1 Composition of Urine Physiological change in body caused by disease Can create a disturbance in kidney function Can be detected by examination of urine Copyright 2016 by Elsevier Inc All rights reserved ID: 1045117
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1. Chapter 30UrinalysisCopyright 2016 by Elsevier Inc. All rights reserved.1
2. Composition of Urine Physiological change in body caused by disease:Can create a disturbance in kidney functionCan be detected by examination of urineCopyright 2016 by Elsevier Inc. All rights reserved.2
3. Composition of Urine Urine is composed of:Water: 95% Organic and inorganic waste products: 5%Organic wastes: urea, uric acid, ammonia, and creatinineUrea is present in greatest amounts – derived from breakdown of proteinsInorganic wastes: chloride, sodium, potassium, calcium, magnesium, phosphate, sulfateCopyright 2016 by Elsevier Inc. All rights reserved.3
4. Composition of Urine Normal adult: excretes 750 to 2000 ml of urine per dayVaries based on:Amount of fluid consumedAmount lost through other means (perspiration, feces)Copyright 2016 by Elsevier Inc. All rights reserved.4
5. Composition of Urine Polyuria: excessive increase in urine outputCaused by:Excessive intake of fluidsIntake of fluids that contain caffeine (mild diuretic)Drugs (diuretics)Pathological conditions (e.g., diabetes, renal disease)Copyright 2016 by Elsevier Inc. All rights reserved.5
6. Composition of Urine Oliguria: decreased output of urineLess than 400 ml in 24 hoursCaused byDecreased fluid intakeDehydrationProfuse perspirationVomitingDiarrheaKidney diseaseMicturition: normal act of voiding urineCopyright 2016 by Elsevier Inc. All rights reserved.6
7. Terms Related to the Urinary System Anuria: failure of the kidneys to produce urineDiuresis: secretion and passage of large amounts of urineDysuria: difficult or painful urinationFrequency: the condition of having to urinate oftenHematuria: blood present in urineCopyright 2016 by Elsevier Inc. All rights reserved.7
8. Terms Related to the Urinary System Nocturia: excessive (voluntary) urination during the nightNocturnal enuresis: the inability of the patient to control urination at night during sleep (bedwetting)Pyuria: pus present in the urineRetention: the inability to empty the bladderThe urine is being produced normally but is not being voidedUrgency: the immediate need to urinateUrinary incontinence: the inability to retain urineCopyright 2016 by Elsevier Inc. All rights reserved.8
9. Collection of UrineAdvantages of urine testingUrine is easily availableDoes not require:An invasive procedureUse of special equipmentTo obtain accurate urine test results:Adhere to proper urine collection proceduresEnsures collection of proper specimenCopyright 2016 by Elsevier Inc. All rights reserved.9
10. Guidelines for Urine Collection Make sure to obtain an adequate volume (usually 30 to 50 ml)Properly label each specimen: avoids mix-up of specimensPatient's name and DOBDate and time of collectionType of specimen (i.e., urine)Copyright 2016 by Elsevier Inc. All rights reserved.10
11. Guidelines for Urine Collection Record medications patient is taking on laboratory requisition and in patient's chart:Some medications interfere with the accuracy of test resultsDo not collect a specimen during menstruationMay contaminate the specimen with bloodResult in false-positive results on test for bloodDifficult for some patients to void under stress and anxietyBe patient and relay understanding to patient Copyright 2016 by Elsevier Inc. All rights reserved.11
12. Guidelines for Urine Collection May be difficult to obtain from a child:May need to use another collection methodUrine collection bagSuprapubic aspirationCatheterizationCopyright 2016 by Elsevier Inc. All rights reserved.12
13. Urine Specimen Collection Methods Type of test being performed: often dictates the collection method ExamplesPregnancy test: first-voided morning specimenIdentification of a UTI: clean-catch midstream collectionCopyright 2016 by Elsevier Inc. All rights reserved.13
14. Urine Specimen Collection MethodsMost offices use disposable plastic specimen containers Available in different sizesHave lids to:Prevent spillageReduce contamination of the specimenCopyright 2016 by Elsevier Inc. All rights reserved.14
15. Random SpecimenUrine testing is often performed on a freshly voided specimenMA instructs patient to void into clean, dry, wide-mouthed containerUrine is tested immediatelyCopyright 2016 by Elsevier Inc. All rights reserved.15
16. First-Voided Morning SpecimenContains greatest concentration of dissolved substancesSmall amount of a substance detected more easilyInstruct patient to collect first specimen of the morningPreserve it in refrigeratorCopyright 2016 by Elsevier Inc. All rights reserved.16
