Manual

dipstick
urinalysis

Lynne Powell RN MSc IP PgCEd

INTRODUCTION

URINALYSIS is a simple non-invasive

diagnostic test which can provide a
glimpse into a person’s health
Objectives
 Give an overview of the anatomy and
physiology of the urinary system
 Explain how urine is produced and its
components
 Describe the types of urine samples and
tests
 Describe the requirements and
procedure for dipstick urinalysis using
the manual method
The urinary
system
Organs of the urinary
system

 Kidneys
 Ureters
 Urinary bladder
 Urethra
The function of the urinary
system

 The kidneys regulate: acid-base balance;

electrolyte concentration; extracellular fluid
volume (homeostasis).
 The kidneys remove waste & water from the
blood stream and reabsorb vital nutrients.
 The kidneys regulate the blood pressure.
 The urinary bladder stores urine.
KIDNEY nephron
Formation of urine

HCO 3 – bicarbonate
NaCl – sodium chloride
K – potassium
H2O – water
H – hydrogen
NH3 - amonia
Components of urine
Components of urine
Collection requirements

 Containers – white/red/green topped

Discuss.
 Mid stream
 Early morning
 Sample storage < 2hrs or kept at 4c out
of direct sunlight - DISCUSS
 Types of sample
 Random – most common for infection.
 Early morning urine (EMU) – has greater
concentration of substances (micro-albumInuria).
 Clean catch midstream (MSU) – genitalia
should be cleaned, urine is tested for micro-
organisms for presence of infection (culture &
sensitivity).
 Timed – specific time of day, always discard the
1st specimen before testing.
 24 hour – used for quantitative and qualitative
analysis of substances.
Types of testing

 Physical
 Chemical
 Microscopic
Physical examination of urine

Done with the naked eye, a very

important part of the test. Findings
should be documented.

Colour (affected by drugs, food, general

condition).
Turbidity (clear; cloudy, particles).
Volume.
Odour (affected by infection, diet)
Chemical testing of urine
 Usually done with reagent strips.

 Used to determine body processes such as

carbohydrate metabolism, liver or kidney
function.

 Used to determine infection.

 Can be used to determine presence of drug

or toxic environmental substances.
 Some chemicals that can be found in
urine (not normal components)
 Ketones .
 pH – acid/alkaline balance.
 Blood
 Bilirubin (urobilinogen)
 Glucose
 Protein
 Nitrates
 Leukocytes
 drugs
 Phenylketones – indicates PKU – a rare genetic disorder of one of the
liver enzymes. If left, can cause a build up of the chemical in the blood and
brain which can cause mental development issues and epilepsy – screened
for in babies 1st week of life with heel prick test.
Microscopic examination of
urine
 Used to examine the elements not
visible without a microscope.
 Centrifuge spins the urine to
separate substances.

• Cells • Bacteria
• Crystal • Yeasts
• Casts • Parasites
Other tests

 Pregnancy tests – EIA (enzyme

immunoassay test) used to detect
human chorionic gonadotrophin (hCG),
secreted by the placenta.

 STIs - chlamydia
The manual
dipstick test
 Do’s and don’ts

DO
 Follow manufacturers instruction.
 Ensure the sample is in the correct container for
the test required (red/white top).
 Ensure correct reagent strips are selected for the
required test. Discuss.
 Always check and record the appearance of the
urine sample.
 Return the top on the reagent strip bottle.
 TIMING IS ESSENTIAL for reliable results.
 Do’s and don’ts

DON’T
 Remove the desiccant from the reagant strip
bottle.
 Touch the test areas of the strip.
 Take out more strips than are required for
immediate use.
Quality control
Sample requirements
 Patients should instructed on how to collect
the sample.
 Sterile containers should be used to collect
the sample
 All samples must be properly labelled with
the patient ID.
 Ensure the sample is in the correct
container for the test required.
 The first sample on waking should be used
for microalbumInuria as other samples may
be less concentrated.
 Patient instruction
‘How should I collect and store a urine sample?” NHS choices (11/10/2013)

