CLINICAL MICROSCOPY INTERNSHIP

Level 1
ACTIVITY 3

PROGRAM OUTCOME/S ADDRESSED (CHED CMO #13-S-2017)

A. Demonstrate technical competence in the performance of clinical laboratory tests in aid
of diagnosis, treatment, and management of diseases vis-à-vis biosafety and waste
management.
 perform laboratory testing accurately through the use of appropriate techniques,
skills and technology
 analyze and interpret laboratory test data
B. Demonstrate analytical and critical thinking skills in the workplace
 evaluate the validity of the generated data and assure its reliability before reporting

PHYSICAL AND CHEMICAL PROPERTIES OF URINALYSIS

INTRODUCTION
In the laboratory, urine can be characterized by physical appearance, chemical composition, and
microscopically. Physical examination of urine includes description of color, odor, clarity, volume, and
specific gravity. Chemical examination of urine includes the identification of protein, blood cells, glucose,
pH, bilirubin, urobilinogen, ketone bodies, nitrites, and leukocyte esterase. Finally, microscopic
examination entails the detection of crystals, cells, casts, and microorganisms.
Source: https://pubmed.ncbi.nlm.nih.gov/20407938/

LEARNING OUTCOMES:
At the end of activity 3, the student intern must be able to:

Cognitive
1. List the three components of urinalysis.
2. Describe quality assurance for urinalysis.
3. List the physical properties of urine.
4. Describe the abnormal colors of urine and explain their clinical significance.
5. Identify the different causes of turbidity in urine.
6. Describe the relationship between urine odor and the patient’s physiological state.
7. Explain the general methodology of urinalysis strip tests.
8. Distinguish between screening and confirmation test in diagnosis and describe when it is
appropriate to use each type of test.
9. Describe laboratory safety related to urinalysis.
10. State the methodology for each analyte tested for in urinalysis.
11. Identify the pathological conditions that each urinalysis analyte can detect.
12. State the normal ranges for each of the analytes of urinalysis.
13. Define specific gravity and explain its relationships to urine concentration.
14. Describe two methods used to measure specific gravity of urine.
15. Identify the confirmation tests commonly used to follow urinalysis strip test for reducing sugars,
ketones, protein, bilirubin and specific gravity.

1
 16. Discuss the advantages of automated urinalysis.

Cognitive/Psychomotor Application
1. Perform quality control testing for urinalysis strips.
2. Perform a physical analysis of urine in order to determine the correct color and clarity of a urine
specimen.
3. Perform a chemical analysis of urine using urinalysis strips in order to correctly determine the
concentration of glucose, pH, specific gravity, bilirubin, urobilinogen, ketones, protein, blood,
leukocytes, and nitrite.
4. Determine the specific gravity of a urine specimen using refractometer.
5. Use an ICTOTEST to confirm the bilirubin concentration of a urine specimen.
6. Perform a CLINITEST analysis of a urine sample to assess the presence of reducing sugars.
7. Perform quality control testing for urinalysis strips.

LEARNING GUIDE:

Learning Steps Equivalent

Resources
Duty Hours
1. Read Information on “PHYSICAL AND CHEMICAL
PROPERTIES OF URINALYSIS” and prepare your 8 hours Printed
“Learner’s Notes” on the following learning outcomes. (Use Textbooks/Refe
provided template “Job Sheet”) rence Books’,
1. List the three components of urinalysis. Online Text
2. Describe quality assurance for urinalysis. References,
Online Videos,
3. List the physical properties of urine.
Online
4. Describe the abnormal colors of urine and explain audio/visual
their clinical significance. presentations,
5. Identify the different causes of turbidity in urine. Job Sheet
6. Describe the relationship between urine odor and Template, etc.
the patient’s physiological state.
7. Explain the general methodology of urinalysis strip tests.
8. Distinguish between screening and confirmation test in
diagnosis and describe when it is appropriate to use
each type of test.
9. Describe laboratory safety related to urinalysis.
10. State the methodology for each analyte tested for
in urinalysis.
11. Identify the pathological conditions that each
urinalysis analyte can detect.
12. State the normal ranges for each of the analytes
of urinalysis.
13. Define specific gravity and explain its relationships
to urine concentration.
14. Describe two methods used to measure specific gravity
of urine.

2
 15. Identify the confirmation tests commonly used to follow
urinalysis strip test for reducing sugars, ketones,
protein, bilirubin and specific gravity.
16. Discuss the advantages of automated urinalysis.
2. Suggested Follow-up/Alternate Self-Directed Learning LMS,
Activities: Instructor,
Trainer,
Attend online/face to face lecture session, or watch videos on Speaker,
“PHYSICAL AND CHEMICAL PROPERTIES OF Internet
URINALYSIS”
Accomplished
3. Submit Student Job Sheet - Learner’s Notes
Job Sheet
4. Perform/Answer on-the-job task/s.
Clinical site,
Note: If the task is a hands-on procedure that requires manual
Online video-on
dexterity, this shall be performed in the clinical site when face-to-
demand (you
face session is allowed, however if a face-to-face session is not
tube, etc.)
(yet) feasible, as alternative, watch related valid online videos for
procedure familiarization.
Summative
5. Take the summative examination for Activity-3 on the
Examination
scheduled dates.
Questionnaires
6. Take the oral examination on the assigned “On the Job” On the Job
task Task
Comprehensive
7. Take the comprehensive (shifting) examination
Examination
on Activity-3 on the assigned on the scheduled
Questionnaires
dates
Summative
8. Report and consult with your clinical instructor for
Examination
your examination results.
results

9. Proceed to Activity 4. Activity 4

3
 Activity 3
PHYSICAL AND CHEMICAL PROPERTIES OF URINALYSIS

STUDENT JOB SHEET: LEARNER’S NOTES

Name: /Date: May 13, 2024

INSTRUCTION: Search from PRINTED OR ONLINE, OR VIDEO RECORDED valid references

information that would help in the achievement of the following learning outcomes. Follow this
template (cut this page or copy paste) for your answers and submit it according to the instruction
of your instructor. Use additional page if needed. PLEASE INDICATE THE SOURCE/S OF YOUR
ANSWERS.

