Urinalysis Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Urinalysis and links to relevant pages within the course.
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| Microalbumin Test The presence of low levels of albumin (microalbumin) in the urine is an important finding in an individual with either type 1 or type 2 diabetes. The development of clinical nephropathy leads to reduced glomerular filtration and eventually may lead to renal failure. For this reason, early detection of microalbumin is important in order to avert renal complications in a diabetic patient. The presence of microalbuminuria has also been associated with an increased risk for cardiovascular disease. Reagent strips that are used for routine urinalysis cannot detect low levels of albumin excretion (1 to 2 mg/dL). Special reagent strips that are sensitive for these low levels of albumin are useful for periodic monitoring of patients with diabetes, hypertension, or peripheral vascular disease. | View Page |
| Heat and Acid Test for Urinary Protein The heat and acetic acid test is another semiquantitative test used to confirm the presence of protein in urine. It is more sensitive than the SSA test because the pH of the sample is brought close to the isoelectric point of proteins. However, this test is sometimes considered too sensitive because it can detect trace amounts of protein which are considered normal. The heat and acetic acid test gives false positive results with inorganic iodides, benzoin, tolutamide, and proteoses, similar to the SSA test. Bence-Jones protein consists of dimers of either kappa or lambda light chains from immunoglobulins. This abnormal protein is most often associated with multiple myeloma, but can also be found in cases of lymphoma, macroglobulinemia, leukemia, and other malignancies (Balant and Fabre, 1978). Testing for Bence-Jones protein is not part of the routine urinalysis. However, if Bence-Jones protein is suspected, the heat precipitation test or immunoelectrophoresis can be performed on a urine specimen. The heat precipitation test is based on the protein’s unusual solubility properties. Bence-Jones protein precipitates at temperatures between 40ºC and 60ºC (56ºC optimum), but dissolves again at 100ºC. Upon cooling, the precipitate will reappear around 60ºC and will dissolve again below 40ºC | View Page |
| Testing for Reducing Substances Other Than Glucose Testing pediatric urine specimens for reducing substances other than glucose is a policy that should be implemented in the urinalysis laboratory. The maximum age for this testing is defined by each laboratory and is usually based on consultation with the pediatric clinical staff. The policy that is implemented in most laboratories is to test urine specimens for other reducing substances if the glucose test on the reagent strip is negative and the urine specimen is from a child below the age of one. Verify the policy for your own laboratory because the cutoff age for testing may be different. | View Page |
| Use the following urinalysis report to answer:The patient was a female and the examination was completed within two hours of collection. Color - light yellow Appearance - slightly turbid Sp. Gravity - 1.009 pH - 8 Glucose (Multistix) - 0 Glucose (Clinitest) - 0 Protein - 1+ Blood - 0 WBC - 5/HPF RBC - 1/HPF Epithelial - 0/HPF Casts - 2 hyaline/LPF Crystals - amorphous urates Bacteria - 2+True or false? The results are abnormal but all results correlate. | View Page |
| Specimen Collection and Storage Examination of a fresh urine specimen provides the best results. If a specimen cannot be examined immediately, it may be refrigerated for up to 12 hours. Refrigeration prevents decomposition of casts, cells and the overgrowth of bacteria. The urine sediment elements begin to lyse after 1-3 hours at room temperature.
Although the most commonly received urine specimen is the random urine collection, the specimen of choice for urinalysis is the first morning urine. The first morning urine is more concentrated and allows for the detection of substances which may not be present in a more dilute random sample.
Once the physical and chemical characteristics of the urine have been determined, the microscopic exam is performed on the sediment. | View Page |
| Correlation of Results Once the microscopic examination is completed, it is important to decide whether the results are normal or abnormal. Correlation involves comparing the microscopic findings with the macroscopic findings. If the results are consistent with each other, the urinalysis may be reported. If a discrepancy exists, the microscopic results cannot be reported. The findings that do not correlate must be repeated. The following table illustrates results which may be found together in a urinalysis. Microscopic Macroscopic Casts (may be accompanied by mucous) Possible positive protein reaction White Blood Cells (bacteria may accompany WBCs in microscopic) Possible positive protein reaction Possible alkaline pH (fresh) Possible cloudy urine Red Blood Cells Possible positive blood reaction Possible positive protein reaction Possible negative blood reaction (if only a few RBCs are seen) Possible cloudy urine Possible red or brown urine Bacteria (may be accompanied by WBCs) Possible alkaline pH (fresh) Possible positive protein reaction Possible cloudy urine Possible positive nitrite reaction Yeast (may be accompanied by WBCs) Possible glucose Possible cloudy urine Crystals Should suggest approximate pH Possible cloudy urine Possible high sp. gravity Trichomonas Possible cloudy urine due to increased WBCs and mucous Report the microscopic findings if they correlate with the macroscopic. Report common crystals if requested or when an unusual number of one type is present. Do not report abnormal crystals unless confirmed by further tests and pathologist. Do not report sperm. | View Page |
| Urinalysis Reports Study the following five urinalysis reports. There will be a short discussion following each report correlating the macroscopic findings with the microscopic findings. | View Page |
| An Introduction to Quantitating the Urine Microscopic In order for a urinalysis to be useful a physician must know not only what elements are present but the quantity of each. This section will deal with counting and estimating the microscopic elements found in the urine sediment. The quantifications may vary slightly between laboratories, but each lab should have its own criteria. Quantitation may be divided into three steps: Looking for casts Counting elements Estimating elements | View Page |