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URINALYSIS: Introduction
Crizelda D. Liwanag
History
• Hieroglyphics
• Uroscopy (Hippocrates)
• Ant & taste testing (Sasruta)
• Urine boiling (F. Dekkers)
History
• Pisse prophets (charlatans)
• Thomas Bryant
• Microscope
• Thomas Addis
• Richard Bright
• Modern urinalysis
Rationale of Urine testing
• (Relatively) readily collectedand easily available specimen
• Contains information about the body’s major metabolic fxns
• inexpensive
Rationale of Urine testing
? Disease conditions
? Hormonal activity
? Ruling out, ruling in, screening & prognosis
Urine Composition
• How do the ff. affect composition:
–Dietary intake
–Physical activity
–Body metabolism
–Endocrine functions
–Body position
Urine Composition
• Substances readily reabsorbed
–GANaCaKUP
• Substances readily excreted
–UCUA
Urine Composition
• Organic
– Urea
– Creatinine
– Uric acid
– Urobilinogen
• Other substances
– Hormones
– Vit & meds
• Inorganic
– Cl2, K, Na
• Formed elements
– Cells & casts
– Crystals
– Mucus
– bacteria
Urine volume
• Factors
– Fluid intake
– Non-renal fluid loss
– ADH
– Solute concentration
• Definition & associated cond– Oliguria
– Anuria
– Nocturia
– Polyuria
– Pollakiuria
– Incontinence
– Residual urine
Specimen
• What was used in the collection? – answered by COLLECTION TECH / MTD
• When was the specimen collected? – answered by TYPE OF SPECIMEN
• What are the criteria for acceptance & rejection of specimen for processing & analysis?
• What is meant by QNS & COC?
• Patient preparation?
Collection technique / method
1. Bottle methoda. Routine void
b. Midstream clean catch
c. Drug testing
2. BD Vacutainer (gray, cherry red & yellow stopper)
3. Gauze method / pediatric bag
4. Catheterization
5. Suprapubic aspiration
Collection technique / method
1. Wash hands thoroughly. Do not open the sterile container until it is absolutely necessary.
2. Wash the vulva and surrounding area with soap and water.
3. Begin urinating into the toilet and stop after a few drops.
4. Position the container to catch the middle portion of the stream. Make sure that at least ¾ of the container has been filled up.
5. Urinate the remainder into the toilet.
6. Securely & immediately replace the cap without touching the inside rim of the container.
Collection technique / method
Types of Specimen
1. First morning specimen
2. Random
3. Fractional
4. Timed1. Pre-determined
length
2. Pre-determined time
1. Advantages
2. Disadvantages
3. Reminders / precautions
4.Uses
5. Subtypes
Specimen handling
• Integrity
• Preservation
Physical changes
Color
• Due to oxidation or reduction of substances
Clarity
• Falsely decreased
• Due to bacterial proliferation, solute ppt’n
Odor
• Falsely increased
• Due to bacterial proliferation
Chemical Changes
pH
• Falsely increased
• Due to bacterial decomposition of urea to ammonia
• Falsely decreased
• Due to bacterial or yeast conversion of glucose to form acids
Chemical Changes
glucose
• Falsely decreased
• Due to cellular or bacterial hydrolysis
ketones
• Falsely decreased
• Due to bacterial metabolism of acetoacetate to acetone
• volatilization of acetone
Chemical Changes
bilirubin
• Falsely decreased
• Due to photo-oxidation to biliverdin and hydrolysis to free bilirubin
urobilinogen
• Falsely decreased
• Due to oxidation to urobilin
Chemical Changes
Nitrite
• Falsely increased
• Due to bacterial production following spx collection
• Falsely decreased
• Due to conversion to nitrogen
Microscopic Changes
RBC, WBC, casts
• Falsely decreased
• Disintegration of cellular & formed elements, esp in dilute alkaline urine
Bacteria
• Falsely increased
• Due to bacterial proliferation ff spx collection
Preservation
WHY IS IT NECESSARY TO:
• Maintain the pH?
• Avoid bacterial contamination?
• Avoid conversion of urea to ammonia?
HOW DO YOU ACCOMPLISH THE AFOREMENTIONED STEPS?
Preservation
A. Physical Methods
PRINCIPLE ? A&D?
1. Refrigeration
2. Dry Ice
B. Chemical Methods
PRINCIPLE ? A&D?
1. Toluol
2. Thymol
3. Formalin
4. Chloroform
5. NaF
Preservation
B. Chemical Methods
6. Benzoic acid
7. Phenol / tricresol
8. 6N Hcl
9. Boric Acid
10. H2SO4
11. Na carbonate
12. Acetic Acid
13. Saccomanno’s fixative
