Urinalysis With Reflex Culture What Does It Mean

Urine Reflex Testing: Why and How?

Dr. Yi Xiao and Dr. Allison B. Chambliss, both of whom have doctorates in biology and chemistry and are FAACC members/Date:SEP.1.2021/ Clinical Laboratory is the source of this information. News Urinalysis (UA) is generally comprised of physical, chemical, and microscopic evaluations, with the complexity, expense, and turnaround time increasing as the number of evaluations increases. As an added bonus, UA is interdisciplinary in that it may be conducted in the core lab or at the point of care, and it can be either a manual or an automated test.

Many laboratories have utilized reflex testing procedures in order to increase efficiency.

There are two types of reflex testing that are often used.

Following an abnormal chemical UA result, a further microscopic UA is performed to examine for cells, bacteria, yeast, casts, and crystals, among other things.

We were interested in implementing a reflex-to-culture approach to reduce the reporting of clinically insignificant catheter-associated urinary tract infections (CAUTI), reduce misinterpretation or overinterpretation of clinically insignificant positive culture results, and support antibiotic stewardship in our hospital system.

Validating Urine Reflex Criteria

A small amount of data has been collected using recent automated UA methods despite the fact that these approaches are now frequently utilized and discussed in the literature. However, whereas the majority of the studies that looked into reflex-to-culture criteria compared manual microscopy findings to urine culture findings, we were interested in using a compounded reflex approach—chemical urine analysis combined with reflex to microbiology for general UA orders, and chemical urine analysis combined with reflex to microbiology followed by reflex to culture for reflex culture UA orders—to see how well it worked.

We also intended to employ an automated user authentication system as the primary user authentication technique.

In order to determine the importance of the diagnoses that would be missed and the number of microscopic UA and cultures that may be avoided by our suggested reflex UA techniques, we conducted a series of simulations.

Six percent of the samples with accessible urine culture findings (n=3,127) were negative for all chemical UA criteria but had clinically significant positive urine cultures, demonstrating that negative chemical UA alone performed rather well in ruling out culture-positive UTIs.

Workflow Challenges and Clinical Considerations

We had many vigorous talks regarding how to standardize the urine reflex testing procedure across our health system, including sample collection and transportation across laboratory sites. The urine specimen container was a key problem that needed to be addressed initially. In fact, some of our institutions were already using a urine collection kit that included a boric acid preservation tube for culture, while others were still using regular urine collection cups for collection. The standard collection kit was used in all of our laboratories since the urine analysis (UA) required to be done and the results obtained before evaluating whether or not the urine culture should be begun in any of our laboratories.

• We came to the conclusion that having a fresh specimen label for urine culture immediately generated in the microbiology lab upon a positive UA result would be an excellent trigger.
• The full UA and urine culture should normally be performed at the same time for pregnant women, newborns, and immunocompromised patients regardless of whether the UA was chemical or microscopic.
• Additionally, if the standalone urine culture order is available to providers, an alert noting that it meets the required requirements may be included.
• Overall, it is critical to maintain the involvement of key clinical stakeholders, including: Our planning process included constant consultation with leaders in infectious diseases, infection prevention, hospital quality, and patient safety to ensure that we were meeting our objectives.
• In conclusion, while our laboratories can appreciate the decrease in labor costs, improvements in patient outcomes or reductions in CAUTI incidence have yet to be determined.

Acknowledgements

The authors would like to express their gratitude to the laboratory directors and personnel of the Los Angeles County Department of Health Services for the numerous and useful talks that they had with reflex urinalysis techniques throughout the years. We would like to express our gratitude to Tam Van, PhD, for supplying data and conducting data analysis. We would also want to express our gratitude to Melanie Yarbrough, PhD, for her critical evaluation of this paper. Doctor Yi Xiao is a clinical chemistry fellow at Children’s Hospital Los Angeles, where she has worked for the past year.

Chambliss (dot) com.

Allison B. Chambliss, PhD, DABCC, FAACC is an assistant professor of clinical pathology at the University of Southern California (USC) Keck School of Medicine. She also serves as director of clinical chemistry and point-of-care testing at the Los Angeles County+USC Medical Center. +EMAIL:

UA with Reflex to Culture

This test is frequently requested when a person is experiencing symptoms that might indicate a urinary tract infection (UTI) (urinary tract infection). These symptoms may include: frequent urination, lower back pain, murky or strongly smelling urine, pain or burning feeling when peeing, and so on and so forth. The following are the components of this test: Visual Examination-A visual examination, also known as a macroscopic examination, will be performed to determine the amount, clarity, color, and cloudiness of the sample.

A variety of illnesses can be indicated by abnormal findings.

In some cases, the presence of tea-colored urine indicates the presence of liver disease.

Chemical Test- A chemical test may be used to assess many different components of your urine, including the following:

