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Urinalysis

The Visual Examination, the Chemical Examination and the Microscopic Examination.

urinalysis

Urinalysis

A urinalysis is, as the name suggests, is an analysis of the urine. A sample of 30-60mls of your urine is needed for urinalysis.

Your GP may order urinalysis in a lab to test for kidney and metabolic disorders and for urinary tract infections. If you are menstruating or close to your period, or are taking any diuretics, it is best to tell your GP in case they wish to postpone obtaining a sample. It is also best to avoid strenuous exercise or eating any foods that could colour your urine before the test - e.g. beetroots, blackberries or rhubarb.

Urinalysis may be needed for a number of reasons, for example:

  • If you are experiencing pain in your lower abdomen or back, blood in the urine (either visible or found on a urine dipstick test), if you are experiencing pain when urinating or an increase in frequency of urination
  • Routine medical examinations such as yearly check-ups, admission to hospital, screening for diabetes, kidney disease, hypertension, liver disease
  • To evaluate new pregnancy
  • To monitor progression and response to treatment in diseases such as diabetes, kidney impairment/disease/stones, lupus
  • To determine the cause of bladder infections.

It is usually recommended to obtain a mid-stream sample in a clean, sterile pot (usually provided by your healthcare professional). You will be given instructions as to what time of day to collect the sample (for example, first urination of the morning). If the sample needs to be kept for more than an hour before it is collected and sent to the lab, it must be kept in a fridge (but for no longer than 24 hours).

There are three testing phases in a complete urinalysis. One of these phases is the visual examination.

The Visual Examination

In the laboratory, the technician will check for clarity, colour and concentration of the urine.

Colour:

Sometimes the urine will be affected by diet - e.g. foods like beetroot can colour the urine red. Other times, red-coloured urine may indicate blood indicating disease or damage to the urinary system. It is important to also rule out blood-contaminated urine from menstruation or haemorrhoids. Normal urine colour usually ranges from a pale yellow colour to a little darker yellow first thing in the morning when urine is more concentrated. A darker amber colour suggests dehydration and that you need to drink more water, and very dark orange could be an indicator of jaundice/bile duct disorder or liver disorder.

Clarity:

The technician will review the urine also on its clarity - whether it is cloudy, turbid, clear. Healthy urine can still be cloudy or turbid if contaminated with substances such as sperm or prostatic fluid, skin cells, asymptomatic urine crystals, mucus or personal hygiene products. However, cloudiness could also be an indicator of a health condition or infection since it can also be caused by the presence of bacteria, or red or white blood cells in the urine.

The visual examination is only part of the story in urinalysis. In order to identify which substances are present, it is necessary to perform further chemical and microscopic examinations on the urine.

The Chemical Examination

The chemical examination is usually performed in the laboratory using test strips with rows of test pads called reagent strips. Each pad on the strip contains a different chemical that will respond with a colour change to indicate the presence of specific substances in your urine. The colour may change across a scale to indicate whether a small or large amount of the substance has been detected. The strip test results are often read by the technician; however, sometimes the reading is automated to prevent errors of interpretation and timing since each pad colour needs to be read at the correct time (ranging from a few seconds to minutes dependent on the reaction it is detecting) to ensure accurate results.

So what does the chemical examination test for?

The chemical examination can test for a range of indicators:

  • Protein
  • Blood (Haemoglobin)
  • pH Level
  • Leukocytes
  • Nitrates
  • Bilirubin
  • Urobilinogen
  • Ketones
  • Glucose
  • Specific Gravity

Protein

Protein in the urine is usually measured by testing for the presence of albumin but there are a range of alternative protein tests that can be used. High protein levels (proteinuria) can be an early indicator of kidney disease. Detection of protein in the test pad may also be an indicator of urinary tract infection/inflammation or injury such as damage to the prostate, bladder or urethra. Proteinuria could also indicate conditions such as bladder or kidney stones, multiple myeloma, or any condition that destroys red blood cells such as haemolytic anaemia. It is often a temporary phenomenon that disappears when an infection has been effectively dealt with.