LEARNING OUTCOMES ANSWERS

List the three components of

urinalysis. A urinalysis is a test of your urine. It's used to detect and manage a wide
range of disorders, such as urinary tract infections, kidney disease and
diabetes. A urinalysis involves checking the appearance, concentration
and content of urine.

1. Physical – describes volume, color, clarity, odor and specific

gravity.

2. Chemical – examines pH level, RBC, WBC, protein, glucose,

urobilinogen, bilirubin, ketone bodies, leukocyte esterase, and
nitrites.

3. Microscopic – determines casts, cells, crystals, and micro-

organisms.

Source: https://www.ncbi.nlm.nih.gov/books/NBK557685/

https://www.mayoclinic.org/tests-procedures/urinalysis/about/pac-20384907

Describe quality assurance for

urinalysis. Properly collected fresh urine samples should be analyzed promptly,
preferably without refrigeration. Each step of the urinalysis procedure
should be carefully controlled and standards applied to assure optimal
results. Reports should include clinically useful pertinent data organized
in convenient, readable fashion.

Running daily Quality Control (QC) for POCT is critical. When measuring
any kind of patient sample for indicators of disease, stable controls
must be used to validate instrument performance and ensure accurate
patient diagnosis.

Source: https://pubmed.ncbi.nlm.nih.gov/3048853/
https://www.mlo-online.com/diagnostics/assays/article/13009286/urinalysis-
quality-control-at-the-pointofcare

4
List the physical properties of
urine. Physical characteristics that can be applied to urine include color,
turbidity (transparency), smell (odor), pH (acidity – alkalinity) and
density. Many of these characteristics are notable and identifiable by
vision alone, but some require laboratory testing.

1. Color – normally yellow to amber

2. Smell – mild smell compared to aged urine that smells like
ammonia
3. pH range – generally in 4.6 – 8
4. density – also known as specific gravity
5. turbidity – clear, slightly cloudy, opaque, or flocculent

Source: https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book
%3A_Anatomy_and_Physiology_(Boundless)/24%3A__Urinary_System/
24.4%3A_Urine/24.4A%3A_Physical_Characteristics_of_Urine

Describe the abnormal colors of

urine and explain their clinical Abnormal urine color may be caused by infection, disease, medicines,
significance. or food you eat.

 Cloudy or Milky Color – indicates bacteria, crystals, fat, white

blood cells, or mucus in the urine

 Pink, red, or light brown urine – indicates consumption of beets,

hemolytic anemia, injury to the kidneys or urinary tract, blood
from vaginal bleeding, or tumor in the kidneys

 Dark yellow or orange urine – caused by vitamin B complex,

recent laxative use, certain medications, and dehydration

 Green or blue urine – artificial coloring in food or drugs,

bilirubin, certain medications that consist of methylene blue,
urinary tract infection.

Source: https://medlineplus.gov/ency/article/003139.htm

Identify the different causes of

turbidity in urine. Turbidity in urine can be caused by many different medical conditions,
ranging from the relatively benign to severe. These conditions can
include dehydration, a urinary tract infection, sexually transmitted
infections, kidney stones, diabetes, and others.

Sometimes cloudy urine indicates an increase in protein, crystalline

substances, blood, pus, or other chemicals in your urine.

Source: https://www.everydayhealth.com/urine/what-causes-cloudy-urine-
women-men/
https://www.medicinenet.com/cloudy_urine/symptoms.htm

5
Describe the relationship
between urine odor and the Urine odor refers to the smell from your urine. Urine odor varies. Most of
patient’s physiological state. the time, urine does not have a strong smell if you are healthy and drink
plenty of fluids.

Foul-smelling urine may be due to bacteria. Sweet-smelling urine may

be a sign of uncontrolled diabetes or a rare disease of metabolism. Liver
disease and certain metabolic disorders may cause musty-smelling
urine.

Some foods and medications, such as asparagus or certain vitamins,

can cause a noticeable urine odor, even in low concentrations

Certain conditions that may cause changes in urine odor include:

1. Bladder fistula and infection
2. Poorly controlled diabetes
3. Liver failure
4. Ketonuria

Source: https://medlineplus.gov/ency/article/007298.htm
https://www.mayoclinic.org/symptoms/urine-odor/basics/causes/sym-20050704

Explain the general

methodology of urinalysis strip The Urinalysis Reagent Strips (Urine) are firm plastic strips onto which
tests. several separate reagent areas are affixed. The test is for the semi-
quantitative detection of one or more of the following analytes in urine:
Specific Gravity, pH, Leukocytes, Nitrite, Protein, Glucose, Ketone
Bodies, Urobilinogen, Bilirubin, and Blood.

The test method consists of immersing the test strip completely in a

well-mixed sample of urine for a short period of time, then extracting it
from the container and supporting the edge of the strip over the mouth
of the container to remove excess urine.

The strip is then left to stand for the time necessary for the reactions to
occur (usually 1 to 2 minutes), and finally the colors that appear are
compared against the chromatic scale provided by the manufacturer.

