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Urine Test

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Urine-test Urine test is useful in providing information to assist in the monitoring, diagnosing and treatment of various diseases. This test helps in determining various components of urine which is produced by the kidneys as the waste product. Kidneys filter the blood to remove the unwanted substances (like minerals, fluids, waste material, etc.) and pour them in the urine, to be excreted. Thus the urine contains hundreds of different wastes from body. A clear picture of how well your kidneys are working, what you are eating and drinking, and how much exercise you are performing, which can affect your urine, can be obtained by undergoing urinalysis (UA). It is the portmanteau of two words: urine and analysis. UA is the most common method of the medical diagnosis for urine. It includes more than 100 different tests done on urine.

The target parameters in UA include color, specific gravity, clarity, odor, pH, proteins, enzymes, nitrites, glucose, ketones, leukocyte esterase (WBC esterase), bilirubin, free cortisol, and many more; some of these parameters are discussed below.

1. Color: an important parameter affected by various things like diet, exercising, drugs and diseases. The dark or light color of the urine indicates the level of the water in it. Yellow-amber color is the normal urine color. Medicines like vitamin B2 supplements can turn the urine color to bright yellow; foods like blackberries, rhubarb, or beets can turn urine red-brown; intake of phenols may turn urine to dark brown; jaundice or problems with bile metabolism turns urine to green; excessive intake of liquids turn urine colorless; and any other colors might be due to what you have consumed the last night.

2. Appearance: normally, the urine is clear. Cloudy urine means presence of crystals, blood, sperm, bacteria or blood.

3. Odor/smell: the urine scent can vary from odorless to a much stronger odor. But in general, the urine smell is not strong and has a nutty odor. A bad odor means an infection in urine due to E. coli; sweet and fruity odor means diabetes; and peculiarly strong odor is due to dehydration and concentrated fluids.

4. pH: it is a measure of how much the urine is acidic or alkaline. A value of 4 means strongly acidic, 7 means neutral, and 9 means strongly alkaline. Certain treatments or medications might change the pH of the urine, which can also be a cause of formation of kidney stones.

5. Specific gravity: the ion concentration of urine can be determined by specific gravity test. Protein amount in the urine can alter the specific gravity of the urine. 1.010 value means that the person is hydrated, while 1.020 value means dehydration.

6. Ions and trace metals

  • a. Nitrites: nitrites in the urine mean that there is a urinary tract infection (UTI) and called nitriuria meaning the presence of coliform bacteria. UTI is caused when bacteria converts the nitrates to nitrites.
  • b. Potassium: potassium if found in the urine may mean the presence of disease called hypokalemia – a condition when the level of potassium falls in the bloodstream.
  • c. Sodium: low levels of sodium in the urine mean you have hyponatremia or some kidney problem, while high levels mean you have hypernatremia.
  • d. Phosphate: if phosphate is found in the urine, it means you have phosphaturia; it is of two types: primary (hypophosphaturia) and secondary (hyperparathyroidism) types.
  • e. Urinary calcium: if calcium is present in the urine in high amounts, it means the person is having hypercalciuria, while low amounts indicate the presence of hypocalciuria.

7. Blood cells: blood cells are not found in the urine. Injury to urethra, kidneys, ureters and bladder, any disease, or inflammation can lead to bloody urine. Vigorous exercising can also lead the blood to come in the urine.

  • a. Red blood cells (RBCs) or erythrocytes: the presence of RBCs in the urine is an indication of bleeding. Hematuria is caused due to urinary tract specific problems, like malignancy, trauma, infection, stone, etc., or a generalized bleeding diathesis. They can cause mechanical damage during the glomerular passage if RBCs are of glomerular or renal origin. Painless hematuria is a sign of urinary tract malignancy – requires a detailed and thorough cytological investigation.
  • b. White blood cells (WBCs) or leukocytes or pus cells: generally WBCs/leukocytes remain absent from the urine. But if found, this means the presence of UTI.
  • c. Casts: casts are plugs made of RBCs, WBCs, protein or waxy substances which get flushed into the urine; this happens in case of kidney disease where casts stuck in the tiny tubes of the kidney and move to the urine. The cast type in the urine can be used to examine the likely kidney disease.
  • d. Hemoglobin: hemoglobinuria is a condition where the blood is found in the urine but no RBCs are present.
  • e. Squamous cells: the presence of squamous cells in the urine means that it is impure and not necessarily means a medical problem, but your doctor might ask to give another sample of the urine.