17. First-Voided Morning SpecimenProvide patient with specimen containerTo prevent use of a container that harbors contaminantsCould cause inaccurate test resultsCopyright 2016 by Elsevier Inc. All rights reserved.17
18. Clean-Catch Midstream Specimen Microorganisms are NOT normally present in:Urinary bladderMost of urethraMicroorganisms are normally present in:Distal urethraUrinary meatusCopyright 2016 by Elsevier Inc. All rights reserved.18
19. Clean-Catch Midstream Specimen Clean-catch: required when urine is cultured and examined for bacteriaTo prevent contamination of the specimen with normally present microorganismsOnly microorganisms causing patient's condition are desired in specimenOrdered for:Detection of a UTIEvaluate effectiveness of drug therapy for a UTICopyright 2016 by Elsevier Inc. All rights reserved.19
20. Clean-Catch Midstream Specimen Clean-catch procedure:Sterile container is usedTo prevent contamination of specimen with normal flora:Microorganisms are removed from urinary meatus by having patient cleanse the meatusMicroorganisms are flushed out of distal urethra by having patient void a small amount into toiletCopyright 2016 by Elsevier Inc. All rights reserved.20
21. Clean-Catch Midstream Specimen Reduces possibility of having to obtain urine specimen by:Bladder catheterization: Passing of a sterile catheter through the urethra into the bladder Suprapubic aspiration of bladder: Passing of a sterile needle through the abdominal wall into the bladderCopyright 2016 by Elsevier Inc. All rights reserved.21
22. Guidelines Collected by patient at officeMA provides instructions:Provide complete instructions:To prevent contamination of specimen with bacteriaAvoid patient having to collect another specimenCopyright 2016 by Elsevier Inc. All rights reserved.22
23. Guidelines When collected: MA should immediately cap and label the container:Patient's name and DOBDate and time of collectionType of collection (clean-catch)Copyright 2016 by Elsevier Inc. All rights reserved.23
24. GuidelinesTest specimen immediately (or refrigerate)To ensure reliable test resultsIf sent to outside laboratoryComplete the laboratory request formRecord in patient's chart: information on transport of specimen to laboratoryCopyright 2016 by Elsevier Inc. All rights reserved.24
25. Twenty-Four Hour Urine SpecimenQuantitative measurement of specific urinary components Greater accuracy of measurement than with random specimenCopyright 2016 by Elsevier Inc. All rights reserved.25
26. Twenty-Four Hour Urine SpecimenExamples of substances measuredCalciumCreatinineLeadPotassiumProteinUrea nitrogenCopyright 2016 by Elsevier Inc. All rights reserved.26
27. Twenty-Four Hour Urine SpecimenOften used to:Diagnose the cause of kidney stone formationAssist in the control and prevention of new stone formationLarge container used (3000 ml)Used to store urine collected over 24 hoursTo prevent changes in the quality of the specimenSpecimen must be kept refrigeratedOr placed in an ice chestCopyright 2016 by Elsevier Inc. All rights reserved.27
28. Twenty-Four Hour Urine SpecimenSome containers also contain a preservativeMaintains quality of specimenHazardous chemical warning label should be attached to containerInstruct patient not to discard or touch the preservativeCopyright 2016 by Elsevier Inc. All rights reserved.28
29. Twenty-Four Hour Urine SpecimenPatient is also provided with container to collect specimenFemale: urine “hat”Placed over commode under toilet seatMale: Collection cup After collection: urine is placed into the large specimen containerCopyright 2016 by Elsevier Inc. All rights reserved.29
30. Twenty-Four Hour Urine SpecimenPatient is also provided with container to collect specimenMakes collection easier and saferIf patient voids directly into container with preservative – could splash onto patient’s skin resulting in a chemical burnCopyright 2016 by Elsevier Inc. All rights reserved.30
31. Twenty-Four Hour Urine SpecimenMA should provide both written and verbal instructionsDrink normal amount of fluid during collection periodAvoid alcohol for 24 hours before and during collectionCopyright 2016 by Elsevier Inc. All rights reserved.31
32. Twenty-Four Hour Urine SpecimenMA should provide both written and verbal instructionsChoose 24-hour period when you will be at homeSo urine won’t have to be transportedDo not perform during menstruationPhysician may want patient to discontinue certain medications for 1 week before the testCopyright 2016 by Elsevier Inc. All rights reserved.32
33. Analysis of Urine Urinalysis: analysis of urineConsists of:Physical examinationChemical examinationMicroscopic examinationCopyright 2016 by Elsevier Inc. All rights reserved.33
