematuria

refers to the existence of blood in urine

Uric acid

A waste product formed when the body breaks down purines. The kidney normally removes uric acid through urine. When the body produces too much uric acid or does not remove a substantial amount, hyperuricemia occurs.

Slightly aromatic

Normal Odor:

Fruity

Abnormal Odor:

Fruity Odor:

• Diabetic ketoacidosis

• starvation/fasting

• ketogenic diet

• alcoholic ketoacidosis

Possible Causes of Abnormality in Odor:

Pale yellow to Deep gold

Normal Color:

Dark red to Bright red

Abnormal Color:

Dark red to bright red:

• Hematuria (UTI, kidney/bladder stones, glomerulonephritis, trauma, tumors), foods (beets, blackberries), medications (rifampin, phenazopyridine, senna)

Possible Cause of Abnormality in Color:

pH 4.5-8.0

Normal pH Value:

pH lower than 4.5 and higher than 8.0

Abnormal pH Value:

High pH (>7.5)

• UTI, vegetarian/vegan diet, metabolic alkalosis, renal tubular acidosis, medications

Low pH (<5.5)

• High-protein diet, metabolic acidosis , diarrhea, dehydration, COPD/respiratory acidosis

Possible Cause of Abnormality in pH Value:

Clear

Normal Clarity:

Cloudy, Foamy or Milky

Abnormal Clarity:

Foamy

• Rapid urination, dehydration, toilet cleaners, proteinuria, UTI

Possible Cause of Abnormality in Clarity:

1.005 - 1.030

Normal Specific Gravity:

< 1.005

> 1.030

Abnormal Specific Gravity:

High specific gravity (>1.030)

• Dehydration, SIADH, heart failure, glycosuria, proteinuria, adrenal insufficiency

Low specific gravity (<1.005)

• Diabetes insipidus, chronic kidney disease, excessive fluid intake, acute tubular necrosis, diuretics

Possible Cause of Abnormality in Specific Gravity:

Dysuria

Painful, burning urination usually associated with bacterial infection, inflammation, or obstruction of the urinary tract

Glycosuria

Presence of glucose in urine, caused by excessive intake of sugary foods or diabetes mellitus

Hematuria

Presence of blood in the urine, caused by urinary tract trauma, kidney stones, and infections

Oliguria

Abnormally low urinary output, between 100 – 400mL, caused by dehydration or renal failure

Polyuria

Voiding of large amounts of urine, caused by excessive water intake or diuretics usage

Retention

Excessive urination at night, caused by excessive fluid intake before bed, renal disease, and prostate enlargement

Kidney stones

When urine becomes highly concentrated, substances such as calcium, oxalate, uric acid, or phosphate can crystallize. The crystals grow and form stone

Urinary tract infections

Occurs when bacteria enter the urinary tract through the urethra, multiplying in the bladder

Urine color and odor

Can be affected by Fluid intake, diet, medicines, and medical conditions

Frequency

Urinary frequency means urinating more often than usual, often with only small amounts being voided each time

Incontinence

The bladder, urethra, pelvic floor muscles, or nervous system may fail to properly control the storage and release of urine, resulting in involuntary urine leakage

Hesitancy

means difficulty starting the urine stream, even when the person feels the need to urinate. Urine needs to pass through the urethra

• Routine Urinalysis

• Clean-Catch Midstream Urine Specimen

• Sterile Technique

• Timed Specimen Or 24-Hour Urine Specimen

• First Morning Specimen

• Random Specimen

Ways of Specimen Collection:

Routine Urinalysis

To detect the number of microorganisms present in the urine and to detect disease and manage various health conditions

When: Usually any time, but preferably a fresh, clean specimen; first-morning urine may be preferred when a more concentrated sample is needed.

Clean-Catch Midstream Urine Specimen

Most common method of obtaining urine specimens from adults, particularly men. This method allows a specimen, which is not contaminated from external sources, to be obtained without catheterization

When: Any time, preferably when the patient has a reasonably full bladder. For culture, collect before antibiotics when possible.

Sterile Technique

Used in insertion of indwelling urinary catheters to remove sterile urine, which must be performed to minimize the risk of introducing bacteria to the urinary bladder

When: Collected when specifically ordered or when a sterile urine sample is required

Timed Specimen Or 24-Hour Urine Specimen

Always begins with an empty bladder so that the urine collected is not "left over" from previous hours. This specimen shows the total amounts of wastes the kidneys are eliminating and the amount of each

When: At the designated starting time, usually after the patient empties the bladder first. The starting urine is discarded, then all urine for the next 24 hours is collected, including the final specimen at the exact end time.

First Morning Specimen

This sample is collected the first time the patient urinates in the morning. This specimen is the most concentrated and is the preferred specimen for pregnancy testing, bacterial cultures and microscopic examinations

When: Immediately after waking, before significant fluid intake or activity.

Random Specimen

Collected anytime during the day. Usually used only for routine screening because the composition of urine changes throughout the day

When: Any convenient time of day.

• Clinitest

• Benedict’s Test

• Acetest

Methods of Urine Testing:

Clinitest

uses a tablet that is dropped into a test tube containing urine. It contains copper sulfate, sodium carbonate, sodium citrate, and sodium hydroxide

Acetest

tablet reagent that contains sodium nitroprusside, glycine, disodium phosphate, and lactose. It detects ketones in urine; and the lactose present in the tablet provides better color differentiation which gives a clearer result when comparing the color of the tablet with the color chart

Benedict’s Test

test to determine glucose in urine

Blue

Clinitest Color:

indicates negative result

Orange

Clinitest Color:

indicates highly positive test

Dark greenish-brown

Clinitest Color:

indicates urine glucose level above 2%

tablet color unchanged/ turns cream colored from wetting

Acetest (Ketone Test):

Negative result

change from lavender to deep purple

Acetest (Ketone Test):

Positive result

Blue

Benedict’s Test Color:

negative

Green

Benedict’s Test Color:

(+)

Yellow

Benedict’s Test Color:

(++)

Yellow orange

Benedict’s Test Color:

(+++)

Red

Benedict’s Test Color:

(++++)

• Health Supervision

• Ante-Partum

• Post-Partum

• Morbid

• Case finding

• Geriatric

• Mental health

Urine testing with high-risk population groups in the community:

Health Supervision

Regular urine testing among children and adolescents to detect possible diabetes, urinary tract infection and other health or metabolic conditions

Ante-Partum

Urine testing of pregnant women to monitor glucose and protein levels and identify possible gestational diabetes or preeclampsia

Post-Partum

Screening after childbirth to identify protein in the urine or possible urinary tract infections and help promote proper maternal recovery

Morbid

Testing high-risk individuals with chronic illnesses (e.g., diabetes, hypertension, kidney disease)

Case finding

To detect if an individual have a specific illness or health risk in order to prevent it

Geriatric

Older adults may require urine testing for incontinence, infections, or renal function monitoring to maintain overall health

Mental health

For individuals with mental health or substance-use concerns may help monitor certain health conditions, hydration, or detect substances when clinically indicated