Lesson 2: Introduction to Urinalysis (History and Urine Formation and Composition) Flashcards by Merch Paul Eli Silvederio

References to the study of urine can be found in the drawings of cavemen and in Egyptian hieroglyphics, such as the?

Edwin Smith Surgical Papyrus

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Who wrote a book on “uroscopy”?

Hippocrates

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Who discovered “albuminuria” by boiling urine?

Frederik Dekkers

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“Pisse prophets” as a subject of his book.

Thomas Bryant (1627)

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Who spearheaded the methods for quantitating the microscopic sediments?

Thomas Addis

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Introduced the concept of “urinalysis” as part of a doctor’s routine patient examination (1827)

Richard Bright

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Defined urinalysis as “the testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe, and cost-effective manner”

CLSI (Clinical and Laboratory Standards Institute)

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It is an ultrafiltrate of plasma

Urine

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Average daily urine output

1,200 mL

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It is a cessation of urine flow, may result from any serious damage to the kidneys or from a decrease in the flow of blood to the kidneys

Anuria

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Approximately how much filtered plasma is converted to urine?

170,000 mL of filtered plasma

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Urine composition:

Water:
Solutes:

Water: 95%
Solute: 5%

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A metabolic waste product produced in the liver from the breakdown of protein and amino acids

Urea

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It accounts for nearly half of the total dissolved solids in the urine

Urea

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These components are significantly higher in urine that in other body fluids, that is why they are important to determine whether a fluid is urine or not

Creatinine
Urea
Sodium
Chloride

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The major inorganic solid dissolved in urine is _______, followed by _______ and _______

Chloride –> Sodium –> Potassium

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True or False

Glucose and Protein are normal constituents of urine

False, these are not normal constituents of urine because of their molecular size

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Normal daily urine output is usually _______ to ________

1200 to 1500 mL

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Oliguria (a decrease in urine output) levels in:

Infants:
Children:
Adults:

Infants: < 1mL/kg/hr
Children: <0.5 mL/kg/hr
Adults: <400mL/day

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True or False

A range of 600 to 2000 mL of urine output is also considered normal

True

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True or False

The kidneys excrete 2x or 3x more urine in the day compared to nighttime

True

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This urine output disorder is commonly seen in patients that enter a state of dehydration caused by vomiting, diarrhea, perspiration, or severe burns

Oliguria

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An increase in the nocturnal excretion of urine is termed as?

Nocturia

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It is an increase in daily urine volume that is often associated with Diabetes mellitus and Diabetes insipidus

Polyuria

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Artificial cause of Polyuria can be caused by these substances that suppress the secretion of ADH

Diuretics ADH Alcohol

Polyuria levels in: Adults: Children:

Adults: > 2.5 L/day Children: 2.5 to 3.0 mL/day

Primary organic component of urine

Urea

Product of breakdown of nucleic acid in food and cells

Uric acid

Primary inorganic component

Chloride

Chloride + Sodium = __________

Table Salt

It combines with sodium to BUFFER the blood

Phosphate

Regulates blood and tissue fluid activity

Ammonium

It combines with chloride, sulfate, and phosphate

Calcium

A type of diabetes where there is a defect either in the pancreatic production of insulin or in the function of insulin, which results in increased concentration of body glucose

Diabetes mellitus

How can Diabetes mellitus cause Polyuria?

Since there is increased glucose concentration, it will increase water excretion to remove the dissolved glucose from the body

Recommended capacity of the container for urine specimen

50 mL Allows 12 mL of specimen needed for microscopic analysis and the rest is for mixing

Tubes with conical bottoms are used for?

Sediment analysis

Sterile containers are suggested if more than __ hours elapse between specimen collection and analysis

more than 2 hours

Tubes with round bottoms are used for?

Automated reagent strip testing

True or False Labels must be attached to the lid

False, it should be attached to the container(body) and not the lid

This should accompany specimens delivered to the laboratory

Requisition form

Technical Tip: NEVER DISCARD A SPECIMEN before checking with a supervisor

Okay!

Identify the preservative: Advantages: Excellent sediment preservative Disadvantages: Acts as a "reducing agent", interfering with chemical tests for glucose, blood, leukocyte esterase, and copper reduction Additional Information: Rinse specimen with this to preserve cells and casts

Formalin (Formaldehyde)

Specimen collected should be delivered to the laboratory and tested within?

2 hours

Most routinely used method of preservation of urine specimens

Refrigeration at 2-8C Note: This temperature decreases bacterial growth and metabolism

When refrigeration is impossible as a preservation method, there are commercially prepared transport tubes with ____________ available that allow for the transport, testing, and storage of the urine specimens

Lyophilized preservative

What test is commonly requested on a catheterized specimen?

Bacterial culture

Technical Tip: Specimens must be returned to room temperature before chemical testing by reagent strips because the enzyme reactions on the strips perform best at Room Temperature

Okay! Thanks!