34. Analysis of Urine Deviation from normal on urinalysisAssists in diagnosis and treatment of pathological conditions of:Urinary systemOther body systemsCopyright 2016 by Elsevier Inc. All rights reserved.34
35. Analysis of Urine May be performed:As screening measurePart of physical examinationAssist in the diagnosis of a patient's conditionEvaluate effectiveness of therapyAfter treatment has been initiatedCopyright 2016 by Elsevier Inc. All rights reserved.35
36. Analysis of Urine Perform urinalysis on a fresh or preserved specimenIf specimen cannot be examined with 1 hour of voidingPreserve immediately in refrigeratorBefore testing: return to room temperature; thoroughly mix specimen (rotate urine container)Copyright 2016 by Elsevier Inc. All rights reserved.36
37. Analysis of Urine Perform urinalysis on a fresh or preserved specimenChanges that take place if specimen stands out for more than 1 hourBacteria in environment that get into specimen – work on urea (acidic): converting it to ammonia (alkaline) – (Changes pH of urine: acid urine becomes alkaline; may result in false-positive result on protein test)Bacteria multiply resulting in: cloudy specimen; increase in nitriteCopyright 2016 by Elsevier Inc. All rights reserved.37
38. Analysis of Urine Perform urinalysis on a fresh or preserved specimenChanges that take place if specimen stands out for more than 1 hourIf glucose is present in specimen: amount decreases – microorganisms use glucose for foodIf any red or white blood cells are present: they may break downCasts decompose after several hoursCopyright 2016 by Elsevier Inc. All rights reserved.38
39. Physical Examination of Urine For accurate evaluation of color and appearanceSpecimen must be in a clear plastic or glass containerCopyright 2016 by Elsevier Inc. All rights reserved.39
40. ColorRanges from almost colorless to dark yellowDilute urine: lighter yellowOccurs as day progresses and more fluids are consumedConcentrated urine: darker yellow (e.g., first-voided specimen)Occurs because fluid consumption is decreased at nightColor due to yellow pigment: urochromeFrom breakdown of hemoglobinColor varies among different shades of yellow throughout the dayCopyright 2016 by Elsevier Inc. All rights reserved.40
41. ColorClassifications used to describe color:Light yellowYellowDark yellowLight amberAmberDark amberColor of urine specimenAssists in determining additional tests that may be necessaryCopyright 2016 by Elsevier Inc. All rights reserved.41
42. ColorAbnormal color may be due toPresence of hemoglobin or blood (reddish color)Bile pigments (yellow-brown or greenish)Fat droplets or pus (milky color)Some foods and medications Abnormal color: helps to determine additional tests neededCopyright 2016 by Elsevier Inc. All rights reserved.42
43. AppearanceFresh urine: usually clear or transparentBecomes cloudy on standing out too longCloudiness in freshly voided specimenPresence of bacteria, pus, blood, fat, yeast, sperm, mucous threads, or fecal contaminantsMicroscopic examination: performed on cloudy specimens to determine causeCloudiness resulting from bacteria may be caused by a UTICopyright 2016 by Elsevier Inc. All rights reserved.43
44. AppearanceClassifications used to describe appearance:ClearSlightly cloudyCloudyVery cloudyCopyright 2016 by Elsevier Inc. All rights reserved.44
45. OdorFreshly voided urine: slightly aromatic odorUrine standing for long periods: ammonia odorAs a result of breakdown of urea by bacteriaUrine of diabetic patients may have fruity odor: presence of ketonesUrine of patient with UTI: foul-smelling odorCertain foods (e.g., asparagus causes a musty smell)Odor not generally used in diagnosis of the patient’s conditionCopyright 2016 by Elsevier Inc. All rights reserved.45
46. Specific GravityMeasures weight of urine as compared with the weight of an equal volume of distilled waterIndicates amount of dissolved substances present in urineProvides information on ability of the kidney to dilute or concentrate the urineDecreased SG:Chronic renal insufficiencyDiabetes insipidusMalignant hypertensionCopyright 2016 by Elsevier Inc. All rights reserved.46
47. Specific GravityIncreased SG:Adrenal insufficiencyCongestive heart failureHepatic diseaseDiabetes mellitus with glycosuriaConditions causing dehydration (e.g., fever, vomiting, and diarrhea)Copyright 2016 by Elsevier Inc. All rights reserved.47
48. Specific GravityNormal range for SG of urine: 1.003 to 1.030Usually between 1.010 and 1.025SG of distilled water: 1.000Copyright 2016 by Elsevier Inc. All rights reserved.48
49. Specific GravityDilute urine: lower SG (fewer dissolved substances)Concentrated urine: higher SG (more dissolved substances)Urine is more concentrated in morning: Increased amount of dissolved substancesUrine is more dilute after fluid consumptionCopyright 2016 by Elsevier Inc. All rights reserved.49
