URINALYSIS **

Effective Date: 
Tue, 05/01/2007
Reviewed: 
Wed, 05/26/2021
Revised: 
Wed, 03/13/2019
Policy: 

MATERIALS AND EQUIPMENT:

  • 10SG Urine Reagent Strips 10 Parameter
  • Consult Liquid Urine Control
  • Consult 120 Urine Analyzer
  • Plastic urine containers, sterile or unsterile
  • Conical centrifuge tube, 15 ml
  • Z 100 A Clinical Centrifuge
  • Microscope slides and #1 coverslips

SPECIMEN: Freshly voided, clean-catch, midstream: first morning or random. Causes for rejection: unlabelled specimen, specimen at room temperature for longer than one hour; Containers and instructions are located in each restroom. (See following page for patient instructions). If specimen cannot be examined within one hour, it may be refrigerated up to eight hours and brought to room temperature before examination.

PRINCIPLE: Through chemical and microscopic analysis of the urine specimen, information about the body’s metabolic functions may be obtained. This aids in the evaluation of renal, urinary, and metabolic disorders.

Procedure: 

ROUTINE URINALYSIS:

  • Color: yellow, straw, or amber (observe well-mixed urine in centrifuge tube). Note: if urine color is orange, see note in "Reporting Results".
  • Appearance: clear, hazy, or cloudy (observe well-mixed urine in centrifuge tube).
  • Record color and appearance on the large patient label.
  • Chemical examination (10SG URINE REAGENT STRIPS 10 PARAMETER)
  1. Before strip assay, verify the test strip tray of the 120 URINE ANALYZER is clean of any residue. If needed, remove Strip Holder (see procedure under 120 Analyzer Maintenance), rinse with water, dry and reinstall.
  2. Press START from the initial screen. Wand the barcode from the patient's Harvest label to enter sample number into instrument. Press START again.
  3. Briefly dip the 10 SG urine test strip into well-mixed urine specimen for no longer than one second. Ensure that the test strip pads are totally immersed.
  4. Gently touch (for one second) the long edge of the test strip on a piece of absorbent paper to remove any excess urine.
  5.  Place the test strip, with pads facing upward, onto the tray. IT IS IMPORTANT THAT THE STRIP IS CORRECTLY POSITIONED, AND THE START BUTTON PRESSED WITHIN 5 –10 SECONDS OF DIPPING THE STRIP.
  6. Press the START button. "Testing" will appear on the screen and there will be a short beep. After 65 seconds, the strip holder will carry the strip inside and begin testing. An automatic calibration is done before each test.
  7.  Results are printed out with the sample number, date and time and unique number for the current day.  Abnormal results are printed in red.  Place label with documented color and appearence on the back of the printed copy of the test results.
  8. The test strip tray will return to the extended or start position.. Remove used test strip and discard in red sharps container.
  9. Machine is now ready for the next test strip.
  10. All urines are saved in a pour off tube with the patient information with a "C" written on the label.  Pour off urines are  refrigerated for the next three days for possible culture or further testing.

TEST & INTERPRETATIONS

  • Specific Gravity: 1.000, 1.005, 1.010, 1.015, 1.020, 1.025, 1.030, 1.035
  • pH: 5, 6, 7, 8, 9
  • Leukocytes: Neg, trace (15), 1+ (70), 2+(125), 3+(500) [Leu/uL]
  • Nitrites: Neg, pos
  • Protein: Neg, +/- (15), 1+ (30), 2+ (100), 3+ (300), 4+(2000) [mg/dL]
  • Glucose: Neg, +/-(100) , 1+(250), 2+(500), 3+(1000), 4+(>/= 2000) [mg/dL]
  • Ketones: Neg, +/-(5), 1+ (15), 2+(40), 3+(80, 4+(160) [mg/dL]
  • Urobilinogen: Norma (0.2), +/-(1), 1+(2), 2+(4), 3+(8), 4+(12) [mg/dL]
  • Bilirubin: Neg, 1+(1), 2+(2), 3+(4) [mg/dL]
  • Occult Blood/Hemoglobin: Neg, 1+ (5-10)), 2+ (50), 3+ (200) [Ery/uL]

 Review product insert for Consult 10SG urine reagent strips for information on individual tests.

Microscopic Examination

  1. Pour off a 12ml aliquot of well-mixed urine into a 15ml conical centrifuge tube.
  2. Spin for 5 minutes at 2000 RPM.
  3. Discard clear supernatant to volume of 0.05ml and resuspend sediment.
  4. Place a drop of well-mixed sediment on a microscope slide using a plastic bulb pipette and cover with a #1 coverslip.
  5. Scan slide under low power for examination of cellular elements. Switch to high power for enumeration and identification of elements found under low power.
  6. Scan at least 10 fields and average the number of elements seen. Report as follows:

ELEMENTS & ENUMERATIONS

  • RBC/HPF: 0-2, 3-10, 11-20, 21-50, >50, TNTC
  • WBC/HPF: 0-5, 6-10, 11-20, 21-50, >50, TNTC
  • Epithelial Cells/HPF: 0-5, 6-10, 11-20, 21-50, >50, TNTC Report type: squamous, transitional, renal etc.
  • Bacteria, yeast, mucus, crystals, Trichomonas: None, 1+, 2+, 3+, 4+; report crystal type
  • Casts/HPF: 0-5, 6-10, 11-20, 21-50, >50, TNTC; report type
  • Other formed elements i.e. sperm, talc: 1+, 2+, 3+, 4+ if present