8. Proteins and enzymes: generally, no proteins and enzymes are found in the urine. The proteins presence in the urine is confirmed when problems like kidney disease, pregnancy, and fever are determined; also in case of vigorous exercises, the proteins are found in the urine. Human chorionic gonadotropin (hCG) is a hormone found in the urine of pregnant women and in the urine of males having testicular cancer

9. Other molecules

  • a. Ketones: these are produced when the body breaks fat for energy. When they pass into the urine, a serious condition called diabetic ketoacidosis is caused. Ketones or ketone bodies are also formed in cases of consuming low sugars and starch diet, vomiting, and starvation.
  • b. Glucose: the blood contains sugar in it called glucose. Normally, it remains absent from the urine. But if found, it means there is a problem. Very high level of glucose in the urine mans uncontrolled diabetes. In case of damaged kidneys or any kidney diseases, the glucose spills over into the urine.
  • c. Urobilinogen: it is by-product of the bilirubin which is passed out from the body through stool. If it is present in the urine, it is indicates liver disease or the blockage of the gall bladder for the bile to flow normally.
  • d. Bilirubin: it remains absent from the urine. But its conjugated form is water-soluble and if cannot pass into the bile, it passes out from the body through the urine. If the urine contains a measurable bilirubin amount, it is an indication of blockage in the bile ducts, hepatitis, or some form of liver damage.
  • e. Cortisol: Addison’s disease is caused when the cortisol value fall below the threshold value and it rises above the threshold value, it shows the presence of another disease called Cushing’s syndrome.
  • f. Creatinine: a high level of creatinine in the urine is indication of a kidney disease or other kidney-related problem.
  • g. Phenylalanine: phenylalanine present in the urine causes phenylketonuria, which causes when the value rises above the upper limit, i.e. >30.0 mg/L
  • h. Catecholamines: these are the neurotransmitters, including norepinephrine, dopamine and epinephrine, produced in the adrenal glands; if they are present in the urine, they indicate the presence of catecholamine-secreting tumor.

10. Drugs: urine is tested o find the individual’s drug usage overtime.

11. Yeast cells or parasites: if they are found in the urine, this shows the presence of an infection.

For this test, 30--50 ml of urine sample is enough -- the morning’s first urine is preferred for UA. There is no special preparation like fasting is required for the test. But in some cases doctors may advise to fast if required.
The sample can be collected by following ways, prescribed by the doctor.

1. Clean-catch midstream one-time urine collection: in this method, the patient is advised to wash hands before collecting the sample; the lab technician provides a container to collect the sample; the patient needs to void the starting urine and collect the midstream urine without letting the container coming in contact with the genitals and voiding out the remaining urine; carefully close the container with the lid; and return it to the lab. Important to notice here is to not stop the flow of the urine while collecting the sample.

2. Double-voided urine sample collection: this method utilizes the technique that involves voiding the first urine of the day and then drinking water; after 30--40 minutes, collect the urine in the container and return the sample to the lab.

3. 24-hour urine collection: this process includes collection of the urine throughout the day in a big container of approx. 4 L capacity having a little amount of preservative. Start collecting your urine from the morning when you first urinate and repeat the process till the end of the 24-hour period. Keep the large container in the refrigerator and keep adding the urine by noting the time of the first and last urination. Now submit the sample to the lab.

There is no problem or discomfort in collection of a urine sample. There are also no risks related to collection of the urine. UA can be evaluated by mainly two means: physical appearance and microscopic analysis. UA test can also be performed by various means: routine UA or routine and microscopy (R/M) UA, urine test strips, and microscopic examination. Other methods include urine culture, urine electrolyte levels, X-rays of the kidneys, ictotest and intravenous pyelogram (IVP) – these tests are conducted when abnormal UA results are observed. Sometimes dip sticks are used to test the urine.