Source: https://www.youtube.com/watch?v=vt7cxyY45nQ
https://en.wikipedia.org/wiki/Urine_test_strip
http://www.linear.es/ficheros/archivos/7101505_Urine_Strip_10_p_150_Test.pdf

Distinguish between screening

and confirmation test in The main difference between Screening and Diagnostics is that the
diagnosis and describe when it basic goal of screening tests would be to discover early diseases or risk
is appropriate to use each type of diseases in large groups of otherwise healthy people. Whereas a
diagnostic study’s objective is to determine the existence (or absence)
of test.
of illness like that of the foundation for clinical judgment in symptomatic
6
 or screening positive persons.

Source: https://www.healthknowledge.org.uk/public-health-textbook/disease-
causation-diagnostic/2c-diagnosis-screening/screening-diagnostic-case-finding

https://my.clevelandclinic.org/-/scassets/files/org/patients-visitors/billing/
understanding-difference-between-screening-and-diagnostic-colonoscopy.ashx

https://www.questdiagnostics.com/our-company/actions-insights/2020/whats-
the-difference-between-screening-and-diagnostic-testing-in-pregnancy

Describe laboratory safety

related to urinalysis. These dangers can be reduced by eliminating hazards where possible,
establishing clean, safe work habits, taking proper precautions, and
maintaining awareness of safety practices.

Standard laboratory safety procedures in urinalysis

 Wear gloves to prevent contact with body fluid contamination
 Face protection must be worn if there are risks of splash
 All body fluid spillages must be decontaminated appropriately
 Wash hands after procedure regardless of whether gloves are
used
Source: https://www.gla.ac.uk/media/Media_678207_smxx.pdf

https://labpedia.net/safety-in-the-clinical-laboratory/

7
State the methodology for each
analyte tested for in urinalysis. Urinalysis can reveal diseases that have gone unnoticed because they
do not produce striking signs or symptoms. Examples include diabetes
mellitus, various forms of glomerulonephritis, and chronic urinary tract
infections.

 pH level - The glomerular filtrate of blood plasma is usually

acidified by renal tubules and collecting ducts from a pH of 7.4
to about 6 in the final urine. However, depending on the acid-
base status, urinary pH may range from as low as 4.5 to as high
as 8.0.

 Specific Gravity - Specific gravity of urine is determined by the

presence of solutes represented by particles of varying sizes,
from small ions to larger proteins. Urine osmolality measures
the total number of dissolved particles, regardless of their size.

 Protein - Dipstick screening for protein is done on whole urine,

but semi-quantitative tests for urine protein should be
performed on the supernatant of centrifuged urine since the
cells suspended in normal urine can produce a falsely high
estimation of protein.

 Glucose - Less than 0.1% of glucose normally filtered by the

glomerulus appears in urine (< 130 mg/24 hr). Glycosuria
(excess sugar in urine) generally means diabetes mellitus.
Dipsticks employing the glucose oxidase reaction for screening
are specific for glucose but can miss other reducing sugars
such as galactose and fructose.

 Ketones - Ketones (acetone, aceto-acetic acid, beta-

hydroxybutyric acid) resulting from either diabetic ketosis or
some other form of calorie deprivation (starvation), are easily
detected using either dipsticks or test tablets containing
sodium nitroprusside.

 Nitrites - A positive nitrite test indicates that bacteria may be

present in significant numbers in urine. Gram negative rods
such as E. coli are more likely to give a positive test.

 Leukocyte esterase - A positive leukocyte esterase test results

from the presence of white blood cells either as whole cells or
as lysed cells. Pyuria can be detected even if the urine sample
contains damaged or lysed WBC's.

Source: https://webpath.med.utah.edu/TUTORIAL/URINE/URINE.html

https://www.ncbi.nlm.nih.gov/books/NBK302/

8
Identify the pathological
conditions that each urinalysis Pathologic conditions that urinalysis analytes can detect,
analyte can detect.

Source: https://www.mayoclinic.org/tests-procedures/urinalysis/about/pac-
20384907
State the normal ranges
for each of the analytes of Urine analyte normal reference range
urinalysis.  Color – Yellow to Amber
 Clarity/Turbidity – Clear or Translucent
 pH level – 4.5 to 8
 Odor – Clear or “Urinoid”
 Nitrites – Negative
 Bilirubin – Negative
 Leukocyte esterase – Negative
 Ketone bodies – None
 Bacteria – None
 Yeast – None
 Crystals – Occasionally
 Specific Gravity – 1.005 to 1.025
 Glucose - <130mg/dL
 Protein - <150mg/dL
Source: https://emedicine.medscape.com/article/2074001-overview
https://www.ncbi.nlm.nih.gov/books/NBK557685/

9
Define specific gravity and
explain its relationships to Specific gravity measures the kidney's ability to concentrate or dilute
urine concentration. urine in relation to plasma. Because urine is a solution of minerals,
salts, and compounds dissolved in water, the specific gravity is greater
than 1.000. The more concentrated the urine, the higher the urine
specific gravity.

It is also used in diagnosing many health conditions, primarily central

diabetes insipidus and nephrogenic diabetes insipidus. Both health
conditions cause your body to signal excessive thirst, resulting in more
urination.

Source: https://www.webmd.com/a-to-z-guides/what-is-urine-specific-gravity
https://www.rnceus.com/ua/uasg.html

Describe two methods used to

measure specific gravity of Clinical Refractometer measures urine specific gravity, or gives the
urine. refractive index in seconds. Dimensions Place a drop or two of a sample
on the prism and read the results. Sper Scientific portable
refractometers work in ambient light with no battery or other power
source necessary.

