Bladder Information and Courses from MediaLab, Inc.

The nitrites portion of the chemical reagent strip provides a rapid screening test for the presence of gram-negative bacteria that are often responsible for urinary tract infections. Urine cultures are still needed to confirm the diagnosis and monitor any urinary tract or kidney infection. Diagnosis and treatment of cystitis (bladder infection) is important because, if left untreated, it may result in kidney damage, impairment of renal function, hypertension and/or septicemia.

False Positives:A false positive nitrite test result may occur when a urine specimen has remained at room temperature for an extended period of time, allowing bacterial contaminants to multiply and produce measurable levels of nitrites. Interference from some medications that cause the urine to become red or orange may lead to an incorrect reading of positive for nitrite. False Negatives:False negative results may occur in urine specimens that did not remain in the bladder for the sufficient length of time needed for the bacteria to reduce a measurable quantity of nitrate to nitrite. Other reasons for false negative results include high specific gravity, ascorbic acid levels above 25mg/dL or a low pH (<6). Less frequently, the cause may be due to a lack of sufficient nitrate in the diet (green vegetables) or further reduction of nitrite to nitrogen when large numbers of bacteria are present. In patients receiving antibiotics, the metabolism of the bacteria may be inhibited which would also produce a false negative reaction.

Bladder infections are usually caused by gram-negative bacteria. These bacteria reduce nitrates derived from food to nitrites when urine remains in the bladder three to four hours, sufficient time for this reaction to occur. Nitrite is not present in urine under normal circumstances. When present, nitrites react with p-arsanilic acid to produce a diazonium compound. The diazonium compound in turn couples with 3-hydroxy-1,2,3,4 tetrahydrobenzo-(h)-quinolin to produce a pink color. A first morning, clean, voided midstream specimen is optimal for detecting nitrites in urine.

Early detection of bacteria is important in order to prevent cystitis from developing into inflammation or infection involving the kidney and renal pelvis. The nitrite portion of the test strip can be used to screen individuals who are at risk for developing urinary tract infections, such as diabetics, persons with recurrent infections, or pregnant women. The test is also useful in evaluating the success of antibiotic therapy that is used to treat a bladder infection.

If a donor for pre-employment testing fails to appear, does not provide a urine specimen, or leaves the collection site before the collection process begins (e.g. before being given a collection cup), this is not considered a refusal to test.If a donor refuses to sign the donor certification on the pink copy of the CCF or to initial the security strips, this is not considered a refusal to test.If a donor refuses to provide an ID or Social Security Number, this is not considered a refusal to test.If a donor during the three (3) hour waiting period for a "shy bladder" refuses to drink any liquids, this is not considered a refusal to test.

If the donor provides an initial insufficient specimen, the collector discards the insufficient specimen and notes in the Remarks section of the CCF when the donor provided the insufficient specimen. If in an insufficient specimen there is enough urine to activate the temperature strip, and the specimen is out of temperature range, the collector will initiate the next collection under direct observation.The "shy bladder" procedure also goes into effect if from an earlier collection it was determined that an observed collection must be made and the donor is unable to provide a specimen.If the donor is unable after three hours to provide a specimen, the collector must discontinue the collection and note that no specimen was obtained in the "check" box and in the Remarks section of the CCF. Notation should also be made as to the quantity of specimen that was collected, if any, and amount of fluids the donor was given to drink. The collector must immediately notify the DER.

If a donor or the collector accidentally spills a specimen before it is sealed, the collector should instruct the donor to provide another specimen. The same CCF may be used. The collector should note in the "Remarks" section that the first specimen was accidentally spilled and the specimen submitted is a second attempt. If the donor can not immediately provide a specimen, follow the procedure outlined in the "Shy Bladder" procedure.

The PAS staining procedure is most commonly used in the clinical histology laboratory to demonstrate glycogen deposits in the liver. Glycogen granules may also be visible in tumors of the bladder, kidney, ovary, pancreas, and lung. Basement membranes, which are present in various tissues in the body, may also be visualized through the PAS staining procedure. Several disorders can be identified through the demonstration of abnormal basement membranes. The PAS staining procedure can also demonstrate fungi in tissue samples due to the high carbohydrate content of the organisms cellular walls. Neutral mucins in the gastrointestinal tract and some epithelial mucins will also give a PAS-positive staining reaction.

The third parasite which may be seen is the Schistosoma haematobium ovum. This parasite is considered an important factor in the etiology of carcinoma of the bladder. The ova are elongated and are 60 X 160 microns. They are a yellowish color, slightly transparent, and possess a delicate terminal spine.