BASIC Technique

s and
URINALYSIS Principle
AGENDA
1. Introduction
2. Manual Urine Strip Interpretation
3. Manual Urine Microscopy Procedure
4. Identification of different urine sediments
5. Urine HCG titer interpretation and procedure
6. Pregnancy test interpretation and procedure
7. Written and practical tests
URINE
ANALYSIS
A urine analysis is a simple
test that looks at a small
sample of your urine. It
can help find problems
that need treatment,
including infection or
kidney problems, diabetes
even liver disease.
 INCLUDES 3 PARTS:

Visual Examination Microscopic Dipstick Test

Color or
Examination
RBC, WBC,
Chemical Test
clearness
CAST, CYSTALS
 VISUAL EXAMINATION
Purple
Bright
• Porphyria or certain metabolic
disorders. • Yellow
An excess of a B vitamin

Red
Colors of
Pale Yellow
• Blood in urine URINE. • Healthy and
hydrated

Green Brown
• Biliverdin (A bile pigment) • Certain anti-psychotic drugs
• Certain infections • Sennosides laxatives
URINE TURBIDITY
1. MATERIALS/TOOLS/EQUIPMENT NEEDED:

2. SPECIMEN COLLECTION AND PREPARATION:

1. USE ONLY WELL-MIXED NON CENTRIFUGATED URINE WHICH SHOULD
NOT BE OLDER THAN 2 HRS. FIRST MORNING SAMPLE IS
RECOMMENDED.
2. IF THE SAMPLE CANNOT BE TESTED IMMEDIATELY, IT SHOULD BE
STORED IN 2-4 DEGREE CELSIUS AND BROUGHT TO ROOM TEMP (15-
25C) BEFORE TESTING.
3. COLLECT SAMPLE IN CLEAN, WELL RAISED CONTAINERS FREE OF
DETERGENT.
 MICROSCOPIC
• EXAMINATION
Identification of formed urine
elements under the microscope.
• Including cells, casts, crystals and
artifacts
EXAMINATION
PROCEDURE
1. Mix the urine thoroughly and place 12ml in a
conical centrifuge tube. Centrifuge for 4
minutes at 1500 to 2500 rpm: pour • Centrifuged at 1500 to 2500
• Mix well
supernatant fluid, resuspend the deposit in • Transfer 12ml urine to tube.
rpm for 5mins.

the fem drops on urine that remain by

flicking the end of the tube with the finger:
then place a drop on the microscope slide
and cover with a cover glass.
2. Examine with the low power objective to
obtain an overall picture of the deposit. Use
the higher power objectives to examine
objects more closely. In order not to miss
cast the microscope should be set up for • Pour supernatant fluid,
critical kohler condenser: the overall resuspend the deposit then • Identify
intensity of light should be reduced to obtain place a drop on the
microscope slide.
maximum contrast.
3. Identify.
4. Report.
COMMON AND NORMAL
URINE CRYSTALS
WHAT AM I?
URIC ACID
• Uric acid crystals can be different
types of shapes: barrel, plate-like, or
diamond. They are typically orange-
brown or yellow in color.
• They can be found in normal urine
when caused by a protein-rich diet,
which increases uric acid in the
urine.
• They can also be caused by kidney
stones, gout, chemotherapy, or
tumor lysis syndrome.
WHAT AM I?
CALCIUM PHOSPHATE
• Calcium phosphate crystals are
colorless and may appear as star-like
or needle-like, though they may also
from plates. They may show up alone
or in clusters.

• They often appear in alkaline urine,

though they can be found in normal
urine. In rare cases, calcium
phosphate crystals could by caused
by hypoparathroidism.
HOW ABOUT ME?
HIPPURIC CRYSTAL
• Maybe either yellow-brown or
clear, and they often resemble
needle-like prisms or plates.
Hippuric acid crystals are often
found clustered together.

• Sometimes caused by an acid

urine ph.
HOW ABOUT ME?
TRIPLE PHOSPHATE
• The crystal is slightly
birefringent and often shows a
polarization color. The classic
shape is the pyramid, that
reminds a coffin lid.
HOW ABOUT ME?
 CALCIUM OXALATE
Oxalate is a natural product of metabolism in the body. It should leave
your body through your urine. If your oxalate levels are too high, the
extra oxalate can combine with calcium to form kidney stones.

