CHEMICAL EXAMINATION OF URINE 120 seconds for leukocytes

Red- research/internet info; Blue- extra notes from book Read between 60 120 seconds
Other reagent strips only have 4 parameters protein,
glucose, pH and specific gravity Errors cause by improper technique
Qualitative detect presence or absence of diseases; 1. Formed elements (WBC, RBC) will sink and
pregnancy kits and rapid diagnostic test kits (RDTs) be undetectable in unmixed specimen.
- Sensitivity ability of test to give a positive result in 2. Prolonged dipping of strip into urine may
presence of disease cause leaching of reagents from the pads.
- Specificity ability of test to give a negative result in 3. Excess urine after removal can produce a
absence of disease run-over between chemicals on adjacent
With Disease W/out disease pads which produce a distortion/ mixing of
+ 96 (true positive) 15 (false positive) colors.
- 4 (false negative) 85 (true negative) a. Prevent by blotting and,
% Sensitivity =
!"#$ !"#$%$&'
x 100 b. Holding the strip horizontally while
!"#$ !"#$%&'!!"#$% !"#$%&'"
!"#$ !"#$%&'" comparing with the color chart
% Specificity = x 100 4. Good light source is important for accurate
!"#$ !"#$%&'"!!"#$% !"#$%$&'
- High sensitivity and high specificity is HIGHLY UNLIKELY interpretation.
If there is an increase in one parameter, the other - Automated reagent strip instruments
will be compromised standardize color interpretation and timing
Possible but NOT probable of reaction, not subject to room light
150 days after expiration, RDTs still give high deficiencies and inconsistency among lab
specificity except for HIV personnel
Quantitative determines the exact concentration of an 5. The strip must be held close to the chart
analyte; spectrophotometer without being placed on the chart.
6. Reagent strips and color charts from
The Reagent Strip different manufacturers are not
Simple and rapid method in determining medically interchangeable.
significant analysis of urine 7. Refrigerated specimens MUST be allowed
Two major trade names: to return to room temperature before
- Multistix: Siemens Healthcare Diagnostics, Deerfield, IN testing since the enzymatic reactions on the
- Chemstrip: Roche Diagnostics, Indianapolis, IN strips are temperature dependent.
Consist of chemical-impregnated absorbent pads attached
to a plastic strip Handling and Storage
- Color producing chemical reaction happens when strip - Reagent strips must be protected from
comes in contact with urine deterioration caused by moisture, volatile
- Reactions interpreted by interpreting color produced on chemicals, heat and light
the pad within a specific time frame with a chart - In opaque containers with a dessicant to
supplied by the manufacturer protect them from light and moisture
- Semi-quantitative value of trace, 1+, 2+, 3+ and 4+ - Removed only before testing and the bottle
Testing is tightly resealed immediately
- Used only once and discarded - Not opened in the presence of volatile
- Perform within 1 hour of collection fumes
- Dip reagent strip completely but briefly in a well-mixed - Stored at RT (below 30C) but NEVER
specimen and removing excess urine by running the refrigerated
edge of the strip on the container, blotting, waiting for - Bottles have expiration date that represents
the specified time to take place and comparing the the functional life expectancy of the pad
reaction on the strip with the manufacturers color chart AND should not be used after said date
in good lighting - Do not touch the chemical pads while
Timing varies between manufacturers removing the strip
Immediate reaction for pH
 - Visual inspection done to check for any secreted by the placenta that block action of
deterioration of the pad even if within expiration insulin
date - Clinical Significance of Urine Glucose
Quality Control Hyperglycemia Renal- Associated
- Strips must be checked with both + and controls a Associated
minimum of once every 24 hours (some every shift) Diabetes Mellitus Fanconi syndrome
- Testing is performed when a new bottle is opened, Pancreatitis Advanced renal
questionable results are obtained or there is concern Pancreatic Cancer disease
with the integrity of the strips Acromegaly Osteomalacia
- QC results must be recorded following lab protocol Cushing syndrome Pregnancy
