Jenivie Morillo Jose University of Santo Tomas National Childrens Hospital

Urine sediment all solid materials suspended in the urine

semiquantative evaluation of the urine sediment

Significance of formed elements in the urine Well performed microscopic exam can provide information nearly equivalent to a biopsy.

QUALITY CONTROL
Specimen requirements:
Collection of specimen

Prefer the concentrated first morning specimen, collected = mid-stream, clean catch . first morning most concentrated and will be able to demonstrate the most abnormalities. Mid stream, clean catch technique will eliminate fecal & vaginal contamination

 Container must be clean and free of lint / debris

usually disposable plastic, must be sure no soap residue

Fresh tested within 2 hours of voiding, or

refrigeration needed.

 Preparation of specimen need to standardize as much as possible Sources of Variation Collection method Centrifugation time and speed Re-suspension of sediment Type of microscope slide Viscosity of specimen Reporting of the results

Sources of Error
Timing - Failure to observe color changes at appropriate time intervals may cause inaccurate results. Lighting - Observe color changes and color charts under good lighting. QC - Reagent strips should be tested with positive controls on each day of use to ensure proper reactivity. Sample - Proper collection and storage of urine is necessary to insure preservation of chemical.

Sources of Error
Testing cold specimens - would result in a slowing down of reactions; test specimens when fresh or bring them to RT before testing Inadequate mixing of specimen - could result in false reduced or negative reactions to blood and leukocyte tests; mix specimens well before dipping Over-dipping of reagent strip - will result in leaching of reagents out of pads; briefly, but completely dip the reagent strip into the urine

Physical Examination
Normal urine color ranges from pale yellow to deep amber the result of a pigment called urochrome
B vitamins turn urine an eye-popping neon yellow

BUT may also indicate liver disease. porphyria, a disease that affects your skin and nervous system, turns urine the color of port wine.

Urine Color
Most changes in urine color are harmless and temporary and may be due to:
Certain foods beets may turn urine red Dyes in foods/drinks Supplements vitamins Prescription drugs

Unusual urine color can indicate an infection or serious illness .

Examples of Urine Color

Urine Clarity
refers to how clear the urine is.
Terms used: clear, slightly cloudy, cloudy, or turbid. Normal urine can be clear or cloudy. The clarity of the urine is not as important as the substance that is causing the urine to be cloudy.

Urine Clarity
Substances that cause cloudiness but that are not considered unhealthy include: mucous, sperm and prostatic fluid, cells from the skin, normal urine crystals, and contaminants (like body lotions and powders). Other substances that can make urine cloudy (such as red blood cells, white blood cells, or bacteria) indicate a condition that requires attention.

Examples of Urine Clarity

Urine Color and Clarity

Urine color and clarity can indicate what substances may

be present in urine.
Confirmation of suspected substances is obtained during

the chemical and microscopic examination.

Urine volume
The average adult : 1000ml to 2000ml/24h
Increase

polyuria---more than 2000ml of urine in 24 hours 1. physiological states: water intake, some drugs, intravenous solutions 2. pathologic states: diabetes mellitus, diabetes insipidus

Urine volume
Decrease Oliguria---less than 400ml of urine in 24 hours Anuria---less than 100ml of urine in 24 hours

1. prerenal: hemorrhage, dehydration, congestive heart failure 2. postrenal: obstruction of the urinary tract (may be stones, carcinoma) 3. renal parenchymal disease: acute tubular necrosis, chronic renal failure

Chemical Examination
Reagent strips are used only once and discarded.
Testing
Perform within 1 hour after collection

Allow refrigerated specimens to return to room

temperature. Dip strip in fresh urine and compare color of pads to the color chart after appropriate time period. Instruments are available which detect color changes electronically

Using Reagent Strips

BRIEFLY dip the strip in urine.

Colors are matched to those on the bottle label at the

appropriate times.

Timing is critical for accurate results.

Reagent Strips

Glucose

Presence of glucose (glycosuria) indicates that the

blood glucose level has exceeded the renal threshold. Useful to screen for diabetes.