Dumbbell – Shaped calcium Envelope – Shaped calcium

oxalate monohydrate oxalate dihydrate
WHAT ABOUT ME?
AMMONIUM BIURATE
• Sometimes ammonium biurate
crystals only appear because the
urine sample is old or has been
poorly preserved. Because of this,
recollecting a urine sample may be
advised.

• Commonly occur in the form of

“thorn apples,” as shown here, or in
polyhedral shapes. They are deeply
colored from a dark yellow to brown
PATHOLOGIC CRYSTALS
WITH CLINICAL
SIGNIFICANCE
 BILIRUBIN CHOLESTEROL CYSTINE LEUCINE
• APPEARS • STRONG INDICATOR • CYSTINURIA CAUSES • ROUND TO OVAL
ORANGE TO OF NEPHROTIC SUPERSATURATION WITH RADIATING
ALMOST BLACK. SYNDROME OR IN THE KIDNEY, BANDS GOING FROM
KIDNEY FAILURE. PREDISPOSING TO A CENTER POINT
• CLEAR AND SHAPED THE DEVELOPMENT OUT TO THE
• GOLD-ORANGE LIKE LONG OF STONES. PERIPHERY, OFTEN
NEEDLE-LIKE RECTANGLES, WITH • COLORLESS, REFERRED TO AS A
FORMS THAT A NOTCH CUT OUT REFRACTILE, “WAGON WHEEL”.
ARE SOMETIME AT THE CORNER. HEXAGONAL PLATES • USUALLY A SYMPTOM
CLUMPED WITH EVEN SIDES. OF SEVERE LIVER
TOGETHER. DISEASE.
 TYROSINE SULFODEHYDE ACYCLOVIR INDINAVIR
• TYROSINE • INTRAVENOUS
• SEEN DURING ACYCLOVIR • INDINAVIR (DRUG)
CRYSTALS ARE
COLORLESS AND
ADMINISTRATION ADMINISTRATION INDUCED.
OF HIGHER INDUCED. • CAUSES
NEEDLE-LIKE. • INCREASED RENAL
• DOSES OF BOTH NEPHROLITHIASIS
FOUND IN ACIDIC CONCENTRATION PF
AND RENAL
URINE, AND THEY ORAL AND THE DRUG
IMPAIRMENT.
MAY BE CAUSED • COMMUNICATE THE
INTRAVENOUS • COLORLESS,
BY METABOLIC PRESENCE OF
FORMULATIONS. ABUNDANT POLARIZABLE, FLAT
DISORDERS LIKE
CRYSTALLURIA TO NEEDLES POINTED
LIVER DISEASE.
CLINICAL STAFF TO AT BOTH
AVOID IRREVERSIBLE EXTREMITIES.
KIDNEY INJURY.
 URINARY CASTS
• Microscopic clusters of urinary
particles, such as cells, fat bodies, or
microorganisms, wrapped in a protein
matrix and found in the urine.
• Urinary casts serve as clinical
indicators of kidney condition and can
be assessed to determine the
functioning of the kidneys.
THE BEST IDEAS DIAGNOSIS OF CAST CELLS:
• The presence of
pathological casts,
Hyaline Granular Waxy including granular cells,
Cast Casts cast epithelial cells, red cells,
white cells, and waxy
casts in urine is a
sensitive diagnostic
Fatty WBC and Epithelial indicator reflecting
casts RBC Cells Cells whether the kidney has
suffered substantial
damage: thus, the
accuracy of detection of
pathological casts is
critical.
1. Hyaline casts are the most
common type of urinary casts.
• Made up of a protein call
uromodulin
• Result of conditions such as
dehydration and strenuous
exercise, as well as chronic
kidney failure.

2. Cellular casts appears to result

from a clumping, or conglutination
of cells that are incorporated in a
protein matrix.
• It is known that the cells were
present in the kidney (nephron).

3. Coarsely granulated casts tend to

be dark in color whereas finely
granulated is lighter in color.
Most common cause of granular
casts is
Red Blood Cells White Blood Cell Yeast Cell
Kidney and other urinary There is an
tract problems, such as The finding of yeast
infection or (almost always Candida
infection, or stones.
Kidney inflammation or inflammation in species) in the urine could
injury. Prostate the urinary mean that the patient has
problems. Bladder, tract. pyelonephritis or cystitis.
kidney, or urinary tract
cancer.
 • May indicate that they have
been shed from an abnormal
site, such as the bladder or
urethra.

