Urinalysis, procedure and interpretation

By | April 17, 2017
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Urinalysis (urine dipstick testing) frequently appears as an OSCE station, so you need to get familiar with the process to look smooth in the exam. It’s actually a very simple process, but people often fail to revise this station and lose marks unnecessarily. With a little practice, you can ensure you get full marks every time! Check out the urinalysis OSCE mark scheme here.

Gather equipment

  • Alcohol gel
  • Gloves
  • Apron
  • Urine dipsticks
  • Urine sample
  • Paper towels

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Inspect urine

  1. Wash hands, don gloves and apron
  2. Confirm patient details are correct on the sample bottle – name / DOB / hospital number
  3. Inspect the colour of the urine:
  • Straw coloured – normal
  • Dark concentrated urine – dehydration
  • Red – macroscopic haematuria / rifampicin / porphyria / beetroot
  • Brown – bile pigments / myoglobin / antimalarials
  1. Inspect the clarity of the urine:
  • Clear – normal
  • Cloudy / debris – urinary tract infection (UTI)
  • Frothy – nephrotic syndrome
  1. Remove the sample bottles’ cap and assess urine odour:
  • Offensive urine – UTI
  • Sweet – glycosuria

758a2f37b023c3d452cdbd2b9f89d4a2.jpgWash hands

 

d8e7029d1a21f94204de194f930494a2.jpgDon apron

9d8fe86dad2b9960062d8d963a06a1f3.jpgDon gloves

21b922fcbc5f9c51b42380cc0307e505.jpgConfirm patient details on the sample bottle are correct

a777e3d3e621b3c32e14605b97527efa.jpgInspect colour of urine

a2ac6d33646b037b381554d2d295ad1b.jpgInspect the clarity of urine

01c96d5c969c6449067e38b20db56e56.jpgAsses odour of urine

Perform dipstick testing

  1. Check urine dipsticks’ expiry date
  2. Remove a testing strip from the container (avoiding touching the testing zones)
  3. Insert test strip into urine sample (ensuring all test zones are immersed)
  4. Remove the strip, ensuring to tap off residual urine before removing from the sample bottle
  5. Ensure test strip remains in a horizontal orientation (to avoid cross contamination of testing zones)
  6. Use the dipstick analysis guide on the side of the testing strip container to interpret the findings
  7. Different tests on the strip are required to be read at different times, so ensure you interpret the appropriate test at the correct time interval – e.g. 60 seconds for protein
  8. Once you have interpreted all of the tests, discard the strip into the clinical waste bin along with your gloves and apron
  9. Wash hands

8ec82fe2af596114db48ae76f0bb21a0.jpgCheck urine dipstick expiry date

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de24cee6616dfec2ff10c00767079a7e.jpgRemove testing strip from container

f8a3685d8ec4d6dd25c6b8db3693096f.jpgFully submerged urine strip into the urine sample

ed5f6baf6fbbb5d0b9535b1c3b90263f.jpgRemove test strip and wipe away any excess urine

f925ba45775a8cec07722dedcdb1bf2e.jpgEnsure the test strip remains horizontal to avoid cross contamination

38c74d2f885bfbebf3afabdb37997a4d.jpgInterpret each test at the appropriate time using the dipstick analysis chart

014751279183f17102303851713ec2bf.jpgDispose of clinical waste
848453718ba4558a75c1a8d914fd5263.jpgWash hands

To complete the procedure

  • Summarise findings
  • Document urinalysis results
  • Indicate that depending on the results, further investigations may be required:
  1. ↑ WCC / Leukocytes – ?UTI – send urine for culture (MSU/CSU)
  2. ↑ Glucose – ?Diabetes – capillary blood glucose

Urine dipstick tests explained

  • pH – indicates acidity of urine –g. ↓pH in systemic acidosis
  • Specific gravity – indicates amount of solute dissolved in urine – ↓ in diabetes insipidus
  • Blood – indicates number of red blood cells in urine – ↑ in haematuria
  • Protein – indicates level of protein in the urine – ↑ nephrotic syndrome
  • Leukocyte esterase – enzyme produced by neutrophils (WCC in urine) – ↑ in UTI
  • Nitrites – breakdown products caused by Gram -ve organisms – Gram -ve UTI e.g. Ecoli
  • Ketones – breakdown product of fatty acid metabolism – ↑ starvation / ↑DKA
  • Glucose – ↑ hyperglycaemia e.g. poorly controlled diabetes
  • Bilirubin – Indicates ↑ conjugated bilirubin (water soluble) – ↑ biliary tract obstruction
  • Urobilinogen – if raised indicates ↑ bilirubin turnover – ↑malaria / ↑haemolytic anaemia
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