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To screen urine for multiple markers to assist in diagnosing disorders such as kidney and liver disease as well as to assess hydration status.
There are no food, fluid, activity, or medication restrictions unless by medical direction. As appropriate, provide the required urine collection container and specimen collection instructions.
Method: Macroscopic evaluation by dipstick and microscopic examination. Urinalysis comprises a battery of tests including a description of the color and appearance of urine; measurement of specific gravity and pH; and semiquantitative measurement of protein, glucose, ketones, urobilinogen, bilirubin, hemoglobin (Hgb), nitrites, and leukocyte esterase. Urine sediment may also be examined for the presence of crystals, casts, renal epithelial cells, transitional epithelial cells, squamous epithelial cells, white blood cells (WBCs), red blood cells (RBCs), bacteria, yeast, sperm, and any other substances excreted in the urine that may have clinical significance. Examination of urine sediment is performed microscopically under high power, and results are reported as the number seen per high-power field (hpf). The color of normal urine ranges from light yellow to deep amber. The color depends on the patient's state of hydration (more concentrated samples are darker in color), diet, medication regimen, and exposure to other substances that may contribute to unusual color or odor. The appearance of normal urine is clear. Cloudiness is sometimes attributable to the presence of amorphous phosphates or urates as well as blood, WBCs, fat, or bacteria.
|Protein||Less than 20 mg/dL|
|Urobilinogen||Up to 1 mg/dL|
|RBCs||Less than 5/hpf|
|WBCs||Less than 5/hpf|
|Renal cells||None seen|
|Transitional cells||None seen|
|Squamous cells||Rare; usually no clinical significance|
|Casts||Rare hyaline; otherwise, none seen|
|Crystals in acid urine||Uric acid, calcium oxalate, amorphous urates|
|Crystals in alkaline urine||Triple phosphate, calcium phosphate, ammonium biurate, calcium carbonate, amorphous phosphates|
|Bacteria, yeast, parasites||None seen|
Critical Findings and Potential Interventions
Possible critical findings are the presence of uric acid, cystine, leucine, or tyrosine crystals.
The combination of grossly elevated urine glucose and ketones is also considered significant.
Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.