50. Specific GravityMeasurement of SGReagent strip method: most common method used to measure SGColor comparison determinationStrip dipped in urineResults compared with color chartCopyright 2016 by Elsevier Inc. All rights reserved.50
51. Chemical Examination of Urine Used to assist in diagnosis of:Kidney functionUrinary tract infectionsCarbohydrate metabolism (diabetes mellitus)Liver functionCopyright 2016 by Elsevier Inc. All rights reserved.51
52. Chemical Examination of Urine Substances present in excess (abnormal) amounts in the blood Are usually removed by urineExample: glucose is normally present in blood – if it exceeds a certain level: excess is excreted in urineIndirect means of detecting abnormal amounts of chemicals in the bodyDetection of substances that do not normally appear in the absence of diseaseExample: blood and nitriteCopyright 2016 by Elsevier Inc. All rights reserved.52
53. Chemical Examination of Urine Chemical tests that are routinely performed:pHGlucoseProteinKetoneCopyright 2016 by Elsevier Inc. All rights reserved.53
54. Chemical Examination of Urine Other tests that may be performed:BloodBilirubinUrobilinogenNitriteLeukocytesCopyright 2016 by Elsevier Inc. All rights reserved.54
55. Chemical Examination of Urine Qualitative test resultsPurposeIndicate whether or not a substance is present in urineProvide approximate indication of amount of substance presentInterpretation of results Usually involves use of color comparison chartCopyright 2016 by Elsevier Inc. All rights reserved.55
56. Chemical Examination of Urine Qualitative test resultsResults recorded in terms ofTrace, 1+, 2+, 3+Trace, small, moderate, largeNegative or positiveUseful as a screening testEasy to performCopyright 2016 by Elsevier Inc. All rights reserved.56
57. Chemical Examination of Urine Quantitative test resultsIndicate exact amount of chemical substance present in the bodyResults reported in measurable unitsExample: 14 mg/dLObtaining quantitative result on urine specimenUsually involves use of complex equipment and testing proceduresNot usually performed in the medical officeCopyright 2016 by Elsevier Inc. All rights reserved.57
58. Urine Testing Kits Most frequently used in the medical office for chemical testing of urineAdvantagesContain premeasured reagentEasy to performProvide immediate resultsMost are qualitative test results: positive result indicates need for further testingCopyright 2016 by Elsevier Inc. All rights reserved.58
59. Urine Testing Kits Rely on color change for interpretation of resultsColor chart used to make a visual comparisonTo ensure accurate and reliable test resultsCarefully read and follow manufacturer's instruction sheetTest strips that contain more than one reagentMay require different time intervals for reading resultsCopyright 2016 by Elsevier Inc. All rights reserved.59
60. Urine Testing Kits Certain medications may affect results: listed in instructionsExpiration date must be checked before usingDo not use if past the expiration dateTest results may be inaccurateCopyright 2016 by Elsevier Inc. All rights reserved.60
61. Urine Testing Kits Should not be used if:Color change has occurred on stripTested strip is a color that does not match chartLight, heat, and moisture can affect stripsStore in cool, dry areaTests are packaged in a light-resistant containerCopyright 2016 by Elsevier Inc. All rights reserved.61
62. Urine Testing Kits Never transfer from original container to anotherAnother container may contain moisture, dirt, chemicalsCould affect test resultsRecording test resultsIndicate brand name of test that was used (e.g., Multistix 10SG)Copyright 2016 by Elsevier Inc. All rights reserved.62
63. pHUnit that indicates acidity or alkalinity of a solutionRange of pH scale: 0.0 to 14.0Lower the number: greater the acidityHigher the number: greater the alkalinitypH readings:Neutral: 7.0Acid: Below 7Alkaline: Above 7Copyright 2016 by Elsevier Inc. All rights reserved.63
64. pHPerform test on freshly voided urineIf urine is allowed to stand out:Becomes more alkaline: urea is converted to ammonia by bacteriapH of urine: ranges from 4.6 to 8.0 (usually around 6.0, which is acidic)High reading on a fresh specimen: may indicate bacterial infection of urinary tractCopyright 2016 by Elsevier Inc. All rights reserved.64
65. GlucoseShould not normally be present in urineGlucose in the blood: filtered through nephrons and reabsorbed into the bodyIf glucose concentration in blood becomes too high: renal threshold is exceeded Kidneys unable to reabsorb all of the glucose back into the bloodResults in glycosuria: glucose in the urineCopyright 2016 by Elsevier Inc. All rights reserved.65
