History of Urinalysis
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1
Who were among the ancient figures who inferred diagnoses from urine evaluation?
Hippocrates, Aristotle, and the ancient Egyptians
2
During what period did uroscopy reach diagnostic dominance?
Middle Ages
3
What publication contributed to the rise of uroscopy in 1491?
Johannes de Ketham's Fasciculus Medicinae
4
What was the significance of Fasciculus Medicinae?
It was the first illustrated medical book printed
5
What illustration in Fasciculus Medicinae demonstrated urine evaluation?
The urine wheel
6
What was the purpose of the urine wheel?
To match urine color and consistency with possible diagnoses
7
What was disease believed to result from according to the ancient theory of humours?
An imbalance of humours
8
Enumerate the four temperaments or humours.
Sanguineous (blood), choleric (yellow bile), phlegmatic (phlegm), melancholic (black bile)
9
What historical method did Babylonians and Egyptians use to detect diabetes?
Taste testing of urine
10
What did Hindu physicians observe about honey urine?
It attracted ants
11
What was Hippocrates' contribution to urinalysis?
Uroscopy and the first documented importance of sputum examination
12
Who demonstrated albuminuria by boiling urine?
Frederik Dekkers
13
Who wrote a book about "pisse prophets" or charlatans?
Thomas Bryant
14
Who contributed to the examination of urine sediment?
Thomas Addis
15
Who introduced urinalysis as part of routine patient examination?
Richard Bright
16
Who discovered urochrome?
Ludwig Thudichum
17
Who is associated with the discovery of cerebrospinal fluid?
Domenico Cotugno
18
Who is associated with phenylketonuria (PKU)?
Ivan Følling
19
Who is associated with alkaptonuria?
Archibald Garrod
20
Who is associated with cystine calculi?
William Wollaston
21
Who developed Benedict's reagent?
Stanley Benedict
22
What percentage of urine is water?
95–97%
23
What percentage of urine consists of solids?
3–5%
24
How many grams of total solids are normally present in 24-hour urine according to the notes?
Approximately 60 grams
25
How much of the total solids is organic?
Approximately 35 grams
26
What is the major organic solid in urine?
Urea
27
What is the second major organic solid in urine?
Creatinine
28
Enumerate the organic solids found in urine.
Urea, creatinine, hippurate, uric acid, carbohydrates, pigments, fatty acids, mucins, enzymes, and hormones
29
How much of the total solids is inorganic?
Approximately 25 grams
30
What is the major inorganic component of urine?
Chloride
31
Arrange the major inorganic components of urine from highest to lowest.
Chloride > Sodium > Potassium
32
What is the principal salt in urine?
Sodium chloride (NaCl)
33
Enumerate the other inorganic substances found in urine.
Sulfate, phosphate, ammonium, magnesium, and calcium
34
What is a random, occasional, or single urine specimen used for?
Routine and qualitative urinalysis
35
When is a random urine specimen ideal for cytology studies according to the notes?
Only after prior hydration and 5 minutes of exercise before collection
36
What is the ideal urine specimen for routine urinalysis and pregnancy testing?
First-morning urine
37
Why is first-morning urine preferred for routine urinalysis?
It is the most concentrated and most acidic specimen, allowing better preservation of cells and casts
38
Why is first-morning urine preferred for pregnancy testing?
It is concentrated and therefore suitable for hCG testing
39
Which specimen is often preferred for cytology or cytodiagnostic urine testing?
First-morning urine
40
What condition can be evaluated using first-morning urine?
Orthostatic proteinuria
41
How should a patient collect a first-morning urine specimen?
Void before going to bed, then collect the urine immediately upon waking
42
What is a second-morning or fasting urine specimen?
The second voided urine after a period of fasting
43
What is the main use of a second-morning or fasting urine specimen?
Glucose determination
44
What is a 2-hour postprandial urine specimen used for?
Diabetic screening or monitoring
45
Which specimen is preferred for glucose testing after a meal?
2-hour postprandial urine
46
What is a glucose tolerance test urine specimen?
An optional urine specimen collected alongside blood samples during a glucose tolerance test
47
What is a fractional urine specimen?
A collection involving at least two voided urine samples
48
What is collected during fractional specimen testing?
A series of blood and urine samples at specific time intervals
49
What is the purpose of fractional specimen collection?
To compare the concentration of a substance in urine with its concentration in blood
50
What condition can be diagnosed using fractional specimens?
Diabetes
51
What is a midstream clean-catch specimen used for?
Routine screening and bacterial culture
52
What should the patient clean before collecting a midstream clean-catch specimen?
The glans penis or urethral meatus
53
What are the two types of catheterized urine specimens?
Urethral and ureteral
54
What is a catheterized urine specimen used for?
Bacterial culture
55
What is suprapubic aspiration?