Clinical Hydrometer measures some characteristics of a liquid, such as

its density or specific gravity. The device consists essentially of a
weighted, sealed, long-necked glass bulb that is immersed in the liquid
being measured; the depth of flotation gives an indication of liquid
density, and the neck can be calibrated to read density, specific gravity,
or some other related characteristic.

Source: https://www.britannica.com/technology/hydrometer
https://sperdirect.com/products/clinical-refractometer-urine-specific

10
Identify the confirmation tests
commonly used to follow Urine Glucose Confirmatory test - Health care professionals can use the
urinalysis strip test for reducing A1C test alone or in combination with other diabetes tests to diagnose
sugars, ketones, protein, type 2 diabetes and prediabetes.
bilirubin and specific gravity. Urine Ketone Confirmatory test - Urine ketones are usually measured as
a "spot test." This is available in a test kit that you can buy at a drug
store. The kit contains dipsticks coated with chemicals that react with
ketone bodies. A dipstick is dipped in the urine sample. A color change
indicates the presence of ketones.

Urine Protein Confirmatory test - Semiquantitative tests are used in

some laboratories to confirm the presence of protein in the specimen
when the result is positive on the urine dipstick. Tests that are used for
confirmation include: sulfosalicylic acid (SSA); heat and acetic acid;
nitric acid ring test; and Roberts' Ring Test.

Urine Bilirubin Confirmatory test - The Ictotest tablets, based on the

diazotization reaction, are utilized as a confirmatory assay for the
presence of urinary bilirubin when a frontline test has provided a
positive bilirubin result. The Ictotest reagent tablets can be used to rule-
out the presence of interfering substances that may cause a false
positive result.

Urine Specific Gravity Confirmatory test - Clinical Refractometer

measures urine specific gravity, or gives the refractive index in seconds.
Dimensions Place a drop or two of a sample on the prism and read the
results. Sper Scientific portable refractometers work in ambient light
with no battery or other power source necessary.

Source: https://www.mlo-online.com/home/article/13004800/confirmatory-
urinalysis-tests-the-experts-respond

https://www.siemens-healthineers.com/nl/urinalysis-products/urinalysis-
reagents/ictotest-reagent-tablets

https://www.ucsfhealth.org/medical-tests/ketones-urine-test

https://www.ucsfhealth.org/medical-tests/glucose-urine-test

https://www.labce.com/spg130919_confirmatory_testing_for_protein.aspx

Discuss the advantages

of automated urinalysis. Urinalysis is one of the most common routine investigations performed
in laboratory medicine which aims to determine various components in
the urine and aid in diagnosis and management of the patient. Urine
examination is done to detect the status of renal and genitourinary
system.

Automated urinalysis offers the benefits of convenience, efficiency, and

increased sensitivity for detecting renal and urinary tract abnormalities.
The true value may lie in the ability to efficiently screen and report out
urine samples that lack pathologic findings.

Source: https://www.mlo-online.com/home/article/13004799/automated-
urinalysis-in-the-clinical-lab

https://www.jscimedcentral.com/ClinicalCytology/clinicalcytology-4-1110.pdf

11
List the three components of
urinalysis. A urinalysis is a test of your urine. It's used to detect and manage a wide
range of disorders, such as urinary tract infections, kidney disease and
diabetes. A urinalysis involves checking the appearance, concentration
and content of urine.

1. Physical – describes volume, color, clarity, odor and specific

gravity.

2. Chemical – examines pH level, RBC, WBC, protein, glucose,

urobilinogen, bilirubin, ketone bodies, leukocyte esterase, and
nitrites.

3. Microscopic – determines casts, cells, crystals, and micro-

organisms.

Source: https://www.ncbi.nlm.nih.gov/books/NBK557685/

https://www.mayoclinic.org/tests-procedures/urinalysis/about/pac-20384907

Describe quality assurance for

urinalysis. Properly collected fresh urine samples should be analyzed promptly,
preferably without refrigeration. Each step of the urinalysis procedure
should be carefully controlled and standards applied to assure optimal
results. Reports should include clinically useful pertinent data organized
in convenient, readable fashion.

Running daily Quality Control (QC) for POCT is critical. When measuring
any kind of patient sample for indicators of disease, stable controls
must be used to validate instrument performance and ensure accurate
patient diagnosis.

Source: https://pubmed.ncbi.nlm.nih.gov/3048853/
https://www.mlo-online.com/diagnostics/assays/article/13009286/urinalysis-
quality-control-at-the-pointofcare

List the physical properties of

urine. Physical characteristics that can be applied to urine include color,
turbidity (transparency), smell (odor), pH (acidity – alkalinity) and
density. Many of these characteristics are notable and identifiable by
vision alone, but some require laboratory testing.

1. Color – normally yellow to amber

2. Smell – mild smell compared to aged urine that smells like
ammonia
3. pH range – generally in 4.6 – 8
4. density – also known as specific gravity
5. turbidity – clear, slightly cloudy, opaque, or flocculent

Source: https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book
%3A_Anatomy_and_Physiology_(Boundless)/24%3A__Urinary_System/
24.4%3A_Urine/24.4A%3A_Physical_Characteristics_of_Urine

Describe the abnormal colors of

urine and explain their clinical Abnormal urine color may be caused by infection, disease, medicines,
significance. or food you eat.

 Cloudy or Milky Color – indicates bacteria, crystals, fat, white

blood cells, or mucus in the urine

 Pink, red, or light brown urine – indicates consumption of beets,

12
 hemolytic anemia, injury to the kidneys or urinary tract, blood
from vaginal bleeding, or tumor in the kidneys

 Dark yellow or orange urine – caused by vitamin B complex,

recent laxative use, certain medications, and dehydration

 Green or blue urine – artificial coloring in food or drugs,

bilirubin, certain medications that consist of methylene blue,
urinary tract infection.