• In some cases, the presence of

squamous epithelial cells in
urine may signify a bladder or
urethral infection, irritation, or
injury.
Squamous
Epithelial Cells
 • Are cells most important of
epithelial cells in urine.
• Reflect damage to tubule cells
in the kidney.
• Are seen in conditions such as
renal tubular necrosis, viral
disease such as
cytomegalovirus (CMV)
nephritis, and kidney transplant
rejection.
Renal Tubular
Epithelial Cells
DIPSTICK METHOD
AKA REAGENT STRIP
METHOD
Urinalysis reagent strips are made
for both qualitative and semi-
quantitative, which are in vitro
reagent for diagnostics.

• It tests for Leukocytes, Nitrite,

Urobilinogen, Protein, pH, Specific
Gravity, Ascorbic Acid, Ketone,
Bilirubin, Glucose, and
Microalbumin.
 Test
Condition Storage
• Ambient • Between 20-30 degree
temperature 20-30 celsius in dry
degree celsius. condition. Do not
refrigerate and keep
away from direct
sunlight.
 Instruction
Remov Immer
Read
e
One strip se
from the The reagent The test carefully
strip in the within 60sec and
bottle and with the test area
replace the urine held near the

cap specimen and appropriate color

chart on the bottle
immediately. take out label.
immediately.
 Changes in color that appear only
along the edges of the test pads or
moving after 2 minutes have
passed are of NO diagnostic
significance.

Only Leukocytes test portion can

be read within 120 seconds.
 test
microalbumin
?
• Early detection of several
diseases: high blood pressure,
increasing microalbumin is the
forecast parameter of
• Cardiovascular disease
• Diabetic nephropathy
• Proteinuria
• Kidney damage
RAPID PREGNANCY
TEST
 INTRODUCTION
During the first eight to 10 weeks of
pregnancy, hcg levels normally increases
very rapidly.

Rapid Pregnancy Test detects your Human

chorionic gonadotropin hormone or also
called the pregnancy hormone as early as
10 days after you missed period.
SPECIMEN COLLECTION

• For optimal detection of • Urine samples with visible

pregnancy, a first morning > precipitates should be
specimen is preferred since it centrifuged or allowed to
generally contains the highest
settle and clear aliquots
concentration of hcg. However,
randomly collected urine may
are obtained for testing.
be used.
 METHODOLOGY AND
INTERPRETATION OF
RESULT
Strictly adhere to the Invalid Result: if the purple color
band is not visible within the
Test Kit Package insert result window after performing
Instruction. the test, the result is considered
invalid.
Negative: Presence if only one Note: A positive result will always be
purple band within the result darker in color than the backhround.
Sometimes one band is darker than
window.
the other. Even if one band is very
Positive: Presence of two color light, the result is positive.
bands.
DETERMINATION OF URINE
HG TITER

Is performed to:
1. Confirm pregnancy
2. Determine the approximate age of the fetus
3. Diagnose an abnormal pregnancy, such as an ectopic
pregnancy.
4. Diagnose potential miscarriage
 METHODOLOGY
1. Label test tubes from 1 to 20.
2. Prepare each tube with 500ul of NSS.
3. Get the total volume of the patient’s urine collected within 24hrs and collect
an aliquot of 500ul from the urine.
4. In the test tube 1, add the 500ul of urine sample to get dilution of 1:2.
5. Perform pregnancy test on test tube 1, when result is negative, proceed to
make an official result.
6. Once you get a positive result, get 500ul aliquot from test tube 1 and add the
aliquot onto test tube 2 to get a dilution of 1:4.
7. If result is still positive, get 500ul aliquot from test tube 2 and add onto test
tube 3 to get a 1:8 dilution.
8. Repeat procedure up to the last labeled tube.
9. Proceed the diluting more tube to get to the tube where you get the last
positive pregnancy test.
10. Mark the tube for the last positive tube and get the dilution.
 HCG TITER DETERMINATION

COMPUTATION: REPORT:
Volume : ______________
HCG titer/24hr urine = sensitivity
Sensitivity: 25mlU/mL
of the test kit x highest dilution
Highest Dilution: _________
HCG titer/24hr urine = HCG Titer /25hr urine =
_____mlU/mL
 Laarne
THANK YOU! Mae N.
Eledia