Puncturing the abdominal wall and directly aspirating urine from the bladder
56
What is suprapubic aspiration used for?
Bladder urine collection for anaerobic bacterial culture and urine cytology
57
How is a pediatric urine specimen commonly collected using a collection bag?
Using a soft, clear plastic bag with adhesive
58
What are the sterile collection methods for pediatric urine specimens?
Catheterization or suprapubic aspiration
59
Is urine collected from diapers recommended for testing?
No
60
What is the three-glass technique used to diagnose?
Prostatic infection
61
What are the three specimens collected in the three-glass technique?
First portion of voided urine, middle portion of voided urine, and urine after prostatic massage
62
Which specimens are examined microscopically in the three-glass technique?
The first and third specimens
63
What is compared between the first and third specimens in the three-glass technique?
The number of WBCs and bacteria
64
What finding indicates prostatitis in the three-glass technique?
The number of WBCs and bacteria in the third specimen is 10 times greater than in the first specimen
65
What is the purpose of the second specimen in the three-glass technique?
It serves as a control for bladder and kidney infection
66
What happens if the second specimen is positive for WBCs and bacteria?
The results from the third specimen are considered invalid
67
What is the Stamey-Meares test used for?
Diagnosis of prostatitis
68
How many specimens are collected in the Stamey-Meares four-glass method?
Four
69
Enumerate the four specimens in the Stamey-Meares test.
Initial voided urine (VB1), midstream urine (VB2), expressed prostatic secretions (EPS), and post-prostatic massage urine (VB3)
70
What does VB1 test for in the Stamey-Meares test?
Urethral infection or inflammation
71
What does VB2 test for in the Stamey-Meares test?
Urinary bladder infection
72
What is done with expressed prostatic secretions (EPS)?
They are cultured and examined for WBCs
73
What does VB3 represent?
Post-prostatic massage urine specimen
74
How many WBCs per high-power field are considered abnormal in the Stamey-Meares test?
More than 10–20 WBCs/HPF
75
What are timed urine specimens primarily used for?
Quantitative testing
76
What is the collection period for a 24-hour urine specimen?
24 hours, such as 8 AM to 8 AM
77
What should the patient do at the starting time of a 24-hour urine collection?
Empty the bladder into the toilet and do not collect that initial urine
78
What should be done with all subsequent urine during a 24-hour collection?
Collect all urine in the designated container
79
What should the patient do at the end time of a 24-hour urine collection?
Empty the bladder into the collection container
80
Does a 24-hour urine specimen require a preservative?
Yes, depending on the test performed
81
What is a 12-hour urine specimen used for?
Addis count
82
What is a 4-hour urine specimen used for?
Nitrite determination
83
How long must urine remain in the bladder before collection for nitrite determination?
At least 4 hours
84
What is an afternoon urine specimen collected between 2–4 PM used for?
Urobilinogen determination
85
What is the chain of custody?
A process that documents proper sample identification from the time of collection until receipt of laboratory results
86
Urine containers should have what physical characteristics?
Wide base and an opening of at least 4 cm.\
87
Why should urine containers have a wide base?
To prevent spillage.\
88
What is the minimum adequate opening diameter of a urine container?
At least 4 cm.\
89
What is the required capacity of a 24-hour urine container?
Up to 3 liters.\
90
Why may 24-hour urine containers be colored?
To protect light-sensitive analytes.\
91
What happens if urine is added before the start of a 24-hour collection period?
False-increased results.\
92
What happens if the final urine specimen is not included in a 24-hour collection?
False-decreased results.\
93
When both routine urinalysis and urine culture are requested, which should be performed first?
Urine culture.\
94
When should urine specimens be delivered to the laboratory and tested after collection?
Within 2 hours (Strasinger and Harr); ideally within 30 minutes (Turgeon).\
95
When do physical, chemical, and microscopic changes in urine begin?
As soon as the urine is voided.
96
What causes increased urine pH in an unpreserved specimen?
Urea breakdown by urease into ammonia and loss of CO₂.\
97
What causes increased bacteria in an unpreserved urine specimen?
Bacterial multiplication.\
98
What causes increased odor in an unpreserved urine specimen?
Urea breakdown by urease into ammonia.\
99
Why does nitrite increase in an unpreserved urine specimen?
Bacterial multiplication.\
100
What causes urine color to darken or change after standing?
Oxidation or reduction of metabolites, with increased urobilin.\
101
What causes decreased urine clarity after standing?
Bacterial multiplication and precipitation of amorphous material.\
102
What causes decreased glucose in an unpreserved urine specimen?
Glycolysis.\
103
What causes decreased ketones in an unpreserved urine specimen?
Volatilization and bacterial metabolism.\
104
What causes decreased conjugated bilirubin in an unpreserved urine specimen?
