(3) Urine Specimen Types, Collection, and Preservation Flashcards
Types of Urine specimen
Random Urine First Morning Second Morning 2 hours Post Prandial OGTT (Oral Glucose Tolerance Test) 24 hour / Timed Catheterized Midstream Clean-Catch SPA (Suprapubic Aspiration) Three-glass collection
Factors that can become falsely increased
Sp. Gravity pH Urobilin Nitrite Bacteria
How to physically preserve sample?
Refrigeration (to prevent bacterial growth/bacteriostatic)
Significant level of bacteria for Midstream Clean-Catch collection
100 cfu/ml
Physical parameters in routine urinalysis
Volume
Color
Transparency
Sp. gravity
STAT acronym meaning
Short Term Around Time!!
Least accepted urine specimen collection
Catheterized Urine Sampling
No. of times blood collection is done for 2 hours Post Prandial Test
2 times (before - to get baseline, and after - to measure abnormality if present)
Three-glass collection sampling is done to…?
To differentiate Prostatic infection from UTI
Normal urine output per day
600-2000ml/day
Most ideal urine specimen
First morning urine
Factors seen in Diabetes Mellitus
Polyuria Polydipsia Polyphagia High specific gravity Low Insulin/ No Insulin Hyperglycemia Glucosuria
24 hour urine/ Timed collection is done because..?
for creatinine CLEARANCE purposes
Average volume of urine excreted per day
1200-1500 ml/day
Condition wherein urine output is increased (about 2500ml a day)
Polyuria
2 Poly’s are seen in what type of Diabetes
Diabetes Insipidus
Why is First Morning Urine the most ideal specimen?
Concentrated (high sp. gravity, high osmolarity)
Uniform pH (acidic)
Uniform volume
least likely to be contaminated with bacteria
to rule out orthostatic proteinuria
Absence of urine output
Anuria
Significant level of bacteria in SPA
<10 000 cfu/ml
Factors falsely decreased when the 2hr time period is exceeded
Glucose Clarity Urobilinogen Bilirubin Ketone bodies
Color range of urine
straw (colorless to amber)
Pigments found in urine
Urochrome (!)
Uroeythrin
Urobilin
Conditions seen in Diabetes Insipidus
Polydipsia Polyuria Low sp. gravity Decreased functionn ADH No hyperglycemia No glucosuria
Decreased urine output (about <400ml)
Oliguria
Diabetes caused by a lack of ADH
Diabetes Insipidus
Most convenient type of urine specimen
Random urine
Chemical regarded as enzyme poison
NaF
Enumerate examples of chemicals to preserve specimen
Boric acid - to retain acidity and to prevent bacterial growth
NaF
Chlorhexidine
10% formalin
Pigment that binds to amorphous crystals
Uroerythrin
Urine sampling done in males only
Three-glass collection
measured in Addis count
WBC
Casts
Epithelial cells
Urine Collection types used to monitor diabetes
Second Morning
2 hours Post Prandial
OGTT
A disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin to meet its needs.
Diabetes Mellitus
Explain Three-glass collection results.
1st tube- contains urine
2nd tube - contains urine, but if positive with bacteria, UTI is present and Prostatic Infection is ruled out, and the test is finished
3rd tube- if positive with prostatic fluid, then prostatic infection is apparent
Parameter that reflects body’s state of hydration
Volume of Urine
A technique for the quantitative determination of cells, casts, and protein in a 12-hour urine sample used in the diagnosis and treatment of kidney disease
Addis Count
Urine color when uroerythrin is present/elevated
light pink/reddish
Urine is often termed as having a “brick dust” color.
Causes of decreased ADH
Medication (diuretics)
Caffeine
Alcohol
Urine specimen for quantitative tests
24 hour / Timed
Elevated factors seen in urine during infection
WBC
Proteins
Bacteria
If NaF is the preservative used in urine, what method would you use for glucose determination?
O-toluidine Method
Blood collection is done how many times when performing OGTT?