• Specific gravity is a measurement of the concentration of urine that may be used to determine whether or not your kidneys are properly concentrating your urine. It also takes into account the concentration of each and every chemical particle identified in your urine throughout the analysis. As a result, the gravity of the urine would be measured in relation to the gravity of the water. In the normal range, the values are between 1.000 and 1.030. If you consume excessive amounts of alcohol before to the test, typical gravity levels will be about 1.000. If you don’t drink anything before the test, you’ll get a usual result of 1.130
• Acidity: This test measures the pH values in the urine in order to determine if the urine is acidic or alkaline. Increased risks for kidney stones are typically associated with acidity levels that are either high or too low (upper high or lower low). Proteinuria is a term used to describe the presence of proteins in the urine, primarily albumin levels, which are measured. Normal urine samples have modest quantities of urine proteins, however excessive levels that persist over time might suggest renal disease. Testing for glucose levels in the urine (also known as glycosuria): This test examines for high amounts of sugar in the urine. Our bodies require and utilize sugar as a source of energy, which is accomplished through the conversion of carbs into glucose. When your blood glucose levels are elevated, it is usually a sign that there is a problem with your digestive system (like diabetes). In the absence of medical intervention, this might develop into a dangerous condition (such as renal failure or nerve damage). Test for ketones: This test detects the amount of ketones in the blood, which are the results of fat breakdown and are also referred to as ketonuria. When glucose levels are low, your body will turn to alternative sources of energy for energy. Ketone levels beyond a certain threshold can suggest ketoacidosis, which is a complication of diabetes that can be fatal. Keeping track of your ketone levels might help you avoid a medical emergency in the future. In the presence of blood in the urine, which is caused by broken red blood cells that have not been reabsorbed by the kidneys, hemoglobin can be detected by the presence of hemoglobin. The presence of hemoglobin in the urine will cause it to be dark in hue. Hemoglobin is not seen in the urine of healthy persons. The presence of white blood cells in urine is determined by the enzyme leukocyte esterase. The enzyme leukocyte esterase is produced by leukocytes and is used in the production of leukocytes. The existence of an infection is indicated by a positive test result. A test for the presence of nitrites in the urine, which might indicate the presence of bacteria, is performed using this method. It is possible for nitrates that are ordinarily detected in the urine to be transformed into nitrites when bacteria are present in the urinary system. The results of a positive nitrite test will need to be analyzed further in the lab in order to determine the precise type of bacteria and its responsiveness to the various therapies. Bilirubin: This test identifies elevated amounts of bilirubin, which may indicate liver or gallbladder problems, as well as the destruction of red blood cells. This test can indicate the existence of a possible liver illness since it measures the amount of bilirubin present in bile, which is the consequence of the breakdown of red blood cells
• Urobilirubin: this test can indicate the presence of a possible liver disease. Urobilirubin is produced as a result of the decrease in bilirubin. Individuals that are in good health have a little level of Urobilirubin in their urine. Positive findings might suggest the presence of liver disorders such as hepatitis, cirrhosis, liver damage, or hemolytic anemia, among others. They can also occur as a result of the use of certain drugs, such as etodolac.

Based on the results of the culture section of this test, it may be necessary to do a sensitivity test. Dr. Kurt Kloss, M.D., has reviewed this document. Date of last review: January 13, 2022

Urinalysis, Complete, with Reflex to Culture

Collection Instructions: U03 – UA Tube with a Yellow Cap (Supply) U01 – C S Gray Tube with Straw (Supply:U01 – C S Gray Tube with Straw) Specimen(s) of preference: Two distinct clean capture specimens should be submitted:

• 1 teaspoon of urine in a urine culture tube (gray top)
• 10 teaspoons of urine in a urine transport tube (yellow top, blue fill line, preservative tube)
• 4 teaspoons of urine in a urinalysis transport tube

The following pediatric specimen(s) are preferred: refrigerated unpreserved sample Procedure: Clean catch mid-stream samples are taken in order to reduce contamination and enhance accuracy. If a sample is submitted unpreserved, please note that it is from a pediatric patient in the body of the submission (patient is less than or equal to 12 years of age). Label the sample in the proper manner. Only urine from pediatric patients will be received, and it must be unpreserved.

• Instructions for a female clean catch
• Instructions for a male clean catch

Instructions for submitting specimens:

1. Remove the sterile urine cup from the refrigerator
2. Fill the dropper halfway with urine collected in the sterile cup
3. Fill the tube up to the fill line (4ML) specified on the tube label using the dropper
4. And Put the gray cap on the tube. Prior to packing for transportation, double-check the patient’s two IDs on the tube.

Containers for transport include a yellow-top urinalysis transport tube with a blue fill line and a gray-top urine culture tube. Temperature during transportation:

• Keep preserved at room temperature
• Keep unpreserved pediatrics refrigerated (in cold packs).

Stability of the specimen:

• Room temperature: preserved specimen for 72 hours
• Refrigerator temperature: unpreserved pediatric specimen for 24 hours

Criteria for rejection are as follows:

• Adult specimens that have not been preserved
• Conical transport tube with a swirled top in yellow and red and a preservative

Please contact DLO’s Customer Service at (800) 891-2917, option 2 if you require any more information on supply or collection devices. The CPT codes supplied are based on American Medical Association criteria and are provided solely for informative purposes. The billing party is solely responsible for the coding of CPT codes. If you have any queries about coding, please send them to the payor who is being invoiced.

Urinalysis with Culture Reflex

Type of Specimen (Needs BOTH tubes)

Test ID		LAB5187
EPIC Order		URINALYSIS with Culture Reflex
CPT Code(s)		81001, 87086 (UA, urine culture)
Group/Individual Test		Group
Laboratory		Core Laboratory/Clinical Microbiology
Tube Station		Gray Top Tube (Culture) to 82 Pale Yellow (Urinalysis) to 30 (routine), 888 (STAT)
Specimen	Routine:	Minimum volume:

NOTE:if Minimum volume cannot be obtained for each tube, send specimen in original collection cup.

Stability		Room temperature: Gray Top – YesRefrigerator: DO NOT Refrigerate Gray Top Pale Yellow Tubes stable 8 hours refrigerated, 2 hours room temperature Refrigerate original collection cup stable8 hours.Frozen:NO
Transport		Deliver urine to lab within 1 hour of collection
Availability	Routine:	24 hrs/day
	STAT:	YES
Turnaround Time		STAT 1 hr., Routine 2.5 hrs.
Reference Range	Normal:	See Urinalysis (UA) webpage for urinalysis reference ranges.
Comments	Criteria for Reflex:Leukocyte esterase: Trace, 1+, 2+Nitrite: PositiveWBC:(greater than) or =(equal to) 5 wbc/hpfBacteria: Rare, Occasional, Few, Moderate, ManyPatients must meet certain criteria in order to have the urinalysis with culture reflex. Excluded patients include:Patients who are5 years old Pregnant womenPatients currently on antibioticsPatients who are neutropenicIt will be the physician’s responsibility to determine if these exclusion criteria apply.The physician will still have the option to order a UA or urine culture separately.

