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What are the primary components in NORMAL URINE?
Water
Urea
Creatinine
Uric Acid
Potassium
Sodium
What instructions should you give a patient about collecting a 24-hour urine?
Discard 1st morning specimen and RECORD TIME
Collect everything after that 1st morning specimen for 24 hours
MUST BE KEPT REFRIGERATED
How does color change in unpreserved urine?
Darkens
How does Glucose change in unpreserved urine?
breaks down due to bacteria
How do ketones change in unpreserved urine?
Decrease
How does Bilirubin change in unpreserved urine?
decrease
How does urobilinogen change in unpreserved urine?
decreases
How does pH change in unpreserved urine?
increases because of breakdown of ammonia and urea
How does nitrite change in unpreserved urine?
increases because bacteria is increasing
How does bacteria change in unpreserved urine?
multiplies
How does clarity change in unpreserved urine
decrease
How does cells and casts change in unpreserved urines?
decrease because they break down
How does odor change in unpreserved urines?
increases
A patient brings a first morning specimen to the laboratory at 1 PM.
How could this affect the urinalysis results
Less concentrated
Increased bacteria, nitrite, and pH
Decreased bilirubin, ketones, clarity, glucose, urobilinogen, and WBCs, RBCs, and casts
A patient brings a first morning specimen to the laboratory at 1 PM.
What could the patient say that would make the specimen satisfactory?
The specimen was refrigerated and brought immediately to the lab
What is the reference range for GFR?
100-120
What is the reference range for BUN?
8-25
What is the reference range for Creatinine?
0.9-1.5 (men)
0.7-1.3 (women)
What is the reference range for the BUN/creatinine ratio?
12-16
What are the three classifications of Azotemia?
Prerenal
Renal
Postrenal
What do results look like for Prerenal Azotemia?
High BUN
N Creatinine
High Ratio
What do results look like for Renal Azotemia?
High BUN
High Creatinine
N Ratio
What do results look like for Postrenal Azotemia?
Very Very High BUN
Very High Creatinine
High Ratio
What conditions are associated with Prerenal Azotemia?
Blood Perfusion
Dehydration
High protein diets
Cortisol treatment
Increased protein catabolism
What conditions are associated with Renal Azotemia?
Glomerulonephritis
Higher Blood Pressure
Water Retention
Chronic nephritis
Tubular necrosis
What conditions are associated with Postrenal Azotemia?
Tumors
Urolithiasis
Enlarged prostate causing blockage
Describe the following result as Prerenal, Renal, Postrenal.
BUN= 58 mg/dL
Crea= 3.7 mg/dL
Renal
Describe the following result as Prerenal, Renal, Postrenal.
BUN= 167 mg/dL
Crea = 4.3 mg/dL
Postrenal
Describe the following result as Prerenal, Renal, Postrenal.
BUN = 37 mg/dL
Crea = 1.4 mg/dL
Prerenal
Name the method of analysis of glucose
Glucose Oxidase
Name the confirmatory test(s) of glucose
Copper Reduction Test (Clinitest)
Name the clinical significance of Glucose
Diabetes Mellitus
Pancreatitis
Pancreatic cancer
Gestational Diabetes
Galactosemia
Fanconi Syndrome
Advanced renal disease
Pregnancy
Name what causes false positives for Glucose Oxidase
Peroxidase or bleach contamination
Name what causes false negatives for Glucose oxidase
Ascorbic Acid
High specific gravity (>1.020)
High Ketone Levels
Low temperature
What is the method of analysis of bilirubin
Diazo Reaction
What is the confirmatory test for bilirubin
Ictotest
What is the clinical significance of bilirubin
Biliary obstruction — gallstones, cancer
Hepatitis
Cirrhosis
Aids in the determination of jaundice
What causes false positive results for bilirubin?
Drugs
Urine pigmentation
What causes false negatives in bilirubin?
Increased nitrite
Ascorbic Acid
Exposure to light
What are the three ketone bodies?
Acetone
Acetoacetic Acid
Beta-hydroxybutyric acid
What is the method of analysis of Ketones?
Sodium nitroprusside
What is the confirmatory test for Ketones?
Acetest
What is the clinical significance of Ketones?