66. GlucoseIf glucose concentration in blood becomes too high: renal threshold is exceeded Renal threshold is exceededRenal threshold: concentration at which a substance in the blood not normally excreted by the kidney begins to appear in the urineRenal threshold for glucose: generally between 160 and 180 mg/dLCopyright 2016 by Elsevier Inc. All rights reserved.66
67. GlucoseDiabetes: most common cause of glycosuriaAlimentary glucosuria: patient has a low renal thresholdGlucose may appear after consumption of large quantities of sugarCopyright 2016 by Elsevier Inc. All rights reserved.67
68. ProteinProteinuria: Presence of protein in the urineTemporary increase may be caused by stress or strenuous exerciseConditions causing proteinuriaGlomerular filtration problemsRenal diseasesBacterial infections of the urinary tractIf proteinuria occurs:Physician usually orders examination of sedimentTo see what is causing the protein to be in the patient's urine (e.g., bacteria)Copyright 2016 by Elsevier Inc. All rights reserved.68
69. KetoneThree types of ketone bodiesBeta-hydroxybutyric acidAcetoacetic acidAcetoneCopyright 2016 by Elsevier Inc. All rights reserved.69
70. KetoneNormal products of fat metabolismCan be used by muscle tissue as a source of energyWhen more than normal amounts of fat are metabolized Muscles cannot handle all of the ketones that resultKetosis: accumulation of large amounts of ketone bodies in tissues and body fluidsCopyright 2016 by Elsevier Inc. All rights reserved.70
71. KetoneKetonuria: presence of ketone bodies in the urineBody rids itself of excess ketones by excreting them in urineConditions causing ketonuriaUncontrolled diabetesStarvationDiet composed almost entirely of fatCopyright 2016 by Elsevier Inc. All rights reserved.71
72. BilirubinLifespan of RBC: 120 daysRBC: contains hemoglobinFunction of hemoglobin: transports oxygen in the bodyCopyright 2016 by Elsevier Inc. All rights reserved.72
73. BilirubinWhen a RBC breaks down: hemoglobin breaks downReleases bilirubin (vivid yellow pigment)Bilirubin: normally transported to liver and excreted with bileEventually leaves body through intestines (feces)With certain liver conditions:Liver cannot accept bilirubinBilirubin is transported to kidneysExcreted into urine: bilirubinuria – causes urine to be yellow-brown or greenishCopyright 2016 by Elsevier Inc. All rights reserved.73
74. BilirubinConditions causing bilirubinuriaGallstonesHepatitisCirrhosis of the liverCopyright 2016 by Elsevier Inc. All rights reserved.74
75. UrobilinogenConditions causing increase in urobilinogen in urine:Excessive hemolysis of red blood cellsInfectious hepatitisCirrhosisCongestive heart failure (CHF)MononucleosisCopyright 2016 by Elsevier Inc. All rights reserved.75
76. BloodConsidered abnormal (unless due to menstruation)Hematuria: presence of blood in the urineConditions causing hematuria:InjuryCystitisTumors of bladderUrethritisKidney stonesCertain kidney disordersCopyright 2016 by Elsevier Inc. All rights reserved.76
77. NitriteIndicates presence of a pathogen in urinary tract (UTI)Pathogens present in the urine in the bladder:Causes nitrate to convert to nitriteNitrate: normally present in the urineNitrite: normally absent in the urinePerform on urine that has been in bladder 4 to 6 hours (first-voided specimen)To ensure the pathogens have converted nitrate to nitriteCopyright 2016 by Elsevier Inc. All rights reserved.77
78. NitriteShould not be performed on specimen that has been standing out Results in a false-positive resultCaused by environmental bacterial contamination of the specimenScreening test: usually followed with culture To identify the pathogenCopyright 2016 by Elsevier Inc. All rights reserved.78
79. LeukocytesLeukocyturia: presence of leukocytes in the urineAccompanies inflammation of kidneys and lower urinary tractConditions causing leukocyturiaAcute and chronic pyelonephritisCystitisUrethritisCopyright 2016 by Elsevier Inc. All rights reserved.79
80. LeukocytesRecommended specimen for women: Clean-catch midstream collectionPrevents contamination of specimen with leukocytes from vaginal secretionsCan cause false-positive test resultsCopyright 2016 by Elsevier Inc. All rights reserved.80
81. Reagent Strips Most common test used in medical office to test urineDisposable plastic strips: contain reagent areas for testing chemicals in urineCopyright 2016 by Elsevier Inc. All rights reserved.81
82. Reagent Strips Results provide physician with information to assist in the diagnosis of:Kidney function conditions (e.g., kidney stones)UTICarbohydrate metabolism conditions (e.g., diabetes mellitus)Liver function conditions (e.g., hepatitis)Copyright 2016 by Elsevier Inc. All rights reserved.82
83. Reagent Strips Test results also provide physician with information related to: Acid-base balance of the bodyUrine concentrationCopyright 2016 by Elsevier Inc. All rights reserved.83
