1. Chapter 44
Urinalysis

3. Learning Objectives
Understand the basic structures of the urinary system
Describe the importance of urinalysis
Explain the importance of medical terms related to the urinary system
Explain the importance of the different methods of urine collection

4. Learning Objectives
Explain and educate the patient in the proper method of urine collection
Identify the various tests included in the physical and chemical examination of urine
Explain the basis for urine pregnancy testing
Recognize the basic structures or elements that may be found in normal and abnormal urine under the microscope

5. Urinary System Structures
Kidneys—filter waste from blood, regulate water, electrolyte, and acid–base content of blood, production of urine
Ureters—tubes carrying urine from kidneys to bladder

6. Urinary System Structures
Urinary bladder— collects urine and stores until released from body
Urethra—tube connecting bladder to outside of body

7. Characteristics of Urine
Urine is sterile inside of body
Urine becomes contaminated when released from the body
Urine is 95% water, 5% organic and inorganic wastes
Humans typically produce 1,000–1,500 ml urine in 24 hours

8. Urine Specimens
Random urine specimen—most common type of urine specimen, used for routine screening
First-morning urine specimen—most concentrated specimen
Clean-catch midstream urine specimen (CCMS)—proper collection technique is necessary, used for urine culture

9. Urine Specimens
24 hour urine specimen—used for quantitative analysis, may have preservative added to container
Catheterized urine specimen—catheter is placed into bladder to collect sterile urine
Suprapubic aspirate urine specimen— syringe used to directly collect urine

10. Urine Collection Procedure
Instruct patient
Use proper collecting containers
Label correctly
Determine if specimen is adequate amount for test
Test specimen within 30–60 minutes, refrigerate up to 8 hours
Gently mix before testing

11. Preparation for Urinalysis
Medical assistant should familiarize self with equipment:
Reagent strip—color pads dipped into urine
Analyzer—automated machine to read reagent strip
Quality control—assures accuracy of testing

12. Reagent Strip
Test strip contains individual color pads that correlate with a urine component such as glucose or blood
After dipping urine, color is compared to chart

13. Analyzer Computer printout of reagent strip
Abnormal values are flagged
Can do more urinalysis in short period of time

14. Urinalysis Three components to urinalysis: Physical—CLIA waived test
Chemical—CLIA waived test
Microscopic—CLIA non-waived test

15. Physical Components of Urine
Color—urochrome, varies due to dilution or concentration of urine
Clarity—appearance or transparency of urine
Odor—varying odors, not generally recorded
Specific gravity— measures concentration of dissolved substances in urine, varies according to dilution or concentration of urine

16. Clarity of Urine Clarity describes the transparency of urine
Terms used can be clear, cloudy, slightly cloudy, or turbid

17. Chemical Components of Urine
pH—measures acidity or alkalinity of urine, scale 0.0–14.0, 0.0–6.0 is acidic and 8.0–14.0 is alkaline
Glucose—no glucose should be present in urine; if present referred to as glycosuria
Protein—protein may be present temporarily; if present referred to as proteinuria

18. Chemical Components of Urine
Ketones—by-products of fat metabolism, should not be present in urine; if present referred to as ketonuria
Bilirubin—not normally found in urine; if present changes color of urine
Urobilinogen—small amounts in urine are normal

19. Chemical Components of Urine
Blood—not normally found in urine; if present referred to as hematuria
Nitrite—should not be present in urine; may suggest urinary tract infection
Leukocytes—should not be present in urine; if present suggests infection

20. Microscopic Components of Urine
Evaluates the sediment or solid components of urine specimen
Correlates physical and chemical findings
Specimen is centrifuged to concentrate sediment, fluid discarded, and assessed under the microscope
Microscopic examination of urine is a CLIA non-waived test

21. Epithelial Cells in Urine
Commonly found in microscopic examination of urine
Larger than WBCs
Three different types: squamous, renal tubular, transitional

22. Urine Pregnancy Testing
Various pregnancy kits
Detects presence of human chorionic gonadotropin hormone (HCG)
Hormone can be detected in blood or urine
Follow manufacturer’s instructions
CLIA waived test

23. Discussion
Review what parts of urinalysis can be performed by a medical assistant
Explain the difference between a random urine specimen and a 24 hour urine specimen
Identify the hormone present in urine if a female is pregnant

24. Credits