Urinalysis

FUNDAMENTAL CONCEPTS
Urinalysis
A dipstick — a thin, plastic stick
with strips of chemicals on it — is
placed in the urine to detect
abnormalities. The chemical strips
change colour if certain substances
are present or if their levels are
above normal. A dipstick test
checks for.
Types of urinalysis
 There are different ways of analysing urine and for different
reasons, namely:
 24-hour collection: patient voids into toilet, then all urine is
collected for the next 24 hours. As the body chemistry alters
constantly, this is used to measure substances, such as
steroids, white cells, electrolytes or determine urine
osmolarity (Tortora and Derrickson, 2009);
 First-morning specimen: first specimen of morning (or eight
hours after recumbent position). Best sample for pregnancy
testing;
 Fasting specimen: the second voided specimen after a period
of fasting;
 Mid-stream urine (MSU): used to obtain urine for bacterial
culture. First and last part of urine stream is voided into the
Types of urine samples
 Random specimen: for chemical or microscopic
examination, a randomly collected specimen suitable
for most screening purposes;
 Catheter specimen of urine: collected for
bacteriological examination if a patient’s symptoms
suggest the presence of a UTI. The sampling
technique used for collection is important (Baillie and
Arrowsmith, 2005).
Urinalysis
 your urine is being tested only for a urinalysis,
you can eat and drink normally before the test. If
you're having other tests at the same time, you
may need to fast for a certain amount of time
before the test. Your doctor will give you specific
instructions.
 Many drugs, including non-prescription
medications and supplements, can affect the
results of a urinalysis. Before a urinalysis, assess
medications, vitamins or other supplements.
Purpose

 To check your overall health

 To diagnose a medical condition
 To monitor a medical condition e.g. kidney disease, Urinary
Track Infection, Nephrotic syndrome, Hyperemesis Gravidarum
Sample of Urine

 Use a fresh sample of urine (preferably less than 4

hours old or in line with the reagent strip
manufacturer’s instructions to obtain accurate
results. Bilirubin and urobilinogen are relatively
unstable compounds when left in light or at room
temperature.
 Collect 50 mls for sample.
Urinalysis
 Assessment – ability to follow
instruction for obtaining a clean catch
sample.
 Assess for continent.
 Exposure of unpreserved urine to room temperature for a period of
time can change pH and increase micro-organisms. If it cannot be
tested immediately, the sample needs to be stored in line with the
reagent strip manufacturer’s instructions or at 2-4°C and then brought
to room temperature (15-20°C) before testing;
 Bacterial growth of contaminated organisms may produce positive
blood reactions;
 Urine high in alkaline can show false positive results for protein;
 Presence of glucose may reduce pH;
 Presence of urea-splitting organisms may cause urine to become more
alkaline (Dougherty and Lister, 2015)
Colour
 Colour
 This usually ranges from pale straw to deep amber, depending on concentration (Steggall,
2007).
 Dark urine: may indicate dehydration
 Brown/green or strong yellow: may indicate presence of bilirubin
 Green: may indicate presence of pseudomonas infection or excretion of cytotoxic drugs.
 Bright red/red-brown: may indicate presence of blood (haematuria). Menstruation should
be ruled out in females
 Certain food or drugs may also influence colour; beetroot can produce a pinkish shade and
rifampicin can turn urine orange/red.
Clarity

 This is usually referred to as clear, slightly cloudy, cloudy or turbid.

 Substances that can cause cloudiness but are not harmful include
mucus, sperm, prostatic fluid and skin cells. Other substances that
make urine cloudy are white/red blood cells, pus or bacteria that need
attention. Frothy urine signifies protein in the urine.
Odor

 Freshly voided urine may have a slight but inoffensive smell.

