AUBF LEC (2nd week) - Preliminary examination is not final, needs to

be confirmed through further testing

PHYSICAL EXAMINATION OF URINE - Tubules are responsible for reabsorption of
substances (glucose, protein, hormones)
Routine Urinalysis
Color
- 3 parts: physical, chemical and microscopic
exam. It is not routine urinalysis if not all are - Ranges from colorless to black (especially in
performed and it should be performed in inborn errors)
order. - Normal variations caused by:
- Physical exam: color, clarity or sometimes o Normal metabolic functions – each
called turbidity/transparency, specific and every one of us have different
gravity, odor (not routinely reported but if metabolism so color may vary, but it
there’s an extreme odor it should be doesn’t mean the patient is sick
reported) o Physical activity – urine becomes
- Let’s assume the specimen is adequate and more concentrated (dark urine) for
acceptable for testing, next thing to do under people who exercise
clinical microscopy department is to proceed o Ingested materials – diet and
to physical examination. Again, that if the medicine (diuretics – water pills, to
request is urinalysis, because in clinical help your body get rid of urine, ex.
microscopy urinalysis isn’t the only one Coffee, alcohol. Effects of diuretics
performed. will be colorless or pale/light yellow)
- Results provide: (Rifampin – drug for TB, can cause
➢ Preliminary or initial information urine to be red)
(screening) with regards to patient o Pathologic conditions – disease
condition. conditions, in UTI can as well be in red
o NOTE: Preliminary information color
is not yet confirmed and the - NOTE:
specimen has to be tested The color of the urine will range to normal as
further for chemical and colorless (straw) to abnormal (black)
microscopic to confirm the
patient’s condition. Normal Urine Color
➢ Correlation with other chemical and
- Common terminology
microscopic results
o Pale yellow, yellow, dark yellow
- Provides preliminary information concerning
o NOTE: sometimes we use
disorders such as:
AMBER (orange-yellow
• Glomerular bleeding – bleeding of the
color)
glomerulus, which is responsible for
o Should be consistent within
filtration in the kidneys. Where blood
laboratory (manner of reporting the
goes first to filter by the kidney.
different parameters should be
▪ Urine could possibly be red
consistent within the lab like
(glomerular bleeding)
reporting results.)
• Liver disease
o Each laboratories have their own
• Inborn errors of metabolism – usually SOPs
with enzyme problem at birth, may o Urochrome (normal) is the primary
affect urine components especially pigment causing yellow color
the color ✓ Normally excreted at
• Urinary tract infection – some urine constant rate
has blood ✓ Increase in thyroid disorders
• Renal tubular function and fasting (yellow to dark
 yellow urine because of o Abnormal = bilirubin in their urine
increase of urochrome) (liver disease e.g., liver cirrhosis,
✓ Increases when specimen sits hepatitis)
at room temperature o Bilirubin – it can only be detected in
(change in the chemical chemical examination. Always
composition of urine, which correlates your result.
can darken our urine) - Foam (bula)
✓ Provides estimate of body o Bilirubin produces yellow foam when
hydration (more hydrated – shaken
colorless to pale yellow; o Yellow foam indicates bilirubin in
dehydrated – dark yellow to urine. Yellow foam is pathologic.
amber) o Normal urine produces small amount
✓ Pale yellow to dark yellow can of white foam caused by protein
be normal ▪ Small amount of white foam
is normal.
- Additional pigments (color changes in older - Bilirubin indicates possible hepatitis virus
urine specimens): present
o Uroerythrin - pink pigment, attaches o Standard precautions
to amorphous urates formed in o Hepatitis A has no problem, but in
prolonged refrigeration of specimens Hepatitis B, Hepatitis C and Hepatitis
o Urobilin - Oxidation of normal E are transmitted via body fluids like
constituent, urobilinogen (we have urine (blood borne Hepatitis are B
this in normal and C) dilution is 10:1 - bleach solution
concentration/constituent). (1 part of bleach to 9 parts of water)
Responsible for orange-brown color hepatitis virus can last for 2 weeks in
in older specimens. the environment
o NOTE: This indicates that the urine is - Photooxidation of large amounts of
not fresh anymore. urobilinogen produces yellow-orange urine
➢ No yellow foam when shaken
Abnormal Urine Color ➢ If no yellow foam but has yellow-
- Many colors and causes orange, it is not a fresh sample, an old
- Often reason patient comes to the physician specimen (not pathologic because no
- Common abnormal colors yellow foam)
• Dark yellow/amber/orange – can be - Photooxidation of bilirubin to biliverdin
normal or abnormal and can also be produces yellow-green urine
an indication of disease. Sometimes o Bilirubin = abnormal urine
amber color is a sign of dehydration, component
but again can also be because of o Bilirubin is photosensitive
pathologic conditions. o Prolong standing or urine containing
bilirubin will decrease bilirubin
• Red/pink/brown
because bilirubin will oxidized to …
• Brown/black
naputol
• Blue/green
- Phenazopyridine (Pyridium) or Azo-Gantrisin
• Violet
for urinary tract infection produces thick
Dark Yellow/Amber/Orange orange pigment and yellow foam (no
bilirubin)
- Dark yellow and amber ➢ Thick pigment is noticeable, obscures
o Normal = concentrated urine (only natural color, and interferes with
dehydrated and its normal, just drink reagent strips
your water bitch, skkkrrt!)
 ➢ No liver disease because no bilirubin - Clear red urine = may indicate either
NOTE: hemoglobin or myoglobin
▪ Bilirubin is detected in - Hemoglobin (hemoglobinuria)
chemical examination o In vivo (inside/within) lysis of RBCs –
▪ Medication affects the color give clear red urine
of the urine. (hemoglobinuria)
▪ Assuming you have a patient o What to do? Request for patient’s
taking Pyridium, upon the plasma if the result is red
collection of urine the patient o Consider in vitro lysis
submitted a urine having a o Request for patient’s plasma for
dark orange color with yellow confirmation if it also appears red
foam. Is the yellow foam o When will in vivo lysis happens inside
present in your patient has a the body? Hemolytic anemia,
liver disease? - NO. autoimmune hemolytic anemia,
- Azulfidine, some laxatives, and certain transfusion reactions
chemotherapy drugs can cause an orange- o In what manner does hemolytic
colored urine transfusion reactions happens?
o Anti-inflammatory drug (Azulfidine) Transfusing wrong blood type to a
patient, hemolytic disorder of a new
Red/Pink/Brown born
- Myoglobin (myoglobinuria)
o Breakdown or damage of skeletal
muscle – gives clear red urine
o Fresh urine is often more
reddish/brown
o Patient’s plasma is clear
o When does damage of skeletal
muscle happens? What possible
situation or instances? muscle injury,
rhabdomyolysis (muscle breakdown
- Blood is a common cause of red urine brought about by trauma)
o Color can range from pink to brown - Port wine-colored urine
o Pinkish = small amount of blood o Oxidation of porphobilinogen to
o Brown = oxidation of hemoglobin to porphyrins
methemoglobin; old blood sample o Seen on patients with porphyria’s
- Methemoglobin - Nonpathogenic red urine – no disease
o RBCs remaining in acid urine for correlation but has red colored urine
several hours o Menstrual contamination
o Fresh brown specimen can indicate o Pigmented foods (blackberries, beets
glomerular bleeding which can produce red acid urine)
NOTE: o Medications (rifampin, pheno-
▪ Blood is the common cause compunds)
of red urine. - Fresh beets
▪ Fresh urine containing blood o Genetically susceptible people in
– red or pinkish depending on alkaline urine (red)
the amount of blood - Red color raspberries in acid urine
▪ Red or brown urine in RBC – - FOR ADDITIONAL INFO REFER TO THE BOOK
bleeding or UTI
- Cloudy red urine = presence of intact RBCs
that have not lysed
Brown/Black - Clorets (green, for fresh breath)
- B vitamins and asparagus (green)
- Additional testing for specimens test that: - Medications: Robaxin (metacarbamole),
o Turn black after standing at room Indocin, Tivorbex, Elavil, Diprivan (blue)
temperature
- Catheter bags: purple color from Klebsiella
o Test negative for blood and Providencia
o Need for additional testing - IV phenol medications cause green
o NOTE: - NOTES:
▪ Possible reasons why urine gets ▪ Extreme abnormal color of UTI in
black standing at room temp: bacterial infection
oxidation of melanogen to ▪ UTI brought about by pseudomonas
melanin which can be seen in color green ang color
patients with malignant ▪ Refer to the book table 5-1 (p.126)
myeloma (type of cancer) and
alkaptonuria Clarity
- Melanin
- Transparency or turbidity of a specimen
o Excess in malignant melanoma
(cancer) - Visual examination
o Oxidation product of melanogen to ➢ Gently swirl specimen in a clear
melanin container in front of a good light
- Homogentisic acid source
o Black color in alkaline urine ➢ Specimens should be in a clear
o Alkaptonuria (Inborn error of container
metabolism) - Color and clarity are routinely done at the
o NOTES: same time
- Terminology used for reporting
▪ Inborn error of metabolism this
is due to homogentisic acid ➢ Clear, hazy, cloudy, turbid, and milky
▪ Homogentisic acid – reason why ➢ Table 5-2 in the book
urine turns black upon standing. NOTE:
Metabolic product of ▪ Do not examine urine if it still not on
phenylalanine. Patient who has the test tube because the container
deficiency in specific enzyme should be clear
which interfere with the Urine Clarity
metabolism.
- Medications: levodopa, methyldopa, phenol - Clear: no visible particulates, transparent
derivatives, flagyl, and furadantin (additional - Hazy: few particulates, print easily seen
info refer to the book) through urine
- Cola-colored – dark brown non-pathologic - Cloudy: many particulates, print blurred
o Ingestion of faba beans through urine
- Turbid: print cannot be seen through urine
Blue/Green - Milky: may precipitate or be clotted
- Urinary and intestinal bacterial infections are NOTES:
the pathogenic cause Need ng to have printed paper at the back to
o Urinary: pseudomonas infection evaluate the clarity of urine. See pic below.
(green) Reporting of clarity and color:
o Intestinal: infection causing
increased urinary “indican” oxidizing
to indigo blue (blue), blue diaper
syndrome especially among babies –
familial benign hypocalcemia
 Pathologic Turbidity – indicative of disease
conditions