- Distilled water is NOT for negative control since the Hyperthyroidism
reagent strip chemical reactions are designed to Pheochromocytoma
perform in ionic concentrations similar to urine CNS damage
- All readings of negative control should be negative and Stress
positive control values must match with published Gestational Diabetes
values. If not, must be resolved through testing of - Reagent Strip Reaction: DOUBLE
additional strips and controls SEQUENTIAL ENZYME REACTION
- Reagent strips have limitations indicated by Test are (adsorbent pad) impregnated with
manufacturers such as interfering substances, glucose oxidase, peroxidase, chromogen
sensitivities, color blindness and buffer
Orange pigment in the urine for px taking (2nd step) Peroxidase catalyzes a reaction
phenazopyridine compounds between hydrogen peroxide and a
Confirmatory Testing chromogen to form an oxidized compound,
- Test using different reagents or methodologies to which is in direct proportion to
detect the same substances with the reagent strip with concentration of glucose
the same or greater level of specificity and sensitivity
- Reduced need at present due to automated strip
readers and increased specificity and sensitivity
of strips
10 Parameters of Reagent Strip (ff. the order of the strip
and not the book) May be reported in:
1. Glucose (Glu) a. Qualitative: negative, trace, 1+, 2+, 3+ and
- Most frequently performed chemical analysis on urine 4+
for detection and monitoring of diabetes mellitus b. Semi-quantitative (provided in the color
- Early diagnosis of DM through blood and urine glucose charts): from 100 mg/dl to 2 g/dl or 0.1% to
tests improved prognosis 2%
- Normally, glucose reabsorbed through the proximal Multisitix Chemstrip
convoluted tubules (PCT) by active transport Reagents Glucose Oxidase Glucose oxidase
- Hyperglycemia: tubular transport of glucose reached Peroxidase Peroxidase
the renal threshold (160-180 mg/dl) and glu starts Potassium Iodide Tetramethylbenzi
appearing in the urine dine
- Glycosuria happens after a meal containing high glu
content since blood glu levels fluctuate Color Green to Brown Yellow to Green
- Fasting specimen for screening tests Reaction
1st morning doesnt always represent fasting Sensitivity 75-125 mg/dl 40 mg/dl
specimen since glu from evening meal may remain Interferences
in bladder a. False Positive
- DM monitoring: specimens are usually 2 hrs after a meal Contamination of containers with peroxide
Gestational Diabetes: onset at around 6th or strong oxidizing detergents
month of pregnancy; due to the hormones
 b. False Negative
High levels of Ascorbic Acid: prevent
oxidation of chromogen; prevention by
addition of Iodate, which oxidizes ascorbic
acid
High levels of Ketones: at low glucose
concentrations; not really a problem
High Specific Gravity AND low temperature:
decrease sensitivity of test
Unpreserved specimen at room
temperature for extended periods of time:
GREATEST SOURCE OF FALSE NEGATIVE
due to bacterial degradation of glucose
- Copper Reduction Test (Clinitest)
One of the earliest test performed in urine
Ability of glucose and other substances to reduce
copper sulfate to cuprous oxide in the presence of
alkali and heat
Classic Benedict solution contained copper sulfate,
sodium carbonate and sodium citrate buffer, heat
was applied and precipitate was observed for color
Clinitest tablet employs Benedicts principle. Tablet
contains copper sulfate, sodium carbonate, sodium
citrate and sodium hydroxide
Production of heat upon addition of tablet
to water and urine due to hydrolysis of
sodium hydroxide, its reaction with sodium
citrate and CO2 released to prevent room
air from interfering with reduction reaction
Tube shaken after effervescent reaction and
color (blue to orange/red) compared with
manufacturers color chart to determine
approximate amount of reducing substance
At high glucose levels: phenomenon of pass
through occurs where color produced
passes through orange/red stage and
returns to green/brown color. Minimize
phenomenon by adding 2 drops of urine
instead of 5
Sensitivity is reduced to minimum of 200
mg/dl
Cannot be used as confirmatory test for
glucose
Hygroscopic
Subject to interference of other reducing
sugars: galactose, lactose, fructose,
maltose, pentose, ascorbic acid,
cephalosporins, etc.
