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PRELIMS developed procedures to control and
Safety and Quality Management monitor infections occurring within
their facilities, which is referred to as
Safety procedure manuals that infection control.
describe the safety policies The chain of
mandated by the Centers for infection is a
Disease Control and continuous
Prevention (CDC) and the link among 6
Occupational Safety and elements:Infectious
Health Administration (OSHA) agent,reservoir,
must be readily available in portal of exit, mode of transmission,
the laboratory. portal of entry, and susceptible host.
the Clinical and Laboratory
Standards Institute (CLSI) provides Infectious Agent (Pathogen)
the guidelines for writing these Bacteria, fungi, parasites, and
procedures and manuals. viruses. The early detection
and treatment of infectious agents
reduce their opportunity
for growth.

Reservoir
This is the location of potentially
harmful microorganisms, such as
contaminated clinical specimen or
an infected patient. It is the place
where infectious agents can live
and multiply. Humans and animals
make excellent reservoirs.
Fomites – equipment and other
soiled inanimate objects
which can serve as reservoir.
Disinfecting the work are can kill
infectious agent and eliminate the
reservoir, breaking the chain of
infection.

Portal of Exit
BIOLOGICAL HAZARDS This can be through the mucous
Understanding how microorganisms membrane of the reservoir’s nose,
are transmitted (chain of infection) mouth, and eyes, and as well as in
is essential to preventing infection. blood or other body fluids.
All health-care facilities have

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The chain of infection is broken
when contaminated materials are Susceptible Host
placed in biohazard containers Susceptible host can be another
and/or tubes and specimen patient during invasive procedures,
containers are sealed. visitors, and health-care personnel
When contaminated materials are when exposed to infectious
sealed, the infectious agent still has specimens or needlestick injuries.
a reservoir but no means of exit. Immunocompromised patients,
newborns, infants, and the elderly
Means of Transmission are often more susceptible hosts.
1. Direct contact – unprotected host Once the chain of infection is
touches the patient, specimen, or a complete, the infected host
contaminated object (reservoir). becomes another source able to
[includes sexual intercourse] transmit the microorganisms to
2. Airborne – the host inhales dried others.
aerosol particles circulating on air To break the chain of infection,
currents or attached to dust particles. health-care personnel must
3. Droplet – the host inhales sanitize hands often, wear gloves,
infected aerosol droplets from the stay current with the required
reservoir immunizations and tests, and
4. Vehicle – the host ingests a maintain a healthy lifestyle.
contaminated substance (e.g., food,
water, specimen) STANDARD PRECAUTIONS
5. Vector – from an animal or insect Proper hand hygiene, correct
bite disposal of contaminated materials,
and wearing of personal
Hand Sanitizing and adhering to protective equipment (PPE) are of
Standard Precautions (SP) are major importance in the laboratory.
methods to break the chain of Concerns over exposure to
infection. bloodborne pathogens like Hepatitis
B (HBV), Hepatitis C (HCV), and
Portal of Entry HIV, caused the CDC and OSHA to
Same as portal of exit: mucous draft guidelines and regulations to
membrane of the reservoir’s prevent exposure. The guideline
nose, mouth, eyes, as well as recommends wearing gloves when
breaks in the skin and open collecting or handling blood and
wounds. body fluids contaminated with blood,
Disinfection, Sterilization, and and wearing face shields when
strict adherence to SPs block the there is danger of blood splashing on
portal of entry; breaking the chain of mucous membranes and when
infection.

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disposing of all needles and sharp Chemicals should never be mixed
objects. together unless specific
In 1996, the CDC and the instructions are followed, and they
Healthcare Infection Control must be added in the order specified.
Practices Advisory Committee Acid should always be added to
(HICPAC) combined the water to avoid the possibility of
major features of UP and BSI sudden splashing caused by the
guidelines and called the new rapid generation of heat.
guidelines Standard Precautions. Pipetting by mouth is
UNACCEPTABLE in the laboratory.
1. Hand Hygiene – hand washing
and the use of alcohol-based
antiseptic cleansers. Sanitize hands Chemical Hygiene Plan
after touching blood, body fluids, OSHA also requires all facilities that
secretions, excretions, and use hazardous chemicals to have a
contaminated items, with or written chemical hygiene plan
without gloves. Sanitize hands (CHP) available to employees.
immediately after removing gloves.
2. Gloves – wear gloves when Chemical Labeling
touching blood, body fluids, Hazardous chemicals should be
secretions, excretions, and labeled with a description of
contaminated items. their particular hazard, such as
poisonous, corrosive, flammable,
explosive, teratogenic, or
SHARP HAZARDS carcinogenic

All sharp objects must FIRE/EXPLOSIVE HAZARDS

be disposed in
puncture-resistant, The Joint Commission
leakproof container with (TJC) requires that all
the biohazard symbol. health-care facilities post
evacuation routes and
detailed plans to follow
CHEMICAL HAZARDS in the event of fire.