- Most common: RBCs, WBCs (both should not

be present in urine) and bacteria
- Also: non-squamous epithelial cells (cells that
line the renal tubules), yeast (Candida
species, Candida albicans in
1st tube (left): turbid, pale yellow
immunocompromised and diabetic patients),
2nd tube (right): hazy or clear, yellow
trichomonads (an STI, Trichomonas vaginalis,
Reporting of color:
a flagellate), abnormal crystals (uric acid),
lymph fluid, lipids
- The extent (degree) of turbidity should
correspond to the amount of material
observed in the microscopic examination
- Clarity is one of the criteria considered in
1st tube: pale yellow
determining the necessity of performing a
2nd tube: yellow
microscopic examination
3rd tube: red
- Always correlate the results.
4th tube: dark yellow
- The more turbid the sample, the more it
Normal Clarity needs to be examined further
- The greater the turbidity, the greater the
- Freshly voided urine is usually clear, need to perform microscopic exam
particularly if it is a midstream specimen - You cannot report a clear sample with a lot of
➢ Midstream clean catch has epithelial cells present.
cells, which are big and may obscure
other significant cells Specific Gravity (SG)
➢ If urine is heavily contaminated, it can
- Determined using chemical reagent strip test
mean a turbid urine
- Evaluation of urine concentration
- Amorphous phosphates and carbonates may
- Determines if specimen is concentrated
cause a white cloudiness in an alkaline urine
enough to provide reliable chemistry results
specimen
➢ Dark colored urine if concentrated
NOTE:
and has high specific gravity – less
What is the advantage of midstream why it is
water, more solutes
clear? Less contamination of epithelial cells
➢ If urine is diluted, it has more water,
especially for females
less solutes and has less specific
Nonpathogenic Turbidity gravity
➢ Exception in diabetes mellitus
- Hazy female specimens with squamous (introduction to urinalysis)
epithelial cells and mucus (hazy to turbid) - Definition: the density of a solution
- Bacterial growth in non-preserved specimens compared with the density of an equal
(more often when it passes 2 hours – can volume of distilled water at the same
cause turbidity) temperature
- Refrigerated specimens with precipitated - Isosthenuric: SG is constant at 1.010 (the SG
amorphous phosphates (white), carbonates of the plasma ultrafilitrate)
(white), and urates (pink) - Hyposthenuric: SG lower than 1.010
- Contamination: fecal, talc (powder), semen, - Hypersthneuric: SG higher than 1.010
vaginal creams, IV contrast media - Normal random specimen range
o 1.002 to 1.035; most common 1.015 to
1.030 in random specimen
 o Below 1.002 may not be urine STEPS TO USE REFRACTOMETER REFER TO THE
- Consistent low readings: further testing BOOK
- NOTES:
Specific gravity – density of solution Urinometry
In normal conditions, concentrated specific - Urinometer consists of a weighted float
gravity increased. attached to a scale that has been calibrated
Refractometer in terms of urine specific gravity
- Weight float displaces a volume of liquid
- Measures velocity of light in air versus equal to its weight and has been designed to
velocity of light in a solution (refractive sink to a level of 1.000 in distilled water
index) - Eye level of reading
- Concentration changes the velocity and - Principle of urinometry: buoyancy or
angle at which the light passes through the paglutang
solution - Disadvantage: least or less accurate because
o Depends on the amount of solutes it requires temperature corrections and
- Prism in the refractometer determines the correction for protein and glucose, not
angle that light is passing through the urine recommended by the CLSI, requires greater
and converts angle to calibrated viewing sample volume
scale - Calibrator: distilled water
- Needs a good light source - Temperature correction (urinometer)
- Observe for light boundary o Subtract 0.001 for every 30C below
- Calibrate device before using urinometer temperature.
- Advantages: o Add 0.001 for every 30C above
o Temperature compensation not urinometer temperature
needed - Corrections for glucose and protein
o Light passes through temperature- (urinometer and refractometer)
compensating liquid o Subtract 0.003 for 1 gram of protein
o Compensated between 150C and o Subtract 0.004 for 1 gram of glucose
380C o Requires 12 mL sample
o Small specimen size: one drop and
you can already get the SG of sample Example: A specimen containing 1 g/dL protein and 1
- Drop of urine placed on prism g/dL glucose has a specific gravity reading of 1.030.
- Focus on light source, and read scale Calculate the corrected reading of specific gravity
- Wipe off prism between specimens
- Calibration: 1.030 – 0.003 (protein) = 1.027 – 0.004 (glucose) =
o Distilled water should read 1.000; 1.023 corrected specific gravity
adjust set screw if necessary
Sample Problems
o 5% NaCl should read 1.022 ± 0.001
(1.021 to 1.023) 1. GIVEN:
o 9% sucrose should read 1.034 ± 0.001 • Specific gravity of urine: 1.035
(1.033 to 1.035) • Urinometer temp = 20 0C
- Disadvantages: • Specimen Temp = 8 0C (below)
o Refractometer requires correction
• What is the corrected specific
for glucose and protein
gravity? 1.031
SOLUTION:
1. Find the difference.
a. 20-8 = 12
2. Divide by 3
a. 12/3 = 4
 3. Multiply by 0.001 - 1 g molecular weight of a substance divided
a. 4 x 0.001 = 0.004 by the number of particles into which it
4. Add/Subtract to or from the dissociates (= to MW of substance)
specific gravity. o Glu= 180 g/osm (C+ H+ O)
a. 1.035 – 0.004 = 1.031 o NaCl = 58.5 g/osm (Na + Cl)
2. A specimen containing 2 g/dl protein & 1 g/dl - The unit of measure used in the clinical
of glucose has a specific gravity reading of laboratory is the milliosmole (mOsm)
1.035. Calculate the corrected specific gravity. - Osmolality of a solution can be determined
SOLUTION: by measuring a property that is
1.035 – 0.006 (protein) – 0.004 (glucose) = mathematically related to the number of
1.025 corrected specific gravity particles in the solution
o Colligative property
Urinometry continuation - Changes in colligative properties
• Abnormally High results = >1.040 o Lower freezing point
o Radiographic contrast media (IVP) o Higher boiling point
o Dextran, other IV plasma expanders o Increased osmotic pressure
o Check patient’s clinical course/history o Lower vapor pressure
NOTE: this is already outside the - Measuring osmolality in the urinalysis
normal range. 1.035 max ang normal laboratory requires an osmometer
urine. o Additional step in the routine
urinalysis procedure
• Reagent strip reading and osmometry not
- Automated osmometer utilizes freezing
affected by high-molecular-weight
point depression to measure osmolality
substances.
o Should be used as an alternative if
NOTE:
possible
A2O Advance Automated osmometer –
NOTE: High Molecular Weight
freezing point depression red color (decrease
Solubility example is protein.
in freezing point)
Reagent strip and Osmometry are
Osmolality – to measure specific gravity in
good alternative for urinometry and
urinalysis
refractometry
Harmonic Oscillation Densitometry
Osmolality
- Based on the principle that the frequency of
- A more representative measure of renal
a sound wave entering a solution change in
concentrating ability can be obtained
proportion to the density of the solution
- Specific gravity depends on the number of
- Was used in early automated urinalysis
particles present in a solution and the density
instruments
of these particles
- Addition of reagent strip for specific gravity
- Osmolality is affected only by the number of
has been replaced in the automated system
particles present
o Substances of interest are small
NOTE:
molecules/particles:
Also used in automated urinalysis – IRIS
o Sodium
automated urinalysis principle
o Chloride
o Urea OTHER METHODS FOR SPECIFIC GRAVITY
NOTE: Principle of Osmolality – based on changes of - Osmolality
colligative properties by particle number o Principle: Changes in colligative
properties by particle number
TABLE 5-3
- Harmonic Oscillation Densitometry
 o Principle: Sound wave Frequency Sweaty feet Isovaleric acidemia
o Automated urinalysis (IRIS) Cabbage Methionine
malabsorption
Reagent Strip Specific Gravity Bleach Contamination

- The reagent strip reaction is based on the

change in pKa (dissociation constant) of a ARALIN YUNG MGA TABLES SA BOOK.
polyelectrolyte in an alkaline medium
o Releasing H ions in direct proportion
to the number of ions in the solution
o The more hydrogen ions released,
the lower is the pH
o Indicator bromothymol-LS blue on
the reagent pad measures the
change in pH
NOTE:
Principle is change in dissociation
constant of a polyelectrolyte in an
alkaline medium.
o Indicator changes from blue (1.000
[alkaline]), through shades of green,
to yellow (1.030 [acid])
o Not affected by nonionizing
substances.

Odor

- Not routinely reported

- Fresh urine; fairly aromatic
- Older urine: ammonia
- Metabolic disorders: maple syrup urine
disease, ketosis (fruity), infection
(ammonia/unpleasant)
- Food: garlic, onions, asparagus (genetic: only
certain people can smell asparagus, but all
produce odor)
- Sweaty feet, rat scent, rancid, cabbage