Glucose in urine
Reference value

Qualitative method: negative Glycosuria--- qualitative test is positive 1.hyperglycemia: diabetes mellitus Cushings syndrom 2.without hyperglycemia: renal tubular dysfunction, such as pyelonephritis

Bilirubin

By product of the breakdown of hemoglobin. Presence may be an indication of liver disease, bile duct obstruction or hepatitis. Since the bilirubin in samples is sensitive to light, exposure of the urine samples to light for a long

period of time may result in a false negative test result.

Ketones

Including three ketone bodies:

acetoacetic acid 20% acetone 2% -hydroxybutyric acid 78%

Ketones in urine
The products of fat metabolism

Reference value:

qualitative method: negative Ketonuria--- qualitative test is positive

Ketones are excreted when the body metabolizes fats incompletely (ketonuria)

Specific Gravity

reflects kidney's ability to concentrate.

Want concentrated urine for accurate testing, best is first morning sample.

Specific gravity (SG)

Reflect the density of the urine
Range of 1.001 to 1.040 Increase: DehydrationFeverVomiting Diarrhea

Diabetes Mellitus and other causes of Glycosuria Congestive Heart FailureSyndrome Inappropriate ADH Secretion (SIADH) Adrenal Insufficiencyfailure (urine volume and SG), first morning, certain drugs Decrease: diabetes insipidus(urine volume and SG ), specimen not concentrated, kidney disease

Blood

Presence of blood may indicate infection, trauma

to the urinary tract or bleeding in the kidneys.

False positive readings most often due to

contamination with menstrual blood.

Ph

measures degree of acidity or alkalinity of urine

Urine PH
Normal PH The average is about 6 Range from 5~9 (depends on diet) Higher PH---alkaline urine

1.drugs: sodium bicarbonate 2.classic renal tubular acidosis 3.alkalosis (metabolic or respiratory) Lower PH---acid urine 1.drugs: ammonium chloride 2. acidosis (metabolic or respiratory)

Protein

Presence of protein (proteinuria) is an important

indicator of renal disease. False negatives can occur in alkaline or dilute urine or when primary protein is not albumin.

Protein in urine
Reference value

Qualitative method: negative Quantitative method: less than 150mg of protein in 24 hours Urine proteins come from plasma protein and Tamm-Horsfall (T-H) glycoprotein

Urobilinogen

degradation product of bilirubin formed by intestinal

bacteria.
It may be increased in hepatic disease or hemolytic

disease

Nitrite

Nitrite formed by gram negative bacteria

converting urinary nitrate to nitrite

Leukocytes

Leukocytes (white blood cells) usually indicate

infection. Leucocyte esterase activity is due to presence of WBCs in urine while nitrites strongly suggest bacteriuria.

Normal Values
Negative results for glucose, ketones, bilirubin, nitrites, leukocyte esterase and blood.
Protein negative or trace. pH 5.5-8.0 Urobilinogen 0.2-1.0 Ehrlich units

Handling and Storage of Strips

Handling and Storage
Keep strips in original container Do not touch reagent pad areas

Reagents and strips must be stored properly to

retain activity Protect from moisture and volatile fumes Stored at room temperature Use before expiration date

Procedure
Dip strip briefly, but completely into well mixed,

room temperature urine sample. Withdraw strip. Blot briefly on its side. Keep the strip flat, read results at the appropriate times by comparing the color to the appropriate color on the chart provided.

Microscopic Examination of Urine

 Preparation of specimen
Mix specimen well

Pour 12 ml into urine centrifuge tube

Centrifuge five minutes, 1200-2000 RPM (speed

varies depending on the centrifuges characteristics) Speed and time should be consistent. The relative centrifugal force is important.

1. Fresh or adequately preserved urine specimen (approximately 10-15 m) is placed preferably on a conical tube and centrifuged for 5 minutes.
2. Decant supernatant and the sediment is resuspendedwith the remaining urine in the tube (usually 0.5 mL or 1.0 mL)

3. Using a pipet, place a drop of resuspended sediment on a clean slide and cover with a cover slip
4. Examine the sediment first using the LPO 5. Shift to HPO to identify specific types of cells, casts, bacteria and crystals

URINARY SEDIMENTS

NORMAL CRYSTALS

ABNORMAL CRYSTALS

Miscellaneous Structures

Manner of Reporting

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