Every chemical in the

workplace should be Follow the acronym RACE:
presumed to be Rescue – rescue anyone in danger
hazardous. Alarm – activate the institutional fire
Chemical Handling alarm system

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Contain – close all doors to
potentially affected areas
Extinguish/Evacuate – attempt to
extinguish the fire, if possible, or
evacuate, closing the door.

The acronym PASS is for using

the fire extinguisher:
Pull pin
Aim at the base of the fire
Squeeze handles
Sweep nozzle side to side

PHYSICAL HAZARDS

Avoid running in rooms

and hallways, watch for
wet floors, bend knees
when lifting heavy
objects, keep hair
pulled back, and maintain a
clean organized work area.

Preexamination (Preanalytical)
Variables
Occurs before the actual testing of
the specimen and include
test request, patient preparation,
timing, specimen collection,
handling, and storage.

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Examination (Analytical) Variables Postexamination Variables
Processes that directly affect the Processes that affect the reporting of
testing of the specimens. results and correct interpretation of
Includes: reagents,instrumentation data.
and equipment, testing procedure,
QC, preventive maintenance (PM), Urine and Body Fluid Analysis
access to procedure manuals, and Automation
competency of personnel.
URINALYSIS AUTOMATION
QUALITY CONTROL
QC refers to the materials, Correct color reading depends on
procedures, and techniques that the accuracy of the timing.
monitor the accuracy, precision, The ultimate goal of urinalysis
and reliability of a laboratory test. automation is to improve
QC procedures are performed to reproducibility and color
ensure that acceptable standards discrimination while increasing
are met during the process of productivity and standardization
patient testing. Patient test results for reporting urinalysis results.
may not be reported until QC is
verified.
REFLECTANCE PHOTOMETRY
➢ External Quality Control Automated reagent strip readers that
Used to verify the: uses a spectrophotometric
Accuracy – ability to obtain the measurement of light reflection.
expected result and; It uses the principle that light
Precision – ability to obtain the reflection from the test pads
same result on the same decreases in proportion to the
specimen. intensity of the color produced by
the concentration of the test
➢ Internal Quality Control substance.
Monitor the sufficient addition of a A monochromatic lights source is
patient sample or reagent, the directed toward the reagent pads by
instruments/reagents interaction, placing a filter between the light
and whether the sample migrated source and the reflective surface of
through the test strip properly. the pad or by using a light-emitting
diode (LED) to provide the specific
➢ Electronic Control wavelength needed for each test pad
Use a mechanical or electrical color reaction.
device in place of a liquid QC
specimen.

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ANALYZERS

• Semiautomated Urine Chemistry

Analyzers
Test for the chemical components
of urine. The instrument read and
interpret the reagent strop results
consistently, thereby standardizing
the interpretation of reagent strip
results and eliminating personnel
color bias and timing discrepancies.
Ff tests can be performed:
Leukocyte: sign of infection
Nitrite: UTI
Protein: damaged kidney
Blood: UTI
Glucose: diabetes
Ketone: acidity
Bilirubin: liver condition (amber in
color)
Urobilinogen: liver diseases
(heap/cirrhosis)
pH: acidic/alkaline
Specific gravity: normal is 1.005 –
1.030
Color: pale yellow – deep amber
Creatinine: kidney function (usually FULLY AUTOMATED URINE
mas detectable sa blood) CHEMISTRY ANALYZERS
Protein-to-creatinine ratio Are designed for a high-volume
urinalysis laboratory with user
SHAKE URINE BEFORE walk-away capability. (di na need ng
PROCESSING. microscope.
The semiautomated instrument
requires the operator to: Introduction to Urinalysis
1. Dip the reagent strip into a urine
sample that has been mixed well HISTORY AND IMPORTANCE
2. Blot the strip to remove excess Analyzing urine was actually the
urine beginning of laboratory medicine.
3. Place the strip onto the reagent References can be found in the
strip platform drawings of cavemen and in
4. Press the analyze/enter button