On November 15, 2021, Christopher Parker gave his opinion. Please keep in mind that the reference ranges supplied on this website are for informational purposes only and may not reflect the most recent revisions.

For the most up-to-date reference data, see laboratory reports. The McLendon Clinical Laboratories at UNC Hospitals are located at 101 Manning Drive in Chapel Hill, North Carolina.

Urinalysis with Reflex to Culture

Test Description	Urinalysis with Reflex to Culture
Test ID	UARC
General Information	Detect abnormalities of urine; diagnose and manage renal diseases, urinary tract infection, urinary tract neoplasms, systemic diseases, and inflammatory or neoplastic diseases adjacent to the urinary tract
Specimen Type	Urine
Specimen Requirements	Urine Cup
Additional Processing Details	If analysis is unable to be performed within one hour of collection, store refrigerated up to 24 hours.
Stability	1 hour room temperature.24 hours refrigerated.48 hours in BD Vacutainer UA Preservative Tube
Unacceptable Specimen Conditions	Quantity not sufficient; improper labeling; specimen received in inappropriate preservative; specimen received in urine cup stored at room temperature greater than 1 hour old; specimen received in urine cup refrigerated more than 24 hours old; frozen specimens; specimens received in BD Vacutainer UA Preservative Tube more than 48 hours old
Limitations	Metabolites of Pyridium® may interfere with the dipstick reactions by producing color interference. High vitamin C intake may cause an underestimate of glucose, blood, bilirubin, and a false-negative nitrite test. A low ph can also result in a false negative for protein and WBC’s. A false negative for WBC’s also can occur with elevated specific gravity, glucose, and/or protein levels. An increased specific gravity may cause a false negative for blood and/or nitrites. False positives can occure for protein when hemoglobin is present and/or an elevated ph level.
Methodology	Automated
Estimated TAT	0-2 days
Testing Schedule	Monday-Saturday,STAT
CPT Code(s)	81003
Additional Information	Includes: Specific Gravity pH Urine Color Appearance WBC Esterase Protein Glucose Ketones Blood Bilirubin Urobilinogen NitriteMicroscopic examination includes; WBC, RBC, epithelial cells, casts, crystals, mucus, bacteria, yeast, trichomonas, any other abnormality
Minimum Sample Volume	5 ml of urine
Pediatric Min. Volume (if applicable)	2 ml of urine
Reference Range

Specific Gravity	1.005 – 1.030
pH	5.0 – 7.5
Urine Color	Yellow
Appearance	Clear
WBC Esterase	Negative
Protein	Negative
Glucose	Normal
Ketones	Negative
Blood	Negative
Bilirubin	Negative
Urobilinogen	Normal
Nitrite	Negative
Microscopic Exam:
WBC	0 – 5/hpf
RBC	0 – 2/hpf
Squamous Epithelial	0 – 10/hpf
Casts	None Seen
Mucus	None Seen
Crystals with Identification	None seen
Bacteria	None seen
Yeast	None seen
WBC and RBC clumps	None seen
Non-squamous Epithelial	None seen
Renal Epithelial	None seen
Transitional Epithelial	None seen
Trichomonas	Not Present

Reflex Conditions	Reflex to Culture with any of the following results: Urine dip results are WBC esterase is ≥ 1+ and/or Nitrite is ≥ 1+ Urine microscopic results are WBC5 per/hpf and/or Bacteria ≥ Moderate
Performing Lab	Incyte Diagnostics
LOINC Code(s)	24356-8

Urinalysis and Urine Culture – Kidney and Urinary Tract Disorders

Urinalysis is a procedure that requires

• The use of chemical tests to identify and evaluate the levels of different compounds in the urine is becoming more common. Frequently, urine is examined under a microscope

Protein, glucose (sugar), ketones, blood, and other compounds are tested for using chemical methods. A tiny strip of plastic (dipstick) is used in these tests, which is impregnated with chemicals that react with compounds in the urine and cause the color to change fast. Occasionally, the results of the urine test are validated by a more sophisticated and accurate laboratory study of the urine specimen. The presence of red and white blood cells, crystals, and casts in the urine can be determined by examining it under a microscope (impressions of the kidney tubules created when urinary cells, protein, or both precipitate out in the tubules and are passed in the urine).

• Depending on the reason, protein may be present in the urine on a consistent basis or just infrequently.
• Small quantities of protein in the urine may be a warning indication of kidney damage caused by diabetes in the early stages of disease.
• During these instances, urine must be collected over a period of 12 or 24 hours and examined in a laboratory.
• As a result of the breakdown of fat, ketones are produced.
• Blood in the urine (hematuria) can be detected using a dipstick and verified with further tests such as inspecting the urine with a microscope and other procedures.
• A dipstick can be used to identify the presence of leukocyte esterase (an enzyme present in some white blood cells) in the urine.
• A dipstick is used to determine the acidity (pH) of urine.

Some people are predisposed to kidney stones as a result of a change in their acidity.

The concentration of urine in the bloodstream can also be useful in identifying faulty kidney function.

One unique test requires a person to refrain from drinking any water or other fluids for 12 to 14 hours.

Following that, the concentration of urine is determined.

When it comes to specific kidney illnesses (such as nephrogenic diabetes insipidus), this is not the case.

In nephrogenic diabetes insipidus, the kidneys generate a high volume of dilute urine because the renal tubules fail to react to vasopressin (antidiuretic hormone) and are unable to reabsorb.

Sedimentin urine may be inspected under a microscope to see if a kidney or urinary tract problem is present, providing valuable information.

Someone suffering from renal or urinary tract disease tends to excrete more cells, which can accumulate in the urine when it is centrifuged or allowed to settle. If the urine is centrifuged or allowed to settle, the cells can form a sediment that can be collected and analyzed later.

Generic Name	Select Brand Names
aspirin	DURLAZA

Urinalysis (UA) with Reflex to Culture if Positive (Outpatient Only)

It is no longer possible to order this test as an inpatient order. This modification is in accordance with the efforts of the CAUTI workgroups. INPATIENT ORDERING: Please substitute URINALYSIS and URINE CULTURE for this test in the absence of a patient.

