Urine Test Strips for Uti How to Read

Urinalysis is an of import screening and diagnostic tool, but health professionals must know how to perform the exam and translate results correctly for it to be beneficial. The article comes with a cocky-assessment enabling yous to test your knowledge after reading it

Abstract

Analysing an individual's urine tin be a useful manner of detecting or ruling out some diseases and infections. Urinalysis can be undertaken in many ways, one of which is using a reagent stick. To be effective, the test must be performed properly and the results interpreted correctly. This article gives an overview of the most important aspects of this investigation, highlighting signs to look for and what they may mean.

Citation: Yates A (2016) Urinalysis: how to translate results.Nursing Times; Online issue 2, 1-3.

Author:Ann Yates is director of continence services, Cardiff and Vale Academy Wellness Lath.

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Introduction

Urine testing or urinalysis is a valuable tool to screen an patient and diagnose their wellness condition. Information technology provides valuable information about hydration, renal and urinary tracts, liver illness, diabetes mellitus and urinary-tract infections. Urine is formed in the kidneys and, through glomerular filtration, tubular reabsorption and tubular secretion, is how the torso gets rid of its natural waste products (Marieb and Hoehn, 2010). Urinalysis is easy to undertake simply results must be interpreted correctly.

Types of assay

There are different means of analysing urine and for unlike reasons, namely:

• 24-60 minutes drove: patient voids into toilet, and then all urine is collected for the next 24 hours. Equally the body chemistry alters constantly, this is used to measure substances, such every bit steroids, white cells, electrolytes or determine urine osmolarity (Tortora and Derrickson, 2009);
• First-morn specimen: first specimen of morning time (or eight hours after recumbent position). Best sample for pregnancy testing;
• Fasting specimen: the second voided specimen later on a period of fasting;
• Mid-stream urine (MSU): used to obtain urine for bacterial civilization. First and final function of urine stream is voided into the toilet to avoid contaminating the specimen with organisms presenting on the skin;
• Random specimen: for chemic or microscopic examination, a randomly collected specimen suitable for most screening purposes;
• Catheter specimen of urine: nerveless for bacteriological examination if a patient'southward symptoms suggest the presence of a UTI. The sampling technique used for collection is important (Baillie and Arrowsmith, 2005).

This commodity focuses on random specimen and MSU samples, and analysis using dipstick reagent strips.

Patient assessment/preparation

Urinalysis tin can potentially place the presence of life-irresolute weather condition, such as diabetes and renal disease. If abnormalities are detected, the individual may demand further investigations, then they should be accordingly counselled to understand the implications before providing a sample. This has to exist balanced against impairment that could be caused by a missed diagnosis if urinalysis is non done.

Approximately 50ml of urine is required for urinalysis. Adults and children who are continent and tin can empty their bladder should either provide a random sample or exist brash to provide an MSU sample. They should be mobile and dextrous enough to be able to do this, and be instructed in the technique to prevent contagion from hands or the genital area. Specific cleaning of the genital area seems not to touch contagion rates (Mousseau, 2001), but may be appropriate when personal hygiene is poor or faecal contamination is apparent.

Box 1 outlines the routine observations when undertaking urinalysis. The properties listed should exist considered in line with clinical presentation, fluid intake and urine output. Earlier testing the urine using a reagent dipstick strip, the observations listed should be completed. The post-obit factors can also affect results:

• Use a fresh sample of urine (preferably less than 4 hours onetime or in line with the reagent strip manufacturer'due south instructions to obtain accurate results. Bilirubin and urobilinogen are relatively unstable compounds when left in low-cal or at room temperature;
• Exposure of unpreserved urine to room temperature for a period of time can modify pH and increase micro-organisms. If it cannot exist tested immediately, the sample needs to exist stored in line with the reagent strip manufacturer'southward instructions or at 2-4°C and then brought to room temperature (15-20°C) before testing;
• Bacterial growth of contaminated organisms may produce positive blood reactions;
• Urine loftier in alkaline can show imitation positive results for protein;
• Presence of glucose may reduce pH;
• Presence of urea-splitting organisms may cause urine to go more alkaline (Dougherty and Lister, 2015).

Box 1. Routine observation of urine

Colour

This usually ranges from pale straw to deep amber, depending on concentration (Steggall, 2007).

• Dark urine: may point dehydration
• Brownish/dark-green or strong yellow: may indicate presence of bilirubin
• Green: may point presence of pseudomonas infection or excretion of cytotoxic drugs, such equally mitomycin
• Brilliant crimson/red-brown: may betoken presence of blood (haematuria). Menstruation should be ruled out in females

Certain food or drugs may as well influence color; beetroot tin produce a pink shade and rifampicin can turn urine orange/cherry-red.