Blood (Haemoglobin)

Haemoglobin is the protein found in red blood cells and carries oxygen. The urine normally contains a small amount of haemoglobin which does not show up on the test, but a higher amount (haemoglobinuria) will show up as a positive test result. It is important that instructions are followed when collecting the sample so that is not contaminated through menstrual blood or blood from haemorrhoids. A slight increase from the norm in haemoglobin can be significant in terms of potential causes such as a urinary tract infection, kidney disease, trauma, strenuous exercise. Smoking or certain medications can also show an increase.

pH Level

The urine must be tested within a few hours of collection to avoid skewing the results for the pH test, as urine will become more alkaline as time passes. The pH test tells us whether the urine is acid or alkaline. This has a bearing particularly where kidney or bladder stones (calculi) are involved. Certain calculi are formed in overly-acid urine; some by overly alkaline urine. Diet largely affects the pH balance of the urine, so this can be modified to reduce or eliminate stones or to inhibit bacterial growth. It is believed that a pH of over 7.5 will inhibit gram negative bacteria from growing as fast.

A vegetarian diet, a low carbohydrate diet or high-citrus fruit diet is associated with alkaline urine, whereas high-protein or consumption of foods such as cranberries, meat or orange juice can produce acidic urine.

Leukocytes

Leukocytes is another name for white blood cells, of which there are several types. Much like with haemoglobin, it is normal for urine to contain a few of these and the chemical test will show up negative for a lower amount. However, a significant increase in leukocyte levels will give a positive test which could be an indicator of inflammation of the kidneys/urinary tract or bladder/kidney infection. Leukocytes and nitrites together suggest a UTI. White blood cells in your urine can suggest that your kidneys/ureters or bladder or even other parts of your body have an infection (viral or bacterial) and/or are inflamed. Inflammation does not automatically mean a bacterial infection.

Nitrite

The test for nitrite can be an indicator of the presence of a range (but not all) of bacteria that can cause a urinary tract infection since some harmful bacteria convert nitrate to nitrite in the urine.

Bilirubin

Bilirubin (a waste product created when old red blood cells are broken down) is not normally present in healthy urine as it is usually removed as a component of bile. A positive test, therefore, for bilirubin is an early indicator of hepatitis, liver disease or jaundice.

Urobilinogen

Urobilinogen is created in the intestine from bilirubin and a proportion of it is reabsorbed into the bloodstream. A positive test for urobilinogen can indicate conditions such as hepatitis/cirrhosis of the liver. The urobilinogen result is also compared with the bilirubin result. A negative test for bilirubin but positive for urobilinogen can indicate haemolytic disease. A low or negative result for urobilinogen in a patient with a positive bilirubin test can indicate biliary/hepatic obstruction.

Ketones

Healthy urine does not usually contain ketones. Presence of ketones in the urine can indicate a lack of carbohydrates in the diet or that the carbohydrates are not being processed normally. Ketones indicate that fat is being metabolised instead of carbohydrates for energy. This may be an indication of frequent vomiting, a starvation diet, extreme exercising regimes, or cold exposure. Raised ketones may also be an early indicator of diabetes as it can point to insufficient insulin levels.

Glucose

Any presence of glucose in the urine will give a positive test result. Conditions indicated by glucose in the urine are uncontrolled diabetes, kidney/hormonal disorders, liver disease. Glucose may also be an indicator of pregnancy. Generally, a blood test is recommended to identify the specific cause of a positive test result.

Specific Gravity

This is a simple indicator of how concentrated the urine is. The normal range of specific gravity in adults is 1 to 1.030. An increase in this could be an indicator of dehydration, diarrhoea, urinary tract infection, heart failure or decrease blood flow to the kidney. A decrease in specific gravity could indicate conditions such as renal failure or pyelonephritis or excessive fluid intake.

The Chemical Examination can only give part of the story in urinalysis. Abnormal findings on this examination will usually be followed up with a microscopic examination.