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Egyptian hieroglyphics, such as Richard Bright introduced the
the Edwin Smith Surgical Papyrus. concept of urinalysis as part of a
Physicians before never saw the doctor’s routine patient examination
patient, only the patient’s urine, but in 1827
they were able to obtain diagnostic By the 1930s, urinalysis began to
information from such basic disappear from routine
observations as color, turbidity, examination because of
odor, volume, viscosity, and even impracticality.
sweetness. Fortunately, the development of
Many well-known names in the modern testing techniques
history of medicine rescued routine urinalysis
are associated with the study of
urine, including HIPPOCRATES,
who in the 5th century BCE, wrote 2 Unique characteristics of a urine
a book on “uroscopy”. By 1140 specimen account for this
BCE, color charts had been continued popularity:
developed that described the 1. A urine specimen is readily
significance of 20 different colors. available and easily collected.
Chemical testing progressed from 2. Urine contains information, which
“ant testing” and “taste testing” can be obtained by inexpensive
for glucose to Frederik Dekkers’s laboratory tests, about many of the
discovery in 1694 of albuminuria body’s major metabolic functions.
by boiling urine.
The credibility of urinalysis became The Clinical and Laboratory
compromised when charlatans / Standards Institute (CLSI)
“pisse prophets” without medical defines urinalysis as “the testing of
credentials began offering their urine with procedures commonly
predictions to the public for performed in an expeditious, reliable,
a healthy fee. They became the accurate, safe, and cost-effective
subject of a book published manner.”
by Thomas Bryant in 1627. The REASONS FOR PERFOMING
revelations in this book inspired the URINALYSIS:
passing of the first medical Aiding in the diagnosis of disease,
licensure laws in England. screening asymptomatic populations
The invention of the microscope in for undetected disorders, and
the 17thcentury led to the monitoring the progress of disease
examination of urinary sediment and the effectiveness of therapy.
and to the development by Thomas
Addis of methods for quantitating
the microscopic sediment.

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URINE FORMATION URINE VOLUME

The kidneys continuously form urine Urine volume depends on the

as an ultrafiltrate of plasma. A amount of water the kidneys
healthy body should convert excrete.
170,000 mL of filtered plasma to the WATER is a major body
average daily urine output of 1200 constituent, so the amount excreted
mL, depending on fluid intake. is usually determined by the
body’s state of hydration.
URINE COMPOSITION
Factors that influence urine
Urine consists of urea and other volume:
organic and inorganic chemicals • Fluid intake
dissolved in water. • Fluid loss from nonrenal sources
Urine is normally 95% water and 5% (sweating, tears)
solutes. • Variations in the secretion of ADH
UREA: a metabolic waste product • Need to excrete increased amounts
produced in the liver from the of dissolved solids, such as glucose
breakdown of protein and amino or salts.
acids.
Other organic substances include Normal Daily Urine Output:
primarily: 1200 – 1500 mL
CREATININE and URIC ACID. A range of 600-2000 mL is
The major inorganic solid dissolved considered normal.
in urine is CHLORIDE, followed by
SODIUM and POTASSIUM. Oliguria – decreased in urine
output is seen commonly when the
body enters a state of dehydration
as a result of excessive water loss
from vomiting, diarrhea,
perspiration, or severe burns.

Infants: less than 1mL/kg/hr

Children: less than 0.5 mL/kg/hr
Adults: less than 400 mL/day

Oliguria leading to anuria

(cessation of urine flow) may result
from any serious damage to the
kidneys or from a decrease in the
flow of blood to the kidneys.