Test Name Alias

The following tests are performed: Urinalysis with Micro Exam, Culture if indicated | Urine Culture | Urine Dose | Urinalysis w/Micro Exam, C S if indicated | 115

Interface Order Alias

However, while refrigeration of urine reduces bacterial development, it does not prevent the lytic effects of a low specific gravity or an alkaline pH from taking place. The development of urine crystals may be produced by the use of refrigeration.

IconsPhotos

Collecting Specimens: Urine (Clean Catch Mid-Stream/CCMS or Straight Catheter) Specimen Collection: The following containers are required: 2 pale yellow top urine tubes (UA No Additive) AND 1 gray top urine C S tube (contains boric acid) One sterile cup and one gray top urine C S tube are acceptable containers (contains boric acid) Preferably, 24 mL (2 x 10 mL Yellow and 1 x 4 mL Gray) is the volume to be collected.

4.0 mLNeonate is the bare minimum volume to collect. Volume to Collect: 3.0 mLVolume to Collect: Instructions:

• There are no preservatives in this product. A clean catch mid-stream or straight catheter collection is performed. It is necessary to get the ambient specimen at the lab within 2 hours. The specimen should be kept cold and should be sent to the laboratory as soon as possible if there is a delay. It is necessary for the specimen to be received in the laboratory for analysis within 24 hours of collection. For Culture and Sensitivity (C S), a gray vacutainer should be used.

Unacceptable It is not recommended to culture specimens with 10 or more squamous epithelial cells; nonetheless, it may be necessary to do a CCMS or catheterized procedure if culture is required. Instructions for Processing (Laboratory, Outpatient or Off-site collection)

• When you pick up your order, two barcode labels will be printed if they are available. One label should be applied on the container, and the second label should be placed in the pouch of the specimen bag. Temperature during transportation:

• Refrigerant: Sterile cup, gray top tube, yellow tube

Rejection Criteria

Specimens that do not fulfill the requirements of the Spectrum Health Laboratory may be rejected (cancelled) for the following reasons:

• When there is no indication of cooling for a sterile cup collection and the specimen is more than 2 hours old, a duplicate specimen should be requested. Cathode ray catheter tips and bags
• Catheter bags are used for catheterization. Containers with leaks
• Container that is not sterile (for example, medicine bottles or home containers)

Specimen Stability

2 yellow top tubes and a urine cup are included: 2 hours at room temperature; 24 hours in the refrigerator Retention time in the laboratory: 3 days Gray top tube: 48-hour exposure to ambient light Refrigerate for at least 48 hours. Retention time in the laboratory: 3 days

Reflex Information

• C S will be conducted if two or more of the following aberrant findings are present, assuming that there are less than ten squamous epithelial cells per high-power field (HPF):

• A WBC value greater than or equal to 10
• Positive leukocyte esterase
• Positive nitrite
• Positive leukocyte esterase

Alternatively, if the specimen is:

• In the case of specimens having more than ten thousand squamous epithelial cells, a culture will not be undertaken
• The following aberrant results will be observed during a Culture and Sensitivity (C S) examination if the volume required for the microscopic examination and the urine analysis (UA) is insufficient:

• If the urinalysis results are negative, no culture will be conducted.

Test Frequency

Available 24 hours a day, with a typical turnaround time of one day.

Reference Range

24 hour availability, with a typical turnaround time of one day (or less).

Color	Yellow/Straw
Clarity	Clear
Glucose	Negative
Bilirubin	Negative
Ketone	Negative
Sp Gravity	1.010-1.030
Blood	Negative
pH	5.0-9.0
Protein	Negative
Urobilinogen	Normal (0.2-1.0mg/dL)
Nitrite(reductase)	Negative
Leukocyte (esterase)	Negative
Ictotest	Negative
Mucus	None to Moderate
Epithelial Cells	0-9/HPF
RBC’s	0-3/HPF
WBC’s	0-5/HPF
Bacteria/Yeast	None
Amorphous	None to Heavy
Casts	None (Few Hyaline may be normal)
Parasites	None
Trichomonas	None
Urine Fat	None
Crystals	None (Some may be normal others pathogenic)

Table of Critical Values in the Laboratory

Performing Department

Grand Rapids, Michigan’s Spectrum Health Regional Laboratory MISpectrum Health Big Rapids Laboratory is located in Big Rapids, Michigan. MISpectrum Health Blodgett Laboratory is located in Grand Rapids, Michigan. Michigan Spectrum Health Gerber Laboratory, Fremont, California MISpectrum Health Kelsey Laboratory is located in Lakeview, Michigan. MISpectrum Health Ludington Laboratory is located in Ludington, Michigan. Michigan Spectrum Health Pennock Laboratory in Hastings, Michigan. MISpectrum Health Reed City Laboratory is located in Reed City, Michigan.

CPT

81001 Neither the CPT code(s) nor the CPT code(s) specified are required to be used in this test.

Others may be added if culture and sensitivity testing are performed, and if additional testing is required based on the pathogens isolated (such as MICs and IDs), as determined by the pathogens isolated.

Beaker LOINC

CHOLESTEROL CRYSTAL:5777-8 (U Cholesterol Crystal) U PATH:N/AU SPERM.:N/AU SRC:N/AU XTAL:N/AU YLC:N/A Crystallization of urine ammonium biurate: n/a CRYSTALS:33240-3URINE CYSTINE CRYSTALS:50557-8URINE LEUCINE CRYSTAL:50232-8URINE MICROSCOPIC:12235-8URINE MICROSCOPIC:12235-8URINE MICROSCOPIC:12235-8URINE MICROSCOPIC:12235-8 TYROSINE CRYSTAL:50238-5URINE URIC ACID CRYSTAL:33233-8URINE UROBILINOGEN:50563-6URINE WBC:46702-7URINE WHITE BLOOD CELL CLUMPS:53317-4URINE YEAST:72223-1 TYROSINE CRYSTAL:50238-5URINE URIC ACID CRYSTAL:33233-8URINE UROBILINO

Beaker Names

Beaker Procedure Name:URINALYSIS WITH MICRO EXAM, C S IF INDICATED, BEAKER PROCEDURE NAME: Urinalysis (UA), with or without culture if indicated on the beaker display NAME OF THE BEAKER TEST:URINALYSIS, WITH CULTURE IN THE IF THE RESULTS ARE POSITIVE BEAKER TEST REPORT NAME:Urinalysis, Culture If Positive If Positive If Positive

Beaker Synonyms

There isn’t a synonym on file.