Microscopic Examination

This test looks at a sample of your urine under a microscope. It looks at cells from your urinary tract, blood cells, crystals, bacteria, parasites, and cells from tumours, should they exist. This test is used to confirm the findings of other tests or add information to a diagnosis and basically, it gives more specific information. Urine Lab Test Part 3: Microscopic Examination.

The microscopic examination is usually performed if the physical or chemical examination shows abnormal findings. The urine sample is centrifuged so that the concentrated substances can be isolated and studied under the microscope where substances such as crystals and cells can be counted.

So what sorts of substances are found in microscopic examination and what do they signify?

Red blood cells

A red blood cell number elevated from the norm can indicate injury, inflammation, disease/infection of the urinary tract (e.g. bladder/kidneys/urethra).

White blood cells

A white blood cell number elevated from the norm can indicate infection or inflammation in the urinary tract.

Epithelial Cells

A raised number of epithelial cells from the norm can indicate infections, malignancies and inflammation in the urinary tract. The types of cells found under the microscope can help to identify the area of the urinary tract where there is a problem:

  • transitional epithelial cells indicate a condition of the bladder
  • squamous epithelial cells indicate a condition of the external urethra
  • kidney cells indicate a kidney condition

Microorganisms

  • Trichomonas: these are parasites found in the urine. If these are found, a further test for Trichomonas vaginalis is often performed to investigate for vaginal infection.
  • Yeast: indicates a vaginal yeast infection and requires a follow-up test on vaginal secretions (swab) to test for fungal infection.
  • Bacteria: these can enter the urethra from the exterior and travel up to the bladder causing a urinary tract infection. If left untreated this can progress to a more serious kidney infection. Sometimes, the bacteria can originate from inside the body, for instance in the case of septicaemia where the bacteria has infected the urinary tract from the blood stream. A follow up urine culture test should be performed where harmful bacteria is found.

Casts

Casts are hot dog-shaped particles produced when the kidney cells secrete protein. Usually, these are visibly clear (hyaline) but various kidney diseases alter their appearance, giving an indicator of which disorder is present. For example, where red or white blood cell casts are found in the microscopic examination, a kidney disorder is indicated.

Crystals

Normal urine contains a range of different crystals such as calcium oxalates, calcium carbonate, crystalline uric acid, amorphous urate which are formed when waste chemicals bind together. Crystals come in all kinds of shapes, colours and sizes. Whether a crystal forms is dependent on how acidic/alkaline your urine is (which can be affected by your diet), urine temperature and how much of a particular substance is in your urine (since it is more likely to bind together). These normal crystals cause no problem, but abnormal crystals may also be found in the urine which can cause pain and damage to the urinary tract such as cysteine, tyrosine and leucine. Kidney stones (calculi) form in the kidney and can become lodged in either the kidney or ureters.

The benefits of UTI Test 5V® for simple urine testing at home.

Simple home test, with 50 strips per pack, allowing for repeat testing over an extended period.

Quickly check the pH of your urine. A pH of 7.5 to 8 (alkaline) helps slow bacterial growth in most cases and helps prevent future infections. (Our grandmothers new this and used to drink lemon barley water to create an alkaline environment, inhospitable to most bacteria that cause UTIs).

Checks for Blood, Leukocytes, Protein and Nitrites. Blood and Leukocytes indicate inflammation and or infection. Protein means possible kidney involvement in the infection. Nitrites are normally only in the urine if bacteria are present.

Gives medical-level reliability.

Provides simple instructions for home use.

A diagnostic aid trusted by Sweet Cures customers for many years (since 2003). We have sold thousands of test kits, and have always received excellent feedback on their effectiveness and how easy they are to use.

Whilst monitoring the health of your urine is important to understanding your progress, it may not represent the whole picture. UTI Test 5V® can tell you with a strong degree of reliability if there is still infection present in your urine, but cannot tell you what species of bacteria are causing the infection. If natural remedies are unable to clear the infection, have your urine cultured by a competent clinic to identify the agents of infection.

MediChecks.com Ltd
Navigation House
48 Mill Gate
Newark
NG24 4TS

www.medichecks.com

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