Clarity

This is unremarkably referred to as clear, slightly cloudy, cloudy or turbid.

Substances that tin can cause cloudiness only are not harmful include mucus, sperm, prostatic fluid and skin cells. Other substances that make urine cloudy are white/ruby-red blood cells, pus or bacteria that need attention. Frothy urine signifies protein in the urine.

Odor

Freshly voided urine may accept a slight simply inoffensive odor.

• Fishy smell/ammonia: may indicate urinary infection
• "Pear drop" or acetone smell: may indicate presence of ketones, equally in diabetic ketoacidosis
• Some strongly flavoured foods can also produce an scent, eg asparagus

Standard urine-examination analysis

Many chemic reagent strips are available and differ between manufacturers. All detect a wide range of substances that can be identified in urine. The tests bachelor include those for substances that are:

• Produced by the body and naturally constitute in urine;
• Produced by the body and not commonly present in the urine;
• Not normally institute in the body.

The following test paddles are commonly featured on reagent strips: blood; bilirubin; urobilinogen; nitrite; leucocytes (white claret cells); protein; ketones; glucose; pH (a mensurate of how acidic or alkaline metal urine is); and specific gravity (relative density). It is important that the professional person undertaking the test understands the manufacturer'due south guidance before using the strip. Box 2 outlines the steps that should be followed when performing the urinalysis.

Box two. Urinalysis using chemical reagent strips

• Explain procedure to patient and gain consent
• Comply with infection-prevention principles: wash hands, use protective equipment
• Check expiry date on reagent-strip container and brand sure it has been stored in line with the manufacturer'south recommendations
• Suggest patient how to collect a fresh sample, preferably a mid-stream sample if possible, as stored urine tin give simulated results
• Remove reagent dipstick from container, taking care to bear on only the plastic handle; replace lid immediately
• Observe urine for colour and clarity, and so fully immerse reagent stick, so all reagent areas are covered. Concord for approximately two seconds. Remove strip from urine and tap on absorbent paper or against inside of urine container to remove excess urine
• Look for manufacturer's recommended fourth dimension to expire, holding strip in horizontal position to prevent interaction betwixt next examination pads
• Compare reagent strip against colour reference guide on outside of container (Fig ane, attached)
• If sample is not being sent to a laboratory for further investigations, dispose of urine, used strip, urine container and gloves, following local policy, and wash hands
• Document results, and inform doctor and patient; take advisable action every bit required

Significance of findings

Urine tests are frequently done in diverse settings, so it is vital that professionals understand how to interpret the common findings displayed on reagent strips and what they mean. This section will hash out each of the paddles identified on the strip.

Blood

Urine does not normally comprise blood detected by reagent strips. Blood in the urine is known as haematuria and can be subclassified equally follows:

• Macroscopic: large volumes of claret in the urine, which takes on a rose or dark colour, especially if left to stand;
• Microscopic: undetectable to the naked eye; reagent strips or a microscope are needed to identify it.

Blood can enter urine via damage to the filtration bulwark in the kidneys that normally prevents claret from entering the urine or considering of an abnormality to the structures that unremarkably drain urine from the kidneys, store urine (bladder) or ship urine outside (urethra) (Bryant and Catto, 2008). Claret in the urine can be indicative of kidney illness; inflammatory lesions of the urinary tract (infection or cancer); renal damage; or kidney/renal stones.

Information technology tin as well point a claret-clotting disorder or be a side-issue of anticoagulant drugs. Health professionals should besides remember that urine tin be contaminated with menstrual blood. Goddard et al (2010) highlighted that in about patients investigated for haematuria, no real presence of an underlying crusade could exist institute and the haematuria was put down to a benign cause. Still, as serious weather cannot be identified unless investigated, it is important that haematuria is appropriately investigated unless a sensible reason, such as menstruation, tin be identified.

Bilirubin and urobilinogen

Bilirubin is a chemical produced when reddish blood cells are broken down. It is transported in the claret to the liver, where it is processed and excreted into the gut as a constituent of bile. In the gut, bacteria acts on the bilirubin to transform it into urobiligen. Information technology is usual for urine to comprise urobiligen merely not bilirubin. Bilirubin in the urine may exist an indicator of a breakdown of cherry blood cells. It may not be effectively removed by the liver, which may suggest liver disease or a problem with drainage of bile into the gut, such as gall stones.

Nitrites

Nitrites are non commonly plant in urine and are associated with the presence of leaner that can catechumen nitrate into nitrite. The presence of nitrites tin exist suggestive of a UTI but clinical presentation of symptoms should also exist taken into business relationship. The absenteeism of nitrites, however, does non always dominion out the presence of a UTI; Devillé et al (2004) identified that in approximately 50% of urine samples containing bacteria, the nitrites test was negative.