Beaker Collection and Specimen Handling

Collection of Beakers (CC/Random+) (1)R

Beaker Location, Container and Temperature

Urine: UR YELLOW/GREY BW URINES (Preferred) -BW URINES: 10 ML URINE YELLOW TUBE REFRIGERATED (Acceptable) 4-ML URINE GREY TUBE A, -RefrigeratedBW URINES: (Acceptable) -Refrigerated BW URINES: UR CUP/GREY BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW URINES: BW (Acceptable) -Refrigerated BW URINES: URINE CUP R (BW URINES) (Acceptable) -Urine that has been refrigerated: UR YELLOW/GREY (Preferred) -Refrigerated BL URINES: 10 ML URINE YELLOW TUBE BL URINES: 10 ML URINE YELLOW TUBE BL URINES: 10 ML URINE YELLOW TUBE BL URINES: 10 ML URINE YELLOW TUBE BL URINES: 10 ML URINE YELLOW TUBE BL URINES: 10 ML URINE YELLOW TU (Acceptable) Refrigerated Bladder Urines: 4 milliliters of urine grey tube A (Acceptable) -Urine that has been refrigerated: UR CUP/GREY (Acceptable) The following urines are available in refrigerated storage: URINE CUP R (Acceptable) -Refrigerated Urine coloration: UR YELLOW/GREY (Preferred) Refrigerated URINE: 10ML URINEYELLOW TUBE -Refrigerated (Acceptable) Urine GREY TUBE A 4 ML URINE GREY TUBE A (Refrigerated) (Acceptable) REFRIGERATED BRUSHES: UR CUP/GREY BRUSHES (Acceptable) -URINE CUP R: URINE CUP R: URINE CUP R: URINE CUP R: (Acceptable) The following GM urines are available in refrigerated form: UR YELLOW/GREY (Preferred) -Refrigerated GM URINES: 10 ML URINE YELLOW TUBE, 10 ML URINE RED TUBE (Acceptable) The following GM urines are available in refrigerators: 4 ML GREY TUBE A (URINE GREY) (Acceptable) -RefrigeratedGM URINES: UR CUP/GREY UR CUP/GREY (Acceptable) -GM URINES: URINE CUP R, URINE CUP R, URINE CUP R (Acceptable) The following colors are available in refrigerated KL URINES: UR YELLOW/GREY (Preferred) -KL URINES: 10 ML URINE YELLOW TUBE (refrigerated) (Acceptable) -KL URINES: 4 ML URINE GREY TUBE A -RefrigeratedKL URINES: 4 ML URINE GREY TUBE A (Acceptable) -KL URINES: UR CUP/GREY (refrigerated) (Acceptable) RefrigeratedKL URINES: URINE CUP R URINE CUP R (Acceptable) Refrigerated LH URINES: URYELLOW/GREY URINE (Preferred) -LH URINES: 10 ML URINE YELLOW TUBE REFRIGERATED (Acceptable) -RefrigeratedLH URINES: 4 ML URINE GREY TUBE A 4 ML URINE GREY TUBE A (Acceptable) Refrigerated LH URINES: UR CUP/GREY URINE (Acceptable) CUP R URINE: URINE CUP R REFRIGERATED LH URINES: (Acceptable) -Urine that has been refrigerated: UR YELLOW/GREY (Preferred) The following items are required for refrigeratedPH URINES: 10ML URINE YELLOW TUBE (Acceptable) RefrigeratedPH URINES: 4 ML UROGEN GREY TUBE A -RefrigeratedPH URINES: (Acceptable) -RefrigeratedPH URINES: UR CUP/GREY UR CUP/GREY (Acceptable) Urine CUP R (refrigerated) is an abbreviation for urine cup (Acceptable) The following RC urines are available in refrigerated condition: UR YELLOW/GREY (Preferred) The following items are required for refrigeratedRC urines: 10ML URINE YELLOW TUBE (Acceptable) -RefrigeratedRC URINES: 4 ML URINE GREY TUBE A, 4 ML URINE GREY TUBE B, 4 ML URINE GREY TUBE C, 4 ML URINE GREY TUBE D, 4 ML URINE GREY TUBE E (Acceptable) RefrigeratedRC URINES: UR CUP/GREY UR CUP (Acceptable) -URINE CUP R: URINE CUP R: URINE CUP R: URINE CUP R: (Acceptable) Refrigerated UN URINES: URYELLOW/GREY URINE (Preferred) -RefrigeratedUN URINES: 10 ML URINE YELLOW TUBE -RefrigeratedUN URINES: 10 ML URINE YELLOW TUBE (Acceptable) Urine GREY TUBE A 4 ML Urine GREY TUBE A (Refrigerated) (Acceptable) Refrigerated urines: UR CUP/GREY URINE (Acceptable) -URINE CUP R: URINE CUP R: URINE CUP R: URINE CUP R: (Acceptable) RefrigeratedZH URINES: Ur Yellow/Grey (UR YELLOW/GREEN) (Preferred) -ZH URINES: 10 ML URINE YELLOW TUBE (refrigerated) (Acceptable) RefrigeratedZH URINES: 4 ML URINE GREY TUBE A 4 ML URINE GREY TUBE A (Acceptable) -Urine that has been refrigerated: UR CUP/GREY (Acceptable) The following urines are refrigerated: URINE CUP R (Acceptable) -Refrigerated

Urinalysis – Mayo Clinic

A urinalysis is a test that is performed on your pee. Urinary tract infections, renal illness, and diabetes are just a few of the conditions for which it is used to diagnose and treat patients. A urinalysis is a procedure that involves examining the appearance, concentration, and content of urine samples. An infection of the urinary system, for example, might cause urine to appear hazy rather than clear. In certain cases, increased amounts of protein in the urine might indicate the presence of renal disease.