84. Reagent Strips Provide qualitative test resultsPositive result: requires further testingNumber and type of reagent areas depend on the particular brandAlways read manufacturer's instructions before performing the testCopyright 2016 by Elsevier Inc. All rights reserved.84
85. Guidelines for Reagent Strip Urine Testing Preferred type of specimen: freshly voided and thoroughly mixedIf not possible: refrigerate specimenBefore testing: allow to return to room temperature; thoroughly mix specimenCopyright 2016 by Elsevier Inc. All rights reserved.85
86. Guidelines for Reagent Strip Urine Testing Type of collection:Most designed to be used with a random specimenCertain tests require a special collection procedure:Nitrite test: First-voided morning specimenLeukocyte test: Clean-catch midstream specimenCopyright 2016 by Elsevier Inc. All rights reserved.86
87. Guidelines for Reagent Strip Urine Testing Specimen containerMust be cleanTo prevent inaccurate test resultsMust be large enoughTo allow for complete immersion of strip Copyright 2016 by Elsevier Inc. All rights reserved.87
88. Guidelines for Reagent Strip Urine Testing Time intervalsRead results at exact time intervalsSpecified on color chartDo not read any test results after 2 minutesCopyright 2016 by Elsevier Inc. All rights reserved.88
89. Guidelines for Reagent Strip Urine Testing Interpretation of results: Compare with color chart in good lightingTo obtain a good visual matchCopyright 2016 by Elsevier Inc. All rights reserved.89
90. Guidelines for Reagent Strip Urine Testing Storage of reagent strips: cool, dry area with the cap tightly closedReagents on strips are sensitive to light, heat, and moistureContainer includes a desiccant to absorb moisture: do not removeCopyright 2016 by Elsevier Inc. All rights reserved.90
91. Guidelines for Reagent Strip Urine Testing Storage of reagent strips: cool, dry area with the cap tightly closedStore at a temperature between 59ºF (15ºC) and 86ºF (30ºC)Do not store in refrigerator or freezerTan-to-brown discoloration or darkening on reagent areasIndicates deterioration of stripsDo not use strips: test results would be inaccurateCopyright 2016 by Elsevier Inc. All rights reserved.91
92. Quality Control Testing Ensures reliability of test results Determines if strips are reacting properlyConfirms that the test is being properly performed and accurately interpretedExample: Chek-Stix control checks reliability of MultistixConsists of a plastic strip with seven synthetic ingredientsReconstituted in distilled water for 30 minutesIngredients dissolve in the waterCopyright 2016 by Elsevier Inc. All rights reserved.92
93. Quality Control Testing Example: Chek-Stix control checks reliability of MultistixResulting solution is tested with a Multistix reagent stripUsing the same procedure as a urine specimenExpected values: outlined on a sheet accompanying the control stripsRecord control test results in a quality control logIf expected values are not obtained: Determine cause of problem and correct it – Outdated strips or control; improper storage of strips or control; error in technique.Copyright 2016 by Elsevier Inc. All rights reserved.93
94. Quality Control Testing Perform quality controlWhen you open a new bottle of stripsQuestion of reliability with testing stripsCopyright 2016 by Elsevier Inc. All rights reserved.94
95. Urine Analyzer Performs chemical examination of urine automatically Uses reagent stripsAdvantageQuick and easyResults are interpreted automaticallyClinitek AnalyzerAutomatically reads Multistix Results printed outAbnormal results are flaggedCopyright 2016 by Elsevier Inc. All rights reserved.95
96. Microscopic Examination of Urine Urine sediment: solid materials contained in urineSediment sample is placed on a slide by MAViewed under a microscope by physicianHelps clarify results of physical and chemical examinationCopyright 2016 by Elsevier Inc. All rights reserved.96
97. Microscopic Examination of Urine First-voided morning specimen preferred: more concentratedContains more dissolved substancesSmall amounts of abnormal substances: more likely to be detectedCopyright 2016 by Elsevier Inc. All rights reserved.97
98. Microscopic Examination of Urine Important to use a fresh specimenChanges occur if specimen is left standing outAffects reliability of test resultsMA responsible for preparing urine specimenFor microscopic examination by the physicianCopyright 2016 by Elsevier Inc. All rights reserved.98
99. Red Blood Cells Round, colorless, biconcave discsNormal: 0 to 5 per high-power fieldCopyright 2016 by Elsevier Inc. All rights reserved.99
100. Red Blood Cells More than 5 per high-power field: may indicate bleeding along the urinary tractConcentrated urine: causes RBCs to become shrunken or crenatedDilute urine: causes RBCs to swell and hemolyzeWill not be seen under a microscopeWill still show a positive on reagent strip test (for blood)Copyright 2016 by Elsevier Inc. All rights reserved.100
