Urinary Analysis

Question 1

History Questions

Answer 1

AHHHH UU VIRC

• Any Abdominal / flank/ groin pain and its relation to movement.
• History of any kidney or any abdominal organs disease
• Urethral Pain or burning during urination
• Increased Frequency or Urgency or Nocturia
• History of diabetes or recent increased thirst/fatigue/cognitive changes
• Change in colour or smell of urine.
• Urethral discharge: if so what is the colour/appearance/smell
• Vaginal discharge: if so what is the colour, consistency, smell
• History of any gynaecological problems or possibility of current pregnancy
• History of STD
• Red flags (night pain, unexplained weight loss, fever/illness, lymphadenopathy)

Question 2

Explanation and Consent

Answer 2

Explains (in non-technical terms) what is involved in the test, why it is necessary and asks for Informed Consent. Explains referral for further laboratory testing may be indicated.

Question 3

Patient Instructions

Answer 3

Instructs the patient to provide a urine midstream sample in a sterilized container as follows:

• Do not wash the container, cap the container tightly then rinse it if there is urine on the outside
• Do not allow the urine to contact the skin (prepuce/labia). We need a “clean catch”.
• If need to collect a sample from a menstruating woman: advise to go home, wash area, use disposable menstrual product, then provide urine a specimen, refrigerate and deliver to clinic

Question 4

Procedure Objectives

Answer 4

• Wash hands, put on gloves and assemble all needed items (water proof pad, timer, gloves, papertowel) on cleared counter
• Make sure lid is firmly on the specimen jar and shake gently to evenly distribute solutes throughout specimen
• Remove cap from bottle and take out one reagent strip without touching the test paper end. Place cap securely back on bottle.
• Dip test paper end of strip into urine specimen with reagent strip down and remove immediately
• Tap edge of strip against container to remove excess urine – if the strip is too saturated, treated test paper chemicals will run together and make results inaccurate
• Place reagent strip next to colour chart on bottle by holding bottom of bottle. Read results by comparing colour of reacted reagent strips with colour chart on bottle. Read results from bottom to top in order of shorter to longer timings. Begin timing tests immediately
• Discard used reagent strip, gloves and other disposables into proper receptacle. Wash hands, return multistix container to proper storage area. Wash sink with disinfectant.
• Record results as indicated in patient’s file.

Question 5

Interpretation

Answer 5

• Inspection: Colour, Odour and Consistency
• Interpretation of results: explain primary findings, and possible implication/diagnoses (2 or 3) for each marker of the reagent strip.

Question 6

Normal Values

Answer 6

Specific Gavity = 1.0-1.35

• Urine specific gravity is a measure of urine concentration.

pH = 4.5-8

• Diabetes (Ketoacidosis), Respiratory acidosis (decreased C02), Respiratory alkalosis (increased C02), Diuretics, Severe dehydration

Bilirubin = Nill

• Biliary obstruction, hepatitis

Urobilinogen (formed in the intestine from bilirubin) = Present in low concerntrations

• Absent may indicate biliary obstruction, hepatitis, cirrhosis, Heamolytic anaemia

Protein = Absent or small amount

• Stress / exercise, Kidney disease or damage Diabetes / Hypertension / CHF Pregnancy/Preeclampsia Multiple Myeloma

Glucose = Absent

• Uncontrolled diabetes / Hormonal disorders Liver disease / Medication/ Pregnancy

Ketone (Produced from fat metabolism) = Absent

• Fasting, starvation, low carb high protein diet Prolonged vomiting / Strenuous exercise

Blood = Small amount of RBCs

• Trauma / Strenuous exercise / Contrast dye
  UTI / Kidney disease / infection, Prostate Ca / Contamination

Nitrite = Absent

• UTI

Leukocyte = Small amount of WBCs

• UTI (Bacterial)

Question 7

Changes to Colour

Answer 7

Brown = Bile or Myoglobin

• Biliary obstruction, Trauma (muscle breakdown), Levadopa (Parkinson’s), Metronidazole (Antibiotic), Nitrofurantoin (Antibiotic for bladder infections)

Green = Pseudonomal UTI, Food Dye

Red = Blood, Beets, Blackberries

Yellow = High concentration of urea,

Bright Yellow = High B-vitamins

Question 8

Consistency and Odour

Answer 8

Turbidity = Contamination, Pyuria, Chyluria, Lipiduria, Hyperoxaluria

Sweet/Fruity = Diabetic keto-acidosis

Faecal = Intestinal-bladder fistula

Strong urine = dehydration