Common Causes of Urine Odor

Table 5-5 Possible Outcomes of Urine Odor

Odor Cause
Aromatic Normal
Foul, ammonia-like Bacterial
decomposition, urinary
tract infection
Fruity, sweet Ketones (diabetes
mellitus, starvation,
vomiting)
Maple syrup Maple syrup urine
disease
Mousy Phenylketonuria
Rancid Tyrosinemia
TABLE 5-1 LABORATORY CORRELATION OF URINE COLOR
Color Cause Clinical Laboratory Correlations
Colorless - Recent fluid consumption Commonly observed with random specimens
Pale Yellow - Polyuria or diabetes insipidus Increased 24-hour volume and low specific gravity
- Diabetes mellitus Elevated specific gravity and positive glucose test result
- Dilute random specimen Recent fluid consumption
Dark Yellow - Concentrated specimen May be normal after strenuous exercise or in first morning
- B complex vitamins
- Dehydration Fever or burns
- Bilirubin Yellow foam when shaken and positive chemical test results for
bilirubin
- Acriflavine Negative bile test results and possible green fluorescence
- Nitrofurantoin Antibiotic administered for urinary tract infections
Orange-Yellow - Phenazopyridine (Pyridium) Drug commonly administered for urinary tract infections
- Phenindione Anticoagulant, orange in alkaline urine, colorless in acid urine
- Sulfasalazine (Azulfidine) Anti-inflammatory drug
Yellow-Green - Bilirubin oxidized to biliverdin Colored foam in acidic urine and false-negative chemical test results
for bilirubin
Green - Pseudomonas infection Positive urine culture
- Asparagus None
Blue-Green - Amitriptyline Antidepressant
- Methocarbamol (Robaxin) Muscle relaxant, may be green-brown
- Clorets None
- Indican Bacterial infections, intestinal disorders
- Methylene blue Fistulas
- Phenol When oxidized
- Propofol Anesthetic
- Familial hypercalcemia “Blue diaper syndrome”
- Indomethacin (Indocin, Tivorbex) Nonsteroidal anti-inflammatory drug
Pink Red - RBCs Cloudy urine with positive chemical test results for blood
and RBCs visible microscopically
- Hemoglobin Clear urine with positive chemical test results for blood; intravascular
hemolysis
- Myoglobin Clear urine with positive chemical test results for blood;
 muscle damage
- Beets Alkaline urine of people who are genetically susceptible
- Rifampin Tuberculosis medication
- Menstrual contamination Cloudy specimen with RBCs, mucus, and clots
Port wine - Porphyrin Negative test for blood, may require additional testing
Red-Brown - RBCs oxidized to methemoglobin Seen in acidic urine after standing; positive chemical test
result for blood
- Myoglobin
Brown Black - Homogentisic acid (alkaptonuria) Seen in alkaline urine after standing; specific tests are
available
- Malignant melanoma Urine darkens on standing and reacts with nitroprusside
Melanin or melanogen and ferric chloride
- Phenol derivatives Interfere with copper reduction tests
- Argyrol (antiseptic) Color disappears with ferric chloride
- Methyldopa or levodopa Antihypertensive
- Metronidazole (Flagyl) Darkens on standing, intestinal and vaginal infections
- Chloroquine and primaquine Antimalarial drugs
- Methocarbamol Muscle relaxant
- Fava beans, rhubarb, or aloe None

BOX 5-2 PATHOLOGICAL CAUSES OF URINE

BOX 5-1 NONPATHOLOGICAL CAUSES OF TURBIDITY
URINE TURBIDITY RBCs
Squamous epithelial cells WBCs
Mucus Bacteria
Amorphous phosphates, carbonates, urates Yeast
Semen, spermatozoa Trichomonads
Fecal contamination Nonsquamous epithelial cells
Radiographic contrast Media Abnormal crystals
Talcum powder Lymph fluid
Vaginal Creams Lipids
Table 5-3 Current Urine Specific Gravity
Method Principle
Refractometry Refractive index
Osmolality Changes in colligative properties by particle
number
Reagent strip pKa changes of a polyelectrolyte by ions Table 5-4 Particle Changes to Colligative Properties
present Property Normal Pure Water Point Effects of 1 Mole of
Solute
Freezing Point 0°C Lowered 1.86°C
Boiling Point 100°C Raised 0.52°C
Vapor Pressure 2.38 mm Hg at 25°C Lowered 0.3 mm Hg at
25°C
Osmotic 0 mm Hg Increased 1.7 × 109 mm
Pressure Hg

Table 5-4 Possible Causes of Urine Odor

Odor Cause
Aromatic Normal
Foul, ammonia- Bacterial decomposition, urinary tract
like infection
Fruity, sweet Ketones (diabetes mellitus, starvation,
vomiting)
Maple syrup Maple syrup urine disease
Mousy Phenylketonuria
Rancid Tyrosinemia
Sweaty feet Isovaleric acidemia
Cabbage Methionine malabsorption
Bleach Contamination
Chemical Examination of Urine (4th week) Specific 45s pKa change Bromthymol blue
gravity of
laboratory is not fully automated yet – use of chemical polyelectrol
strips ytes
Ketones 40s Na Na nitro-prusside
Black bottle – multi sticks nitroprussid
reagent e rxn
Bilirubin 30s Diazo rxn 2,4-dicholoro-aniline
White bottle – chem strips diazonium salt
Glucose 30s Double Glu oxidase
It has 10 sequential Peroxidase
parameters. Each enzyme rxn K iodine
pad correspond to Reagent Strips
a chemical
parameter. o Reagent strips provide a simple, rapid means for
performing routine chemical tests on urine
On Top – o Single and multitest strips available
leucocytes parameter o The brand and number of tests used are a
matter of laboratory preference
On laboratory, we determine the specific gravity of
o Specified by urinalysis instrumentation
the urine with the use of chemical strip.
manufacturers
In routine urinalysis, small clinics will only comprise of o Strips consist of chemical-impregnated
4 parameter strip. The 4 parameter strip will only absorbent pads on a plastic strip (handle is a
include protein, pH, specific gravity, and glucose. plastic strip)
Notes:
The 10 parameters
- Dip the strip into your simple and wait for a
o Each pad has embedded its own chemicals. few minutes. Pinakamatagal na dip is 2
o They work in an independent and respective minutes or 120 sec.
principles. - Isang bottle of reagent strip has 50 strips.
o Reading time yung dapat sinusunod, especially We don’t reuse the strip. One patient=one
leukocyte esterase. strip. There’s also machine who uses reagent
o Reagents (Multistix) reagent strip only. strips.
o A color-producing chemical reaction takes place
Parameter Readin Principle Reagents (Multistix) when the absorbent pad comes in contact with
g time
Leukocyte 2 mins Granulocytic Derivatized pyerole
urine
Esterase esterase rxn AA ester o The reactions are interpreted by comparing the
Diazonium salt color produced on the pad within the required
Nitrite 60s Greisis rxn P-arsanilic acid time frame with a chart supplied by the
Tetrahydorbenzo (h) manufacturer
quinilin-3-ol
Notes:
Urobilino 60s Ehrlich rxn P-diethylamino
gen benzaldehyde - We are after color reaction or color
Protein Timing Protein Tetrabromphenol producing chemical reaction. Nag o-observe
not error of blue ka kung may pagbabago sa kulay ng strip mo
critical indicators after mo mag dip at mag wait for a few
pH Double Methyl Red, minutes.
indicator Bromthymol blue
- Yung bottle dun mo pagbabasehan yung
system
Blood 60s Pseudopero Diisoppropyl-
urine results mo.
xidase benzene o Several degrees of color are shown to provide
activity of dehydroperoxide, semi-quantitative readings of neg, trace, 1+, 2+,
Hgb tetramethyl- 3+, and 4+
benzidine
 o Estimates of mg/dL are also provided for many Improper Technique Errors
of the test areas
o Formed elements such as red and white blood
Note:
cells sink to the bottom of the specimen and will
- The greater the color, the greater the
be undetected in an unmixed specimen
reading.
o Allowing the strip to remain in the urine for an
- Example: 4+ intense color reaction, yung din
extended period may cause leaching of reagents
yung dami ng concentration ng urine. Pwede
from the pads
rin yan i-report nang
o Excess urine remaining on the strip after its
✓ Trace = +/-
removal from the specimen can produce a
✓ 1+ = +
runover between chemicals on adjacent pads,
✓ 2+ = ++
producing distortion of the colors
✓ 3+ = +++
NOTES:
✓ 4+ = ++++
- Wag ninyo ibabad ng matagal yung strip
o Urine reagent strips
ninyo doon sa urine.
▪ pH
- Leaching of reagents– extraction of chemcial
▪ Protein
reganets from the pad. Avoid doing it.
▪ Glucose
- Run over phenomenon – there is excessive
▪ Ketones
urine tendency between adjacent pads. We
▪ Blood
are trying to avoid the run over
▪ Bilirubin and urobilinogen
phenomenon.
▪ Nitrate and leukocytes
o The timing for reactions to take place varies
▪ Specific gravity
between tests and manufacturers; the
Reagent Strip Technique manufacturer's stated time should be followed
o A good light source is essential for accurate
o Dip strip briefly into well-mixed specimen at
interpretation of color reactions
room temperature
o The strip must be held close to the color chart
o Remove excess urine by touching edge of strip
without actually being placed on the chart;
to container as strip is withdrawn
reagent strips and color charts from different
o Blot edge of strip on absorbent pad
manufacturers are not interchangeable
o Wait specified amount of time
NOTE:
o Read using a good light source
- Color chart pwedeng mag ibaiba depende sa
NOTE:
brand.
- Need to be well-mixed, because hindi pwede
o Specimens that have been refrigerated must be
na matagal nakatenga sa test tube yung
allowed to return to room temperature prior to
sample kasi baka nag settle na sa bottom
reagent strip testing
yung mga urine constituents.
NOTE:
- Why is it important that your experiment is
- Kung hindi masusubmit within an hour, it
well-mixed? Tendency of false negative,
needs to be preserved. Allow your sample to
especially sa leukocyte esterase na nasa top
return to room temperature prior to perform
yung strip, hindi maabot.
the reagent strip test.
- Wala dapat sobra sobra. Hindi dapat
overwet ang strip kapag nagchechemical Handling and Storing Reagent Strips
exam.
o Store with desiccant in an opaque, tightly sealed
- Uncentrifuge pa lang yung mga urine. (b4)
container
- Centrifuge of urine – after the strip is dip
o Remove strips immediately prior to use
o Do not expose to volatile fumes
o Store below 30°C
o Do not use past the expiration
o Visually inspect for discoloration/deterioration
Quality Control of Reagent Strips THE 10 PARAMETERS