Source: https://medlineplus.gov/ency/article/003139.htm

13
 Activity 3
PHYSICAL AND CHEMICAL PROPERTIES OF URINALYSIS

ON THE JOB TASK SHEET: COGNITIVE APPLICATION

Name: /Date: May 13, 2024

INSTRUCTION: Search from PRINTED OR ONLINE, OR VIDEO RECORDED valid references

information that would help in the achievement of the following learning outcomes. Follow this
template (cut this page or copy paste) for your answers and submit it according to the instruction
of your instructor. Use additional page if needed. PLEASE INDICATE THE SOURCE/S OF YOUR
ANSWERS.

ON-THE-JOB TASKS ANSWERS

Assume that you are employed

in a clinical laboratory and that Assuming that I was employed to work in a clinical laboratory, the
important physical characteristics for the patient’s urine specimen are
one of your duties is performing the following:
urinalysis. The urine specimens
submitted for testing have a 1. Color – normally yellow to amber
2. Smell – mild smell compared to aged urine that smells like
variety of appearances. Some
ammonia
are clear, others are cloudy, and 3. pH range – generally in 4.6 – 8
there are variations in color. 4. density – also known as specific gravity
Some also have distinctive 5. turbidity – clear, slightly cloudy, opaque, or flocculent
odors. What is it important to
Source:
make note of these physical
characteristics of urine? https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book
%3A_Anatomy_and_Physiology_(Boundless)/24%3A__Urinary_System/
24.4%3A_Urine/24.4A%3A_Physical_Characteristics_of_Urine

A patient has just handed you a

urine specimen with an intense If your urine looks foamy, it could be because your bladder is full and
the urine is hitting the toilet fast enough to stir up the water. Foamy
orange-gold color. Yellow foam urine is a sign of protein in the urine, which is not normal. “Kidneys
floats on top. What might be filter the protein, but should keep it in the body,” explains Dr.
the cause of the abnormal Ghossein. If kidneys are releasing protein into the urine, they are not
working properly.
appearance of the urine?
Other symptoms can occur with foamy urine are the following:
 Swelling of hands, feet, face, and abdomen
 Fatigue
 Loss of appetite
 Nausea and vomiting
 Trouble sleeping

Source: https://www.healthline.com/health/foamy-urine#symptoms

https://www.nm.org/healthbeat/healthy-tips/foamy-urine-whats-normal-
whats-not

14
Among the urine specimens
this morning is one with a Strong, ammonia-like urine is a sign that you’re a little dehydrated.
Drinking more water can often help. Sometimes, ammonia is also a
pungent odor of ammonia. sign of Urinary Tract Infection wherein bacteria is present in your
What could this smell indicate? urinary system.

Source: https://www.webmd.com/urinary-incontinence-oab/what-to-
know-about-unusual-smell-of-urine

Assume that you perform the

urinalysis in the POL where The refractive index of urine correlates closely with the specific
gravity. It is a ratio of the velocity of light in air to the velocity of light in
you work. What quality control solution, and is directly proportional to the number of dissolved solids
will you employ to ensure that in urine. This ratio varies directly with the number of dissolved
your specific gravity readings particles in urine and, as such, varies similarly with the specific gravity
of urine.
are accurate?
Once a day, quality control should be tested on the refractometer.
1. On initial use, remove the controls from the refrigerator and allow
to reach room temperature prior to testing.
2. Remove cap and invert bottle. Apply urine control to refractometer
as you would a patient sample.
3. Read the refractometer according to the procedure above. Record
result on the Quality Control Log Sheet.
4. Wipe off dropper tips and recap control. The controls can be
stored at room temperature. Record room temperature expiration
date in the space provided on the bottle label.

Source: http://www.pointofcare.net/procedures/SPECIFIC%20GRAVITY
%20ON%20REFRACTOMETER%20PROCEDURE.htm

http://policyandorders.cw.bc.ca/resource-gallery/Documents/Lab
%20and%20Pathology%20Medicine/Urine%20Specific%20Gravity
%20Quality%20Control%20Test%20Procedure.pdf

15
An infant’s urine has been
A urinalysis is usually ordered when a doctor suspects that a child has a urinary
submitted to the laboratory with tract infection (UTI) or a health problem that can cause an abnormality in the
a request for a CLINITEST urine. This test can measure:
along with routine urinalysis.  Presence of RBC and WBC
Why would such a request be  Presence of Bacteria and other micro-organisms
made?  Presence of substances such as glucose, ketone bodies, etc.

Source: https://kidshealth.org/en/parents/labtest7.html

https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?
hwid=ug5452

In the lab where you work,

several patients have tested
positive for urinary protein.
Classify each of the following
protein levels as marked,
moderate, or minimal and list
two possible causes of each.

5 grams /day

2 grams /day

0.2 grams /day

16
 Source: https://litfl.com/dipstick-urinalysis/

Mrs. Jones’ urine specimen test

Due to the following results in Mrs. Jones’ urinalysis, she is highly presumed to
positive for nitrite and leukocyte have Urinary Tract Infection because of the positive result for Nitrites,
esterase and is strongly alkaline Leukocyte esterase, and presence of ammonia odor
(8.5). it also has an ammonia
smell. What type of illness might
she have? Source: https://education.kidney.org/sites/default/files/Slides_11.pdf

Palko’s Medical Laboratory Procedures (Cox, P., Palko, T.)

