Normal protein level

5 - 15 mg/dl

Trace protein level

15 mg/dl

Should perform microalbuminuria

1+ protein level

30 mg/dl

Indication for 24 hour urine collection with protein in urine

Perform with 1+ (30 mg/dl) or greater protein

Protein for 2+ level

100 mg/dl

Protein for 3+ level

300 mg/dl

Protein for 4+ level

1000 mg/dl

Amount of time to wait before reading protein levels

60 seconds

Amount of time to wait before reading glucose levels

30 seconds

Cause of an ↑ in glucose

Implies the plasma glucose level is elevated or that renal tubules have impaired capacity to reabsorb glucose

Amount for trace level of glucose

100 mg/dl

Amount for 1+ level of glucose

200 mg/dl

Amount for 2+ level of glucose

500 mg/dl

Amount for 3+ level of glucose

1000 mg/dl

Amount for 4+ level of glucose

2000 mg/dl

Amount of time to wait before reading ketone level

40 seconds

Definition of ketone level

• Detects acetoacetic acid (ketoacid) in the urine which is produced in excess whenever there is lipolysis with liberation of fatty acid substrates (DKA, starvation ketosis, intoxicants)

Normal elevations of ketones can occur with

Fasting

Pregnancy

Frequent strenuous exercise

Trace level of ketones

5 mg/dl

Small/"+" level of ketones

10 mg/dl

Moderate/"++" level of ketones

50 mg/dl

Large/"+++" level of ketones

100 mg/dl

Amount of time to wait to read bilirubin

30 seconds

Small/"+" level of bilirubin

0.5 mg/dl

Moderate/"++" level of bilirubin

1.0 mg/dl

Large/"+++" level of bilirubin

3.0 mg/dl

Trace level of blood

< 10

Small/"+" level of blood

10

Moderate/"++" level of blood

50

Large/"+++" level of blood

250

Amount of time to wait to read pH

30 seconds

Overall and normal range of pH

Indicators of pH

Overall: 4.5 - 9

Normal: 5 - 7.5

Indicators: 5.0, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5

Amount of time to wait to read specific gravity

Normal range of specific gravity

45 seconds

Normal: 1.003 - 1.030

What specific gravity is

• Measure of urine density
• Measures the content of urine solute relative to the volume of solvent
• Glucose, protein, radiographic dyes elevate specific gravity

Indicators of specific gravity

1000, 1005, 1010, 1015, 1020, 1025, 1030

Amount of time to wait to read Nitrite

What Nitrite measures

Indicators

Wait 60 seconds to read

Measures conversion of Nitrate to Nitrite by bacteria

Indicators: Negative, Slightly positive, Highly positive

Amount of time to wait to read urobilinogen

Normal range

Wait 60 seconds to read

Normal 0.1 - 1.0

+ level of urobilinogen

1 mg/dl

++ level of urobilinogen

4 mg/dl

+++ level of urobilinogen

8 mg/dl

++++ level of urobilinogen

12 mg/dl

Amount of time to wait to read leukocyte esterase

Levels

120 seconds

Small +

Moderate ++

Large +++

Normal urine microscopy:

RBCs

WBCs

Epithelial cells

Hyaline casts

Crystals

Bacteria

Fungi

< 5 RBCs females, < 3 RBCs males

< 10 WBCs

Few epithelial cells

Occasional hyaline casts

Occasional crystals

No bacteria

No fungi

Order to read urinalysis tests

1. Glucose
2. Bilirubin, ketones, specific gravity, blood, pH
3. Protein, urobilinogen, nitrites, leukocyte esterase

Must be evaluated within 30 minutes

or

Must be refrigerated up to 8 - 12 hours

Indication to do urine culture

Nitrite positive, leukocyte esterase positive on UA

↑ WBC count & bacteria on microscopy

Color, Consistency, & Odor Ranges

for Urine Examination/Appearance

Color:  Straw colored to dark yellow

Consistency:  Clear to hazy

Odor:  Non to odorous

Characteristics of Casts

• Formed by precipitation of proteins & agglutination of cells within the renal tubules
• Not generally found in urine specimens
• One hyaline cast & occasional granular cast may be normal

Hyaline casts

Consists largely of mucoprotein from renal epithelium

Do not have formed elements

Granular Casts

Considered a phase of breakdown of cellular casts

Observed in chronic renal failure

Types of Cellular Casts

RBC

WBC

Fatty

Epithelial

Waxy

RBC casts

• Indicates primary glomerular disease or parenchymal lesion
• Glomerulonephritis or SLE

WBC casts

Observed with inflammatory renal parenchymal disease

Bacterial pyelonephritis

Fatty casts

Contain numerous fatty droplets

Nephrotic syndrome, diabetic nephropathy

Epithelial casts

Presence of a large number of epithelial casts

Renal parenchymal disease with tubular damage

Waxy casts

Yellow, brittle, irregularly shaped, corkscrew appearance

Chronic renal disease

Triple phosphate crystals

Struvite, magnesium

Colorless, prism-like "coffin lids"

Neutral & alkaline urine

Observed in UTIs with Proteus

Uric Acid Crystals

Yellow to brown rhombic or hexagonal plates, needles, or rosettes

Little clinical value

Ammonium Urate crystals

Yellow-brown, radially-striated spheres with irregular "thorn-apple" projections

Neutral & alkaline urine

Cystine crystals

Flat, colorless, hexagonal plates

Seen in layers

Acidic urine

Associated with calculi

Defective renal tubular reabsorption

Leucine crystals

Yellow spheres with concentric and radial strias

Often mistaken for cells, center resembles a nucleus

Tyrosine crystals

Fine, brownish needles

Isolated or groups

Severe liver disease

Cholesterol crystals

Rectangular plates, corners have squared notches

Rarely observed

Accompanied by proteinuria

See with degenerative renal disease

Sulfadiazine crystals

"Shocks of wheat" or radially striated-spheres

Observed with Bactrim use

Sulfonamide crystals

Yellow, resemble uric acid crystals

Trichomonas vaginalis

STD

Parasite

Resemble ovoid epithelial cells, anterior flagella

1-2x diameter of WBC

Rapid erratic "jerky" movements

Artifacts

Cotton fibers

Hair

Starch granules

Wood fibers

Wool fibers