 Fishy smell/ammonia: may indicate urinary infection
 “Pear drop” or acetone smell: may indicate presence of ketones, as in
diabetic ketoacidosis
 Some strongly flavoured foods can also produce an odour, eg
asparagus
Urinalysis

 Explain procedure to patient and gain consent

 Comply with infection-prevention principles: wash hands, use
protective equipment
 Check expiry date on reagent-strip container and make sure it has
been stored in line with the manufacturer’s recommendations
 Advise patient how to collect a fresh sample, preferably a mid-stream
sample if possible, as stored urine can give false results
 Remove reagent dipstick from container, taking care to touch only the
plastic handle; replace lid immediately
Urinalysis
 Observe urine for colour and clarity, then fully immerse reagent
stick, so all reagent areas are covered. Hold for approximately
two seconds. Remove strip from urine and tap on absorbent
paper or against inside of urine container to remove excess urine
 Wait for manufacturer’s recommended time to elapse, holding
strip in horizontal position to prevent interaction between
adjacent test pads
 Compare reagent strip against colour reference guide on outside
of container (Fig 1, attached)
 If sample is not being sent to a laboratory for further
investigations, dispose of urine, used strip, urine container and
gloves, following local policy, and wash hands
 Document results, and inform doctor and patient; take
appropriate action as required
Blood

 Urine does not normally contain blood detected by reagent

strips. Blood in the urine is known as haematuria and can be
sub-classified as follows:
 Macroscopic: large volumes of blood in the urine, which takes
on a rose or dark colour, especially if left to stand;
 Microscopic: undetectable to the naked eye; reagent strips or a
microscope are needed to identify it.
 Pay attention to small details!
Blood/ Hematuria

 Indicate a blood-clotting disorder or be a

side-effect of anticoagulant drugs
 Haematuria
Bilirubinogen

 Bilirubin is a chemical produced when red blood

cells are broken down
 Processed by the liver excreted into the gut as a
constituent of bile
 May indicate liver damage
 Problem with drainage of bile into the gutsuch as
gall stones
 The gut, bacteria acts on the bilirubin to
transform it into urobiligen. This is normal in
urine
Nitrites

 Nitritesare not usually found in urine and are

associated with the presence of bacteria that
can convert nitrate into nitrite
 nitrites
can be suggestive of a UTI but is not
always present in UTI
Leucocytes (white blood cells)

 In urine, leucocytes are usually associated

with a urinary infection but sometimes may
indicate a more severe renal problem
 Referred to as pyuria (pus in the urine).
Sterile Pyuria

 Toestablish the cause, a clean-catch urine

sample should be examined under a
microscope, cultured to see what bacteria
grows and tested for sensitivity to establish
antibiotic treatment. Where no bacterial cells
are detected, the patient is said to have
sterile pyuria; this can occur in tuberculosis
and inflammatory disease of the kidneys
Protein

 urine does not contain a level of protein that is

detectable on a urine reagent strip
 If protein pass through glomerular filtration barrier, it
is known as proteinuria. This is not normal.
hypertension; kidney damage; diabetes mellitus; and
pre-eclampsia (Mulryan, 2011). Further investigation
is required.
Ketones

 Not normally in the composition of urine

 Break down of fats
 prolonged vomiting,
 fasting or starvation;
 individuals on a diet or who present with diarrhoea and
vomiting
 poorly controlled diabetes- diabetic ketoacidosis read
medication can cause false positives
Glucose

 Glucose in the urine (glycosuria) can occur in

pregnancy or patients taking corticosteroids.
It may also be indicative of diabetes mellitus
but is not a normal constituent of urine.
 indication
of endocrine abnormality but not
conclusive.
Ph

 This is a measure of acidity or alkalinity in urine

 range of 5.0-8.0 is considered normal
 pH reading on analysis
 Acidic urine may indicate formation of urinary stones
 while alkaline urine may indicate a UTI
 Read: Proteus mirabilis, Klebsiella or Pseudomonas
 High protein diet can cause a acidic urine.
 (Alkaline urine) diets such as diary products,
vegetables
Specific gravity (SG) (relative
density)

 range from very diluted to very concentrated; its

density is measured against pure water at room
temperature and pressure. Specific gravity identifies
the hydration of an individual – a well-hydrated
person will have diluted urine whereas someone who
is dehydrated will present with concentrated urine.
The normal range of specific gravity is 1.001-1.035
Video

 https://www.youtube.com/watch?v=T9eOPhpUeF8
Video

 https://www.youtube.com/watch?v=0xT5mfWrW_I&t=24s
Refrence

 Yates A (2016) Urinalysis: how to interpret results. Nursing Times;

Online issue 2, 1-3
https://www.nursingtimes.net/clinical-archive/continence/urinalysis-how
-to-interpret-results-07-06-2016/