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URINALYSIS A urinalysis (or "UA") is an array of tests performed on urine and one of the most common methods of medical

diagnosis.[1] A part of a urinalysis can be performed by using urine dipsticks, in which the test results can be read as color changes. Urinalysis is a simple test that assesses the physical and chemical composition of urine. Abnormal results usually indicate that there is a problem with the kidneys and/or urinary system. However, a urinalysis can also provide clues about problems in other organ systems, or may indicate the presence of a metabolic disease, such as diabetes mellitus. Urinalysis is necessary for a complete assessment of the kidneys and urinary system. The sample can be either analyzed in the medical clinic or sent to a laboratory to perform the tests. Urinalysis is abbreviated UA. Urine can be evaluated by its physical appearance (color, cloudiness, odor, clarity), or macroscopic analysis. It can be also analyzed based on its chemical and molecular properties or microscopic assessment. Indication & Purpose of a Urinalysis A urinalysis consists of a number of physical, chemical and microscopic tests of a urine sample as part of a checkup to help diagnose a urinary tract or metabolic disease. Doctors also use urinalysis as a general health screen. Routine physical/medical evaluation: general yearly screening, assessment before surgery (pre-operative assessment), admission to hospital, screening for kidney disease, diabetes mellitus, hypertension (high blood pressure), liver disease, etc. A routine physical exam often includes a urinalysis to screen for early signs of medical problems. Abnormal waste products or abnormal levels of cells may indicate disease. Assessing particular symptoms: abdominal pain, painful urination, flank pain, fever, blood in the urine, or other urinary symptoms. Pregnancy A different type of urinalysis for the hormone human chorionic gonadotropin shows pregnancy. You can get this test at your doctor's office, or you can perform a test yourself using a home-testing kit. Drug Screening Employers may use specialized urinalysis tests to screen job applicants and employees for drug use. Sports associations test athletes for drugs. Law enforcement also uses forensic urinalysis to screen for drugs and toxins. Diagnosing medical conditions: urinary tract infection, kidney infection, kidney stones, uncontrolled diabetes (high blood sugars), kidney impairment, muscle breakdown (rhabdomyolysis), protein in urine, kidney inflammation (glomerulonephritis). Patients who have urinary symptoms undergo urinalysis to help doctors diagnose urinary tract diseases, like infections. Abnormal test results in such cases commonly include blood and increased white cells in the urine Monitoring disease progression and response to therapy: diabetes related kidney disease, kidney impairment, lupus related kidney disease, blood pressure related kidney disease, kidney infection, protein in urine, blood in urine. For patients who already have an existing condition like diabetes or kidney disease, urinalysis helps to monitor their status and determines whether their course of treatment requires adjustment. CLIENT PREPARATION Urinalysis is done by collecting a urine sample from a patient. The optimal sample tends to be an early morning urine sample because it is frequently the most concentrated urine produced in the day. Typically, no fasting is required before the collection of urine sample and routine medications can be taken before the test, unless otherwise instructed by the ordering physician. Methods of collection are slightly different for female and male patient. For females, the patient is asked to clean the area around the urethra with a special cleansing wipe, by spreading the labia of the external genitals and cleaning from front to back (toward the anus). For men, the tip of the penis may be wiped with a cleansing pad prior to collection.

The urine is then collected in a clean urine specimen cup while the patient is urinating. It is best to avoid collecting the initial stream of urine. After the initial part of urine is disposed of in the toilet, then the urine is collected in the urine container provided. Once about 30 to 60 ml (roughly 3 to 5 tablespoons) are collected in the container for testing, the remainder of the urine may be voided in the toilet again. This is called the clean catch or the midstream urine collection.

The collected urine sample should be taken to the laboratory for analysis, typically within one hour of collection. If transportation to the lab could take more than one hour, then the sample may be refrigerated. In some patients who are unable to void spontaneously or those who are not able to follow instructions other methods may be used, such as placing a catheter (a small rubber tube) through the outside opening to the bladder (urethra) to collect the sample directly from the bladder. Aftercare The patient may return to normal activities after collecting the sample and may start taking any medications that were discontinued before the test. Normal results Normal urine is a clear straw-colored liquid, but may also be slightly hazy. It has a slight odor, and some laboratories will note strong or atypical odors on the urinalysis report. A normal urine specimen may contain some normal crystals as well as squamous or transitional epithelial cells from the bladder, lower urinary tract, or vagina. Urine may contain transparent (hyaline) casts, especially if it was collected after vigorous exercise. The presence of hyaline casts may be a sign of kidney disease, however, when the cause cannot be attributed to exercise, running, or medications. Normal urine contains a small amount of urobilinogen, and may contain a few RBCs and WBCs. Normal urine does not contain detectable amounts of glucose or other sugars, protein, ketones, bilirubin, bacteria, yeast cells, or trichomonads. Normal values used in many laboratories are given below: Glucose: negative (quantitative less than 130 mg/day or 30 mg/dL). Bilirubin: negative (quantitative less than 0.02 mg/dL). Ketones: negative (quantitative 0.53.0 mg/dL). pH: 5.08.0. Protein: negative (quantitative 15150 mg/day, less than 10 mg/dL). Blood: negative. Nitrite: negative. Specific gravity: 1.0151.025. Urobilinogen: 02 Ehrlich units (quantitative 0.31.0 Ehrlich units). Leukocyte esterase: negative. Red blood cells: 02 per high power field. White blood cells: 05 per high power field (010 per high power field for some standardized systems).

ABNORMAL RESULT Urinalysis can disclose evidence of diseases, even some that have not caused significant signs or symptoms. Therefore, a urinalysis is commonly a part of routine health screening. Urinalysis is commonly used to diagnose a urinary tract or kidney infection, to evaluate causes of kidney failure, to screen for progression of some chronic conditions such as diabetes mellitus and high blood pressure (hypertension). It also may be used in combination with other tests to diagnose some diseases. Examples of this include kidney stones, inflammation of the kidneys (glomerulonephritis), or muscle break breakdown (rhabdomyolysis). Additional tests and clinical assessment are often required to further investigate findings of urinalysis and ultimately diagnose the causes or specific features of underlying problems. For example, urine infection is generally diagnosed based on results of urinalysis. However, urine culture is often ordered as a follow-up test to identify the bacteria that may be causing the infection.

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