EXPECTED VALUES:
A. Specific Gravity: random urine = 1.001 - 1.035
B. Leukocytes: normal urine produces no color reaction.
C. Nitrite: normal urine is negative
D. pH: normal urine = 5-9, first morning specimen = 5-6
E. Protein: normal urine = negative. Clinical significance of trace result should be determined by additional testing (may be done at clinician’s discretion i.e. urine microalbumin sent to Quest Lab
F. Glucose: normal urine = negative. Any positive result should be followed up with blood testing.
F. Ketones: normal urine = negative. Fasting or starvation diets may produce positive reaction.
H. Bilirubin: normal urine = negative.
I. Blood: RBC excretion up to 5 RBC/l is expected in normal urine. If greater, further diagnostic evaluation is required.

REPORTING RESULTS:

ORDER:

  •  Urinalysis Dipstick only: Record color and appearance, noted on the large label on the back of the result strip, in Harvest. Approve the instrument results.

NOTE: If patient has taken a medication containing a pyridium type substance, urine will be orange in color, and several parameters (nitrites, protein, urobilinogen, and bilirubin) may be false positive. In this case, choose "Pigmented Medication?" at the end of the test result list and answer "Yes" on the dropdown. This choice will automically fill in the strip values as "Unable to Analyze", and microscopic analysis will automaticaly reflex as an order.  Perform microscopic analysis to complete the testing.

  •  Urinalysis w/Micro: The microscopic examination must be completed and entered before the reults can be approved.  Record color, appearance and microscopic results and approve.
  •  Urinalysis Micorscopic only:  Record microscopic results only and approve. (If no Unine Dipstick has been ordered, it is a good idea to have the strip results available. It is often ordered by the provider after the microscopic has been resulted.)

QUALITY CONTROL: CAUTION: All materials should be considered potentially hazardous and handled in the same manner as an infectious agent. Discard if there is excessive turbidity or evidence fo microbial contamination.

Consult Urinalysis Control

  1. Order QC in Harvest on both levels of control.
  2. Run QC daily on Level 1(high abnormal) and Level 2(normal) in the morning after performing daily maintenance (see Consult 120 maintenance procedure in the Lab Manual) or when opening a new vial of dipsticks. Approve all values in Harvest LIS. DO NOT REPORT PATIENT VALUES UNLESS CONTROL VALUES ARE WITHIN SPECIFIED RANGE.
  3. Allow each aliquot of control to warm to room temperature for 15 minutes before assay.
  4. Verify lot number matches assay sheet with known values.
  5. After pressing START, scan the barcodes located on the rack near the instrument for Control 1 (4910) and, in turn, Control 2 (4920).
  6. Remove dropper cap, invert bottle and apply control liquid directly across Urine Reagent Strip pads by gently squeezing bottle, blot long edge of strip, place strip in test strip tray and press START again. EACH PAD MUST BE COMPLETELY SATURATED TO AVOID TEST ABORT.
  7.  ALL VALUES MUST BE WITHIN ACCEPTABLE RANGE - do not report patient values if contol values are not within range.
  8. Refrigerate controls after use.

 Review product insert for Consult 10SG urine reagent strips for information on individual tests.

Microscopic Control

Whenever a Urine with Micro, or UAMicro is ordered, perform a control with Quantimetrix QuanTscopics Urinalysis Microscopics Control 2.

  1. Allow the control to come to room temperatue for 15-90 minutes, depending on volume in the bottle.
  2. Invert the container at least 20 times to assure homogeneity.
  3. After it is at RT, spin 10cc of the liquid.
  4. Dump off the supernatant, apply a drop of the remaining liquid to a microscope slide, and read as you would a urine.
  5. Enter a value in Harvest, under QuanTscopics Control for RBC, WBC, Casts, Crystals and Bacteria.

Store the control tightly capped at 2o to 8when not in use.  The controls are stable stored in this way until the expiration date on the container.

 

As with all laboratory tests, diagnostic and therapeutic decisions should not be based on any singe result or method and must be considered with other clinical information available to the provider.

The McKesson CONSULT Urinalysis Reagent may be affected  by substances that cause abnormal urine color such as drugs containing azo dyes (e.g. Pyridium, Azo Gantrisin, Azo Gantanol), nitrofurantoin and riboflavin.  The color development on the test pad may be masked or a color reaction may be produced that could be interpreted as false results.

See the 10SG Reagent Strips package Insert for information on specific test reactions and interferences.

 

Key Points: 

References:

  • Davidsohn, MD, Israel, Clinical Diagnosis by Laboratory Methods, 15th Edition, W.B. Saunders Co., Philadelphia, pp.18-45
  • Instruction Manual, 120 Urine Analyzer, Roche Diagnostics, 2005
  • Product Insert, Chemstrip 10-UA, Consult  Diagnostics, 06/29/2017
  • Product insert, Liquid Urine Controls,, Consult Diagnostics, 02/09/2018
  • Product Insert, 10SG Urine Reagent Srips 10 Parameter, Consult Diagnostics, 05/12/2016
  • Product Insert, QuanTscopics Urinalysis Micoscopics Control