o Run positive and negative controls, usually at 1. URINE PH

the beginning of a shift o Lungs and kidneys are major regulators of
o Run additional controls acid-base content
▪ When a new bottle of strips is opened o First morning specimen slightly acidic at 5.0
▪ When results are questionable to 6.0
▪ When there are concerns over strip o Postprandial specimen more alkaline
integrity o Normal range is 4.5 to 8.0
o Record control results o No absolute values are assigned
o Manufactured positive and negative controls are NOTES:
available ➢ Postprandial specimen – after meal test
NOTES: ➢ Random urine specimen- urine pH 4.5-8.0
- QC control –at the beginning of shift o Consideration include
morning na medtech ▪ Acid-base content of the blood
- Always record your control results dapat sa ▪ Patient’s renal function
laboratory dapat laging black and white. ▪ Presence of UTI
o Do not use distilled water as a negative control ▪ Patient’s dietary intake
as reactions are designed for urine ionic ▪ Age of the specimen (fresh or old)
concentration o Summary of Clinical Significance of Urine pH
o All negative control readings should be negative ▪ Respiratory or metabolic
o Positive control readings should agree with acidosis/ketosis
published control values ▪ Respiratory or metabolic alkalosis
o Be aware of manufacturer-stated limitations and urine is alkaline
interfering substances ▪ Renal calculi formation
NOTES: ▪ Treatment of urinary tract infections
- The strip is designed for ionic concentration ▪ Precipitation/identification crystals
- Always read your inserts provided by the ▪ High-protein diets-acidic urine
manufacturers. ▪ Low-protein diets-alkaline urine
Confirmatory Testing NOTES:
✓ Ketosis – urine is acidic
o Confirmatory tests use different reagents or ✓ Respiarory alkalosis – alkaline
methodologies to detect the same substances as ✓ Renal calculi (repetition of inorganic
reagent strips with the same or greater salts) and precipitation of crystals – pH
sensitivity or specificity dependent
o Nonreagent strip testing procedures using ✓ pH dependent - certain crystals that can
tablets and liquid chemicals may be available be seen or formed in acidic pH, some in
when questionable results are obtained an alkaline urine. You have to regulate
o Chemical reliability of these procedures also and pH of the urine.
must be checked using positive and negative ✓ High protein diets – meats (acidic)
controls ✓ Low protein diets – fruits and
NOTES: vegetables (alkaline)
- Example: glucose confirmatory test– Bendex ✓ Cranberries – acid urine
tablet ✓ Renal tubular acidosis – pH of urine is
- Using liquid chemicals – need to check alkaline. Why alkaline? What happens
reliability of positive and negative controls to kidney? The kidneys do not remove
acids from the blood into the urine as
they should. Kidney is damaged. Urine
will remain alkaline or basic.
 ✓ Old urine – alkaline. Why alkaline in b. Bromthymol blue = 6 to 9 green
old urine? Urea is breakdown to to blue
ammonia because of the presence of
urease producing bacteria. Urea is
your major organic compound in
urine.
✓ Table 6-1. ➢ Interference – No known substances
▪ A pH above 8.5 is associated with a interfere with urinary pH
specimen that has been preserved measurements performed by
improperly and indicates that a fresh reagents strips.
specimen should be obtained to ensure NOTES:
the validity of testing ✓ Priniple for reagent strip test:
NOTES: double indicator system
✓ It indicates that your sample is no ✓ If the urine pH is between 4 to 6
longer fresh. - from red to orange pag 6 yan
✓ You receive a sample of 9.0 specimen. yellow na
What will you do? If the specimen is ✓ If the urine pH is between 6 to
9.0, you have to ask your patient to 9 – from yellow to green to
recollect. Improperly preserved. blue (pH 9)
Reject and ask for another. ✓ Methyl red added hydronium
✓ Changes in unpreserved urine. ions; bromthymol blue
❖ Glucose strip – decrease because substract
consumption of glucose by ✓ The hydronium ions are
bacteria. Glycolysis. (false secreted by the kidney in the
negative) form of ammonium ions and
❖ Color - darken, oxidation and other weak organic acids.
reduction of metabolites ✓ Color change is also dependent
❖ Clarity – decrease because bacteria on the amount of the
nag multiply hydronium ions in the urine.
❖ Odor – increase, foul-ammonia like ✓ Required reading time for urine
❖ pH – increase, breakdown of urea pH: not critical.
❖ Ketones – decerase, volatilization ✓ If in case hindi masunod yung
❖ Bilirubin – decrease, reaction sa required reading time, at least
light you shoud read all these
❖ Urobilinogen – decrease, reduction parameters within 60 seconds
to bilirubin except the leukocyte esterase.
❖ Nitrite – increase, nitrite reducing ✓ Least acceptable reading time –
bacteria 60 seconds or 1 minute
❖ RBC, WBC, casts – decrease 2. PROTEIN
❖ Bacteria – increase, multiplying o Most indicative of renal disease
❖ Trichomonas – decrease ▪ Proteinuria disease
o pH – Reagent Strip Reactions o Normal = <10 mg/dL or 100 mg/24h
▪ Needed to measure between 5.0 and o Low-molecular-weight serum proteins
9.0 in one half or one unit increments filtered; are reabsorbed
➢ Double-indicator system reaction o Albumin primary protein concern
a. Methyl red = 4 to 6 red o Other proteins
orange/yellow ▪ Prostatic, seminal, vaginal secretions
▪ Uromodulin
o NOTES:
 ✓ Pag nag positive sa protein, most  Proteinuria is associated with
likely may tama yung kidney ng renal disease.
patient.  Glomerular proteinuria or pwede
✓ Our reagent strip cannot detect lower ren tubular proteinuria yung
than 10mg/dL problem.
✓ 10mg/dL or even 20mg/dL – negative  Glomerulus – tuft of capillaries;
result. Because di yan maddetect ng for filtration in kidney; permeable
strip naten  A. Glomerular proteinuria
✓ Pag 20+ na or 30 – positive or • if the membrane is already
maddetect na damage, large substances,
✓ Albumin lang ma d-detect ng protein rbc, wbc and etc can easily
test. Abnormal protein cannot be pass through it.
detected by the reagent strip. • conditions: bacterial
✓ Uromodulin aka Tamm-horsfall infections,
protein – protein that comprises of glomerulonephritis
cast (hyaline cast etc.) (inflamed na glomelur),
o Clinical Significance streptococcus, toxic
▪ Presence requires determination of substances, immune
normal or pathological condition complexes (especially SLE)
▪ Clinical proteinuria = 30 mg/dL, 300 • another cause: increase
mg/24h pressure of the blood
▪ Variety of causes entering the glomerulus.
➢ Prerenal  B. Tubular proteinuria
➢ Renal • ang sira ay renal tubules.
➢ Postrenal • You have PCT , DCT,
o NOTES: Collecting tubules.
✓ Proteinuria- presence of protein and • Tubules- Reabsorptions of
urine substances.
✓ Already detectable by the strip • if the membrane is already
✓ Pre renal damaged, it cannot be
 before reabsorbed anymore.
 Normal kidney and they maybe Therefore, it is excreted
other causes which result to through urine.
appearance of urine. • Conditions : exposure of
 Has problem on plasma, toxic substances (heavy
especially low molecular weight metals), vial infections,
plasma proteins. Fanconi syndrome
 No problem on kidney. (disorder of kidney tuules;
 Hemoglobin, myoglobin, acute genetic defect; seen in
phase reactants, multiple children; due to exposure
myeloma (increase BJP). of certain drugs)
 Increase acute phase reactants  C. Microalbuminuria
kapag may inflammation. • presence in patients with
 In BJP, you need to use DM.
confirmatory test to detect
• diabetic methrophaty –
because it is a light chain.
nararanasan ng patient
✓ Renal
with DM nasisira na kidney
 The problem is kidney.
nila.
 • Meron nang mga pluck. Confirmatory test for
Mga pluck na bumabara. multiple myeloma
• Malapit na sa renal failure ✓ Screening test for BJP
 Postural proteinuria – SSA (sulfosalicylic
• this is not a true case of acid)- acid
renal disease. precipitation test
• Long time of standing ➢ Screening Test for Bence Jones Protein
increase pressure of renal (BJP)
kaya nagkakaroon ng  Coagulates between 40°C and 60°C
excretion ng protein ng ihi.  Dissolves when temperature reaches
• Di ibig sabihin sira yung 100°C
kidney nila.  Specimens that appear turbid
• The doctor will have to between 40°C and 60°C and clear at
request for a first-morning 100° are suspected of containing BJP
urine specimen. ▪ Renal Proteinuria
✓ Post renal ➢ Glomerular or tubular damage
 after  Glomerular proteinuria
 Problem of organs located in the  Microalbuminuria
urinary tract: ureters, urethra,  Orthostatic (postural) proteinuria
bladder, prostate, vagina.  Tubular proteinuria
 Conditions: bacterial and fungal ➢ Glomerular Proteinuria
infections  Damage to glomerular membrane
 Possible na laman ng ihi exudates  Impaired selective filtration causes
(composed of proteins). increased protein filtration leading
 menstruation, injury affecting to cellular excretion
vagina or prostate  Abnormal substances deposit on the
▪ Pre renal Proteinuria (continuation ng clin sig- membrane
di napansin ni miss na may slide sya n2 -_-) Primarily immune disorders result
➢ Conditions affecting the plasma, not the in immune complex formation
kidney ✓ Lupus erythematosus,
➢ Not indicative of renal disease glomerulonephritis,
➢ Transient, increase levels of low- amyloids, and other toxins
molecular weight plasma proteins, acute  Increased pressure on the filtration
phase reactants, exceed reabsorptive mechanism
capacity • Hypertension
➢ Rarely seen on reagent strip (not • Strenuous exercise
albumin) • Dehydration
➢ Bence Jones Protein (BJP) • Pregnancy – Preeclampsia
 Multiple myeloma (plasma cell  Benign proteinuria (transient)
myeloma) • Strenuous exercise, high
 Immunoglobulin light chains fever, dehydration, and
 Multiple myeloma confirmation is exposure to cold
serum electrophoresis and ➢ Microalbuminuria
immunoelectrophoresis  Diabetic nephropathy with type 1
 Screening for BJP is not performed and type 2 diabetes mellitus
routinely • Microalbuminuria detection
o NOTE: • Eventual renal failure
✓ Not detected by  Also associated with an increased
reagent strip, risk of cardiovascular
 Microalbuminuria Testing • Albumin binds to blue latex
• Prior to the current reagent particles coated with
strip, microalbuminuria antihuman albumin antibody
testing required the collection • Bound and unbound migrate
of a 24-hour urine specimen up strip
• Results were reported in mg NOTE:
of albumin/24 hours or as the ✓ Microalbumin- hindi na ddetect
albumin excretion rate (AER) reagent strip test protein.
• Microalbumin was significant Kailangan mo gumamit ng special
when 30 to 300 mg of albumin strip test na tinatawag na
were secreted in 24 hours or microalbumin reagent strip for
the AER was 20 to 200 µg/min able for you to detect
• ▪ Semiquantitative testing for microalbuminiria
patients at risk for renal ✓ Should be a 24 hour urine
disease ✓ Microalbumnin test aka Micral
• Immunochemical assays for Test (reagent strip test that
albumin or albumin-specific detects microalbumin)
reagent strips ➢ Orthostatic (Postural) Proteinuria
• Measure creatinine to  Increased pressure on the renal vein
produce an albumin:creatinine when in the vertical position
ratio  Occurs in vertical position, disappears
• First morning specimens are in horizontal position
recommended  Collection instructions
• Gold-labeled antihuman • Empty bladder before bed
antibody-enzyme conjugate  Collect specimen immediately on
• Dip strip in urine to marked arising and collect a second specimen
level for 5 seconds after remaining in vertical position for
• Albumin binds to antibody several hours
• Bound and unbound • Negative reading will be seen
conjugates move up strip on the first morning specimen
Unbound removed in captive • Positive result will be found
zone containing albumin; on the second specimen
bound continues up strip ➢ Tubular Proteinuria
• Reaches enzyme substrate,  Tubular damage affecting
reacts reabsorptive ability
• Colors from white (neg) to red  Tubular dysfunction causes
(varying degrees) • Toxic substances, heavy metals,
• Compare color chart viral infections, Fanconi
• Results read from 0 to 10 syndrome (generalized
mg/dL proximal convoluted tubule
defect)
• Immunochromographic
 Amount of protein
technique
• Glomerular disorders: up to 4
• Specially designed container
g/day
for strip
• Tubular disorders: much lower
• Place container in controlled
levels
amount of specimen for 3 min,
urine enters container • NOTE: Amount of protein may
through a vent hole reach up to 4 grams/day RED
COLOR
▪ Post renal Proteinuria o Reaction Interference
➢ Protein added in the lower urinary and ➢ Highly buffered alkaline urine overrides
genitourinary tract acid buffer system (color change
➢ Microbial infections causing inflammations unrelated to protein concentration)
and release of interstitial fluid protein • Leaving reagent pad in urine too
➢ Menstrual contamination long removes buffer
➢ Semen/prostatic fluid ➢ False-positive
o Reagent Strip Reactions • Highly pigmented urine
◼ Traditional Principle • High SG
➢ PRINCIPLE: Protein error of indicators • Quaternary ammonium
➢ Certain indicators change color in the compounds, detergents,
presence of protein at a constant pH antiseptics, chlorhexidine
➢ Protein accepts H+ from the indicator, NOTES:
increased sensitivity to albumin due ✓ what causes false results? Mga highly
to more amino groups to accept H+ unbuffered sht
than other proteins ✓ Highly pigmented urine – sobrang dark
NOTES: urine
✓ What is protein error o Sulfosalicylic Acid (SSA) Precipitation
indicators? the indicators ➢ Confirmatory test for protein
change in color in the ➢ Cold precipitation test that reacts equally
presence of protein that with all forms of protein
happen in a pH constatnt ➢ Must be performed on centrifuged
✓ Indicator of strip: specimens to remove any extraneous
tetrabromphenol blue contamination
➢ ▪ Tetrabromophenol blue or NOTE:
tetrachlorophenol ✓ Re emphasize – SSA can detect all
tetrabromosulfonephthalein and an acid forms of proteins kabilang na yung
buffer BJP. I
➢ pH level 3 both indicators are yellow ✓ t was also used in confirmatory
➢ Color progresses through green to blue test for protein which is not
➢ Report: neg, trace, 1+, 2+, 3+, 4+, or 30, 100, detected by the reagent strip test
300, 2000 mg/dL of protein.
➢ Trace values are <30 mg/dL ✓ You will look for the presence of
NOTES: precipitates or cloudiness in your
✓ Absence of protein the color of the sample. You will report your
pad is yellow. sample based on the degree of
✓ If there is protein present it will turbidity.
change from green to blue
✓ Semi quantitative 1+, 2+
✓ Quantitative 30,100, 300
✓ <10-20 – not detectable
 ✓ bis(3,3", diodo-4',4"-dihydroxy-5',5"-
dinitrophenyl) 3,4,5,6-tetra-bromo-
sulfonphthalein
✓ Specific for albumin
✓ Sensitivity: 8 to 15 mg/dL (80 to 150
mg/L)
✓ Highly buffered alkaline urine
interference is controlled by treated
paper
Reporting: ✓ Polymethyl vinyl glycol carbonate
decreases nonspecific binding of poly
- 0 – no cloudiness, no turbidity, no precipitate amino acids
presence
- Trace – noticeable turbidity • Reagent strip reactions
- 1+ - distinct turbidity presence without ✓ Colors range from pale green to aqua
granulation blue
- 2+ - turbidty with granulation but with no ✓ Visibly bloody urine elevates results
flocculation presence ✓ Abnormally colored urines may
- 3+ - turbidity, granulation presence and maybe interfere with readings
flocculation presence
- 4+ - clumps of proteins (protein may have Creatinine
greater than 400mg/dL) • Principle: pseudoperoxidase activity of
Reagent – 3% SSA reagent copper-creatinine complexes
• Reagent strips contain copper sulfate (CuSO4,
SSA – may detect all forms of proteins especially 3,3',5,5'-tetramethylbenzidine (TMB) and
abnormal proteins diisopropyl benzene dihydroperoxide (DBDH))
Reagent strip – ONLY albumin is detected • Creatinine in urine combines with copper
sulfate to form copper-creatinine peroxidase
Example • Peroxidase reacts with DBDH, releases oxygen
1. (+) RgtStrip; (-) SSA = presence of albumin ions that oxidize TMB
2. (+) RgtStrip; (+) SSA = case of proteinuria (they • Colors change from orange to green to blue
may be other presents other than protein)
3. (-) RgtStrip; (+) SSA = indicative of abnormal
proteins (example: BJP, globulin and etc.