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The kidneys excrete 2-3 times more SPECIMEN COLLECTION
during the day than during the
night. Urine is a biohazardous substance
whose handling requires the
Nocturia – increased in the observance of Standard Precautions
nocturnal urine excretion. (SP). gloves should be worn at all
Polyuria – an increase in daily times when in contact with the urine
urine output is often associated with specimen.
diabetes mellitus and diabetes
insipidus. Containers
Children: 2.5 to 3 mL/kg/day Specimens must be collected in
Adults: greater than 2.5 L/day clean, dry, leakproof disposable
However, it may be induced containers.
artificially by diuretics, Containers for routine urinalysis
caffeine, or alcohol, all of which should have a wide mouth to
suppress the secretion of ADH. facilitate collections from female
patients and a wide, flat bottom to
Diabetes mellitus – caused by a prevent overturning. They should be
defect in the pancreatic made of a clear material to allow for
production of insulin or in the determination of color and clarity.
insulin itself, which results in an The recommended capacity of the
increased concentration of body container is 50 mL, which allows 12
glucose. Patient with D. mellitus has mL of specimen needed for
a high specific gravity because of microscopic analysis.
the increased glucose content.
Labels
Diabetes insipidus – results from a All specimens must be labeled
decrease in the production or immediately after collection
function of ADH. The urine is truly (pwede din before) with the patient’s
dilute and has a low specific last and first name and identification
gravity. number. Labels must be attached to
the container, NOT TO THE LID,
Fluid loss in both diseases is and should not become detached if
compensated by increased the container is refrigerated or
ingestion of water (polydipsia), frozen.
producing an even greater
volume of urine. SPECIMEN COLLECTION

Situations leading to rejections:

1. Specimens in containers that are
unlabeled or improperly labeled

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2. Labels and requisition forms that
do not match
3. Specimens contaminated with
feces or toilet paper
4. Containers with contaminated
exteriors
5. Specimens if insufficient quantity
6. Specimens that have been
transported improperly
7. Specimens that have not been
preserved correctly during a time
delay
8. specimens for urine culture
collected in a nonsterile container
9. Inappropriate collection for the
type of testing needed (for example,
midstream clean-catch specimen for
bacterial culture)

SPECIMEN HANDLING

Specimen Integrity
Specimen should be delivered to
the laboratory promptly and tested
within 2 hours. A specimen that
cannot be delivered and tested
within 2 hours should be
refrigerated or have appropriate SPECIMEN PRESERVATION
chemical preservative added.
The method of preservation used
most routinely is refrigeration at 2°C
to 8°C, which decreases bacterial
growth and metabolism.
If urine is to be cultured, it should
be refrigerated during transit and
kept refrigerated until cultures, up
to 24 hours.
The specimen must return to room
temperature before chemical testing
by reagent strips.

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If refrigeration is impossible,
chemical preservatives may
be added.

The ideal preservative should be

bactericidal, inhibit urease, and
preserve formed elements in the
sediment.
The preservative should not
interfere with chemical tests.

TYPES OF SPECIMEN

Random Specimen
Most common because of its ease
of collection and convenient for the
patient. The random specimen may
be collected at any time.

First Morning Specimen

This is the ideal screening
specimen. Used to prevent
false-negative pregnancy tests and
for evaluating orthostatic proteinuria.
The first morning specimen is a
concentrated specimen.

24-Hour (or Timed) Specimen

A carefully timed specimen.
Lowest concentration is in the
early morning and the highest
concentration occurs in the
afternoon.
For accurate timed specimen,
patient must begin and end the
collection with an empty bladder.

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The preservative chose must be a bacterial count 10 times that of
nontoxic to the patient and should the first specimen.
not interfere with the tests to be ➢ Pre- and Postmassage Test
performed. (PPMT) – a cleancatch midstream
urine specimen is collected. A
Catheterized Specimen second urine sample is collected
The test requested most commonly after the prostate is massaged.
on a catheterized specimen is a ➢ A positive result is significant
bacterial culture. bacteriuria in the postmassage
specimen of greater than 10 times
Midstream Clean-Catch Specimen the premassage count.
Provides a safer, less traumatic
method for obtaining urine for
bacterial culture and routine Pediatric Specimen
urinalysis. Soft, clear plastic bags are used.
These have hypoallergenic
Suprapubic Aspiration skin adhesive to attach to the
Introduction of needle through the cleaned genital area of both
abdomen into the bladder. This boys and girls.
provides a specimen for bacterial
culture that is completely free of Drug Specimen Collection
extraneous contamination, Urine specimen collection is the
particularly in infants or children. most vulnerable part of a
drug-testing program.
Prostatitis Specimen The chain of custody (COC) is the
➢ Three-Glass Collection – first process that provides this
urine passed is collected in a sterile documentation of proper specimen
container; Next, the midstream identification from the time of
portion is collected in another collection to the receipt of laboratory
sterile container. Then the results. The COC is a standardized
prostate is massaged so that form that must document and
prostate fluid will pass with the accompany every step of drug
remaining urine into a third sterile testing, from collector to
container. Quantitative courier to laboratory to medical
cultures are performed on all review officer to employer.
specimens; first and third The urine temperature must be
specimens are examined taken within 4 minutes from the
microscopically. time of collection to confirm the
In prostatic infection, the third specimen has not been adulterated.
specimen will have a white blood The temperature should read
cell/high-power filed count and within the range of 32.5°C to 37.7°C.