Diabetic acidosis
Starvation
Decreased carb intake
Vomiting/Diarrhea
What causes false positives of Ketones?
Levadopa metabolites
Urine pigmentation
What causes false negatives for ketones?
Proper Specimen preservation
Evaporation
What is the method of analysis of specific gravity?
Bromthymol Blue
What is the confirmatory test for specific gravity?
refractometer
What is the clinical significance of specific gravity?
Monitor patient hydration and dehydration
Loss of renal tubular concentrating ability
Diabetes insipidus
Determination of unsatisfactory specimens due to low concentration
What causes a false increase in specific gravity?
High protein
High Glucose
What causes a false decrease in specific gravity?
Highly alkaline urine
What is the method of analysis of Blood?
hemoglobin peroxidase
What is the confirmatory test of Blood?
Precipitation test
What causes false positive for blood?
Peroxide or bleach contamination
Bacterial peroxidase
Menstrual contamination
What causes false negatives in blood?
Ascorbic Acid
High SG
Poor Mixing of urine
Excess nitrites
What is the method of analysis of pH?
Bromthymol Blue - alkaline
Methyl Red - Acidic
What is the clinical significance for pH?
Varies according to body’s acid-base balance status
Defects in renal tubular secretion/reabsorption
Renal calculi formation
Treatment of UTI
Precipitation/identification of crystals
Determination of unsatisfactory specimens
What causes a false increase of pH?
Urine at room temp for too long
Loss of CO2
Bacterial contamination
What causes a false decrease of pH?
“Run over” from protein pad
(highly acidic)
What is the confirmatory test for protein?
3% Sulfosalicylic Acid (SSA)
What is the clinical significance of protein
Glomerular disorders
UTI
Impaired tubular reabsorption
Diabetic neuropathy - microalbumin
Preeclampsia
Nephrotic syndrome
Multiple Myeloma - Bence Jones Proteins
Strenuous exercise
What causes a false positive of protein?
Prolonged immersion of strip
Highly alkaline urine
Bloody urine
Bleach
High SG
What causes a false negative of protein?
Dilute urine
Non-albumin proteins
What is the method of analysis for urobilinogen?
Ehrlich’s aldehyde reaction
What is the clinical significance of urobilinogen?
Liver Disease
Hemolytic disorders
Determination of Clinical jaundice
Bile Duct obstruction
What causes false positives for urobilinogen?
Some drug metabolites
Highly pigmented urine
Porphrobilinogen
What causes false negative for urobilinogen?
Old urine
Formalin
What is the method of analysis for nitrite?
Greiss Reaction
What is the clinical significance of nitrite?
Cystitis
Pyleonephritis
Evaluation of antibiotic therapy
Monitors patients at high risk for UTI
Screen of urine culture specimens
What causes false positives for nitrite?
Poor collection
Improper preservation
Highly pigmented
What causes false negatives for nitrites?
Ascorbic acid
High SG
Antibiotics
What is method of analysis for leukocyte esterase?
acid ester????
What is the clinical significance of leukocyte esterase?
Bacterial and nonbacterial UTI
Inflammation of urinary tract
Screen of urine culture specimens
What causes false positives for leukocyte esterase?
Vaginal contamination
Oxidizing agents
Formalin
Highly pigmentation
What causes false negatives for leukocyte esterase?
High protein
High glucose
Antibiotics
Ascorbic acid
A urine specimen with a pH of 9.0:
Should be recollected
In the laboratory, a primary consideration associated with pH is
Identifying urinary crystals and determining specimen acceptability
What stains are used to make sternheimer-malbin stain?
1:1 crystal violet & safranin O
What does Sternheimer-Malbin Stain identify?
WBCs, epithelial cells, and casts
What makes up the lipid stains?
Sudan III and Oil Red O
What do lipid stains identify?
Identifies fat free droplets and lipid containing cells and casts. Stains triglycerides and natural fats orange-red. Cholesterol does not stain
What makes up a gram stain?
Gram stain procedure (crystal violet, iodine, safranin)
What do Gram Stains identify?
Identifies of bacterial casts. Differentiates gram positive and gram negative bacteria
What is the Hansel Stain made of?
Methylene blue and eosin Y
What do Hansel Stain identify?
Identification of urinary eosinophilia
What makes up the Prussian blue stain?
