The document discusses urine formation and urinalysis. It describes how the kidneys filter waste from the blood to form urine, which is composed primarily of water and dissolved substances. It outlines the steps of routine urinalysis, including physical examination to assess attributes like color, specific gravity, and chemical testing using reagent strips. Microscopic examination of urine sediment is discussed to identify any cells, crystals, casts, bacteria, or parasites present that could indicate health issues. Quality control procedures and documentation standards are also reviewed.

1. U R I N A L Y S I S
Chapter 30
Deborah Walker, ARNP, BSN, MN
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2. Urine Formation
 Urine forms in
kidneys and
leaves body
through urethra
The urinary system >>

3. Urine Formation
 How body excretes water and gets rid of waste
 Waste can become toxic if not removed
 Two kidneys eliminate soluble waste products of
metabolism
 Click here for an animation
Deborah Walker, ARNP, BSN, MN
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4. Urine Formation
 Filtration
 Glomerulus filters waste products, salts, and excess fluid from
blood
 Tubule concentrates filtered material
 Nephron
 Combination of glomerulus and tubule
 One million nephrons in each kidney
Deborah Walker, ARNP, BSN, MN
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5. Urine Formation
 Filtration
 Substances filtered out from body
 Water
 Ammonia
 Electrolytes
 Glucose
 Amino acids
 Creatinine
 Urea
 Diabetes diagnosis
 Routine urinalysis testing
Deborah Walker, ARNP, BSN, MN
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6. Urine Formation
 Reabsorption
 About 180 liters of filtrate produced daily
 Only 1–2 liters of urine eliminated
 Much filtrate reabsorbed into body
 Blood cells and most proteins stay in blood
 Concentration of glucose in blood below 180 mg/dl will be
reabsorbed
 Glucose is a threshold substance
Deborah Walker, ARNP, BSN, MN
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7. Urine Formation
 Secretion
 Substances not already filtered are secreted into urine through
distal convoluted tubule
 Hydrogen and ammonium ions may be secreted into urine in
exchange of sodium
 *Know the major functions of the urine*
Deborah Walker, ARNP, BSN, MN
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8. Urine Composition
 After passing through kidney, urine is 96% water and
4% dissolved substances (urea, salt, sulfates,
phosphates)
Deborah Walker, ARNP, BSN, MN
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9. Urine Composition
 Abnormal constituents of urine
 WBC
 Fat
 Glucose
 Casts
 Bile
 Hemoglobin and RBC
Deborah Walker, ARNP, BSN, MN
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10. Urine Composition
 Changes in urine production
 Amount of urine excreted can rise or fall
 Urine color can change
 Urine appearance can vary
Deborah Walker, ARNP, BSN, MN
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11. Urine Composition
 Changes in urine production
 Urine odor can change
 Cells can be present in urine
 Chemical constituents in urine can change
 Urine concentration (specific gravity) may vary
Deborah Walker, ARNP, BSN, MN
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12. Safety
 Standard precautions
 Transmission-based precautions
 Biohazard precautions
 Proper disposal of urine
Deborah Walker, ARNP, BSN, MN
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13. Quality Control
 Regulatory agencies
 Written testing protocols
 Maintained testing records
 Recalibration of instruments
Deborah Walker, ARNP, BSN, MN
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14. Quality Control
 Documentation of daily control testing must be kept
at least 3 years
 Commercially available urine control samples
 Run positive and negative controls each day on all
tests
Deborah Walker, ARNP, BSN, MN
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15. CLIA 88
 Appropriate training in methodology of test being
performed
 Understanding of urine testing quality control
procedures
 Proficiency in the use of instrumentation; being able
to troubleshoot problems
Deborah Walker, ARNP, BSN, MN
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16. CLIA 88
 Knowledge of stability and proper storage of reagents
 Awareness of factors that influence test results
 Knowledge of how to verify test results
 CLIA categorizes microscopic exam as a PPMP
Deborah Walker, ARNP, BSN, MN
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17. Urine Containers
 Types
 Nonsterile containers for cultures
 24 hour collection containers with added preservatives