Strong blue color and tablet fizzing in
unused tablets suggest deterioration due to
moisture accumulation
Clinical Significance: Presence of other
reducing sugars (galctose, lactose: in
nursing mothers, etc.) Galactose in the urine
of newborn represents inborn error of
metabolism
- LACK of enzyme galactose-1-phosphate
uridyl transferase which prevent
breakdown of ingested galactose
- Required newborn screening program
since early detection followed by
dietary restriction can control condition
- Often performed on pediatric
specimens from px at least up to 2 years
of age
2. Bilirubin
- Appearance in urine can provide early
indication of liver disease
- By-product of the breakdown of hemoglobin
- Early indication of liver disease (jaundice)
- Highly pigmented yellow compound
- Converted from protoporphryin
- Urine normally contains no bilirubin
- Only conjugated bilirubin can be seen in urine
Bile duct obstruction (post-hepatic jaundice)
Gallstones
Cancer
Integrity of liver is damaged (hepatic
jaundice)
Hepatitis
Cirrhosis
- Presence or absence can be used to determine
the cause of clinical jaundice
Jaundice due to increased destruction of
RBCs do not produce bilirubinuria (serum
bilirubin is in unconjugated form and
kidneys cannot excrete it)
Urine
Urine
Urobilinogen
Bilirubin
Bile duct Normal
+++
obstruction
Liver ++
+ or -
damage
 Hemolytic
Negative +++
disease
- Sensitive to light, therefore, exposure of the urine
samples to light = false negative
- Reagent Strip Reaction: DIAZO REACTION
Azo dye: tan or pink to violet
Reporting: negative, small/1+, moderate/2+,
large/3+
False positive reactions
Yellow-orange urine from people taking
phenazopyridine compounds
Indican and metabolites of Lodine
False negative reactions
Not fresh specimen
Exposed to light (bilirubin is oxidized to
biliverdin which does not react with diazo
tests)
Production of free bilirubin
High concentrations of ascorbic acid (>25
mg/dL) and nitrite combine with
diazonium salt
3. Ketones
- Use of available carbohydrate as energy is
compromised and fat is used for energy DIABETES
MELLITUS TYPE 1
- 3 intermediate products of FAT METABOLISM
Acetone 2%
Acetoacetic Acid 20%
Beta-hydroxybutyrate 78%
- Clinical Significance
Inability to metabolize carbohydrate in DM
important for MANAGEMENT AND MONITORING
OF INSULIN INDEPENDENT DM
Ketonuria show deficiency of insulin
Increased loss of carbohydrate from vomiting
Inadequate intake of carbohydrates associated with
malnutrition and malabsorption
Frequent and strenuous exercise
Weight-loss and eating disorders
Diabetic acidosis
Starvation
Malabsorption or Pancreatic disorders
Inborn errors of Amino Acid metabolism
- Reagent Strip Reaction: SODIUM NITROPRUSSIDE
(NITROFERICYANIDE) REACTION
Acetone and Beta-hydroxybutyric acid are
produced from acetoacetic acid
Acetoacetic acid in alkaline medium reacts
with sodium nitroprusside to produce a
purple color
Doesnt measure Beta-hydroxybutyrate
Only sensitive to acetone when glycine is
added (Chemstrip)
May be reported as:
a. Qualitative: negative, trace, small (1+),
moderate (2+) or large (3+
b. Semi-quantitative: negative, trace (5
mg/dl), small (15 mg/dl), moderate (40
mg/dl) or large (80-160 mg/dl)
Sensitivity
a. Multistix: 5-10 mg/dl acetoacetic acid
b. Chemstrip: 9 mg/dl acetoacetic acid and
70 mg/dl acetone
Interferences
a. False Positive
Large amounts of Levodopa and other
drugs with sulfhydryl groups
(Mercaptoethane sulfonate sodium
MESNA and captopril) atypical color
reaction
Highly pigmented red urine
Pthalein dyes
Improperly timed specimens: color
development from acetoacetic acid
increases
b. False Negative
Improperly preserved specimen:
Volatilization of acetone and breakdown
of acetoacetic acid by bacterial
degradation
Acetest tablet for confirmatory test of
questionable reagent strip results
Primarily for testing serum and other
bodily fluids
Dilutions for severe ketosis
Addition of lactose better for color
differentiation
Hygroscopic
Specimen must be completely
absorbed within 30 seconds
 4. Specific Gravity Major causes:
- Reflects the kidneys ability to concentrate renal calculi
- Clinical Significance: glomerular diseases
Monitoring hydration and dehydration tumors
Loss of renal tubular concentrating ability trauma
Diabetes Insipidus pyelonephritis
Determination of unsatisfactory specimens due to exposure to toxic chemicals
low concentration anticoagulant therapy
Reagents
Non-pathologic:
Multistix: Poly(methyl vinyl ether/maleic
strenuous exercise
anhydride) bromthymol blue
menstruation
Chemstrip: Ethylene glycol diaminoethyl ether
- HEMOGLOBINURIA
tetraacetic acid, bromthymol blue
May result from the lysis of RBS produced
- Sensitivity: 1.000 to 1.030
in the urinary tract particularly in dilute,
- False positive: high concentrations of protein
alkaline urine
- False negative: highly alkaline urine (>6.5)
May result from intravascular hemolysis
- Reagent strip reaction: pKA CHANGE
and subsequent filtering of hemoglobin
through the glomerulus
No RBCs seen in cases of intravascular
hemolysis
Under normal conditions, the formation of
large Hb-haptoglobin complexes prevents
the glomerular filtration of Hb. When the
amount of free Hb present exceed that of
the haptoglobin (hemolytic anemias,
transfusion rxns, severe burns, spider bites,
infections & strenuous exercise) Hb is
available for glomerular filtration.