Mr. Chan’s urinalysis strip test
Confirmatory tests are also called diagnostic tests. They confirm or rule out a
for protein was negative, yet medical condition in an individual with concerning symptoms or an out-of-range
the physician has ordered a screening result.
precipitation test for him, which In other words, a confirmatory test is done to conclude a patient’s test result.
you know also screens for
protein. Why did the doctor
Source:
order a confirmation test for an https://www.usdtl.com/media/mediaarticles/why-is-confirmation-testing-
analyte when the screening test necessary
was negative? Palko’s Medical Laboratory Procedures 3rd edition (Cox, P., Palko, T.)

Elaine’s urine specimen appears

Occult blood is blood that cannot be seen without a microscope. Normal urine
normal, but the urinalysis strip doesn’t contain red blood cells, except females’ urine during menstruation.
test reveals occult blood. She Blood in the urine, called hematuria, is not a normal finding, but it is not
uncommon and not necessarily a cause for alarm.
does not understand how blood
can be present without being Risk factors that may cause occult blood are:
obvious. The doctor has asked
 Urinary Tract infection
you to explain this to her. What  Family history
do you say?  Certain medications such as aspirin or penicillin
 Strenuous exercise

Source: https://healthmatters.io/understand-blood-test-results/urine-occult-
blood

https://www.med.or.jp/english/pdf/2004_05/240_246.pdf

One of the urine specimens

Occult blood is blood that cannot be seen without a microscope. Normal urine
that you analyze today tested doesn’t contain red blood cells, except females’ urine during menstruation.
positive for occult blood. What is Blood in the urine, called hematuria, is not a normal finding, but it is not
the clinical significance of this uncommon and not necessarily a cause for alarm.
finding?
Source: https://healthmatters.io/understand-blood-test-results/urine-occult-
blood

Your student group is visiting a

Confirmatory tests are also called diagnostic tests. They confirm or rule out a
clinical laboratory. One of the medical condition in an individual with concerning symptoms or an out-of-range
students asks why both screening result.
screening and confirmation test In addition to that, although it may not be cost effective, confirmatory testing is
are done for a single analyte. also done to give assurance that the result will be accurate without any mistaken
She thinks that it might be and to prevent false positive/false negative outcomes.

quicker and cheaper to do just

confirmation test in the first
place and eliminate screening. Source: https://www.babysfirsttest.org/newborn-screening/confirmatory-testing

17
Explain to her why the https://blog.averhealth.com/immunoassay-drug-test-confirmation-drug-test
laboratory uses screening test
in addition to confirmation tests.

18
You are employed in a clinical
A bilirubin in urine test measures the levels of bilirubin in your urine. Bilirubin is
laboratory where you perform a a yellowish substance made during the body's normal process of breaking down
urinalysis that test positive for red blood cells. Bilirubin is found in bile, a fluid in your liver that helps you digest
food.
bilirubin. With what infectious
disease might this patient be If bilirubin is present in your urine, it may indicate that the patient has:
infected?
1. Liver disease such as hepatitis
2. Blockage in bile transport

Source: https://medlineplus.gov/lab-tests/bilirubin-in-urine/

As the clinical worker in charge

Running daily Quality Control (QC) for POCT is critical. When measuring any kind
of the urinalysis section, how will of patient sample for indicators of disease, stable controls must be used to
you maintain quality control of validate instrument performance and ensure accurate patient diagnosis.
urine testing? When should a quality control be performed in a urinalysis laboratory?
Ideally, urine should be examined promptly after voiding. It should therefore be
taken to the laboratory shortly after voiding and logged in; a urinalysis is then
performed as soon as possible.

Source: https://doi.org/10.1016/S0272-2712(18)30666-8

https://www.mlo-online.com/diagnostics/assays/article/13009286/urinalysis-
quality-control-at-the-pointofcare

Jerry is having a busy day in the

Jerry is clearly seen to be imposing risks in specimen analysis. Jerry should
laboratory. He dips urinalysis work on urinalysis strips one by one without hastening the process to prevent
trips into several different urine errors in patient’s results.
specimens at the same time and Due to Jerry’s neglection, the urine specimen may be:
attempts to read several  Contaminated with bacteria
urinalysis strips simultaneously.  Wrong specimen for each patient will be sent out
 Careless mistakes in specimen handling
What problem do you see in this
scenario?
Source:
https://www.cartercenter.org/resources/pdfs/health/ephti/library/lecture_notes/
med_lab_tech_students/ln_urinalysis_final.pdf

https://www.nursingtimes.net/clinical-archive/continence/urinalysis-how-to-
interpret-results-07-06-2016/

Clarisse has just received the

printout from the new urine In situations like these, it is best to consult your Laboratory supervisor
chemistry analyzer for the first and report that the reference ranges for color and clarity of the
batch of samples that she is samples were not included. If this is the case, it is best to perform
testing using the new manual method of urinalysis using reagent strips so that the laboratory
work flow will still go on.
instruments. She cannot find
anything on the printout about
color or clarity of the samples
and fears that the instrument is
Source: Palko’s Medical Laboratory Procedures 3rd edition (Cox, P., Palko, T.)
malfunctioning. What to do you
think might be the problem?

19
Juan has just one more urine
Despite the time and urine strips left in the old box, Juan should have
sample to analyze before he is
opened a new box of urine strips and continued with the last urine
done with work for the day. specimen. Forgetting to do quality control increases the risk of
There are no more urinalysis production of false results.
strips in the box, so he has to
Normal and abnormal controls should be tested whenever a new lot of
open a new one. The urine strips is opened, and at the frequency defined by the laboratory's
control has already been used procedure. If quality control results do not correspond to the published
the specified number of times. control values, the problem must be resolved before patient samples
Juan decides just to test the are tested.
urine sample and forgo quality
control this one time. What
Source:
should Juan have done? Why? https://www.labce.com/spg506322_handling_and_storage_of_urine_reagent_str
ips.aspx

Palko’s Medical Laboratory Procedures 3rd edition (Cox, P., Palko, T.)