HINDI ‘TO DINISCUSS PERO NI COPY KO NA LANG • Results: 10, 50, 100, 200, 300 mg/dL or
REN. UNDER PA REN SYA NG PROTEIN. ✓ 0.9, 4.4, 8.8, 17.7, 26.5 mmol/L
Albumin: Creatinine Ratio • Falsely elevated results: bloody urine,
Tagamet (cimetidine), abnormal urine color
• Clinitek microalbumin reagent strips and • No creatinine results are abnormal
Multistix Pro reagent strips • Purpose is to correlate creatinine with
• Simultaneous measurement of albumin results to determine the
albumin/protein and creatinine albumin:creatinine ratio
• Provide an estimate of the 24-hour albumin
Albumin (Protein): Creatinine Ratio
concentrations from random urine
• Albumin pad uses dye-binding reaction for • Automated and manual methods available
specific albumin testing • Clinitek microalbumin strips can be read only
• Albumin strip dye (DIDNTB) on Clinitek instruments
 • Instrument calculates A:C ratio and prints out ▪ Insulin: converts glucose to storage
albumin, creatinine, and A:C results glycogen
• Results in conventional and Sl units ▪ Hormones: glycogen back to glucose
• Abnormal A:C ratio: 30 to 300 mg/g or 3.4 to ▪ Epinephrine: inhibits insulin; seen with
33.9 mg/mol stress, cerebral trauma, and myocardial
• Seimens Multistix Pro 10 strips measure infarction
creatinine, protein-high and protein-low ▪ NOTES:
• Protein-high is protein error of indicators ✓ Increase of glucose.
method ✓ Acromegaly – increase of growth
• Protein-low is dye-binding method hormone
• Urobilinogen is not included on these strips ✓ Most of these hormones,
• Strips read manually or on instrumentation piapataas yung mga blood sugar.
• Results are reported as the protein:creatinine They’re hyperglycemic hormones.
ratio ✓ Glycogen back to glucose –
glycogenolysis
• Results are calculated automatically and are
✓ All of them increases glucose
reported as normal or abnormal
except for insulin
Next parameter ▪ Possible causes of appearance of
glucose in urine
3. GLUCOSE ➢ Tubular reabsorption disorder=renal
o The most frequent chemical analysis glycosuria
performed on urine ➢ End-stage renal disease
o Blood and urine glucose tests are included in all ➢ Cystinosis
physical examinations ➢ Fanconi syndrome
o Focus of mass health screening programs ➢ Temporary lowering of renal threshold
o Clinical significance in pregnancy
▪ Major screening test for diabetes mellitus o Reagent Strip (Glucose Oxidase) Reactions
▪ Renal threshold is 160 to 180 mg/dL ▪ Glucose oxidase reaction specific for
▪ Higher blood sugar = glycosuria glucose
▪ Fasting is recommended (DM patients) ▪ 1st sequence: Glucose oxidase, peroxide,
▪ Specimens are usually tested 2 hours chromogen, buffer on test pad
postprandial ➢ Double sequential enzyme
▪ Gestational diabetes reaction
➢ Placental hormones block action of ▪ 2 sequence: Glucose oxidase catalyzes
nd

