1. INTRO TO URINALYSIS

Hippocrates (5th century BC)

Wrote a book on uroscopy (visual examination of urine).

1140 AD

in what year did they developed urine color charts describing 20 different urine colors and their meanings.

Frederik Dekkers (1694)

Discovered albuminuria (protein in urine) by boiling urine.

Thomas Bryant (1627

Wrote about fraudulent urine examiners ("pisse prophets"), leading to the first medical licensure laws in England.

Thomas Addis

Developed methods to quantify urinary sediment under the microscope.

Richard Bright (1827)

Introduced urinalysis as a routine part of patient examination.

1930s

By the ______, urinalysis became too complicated because many tests were added. As a result, it became less common in routine examinations.

1. Easy Specimen Collection

2. Provides Valuable Health Information

ENUMERATE:

two unique characteristics of urine specimen that account for its continuity

urinalysis

the testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe, and cost-effective manner.

1. physical (macroscopic) examination

2. chemical (dipstick) analysis

3. microscopic examination

what are the three components of modern urinalysis?

Pisse prophets

were fraudulent urine examiners whose activities led to the first medical licensure laws in England.

170 L (170,000 mL)

how many L of plasma is filtered daily?

12 L (1,200 mL)

how many L of urine is excreted daily?

• 95% Water

• 5% Solutes (dissolved substances)

what is the general composition of urine?

• Diet

• Physical activity

• Metabolism

• Hormonal (endocrine) function

• Body position

The concentration of solutes varies depending on:

Urea

• Most abundant organic solute in urine.

• Accounts for nearly half of the total dissolved solids.

• Produced in the liver from the breakdown of proteins and amino acids.

Creatinine

• Produced from muscle metabolism.

• Normally excreted in urine.

• Commonly used to assess kidney function.

Uric Acid

• Produced during the breakdown of purines (nucleic acids).

• Excreted through urine.

• Chloride (Cl⁻) – Most abundant inorganic solute.

• Sodium (Na⁺)

• Potassium (K⁺)

ENUMERATE: major inorganic compounds found in urine

urea and creatinine

what are the two markers that is used to identify whether a particular fluid is urine?

Urine

is an ultrafiltrate of plasma.

urine volume

it is determined by the body’s hydration status

1200–1500 mL/day

Average urine daily output

600–2000 mL/day

Normal range or urine output per day

Oliguria

A decrease in urine output.

• Infants: < 1 mL/kg/hour

• Children: < 0.5 mL/kg/hour

• Adults: < 400 mL/day

Diagnostic criteria for Oliguria

• Infants:

• Children:

• Adults:

Oliguria

this condition occur when the body is dehydrated , such as from: Vomiting, Diarrhea, Excessive sweating, Severe burns.

The body wants to conserve water, so the kidneys reabsorb more water, producing less urine.

Anuria

Almost complete cessation of urine production.

Nocturia

increased urination at night.

2–3

People produce _____ times more urine during the day than at night.

Polyuria

Excessive urine production.

• Adults: > 2.5 L/day

• Children: > 2.5–3 mL/kg/day

Diagnostic criteria for polyuria

• Adults:

• Children:

diabetes mellitus

which type of diabetes has a increased SG

diabetes insipidus

which type of diabetes has a decreased SG

diabetes insipidus

what type of diabetes is usually associated with decreased production or function of ADH

diabetes mellitus

what type of diabetes is usually associated with decreased insulin or decreased function of insulin and an increase of glucose

Polydipsia

Excessive thirst and increased water intake.

Urea

Most abundant organic waste; produced in the liver from protein and amino acid metabolism. Makes up 60–90% of urinary nitrogen.

Creatinine

Produced from creatine in muscles; reflects muscle metabolism and is commonly used to assess kidney function.

Uric acid

Produced from the breakdown of purines (DNA/RNA); a common component of kidney stones.

Hippuric acid

Formed when benzoic acid is detoxified; increases with high-vegetable diets.

Sodium chloride (NaCl)

Principal salt in urine; amount depends on dietary salt intake.

Potassium (K )

Helps regulate nerve and muscle function; excreted as chloride, sulfate, or phosphate salts.

Sulfate (SO4 2 )

Produced during amino acid metabolism.

Phosphate (PO4 3 )

Mainly present as sodium phosphate; helps buffer blood pH.

Ammonium (NH4 )

Derived from protein metabolism and glutamine in kidneys; Helps regulate acid-base balance amount varies depending on blood and tissue fluid acidity

Magnesium (Mg2 ) and Calcium (Ca2 )

Excreted as chloride, sulfate, or phosphate salts.

160 - 180 g/dL or 8.88 - 9.99 mmol/L

renal threshold for glucose

wee bag

bags with adhesive for the collection of pediatric specimens

50 mL ; 12 mL

The recommended capacity of the container is ____, which allows _____ of specimen needed for micro scopic analysis

sterile containers

this container is used for bacterial culture and if there is more than 2 hours elapse between specimen collection and analysis

• Patient's name

• Identification number

• Date

• Time of collection

• Additional information (depending on hospital policy):

  • Age

  • Location/ward

  • Physician's name

Every specimen must include:

requisition form

A _________________ accompanies every specimen. It should match the specimen label exactly.

It may include:

• Collection method

• Type of specimen

• Medications

• Clinical history

• Time received in the laboratory

• Unlabeled

• Label doesn't match the requisition form

• Contaminated with feces

• Contaminated with toilet paper

• Container exterior contaminated

• Insufficient volume

• Improperly transported

ENUMERATE:

grounds for rejection of specimen

• Refrigerate the specimen (2–8°C) ✅ Preferred

• Add a chemical preservative

if testing cannot be done within 2 hours, what are your options?

