11/13/24, 7\:28 PM Guide | Urinalysis

Urinalysis

Table of contents
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Gather equipment

Gather the equipment you'll need to perform urinalysis\:
Alcohol gel
Gloves
Apron
Dipsticks
Urine sample
Paper towels
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Gather urinalysis equipment

Initial assessment of urine

1. Wash your hands and don PPE.
2. Con
3. Inspect the colour of the urine\:
Straw-coloured urine\: this is the normal colour of urine in a healthy, hydrated individual.
Dark concentrated urine\: suggests the individual is dehydrated.
Red urine\: can be caused by the presence of blood in the urine (macroscopic haematuria), porphyria, drugs such as
rifampicin and certain foods (e.g. beetroot).
Brown urine\: can be caused by the presence of bile pigments (e.g. jaundice) or myoglobin (e.g. rhabdomyolysis) in the urine.
Some antimalarial medication, such as chloroquine, also cause brown discolouration of the urine.
4. Inspect the clarity of the urine\:
Clear urine\: this is normal for healthy, well-hydrated individuals.
Cloudy urine with sediment\: may indicate urinary tract infection, renal stones, high protein content (e.g. nephrotic
syndrome).
Frothy urine\: typically associated with signinephrotic syndrome).
5. Consider opening the sample pot's cap and assessing the urine's odour\:
O
Sweet odour\: suggestive of glycosuria (e.g. diabetes mellitus).
Assessment of urinary odour is rarely performed in practice.
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Wash your hands

Dipstick testing

Procedure

1. Check the expiry date of the urinalysis dipstick.
2. Remove a dipstick from the container whilst avoiding touching the reagent squares.
3. Replace the container lid to prevent oxidisation of the remaining dipsticks.
4. Insert the dipstick into the urine sample, ensuring all reagent squares are fully immersed.
5. Remove the dipstick immediately and tap o
dipstick horizontally to avoid cross-contamination of the reagent squares.
6. Lay the dipstick
7. Use the urinalysis guide on the side of the testing strip container to interpret the
strip need to be interpreted at di
seconds for protein).
8. Once you have interpreted all of the tests, discard the strip into the clinical waste bin along with your PPE.
9. Wash your hands.
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Check the urine dipstick expiry date
Interpretation of dipstick results
The following tests are ordered by the time at which the reagent square should be interpreted.
Glucose
Glucose is a water-soluble sugar molecule and its presence in the urine is known as glycosuria\:
Time at which the reagent square should be interpreted\: 30 seconds
The absence of glucose in the urine is normal.
Causes of glycosuria include diabetes mellitus, renal tubular disease and some diabetic medications (e.g. SGLT2
inhibitors).
Bilirubin
Conjugated bilirubin is a water-soluble yellow pigment\:
Time at which the reagent square should be interpreted\: 30 seconds
The absence of bilirubin in the urine is normal.
The presence of bilirubin in the urine suggests increased serum levels of conjugated bilirubin, which can occur in
conditions such as biliary obstruction (e.g. pancreatic cancer).
Ketones
Ketones are a breakdown product of fatty acid metabolism\:
Time at which the reagent square should be interpreted\: 40 seconds
The absence of ketones in the urine is normal.
The presence of ketones in the urine suggests increased fatty acid metabolism, which occurs during starvation and in
conditions such as diabetic ketoacidosis.
Speci
The speci
Normal range\: 1.002 - 1.035 mOsm/kg
Time at which the reagent square should be interpreted\: 45 seconds
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Causes of low speci
and acute tubular necrosis.
Causes of raised speci
syndrome).
pH
The pH reagent square represents the acidity of the urine\:
Normal range\: 4.5 - 8
Time at which the reagent square should be interpreted\: 60 seconds
Causes of low urinary pH include starvation, diabetic ketoacidosis and other conditions that cause metabolic acidosis
(e.g. sepsis).
Causes of raised urinary pH include urinary tract infection, conditions that cause metabolic alkalosis (e.g. vomiting) and
medications (e.g. diuretics).
Blood
The blood reagent square indicates the amount of red blood cells, haemoglobin and myoglobin in the urine\:
Time at which the reagent square should be interpreted\: 60 seconds
The absence of red blood cells, haemoglobin and myoglobin in the urine is normal.
The presence of red blood cells, haemoglobin and myoglobin in the urine may indicate urinary tract infection, renal
stones, injury to the urinary tract, myoglobinuria (rhabdomyolysis), nephritic syndrome and malignancy of the urinary
tract.
Protein
The protein reagent square indicates the level of protein present in the urine (proteinuria)\:
Time at which the reagent square should be interpreted\: 60 seconds
The absence of protein in the urine is normal.
Causes of proteinuria include nephrotic syndrome and chronic kidney disease.
Nitrites
Nitrites are a breakdown product of gram-negative organisms such as E.Coli\:
Time at which the reagent square should be interpreted\: 60 seconds
The absence of nitrites in the urine is normal.
The presence of nitrites in the urine is suggestive of urinary tract infection.
Urobilinogen
Urobilinogen is a byproduct of bilirubin breakdown in the intestine and it is normally excreted in the urine\:
Normal range\: 0.2 - 1.0 mg/dL
Time at which the reagent square should be interpreted\: 60 seconds
The presence of increased levels of urobilinogen in the urine can be caused by haemolysis (e.g. haemolytic anaemia,
malaria).
Low levels of urobilinogen can be caused by biliary obstruction.
Leukocyte esterase
Leukocyte esterase is an enzyme produced by neutrophils and therefore, when positive, it indicates the presence of
white cells in the urine\:
Time at which the reagent square should be interpreted\: 2 minutes
A negative leukocyte esterase test is normal.
Causes of a positive leukocyte esterase include urinary tract infection and any condition that could result in
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