insulin a reaction between glucose and oxygen

➢ High fetal glucose stresses baby's ➢ Produces gluconic acid and
pancreas peroxide
➢ Result is fat baby ▪ NOTES:
➢ Mother prone to type 2 diabetes ✓ principle: double sequential
➢ Tumataas yung blood sugar ng enzyme reaction
mga buntis ✓ Why double sequential? Because it
▪ Hormonal disorders: pancreatitis, uses two enzymes and it is
acromegaly, Cushing's syndrome, composed of two sequence of
hyperthyroidism, pheochromocytoma, and enzymatic reaction
thyroxicosis ✓ Indicators : glucose oxidase and
▪ Hormones: glucagon, epinephrine, peroxidase enzyme
cortisol, thyroxine, growth hormone ✓ Glucose reagent strip is only
oppose glucose specific for glucose. Other sugars
cannot be detected for the strip
 test in glucose (ex: galactose, ▪
Greatest source of error is unpreserved
lactose and etc) specimens sitting at room termperature
▪ Peroxidase catalyzes the reaction for extended periods
between peroxide and chromogen to ➢ Subjecting the glucose to bacterial
form an oxidized colored compound degradation
➢ Direct proportion to the o Copper Reduction Test
concentration of glucose ▪ Reduction of copper sulfate to cuprous
▪ NOTE: oxide with alkali and heat
✓ Chromogen means dye. ▪ Clinitest tablets: copper sulfate, sodium
✓ The darker the color of the pad, carbonate, sodium citrate, sodium
the greater the concentration of hydroxide
glucose in the patients urine. ▪ Sodium citrate + NaOH = heat
▪ Sodium carbonate = CO₂ blocks room air
▪ Reducing substance + CuSO4
➢ Color change: negative blue (CuSO₂)
through green, yellow, and orange/red
(Cu₂O)
▪ NOTES:
Substrate: glucose; product: gluconic acid with H20 ✓ Principle: copper reduction principle
✓ You’ll need this to confirm the other
▪Chromogens used reducing substance of urine such as
➢ Potassium iodide (green to brown) galactose, lactose, fructose
(Multistix) ✓ The tablet is able to generate heat by
➢ Tetramethylbenzidine (yellow to sodium citrate and NaOH.
green) (Chemstrip) ✓ Reducing substance CHO + CuSO4 →
▪ Reporting results ( can be semi- C2O
quantitative, quantitative and in
percentage)
➢ Neg, trace, 1+, 2+, 3+, 4+
➢ 100 mg/dL to 2 g/dL
➢ 0.1% to 2%
o Reaction Interference
▪ "Pass through" phenomenon
▪ False-positive: only peroxide, oxidizing
detergents from disinfectants used on ➢ High levels of glucose
laboratory instruments ➢ Color passes through orange/red and
▪ False-negative: enzymatic reaction. returns to green-brown: rapid reaction
➢ Repeat with two-drop procedure
Interference
➢ Ascorbic acid and strong reducing  10 drops water
agents  2 drops urine
➢ High levels of ketones (unlikely)  Values up to 5 g/L versus 2 g/L
➢ High specific gravity and low  Separate chart must be used
temperature NOTES: pass through phenomenon is parehas sa run
➢ NOTE: over phenomenon
✓ False positive because it
will mimic the activity of o Copper Reduction Test (Clinitest)
oxidases in our pad. ▪ Not a specific test for glucose
✓ False negative – reduction, ➢ Sensitivity: 200 mg/dL (lower) than
counter act strip
▪ Clinitest does not provide a confirmatory
test for glucose
 ▪ Interference from reducing sugars 4. KETONES
➢ Galactose, lactose, fructose, o Three intermediate products of fat
maltose, pentoses, ascorbic acid,
metabolism
certain drug metabolites, and
▪ Acetone: 2%
antibiotics
▪ Hygroscopic tablets: strong blue color and
▪ Acetoacetic acid: 20%
excess fizzing = deterioration due to ▪ B-hydroxybutyrate: 78%
moisture accumulation o Appear in urine when body stores of fat
▪ NOTE: Interference form reducing (false must be metabolized to supply energy
positive) o Clinical Significance
o Clinical Significance of (Clinitest) ▪ Increased fat metabolism = inability
▪ Galactose in the urine of a newborn to metabolize carbohydrate
signifies an "inborn error of ▪ Primary causes
metabolism" ➢ Diabetes mellitus
➢ Prevents breakdown of
➢ Vomiting (loss of
ingested galactose
carbohydrates)
➢ Results in failure to thrive and
possible death
➢ Starvation, malabsorption,
▪ All states must screen for galactosemia dieting (↓intake)
as part of the newborn screening ▪ Ketonuria shows insulin deficiency
process ➢ Monitor diabetes
▪ Dietary restriction can control the ➢ NOTE: DM patients are prone
condition to ketosis not only in blood sa
▪ NOTES: urine ren
✓ Resulting of Galactosuria ▪ Diabetic ketoacidosis = increased
(prone sa mga inborn errors of accumulation of ketones in the
metabolism sa mga babies) sa blood
galactosemia ➢ Electrolyte imbalance,
✓ RGT strip – only glucose is
dehydration, and diabetic
present
coma
✓ CLINTEST – reducing sugars are
present
▪ Ketonuria unrelated to diabetes
✓ Interpretation examples ➢ Inadequate
intake/absorption of
(+) RGT strip (-) CLINITEST = presence of glucose only carbohydrates
(-) RGT strip (+) CLINITEST = presence of non-glucose ➢ Vomiting
reducing sugars (galactose, fructose etc.) ➢ Weight loss
➢ Eating disorders
Benedix test
➢ Frequent strenuous
- A very old method exercises
- Tube method ➢ NOTES:
- Same color reaction and principle in copper ✓ (-) glucose (+) ketones =
reduction test unrelated to diabetes
✓ Eating disorders:
bulimia, anorexia
o Reagent Strip Reactions
▪ Primary reagent: sodium
nitroprusside
 ➢ (Nitroferricyanide) for testing serum and other bodily
▪ Measure primarily acetoacetic acid fluids (serum and urine)
➢ Assumes the presence of B- ▪ Tablet = sodium nitroprusside, glycine,
hydroxybutyrate and disodium phosphate, lactose (gives
better color)
acetone
▪ Tablet must be absorbed within 30
▪ Acetoacetic acid (alkaline) +
minutes
nitroprusside → purple color ▪ NOTE: Time requirement of ketone = 40
▪ NOTES: sec
✓ Principle : sodium nitroprusside
5. BLOOD
reaction
o Hematuria: intact RBCs
✓ Sa strip minemeasure lang natin
▪ Cloudy red urine
ang acetoacetic acid or known
o Hemoglobinuria: product of RBC
as diacetic acid
destruction
✓ Presence of ketone – purple
▪ Clear red urine
color on your pad
o Any amount of blood greater than five cells
▪ Report qualitatively
per microliter of urine is considered clinically
➢ Negative significant
➢ Trace o NOTES:
➢ Small (1+) ✓ It also can detect myoglobinuria
➢ Moderate (2+) ✓ Hematuria – speckled pattern on
➢ Large (3+) pad (dot dot green)
▪ Semi-quantitatively ✓ Hemoglobinuria – pantay pantay
➢ Negative yung pattern or color; homologous
➢ Trace (5 mg/dL) pattern
➢ Small (15 mg/dL) ✓ >5 – disease patterns
o Chemical tests for hemoglobin provide the
➢ Moderate (40 mg/dL)
most accurate means for determining the
➢ Large (80 to 160 mg/dL)
presence of blood
o The microscopic examination can be used to
differentiate between hematuria and
hemoglobinuria
o NOTES:
✓ Microscopic exam:
o Reaction Interference
✓ Hematuria - rbc seen in urine pa
▪ Levodopa in large dosage
✓ Hemoglobinuria – no rbcs in urine,
▪ Medications containing sulfhydryl
only hemoglin granules are seen
groups
* Lysis of red cell cannot be seen
➢ May produce atypical color
microscopically
reactions
o Hematuria
▪ False-positive results from improperly
▪ Hematuria: intact RBCs, cloudy red
timed readings
urine
▪ Falsely decreased values in improperly
▪ Damage to renal system
preserved specimens
➢ Renal calculi
➢ Breakdown of acetoacetic acid
➢ Glomerular disease
by bacteria
➢ Tumors
▪ Acetest tablet test used as
➢ Trauma
confirmatory test for questionable
➢ Pyelonephritis
results; however, it was primarily used
➢ Exposure to toxic chemicals
 ➢ Anticoagulant therapy ▪ Two charts corresponding to different
o Hemoglobinuria reactions
▪ Hemoglobinuria: clear, red urine ▪ Free hemoglobin shows uniform color
➢ Hemolytic anemias ▪ Intact RBCs show a speckled pattern on
➢ Transfusion reactions pad
➢ Severe burns ➢ Report: trace, small (1+), moderate
➢ Brown recluse spider bites (2+), large (3+)
➢ Infections ➢ Sensitivity 5 RBCs/μL
➢ Strenuous exercise o Reaction Interference
▪ Hemoglobinuria may result from the ▪ False-positive
lysis of red blood in dilute, alkaline ➢ Menstrual contamination, strong
urine oxidizing agents, vegetable
▪ Hemosiderin: yellow brown granules in peroxidase, bacterial
sediment peroxidases,
o Myoglobinuria ▪ False-negative
▪ Myoglobinuria: heme-containing ➢ Ascorbic acid >25 mg/dL
protein in muscle tissue; clear, ➢ High SG/crenated cells
red/brown urine ➢ Formalin
▪ Rhabdomyolysis: muscle destruction ➢ Captopril
➢ Muscular trauma/crush syndromes ➢ High concentrations of nitrite
➢ Prolonged coma ➢ Unmixed specimens
➢ Convulsions
➢ Muscle-wasting diseases
➢ Alcoholism May uupload na video. Need panoorin kukuha daw ng
➢ Heroin abuse tanong sa lq.
➢ Extensive exertion
➢ Cholesterol-lowering statin
medications

NOTE: Microscopic myoglobinuria – homogenous

pattern

o Reagent Strip Reactions

▪ Principle: pseudoperoxidase activity of
hemoglobin.
▪ Catalyze a reaction between the heme
component
➢ Hemoglobin and myoglobin
➢ Chromogen tetramethylbenzidine
➢ Produce an oxidized chromogen
• Green-blue color
➢ NOTE:
✓ Reagents strip test for
blood : Diasopropyl-
benzene ,
Dehydroperoxide
Summary 6-1 Reagent Strip Testing
Care of Reagent Strips Technique Quality Control
1. Store with desiccant in an 1. Mix specimen well. 1. Test open bottles of reagent
opaque, tightly closed 2. Let refrigerated specimens strips with known positive and
container. warm to room temperature negative controls per facility
2. Store below 30°C; do not before testing. protocol.
freeze. 3. Dip the strip completely, but 2. Resolve control results that
3. Do not expose to volatile briefly, into the specimen. are out of range by further
fumes. 4. Remove excess urine by testing.
4. Do not use past the withdrawing the strip against 3. Test reagents used in
expiration date. the rim of the container and by confirmatory tests with
5. Do not use if chemical pads blotting the edge of the strip. positive and negative controls.
become discolored. 5. Compare reaction colors with 4. Perform positive and negative
6. Remove strips immediately the manufacturer’s chart under a controls on new reagents and
before use good light source at the newly opened bottles of
specified time. reagent strips.
6. Perform confirmatory tests 5. Record all control results and
when indicated. reagent lot numbers
7. Be alert for the presence of
interfering substances.
8. Understand the principles and
significance of the test; read
package inserts.
9. Relate chemical findings to each
other and to the physical and
microscopic urinalysis results

Table 6-1 Causes of Acid and Alkalide Urine

Acid Urine Alkaline Urine
Emphysema Hyperventilation
Diabetes mellitus Vomiting
Starvation Renal tubular acidosis
Dehydration Presence of urease-producing bacteria
Diarrhea Vegetarian diet
Presence of acid-producing bacteria (Escherichia coli) Old specimens
High-protein diet
Cranberry juice
Medications (methenamine, mandelate
[Mandelamine],
fosfomycin tromethamine [Monurol])