1. Urine dipsticks: this is a chemical analysis method of determining urine. This method exploits the technique of using a strip of plastic which has several squares made on it; each square measures different parameters of the urine. The urine is collected in a container and the entire strip is dipped into it. After few seconds to a few minutes, the color change occurs and every color change has a specific meaning and leads to important clinical decisions. If read too late or too early, the interpretation may be wrong and not accurate. The squares present on the strip measures various parameters of the urine: specific gravity, ketones, bilirubin, pH (acidity of the urine), leukocyte esterase, nitrite, urobilinogen, glucose, and protein.

2. Microscopic examination: this method uses microscope for examining the urine sample. It uses light microscope for this purpose. The urine sample is centrifuged, the top liquid part is discarded, the remaining solid portion is taken and mixed with the last drop of urine; and only one drop is taken and examined under the microscope while the sediment is examined under a low-power microscope. Low-power microscope helps in identifying the presence of any crystals, casts, squamous cells, etc. If high-power microscope is used, bacterial cells, clumps of cells, or other infectious cells present can be examined.

3. Macroscopic examination: this method involves examining the urine visually by noting its various characteristics like color, appearance, quantity, etc. Normal urine color is light yellow and clear. However, if cloudiness is observed with changes in the color and clarity, this suggests possibility of dehydration (dark color urine), liver disease (tea colored urine), infection (cloudy urine), muscle breakdown (orange or tea colored urine), etc. Apart from problems, medications can also be one of the reasons of change in the urine color.

4. Drug screening: the test is done to measure the amount of the drugs and their byproducts in the urine. In addition, this test is done for many purposes: school and employment screening, athletic screening, emergency room settings, and drug detoxification programs. This test helps in detecting cocaine, marijuana, amphetamines, metamphetamines, barbiturates, opiates, phenylcyclidine, and benzodiazepines.

5. Other common methods: other methods apart from UA include tests like pregnancy test, drug test, and specific chemicals test, which are not included in the routine UA.

6. Home test kit: this test is generally used by women to check if they are or not pregnant.

7. Other tests

  • a. Urine culture test: this test determines the bacterial cause.
  • b. Urine cytology test: this test determines the tumor presence and location – bladder or urinary tract.
  • c. Urine calcium test: this test helps in determining the elevated calcium levels in the urine.
  • d. Urine protein and albumin test: this test helps in determining the kidney’s protein loss and assessment of the kidney disease.
  • e. Urine creatinine test: this test helps in determining the kidney disease.
  • f. Ictotest: this test helps in determining the destruction of old RBCs in the urine.

This test is done on encounter of the following symptoms: colored urine, bad odor, flank pain, painful urination, red urine (blood in the urea, hematuria), fever, etc. All these symptoms mean a urine infection for which urinary tract is examined by undergoing the urine tests. To check the treatment conditions like diabetes, high blood pressure, kidney stones, etc., monitoring the disease progression and response to therapy, urine tests are done. The results of UA can have many interpretations. The more the atypical substances detected in the urine, the more likely it is to have a problem. During menstrual period and consuming medicines like tetracycline, the urine test is not performed. To lower the contamination chances, the doctor may use a urinary catheter to collect the sample. In case of serious illness where person is unable to provide the urine, doctors use catheter to collect their sample. In addition, a normal UA does not indicate that their there is no problem. Cases where person do not release significant amounts of substance or chemicals in the urine, the test result is normal but the problem exists. In early disease span, some people might not be urinating with the elevated atypical substances but during the day, which thus gets missed by the doctor.

The UA is a process of revealing a person’s health overview. A doctor correlates the person’s reports and the symptoms to conclude the result and findings, and look for the causes of abnormality in the results with other specific tests – comprehensive metabolic panel (CMP), urine culture, complete blood count (CBC), etc. and look for UTI

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