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RENAL FUNCTION Renal Blood Flow
The renal artery supplied blood to
RENAL PHYSIOLOGY the kidney. The human kidney
receives approxi. 25% of the blood
Each kidney contains approximately pumped through the heart at all
1 to 1.15 million functional units times.
called nephrons. Blood enters the capillaries of the
nephron through the afferent
2 TYPES OF NEPHRONS: arteriole.
• Cortical nephrons – make up 85% In then flows through the
of nephrons, located primarily in the glomerulus and into the efferent
cortex of the kidney. arteriole.
Responsible for removal of waste Before returning to the renal vein,
products and reabsorption of blood from the e. arteriole enters the
nutrients. peritubular capillaries and the
vasa recta and flows slowly through
• Juxtamedullary nephrons – have the cortex and medulla of the kidney
longer loops of Henle that extend close to the tubules.
deep into the medulla of the
kidney. Their primary function is
concentration of urine.

RENAL FUNCTIONS:
1. Renal blood flow
2. Glomerular filtration
3. Tubular reabsorption
4. Tubular secretion

The peritubular capillaries

surround the proximal and distal
convoluted tubes, providing for the
immediate reabsorption of essential
substance from the fluid in the
proximal convoluted tube and final
adjustment of urinary composition in
the distal convolute tubules.

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The vasa recta are located 2. Hydrostatic pressure
adjacent to the ascending and 3. Oncotic pressure
descending loops of Henle in 4. Feedback mechanisms of the
juxtamedullary nephrons. renin-angiotensinaldosterone system
(RAAS).
Osmotic gradient (salt
concentration) – exchanges of Cellular Structure of the
water and salts b/w blood and the Glomerulus – plasma
medullary interstitium. (takes filtrate must pass through 3
place in vasa recta. glomerular filtration barrier
cellular layers: the capillary wall
Average body size of 1.73 m2 of membrane, the basement
surface: membrane (basal lamina),
Total Renal Blood flow: approx. and the visceral epithelium of the
1200 mL/min Bowman capsule.
Total Renal Plasma flow: ranges Fenestrated epithelium – pores
from 600- to 700 mL/min The barrier contains a shield of
(Normal values depend on body negativity that repels molecules
size). with a negative charge even though
they are small enough to pass
Glomerular Filtration Rate (GFR) – through the 3 layers of the barrier.
calculation to determine whether This shield is where albumin (the
the observed measurements primary protein associated with renal
represent normal function. disease) has a negative charge
and is repelled.
Glomerular Filtration
the glomerulus consists of a coil
of approx. eight capillary lobes,
the walls of which are referred to as Glomerular Pressure – hydrostatic
the glomerular filtration barrier. It pressure is a result from the
is located within Bowman capsule, smaller size of the efferent
which forms the beginning of the arteriole and the glomerular
renal tubules. capillaries. E. arteriole enhances
The glomerulus serves as a filtration.
nonselective filter of plasma
substances with molecular weights Renin-Angiotensin-Aldosterone
less than 70,000. System – the
Factors influencing actual RAAS regulated the blood flow to
filtration process: and within the glomerulus. The
1. Cellular structure of the capillary system responds to changes in
walls and Bowman capsule

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blood pressure and plasma sodium Active transport is responsible for
content that are monitored by the reabsorption of the ff:
juxtaglomerular apparatus, which 1. Glucose, amino acids, and salts in
consists of the juxtaglomerular cells the proximal convoluted tubule
in the afferent arteriole and the 2. Chloride in the ascending loop of
macula densa of the distal Henle
convoluted tubule. 3. Sodium in the distal convoluted
tubule

Passive transport is the movement

of molecules across a membrane
as a result of difference (gradients)
in their concentration or electrical
potential on opposite sides of the
membrane.

Tubular Reabsorption
The body cannot lose 120 mL of
water-containing essential
substances every minute.

Reabsorption Mechanism
For active transport to occur, the
substance to be reabsorbed must
combine with a carrier protein.

