URINALYSIS

urine

• a sterile liquid by-product of the body

• secreted by kidneys and excreted through the urethra through urination

• aqueous solution of >95% water with:

  • urea

  • chlorides

  • sodium

  • potassium

  • creatinine

  • other dissolved ions

  • other inorganic/organic compounds

epithelial cells

lining the urethra are colonized by facultative anaerobic gram (–) rods and cocci

urea

is a processed form of ammonia that is non-toxic to mammals

urinalysis

• UA, R&M (routine & microscopy)

• array of tests used to diagnose several diseases

test strips / light microscopy

urinalysis is done by __ or __

routine analysis

usual target parameters of UA

microscopy

used specifically for culturing bacteria

24-hour collection

• patient voids into toilet, then all urine is collected for the next __;

• as the body chemistry alters constantly, this is used to measure substances, such as steroids, white cells, electrolytes or determine urine osmolarity

first-morning specimen

• first specimen of morning (or eight hours after recumbent position);

• best sample for pregnancy testing

fasting specimen

the second voided specimen after a period of fasting

mid-stream urine (MSU)

• used to obtain urine for bacterial culture;

• first and last part of urine stream is voided into the toilet to avoid contaminating the specimen with organisms presenting on the skin

random specimen

for chemical or microscopic examination, a randomly collected specimen suitable for most screening purposes

catheter specimen of urine

• collected for bacteriological examination if a patient’s symptoms suggest the presence of a UTI;  The sampling technique used for collection is important

test strip urinalysis

• urine dipstick

• comprise up to 10 chemical pads which react through change in color when immersed in urine

• qualitative (+ or –); some are semi-quantitative

5 mm wide

strips consist of a plastic ribbon of about __

reagent

have pads impregnated with __ that react with the compounds in urine

urine dipstick

test strip is submerged in a urine

30 to 120 seconds

it can take from __ seconds for the compounds in the urine to react with the reagents on the test squares

squares

• __ on a test strip are designed to react sequentially;

• this makes trying to examine the findings less chaotic

color
transparency
odor
pH
density

physical characteristics of urine

abnormalities (in urine)

• may indicate disease or metabolic imbalances

• may seem superficial or minor, but can be symptom for an underlying disease

yellow amber

typical color of urine

water

drinking more __ generally tends to reduce the concentration of urine

dark urine

__ may indicate dehydration

red urine

__ indicates a sign of kidney damage and disease

green urine

__ may indicate pseudomonas infection or excretion of mitomycin

urine transparency

gauged subjectively and reported as clear, slightly cloudy, cloudy, opaque or flocculent

fresh urine

either clear or very slightly cloudy

excess turbidity

results from the presence of suspended particles in the urine, the cause of which can usually be determined by the results of the microscopic urine sediment examination

abnormal turbidity

common causes of __ include:

• increased cells

• urinary tract infections

• obstructions

urine odor

the smell of urine may provide health information

urine of diabetics

may have a sweet or fruity odor due to the presence of ketones or glucose

mild smell

smell of fresh urine

aged urine

__ has a stronger odor similar to that of ammonia

glucose

• normal: urine does not contain __

• it occurs in pregnancy or patients taking corticosteroids

• indicative of diabetes mellitus

• indicative of endocrine abnormality

• not diagnostic; further testing by blood test (FBS)

glycosuria

abnormal urine

bilirubin

• a product of RBC hydrolysis

• it is transported in the blood to the liver where it is processed and excreted into the gut as a constituent of bile

urobilinogen

• in the gut, bacteria acts on bilirubin to transform it into ___

• it is normal for urine to contain __ but not bilirubin

RBC breakdown
liver damage
gallstones

presence of bilirubin & urobilinogen may indicate ___

ketone

• formed during abnormal breakdown of fat

  • may result from prolonged vomiting, fasting or starvation, on a diet, or with diarrhea also present in poorly controlled diabetes patient

diabetic ketoacidosis

it can make blood more acidic

specific gravity

• identifies hydration of an individual

• when assessing, environmental factors such as temperatures should be taken into account

well-hydrated

• will have diluted urine

• high fluid intake, diabetes insipidus, endocrine disorders

dehydrated

will have a concentrated urine (low fluid intake)

1.001 - 1.035

normal specific gravity

BLOOD

• normal urine does not have __

• enters urine due to damage in the filtration barriers in kidneys (kidney damage)

• also indicative of inflammatory lesions of the urinary tract and kidney stones

• urine can also be contaminated with menstrual __

hematuria

abnormal presence of blood in urine

macroscopic

large volumes; dark colored

microscopic

undetectable in naked eye; reagent strip or microscope are needed

slightly acidic

pH of urine

5.0 - 8.0

normal pH range of urine

kidney stones

too acidic urine may indicate __

UTI

too basic urine may indicate __

proteus
klebsiella
pseudomonas

UTI is caused by __

acidic urine

high protein causes __

alkaline urine

high intake of dairy products or vegetable causes __

conjunction

results should be interpreted in __ with an individual’s specific presentation

protein

• normal: urine does not contain high level of __

• __ is a large molecule to pass through the glomerular filtration barrier

• can be caused by glomerular filtration barrier damage or disease, kidney damage, hypertension, diabetes mellitus

proteinuria

• abnormal presence of protein in urine

• specific investigations will be required to detect the cause of __

nitrite

• normal: urine does not contain __

• presence are ad with presence of bacteria that converts nitrate to __ may indicate UTI but clinical presentation of symptom should be observed

• absence of __ however does not always rule out the presence of UTI

nitrite test

approximately 50% of urine samples containing bacteria, the __ was negative

leukocytes

usually associated with UTI but may indicate a more severe renal problem

pyuria

• pus in the urine

• when WBCs are present, patients are said to have __

sterile pyuria

• where no bacterial cells are detected, patients have __

• which occurs in tuberculosis and kidney inflammatory disease