Hemosiderin large yellow-brown
granules of denatured ferritin in the renal
tubular epithelial cells and in the urine
sediment resulting from the reabsorption
indicator: Bromthymol blue of filtered hemoglobin
low specific gravity = blue-green alkaline pH - MYOGLOBIN
high specific gravity = yellow-green acid pH Heme-containing protein found in muscle
5. Blood tissue
- >5 RBCS per microliter of urine is considered chemically Clear red-brown urine
significant Conditions associated with muscle
- Hemoglobin testing most accurate to determine destruction (rhabdomyolysis - side effect in
presence of blood intake of cholesterol lowering statin
- Once blood is detected, microscopic examination can medications)
be used to differentiate Trauma
- HEMATURIA Crush syndromes
most closely related to disorders of renal or Prolonged coma
genitourinary origin in which bleeding is the result Convulsions
of trauma or damage to the organs Muscle-wasting diseases
 Alcoholism
Heroin abuse
Extensive exertion
Heme portion: toxic to renal tubules; high
concentrations can cause renal failure
- Reagent Strip Reaction: PEROXIDASE ACTIVITY of Hb
to catalyze a reaction between hydrogen peroxide and
the chromogen tetramethylbenzidine to produce an
oxidized chromogen which has a green-blue color:
Free hgb: uniform color (negative: yellow green;
strongly positive green-blue)
Intact RBCs: lysed and produce a speckled pattern
Reporting: trace, small/1+, moderate/2+, large/3+
False positive reactions
Menstruation
Strong oxidizing detergents
Vegetable peroxidase
Bacterial enzymes (Escherichia coli peroxidase)
False negative reactions
Ascorbic acid
Urine with high specific gravity contains
crenated RBCs that do not lyse when they
come in contact with the pad
Formalin
Captopril (for hypertension)
High concentrations of nitrite (greater than 10
mg/dL)
Failure to mix the specimen prior to testing
6. pH
- Measures degree of acidity or alkalinity of urine
- Regulation of the acid-base balance in the body
- First morning urine slightly acidic (pH 5.0-6.0)
- Alkaline urine following a meal (alkaline tide)
- No normal values assigned
- Clinical Significance
Systemic acid-base disorders (metabolic or
respiratory origin)
Management of urinary conditions
Acidic: respiratory or metabolic acidosis not
related to renal function; high protein diet,
methanamine mandelate & fosfomycin
tromethamine
Alkaline: respiratory or metabolic
acidosis is present; vegetarians (due to
the formation of bicarbonate)
*exception: cranberry juice produces
acidic urine
Promotion or inhibition of stone
formation/ renal calculi formation (e.g.
calcium oxalate precipitates in acidic
urine)
Treatment of UTI (urea-splitting
bacteria); not multiply readily in acidic
urine
Does not reach pH 9/8.5 (associated
with unpreserved specimens)
- Reagent Strip Reaction: DOUBLE
INDICATOR SYSTEM OF METHYL RED
AND BROMOTHYMOL BLUE:
- Kidneys major regulators of acid base content
in body (along w/ lungs)
Secretion of hydrogen ion in the form of
ammonium ions, hydrogen phosphate, and
weak organic acids
Reabsorption of bicarbonate
- Random samples: pH 4.5 8.0
- Must be considered in conjunction with:
Acid-base content of blood
Renal function
Presence of UTI
Dietary intake
Age of specimen
7. Protein
- Most indicative of renal disease
- In normal urine:
Less than 10 mg/dl protein is present (100
mg/24 hours)
Normal protein in urine is composed of low
molecular weight serum proteins
Small amounts of albumin: which is the
major serum protein found in urine
Tamm-Horsfall protein/ Uromodulin:
which forms the matrices of casts
 Proteins from the prostatic, seminal and substances, viral infections and Fanconi's
vaginal secretions syndrome
- Clinical Significance: causes of proteinuria are C. Post- renal Proteinuria
divided into Pre-renal, renal, and post-renal - When protein is added as it passes through the
lower urinary tract (ureters, bladder, prostate,
A. Pre-renal urethra, vagina)
- Caused by conditions affecting the plasma - Most common causes:
before reaching the kidney Bacterial and fungal infections and
- Not indicative of renal disease inflammations which form exudates from
- Commonly caused by increased levels of: interstitial fluid
Hemoglobin Blood as result of injury/menstruation
Myoglobin Prostatic fluid/spermatozoa in urine
Acute phase reactants (found in infection
and inflammation)
Not discovered in routine urinalysis (since
reagent strips mainly detect albumin)