Leucocytes (white blood cells)

In urine, leucocytes are normally associated with a urinary infection but sometimes may signal a more astringent renal problem (Steggall, 2007). When white blood cells are present in the urine, patients are said to have pyuria (pus in the urine). To found the cause, a make clean-catch urine sample should be examined under a microscope, cultured to encounter what bacteria grows and tested for sensitivity to constitute antibody treatment. Where no bacterial cells are detected, the patient is said to have sterile pyuria; this can occur in tuberculosis and inflammatory illness of the kidneys (Higgins, 2007).

Poly peptide

In a healthy person, urine does not contain a level of poly peptide that is detectable on a urine reagent strip. This is due to the protein molecules being besides large to pass through the glomerular filtration barrier. When protein can pass through this barrier, information technology is known as proteinuria. Proteinuria tin be acquired by many things, such as harm or disease to the glomerular filtration barrier; hypertension; kidney damage; diabetes mellitus; and pre-eclampsia (Mulryan, 2011). Specific investigations will be required to detect the cause of proteinuria.

Ketones

These are chemicals that are formed during the abnormal breakdown of fat and are non normal constituents of urine. Breakdown of fatty may result from prolonged vomiting, fasting or starvation; individuals on a diet or who present with diarrhoea and vomiting may have a positive result. Ketones tin also exist present in the urine of people with poorly controlled diabetes. This tin can brand the blood more acidic and is known as diabetic ketoacidosis; information technology should be reviewed urgently by a physician. Some medications, such as captopril, may also produce a faux positive issue (Steggall, 2007).

Glucose

Glucose in the urine (glycosuria) can occur in pregnancy or patients taking corticosteroids. It may also be indicative of diabetes mellitus but is not a normal elective of urine. Although glycosuria is an indication of endocrine aberration, it is not diagnostic and further investigation, such as fasting blood tests, may be required.

pH

This is a measure of acerbity or alkalinity in urine. All urine will give a pH reading on analysis and it is normally slightly acidic. A range of 5.0-8.0 is considered normal (Higgins, 2007). Acidic urine may point formation of urinary stones, while alkali metal urine may signal a UTI with certain types of bacteria, such as Proteus mirabilis, Klebsiella or Pseudomonas (Higgins, 2007). Notwithstanding, pH is besides affected by diet; a high poly peptide intake tin can requite rise to acidic urine, whereas a loftier intake of dairy products or vegetables tin give ascent to alkaline urine. UTIs and medication can also result in alkaline urine. Results should be interpreted in conjunction with an individual's specific presentation.

Specific gravity (SG) (relative density)

Urine tin range from very diluted to very concentrated; its density is measured confronting pure water at room temperature and pressure level. Specific gravity identifies the hydration of an individual – a well-hydrated person volition have diluted urine whereas someone who is dehydrated will present with full-bodied urine. The normal range of specific gravity is 1.001-1.035.

Diluted urine could occur in an individual who has high fluid intake; diabetes insipidus; hypercalcaemia; endocrine disorders, such every bit kidney affliction; or failed to produce anti-diuretic hormone.

Concentrated urine can be the event of dehydration. When assessing specific gravity, ecology factors such equally temperatures should be taken into account.

Conclusion

Urinalysis using a dipstick reagent strip is an constructive screening tool to assess the health condition of an individual and detect some diseases and infections. It is important that professionals empathize methods for collecting urine, limit the risk of contamination by using reagent strips correctly and accurately interpret results.

Central points

• Urinary dipstick reagent strips are a quick, constructive screening assistance to urinalysis
• Nursing staff should sympathize the importance of examining urine for colour, clarity and smell earlier undertaking dipstick assay
• Urine tin be collected in unlike ways to limit contamination
• Nursing staff should be able to bear out the procedure correctly and accurately interpret the results
• Different components of the reagent strip have different clinical implications

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Devillé W et al (2004) The urine dipstick exam useful to rule out infections. A meta-analysis of the accurateness. BMC Urology; 4: 4.

Dougherty L, Lister S (2015) The Purple Marsden Infirmary Manual of Clinical Nursing Procedure. Chichester: Wiley-Blackwell

Goddard J et al (2010) Kidney and urinary tract disease. In: Colledge NR et al (eds) Davidson'due south Principles and Do of Medicine. London: Churchill Livingstone.

Higgins C (2007) Agreement Laboratory Investigations: for Nurses and wellness professionals. Oxford: Blackwell Publishing.

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Mousseau J (2001) Contamination of urine specimens from women with acute dysuria did not differ with collection technique. Show Based Nursing; iv: 46.

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Steggall MJ (2007) Urine samples and urinalysis. Nursing Standard; 22: fourteen, 42-45.

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