Denielle Genesis B. Camato V. URINALYSIS ANALYSIS OF URINALYSIS AND BODY FLUIDS | REVIEWER 1 URINALYSIS [ Probably the oldest clinical laboratory practice [ Usually involves gross observation and assessment of general appearance, dipstick analysis, and microscopic assessment [ One of the most commonly performed laboratory test URINE [ pale yellow fluid produced by the kidneys, composed of dissolved wastes and excess water or chemical substances from the body [ produced when blood is filtered through the kidneys CHANGES IN URINE AT ROOM TEMPERATURE r Bacteria multiply and may cause turbidity and a positive protein reaction r Bacteria convert urea to ammonia, which increases pH. r Bacteria metabolize glucose. r RBCs lyse in dilute or alkaline urine. r Casts lyse in alkaline urine. r WBCs disintegrate. r Bilirubin/urobilinogen are lost through exposure to light and/or oxidation. r Ketones are lost through evaporation. URINE VOLUME Normal daily volume 1200-1500 mL Normal day-night ratio 2:1 – 3:1 Diuresis Increased urine production Polyuria >2000 mL/day r diabetes mellitus r diabetes insipidus Oliguria <500 mL/day r dehydration r renal disease r obstruction of urinary tract Anuria No urine production URINE COLOR AND CLARITY Urochrome Normal yellow color Dilute urine Colorless Concentrated urine Dark yellow, amber Bilirubin Yellow-brown or olive green Yellow foam on shaking Homogentistic acid Normal on voiding Brown or black on standing Beginning at surface Melanin Brown or black on standing Methemoglobin Brown or black due to oxidation of hemoglobin in acid urine Myoglobin “Cola” on standing Blood/hemoglobin Pink or red when fresh “Cola” or “Smoky” on standing Cloudy with RBCs Clear with hemoglobin Porphyrin Port-wine Drugs, medications, food Green, blue, orange Pseudomonas infection Green, blue-green Urobilinogen Colorless when excreted Oxidized to orange-brown urobilin Crystals, WBCs, RBCs, epithelial cells, bacteria CHEMICAL URINALYSIS BY REAGENT STRIP
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Denielle Genesis B. Camato
V. URINALYSIS ANALYSIS OF URINALYSIS AND BODY FLUIDS | REVIEWER
1
URINALYSIS
[ Probably the oldest clinical laboratory practice [ Usually involves gross observation and assessment of general appearance,
dipstick analysis, and microscopic assessment [ One of the most commonly performed laboratory test
URINE
[ pale yellow fluid produced by the kidneys, composed of dissolved wastes and excess water or chemical substances from the body
[ produced when blood is filtered through the kidneys
CHANGES IN URINE AT ROOM TEMPERATURE
r Bacteria multiply and may cause turbidity and a positive protein reaction
r Bacteria convert urea to ammonia, which increases pH. r Bacteria metabolize glucose. r RBCs lyse in dilute or alkaline urine. r Casts lyse in alkaline urine. r WBCs disintegrate. r Bilirubin/urobilinogen are lost through exposure to light and/or oxidation. r Ketones are lost through evaporation.
URINE VOLUME
Normal daily volume 1200-1500 mL
Normal day-night ratio 2:1 – 3:1 Diuresis Increased urine production Polyuria >2000 mL/day
r diabetes mellitus r diabetes insipidus
Oliguria <500 mL/day r dehydration r renal disease r obstruction of urinary
tract Anuria No urine production
URINE COLOR AND CLARITY
Urochrome Normal yellow color
Dilute urine Colorless Concentrated urine Dark yellow, amber Bilirubin Yellow-brown or olive green
Yellow foam on shaking Homogentistic acid Normal on voiding
Brown or black on standing Beginning at surface
Melanin Brown or black on standing Methemoglobin Brown or black due to oxidation of
hemoglobin in acid urine Myoglobin “Cola” on standing Blood/hemoglobin Pink or red when fresh
“Cola” or “Smoky” on standing Cloudy with RBCs Clear with hemoglobin
Detects all proteins, including Bence Jones proteins.
Clinitest Reducing substances Copper reduction False-positive: High levels of ascorbic acid. False-negative: Glycolysis, pass through. (Color goes through orange and returns to blue or blue-green. Repeat using two-drop method and two-drop color chart.)
Non-specific. Reacts with glucose, galactose, fructose, maltose, lactose. (Sucrose is not reducing sugar.) Test all infants to diagnose galactosemia. Not as sensitive for glucose as reagent strip. Self-heating method. Perform in rack to avoid burning.
Acetest Ketones Sodium nitroprusside reaction
False-negative: Improperly stored specimen
Most sensitive to acetoacetic acid
Ictotest Bilirubin Diazo reaction Drecreased: exposure to light, improperly stored specimen, high levels of ascorbic acid, nitrites. False-positive: Urine pigments.
More sensitive than reagent strip. Less affected by interfering substances
Watson-Shwartz Test Urobilinogen, porphobilinogen
Ehrlich’s aldehyde reaction
Decreased: exposure to light, more than 1 hour at room temperature. False-positive: Warm aldehyde reaction. (Urine should be at room temperature.)
Collect specimen from 2-4pm. Store in dark. Urobilinogen is soluble in chloroform and butanol. Porphobilinogen is not soluble in either.
Hoesch Test Porphobilinogen Ehrlich’s aldehyde reaction
Similar to Watson-Schwartz
Urobilinogen doesn’t react unless very high.
!
[ Sources of error may vary with brand of reagent strip. Refer to manufacturer’s package insert.
CONFIRMATORY/ SUPPLEMENT URINE CHEMISTRY TESTS
EFFECT OF HIGH LEVELS OF ASCORBIC ACID ON URINALYSIS TESTS
*May vary with brand of reagent strip. Refer to manufacturer’s package insert.
V. URINALYSIS ANALYSIS OF URINALYSIS AND BODY FLUIDS | REVIEWER
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TYPE DESCRIPTION SIGNIFANCE COMMENTS Hyaline Homogenous with
parallel sides and rounded ends
0-2/low power field (LPF) are normal. Increased with stress. Fever, trauma exercise, renal disease
Most common type. Least significant. Contain Tamm-Horsfall protein only. Maybe overlooked if light is too bright
Granular Same as Hyaline but contain granule
0-1/LPF is normal increased with stress, exercise Glomerulonephritis Pyelonephritis
May originate from disintegration of cellular casts.
RBC RBCs in cast matrix Yellowish to orange
color
Acute Glomerulonephritis Strenuous exercise
Pinpoints source of bleeding in kidney. Most fragile of casts. Often in fragments.
Blood Contain hemoglobin. Yellowish to orange
color
Same as RBC cast From disintegration of RBC casts
WBC Leukocytes incorporated into cast matrix.
Irregular in shape
Pyelonephritis Pinpoints kidney as the site of infection
Epithelial cell Renal tubular epithelial cells incorporated into cast matrix
Renal tubular damage Transitional and squamous epithelial cell cast do not exist These cells are found distal to renal tubules and collecting ducts where casts are formed.
Waxy Homogenous Opaque Notched edges Broken ends
Urinary stasis From degeneration of cellular and granular casts Unfavorable sign
Fatty Cast containing lipid droplets
Nephrotic syndrome Maltese crosses with polarized light. Stain with Sudan and oil red O
Broad Wide Maybe cellular, granular
or waxy
Advanced renal disease Formed in dilated distal tubules and collecting ducts. “Renal failure casts.”