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Tubular Concentration in a large volume of dilute urine.
Renal concentration begins in the
descending and ascending loops
of Henle, where the filtrate is
exposed to the high osmotic gradient
of the renal medulla. Tubular Secretion
Water is removed by osmosis in Tubular secretion involves the
the descendingloop of Henle, and passage of substances from
sodium and chloride are the blood in the peritubular
reabsorbed in the ascending loop of capillaries to the tubular
Henle. filtrate.

Countercurrent mechanism – Tubular secretion serves 2 major

selective reabsorption process functions:
which serves to maintain the 1. Eliminating waste products not
osmotic gradient of the medulla. filtered by the glomerulus and;
Maintenance of this osmotic gradient 2. Regulating the acid-based
is essential for the final concentration balance in the body through the
of the filtrate when it reaches the secretion of hydrogen ions.
collecting duct.
Proximal convoluted tubule –
Collecting Duct Concentration major site for removal of the
The final concentration of the nonfiltered substances.
filtrate through the reabsorption of
water begins in the late distal
convoluted tubule and continues in Acid-Base Balance
the collecting duct. To maintain the normal blood pH
Reabsorption depends on osmotic of 7.4, the blood must buffer and
gradient in the medulla and the eliminate the excess acid formed by
hormone vasopressin (antidiuretic dietary intake and body metabolism.
hormone [ADH]) that is released by The buffering capacity of the
the posterior pituitary gland when blood depends on bicarbonate
the amount of water in the body (HCO3-)
decreases.
A high level of ADH increases
permeability, resulting in RENAL FUNCTION TESTS
increased reabsorption of water,
and a low-volume Glomerular Filtration Tests (GFR)
concentrated urine. Clearance Tests
Absence of ADH renders the walls The standard test used to measure
impermeable, resulting the filtering capacity of the glomeruli.

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It measures the rate in milliliters
per minute.
Creatinine, beta2-microglobulin
(B2M), cystatin C, and possibly
radioisotopes, are the primary
substancesused in clearance
tests.

Glomerular Filtration Tests (GFR)

➢ Osmolality
Measures only the number of
particles in a solution,primarily
sodium and chloride molecules.
➢ Freezing-Point Osmometers
Supercooling a measured amount of
sample to approx. 27°C. the
supercooled sample is vibrated to
produce crystallization of water in
the solution.
➢ Vapor Pressure Osmometers
The actual measurement performed
is that of the dew point. The
depression of dew point temperature
by solute parallels the decrease in
vapor pressure, thereby providing a
measure of this colligative property.
Tubular Secretion and Renal
Blood Flow Tests
Tests to measure tubular secretion
of nonfiltered substances and renal
blood flow. Commonly associated
with p-aminohippuric acid (PAH)
test.

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MIDTERMS
Physical Examination of Urine
The physical examination of urine
includes the determination of the
urine color, clarity, and specific
gravity.

Color
Common descriptions include pale
yellow, yellow, and dark yellow. The
yellow color of urine is caused by the
presence of a pigment, which
Thudichum named urochrome in
1864.

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CLARITY
“Clarity” is a general term which
refers to the transparency or
turbidity of a urine specimen

Chemical Examination of Urine

Pathologic Turbidity Reagent strips chemical analysis:

The most commonly encountered ➢ pH
pathologic causes of turbidity in a ➢ protein
fresh specimen are RBCs, white ➢ blood
blood cells (WBCs), and bacteria ➢ specific gravity
caused by infection or a systemic ➢ ketones
organ disorder. Other, less ➢ bilirubin
frequently encountered causes of ➢ glucose
pathologic turbidity include abnormal ➢ nitrite
amounts of nonsquamous ➢ urobilinogen
➢ leukocytes

Odor
Although it is seldom of clinical pH
significance and is not a part of the Reaction time: 60 secs
routine urinalysis, urine odor is a The pH of normal random
noticeable physical property. specimens can range from
Freshly voided urine has a faint 4.5 to 8.0.
aromatic odor. (mapanghi)
CLINICAL SIGNIFICANCE:
The importance of urinary pH is
primarily as an aid in determining the
existence of systemic acid-base
disorders of metabolic or respiratory
origin

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Acute-phase reactants (APR) is
elevated during infection and
inflammation.

• Bence Jones Protein

A primary example of proteinuria
due to increased levels of serum
proteins is the excretion of Bence
Jones protein by people with
multiple myeloma.

