| Positive reaction for Urobilinogen | : light to dark
pink |
| Classic test to differentiate urobilinogen from porphobilinogen | Watson-Schwartz Differentiation Test |
| main reacting agent for Copper Reduction Method (Clinitest Tablet) | Copper sulfate |
| Provide a simple, rapid means for performing medically
significant chemical analysis of urine, including pH, protein,
glucose, ketones, blood, bilirubin, urobilinogen, nitrite,
leukocytes, and specific gravity | Reagent Strips |
| What does reagent strip contains? | pH, protein,
glucose, ketones, blood, bilirubin, urobilinogen, nitrite,
leukocytes, and specific gravity |
| Consist of chemical-impregnated absorbent pads attached to a
plastic strip. A color-producing chemical reaction takes place
when the absorbent pad comes in contact with urine. | Reagent Strips |
| he reactions are interpreted by comparing the____produced
on the pad with a chart supplied by the manufacturer. | color |
| Allowing the strip to remain in
the urine for an extended
period may cause ____ of
reagents from the pads. | leaching |
| Care of Reagent Strips
1. Store with desiccant in an_______,
tightly closed container. | opaque |
| Care of Reagent Strips
Store below____; do not freeze. | 30C |
| Care of Reagent Strips
Do not expose to ___fumes | volatile |
| Determined by the concentration of free H+ | pH |
| as H+ increases, pH decreases (becomes more
acidic) | True |
| as H+ decreases, pH increases (becomes more
alkaline) | True |
| Normal urine pH for random specimen | 4.5 – 8.0 |
| Normal urine pH for first morning | 5.0 – 6.0 |
| Normal urine pH for With normal protein diet | 4.5 – 6.5 |
| What type of bacteria that causes an acidic urine? | Eschericia coli |
| It has a principle of Double-indicator system of methyl red
and bromthymol blue | pH |
| It has a principle of change in pKa of a polyelectrolyte | Specific
Gravity |
| Often associated with early renal disease. | Protein |
| major serum protein found in urine serum and tubular microglobulins | Albumin |
| produces by the tubules and forms
the matrix of all types of casts | Tamm-Horsfall protein |
| What is the normal range of protein? | <10 mg/dL or 100 mg/24 hrs |
| It has a principel of protein error of indicators | Protein |
| Confirmatory test for protein | sulfosalicyclic acid (SSA) precipitation test. |
| Interpretation? | <6 |
| Interpretation? | Noticeable turbidity |
| Interpretation? | 30-100 |
| Interpretation? | Turbidity with granulation with no flocculation |
| Interpretation? | 200-400 |
| Interpretation? | Clumps of protein |
| (+) Reagent strip & (-) SSA | Albumin |
| (+) Reagent strip & (+) SSA | Albumin |
| (-) Reagent strip & (-) SSA | Proteins other than albumin |
| radiographic dyes, tolbutamide metabolites,
cephalosporins, penicillin and sulfonamides | Causes false positive for protein |
| highly alkaline urine, very dilute samples | False negative for urine |
| Clinical significance: detection of Diabetes
Mellitus | Glucose |
| What is the normal quantity of glucose? | 15 mg/dL |
| Renal Threshold for glucose | 160 – 180 mg/dL |
| Tests for Glucose that is general test for glucose and
other reducing sugars. | Benedict’s Test |
| Reagent for Benedict's test | Benedict’s Solution |
| Principle for Benedict's test | relies on the ability of the
glucose substances to reduce copper
sulfate to cuprous oxide in the presence of
alkali and heat |
| Tests for Glucose that is non-specific for glucose | Copper Reduction Method (Clinitest Tablet) |
| Sensitivity of Copper Reduction Method (Clinitest Tablet) | 200 mg/dL |
| main reacting agent for Copper Reduction Method (Clinitest Tablet) | Copper sulfate |
| effervescent for effervescent | Sodium Carbonate and Citric Acid: |
| provides alkaline medium for Copper Reduction Method (Clinitest Tablet) | Sodium hydroxide |
| provides heat for Copper Reduction Method (Clinitest Tablet) | Sodium hydroxide |
| What is the positive reaction for Copper Reduction Method (Clinitest Tablet) | : blue to orange/red |
| Interpretation? | Presence of glucose |
| Interpreration? | Presence of non-glucose reducing sugar |
| Interpretation? | Presence of small amount of glucose |
| Interpretation? | False positive reaction |
| Normally, NO BLOOD in the form of ___,
____, or _____ should be
detected in the urine | hematuria, hemoglobinuria, myoglobinuria |
| Presence of ____ is clinically significant (
Microscopic Hematuria) | >5 RBCs/uL |
| Interpretation? | Bleeding is renal or
genitourinary origin |
| Interpretation? | Lysis of RBC produced in urinary tract,
particularly in dilute, alkaline urine.