Identify the preservative: Advantages: Good preservative for drug analyses (prevents glycolysis) Disadvantages: Inhibits reagent strip tests for glucose, blood, and leukocytes Additional Information: May use sodium benzoate

Sodium Fluoride

This is the specimen received most commonly because of its ease of collection and convenience for the patient

Random specimen

Identify the preservative: Advantages: Prevents bacterial growth and metabolism Disadvantages: Interferes with analysis of drugs and hormones Additional Information: Keeps pH at 6.0 , used for transport of urine cultures

Acids (boric acid, HCL, acetic acid, tartaric acid)

This urine specimen is essential for preventing "false-negative pregnancy tests" and for evaluating "orthostatic proteinuria" A concentrated specimen.

First morning specimen

Identify the preservative: Advantages: Specimen stable at RT for 48 hours; prevents bacterial growth and metabolism Disadvantages: Do not use if urine is below minimum fill line Additional Information: preservative is boric acid, sodium borate, and sodium formate ; keeps pH at 6.0

Light gray and gray C&S Tube

Urine specimen used for: Quantitative chemical tests

24-hour (or time)

What type of specimen is used for solutes with diurnal variation like: Catecholamines 17-hydroxysteroids Electrolytes

24-hour (or Timed) Specimen

Prostatitis Specimen: Three Glass Collection 1st: Before collection, area is cleansed using male midstream clean-catch procedure 2nd: Instead of discarding the first urine passed, it is collected in a "sterile container" 3rd: The midstream portion is collected in another sterile container 4: Prostate is massaged and prostate fluid is passed with the remaining fluid in a third sterile container Note: 1st and 3rd specimens are examined microscopically Note: 2nd specimen is used as a control for bladder and kidney infection (If positive = results from the 3rd specimen is invalid) Note: In prostatic infection, the 3rd specimen will have a WBC/Hpf count and bacterial count 10x than of the 1st specimen

Okay thank you gid! Go! Go! Go! Topnotcher!

Urine specimen used for: Bladder urine for bacterial culture and cytology

Suprapubic aspiration

Identify the preservative: Advantages: Specimen stable for 72 hours at RT ; instrument-compatible Disadvantages: Must be filled to minimum fill line Additional Information: preservative is sodium propionate, ethyl paraben, and chlorhexidine

Cherry red/yellow preservative plus tube

It is used to produce accurate Quantitative Results

24-Hour (or Timed) Specimen

This is the ideal screening specimen

First morning specimen

Technical Tip: Adding urine formed before the start of the collection period will falsely elevate the results; and failure to include the urine produced at the end of the collection period will falsely decrease the results For 24-Hour (Time) Specimen

Okay! Thank you so much!

Urine specimen used for: Bacterial culture

Catheterized Midstream clean-catch

Urine specimens used for: Routine Screening

Random First morning Midstream clean-catch

Urine specimen used for: Pregnancy tests and orthostatic protein

First morning

It provides a specimen that is less contaminated by epithelial cells and bacteria therefore is more representative of the actual urine that is routinely voided specimen.

Midstream clean-catch specimen

True or False Strong bacterial agents such as hexachlorophene or povidone-iodine can be used as cleansing agents for Midstream clean-catch specimens

False, the recommended cleansing agent for Midstream clean-catch specimens is "Mild antiseptic towelettes"

Urine specimen used for: Prostatic infection

Three-glass collection Four-glass collection

It is an alternative to the catheterized specimen which provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis

Midstream clean-catch specimen

Technical Tip: When both a routine urinalysis and a culture are requested on a catheterized or midstream collection, the culture should be performed first to prevent contamination of the specimen. A collection transfer kit also can be used.

Okay! Yehey!

Four-glass urine collection technique is also known as?

Stamey-Meares Test for Prostatitis

Prostatitis Specimen: Four-Glass Collection 1st specimen(urine specimen): Voided bladder (VB1), first 10 mL, represents urethral specimen Then, the patient voids another 100 to 150 mL of urine 2nd specimen(urine specimen) : Voided bladder (VB2), another 10 mL, represent the bladder specimen 3rd specimen: Expressed prostatic specimen (EPS), the fluid collected during prostatic massage 4th specimen(urine specimen): Voided bladder (VB3), first 10 mL collected after EPS, contains EPS trapped in prostatic urethra Note: All specimens are sent for culture Note: The 3 urine specimens are centrifuged and examined Urethral infection or inflammation: VB1 (Voided bladder 1) Urinary bladder infection: VB2 (Voided bladder 2)

Okiiiiiiiiiiiii

Technical Tip: For Pediatric Specimens, check the applied bags approximately every 15 minutes until the needed amount of sample has been collected

YAY!

It is the most vulnerable part of a drug-testing program

Urine specimen collection

If a witnessed specimen collection is ordered, a same-gender collector will observe the collection of __ to __ mL of urine

30 to 45 mL of urine

A specific gravity of less than _____ could indicate dilution of the urine specimen and requires recollection

< 1.005

It is the process that provides this documentation of proper specimen identification from the time of collection to the receipt of laboratory results

Chain of Custody (COC)

It is a standardized form that must document and accompany every step of drug testing, from collector to courier to laboratory to medical review officer to employer

Chain of Custody

The urine temperature must be taken within __ minutes from the time of collection to confirm the specimen has not be adulterated

4 minutes

The temperature should read within the range of ___ to ___

32.5 to 37.7C

A urine pH of greater than _ suggests adulteration of the urine specimen and requires that the specimen be recollected if clinically necessary

greater than 9