2 hours

urine Spx should be delivered to the laboratory promptly and tested within _______

• color

• turbidity

• pH

• nitrite

• bacteria

• odor

what analytes INCREASES in an unpreserved urine?

• glucose

• ketones

• bilirubin

• urobilinogen

• RBCs

• WBSs

• casts

what analytes DECREASES in an unpreserved urine?

amorphous phosphate

this crystal is brought upon by higher pH (BASIC)

amorphous ureate

this crystal is brought upon by lower pH (ACIDIC)

True

T or F

a refrigerated specimen must first be put back to room temperature to proceed with the testing and analyzing of the specimen

✅ Kill bacteria (bactericidal)

✅ Inhibit urease

✅ Preserve cells and casts

✅ Not interfere with chemical tests

what are the ideal requirements for urine preservatives?

Random Specimen

TYPE OF SPX

• Collected any time.

• Most commonly received specimen.

First Morning Specimen

TYPE OF SPX

• ideal screening specimen.

• Immediately after waking.

• Before eating or drinking.

First Morning Specimen

essential for preventing false-negative pregnancy tests and for evaluating orthostatic proteinuria

8-hour specimen

First Morning Specimen aka?

it is the most concentrated urine

why is First Morning Specimen ideal?

Fasting Specimen (Second Morning)

The second urine specimen collected after an overnight fast, used mainly for glucose monitoring because it is free of dietary metabolites.

2-Hour Postprandial Specimen

A urine specimen collected exactly 2 hours after a meal to monitor glucose excretion and evaluate insulin therapy.

Glucose Tolerance Specimens

Timed urine specimens collected during a glucose tolerance test (GTT) to assess glucose metabolism by testing for glucose and ketones.

24-Hour (or Timed) Specimen

A urine specimen collected over a 24-hour period to measure the total daily excretion of specific substances for quantitative analysis.

Catheterized Specimen

A sterile urine specimen obtained by inserting a catheter through the urethra into the bladder, commonly used for urine culture

Midstream Clean-Catch Specimen

A urine specimen collected from the middle portion of the urinary stream after cleansing the genital area to minimize contamination

glans, which begins at the urethra, and withdraw the foreskin,

in collecting Midstream Clean-Catch Specimen MALE patients should clean the ___________

labia and clean the urinary meatus and surrounding area.

in collecting Midstream Clean-Catch Specimen FEMALE patients should clean the ___________

hexachlorophene or povidone-iodine

what strong bacterial agents should not be used as cleansing agents in midstream clean-catch specimen collection?

Suprapubic Aspiration

A sterile urine specimen obtained by inserting a needle directly into the bladder through the abdominal wall.

Prostatitis Specimen

A series of urine specimens collected before and after prostate massage to diagnose prostate infection.

Pediatric Specimen

A urine specimen collected from infants or young children using an adhesive collection bag, catheterization, or suprapubic aspiration

Drug Specimen Collection

A urine specimen collected following strict legal procedures and chain-of-custody documentation for drug screening.

urethral infection

in prostatitis spx collection, what does glass 1 tell us about?

bladder and kidney infection

in prostatitis spx collection, what does glass 2 tell us about?

prostate infection

in prostatitis spx collection, what does glass 3 tell us about?

• White blood cell (WBC) count is increased.

• Bacterial count is ≥10× higher than the first specimen (Glass 1).

• Lipid-laden macrophages may also be present.

What are the characteristic findings in the third specimen of a positive prostatitis (three-glass) test?

False

T or F

if the glass 2 spx is positive, the the results from the third specimen can still be collected

1. Stamey-Mears four-glass localization method

2. pre and postmassage test (PPMT)

what are the other procedures to collect prostatitis spx?

Stamey-Mears four-glass localization method

A diagnostic procedure used to localize the site of a urinary tract infection by collecting four sequential specimens: VB1, VB2, expressed prostatic secretions (EPS), and VB3.

expressed prostatic secretions (EPS)

Prostatic fluid collected after prostate massage, cultured and examined for bacteria and white blood cells (WBCs) to assess prostatic infection.

pre and postmassage test (PPMT)

A simplified prostatitis test that compares a clean-catch midstream urine specimen before prostate massage with a urine specimen collected after massage.

32.5°C to 37.7°C

what is the required normal temperature range of urine sample for drug specimen collection?

30–45 mL

volume of urine collected for drug specimen

Refrigeration

the preferred urine preservative that slows bacterial growth and metabolism but may increase specific gravity and cause precipitation of amorphous phosphates and urates.

Thymol

A urine preservative that preserves glucose and urinary sediment but interferes with acid precipitation tests for protein.

Boric acid

A bacteriostatic urine preservative that maintains urine pH around 6.0, thus preserves protein and formed elements well and is commonly used for urine culture transport.

Formalin (Formaldehyde)

A urine preservative that excellently preserves cells and casts but interferes with tests for glucose, blood, leukocyte esterase, and copper reduction.

Toluene

A urine preservative that forms a protective layer on the urine surface to reduce bacterial growth without interfering with routine tests.

Sodium fluoride

A urine preservative that prevents glycolysis and preserves glucose, making it useful for glucose and drug analysis.

Phenol

A urine preservative that does not interfere with routine tests but may produce a noticeable odor.

Commercial preservative tablets

Premeasured urine preservatives used when refrigeration is unavailable; tablet composition should be checked for possible test interference.

Gray C&S Tube

A urine collection tube containing boric acid that preserves bacteria for culture and sensitivity (C&S) testing for up to 48 hours at room temperature.