May result from intravascular
hemolysis |
| Interpretation? | Characterized by “cola drink”
or “black coffee” urine |
| Interpretation? | Red/Pink with haptoglobin |
| Interpretation? | Clear and Negative |
| Interpretation? | Red and Positive |
| Myoglobin levels must be _____ before red pigmentation | 25mg/dL |
| Ammonium sulfate precipitates _____ | hemoglobin |
| Principle for blood in reagent strip | Pseudo-peroxidase activity of hemoglobin |
| Presence in urine implies that an inflammatory
process is occurring in the kidney or urinary tract | Leukocyte
Esterase |
| Indicates pyuria | Leukocyte
Esterase |
| Used for screening of urine culture specimens
Correlates with: protein, nitrite, microscopic
examination | Leukocyte
Esterase |
| Principle of Leukocyte esterase | Leukocyte esterase |
| POSITIVE reaction of : Leukocyte esterase | Purple color |
| strong oxidizing agents, formalin, highly pigmented urine,
nitrofurantoin | False Positive for Leukocyte esterase |
| High concentration of protein, glucose, oxalic acid, ascorbic
acid, gentamicin, cephalosporins, tetracyclines, inaccurate timing | False Negative for Leukocyte esterase |
| Rapid, indirect method for detection of bacteria capable of reducing ___ | Nitrite |
| Most common organisms that infect the urinary tract | Proteus spp., E. coli. Klebsiella pneumoniae, and Pseudomonas aeruginosa |
| Nitrite correlates with? | Protein, Leukocytes, and microscopic examination |
| Principle for Nitrite | Greiss reaction |
| Positive reaction for nitrite | Pink color |
| Products of fat metabolism | Ketones |
| Normally NOT present in urine | Presence of ketone bodies in urine
results from increased fat metabolism
due to abnormal carbohydrate
utilization. |
| 3 ketone bodies | 1. Acetone
2. Acetoacetic acid
3. Beta-hydroxybutyric acid |
| Increased accumulation in the blood leads to ____ imbalance, dehydration, and, if not corrected, _____and eventual diabetic _____. | electrolyte
acidosis and coma |
| Testing for urinary ketones is most valuable in the management and monitoring of _____ | insulin-dependent (type 1) diabetes mellitus. |
| Principle of ketone | Sodium
nitroprusside |
| Positive color of Ketone | Purple Color |
| Provides sodium nitroprusside,
glycine, disodium phosphate, and
lactose in tablet form | ACETEST |
| Added for better color differentiation | Lactose |
| About 10x more sensitive to diacetic acid and acetone | ACETEST |
| ACETEST DOES NOT detect what? | betahydroxybutyric acid |
| A highly pigmented yellow compound that is a product of hemoglobin degradation | BILIRUBIN |
| appears in the urine when the normal degradation cycle is disrupted by obstruction of
the bile duct (e.g., gallstones or cancer) or when the integrity of the liver is damaged. | Conjugated bilirubin |
| Principle of Bilirubin | Diazo Reaction |
| Positive reaction of Bilirubin | Tan/Pink to Violet |
| Clinical Significance of BILIRUBIN | Screening of abnormal
hepatobillary function |
| More sensitive than diazo reaction in reagent strips | Ictotest |
| Consists of testing mats and tablets containing pnitrobenzene-diazonium-ptoluenesulfonate,
SSA, sodium carbonate, and boric acid. | Ictotest |
| Positive result for Bilirubin | BLUE TO PURPLE |
| Negative result for Bilirubin | colors other than blue or purple |
| A colorless pigment formed from bilirubin breakdown in the intestines | UROBILINOGEN |
| Appears in urine because as it circulates in the blood on the way to the liver, it may mass through the kidneys and be filtered by the glomerulus. | UROBILINOGEN |
| Normal urine urobilinogen | <1 mg/dL |
| Principle for UROBILINOGEN | Ehrlich’s Reaction |
| Positive reaction for Urobilinogen | light to dark pink |
| Early detection of liver disease
• Liver disorders, hepatitis, cirrhosis,
carcinoma
• Hemolytic disorders | UROBILINOGEN |
| Reagent: p-dimethylaminobenzaldehyde, sodium acetate (added to enhance reaction) | Ehrlich’s Tube Test |
| Result for Ehrlich’s Tube Test | CHERRY RED COLOR |
| Rapid screening test for porphobilinogen (2mg/dL) | Hoesch Test (Inverse Ehrlich) |
| Hoesch Test
(Inverse Ehrlich)
Reagent | Hoesch reagent (Ehrlich
reagent dissolved in 6M HCl) |
| RESULT: RED COLOR upon addition of reagent (presence of porphobilinoen) | Hoesch Test (Inverse Ehrlich) |
| Urobilinogen is inhibited by? | acidic pH |
| Classic test to differentiate urobilinogen from porphobilinogen | Watson-Schwartz Differentiation Test |