Light exposure and photo-oxidation to biliverdin.\
105
What causes decreased urobilinogen in an unpreserved urine specimen?
Oxidation to urobilin.\
106
Why do RBCs, WBCs, and casts decrease in unpreserved urine?
They disintegrate in dilute alkaline urine.\
107
What happens to Trichomonas in an unpreserved urine specimen?
They become immobile or die and may be misidentified as WBCs.\
108
Which urine parameter is least affected by standing?
Protein
109
What is the ideal urine preservative?
An ideal urine preservative does not exist (Strasinger).
110
How should a urine preservative be selected?
Choose the preservative that best suits the required analysis.
111
What is the main advantage of refrigeration as a urine preservative?
Does not interfere with chemical tests.
112
What are the disadvantages of refrigeration as a urine preservative?
Raises specific gravity (SG) by hydrometer and precipitates amorphous phosphates and urates.
113
What is the preservative of choice for routine urinalysis and urine culture?
Refrigeration, for up to 24 hours.
114
How long does refrigeration prevent bacterial growth in urine?
Up to 24 hours.
115
What is the main advantage of using thymol?
Preserves glucose and sediments well
116
What is the disadvantage of using thymol?
Interferes with acid precipitation test for protein
117
Main advantage of boric acid?
Preserves protein & formed elements well, Does not interfere w routine analyses
118
Disadvantage of using boric acid
May precipitate crystals when used in large amounts
119
What urine pH does boric acid maintain?
Approximately 6.00.
120
What is the bacteriostatic concentration of boric acid?
18 g/L.
121
What is boric acid used for during specimen transport?
Culture and sensitivity (C&S).
122
What analyses may be affected by boric acid?
Drug and hormone analyses.
123
What are the advantages of formalin as a urine preservative?
Excellent sediment preservative.
124
What are the disadvantages of formalin?
Acts as a reducing agent and interferes with chemical tests for glucose, blood, leukocytes, and copper reduction.
125
What is the additional important information about formalin?
Rinse the specimen container with formalin to preserve cells and casts; preservative of choice for Addis count.
126
What are the advantages of toluene as a urine preservative?
Does not interfere with routine tests.
127
What are the disadvantages of toluene?
Floats on the urine surface and clings to pipettes and testing materials.
128
What is the additional important information about toluene?
Considered the best all-around urine preservative according to Turgeon.
129
What are the advantages of sodium fluoride as a urine preservative?
Prevents glycolysis; good preservative for drug analysis.
130
What are the disadvantages of sodium fluoride?
Inhibits reagent strip tests for glucose, blood, and leukocytes.
131
What is the additional important information about sodium fluoride?
Sodium benzoate may be used instead for reagent strip testing; used for drug-testing specimens.
132
What are the advantages of phenol as a urine preservative?
Does not interfere with routine tests.
133
What are the disadvantages of phenol?
Causes an odor change.
134
What is the additional important information about phenol?
Use 1 drop per ounce of urine specimen.
135
What are the advantages of commercial preservative tablets?
Convenient when refrigeration is not possible; have controlled concentrations to minimize interference.
136
What are the disadvantages of commercial preservative tablets?
May contain one or more preservatives, including sodium fluoride.
137
What is the additional important information about commercial preservative tablets?
Check the tablet composition to determine possible effects on the desired tests.
138
What do urine collection kits contain?
A collection cup, C&S preservative tube, or urinalysis (UA) tube.
139
What are the advantages of the gray C&S tube?
Stable at room temperature for 48 hours; preserves bacteria.
140
What are the disadvantages of the gray C&S tube?
Decreases urine pH; should not be used if the urine is below the minimum fill line.
141
What is the additional important information about the gray C&S tube?
Contains boric acid as a preservative and may not be used for routine urinalysis (UA)
142
What are the advantages of the yellow plain UA tube?
Can be used with automated instruments.
143
What is the additional important information about the yellow plain UA tube?
Has a round or conical bottom.
144
What are the advantages of the cherry red/yellow top tube?
Stable for 72 hours at room temperature; compatible with automated instruments.
145
What are the disadvantages of the cherry red/yellow top tube?
Must be refrigerated within 2 hours; bilirubin and urobilinogen may decrease if the specimen is exposed to light and left at room temperature.
146
What is the additional important information about the cherry red/yellow top tube?
Contains sodium propionate as a preservative; has a conical bottom.
147
What are the advantages of Saccomanno fixative?
Preserves cellular elements.
148
What is the composition of Saccomanno fixative?
50% ethanol and 2% carbowax.
149
What is the additional important information about Saccomanno fixative?
Used for cytology studies; requires 50 mL of urine.
150
What preservatives are used for 5-HIAA (serotonin) testing?
Boric acid and HCl.
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