- Bence Jones Protein
Excreted in people with multiple myeloma
Monoclonal Ig-light chains produced by
proliferative plasma cells
Chemically detected using Variations in
Heat
40-60C protein coagulation occurs-
turbid
100C- dissolving of coagulum- clear
B. Renal
- Either Glomerular or Tubular
a. Glomerular Proteinuria
- Damage to glomerular membrane
- Impairment in selective filtration, therefore
increased amounts of serum protein, and
eventually blood cells pass through
- Causes of glomerular damage, which leads - Reagent Strip Reaction: PROTEIN ERROR OF
to proteinuria, are conditions wherein INDICATORS
introduction of abnormal substances occur
Multistix Chemstrip
such in the case of lupus erythematosus and
Reagent Tetrabromph 3355-
streptococcal glomerulonephritis
enol blue tetrachlorophenol
- Non-pathological conditions which increase
3,4,5,6
blood pressure- overriding the selective
tetrabromosulfop
function of the glomerulus are exercise and
htahlein
dehydration
Color (Absence) Yellow Green Blue
- Microalbuminuria: detected in diabetic
nephropathy which leads to reduced
Sensitivity 15-30 mg/dl 6 mg/dl of
filtration and eventually leads to renal failure
of albumin albumin
- Orthostatic/Postural Proteinuria- proteinuria
caused by posture/long standing position
which increases pressure on the renal vein; Protein accepts hydrogen ions from
most commonly affected are young adults indicator
b. Tubular Proteinuria: due to impaired More sensitive for albumin, since it has
reabsorption, caused by exposure to toxic more amino groups to accept the hydrogen
ions than other proteins
 In acid buffer to maintain pH at constant level Hemolytic disorders- more intravascular
May be reported as hemolysis= more biliverdin= more B1= more
a. Qualitative: negative, trace, 1+, 2+, 3+ or 4+ B2= more urobilinogen produced=
b. Semi-quantitative: positive results are estimated overworked liver is unable to process
as 30, 100, 300, 2000 mg/dl corresponding to each recirculated urobilinogen
color change Valuable in detection of early liver disease
Interference Hepatitis, Cirrhosis, Carcinoma
a. False Positive: when reaction does not take place - Reagent strip reaction: EHRLICHS REACTION
in acidic conditions
Highly buffered interference alkaline urine:
overrides acid buffer system rise in pH
and color change unrelated to protein
concentration
Pigmented specimens, Phenazopyridine
Quaternary ammonium compounds
(detergents)
Antiseptics, chlorhexidine
Loss of buffer from prolonged exposure of
Results are reported in Ehrlich's unit
strip to specimen reagent
Multistix Chemstrip
High specific gravity
Reagent p- 4-
b. False Negative
dimethylaminobenzal methoxybenzene
Proteins other than albumin
dehyde (Ehrlichs -diazonium-
Microalbuminuria
reagent) tetrafluoroborate
SSA (Sulfosalicylic Acid) Test: cold precipitation test
which reacts with all forms of protein
Miscellaneous readings on albumin and creatinine Color Light pink Dark pink White pink
measurements, further readings at p 78-79 Sensitivity 0.2 mg/dl 0.4 mg/dl
8. Urobilinogen urobilinogen urobilinogen
- With stercobilinogen, is a product of bilirubin False Porphobilinogen Highly
conversion by intestinal bacteria Positive (clinically significant pigmented urine
- Normally reabsorbed, recirculated to the liver and but strip cant detect
excreted back into the intestines (however its presence
stercobilinogen is no longer reabsorbed but oxidized to Indican, p-
stercobilin) aminosalicylic acid,
- Recirculated urobilinogen is oxidized to urobilin sulfonamides,
- Stercobilin and urobilin are responsible for brown color methldopa, Procaine,
of feces Chlorpromazine,
Acholic stools- stools without color; absence of highly pigmented
either stercobilin or urobilin or both urine
- In normal urine:
False Old specimens Old specimens
Less than 1 mg/dl or Ehrlich unit
Negative Preservation in Preservation in
Since in recirculation, blood passes through the
formalin formalin
kidneys, a small amount is filtered by the glomerulus
Photo-oxidation of Photo-oxidation
and passes in urine
sample to urobilin in of sample to
- Clinical Significance:
unpreserved urobilin in
Increased amounts appear in liver damage and
specimens unpreserved
hemolytic disorders
specimens
Liver disease: liver is not able to process
High
recirculated urobilinogen back to bilirubin
concentrations of
Nitrite
 Sensitivity of Ehrlich reaction increases with 10. Leukocyte Esterase