20
 Activity 3
PHYSICAL AND CHEMICAL PROPERTIES OF URINALYSIS

ON THE JOB TASK SHEET: PSYCHOMOTOR APPLICATION

Name: /Date: May 13, 2024

INSTRUCTION: Search from PRINTED OR ONLINE, OR VIDEO RECORDED valid references

information that would help in the achievement of the following learning outcomes. Follow this
template (cut this page or copy paste) for your answers and submit it according to the instruction
of your instructor. Use additional page if needed. PLEASE INDICATE THE SOURCE/S OF YOUR
ANSWERS.

ON-THE-JOB TASKS ANSWERS

Perform quality control testing

for urinalysis strips.

Video Link/ Source:

https://www.youtube.com/watch?v=ocF3av7mxlc

https://www.youtube.com/watch?v=uxBCLb5cQpc

https://www.youtube.com/watch?v=if81055ugow

21
 Activity 3
Perform a physical analysis of
urine in order to determine the
correct color and clarity of a
urine specimen.

Video Link/ Source:

https://www.youtube.com/watch?v=B9EVDIHfZFw

https://www.youtube.com/watch?v=d8w5SICzzxc

https://www.youtube.com/watch?v=6PTB254Kkbk

Perform a chemical analysis of

urine using urinalysis strips in Video Link/ Source:
order to correctly determine
the concentration of glucose, https://www.youtube.com/watch?v=xUP0tJPm4V4

pH, specific gravity, bilirubin, https://www.youtube.com/watch?v=YrweUovK3s8

urobilinogen, ketones, protein,
https://www.youtube.com/watch?v=6PTB254Kkbk
blood, leukocytes, and nitrite.

Determine the specific gravity

of a urine specimen using
refractometer.

Video Link/ Source:

https://www.youtube.com/watch?v=l8yysa48nkQ
https://www.youtube.com/watch?v=zep2-SHZgdA
https://www.youtube.com/watch?v=-sRJ9zLmkc0
Use an ICTOTEST to confirm
Video Link/ Source:
the bilirubin concentration of https://www.youtube.com/watch?v=u7oWnlEtbKU
a urine specimen.
https://www.youtube.com/watch?v=3M_b3EzEK50

22
 Activity 3
https://www.youtube.com/watch?v=akn4QHf51zQ

Perform a CLINITEST analysis

of a urine sample to assess Video Link/ Source:
the presence of reducing https://www.youtube.com/watch?v=lI2HW2Sr2O0
sugars. https://www.youtube.com/watch?v=PAKCgrnKeBA
https://www.youtube.com/watch?v=bVvy2UTfcl4

23
 Activity 3
Intern’s Performance Evaluation

PHYSICAL AND CHEMICAL PROPERTIES OF URINALYSIS

Learner’s Notes

Date: May 13, 2024

Name of Student: / Year Level/Section: 4th year

At the end of Activity 3, the student was POINTS MAXIMUM Feedback/Remarks

able to: AWARDED POINTS
1. List the three components of 4
urinalysis.
2. Describe quality assurance for 4
urinalysis.
3. List the physical properties of urine. 4
4. Describe the abnormal colors of 4
urine and explain their clinical
significance.
5. Identify the different causes of 4
turbidity in urine.
6. Describe the relationship between 4
urine odor and the patient’s
physiological state.
7. Explain the general methodology of 4
urinalysis strip tests.
8. Distinguish between screening and 4
confirmation test in diagnosis and
describe when it is appropriate to
use each type of test.
9. Describe laboratory safety related 4
to urinalysis.
10. State the methodology for each 4
analyte tested for in urinalysis.
11. Identify the pathological conditions 4
that each urinalysis analyte can
detect.
12. State the normal ranges for each of 4
the analytes of urinalysis.
13. Define specific gravity and explain 4
its relationships to urine
concentration.
14. Describe two methods used to 4
measure specific gravity of
urine.
15. Identify the confirmation tests 4
commonly used to follow urinalysis
strip test for reducing sugars,

24
 ketones, protein, bilirubin and
specific gravity.
16. Discuss the advantages of 4
automated urinalysis.
TOTAL POINTS 64
AVERAGE (%) 100%
Instructor’s Signature/Date

RUBRICS IN AWARDING POINTS:

4 Answer presented is complete and correct with indicated reference

3. Answer presented is incomplete and correct with indicated reference
2 Answer presented is complete and correct but with no indicated reference
1 Answer presented is incomplete and correct but with no indicated reference
0 No answer or the answer presented is incorrect.

25
 Activity 3
Intern’s Performance Evaluation

PHYSICAL AND CHEMICAL PROPERTIES OF URINALYSIS

ON-THE-JOB TASK/S: COGNITIVE APPLICATION

Date: May 13, 2024

Name of Student: /

ON-THE-JOB TASKS POINTS MAXIMUM Feedback/Remarks

AWARDED POINTS
1. Assume that you are employed in a 4
clinical laboratory and that one of
your duties is performing urinalysis.
The urine specimens submitted for
testing have a variety of
appearances. Some are clear,
others are cloudy, and there are
variations in color. Some also have
distinctive odors. What is it
important to make note of these
physical characteristics of urine?
2. A patient has just handed you a 4
urine specimen with an intense
orange-gold color. Yellow foam
floats on top. What might be the
cause of the abnormal
appearance
of the urine?
3. Among the urine specimens this 4
morning is one with a pungent odor
of ammonia. What could this smell
indicate?
4. Assume that you perform the 4
urinalysis in the POL where you
work. What quality control will you
employ to ensure that your
specific gravity readings are
accurate?
5. An infant’s urine has been 4
submitted to the laboratory with a
request for a CLINITEST along
with routine urinalysis. Why would
such a request be made?

