URINE (COLLECTION & URINALYSIS)

• URINALYSIS

  • Testing of urine with procedures commonly performed in an expeditious, reliable, safe and cost-effective manner.
• REASONS FOR URINALYSIS

  • Diagnosis of Disease
  • Screening asymptomatic populations for undetected disorders.
  • Monitoring progress of disease and effectiveness of therapy.
• URINE FORMATION

  • Ultrafiltrate of Plasma
  • Formed at Kidneys
  • Average Daily Output is 1200mL - 1500mL
• TERMINOLOGIES RELATED TO URINE OUTPUT

  • Normal Daily Output  
  • Oliguria
  • Anuria
  • Nocturia
  • Polyuria
• Normal Daily Output

  • 1200mL-1500mL (600mL - 2000mL also considered normal)
• Oliguria 

  • Decreased Urine Output: 400mL/day (Adults)
  • Occurs at excessive water loss
• 1. Anuria

  • Cessation of urine flow; suggests severe kidney damage. 
• 1. Nocturia

  • Increased excretion of urine during the night.
• Polyuria

  Increased Urine Output: >2.5L/day (Adults)
• URINE COMPOSITION

  • Urine is normally 95% water and 5% solutes (Organic and Inorganic)
• ORGANIC SOLUTES IN URINE (24-HOUR SPECIMEN)

  • Urea 
  • Creatinine
  • Uric Acid
  • Hippuric Acid
  • Others
• 1. Urea 

  • Amount: 25.0g - 35.0g
  • Remark: 60-90% Nitrogenous material (protein metabolism)
• 1. Creatinine

  • Amount: 1.5g
  • Remark: Derived from creatine (muscle metabolism)
• 1. Uric Acid

  • Amount: 0.4g 1.0g
  • Remark: Common component of Kidney Stones
• 1. Hippuric Acid

  • Amount: 0.7g
  • Remark: Derived from Benzoic Acid
• 1. Others

  • Amount: 2.9g
• INORGANIC SOLUTES IN URINE (24-HOUR SPECIMEN)

  1. NaCl (Sodium)
  2. Amount: 15.0g
  3. Description: Principle Salt
  4. Potassium
  5. Amount: 3.3g
  6. Description: Occurs as chloride, sulfate, phosphate salts
  7. Sulfate
  8. Amount: 15.0g
  9. Description: Derived from amino acids
  10. Phosphate
  11. Amount: 2.5g
  12. Description: Serves as buffers in blood
  13. Ammonium
  14. Amount: 0.7g
  15. Description: Derived from protein and glutamine metabolism
  16. Magnesium
  17. Amount: 0.1g
  18. Description: Occurs as chloride, sulfate, phosphate salts
  19. Calcium
  20. Amount: 0.3g
  21. Description: Occurs as chloride, sulfate, phosphate salts
• URINE COLLECTION

  • Remember that urine is classified as a BIOHAZARD.
  • Observe Standard Precautions
  • Requisition Forms are required
• • Containers for urine routine analysis:
  • Clean and Dry (Sterile)
  • Leak Proof
  • Screw top lids
  • Should have a wide mouth
  • Made of clear material
  • Recommended capacity: 50mL
  • Labeled. (Attached to CONTAINER, not the lid)
• Types of urine specimen

  • Random urine
  • First morning urine
  • Fasting urine
  • 24-hour specimen
  • Catheterized urine
  • Midstream clean-catch urine
  • Suprapubic aspiration
• Most Common: Random urine


  Purpose: Routine screening
• Most Preferred: First morning urine


  Purpose: Routine screening, Pregnancy tests, Orthostatic protein
• Fasting urine

  Purpose: Diabetic screening/monitoring
• 24-hour specimen


  • Purpose: For Quantitative Measurements
  • Patients are given large container with preservative
  • Container is stored at 2-8ᵒ C
• Catheterized urine

  • Purpose: Bacterial culture
  • Collected under sterile conditions by passing a sterile hollow tube through the urethra into the bladder
• Midstream clean-catch urine

  • Purpose: Routine screening, Bacterial culture
  • Alternative to catheterized specimens
  • Less traumatic
  • Less contaminated by epithelial cells and bacteria
• Suprapubic aspiration

  • Purpose: Bladder urine for bacterial culture, Cytology
  • Commonly done on pediatrics
  • Needle is introduced through the abdomen into the bladder
• URINE DRUG SAMPLE COLLECTION

  • Sample collection is the most vulnerable part of Drug Testing. 
  • Phlebotomists must ensure that no tampering of the specimen was done by the patient. 
  • Chain of Custody - documentation of Sample Handling
  • Must be properly documented.
  • May be “witnessed” or “unwitnessed”
  • If Witnessed, a same-gender collector will observe the collection.
• Types of Tampering:

  • Adulteration
  • Substitution
  • Dilution
• URINE DRUG SAMPLE COLLECTION

  • 30mL - 45mL of Urine is collected. 
  • Temperature, pH, Color and Specific Gravity of Urine will be tested immediately. 
  • Ideal Temperature: 32.5 - 37.7ᵒ C
  • Urine pH of greater than 9 suggests adulteration
  • Specific Gravity less than 1.005 suggests dilution
• Bluing dye - placed on toilets to prevent patients to use toilet water to dilute specimen.
• URINE SPECIMEN HANDLING & STORAGE

  • Specimens should be delivered and tested within 2 hours.
• URINE PRESERVATIVES

  1. Refrigeration (2-8ᵒC)
  2. Tolouine
  3. Sodium fluoride
  4. Formalin
  5. Phenol
• PRESERVATIVES: Refrigeration (2-8ᵒC)

  1. ADVANTAGE: Doesn’t interfere with chemical tests
  2. DISADVANTAGE: Raises Specific Gravity, Precipitates Urates and Phosphate 
• PRESERVATIVES: Tolouine

  1. ADVANTAGE: Doesn’t interfere with routine tests
  2. DISADVANTAGE: Floats on surface of specimens and clings to pipettes and testing materials
• PRESERVATIVES: Sodium fluoride

  1. ADVANTAGE: Ideal for Drug Testing
  2. DISADVANTAGE: Inhibits Reagent Strip Tests
• PRESERVATIVES: Formalin

  1. ADVANTAGE: Preserves Sediments
  2. DISADVANTAGE: Interferes with Chemical Tests
• PRESERVATIVES: Phenol

  1. ADVANTAGE: Doesn’t interfere with routine tests
  2. DISADVANTAGE: Cause Odor Change
• PHYSICAL EXAMINATION OF URINE

  • Color
  • Color of urine varies from almost colorless to black. These variations may be due to normal metabolic functions, physical activity, ingested materials, or pathologic conditions. 
  • Normal Color: pale yellow, yellow, dark yellow, and amber
  • Yellow color of urine is caused by the presence of a pigment called urochrome. 
  • Care should be taken to examine the specimen under a good light source, looking down through the container against a white background. 

  
• Dark Yellow or Amber


  Presence of the abnormal pigment bilirubin. Bilirubin (yellow foam); Increase urobilin (no yellow foam)