101. White Blood Cells Round, granular, with a nucleusApproximately 1.5 times larger than RBCNormal: 0 to 8 per high-power fieldMore than 8 per high-power field: may indicate inflammation of genitourinary tractCopyright 2016 by Elsevier Inc. All rights reserved.101
102. Epithelial Cells Most structures making up urinary system: composed of several layers of epithelial cellsOuter layer: constantly being sloughed offReplaced by cells underneathSquamous epithelial cells: large, clear, flat cells with irregular shapeContain small nucleusCome from urethra, bladder, vaginaNormally present in small amounts in urineCopyright 2016 by Elsevier Inc. All rights reserved.102
103. Epithelial Cells Renal epithelial cells: round with large nucleusCome from deeper layers of urinary tractPresence in urine is abnormalCopyright 2016 by Elsevier Inc. All rights reserved.103
104. CastsCylindrical structures: formed in lumen of nephron tubulesMaterials in tubules harden and are flushed out: appear in urine as castsGenerally indicate diseased conditionNamed according to what they containHyaline casts: pale, colorless cylinders with rounded edgesVary in sizeCopyright 2016 by Elsevier Inc. All rights reserved.104
105. CastsNamed according to what they containGranular casts: hyaline casts that contain granulesNamed according to what they containFatty casts: hyaline casts that contain fat dropletsNamed according to what they containWaxy casts: light yellowish with serrated edgesAppear to be made of waxCopyright 2016 by Elsevier Inc. All rights reserved.105
106. CastsCellular Casts: hyaline casts that contain organized structuresNamed for what they containRBC castsWBC castsEpithelial castsVariety may be found in urineType and number vary with urine pH Copyright 2016 by Elsevier Inc. All rights reserved.106
107. CrystalsAbnormal crystals:LeucineTyrosineCystineCholesterolCopyright 2016 by Elsevier Inc. All rights reserved.107
108. CrystalsCrystals that commonly appear in acidic urineAmorphous uratesUric acidCalcium oxalateCommonly appear in alkaline urineAmorphous phosphateTriple phosphateCalcium phosphateAmmonium urateCopyright 2016 by Elsevier Inc. All rights reserved.108
109. Miscellaneous Structures Mucous threads: normally present in small amounts in urineLong, wavy, threadlike structures with pointed endsBacteria: rod shaped or roundShould not normally be presentPresence of more than a few: May indicate contamination of specimen during collectionUTICopyright 2016 by Elsevier Inc. All rights reserved.109
110. Miscellaneous Structures Yeast cellsSmooth, refractile bodies with oval shapeSmall buds project from cellsIn females Usually vaginal contaminant caused by Candida albicans (yeast infection)May also be present in patients with diabetesCopyright 2016 by Elsevier Inc. All rights reserved.110
111. Miscellaneous Structures ParasitesMay be present as a contaminate from fecal or vaginal materialTrichomonas vaginalis: parasite that causes trichomoniasis vaginitisSpermatozoaMay be present in men or women after intercourseHave round heads, long, slender, hairlike tailsCopyright 2016 by Elsevier Inc. All rights reserved.111
112. Urine Pregnancy Testing PurposeTo determine if a woman is pregnantBefore certain medications are given or procedures performed that may cause injury to a fetusCopyright 2016 by Elsevier Inc. All rights reserved.112
113. Urine Pregnancy Testing Immunological tests often used in the officeTest results rely on the presence of human chorionic gonadotropin (HCG)Concentrated urine specimen required (first-voided morning)HCG: produces positive resultCopyright 2016 by Elsevier Inc. All rights reserved.113
114. Human Chorionic Gonadotropin Produced by developing fertilized eggSmall amounts secreted into urine and bloodImmediately after conception and implantation: level of HCG rises rapidlyCan detect pregnancy with a serum pregnancy test As early as 6 days before the first missed periodCopyright 2016 by Elsevier Inc. All rights reserved.114
115. Human Chorionic Gonadotropin Highest level: occurs 8 weeks after conceptionAfter this time: HCG declines72 hours after delivery: HCG disappears entirelyPregnancy tests are more sensitive in the first trimesterMay even show a negative reaction during the second and third trimesterCopyright 2016 by Elsevier Inc. All rights reserved.115
116. Immunoassay Tests Used in medical office to detect pregnancyConvenient to performProvide immediate test resultsPositive and negative reactionsResults in a specific visible reactionThat can be observed and interpretedCopyright 2016 by Elsevier Inc. All rights reserved.116