26
6. In the lab where you work, several 4
patients have tested positive for
urinary protein. Classify each of the
following protein levels as marked,
moderate, or minimal and list two
possible causes of each.

27
7. 5 grams /day 4
8. 2 grams /day 4
9. 0.2 grams /day 4
10. Mrs. Jones’ urine specimen test 4
positive for nitrite and leukocyte
esterase and is strongly alkaline
(8.5). it also has an ammonia smell.
What type of illness might she
have?
11. Mr. Chan’s urinalysis strip test for 4
protein was negative, yet the
physician has ordered a
precipitation test for him, which you
know also screens for protein. Why
did the doctor order a confirmation
test for an analyte when the
screening test was negative?
12. Elaine’s urine specimen appears 4
normal, but the urinalysis strip test
reveals occult blood. She does not
understand how blood can be
present without being obvious. The
doctor has asked you to explain this
to her. What do you say?
13. One of the urine specimens that 4
you analyze today tested positive
for occult blood. What is the clinical
significance of this finding?
14. Your student group is visiting a 4
clinical laboratory. One of the
students asks why both screening
and confirmation test are done for a
single analyte. She thinks that it
might be quicker and cheaper to do
just confirmation test in the first
place and eliminate screening.
Explain to her why the laboratory
uses screening test in addition to
confirmation tests.
15. You are employed in a clinical 4
laboratory where you perform a
urinalysis that test positive for
bilirubin. With what infectious
disease might this patient be
infected?
16. As the clinical worker in charge of 4
the urinalysis section, how will you
maintain quality control of urine
testing?
17. Jerry is having a busy day in the 4
laboratory. He dips urinalysis trips
into several different urine
specimens at the same time and
attempts to read several
urinalysis
strips simultaneously. What

28
 problem do you see in
this scenario?
TOTAL POINTS 68
AVERAGE (%) 100%
Instructor’s Signature/Date

RUBRICS IN AWARDING POINTS:

4 Answer presented is complete and correct with indicated reference

3. Answer presented is incomplete and correct with indicated reference
2 Answer presented is complete and correct but with no indicated reference
1 Answer presented is incomplete and correct but with no indicated reference
0 No answer or the answer presented is incorrect.

29
 Activity 3
Intern’s Performance Evaluation

PHYSICAL AND CHEMICAL PROPERTIES OF URINALYSIS

ON-THE-JOB-TASK/S: PSYCHOMOTOR APPLICATION

Date: May 13, 2024

Name of Student: // Year Level/Section: 4th year

At the end of the activity, the student POINTS MAXIMUM Feedback/Remarks

was able to OR (watch videos on): AWARDED POINTS
1. Perform quality control testing for 2
urinalysis strips.
2. Perform a physical analysis of urine 2
in order to determine the correct
color and clarity of a urine
specimen.
3. Perform a chemical analysis of 2
urine using urinalysis strips in order
to correctly determine the
concentration of glucose, pH,
specific gravity, bilirubin,
urobilinogen, ketones, protein,
blood, leukocytes, and nitrite.
4. Determine the specific gravity of a 2
urine specimen using refractometer.
5. Use an ICTOTEST to confirm the 2
bilirubin concentration of a urine
specimen.
6. Perform a CLINITEST analysis of a 2
urine sample to assess the
presence of reducing sugars.
TOTAL POINTS 12
AVERAGE (%) 100%
Instructor’s Signature/Date

RUBRICS IN AWARDING POINTS:

2 Perform the procedure within acceptable standards.

Watch online video on the procedure performed within acceptable standards
1 Perform the procedure with deviations from acceptable standards
Watch online video on the procedure performed with deviations from
acceptable standards
0 Did not perform or watch video on the procedure

30
 Activity 3
Intern’s Performance Evaluation

PHYSICAL AND CHEMICAL PROPERTIES OF URINALYSIS

Summative Examination

Date: May 13, 2024

Name of Student: / Year Level/Section: 4th year

Note: Please submit with this form together with your summative examination.

At the end of lesson 1, the student was Total No. of No. of % Remarks
able to: Items Correct
Answers
1. List the three components of
urinalysis.
2. Describe quality assurance
for urinalysis.
3. List the physical properties of urine.
4. Describe the abnormal colors of
urine and explain their clinical
significance.
5. Identify the different causes of
turbidity in urine.
6. Describe the relationship between
urine odor and the patient’s
physiological state.
7. Explain the general methodology of
urinalysis strip tests.
8. Distinguish between screening and
confirmation test in diagnosis and
describe when it is appropriate to
use each type of test.
9. Describe laboratory safety related
to urinalysis.
10. State the methodology for each
analyte tested for in urinalysis.
11. Identify the pathological conditions
that each urinalysis analyte can
detect.
12. State the normal ranges for each of
the analytes of urinalysis.

31
 13. Define specific gravity and explain Activity 3
its relationships to urineIntern’s Performance Evaluation
concentration.
14. Describe two PHYSICAL AND to
methods used CHEMICAL PROPERTIES OF URINALYSIS
measure specific gravity of
urine.
15. Identify the confirmation tests
commonly used to follow urinalysis
strip test for reducing sugars,
ketones, protein, bilirubin and
specific gravity.
16. Discuss the advantages of
automated urinalysis.
Over-all Performance
Instructor’s Signature/Date

32