temperature so it should be done at room temp - Offers a more standardized mean for leukocyte
High urobilinogen results after a meal due to detection than microscopic exam
increased excretion of bile salts Quantitation should be done by microscopic
9. Nitrite exam
- Rapid screening test for UTI - An advantage is that it can detect lysed WBC
- Screening test only; primary test for diagnosis and undetected in microscopic exam
monitoring of UTI is urine culture - Most preferred specimens for urine culture:
- Used in combination with leukocyte esterase test to Suprapubic > catheterized > midstream clean
determine necessity for urine culture catch
- Clinical Significance - Clinical Significance:
Valuable for detecting initial bladder infection Bacterial and nonbacterial UTI
(cystitis) since patients are often asymptomatic Inflammation of urinary tract
Pyelonephritis Screening of urine culture specimens
Evaluation of antibiotic therapy Normal values are 0-2/0-5 per HPO field
Monitoring patients at high risk for UTI Women have higher values than men due to
Screening of urine culture specimens vaginal contamination
- Reagent strip reaction: GREISS REACTION LE detects presence of esterase in
granulocytes and monocytes, but not in
lymphocytes
Esterase is also produced by Trichomonas
and histiocytes
Positive result is accompanied by presence of
bacteria
Bacteria reduces nitrate, normal component of
Infections of Trichomonas, Chlamydia, yeast,
urine, into nitrite
inflammation of renal tissue produces
Reported qualitatively, either positive or negative
leukocyturia but not bacteuria
Any shade of pink = positive
More reliable than nitrite test
Cost efficient screening test to determine
necessity for urine culture
Multistix Chemstrip
- Reagent strip reaction: INDOXYLCARBONIC
Reagent p-arsanilic acid Sulfanilamide ACID ESTER
Tetrahydrobenzo(h)- Hydroxytetra
quinolin-3-ol benzoquinoline
Sensitivity 0.06 to 0.1 mg/dl 0.05 mg/dl
nitrite ion nitrite ion
False Improperly preserved specimens LE requires longest time of all reagent strip
Positive Highly pigmented urine reactions (2 minutes)
False Nonreductase-containing bacteria UTI: 7-7.5 pH, dark yellow and clear urine,
negative Insufficient contact time between + for LE and nitrite, high specific gravity
bacteria and urinary nitrate: first morning confirm with microscopic exam
specimen or urine that has remained in Report reaction qualitatively as trace, 1+, 2+
the bladder for 4 hours and 3+
Lack of urinary nitrate Multistix Chemstrip
Large quantities of bacteria further Reagent Derivatized Indoxylcarbonic
reduces nitrite to nitrogen pyrrole acid ester
Antibiotics amino acid Diazonium salt
High concentrations of ascorbic acid ester
High specific gravity Diazonium
 salt 4. The reagent strip reaction that requires thelongest reaction
Sensitivity 5-15 10-25 WBC/hpf time is the:
WBC/hpf A. Bilirubin
False Strong oxidizing agents B. pH
Positive Formalin C. Leukocyte esterase
Highly pigmented urine D. Glucose
Nitrofurantoin: may obscure 5. Quality control of reagent strips is performed:
color reaction A. Using positive and negative controls
False High concentrations of protein B. When results are questionable
Negative (>500 mg/dl), glucose (>3 g/dl), C. At least once every 24 hours
oxalic acid, ascorbic acid, D. All of the above
gentamicin, cephalosporins, 6. All of the following are important to protect the
tetracyclines integrity of reagent strips except:
High specific gravity: crenation A. Removing the desiccant from the bottle
of WBC preventing release of LE B. Storing in an opaque bottle
Inaccurate timing C. Storing at room temperature
D. Resealing the bottle after removing a strip
11. Ascorbic Acid 7. The principle of the reagent strip test for pH is the:
- Reagent Strip Reaction: TILLMANS REACTION A. Protein error of indicators
Reagent: 2,6-dichloroindophenol sodium B. Greiss reaction
Blue-green color C. Dissociation of a polyelectrolyte
- Significance D. Double indicator reaction
Increased levels indicate possible interference and 8. A urine specimen with a pH of 9.0:
show a false negative reaction with A. Indicates metabolic acidosis
Blood B. Should be recollected
Glucose C. May contain calcium oxalate crystals
Nitrite D. Is seen after drinking cranberry juice
Leukocytes 9. In the laboratory, a primary consideration associated
Bilirubin with pH is:
Urobilinogen A. Identifying urinary crystals
Study Questions (Disclaimer: we answered it according to B. Monitoring vegetarian diets