Summary 6-2 Clinical Significance of Urine pH

Respiratory or metabolic acidosis/ketosis
Respiratory or metabolic alkalosis
Defects in renal tubular secretion and reabsorption of acids and bases—
renal tubular acidosis
Renal calculi formation and prevention
Treatment of UTIs
Precipitation/identification of crystals
Determination of unsatisfactory specimens
Summary 6-3 pH reagent strip
Reagents Methyl red, bromothymol blue
Sensitivity Multistix: 5.0–8.5 in 0.5 increments visually; 5.0–9
instrumentally
Chemstrip: 5.0–9.0 in 1.0 increments
Sources of error/ interference No known interfering substances
Runover from adjacent pads
Old specimens
Bacterial growth
Correlations with other tests Nitrite
Leukocytes
Microscopic

Summary 6-4 Clinical Significance of Urine Protein

Prerenal Tubular Disorders
o Intravascular hemolysis o Fanconi syndrome
o Muscle injury o Toxic agents/heavy metals
o Acute-phase reactants o Severe viral infections
o Multiple myeloma
Renal Post renal
o Glomerular disorders o Lower urinary tract infections/ inflammation
o Immune complex o Injury/trauma disorders
o Amyloidosis o Menstrual contamination
o Toxic agents o Prostatic fluid/spermatozoa
o Diabetic nephropathy o Vaginal secretions
o Strenuous exercise
o Dehydration
o Hypertension
o Preeclampsia
o Orthostatic or postural proteinuria

Table Reporting SSA Turbidity

Grade Turbidity Protein Rage (mg/dL)
Negative No increase in turbidity Less than 6
Trace Noticeable turbidity 6–30
1+ Distinct turbidity, no granulation 30-100
2+ Turbidity, granulation, no flocculation 100-200
3+ Turbidity, granulation, flocculation 200-400
4+ Clumps of protein Greater than 400
Summary 6-5 Protein Reagent Strip
Reagents Multistix: Tetrabromophenol blue
Chemstrip: 3’,3”,5’,5”-tetrachlorophenol
3,4,5,6-tetrabromosulfophthalein
Sensitivity Multistix: 15 to 30 mg/dL albumin
Chemstrip: 6 mg/dL albumin
Sources of Error/ Interference False positive
o Highly buffered interference alkaline urine
o Pigmented specimens, phenazopyridine
o Quaternary ammonium compounds (detergents) Antiseptics,
chlorhexidine
o Loss of buffer from prolonged exposure of the strip to the specimen
reagent
o High specific gravity
False negative
o Proteins other than albumin
o Microalbuminuria
Correlation with other tests: Blood
Nitrite
Leukocytes
Microscopic

Summary 6-6 Microalbumin Testing

Immunological Tests
Micral-Test ImmunoDip Albumin:Creatinine Ratio
Clinitest Microalbumin Strips/Multistix-Pro
Principle Enzyme Immunochromographics Sensitive albumin tests related to creatinine
immunoassay concentration to correct for patient
hydration
Sensitivity 0–10 mg/dL 1.2–8.0 mg/dL Albumin: 10–150 mg/L
Creatinine: 10–300 mg/dL, 0.9–26.5 mmol/L
Reagents Gold-labeled Antibody-coated blue Albumin: dye DIDNTB
antibody latex particles Creatinine: CuSO4, 3,3’,5,5’-TMB, and DBDH
B-galactosidase
Chlorophenol red
galactoside
Interference False negative: False negative: Dilute Visibly bloody or abnormally colored urine
Dilute urine Creatinine: cimetidine: False positive
urine

Summary 6-7 Clinical Significance of Glucose

Hyperglycemia-Associated Renal-Associated
Diabetes mellitus Fanconi syndrome
Pancreatitis Advanced renal disease
Pancreatic cancer Osteomalacia
Acromegaly Pregnancy
Cushing syndrome
Hyperthyroidism
Pheochromocytoma
Central nervous system damage
Stress
Gestational diabetes
Summary 6-8 Glucose Reagent Strip
Reagents Multistix
o Glucose oxidase
o Peroxidase
o Potassium iodide
Chemstrip
o Glucose oxidase
o Peroxidase
o Tetramethylbenzidine
Sensitivity Multistix: 75 to 125 mg/dL
Chemstrip: 40 mg/dL
Interference False positive
o Contamination by oxidizing agents and
detergents
False negative
o High levels of ascorbic acid
o High levels of ketones
o High specific gravity
o Low temperatures
o Improperly preserved specimens
Correlations with other tests Ketones
Protein

Summary 6-9 Clinical Significance of Urine Ketones

Diabetic acidosis
Insulin dosage monitoring
Starvation
Malabsorption/pancreatic disorders
Cold exposure
Strenuous exercise
Vomiting
Inborn errors of amino acid metabolism
Alcoholism
Febrile state in children

Summary 6-10 Ketone Reagent Strip

Reagents Sodium nitroprusside
Glycine (Chemstrip)
Sensitivity Multistix: 5–10 mg/dL
acetoacetic acid
Chemstrip: 9 mg/dL acetoacetic acid; 70 mg/dL
acetone
Interference False positive:
o Phthalein dyes
o Highly pigmented red urine
o Levodopa
o Medications containing free sulfhydryl groups
False negative:
Improperly preserved specimens
Correlations Glucose
Summary 6-11 Clinical Significance of a Positive Reaction of Blood
Hematuria Myoglobinuria
o Renal calculi o Muscular trauma
o Glomerulonephritis o Crush injuries
o Pyelonephritis o Prolonged coma
o Tumors o Convulsions
o Trauma o Muscle-wasting diseases
o Exposure to toxic chemicals o Alcoholism/overdose
o Anticoagulants o Drug abuse
o Strenuous exercise o Extensive exertion
Hemoglobinuria o Cholesterol-lowering statin medications
o Transfusion reactions
o Hemolytic anemias
o Severe burns
o Infections/malaria
o Strenuous exercise/ RBC trauma
o Brown recluse spider bites

Summary 6-12 Blood Reagent Strip

Reagents Multistix: Diisopropylbenzene dihydroperoxide and 3,3’,5,5’-
tetramethylbenzidine
Chemstrip: dimethyldihydroperoxyhexane and tetramethylbenzidine
Sensitivity Multistix: 5–20 RBCs/mL, 0.015–0.062 mg/dL hemoglobin Chemstrip: 5
RBCs/mL, hemoglobin corresponding to 10 RBCs/mL
Interference False positive:
o Strong oxidizing agents
o Bacterial peroxidases
o Menstrual contamination
False negative:
o High specific gravity/crenated cells
o Formalin
o Captopril
o High concentrations of nitrite
o Ascorbic acid greater than 25 mg/dL
o Unmixed specimens
Correlation with other tests Protein
Microscopic

Table 6-2 Urine Bilirubin and Urobilinogen in Jaundice

Urine Bilirubin Urine Urobilinogen
Bile duct obstruction +++ Normal
Liver damage + or – ++
Hemolytic disease Negative +++

Summary 6-13 Clinical Significance of Urine Bilirubin

Hepatitis
Cirrhosis
Other liver disorders
Biliary obstruction (gallstones, carcinoma)
Summary 6-14 Bilirubin Reagent Strip
Reagents Multistix: 2,4-dichloroaniline diazonium salt
Sensitivity Chemstrip: 2,6-dichlorobenzenediazonium salt
Multistix: 0.4–0.8 mg/dL bilirubin
Chemstrip: 0.5 mg/dL bilirubin
Interference False positive:
o Highly pigmented urines, phenazopyridine
o Indican (intestinal disorders)
o Metabolites of Lodine
False negative:
o Specimen exposure to light
o Ascorbic acid greater than 25 mg/dL
o High concentrations of nitrite
Correlation with other tests Urobilinogen

Summary 6-15 Clinical Significance of Urobilinogen

Early detection of liver disease
Liver disorders, hepatitis, cirrhosis, carcinoma
Hemolytic disorders

Summary 6-16 Urobilinogen Reagent Strip

Reagents Multistix: p-dimethylaminobenzaldehyde
Chemstrip: 4-methoxybenzenediazonium-tetrafluoroborate
Sensitivity Multistix: 0.2 mg/dL urobilinogen
Chemstrip: 0.4 mg/dL urobilinogen
Interference Multistix
False positive:
o Porphobilinogen
o Indican
o p-aminosalicylic acid
o Sulfonamides
o Methyldopa
o Procaine
o Chlorpromazine
o Highly pigmented urine
False negative:
o Old specimens
o Preservation in formalin
Chemstrip
False positive:
o Highly pigmented urine
False negative:
o Old specimens
o Preservation in formalin
o High concentrations of nitrite
Correlation with other tests Bilirubin
Summary 6-17 Clinical Significance of Urine Nitrite
Cystitis
Pyelonephritis
Evaluation of antibiotic therapy
Monitoring of patients at high risk for UTI
Screening of urine culture specimens

Summary 6-18 Nitrite Reagent Strip

Reagents Multistix: p-arsanilic acid
Tetrahydrobenzo(h)-quinolin-3-ol
Chemstrip: Sulfanilamide, hydroxyte-trahydrobenzoquinoline
Sensitivity Multistix: 0.06–0.1 mg/dL nitrite ion
Chemstrip: 0.05 mg/dL nitrite ion
Interference False positive:
o Improperly preserved specimens
o Highly pigmented urine
False negative:
o Nonreductase-containing bacteria
o Insufficient contact time between bacteria and urinary nitrate
o Lack of urinary nitrate
o Large quantities of bacteria converting nitrite to nitrogen
o Presence of antibiotics
o High concentrations of ascorbic acid
o High specific gravity
Correlation with other tests Protein
Leukocytes
Microscopic

Summary 6-19 Clinical Significance of Urine Leukocytes

Bacterial and nonbacterial UTI
Inflammation of the urinary tract
Screening of urine culture specimens

Summary 6-20 Leukocyte Esterase Reagent Strip

Reagents Multistix: Derivatized pyrrole amino acid ester
Diazonium salt
Chemstrip: Indoxylcarbonic acid ester
Diazonium salt
Sensitivity Multistix: 5–15 WBC/hpf
Chemstrip: 10–25 WBC/hpf
Interference False positive:
o Strong oxidizing agents
o Formalin
o Highly pigmented urine, nitrofurantoin
False negative:
o High concentrations of protein, glucose, oxalic acid, ascorbic
acid, gentamicin, cephalosporins, tetracyclines; inaccurate timing
Correlation with other tests Protein
Nitrite
Microscopic
Summary 6-21 Clinical Significance of Urine Specific Gravity
Monitoring patient hydration and dehydration
Loss of renal tubular concentrating ability
Diabetes insipidus
Determination of unsatisfactory specimens due to low concentration