Multiple myeloma – elevated levels

of monoclonal immunoglobulin light
chains (Bence Jones protein). This is
diagnosed and detected through
serum electrophoresis and
PROTEIN immunoelectrophoresis
Reaction time: 60 secs
This is an indicative of renal
disease. Normal urine contains very
little protein usually less than
10mg/dL or 100 mg per 24 hours is
excreted.

CLINICAL SIGNIFICANCE:
Clinical proteinuria is indicated at
30 mg/dL or greater (300mg/L)

Prerenal Proteinuria
- caused by conditions affecting
the plasma before it reaches the
kidney and therefore is NOT Renal Proteinuria
indicative of actual renal disease. - True renal disease that may be
- Often this condition is transient, the result of damage to the
and caused by increased levels of glomerular membrane a or tubular
low-molecular-weight plasma dysfunction.
proteins, such as hemoglobin,
myoglobin, and the acute-phase • Glomerular Proteinuria
reactants such as CRP or When the glomerular membrane is
C-reactive protein. damaged, selective filtration is

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impaired and increase amounts of • Gestational diabetes
serum protein and, eventually, red Hyperglycemia that occurs during
and white blood cells pass through pregnancy and disappears after
the membrane and are excreted in delivery.
the urine.

• Microalbuminuria
The development of diabetic
nephropathy leading to reduced
glomerular filtration and eventual
renal failure is a common
occurrence in people with both Type
1 and Type 2 diabetes mellitus.

• Orthostatic (Postural)
Proteinuria
It occurs after periods spent in a
vertical posture and disappears
when a horizontal position is
assumed.

• Tubular Proteinuria
Increased albumin is also present
in disorders affecting tubular
reabsorption because the albumin
that is normally filtered can no longer
be reabsorbed.

GLUCOSE
Reaction time: 30 secs
Because of its value in the detection
and monitoring of diabetes
mellitus, the glucose test is the
chemical analysis performed most
frequently on urine.

CLINICAL SIGNIFICANCE:
• Hyperglycemia
Elevated level of glucose.

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KETONES
Reaction time: 40 secs
The term “ketones’ represents three
intermediate products of fat
metabolism:
➢ Acetone (2%)
➢ Acetoacetic acid (20%)
➢ Β-hydroxybutyrate (78%)

CLINICAL SIGNIFICANCE:
Clinical reasons for increased fat
metabolism include the inability to
metabolize carbohydrate, as occurs
in diabetes mellitus; increased loss
of carbohydrate from vomiting; and
inadequate intake of carbohydrate
associated with starvation and BLOOD
malabsorption. Reaction time: 60 secs
Detected blood in urine can be used
• Ketonuria to differentiate between hematuria
A deficiency in insulin, indicating and hemoglobinuria.
the need to regulate dosage. It is
often an early indicator of
insufficient insulin dosage in Type CLINICAL SIGNIFICANCE:
1 diabetes. • Hematuria
Most closely related to disorders of
renal or genitourinary origin in which
bleeding is the result of trauma or
damage to the organs of these
systems.
Major causes:
o Renal calculi
o Glomerular diseases
o Tumors
o Trauma
o Pyelonephritis
o Exposure to toxic chemicals
o Anticoagulant therapy

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• Hemoglobinuria
May result from the lysis of RBCs
produced in the urinary tract,
particularly in dilute, alkaline
urine. It also may result from
intravascular hemolysis and the
subsequent filtering of hemoglobin
through the glomerulus.

• Myoglobinuria
(muscle distraction). Myoglobin, a
hemecontaining protein found in
muscle tissue, not only reacts
positively with the reagent strip test
for blood but also produces a clear
red-brown urine.
Examples of these conditions
include:
o Trauma
o Crush syndromes
o Prolonged coma
o Convulsions
o Muscle-wasting diseases BILIRUBIN
o Alcoholism Reaction time: 30 secs
o Heroin abuse Appearance of bilirubin in urine is an
o Extensive exertion early indication of liver disease.it
is often detected long before the
patient exhibits jaundice (yellowish
eyes and skin).

Bilirubin, a highly pigmented

yellow compound, is a degradation
product of hemoglobin.