info in the book, not the answer key) C. Determining specimen acceptability
1. Leaving excess urine on the reagent strip after removing it D. Both A and C
from the specimen will 10. Indicate the source of the following proteinurias
A. Cause run-over between reagent pads by placing a 1 for prerenal, 2 for renal, or 3 for
B. Alter the color of the specimen postrenal in front of the condition.
C. Cause reagents to leach from the pads A. 2 Microalbuminuria
D. Not affect the chemical reactions B. 1 Acute phase reactants
2. Failure to mix a specimen before inserting the reagent strip C. 2 Pre-eclampsia
will primarily affect the: D. 3 Vaginal inflammation
A. Glucose reading E. 1 Multiple myeloma
B. Blood reading F. 2 Orthostatic proteinuria
C. Leukocyte reading G. 3 Prostatitis
D. Both B and C 11. The principle of the protein error of indicators
3. Testing a refrigerated specimen that has not warmed to room reaction is that:
temperature will adversely affect: A. Protein keeps the pH of the urine constant
A. Enzymatic reactions B. Albumin accepts hydrogen ions from the
B. Dye-binding reactions indicator
C. The sodium nitroprusside reaction C. The indicator accepts hydrogen ions from
D. Diazo reactions albumin
 D. Albumin changes the pH of the urine
12. All of the following will cause false-positive protein reagent
strip values except:
A. Microalbuminuria
B. Highly buffered alkaline urines
C. Delay in removing the reagent strip from the specimen
D. Contamination by quaternary ammonium compounds
13. A patient with a 2+ protein reading in the afternoon is asked
to submit a first morning specimen. The second specimen
has a negative protein reading. This patient is:
A. Positive for orthostatic proteinuria
B. Negative for orthostatic proteinuria
C. Positive for Bence Jones protein
D. Negative for clinical proteinuria
14.Testing for microalbuminuria is valuable for early detection of
kidney disease and monitoring patients with:
A. Hypertension
B. Diabetes mellitus
C. Cardiovascular disease risk
D. All of the above
15. The primary chemical on the reagent strip in the Micral- Test
for microalbumin binds to:
A. Protein
B. Antihuman albumin antibody
C. Conjugated enzyme
D. Galactoside
16. All of the following are true for the ImmunoDip test for
microalbumin except:
A. Unbound antibody migrates farther than bound antibody
B. Blue latex particles are coated with antihuman albumin
antibody
C. Bound antibody migrates further than unbound antibody
D. It utilizes an immunochromographic principle
17. The principle of the protein-high MultiStix Pro reagent strip
is
A. Diazo reaction
B. Enzymatic dye-binding reaction
C. Protein error of indicators
D. Microalbumin-Micral-Test
18. Which is not tested on the MultiStix Pro reagent strip?
A. Urobilinogen
B. Specific gravity
C. Creatinine
D. Protein-high
19. The principle of the protein-low reagent pad on the
Multistix Pro is the:
A. Binding of albumin to sulphonphthalein dye
B. Immunologic binding of albumin to antibody
C. Reverse protein error of indicators reaction
D. Enzymatic reaction between albumin and dye
20. The principle of the creatinine reagent pad on microalbumin
reagent strips is the:
A. Double indicator reaction
B. Diazo reaction
C. Pseudoperoxidase reaction
D. Reduction of a chromogen
21. The purpose of performing an albumin:creatinine
ratio is to:
A. Estimate the glomerular filtration rate
B. Correct for hydration in random specimens
C. Avoid interference for alkaline urines
D. Correct for abnormally colored urines
22. A patient with a normal blood glucose and a
positive urine glucose should be further checked for:
A. Diabetes mellitus
B. Renal disease
C. Gestational diabetes
D. Pancreatitis
23. The principle of the reagent strip tests for glucose
is the:
A. Peroxidase activity of glucose
B. Glucose oxidase reaction
C. Double sequential enzyme reaction
D. Dye-binding of glucose and chromogen
24. All of the following may produce false-negative
glucose reactions except:
A. Detergent contamination
B. Ascorbic acid
C. Unpreserved specimens
D. Low urine temperature
25. The primary reason for performing a Clinitest is to:
A. Check for high ascorbic acid levels
B. Confirm a positive reagent strip glucose
C. Check for newborn galactosuria