Prussian Blue Stain
What does the Prussian Blue stain identify?
Identifies yellow-brown granules of hemosiderin in cells and casts (structures containing iron)
What is the most common stain used in UA?
Sternheimer-Malbin Stain
A construction worker is pinned under collapsed scaffolding for several hours prior to being taken to the emergency room. His abdomen and upper legs are severely bruised, but no fractures are detected. A specimen for urinalysis obtained by catheterization has the following result:
COLOR: Red-brown
CLARITY: Clear
SP. GRAVITY: 1.017
pH: 6.5
UROBILINOGEN: 0.4 EU
PROTEIN: trace
GLUCOSE: negative
KETONES: negative
BLOOD: 4+
BILIRUBIN: negative
NITRITE: negative
LEUKOCYTE ESTERASE: negative
Would hematuria be suspected in this specimen? Why or why not?
No, the specimen is clear
A construction worker is pinned under collapsed scaffolding for several hours prior to being taken to the emergency room. His abdomen and upper legs are severely bruised, but no fractures are detected. A specimen for urinalysis obtained by catheterization has the following result:
COLOR : Red-brown
CLARITY: Clear
SP. GRAVITY: 1.017
pH: 6.5
UROBILINOGEN: 0.4 EU
PROTEIN: trace
GLUCOSE: negative
KETONES: negative
BLOOD: 4+
BILIRUBIN: negative
NITRITE: negative
LEUKOCYTE ESTERASE: negative
What is the most probable cause of the positive blood reaction?
Myoglobinuria
A construction worker is pinned under collapsed scaffolding for several hours prior to being taken to the emergency room. His abdomen and upper legs are severely bruised, but no fractures are detected. A specimen for urinalysis obtained by catheterization has the following result:
COLOR: Red-brown
CLARITY: Clear
SP. GRAVITY: 1.017
pH: 6.5
UROBILINOGEN: 0.4 EU
PROTEIN: trace
GLUCOSE: negative
KETONES: negative
BLOOD: 4+
BILIRUBIN: negative
NITRITE: negative
LEUKOCYTE ESTERASE: negative
What is the source of the substance causing the positive blood reaction and name the condition?
Muscle damage from the accident
A construction worker is pinned under collapsed scaffolding for several hours prior to being taken to the emergency room. His abdomen and upper legs are severely bruised, but no fractures are detected. A specimen for urinalysis obtained by catheterization has the following result:
COLOR: Red-brown
CLARITY: Clear
SP. GRAVITY: 1.017
pH: 6.5
UROBILINOGEN: 0.4 EU
PROTEIN: trace
GLUCOSE: negative
KETONES: negative
BLOOD: 4+
BILIRUBIN: negative
NITRITE: negative
LEUKOCYTE ESTERASE: negative
Would this patient be monitored for changes in renal function? Why or why not?
Yes, myoglobin is toxic to the renal tubules.
An obese 45-year-old woman has been trying a variety of diets in the hopes of losing weight. UA is performed and the urine is noted to have a fruity odor. What is the likely explanation for the UA results?
Appearance: Yellow, hazy
Glucose: Negative
pH: 5.0
Bilirubin: Negative
Protein: Negative
Ketones: Moderate
Urobilinogen: 0.2 EU/dl
Specific Gravity: 1.015
Nitrite: Negative
Leukocyte Esterase: Negative
Blood: Negative
The presence of ketones, in the absence of glucose, suggests the woman has been on a low carb or starvation diet
Ketones are present due to incomplete fat metabolism and cause a fruity odor.
A female patient arrives at the outpatient clinic with symptoms of lower back pain and urinary frequency with a burning sensation. She is a firm believer in the curative power of vitamins. She has tripled her usual dosage of vitamins in an effort to alleviate her symptoms; however, the symptoms have persisted. She is given a sterile container and asked to collect a clean-catch urine specimen. Results of this routine urinalysis are as follows:
COLOR: Dark yellow KETONES: negative
CLARITY: hazy BLOOD: negative
SP. GRAVITY: 1.012 BILIRUBIN: negative
pH: 7.0 UROBILINOGEN: 0.2 EU
PROTEIN: trace NITRITE: negative
GLUCOSE: negative LEUKOCYTES: 1+
Microscopic
RBC: 8-12/hpf
WBC: 40-50/hpf
BACTERIA: Large numbers
EPITHELIALS: many, squamous epithelial cells
What discrepancies between the chemical and microscopic tests results are present? State and explain a possible reason for each discrepancy?