CLINICAL SIGNIFICANCE:
➢ Hepatitis
➢ Cirrhosis
➢ Other liver disorders
➢ Biliary obstruction (gallstones,
carcinoma)

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Routine testing for urinary bilirubin
by reagent strip uses the diazo
reaction.
Qualitative results are reported as
negative, small, moderate, or
large or as negative, 1+, 2+, or 3+

UROBILINOGEN
Reaction time: 60 secs
NITRITE
CLINICAL SIGNIFICANCE: Reaction time: 60 secs
Increased urine urobilinogen It provides a rapid screening test
(greater than 1mg/dL) is seen in for the presence of UTI.
liver disease and hemolytic
disorders. CLINICAL SIGNIFICANCE:
Measurement of urine urobilinogen Cystitis
can be valuable in the detection of Pyelonephritis
early liver disease. Evaluation of antibiotic therapy
➢ Early detection of liver disease Monitoring of patients at high risk of
➢ Liver disorders, hepatitis, cirrhosis, UTI
carcinoma Screening of urine culture
➢ Hemolytic disorders specimens

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SPECIFIC GRAVITY
Reaction time: 45 secs
LEUKOCYTE ESTERASE
Reaction time: 120 secs CLINICAL SIGNIFICANCE:
Detection of increased urinary ➢ Monitoring patient hydration and
leukocytes. dehydration
This reaction requires the longest ➢ Loss of renal tubular
time of all the reagent strip concentrating ability
reactions. ➢ Diabetes insipidus
➢ Determination of unsatisfactory
CLINICAL SIGNIFICANCE: specimens due to low concentration
Bacterial and nonbacterial UTI
Inflammation of the urinary tract
Screening of urine culture
specimens

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Macroscopic Screening Centrifugation
Centrifugation for 5 minutes at a
Abnormalities in the physical and relative centrifugal force (RCF) of
chemical portions of the urinalysis 400 produces an optimum amount
play a primary role in the decision to of sediment with the least chance of
perform a microscopic analysis, thus damaging the elements.
the use of the term “macroscopic
screening.” Centrifugation calibration should
be routinely performed.
Use of the braking mechanism to
slow the centrifuge causes
disruption of the sediment prior to
decantation and should not be used.

Sediment Preparation
A uniform amount of urine and
sediment should remain in the
tube after decantation. Volumes of
0.5 and 1.0 mL are frequently
used.

Specimen Volume
A standard amount of urine, Volume of Sediment Examined
usually between 10 and 15 mL, is When using the conventional
centrifuged in a conical tube. glass-slide method, the
recommended volume is 20 μ L
A 12-mL volume is frequently (0.02 mL) covered by a 22 × 22 mm
used because multiparameter glass cover slip.
reagent strips are easily immersed
inthis volume, and capped centrifuge
tubes are often calibratedto this Examining the Sediment
volume. Microscopic examination should be
performed in a consistent manner
If obtaining a 12-mL specimen is and include observation of a
not possible, as with pediatric minimum of 10 fields under both
patients, the volume of the low (10×) and high (40×) power.
specimen used should be noted on
the report form. LPO = Epithelial Cells
Mucus threads
Amorphous Phosphates

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HPO = Neutrophils Red Blood Cells
Leukocytes In the urine, RBCs appear as
Monocytes smooth, non-nucleated,
Eosinophils biconcave disks measuring
Basophils approximately 7 mm in diameter
(Fig. 6-8)
WBC, RBC, bacteria, crystal, cast, They must be identified using
parasites can be seen through HPO high-power (40×) objective
(×400 magnification). RBCs are
routinely reported as the aver-
Microscopy age number seen in 10 hpfs.
Bright-field microscopy is the most
common type of microscopy In concentrated (hypersthenuric)
performed in the urinalysis urine, the cells shrink due to loss
laboratory. Other types of of water and may appear crenated
microscopy that are useful for or irregularly shaped (Fig. 6–9).
examining the urine sediment In dilute (hyposthenuria) urine, the
are phase contrast, polarizing, cells absorb water, swell, and lyse
dark field, fluorescence, and rapidly, releasing their hemoglobin
interference contrast and leaving only the cell membrane.

Reporting of RBC in urine: neg,

trace, +1, +2, +3, TNTC

Neg = 0-2
Trace = 3-5
+1 = 8-10
+2 = 10-15
+3 = 20+
TNTC = 100

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Clinical Significance
The presence of RBCs in the urine is
associated with damage to the
glomerular membrane or vascular
injury within the
genitourinary tract.

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