Why it’s done

A urinalysis is a frequent test that is performed for a variety of reasons, including:

• In order to assess your general health. It is possible that a urinalysis will be performed as part of a standard medical exam, pregnancy checkup, or pre-surgical preparation. When you’re admitted to a hospital, it may be used to screen for a number of problems, such as diabetes, renal disease, or liver disease
• Or it might be used to screen for a variety of disorders, such as cancer. In order to determine the existence of a medical problem. If you are experiencing stomach discomfort, back pain, frequent or painful urination, blood in your urine, or any other urinary issues, your doctor may recommend a urinalysis. A urinalysis can aid in the identification of the underlying cause of these signs and symptoms. In order to keep track of a medical condition. After being diagnosed with a medical problem, such as kidney disease or a urinary tract infection, your doctor may recommend testing your urine on a regular basis to keep track of your progress and treatment.

For the purpose of determining your overall well-being, If you’re having a standard medical exam, a pregnancy checkup, or pre-surgery preparation, you may be asked to have a urine test done. While in the hospital, it may be used to screen for a number of illnesses, such as diabetes, kidney disease, or liver disease; alternatively, it may be used to screen for a variety of disorders, such as diabetes, kidney disease, or liver disease; A medical issue must be identified in order to be treated effectively.

When certain indications and symptoms are present, a urine test can be used to determine the source of the problem; A medical condition is being watched over.

How you prepare

In order to determine your overall health. It is possible that a urinalysis will be performed as part of a standard medical exam, pregnancy checkup, or pre-surgery preparation. When you’re admitted to a hospital, it could be used to test for a range of illnesses, such as diabetes, renal disease, or liver disease. To determine the existence of a medical problem. If you are experiencing stomach discomfort, back pain, frequent or painful urination, blood in your urine, or other urinary issues, your doctor may recommend a urinalysis.

To keep track of a medical condition.

What you can expect

You may choose to collect a urine sample at home or at the office of your health-care provider. Typically, providers hand out containers for collecting urine samples. It is possible that you may be requested to collect the sample at your residence first thing in the morning, when your pee will be at its most concentrated.

It is possible that you will be required to collect the sample in the middle of the process, utilizing a clean-catch approach. The following are the stages involved in this method:

• Cleanse the entry of the urine bladder. Women should spread their labia and clean from the front to the back of their bodies. Men should clean the tip of their penis with a damp cloth. start using the toilet and urinating into it Pass the collecting container into your urine stream
• This will help to prevent infection. Fill the collection container with at least 1 to 2 ounces (30 to 60 milliliters) of urine
• Complete your urination in the toilet
• Deliver the sample in accordance with the instructions provided by your health care practitioner. Refrigerate the sample if it cannot be delivered to the specified place within 60 minutes after its collection, unless your provider has instructed otherwise.

Cleanse the entry of the urinary tract. Spreading the labia and cleaning from front to back should be the norm for females. Wiping the tip of the penis is recommended for men. start using the toilet and urinating in it Fill your urine stream with the collecting container, and then flush it out. Fill the collection container with at least 1 to 2 ounces (30 to 60 milliliters) of urine. To complete the urination into the toilet, flush the toilet. Your health-care professional will instruct you on how to provide the sample.

Results

An examination of your urine sample using three methods is performed during a urinalysis. These methods are: visual examination; dipstick examination; and microscopic examination.

Visual exam

The look of the urine is examined by a lab professional. Urine is usually clear in color. The presence of cloudiness or an odd odor may suggest the presence of a condition such as an infection. The presence of protein in urine might cause it to appear frothy. The presence of blood in the urine might cause it to appear red or brown. Urine color might be affected by what you’ve eaten recently as well as by some medications you’re taking. Beets and rhubarb, for example, may cause your urine to become crimson.

Dipstick test

A dipstick — a small, plastic stick with chemical strips attached to it — is inserted into the urine sample. The color of the chemical strips changes if specific compounds are present or if their concentrations are higher than normal limits. A dipstick test looks for the following things:

• Acidity is a term used to describe the state of being acidic (pH). In urine, the pH level shows the quantity of acid present in the urine. In some cases, a high pH level might suggest a kidney or urinary tract disease
• Concentration The concentration of the particles in your urine may be determined by measuring the concentration of the particles. A greater than usual concentration is frequently caused by a lack of fluid intake
• Protein intake is also inadequate. Protein concentrations in urine are typically low. In most cases, small increases in protein in urine are not a cause for worry, but bigger quantities may signal a kidney disease
• Sugar. Most of the time, the amount of sugar (glucose) present in urine is insufficient to be identified. Following the finding of sugar on this test, it is common for follow-up testing for diabetes and ketones to be performed. Ketones found in your urine, like sugar, might be an indication of diabetes and necessitate more testing
• Bilirubin is one such test. Bilirubin is a byproduct of the destruction of red blood cells. Normally, bilirubin is transported via the bloodstream and into the liver, where it is excreted and absorbed as part of the bile. The presence of bilirubin in your urine might suggest liver damage or illness
• It could also be an indication of an infection. In your urine, the presence of nitrites or leukocyte esterase – a product of white blood cells — may suggest a urinary tract infection
• Blood may be present. Additional testing is required if you have blood in your urine. Symptoms of kidney damage or infection, kidney or bladder stones, kidney or bladder cancer, and blood abnormalities can all be seen with this condition.