D. Confirm a negative glucose reading
26. The three intermediate products of fat metabolism
include all of the following except:
A. Acetoacetic acid
B. Ketoacetic acid
C. -hydroxybutyric acid
D. Acetone
27. The most significant reagent strip test that is associated with A. 1 Conjugated bilirubin
a positive ketone result is: B. 3 Urobilinogen and stercobilinogen
A. Glucose C. 4 Urobilin
B. Protein D. 2 Unconjugated bilirubin
C. pH 35. The principle of the reagent strip test for
D. Specific gravity bilirubin is the:
28. The primary reagent in the reagent strip test for ketones is: A. Diazo reaction
A. Glycine B. Ehrlich reaction
B. Lactose C. Greiss reaction
C. Sodium hydroxide D. Peroxidase reaction
D. Sodium nitroprusside 36. An elevated urine bilirubin with a normal
29. Ketonuria may be caused by all of the following except: urobilinogen is indicative of:
A. Bacterial infections A. Cirrhosis of the liver
B. Diabetic acidosis B. Hemolytic disease
C. Starvation C. Hepatitis
D. Vomiting D. Biliary obstruction
30. Urinalysis on a patient with severe back and abdominal pain 37. The primary cause of a false-negative bilirubin
is frequently performed to check for: reaction is:
A. Glucosuria A. Highly pigmented urine
B. Proteinuria B. Specimen contamination
C. Hematuria C. Specimen exposure to light
D. Hemoglobinuria D. Excess conjugated bilirubin
31. Place the appropriate number or numbers in front of each of 38. The purpose of the special mat supplied with
the following statements. Use both numbers for an answer if the Ictotest tablets is that:
needed. (1) Hemoglobinuria (2) Myoglobinuria A. Bilirubin remains on the surface of the mat.
1 Associated with transfusion reactions B. It contains the dye needed to produce
2 Clear red urine and pale yellow plasma color.
1 Clear red urine and red plasma C. It removes interfering substances.
2 Associated with rhabdomyolysis D. Bilirubin is absorbed into the mat.
1 Produces hemosiderin granules in urinary sediments 39. The reagent in the Multistix reaction for
2 Associated with acute renal failure urobilinogen is:
32. The principle of the reagent strip test for blood is based on A. diazonium salt
the: B. Tetramethylbenzidine
A. Binding of heme and a chromogenic dye C. p-Dimethylaminobenzaldehyde
B. Peroxidase activity of heme D. Hoesch reagent
C. Reaction of peroxide and chromogen 40. The primary problem with urobilinogen tests
D. Diazo activity of heme using Ehrlich reagent is:
33. A speckled pattern on the blood pad of the reagent strip A. Positive reactions with porphobilinogen
indicates: B. Lack of specificity
A. Hematuria C. Positive reactions with Ehrlichs reactive
B. Hemoglobinuria substances
C. Myoglobinuria D. All of the above
D. All of the above 41. The reagent strip test for nitrite uses the:
34. List the following products of hemoglobin degradation in A. Greiss reaction
the correct order by placing numbers 1 to 4 in the blank. B. Ehrlich reaction
C. Peroxidase reaction
 D. Pseudoperoxidase reaction 49. Reagent stripspecific gravity readings are
42. All of the following can cause a negative nitrite reading affected by:
except: A. Glucose
A. Gram-positive bacteria B. Radiographic dye
B. Gram-negative bacteria C. Alkaline urine
C. Random urine specimens D. All of the above
D. Heavy bacterial infections
43. A positive nitrite test and a negative leukocyte esterase test
is an indication of a:
A. Dilute random specimen
B. Specimen with lysed leukocytes
C. Vaginal yeast infection
D. Specimen older than 2 hours
44. All of the following can be detected by the leukocyte
esterase reaction except:
A. Neutrophils
B. Eosinophils
C. Lymphocytes
D. Basophils
45. Screening tests for urinary infection combine the leukocyte
esterase test with the test for:
A. pH
B. Nitrite
C. Protein
D. Blood
46.The principle of the leukocyte esterase reagent strip test
uses a:
A. Peroxidase reaction
B. Double indicator reaction
C. Diazo reaction
D. Dye-binding technique
47. The principle of the reagent strip test for specific gravity
uses the dissociation constant of a(n):
A. Diazonium salt
B. Indicator dye
C. Polyelectrolyte
D. Enzyme substrate
48. A specific gravity of 1.005 would produce the reagent strip
color:
A. Blue
B. Green
C. Yellow
D. Red