117. Immunoassay Tests Commercially available in testing kitsContain required reagents and suppliesEach kit performs a specific number of testsProduct insert includedMust follow exactly to prevent inaccurate test resultsMost are 99% accurate With low occurrence of false-positive test resultsCopyright 2016 by Elsevier Inc. All rights reserved.117
118. Immunoassay Tests Brand namesQuickVue One StepOSOMClearviewCopyright 2016 by Elsevier Inc. All rights reserved.118
119. Immunoassay Tests Early prediction pregnancy testsMay be able to detect pregnancyAs early as 2-3 days before first missed period – may sometimes show a false-negative when performed early (repeat later to confirm results)Accurate results more probableIf urine testing 1 week after a missed periodCopyright 2016 by Elsevier Inc. All rights reserved.119
120. Immunoassay Tests Results observed as a color changeInstructions for interpreting resultsIncluded in product insertCopyright 2016 by Elsevier Inc. All rights reserved.120
121. Guidelines for Urine Pregnancy Testing Use clean, disposable urine containersPreferred specimen: first-voided morning specimenContains highest concentration of HCGHowever a random specimen can be usedSpecific gravity should be determined before the testLess than 1.007: too dilute for testingCould cause a false-negative resultCopyright 2016 by Elsevier Inc. All rights reserved.121
122. Guidelines for Urine Pregnancy Testing Urine specimen should be at room temperatureKit should be stored according to manufacturer's instructionsMost testing kits are stored at room temperature (between 59ºF [15ºC] and 86ºF [30ºC])Away from direct sunlightKit past the expiration date: should not be usedCopyright 2016 by Elsevier Inc. All rights reserved.122
123. Guidelines for Urine Pregnancy Testing If more than one patient is being testedLabel each testing device with patient’s namePrevents mixup of specimensMost testing kits include an internal controlPerformed at same time as testing procedureDetermines:Whether sufficient amount of specimen was added to cassetteIf correct technique was followedCopyright 2016 by Elsevier Inc. All rights reserved.123
124. Guidelines for Urine Pregnancy Testing Internal ControlPerformed at the same time as the test procedureDetermines whether the specimen is sufficient for testing purposesCopyright 2016 by Elsevier Inc. All rights reserved.124
125. Guidelines for Urine Pregnancy Testing If it does not perform as expectedTest result is invalid Must retest the specimenDocument internal control in quality control logFor first test run each dayCopyright 2016 by Elsevier Inc. All rights reserved.125
126. Guidelines for Urine Pregnancy Testing Perform a positive and negative external control With each new lot of urine pregnancy testing kits Monthly thereafterExternal controls are used to:Determine if testing reagents are performing properly Detect any errors in technique Copyright 2016 by Elsevier Inc. All rights reserved.126
127. Guidelines for Urine Pregnancy Testing External controls:Consist of commercially available solutions May be included with test system Or may need to be purchased separatelyCopyright 2016 by Elsevier Inc. All rights reserved.127
128. Guidelines for Urine Pregnancy Testing Control procedure Performed in a similar manner To procedure for performing the test on a specimen collected from a patientInstead of adding the patient specimen to testing deviceControl is added Positive control: should produce a positive result Negative control: should produce a negative resultDocument result in a quality control log Copyright 2016 by Elsevier Inc. All rights reserved.128
129. Guidelines for Urine Pregnancy Testing Failure of external control to produce expected results may be due to:Deterioration of testing components due to improper storageImproper environmental testing conditions Errors in technique used to perform the procedureCopyright 2016 by Elsevier Inc. All rights reserved.129
130. Guidelines for Urine Pregnancy Testing Conditions that can result in a positive result (other than normal pregnancy): Ectopic pregnancy Molar pregnancyCopyright 2016 by Elsevier Inc. All rights reserved.130
131. Serum Pregnancy Test Radioimmunoassay (RIA) for HCG: used to detect HCG in serum of bloodMore sensitive than urine testingCan detect pregnancy earlier with more accuracyCan detect pregnancy at approximately eighth day after fertilization (6 days before first missed period)Uses radioisotope techniqueCapable of detecting minute amounts of HCG in the bloodCopyright 2016 by Elsevier Inc. All rights reserved.131
132. Serum Pregnancy Test UseDiagnose abnormalities (ectopic pregnancy)Follow course of early pregnancy:When abnormalities of embryonic development are suspectedProvide early diagnosis of pregnancy in high-risk patientsExample: Patient with diabetes mellitusCopyright 2016 by Elsevier Inc. All rights reserved.132