Microscopic exam

This test, which is sometimes done as part of a urinalysis, involves looking via a microscope at droplets of concentrated pee — urine that has been spun in a machine — to look for signs of infection. If any of the following levels are much higher than typical, you may require further testing:

• The presence of white blood cells (leukocytes) may indicate the presence of an infection. If you have high levels of red blood cells (erythrocytes), it might indicate that you have renal illness. It could also indicate that you have a blood issue or some underlying medical condition such as bladder cancer. Infection is indicated by the presence of bacteria, yeast, or parasites. Casts, which are tube-shaped proteins, can develop as a result of renal disease. In some cases, crystals formed by chemicals in urine may be an indication of kidney stones.

A urinalysis by alone does not generally yield a definitive diagnosis in most cases. Depending on the reason your physician ordered this test, you may require follow-up if the findings are out of the ordinary. The findings of the urinalysis, in conjunction with the results of other tests, can assist your provider in determining the next steps. You should never assume that you are not sick just because you have normal test results from your urinalysis. It is possible that the sickness is detected too early, or that your urine is overly diluted.

Consult with your health-care practitioner for further information on the significance of your urinalysis findings.

Interpreting Culture Results – Part 1: Urinalysis and Urine Cultures

In clinical practice, interpreting culture data and laboratory testing has long been the bread and butter of the profession. Basic chemistry is pretty straightforward, and current lab result sheets include a convenient reference that displays the upper and lower limits of what is considered ‘normal’ readings as well as the higher and lower limits of what is considered abnormal. The interpretation of culture results, on the other hand, is more difficult.

This series will cover the specifics of urine cultures, blood and bodily fluid cultures, as well as other types of cultures, including those used to treat wounds and treat respiratory infections. Let’s start with a discussion of urine cultures.

Interpreting Urine Cultures

For many years, the interpretation of culture data and laboratory testing was the mainstay of clinical treatment. Modern lab result sheets have a useful reference that illustrates the upper and lower ranges of ‘normal’ values, which makes it easy to understand the fundamentals of chemistry. Nevertheless, interpreting culture results might be difficult. In this series, we will cover the intricacies of urine cultures, blood and bodily fluid cultures, and other cultures, such as wound and respiratory cultures, in greater detail than previously.

Specimen Collection

First and foremost, in order to address urine cultures, we must first consider specimen collection as well as the possibility of contamination. It is only by the use of a sterile, suprapubic percutaneous bladder tap that the possibility of contamination of the urine sample may be fully eliminated from consideration. However, in clinical practice, this is not a viable alternative, therefore let’s move on from this point. The urethral catheterization procedure, which takes a sample of urine straight from the bladder, would be the next step in the aseptic collection process.

It is the ‘clean capture’ midstream specimen that is the most often used sample collecting method.

For uncircumcised men, it is essential to retract the foreskin, and for women, it is necessary to remove the labia away from the urethral entrance in order to prevent contamination of the samples with cells from the vaginal mucosa or skin.

Urinalysis Assessments

Now that we have a decent specimen, let’s talk about how to interpret the urinalysis results. The dipstick method, in which a test strip is dipped into a urine sample for a predetermined period of time and then either’read’ by a colorimetric machine or compared to a standardized chart that is included with the kit, is used to perform the vast majority of urinalysis tests. In this case, the pH, specific gravity, protein content, WBC count, and presence of Leukocyte Estrace and Nitrite will all be determined by the urine test results.

• All of these information can assist the attentive clinician in determining whether or not the patient is likely to have a urinary tract infection and whether or not a urine culture should be performed.
• Although leukocyte esterase is a consequence of the presence of white blood cells in the urine (pyuria), it does not always indicate the presence of an active urinary tract infection.
• In both men and women, the presence of nitrite in the urine is a far more reliable indicator of urinary tract infection.
• However, not all urinary bacteria do this, thus a negative nitrite test does not rule out the possibility of a UTI.
• The converse is true: drugs that can cause a red colour in the urine, such as AZO, Pyridium, and beets, can result in an incorrectly positive nitrite test result.
• Several possible problems must be addressed before to proceeding with the evaluation of the culture data.
• First and foremost, the presence of bacteria in the urine does not always imply active infection, particularly in the asymptomatic patient, as previously stated.

We won’t go into detail about these things here, but I want to make certain that they are included in your differential compensation.

To culture or not to culture?

What do you think? Do we need to culture the urine because we have a UA from a symptomatic patient that shows infection? Patients who have characteristic UTI symptoms without signs of pyelonephritis on physical examination, as well as those who have often recurring UTI, are unlikely to require a culture. However, if they have a history of recurring urinary tract infections (UTIs), or if they have UTIs that are difficult to cure and require numerous rounds of antibiotics, a culture is recommended.

Interpreting Culture Results

What do you think? Do we need to culture the specimen because we have a UA from a symptomatic patient that shows infection? It is unlikely that the patient will require culture if they have characteristic UTI symptoms without signs of pyelonephritis on physical examination and do not have a history of often recurring UTI. An infection culture, on the other hand, is recommended if the patient has had repeated urinary tract infections (UTIs) or if the infection has been difficult to cure and has required many rounds of antibiotics.

Beyond the Automatic Reflex

Remember what I said earlier about the instinctive impulse to culture from hospital laboratories? Well, remember that bit too. Even if the patient has no particular urinary symptoms or complaints, what happens when you acquire a UA as part of a generic “abdominal discomfort” workup and the patient has 2+ WBC, is positive for leukocyte esterase and has 3+ Squamous epithelial cells? This is the type of sample that is usually used for automated culture and is regularly reflexed. As a result of your meticulous approach to the patient’s history and examination, as well as your interpretation of the UA, you have established that the patient does not have a UTI and that the sample in question is tainted.

coli, what should you do next in this situation?

As long as they are not experiencing any urine symptoms, are afebrile, and generally stable, this may indicate that the patient has a contaminant, and the patient may be encouraged to return for another urinary assessment.