4x (initial, 5mins, 30mins, 1hr)
Conditions of urine output
Oliguria
Anuria
Polyuria
Nocturia
2 chemical used to preserve the glucose in urine
- chlorhexidine
- mannitol
Chemical used to preserve urine pH
Boric acid
Reasons for urine specimen rejection
Unlabeled urine specimen container
Mislabeled urine specimen
Inappropriate urine collection technique or specimen type for test requested
Specimen not properly preserved during a time delay or inappropriate urine preservative used
Visibly contaminated urine
Insufficient volume of urine for test requested
Urine collection for routine screening and quantitative assays
Pediatric collection bag
Urine specimen collection for differentiation of kidney infections
Catheterized, ureteral
Use of routine void collection
Routine screning
Bacterial and fungal cultures
Cytology
Collection procedure used with patients that are unable to urinate voluntarily
Pediatric collection bag
Collecting urine directly from the bladder by puncturing the abdominal wall and the distended bladder using a syringe and needle
Suprapubic aspiration
A urine specimen collected at any time, day or night, without prior patient preparation
Random urine specimen
A urine specimen collected throughout a specific time interval
Timed collection
A urine specimen obtained using a sterile flexible tube inserted through the urethra and into the bladder
Catheterized specimen
The first urine specimen voided after rising from sleep
First morning specimen
Ideal urine specimen to test for substances that may require concentration
First morning urine
A urine specimen collected throughout a specific time interval
Timed collection
A urine specimen obtained after thorough cleansing of the glans PENIS in the male or the urethral meatus in the female
Midstream “clean catch” specimen
A chemical substance or process used to prevent composition changes in a urine specimen
Urine preservative
Purposes of routine urinalysis
To aid in the diagnosis of disease
To screen for asymptomatic, congenital, or hereditary disease
To monitor therapy effectiveness or complications
A fluid biopsy of the kidney
Urine
The only organ with noninvasive means to directly evaluate its status
Kidney
Three basic types of urine
First morning
Random
Timed
How long is the urine approx. retained in the bladder for first morning specimen collection?
8 hours
Ultrafiltrate of plasma
Urine
Most cytologic protocols require collection of random urine specimen daily for up to how many days?
3-5 consecutive days
Formed elements that are more stable in first morning specimen
WBC
RBC
Casts
Epith. Cells
The most concentrated and frequently specimen of choice for urinalysis
First morning urine
Specimen used for evaluation of fistula, clearance tests, cytology studies, and quantitative chemical analysis
Timed
Factors that may affect quantitative urine assays
Circadian rhythms
Excretion of many substances (eg. Hormones, proteins, glomerular filtration rate)
Effects of exercise, hydration, body metab on excretion rates
Two types of timed urine specimens
Those collected for a predetermined amount of time (eg. 2hrs, 12 hrs, 24 hrs)
Those collected for a specific time of the day (eg. From 2pm to 4pm)
UrineSpecimen type for routine screening, cytology studies with prior hydration, and fluid deprivation tests
Random
Uses of first morning urine
Routine screening; good recovery of cells and casts
To confirm postural or orthostatic proteinuria
Cytology studies
Specimen to use if the possibility of contamination exists or if a bacterial culture is desired
Midstream “clean catch” specimen
Collection type that most often leads to UTI
Catheterized
Procedure for bacterial cultures, esp. for anaerobic microbes and in infants, in whom specimen contamination is often unavoidable
Suprapubic aspiration
Volume usually required for Routine urinalysis
10-15ml
Physical changes in unpreserved urine
Color (darkens or changes)
Clarity (decreases)
Odor (ammoniacal, foul smelling)
Microscopic changes in unpreserved urine
Blood cells (decrease)
Casts (“)
Trichomonads (“)
Bacteria (increase)
Chemical changes in unpreserved urine
pH (increase)
Nitrite (")
Glucose (decrease)
Ketones (")
Bilirubin (")
Urobilinogen (")Causes of changes in physical examination of unpreserved urine
Alteration of the urine solutes to a different form
Bacterial growth causing an increased odor bec. Of metab or proliferation of bacteria
Solute precipitation in the form of amorphous material which decreases urine clarity
The easiest and most common form of preservation
Refrigeration at 4degrees C to 6degrees C -suitable for up to 24 hours
Factors to help you identify if the fluid passed is urine
Specific gravity (1.002-1.035)
Temperature (32.5 C-37.5C)
pH (4.0 - 8.0)
High creatinine concentration (approx. 50x that of plasma)—most useful substance!!!!!!!!
Examples of urine specimen preservatives
Refrigeration Commercial transport tubes Thymol Formalin Saccomanno's fixative Acids (HCl,glacial acetic acid) Sodium carbonate
Preservatives used for cytology purposes
Formalin
Saccomanno’s fixative
Urine preservatives that are unacceptable for urinalysis testing
Acids (HCl, glacial acetic acid)
Sodium carbonate
Preservative for sediment preservation
Thymol
Preservative used for storage before and after testing of the urine specimen
Refrigeration
Urine preservative used for quantitative analysis of urine solutes such as steroids, hormones, etc.
Acids (HCl, glacial acetic acid)
Urine preservative for quantitative analysis of porphyrins, porphobilinogen, etc.
Sodium carbonate
Urine preservative to preserve specimen at room temp for longer time period that varies with tube used
Commercial transport tubes
Preservative of urine to transport it from off-site to laboratory
Commercial transport tubes
Examples of commercial transport tubes
BD Vacutainer; plus plastic conical UA preservative tube
InTac UA System, Therapak corporation product
BD Vacutainer; C & S preservative tube
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