18. Urine Containers
 Label container immediately after specimen
collection
 Patient’s name, age, gender, identifying number
 Date and time of collection
 Physician’s name
 Label the cup, not the lid
Deborah Walker, ARNP, BSN, MN
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19. Urine Collection
 Urinalysis is the most frequently performed
procedure done in the medical office lab
 Giving patient instructions
Deborah Walker, ARNP, BSN, MN
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20. Urine Collection
 Click to play the video
Deborah Walker, ARNP, BSN, MN
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21. Urine Collection
 Urine specimen types
 Random (spot) specimen
 Obtained at any time
 Most common
 If concentrated specimen preferred, first specimen of day is most
concentrated
Deborah Walker, ARNP, BSN, MN
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22. Urine Collection
 Urine specimen types
 Fasting/timed specimens
 Used when physician wants to measure substance without
interference from food intake
 Length of fast varies
 Give patient written directions
 Use regular urinalysis container
Deborah Walker, ARNP, BSN, MN
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23. Urine Collection
 Urine specimen types
 24-hour specimen
 Circadian rhythm and intake of food and water determine
concentration of substances at different times during day/night
 Requested when quantitative tests for different substances are
desired
 Expressed in units per 24 hours
 Use of preservatives and refrigeration
 Sometimes use 2-hour or 12-hour collection instead
Deborah Walker, ARNP, BSN, MN
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24. Urine Collection
 Urine specimen types
 Catheterized specimen
 Insert sterile tube directly into bladder through urethra
 Not contaminated
 Can cause infection if not done correctly
 Use only when other methods are contraindicated or show
repeated positive testing for bacteria
Deborah Walker, ARNP, BSN, MN
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25. Urine Collection
 Collection methods
 Random collection
 Clean-catch method; midstream collection
 Catheterized
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26. Examination of Urine
 Best when fresh, even still warm
 Test within 30 minutes, or refrigerate
Deborah Walker, ARNP, BSN, MN
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27. Routine Urinalysis Procedure
 Physical examination of urine
 Assess volume of urine specimen, making sure specimen is
sufficient for testing
 Note any unusual urine odor
 Measure specific gravity of specimen
 Normal specific gravity (SG) of urine varies slightly, but 1.005-
1.030 (some may say 1.000-1.035)
Deborah Walker, ARNP, BSN, MN
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28. Routine Urinalysis Procedure
 Physical examination of urine
 Observe and record color and transparency of specimen

29. Measuring Specific Gravity
 Urinometer
 Measures specific gravity
 Reading the meniscus
 Take temperature of urine into account
Deborah Walker, ARNP, BSN, MN
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30. Measuring Specific Gravity
 Refractometer
 Most common tool for
measuring specific gravity
of liquids
 Measures refractive index
of urine
 Reads about 0.002 below
that of true specific gravity
 Needs 1 drop of urine
 Easy to use but more
expensive

31. Routine Urinalysis Procedure
 Chemical examination of urine
 Use of multistix reagent strips with color-coded chart
 Chemical testing available on urine reagent test strips
 See Table 30-3, 30-4

32. Routine Urinalysis Procedure
 Chemical
examination of
urine
 Reagent test strip
quality control
 Automated urine
analyzers >>

33. Routine Urinalysis Procedure
 Microscopic examination of urine sediment
 Classified as PPMP
 Sediment is forced to the bottom of centrifuged tube
 Helps determine kidney disease, disorders of urinary tract, and
systemic disease
 Need fresh urine
 Use of urine color atlas
 Use of urine stains
Deborah Walker, ARNP, BSN, MN
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34. Preparing for Microscopic
Examination
 Centrifuge 10–15 mL
of urine
 Pour off supernatant
urine
 Resuspend sediment
by tapping
 Stain (optional) >>
 Put drop of sediment
on slide

35. Urine Sediment Cells and
Microorganisms
 RBC
 WBC
 Renal epithelial cells
 Bacteria
 Yeast-most common is
candida albicans
 Parasites- most
common is
Trichomonas
 Sperm
 Artifacts
 Squamous epithelial
cells- skin cells;
normal; report as few,
moderate, or many
Deborah Walker, ARNP, BSN, MN
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36. Crystals in Urine Sediment
 Require little attention
 Form as urine specimens stand
 Uric acid, cystine, and sulfa drug crystals can
indicate disease states
Deborah Walker, ARNP, BSN, MN
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37. Casts in Urine Sediment
 Important to note
 Formed when protein accumulates and precipitates
in kidney tubules
 Appearance of casts
 Hyaline cast most common kind seen
 Granular casts and cellular casts also seen
 Takes an experienced eye to identify
Deborah Walker, ARNP, BSN, MN
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38. Urinalysis Report
 Include patient’s name, type of specimen,
collection method, ordering provider, MA
name, date and time of collection, date and
time of testing, findings

39. Drug Screening
 Becoming more common for employment
 Test itself is CLIA waived, but detailed protocols
must be followed
 Chain of custody
Deborah Walker, ARNP, BSN, MN
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40. Medical Terminology
 Part VII Urinary System handouts
Deborah Walker, ARNP, BSN, MN
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