Summary 6-22 Leukocyte Esterase Reagent Strip

Reagents Multistix: Poly (methyl vinyl ether/maleic anhydride) bromothymol blue
Chemstrip: Ethylene glycol diaminoethyl ether tetra-acetic acid, bromothymol blue
Sensitivity 1.000–1.030
Interference False positive:
o High concentrations of protein
False negative:
o Highly alkaline urines (greater than 6.5)
Given the following physical urinalysis results, a. What is a probable cause of the woman’s red urine?
determine additional urinalysis results that may be The woman has been eating fresh beets
abnormal.
b. The woman collects a specimen at the physician’s
a. A green specimen with a strong foul odor of office. The color is yellow, and the pH is 5.5. Is this
ammonia - An elevated pH and a positive reagent strip consistent with the previous answer? Why or why not?
reaction for nitrite. Yes. The pH of the woman’s urine is acidic or she has
not recently consumed fresh beets.
b. A pale yellow urine with a specific gravity of 1.030 -
An elevated pH and a positive reagent strip reaction 5. Is a clear urine always normal? Explain your answer.
for nitrite. No. The urine can contain increased pH, glucose,
ketones, bilirubin, urobilinogen, nitrite, and small
c. A dark yellow specimen with yellow foam - The
amounts of cellular structures.
reagent strip test for bilirubin would be positive.

d. A cloudy red urine - The reagent strip reaction for

blood would be positive, and RBCs would be seen in
the microscopic examination.

2. The urology clinic questions a urinalysis report from

the laboratory. The laboratory report states a reagent
strip reading of a specific gravity of 1.020, protein 3
g/dL, and glucose 2 g/dL. The specific gravity in the
urology clinic was greater than 1.035.

a. Correct the refractometer reading to account for

the concentrations of protein and glucose. What is
the corrected specific gravity? 1.018.

b. Do the specific gravities correlate? YES.

c. If the specific gravity was also checked using

osmometry, should the result agree with the
laboratory or the urology clinic results? Why or why
not? It would agree with the reagent strip reading
because, like the osmometer, the reagent strip is not
affected by high-molecular-weight substances.

3. State two pathological causes of a clear red urine.

a. State a method that could distinguish between the

two causes that does not require laboratory testing. -
Hemoglobin and myoglobin. Examine the patient’s
plasma/serum. The breakdown of red blood cells to
hemoglobin produces a red serum/plasma. Myoglobin
is produced from skeletal muscle and is rapidly cleared
from the plasma/serum. The serum/plasma color
would not be affected.

4. A woman frequently shops at the farmer’s market

near her home. She notices her urine has a red color
and brings a specimen to her physician. The specimen
tests negative for blood.
1. A patient taken to the emergency department after b. Explain the correlation between the patient’s
an episode of syncope has a fasting blood glucose scheduled surgery and the normal urobilinogen. -
level of 450 mg/dL. Results of the routine urinalysis Possible biliary duct obstruction preventing bilirubin
are as follows:
from entering the intestine.
COLOR: Yellow KETONES: 2+
c. If blood were drawn from this patient, how might
CLARITY: Clear BLOOD: Negative the appearance of the serum be described? Icteric.

SP. GRAVITY: 1.015 BILIRUBIN: Negative d. What special handling is needed for specimens of
serum and urine from this patient? Protection from
pH: 5.0 PROTEIN-LOW: 15 mg/dL
light
PROTEIN-HIGH: 30 mg/dL NITRITE: Negative
3. Results of a urinalysis on a patient who is very
GLUCOSE: 250 mg/dL LEUKOCYTES: Negative anemic and jaundiced are as follows:

CREATININE: 200 mg/dL COLOR: Red KETONES: Negative

a. Explain the correlation between the patient’s blood CLARITY: Clear BLOOD: Large
and urine glucose results. - No. The urine can contain
SP. GRAVITY: 1.020 BILIRUBIN: Negative
increased pH, glucose, ketones, bilirubin,
urobilinogen, nitrite, and small amounts of cellular pH: 6.0 UROBILINOGEN: 8 EU
structures.
PROTEIN: Negative NITRITE: Negative
b. What is the most probable metabolic disorder
GLUCOSE: Negative LEUKOCYTES: Negative
associated with this patient? Diabetes mellitus.
a. Would these results be indicative of hematuria or
c. Considering the patient’s condition, what is the
hemoglobinuria? Hemoglobinuria.
significance of the reading of the patient’s protein-to
creatinine ratio? It indicates diabetes mellitus–related b. Correlate the patient’s condition with the
renal disease. urobilinogen result.- Increased hemoglobin presented
to the liver results in increased bilirubin entering the
d. If the patient in this study had a normal blood
intestine for conversion to urobilinogen.
glucose level, as well as normal results for protein and
creatinine, to what would the urinary glucose level be c. Why is the urine bilirubin result negative in this
attributed? Renal tubular reabsorption disorders. jaundiced patient? The circulating bilirubin is
unconjugated.
2. Results of a urinalysis performed on a patient
scheduled for gallbladder surgery are as follows: d. Would this method also measure urine
porphobilinogen? Why or why not? It would if a
COLOR: Amber KETONES: Negative
Multistix reagent strip is used and would not if a
CLARITY: Hazy BLOOD: Negative Chemstrip is used. A Watson-Schwartz test is more
specific for porphobilinogen
SP. GRAVITY: 1.022 BILIRUBIN: Moderate

pH: 6.0 UROBILINOGEN: Normal

PROTEIN: Negative NITRITE: Negative

GLUCOSE: Negative LEUKOCYTES: Negative

a. What would be observed if this specimen were

shaken? Yellow foam
4. A female patient arrives at the outpatient clinic with bacteria. - Nonnitrite–reducing microorganisms; lack
symptoms of lower back pain and urinary frequency of dietary nitrate; antibiotic administration
with a burning sensation. She is a firm believer in the
5. Results of a urinalysis collected from a 20-year-old
curative powers of vitamins. She has tripled her usual
college athlete after practice are as follows:
dosage of vitamins in an effort to alleviate her
symptoms; however, the symptoms have persisted. COLOR: Dark yellow KETONES: Negative
She is given a sterile container and asked to collect a
clean-catch midstream urine specimen. Results of this CLARITY: Hazy BLOOD: 1+
routine urinalysis are as follows: SP. GRAVITY: 1.030 BILIRUBIN: Negative
COLOR: Dark yellow KETONES: Negative pH: 6.5 UROBILINOGEN: 1 EU
CLARITY: Hazy BLOOD: Negative PROTEIN: 2+ NITRITE: Negative
SP. GRAVITY: 1.012 BILIRUBIN: Negative GLUCOSE: Negative LEUKOCYTES: Negative
pH: 7.0 UROBILINOGEN: Normal The physician requests that the athlete collect
PROTEIN: Trace NITRITE: Negative another specimen in the morning before classes and
practice.
GLUCOSE: Negative LEUKOCYTES: 1+
a. What is the purpose of the second specimen? - To
Microscopic check for possible exercise-induced abnormal results.
8 to 12 RBC/hpf Heavy bacteria b. What changes would you expect in the second
specimen? - . Negative protein and blood, possible
40 to 50 WBC/hpf Moderate squamous
changes in color and specific gravity
epithelial cells
c. Is the proteinuria present in the first specimen of
a. What discrepancies exist between the chemical and prerenal, renal, or postrenal origin? Renal

microscopic test results? State and explain a possible 6. A construction worker is pinned under collapsed
scaffolding for several hours before being taken to
reason for each discrepancy. - Negative chemical
the emergency room. His abdomen and upper legs are
reactions for blood and nitrite. Ascorbic acid
severely bruised, but no fractures are detected. A
interference for both reactions. A random specimen
specimen for urinalysis obtained by catheterization
or further reduction of nitrite could cause the
has the following results:
negative nitrite.
COLOR: Red-brown KETONES: Negative
b. What additional chemical tests could be affected by
the patient’s vitamin dosage? Explain the principle of CLARITY: Clear BLOOD: 4+
the interference. - Glucose, bilirubin, LE. Ascorbic acid
SP. GRAVITY: 1.020 BILIRUBIN: Negative
is a strong reducing agent that interferes with the
oxidation reaction in the glucose test. Ascorbic acid pH: 6.5 UROBILINOGEN: 0.4 EU
combines with the diazo reagent in the bilirubin and
LE tests, lowering the sensitivity. PROTEIN: Trace NITRITE: Negative

c. Discuss the correlation between urine color and GLUCOSE: Negative LEUKOCYTES: Negative
specific gravity results, and give a possible cause for a. Would hematuria be suspected in this
any discrepancy. - The dark yellow color may be specimen? Why or why not? . No, the
caused by betacarotene and vitamin A, and some B specimen is clear.
vitamins also produce yellow urine. b. What is the most probable cause of the
d. State three additional reasons not previously given positive blood reaction? . Myoglobinuria.
for a negative nitrite test in the presence of increased c. What is the source of the substance causing
the positive blood reaction and the name of
 the condition? . Muscle damage from the
accident (rhabdomyolysis).
d. Would this patient be monitored for changes
in renal function? Why or why not? - . Yes.
Myoglobin is toxic to the renal tubules.

7. Considering the correct procedures for care,

technique, and quality control for reagent strips, state
a possible cause for each of the following scenarios.

a. The urinalysis supervisor notices that an unusually

large number of reagent strips are becoming
discolored before the expiration date has been
reached. - Laboratory personnel are not capping the
reagent strip containers tightly in a timely manner.

b. A physician’s office is consistently reporting

positive

nitrite test results with negative LE test results. -

Personnel performing the CLIA-waived reagent strip
test are not waiting 2 minutes to read the LE reaction.

c. A student’s results for reagent strip blood and LE

are consistently lower than those of the laboratory
staff. - The student is not mixing the specimen.

d. One morning, the urinalysis laboratory was

reporting results that were questioned frequently by
physicians. - The reagent strips have deteriorated, and
the quality control on the strips was not performed
before reporting the results