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Urinalysis

Urinalysis is a topic covered in the Davis's Lab & Diagnostic Tests.

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Synonym/Acronym:
UA.

Rationale
To screen urine for multiple markers to assist in diagnosing disorders such as kidney and liver disease as well as to assess hydration status.

Patient Preparation
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.

Normal Findings
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.


Dipstick
pH4.5–8
ProteinLess than 20 mg/dL
GlucoseNegative
KetonesNegative
HemoglobinNegative
BilirubinNegative
UrobilinogenUp to 1 mg/dL
NitriteNegative
Leukocyte esteraseNegative
Specific gravity1.005–1.03

Microscopic Examination
RBCsLess than 5/hpf
WBCsLess than 5/hpf
Renal cellsNone seen
Transitional cellsNone seen
Squamous cellsRare; usually no clinical significance
CastsRare hyaline; otherwise, none seen
Crystals in acid urineUric acid, calcium oxalate, amorphous urates
Crystals in alkaline urineTriple phosphate, calcium phosphate, ammonium biurate, calcium carbonate, amorphous phosphates
Bacteria, yeast, parasitesNone 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.

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Citation

Bladh, Mickey Lynn., and Anne M. Van Leeuwen. "Urinalysis." Davis's Lab & Diagnostic Tests, 7th ed., F.A. Davis Company, 2017. Nursing Central, nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425285/4/Urinalysis.
Bladh ML, Van Leeuwen AM. Urinalysis. Davis's Lab & Diagnostic Tests. 7th ed. F.A. Davis Company; 2017. https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425285/4/Urinalysis. Accessed June 24, 2019.
Bladh, M. L., & Van Leeuwen, A. M. (2017). Urinalysis. In Davis's Lab & Diagnostic Tests. Available from https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425285/4/Urinalysis
Bladh ML, Van Leeuwen AM. Urinalysis [Internet]. In: Davis's Lab & Diagnostic Tests. F.A. Davis Company; 2017. [cited 2019 June 24]. Available from: https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425285/4/Urinalysis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Urinalysis ID - 425285 A1 - Bladh,Mickey Lynn, AU - Van Leeuwen,Anne M, BT - Davis's Laboratory & Diagnostic Tests UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425285/4/Urinalysis PB - F.A. Davis Company ET - 7 DB - Nursing Central DP - Unbound Medicine ER -