To collect a clean urine sample:

label the container with your name, date of birth and the
date
wash your hands
men should wash their penis 
women should wash their genitals, including between the
labia (lips around the entrance to the vagina)
start to urinate but don’t collect the first part of urine that
comes out
collect a sample of urine ‘mid-stream’ (see below) in a
sterile screw-top container
screw the lid of the container shut
wash your hands thoroughly

http://www.nhs.uk/chq/pages/how-should-i-collect-and-store-a-urine-sample.aspx?CategoryID=69&SubCategor
yID=692
Materials/equipment required
for dipstick testing
 Reagent/test strips – in-date and stored
correctly
 Watch
 Urine sample in suitable container
 Gloves
 Good lighting
 Access to hand washing and drying
 Suitable room (sluice) for testing
 Suitable waste disposal - discuss
Manual Test procedure

① Wear gloves.
② Ensure the sample is in the correct
container.
③ Check the appearance of the sample
and record results.
④ Ensure the strips have been stored
properly & are in-date.
⑤ Remove the cap, take out strip and
replace the cap on the bottle.
Manual Test procedure
⑥ Using the appropriate reagent strip
completely immerse all reagent areas
into the sample. Dip briefly and
remove immediately to avoid
dissolving out the reagents.
⑦ While removing the strip, run the edge
against the rim of the urine container
to remove excess urine.
⑧ Hold the strip in a horizontal position to
prevent possible mixing of chemicals
from the adjacent areas.
Manual Test procedure

⑨ After the appropriate time, compare

test areas closely with the
corresponding colour chart on the
bottle label at the specified time. Hold
the strip close to the colour blocks and
match carefully.
⑩ Always record results.
 Sources of error
 Incorrect dipping of reagent strip.
 Incomplete wetting of strip.
 Incorrect storage of strips – always check
manufacturers instructions.
 Sample error – sample must be allowed to return to
room temperature, non sterile containers; sample
needs to be fresh for best results.
 Contamination of the reagant pad by handling or
non sterile container.
 pH may be falsely elevated if the urine is stale.
 Some medication can affect some of the reagents on
the strips (e.g. cephalosporins; L-dopa; high levels of
salicylates; chlorhexadine; ferrous sulphate)
 Strips out of date.
 Vegetarians may have a urine pH >8.
 Visual significance of
urinalysis
 Colour: The colour and clarity of the urine has
significant implications and should always be noted.
The colour of normal urine varies with its
concentration, from deep yellow to almost clear. In
disease, the colour may be abnormal due to excretion
of the endogenous pigments as well as drugs and their
metabolites.

 Odour: Odour in the urine of patients who have a

urinary tract infection, is often due to the urea-splitting
organisms. This makes it smell ammonia. The presence
of urinary ketones, as in diabetic ketoacidosis, leads to
an acetone smell. The presence of malodorous urine
does not indicate the presence of infection and does
not negate the need for testing.
 Clinical significance of test
results
 Glucose - is found when its concentration in
plasma exceed the renal threshold (may
indicate diabetes)
 Bilirubin/urobilinogen – indicates an excess in
the plasma. Commonest cause of positive
results is liver cell injury e.g. hepatitis,
paracetamol overdose, late-stage cirrhosis.
 Ketones – due to excessive breakdown of
body fat. Common in fasting, may indicate
low carbohydrate diet, vomiting & fever,
present in starvation
 Clinical significance of test
results (cont.)
 Specific gravity – a measure of solute concentration.
High values can be found in dehydration. Low
values found in high fluid intake. Diabetes insipidus;
chronic renal failure; hypercalcaemia; hypokalaemia.
 Blood – menstruation, kidney disorders; urinary tract
disorders (e.g. tumours, prostatic enlargement).
 pH – high values - commonest cause of high vales is
stale urine; large intake of antacids;UTI with
ammonia forming organisms. Low values – acidosis
(diabetic & lactic); starvation; potassium depletion.
 Clinical significance of test
results (cont.)
 Protein – excess albumen in the urine is unusually due
increased permeability in the glomeruli. Positive
results in acute and chronic kidney disease, pre-
eclampsia.
 Nitrite – UTI – most of the organisms which infect the
urinary tract contains an enzyme that convers nitrate
(normally found in urine) to nitrite which is not found
in urine in the absence of infection. Some organisms
do not convert nitrate to nitrite (false negative).
 Leucocytes – leucocytes enter inflamed tissue from
the blood and are shed into the urine. UTI is
commonest cause of positive results.
UTI testing pathway
Any questions?