Know the Nuances

Keep in mind what we said earlier about the reflexive response to culture that happens in hospital laboratories? Even if the patient has no particular urinary symptoms or complaints, what happens when you acquire a UA as part of a generic “abdominal discomfort” workup and the patient has 2+ WBC, is positive for leukocyte esterase and has 3+ Squamous Epithelial Cells? In automatic culture, this is the type of sample that is most commonly reflexed. As a result of your meticulous approach to the patient’s history and examination, as well as your interpretation of the UA, you have established that the patient does not have a UTI and that the sample has been tampered with.

coli, what should you do next remains unclear.

As long as they are not experiencing any urinary symptoms, are afebrile, and generally stable, this may indicate that the patient has a contaminant and that they should be seen for a repeat UA.

A course of antibiotics is certainly indicated if they have begun to experience signs of a urinary tract infection.

Urinalysis, Complete, with Reflex to Culture

Bacteria are single-celled organisms that are capable of reproducing. The vast majority of bacteria will not harm you; fewer than one percent of the various varieties will cause illness. There are many who are helpful. Some bacteria aid in the digestion of food, the destruction of disease-causing cells, and the provision of essential vitamins to the body. Infectious microorganisms, on the other hand, can make you sick. In your body, they replicate at a rapid pace. Many of them release substances known as toxins, which can cause tissue damage and make you unwell.

coli are just a few of the bacteria that may cause illnesses.

Bilirubin

Bacteria are single-celled organisms that are capable of reproducing in the absence of an external environment. It is estimated that less than 1% of the many bacteria kinds are harmful to human health. Numerous people can be of assistance. A number of bacteria aid in digestion, the destruction of disease-causing cells, and the provision of essential vitamins to the body. Infected germs, on the other hand, can cause illness. In your body, they proliferate at a rapid pace. There are several that release substances known as toxins, which can cause tissue damage and even illness in certain people.

coli are only a few of the bacteria that cause illnesses.

Calcium Oxalate Crystals

Calcium oxalate is a chemical substance that crystallizes in the form of envelope-shaped spheres. Human kidney stones contain a significant amount of this substance.

Casts

Urinary casts are cylindrical formations created by the kidney that can be seen in the urine of patients suffering from certain diseases. They originate in the distal convoluted tubule and collecting ducts of nephrons, then detach and move into the urine, where they may be discovered using a microscopical technique (see below).

Color

Crystals in the urine may arise as a consequence of a disease or as a result of normal catabolism, depending on the situation.

Glucose

In a blood glucose test, the quantity of a sugar known as glucose present in a sample of your blood is determined. For most cells in the body, including those in the brain, glucose serves as a key source of fuel for energy production. Insulin and glucagon are two hormones that aid in the regulation of blood glucose levels.

Granular Cast

In addition to being the second most common type of cast, granular casts can be formed either by breaking down cellular casts or by incorporating large aggregates of plasma proteins (e.g, albumin) or immunoglobulin light chains into cellular casts. It is possible to classify inclusions as fine or coarse depending on their size, albeit this distinction has no diagnostic value. Compared to hyaline casts, their look is often more cigar-shaped, and they have a higher refractive index. They are most typically associated with chronic renal illness, but, like hyaline casts, can also be observed for a brief period of time after severe activity.

Hyaline Cast

Urinary casts are microscopic tube-shaped particles that are seen in the urine. Depending on their composition, urine casts may contain white blood cells, red blood cells, kidney cells, or other compounds such as protein or fat. Hyaline casts, the most frequent form of cast, are made of solidified Tamm-Horsfall mucoprotein, which is released by the tubular epithelial cells of individual nephrons and hardened over time. Low urine flow, concentrated urine, and an acidic environment can all lead to the creation of hyaline casts, which can be seen in healthy persons who are dehydrated or engaged in strenuous physical activity, among other things.

In addition to being cylindrical and transparent, hyaline castings have a low refractive index.

Ketones

Ketones are chemicals formed in the liver as a result of the breakdown of fat cells in the bloodstream. A serum ketone test is a method of determining the amount of ketones present in the blood.

Leukocyte Esterase

The test searches for concealed (occult) blood in a sample of a specimen under examination. It is capable of detecting blood even if you are unable to see it yourself.

Ph

Acidity at a certain point

Protein

Body fluids include a wide variety of proteins that perform a variety of activities, including the transportation of nutrients, the elimination of toxins, the regulation of metabolic processes, and the defense against intruders. Protein electrophoresis is a technique for separating proteins depending on the size and electrical charge of the proteins being separated. In the presence of a protein mixture, when blood and bodily fluids are separated by electrophoresis, they exhibit a distinctive pattern of bands of varying widths and intensities, which is indicative of the protein mixture present.

Albumin is the most abundant fraction.

In the blood, albumin, which is generated by the liver, accounts for approximately 60% of total protein in the bloodstream.

With the exception of immunoglobulins and a few complement proteins, the liver is also responsible for the production of the majority of globulins.

Rbc

RBCs carry hemoglobin, which is responsible for the transportation of oxygen. The number of red blood cells (RBCs) in your body and the efficiency with which they function determine how much oxygen your bodily tissues receive.

Reducing Substances

The mineral struvite (ammonium magnesium phosphate, NH4MgPO4H2O) is found in around 10–15 percent of urinary calculi. Struvite stones are made of triple phosphate and magnesium ammonium phosphate. When urea-splitting bacteria infect the body, the formation of struvite stones (sometimes referred to as “infection stones”, urease or triple-phosphate stones) occurs most frequently as a result of infection.

Uric Acid Crystals

Crystals in the urine may arise as a consequence of a disease or as a result of normal catabolism, depending on the situation.

WBC

WBCs are important in the fight against infections. They are referred to as leukocytes in some circles. There are five primary types of white blood cells: basophils, eosinophils, lymphocytes (T cells and B cells), monocytes, and neutrophils. Basophils are the most common form of white blood cell.

YEAST

Yeast is referred to as Candida in the scientific community.

It is a kind of fungus that may be found practically anywhere, including within your body. Normally, your immune system is effective at keeping yeast under control. It has the potential to proliferate and create an infection if you are unwell or taking medications.