Urinalysis

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

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Core Lab Study

Synonym/Acronym:

UA.

Rationale

To screen urine for multiple markers to assist in diagnosing disorders such as urintary tract infections (UTIs), kidney and liver disease, as well as to assess hydration status.

A small group of studies in this manual have been identified as Core Lab Studies. The designation is meant to assist the reader in sorting the basic “always need to know” laboratory studies from the hundreds of other valuable studies found in the manual—a way to begin putting it all together.

Normal, abnormal, or various combinations of core lab study results can indicate that all is well, reveal a problem that requires further investigation with additional testing, signal a positive response to treatment, or suggest that the health status is as expected for the associated situation and time frame.

Urinalysis is another of the most commonly ordered laboratory studies. Its popularity is based on the wide range of clinical information it can provide, ease of collection (noninvasive), low cost, and availability in most settings.

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).

    Normal Physical Characteristics of Urine
  • Color: ranges from light yellow to deep amber and depends on:
    • the patient’s state of hydration (more concentrated samples are darker)
    • diet
    • medication regimen
    • exposure to other substances or foods may contribute to unusual color.
  • Appearance: Clear Cloudiness is sometimes attributable to the presence of amorphous phosphates or urates as well as blood, WBCs, fat, or bacteria.
  • Odor: Varies by individual, but generally urine does not have a strong odor. In the case of dehydration, the urine is more concentrated and may have a stronger, almost ammonia-type odor; exposure to other substances or foods may also contribute to unusual odor (e.g., asparagus)


Dipstick
pH4.5–8
ProteinNegative
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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Core Lab Study

Synonym/Acronym:

UA.

Rationale

To screen urine for multiple markers to assist in diagnosing disorders such as urintary tract infections (UTIs), kidney and liver disease, as well as to assess hydration status.

A small group of studies in this manual have been identified as Core Lab Studies. The designation is meant to assist the reader in sorting the basic “always need to know” laboratory studies from the hundreds of other valuable studies found in the manual—a way to begin putting it all together.

Normal, abnormal, or various combinations of core lab study results can indicate that all is well, reveal a problem that requires further investigation with additional testing, signal a positive response to treatment, or suggest that the health status is as expected for the associated situation and time frame.

Urinalysis is another of the most commonly ordered laboratory studies. Its popularity is based on the wide range of clinical information it can provide, ease of collection (noninvasive), low cost, and availability in most settings.

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).

    Normal Physical Characteristics of Urine
  • Color: ranges from light yellow to deep amber and depends on:
    • the patient’s state of hydration (more concentrated samples are darker)
    • diet
    • medication regimen
    • exposure to other substances or foods may contribute to unusual color.
  • Appearance: Clear Cloudiness is sometimes attributable to the presence of amorphous phosphates or urates as well as blood, WBCs, fat, or bacteria.
  • Odor: Varies by individual, but generally urine does not have a strong odor. In the case of dehydration, the urine is more concentrated and may have a stronger, almost ammonia-type odor; exposure to other substances or foods may also contribute to unusual odor (e.g., asparagus)


Dipstick
pH4.5–8
ProteinNegative
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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