Negative chemical reactions for blood and nitrite. Ascorbic acid interference for both reactions. A random specimen and further reduction of nitrate could cause the negative nitrite
A female patient arrives at the outpatient clinic with symptoms of lower back pain and urinary frequency with a burning sensation. She is a firm believer in the curative power of vitamins. She has tripled her usual dosage of vitamins in an effort to alleviate her symptoms; however, the symptoms have persisted. She is given a sterile container and asked to collect a clean-catch urine specimen. Results of this routine urinalysis are as follows:
COLOR: Dark yellow KETONES: negative
CLARITY: hazy BLOOD: negative
SP. GRAVITY: 1.012 BILIRUBIN: negative
pH: 7.0 UROBILINOGEN: 0.2 EU
PROTEIN: trace NITRITE: negative
GLUCOSE: negative LEUKOCYTES: 1+
Microscopic
RBC: 8-12/hpf
WBC: 40-50/hpf
BACTERIA: Large numbers
EPITHELIALS: many, squamous epithelial cells
What additional chemical tests could be affected by the patient’s vitamin dosage? Explain the principle of the interference.
Glucose, bilirubin, leukocyte esterase. Ascorbic acid is a strong reducing agent that interferes with the oxidation reaction in the glucose test. Ascorbic acid combines with the diazo reaction in the bilirubin and LE tests, lowering the sensitivity.
A female patient arrives at the outpatient clinic with symptoms of lower back pain and urinary frequency with a burning sensation. She is a firm believer in the curative power of vitamins. She has tripled her usual dosage of vitamins in an effort to alleviate her symptoms; however, the symptoms have persisted. She is given a sterile container and asked to collect a clean-catch urine specimen. Results of this routine urinalysis are as follows:
COLOR: Dark yellow KETONES: negative
CLARITY: hazy BLOOD: negative
SP. GRAVITY: 1.012 BILIRUBIN: negative
pH: 7.0 UROBILINOGEN: 0.2 EU
PROTEIN: trace NITRITE: negative
GLUCOSE: negative LEUKOCYTES: 1+
Microscopic
RBC: 8-12/hpf
WBC: 40-50/hpf
BACTERIA: Large numbers
EPITHELIALS: many, squamous epithelial cells
Discuss the urine color and specific gravity results with regard to correlation and give possible cause for discrepancy.
The dark yellow color may be caused by beta-carotene and vitamin A, and some B vitamins also produce yellow urine.
A female patient arrives at the outpatient clinic with symptoms of lower back pain and urinary frequency with a burning sensation. She is a firm believer in the curative power of vitamins. She has tripled her usual dosage of vitamins in an effort to alleviate her symptoms; however, the symptoms have persisted. She is given a sterile container and asked to collect a clean-catch urine specimen. Results of this routine urinalysis are as follows:
COLOR: Dark yellow KETONES: negative
CLARITY: hazy BLOOD: negative
SP. GRAVITY: 1.012 BILIRUBIN: negative
pH: 7.0 UROBILINOGEN: 0.2 EU
PROTEIN: trace NITRITE: negative
GLUCOSE: negative LEUKOCYTES: 1+
Microscopic
RBC: 8-12/hpf
WBC: 40-50/hpf
BACTERIA: Large numbers
EPITHELIALS: many, squamous epithelial cells
State additional reasons not previously given for a negative nitrite test in the presence of increased bacteria.
Inadequate incubation period of bacteria in bladder
Bacteria unable to reduce nitrate to nitrite
Bacterial conversion of nitrate to nitrogen
No nitrate in diet
What is the appearance of RBCs?
Smooth biconcave disks
What are sources of identification error in RBCs?
yeast cells, oil droplets, air bubbles
How do you differentiate RBCs from the source(s) of ID error?
Definitive differentiation made by using 2% ACETIC ACID. The acetic acid lyses RBCs and has no effect on yeast or oil droplets.
How do you report RBCs?
average number per 10/hpfs
Note
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