Test Code UMAC Urinalysis, Macroscopic
Additional Codes
St. Luke's Compendium Code (Iatric): L800.0025
Performing Laboratory
St. Lukes Hospital Laboratory
Methodology
Arkray Uriflet S, 9HA Test Strips
Chemical Methods Include:
Glucose: glucose oxidase-peroxidase-chromogen reaction
Protein: protein-error reaction of pH indicator
Bilirubin: coupling of bilirubin with a diazonium salt
Urobilinogen: coupling of urobilinogen with a diazonium salt
pH: pH indicator
Blood: pseudoperoxidase activity of hemoglobin with catalyzes the oxidation of chromogen
Ketones: sodium nitroprusside
Nitrite: reacts with sulfanilamide to form a diazo compound which couples with NEDA-2HCl to form a red azo dye
Leukocytes: indoxyl reacts with diazonium salt
Includes glucose, protein, bilirubin, urobilinogen, pH, blood, ketones, nitrite, and leukocytes.
Specimen Requirements
Submit only 1 of the following specimens:
Catheterized
1. Avoid sending urine that has remained stagnant in catheter
tubing for any length of time, do not send catheter bag urine, and
avoid sending urine from catheters that have been in place longer
than 5 to 9 days.
2. Clean catheter with an alcohol sponge, puncture with sterile
needle, and collect in sterile syringe.
3. Pour 12 mL of urine into a screw-capped, sterile container.
Mix well.
4. Label container with two patient
identifiers: patient’s name (first and last), patient's
date of birth, date and actual time of collection, and type
of specimen.
5. Send specimen refrigerated. Maintain sterility and forward
promptly.
Note: Specimen source is required on request
form for processing.
Clean-Catch, Midstream
1. Collect a clean-catch, midstream urine specimen (12 mL of urine)
as follows:
Males
A. Prepare obstetrical Towelette® by opening packages (do not
remove Towelette® until ready to use), and place on sink. Take
top off of plastic urine container, and set on edge of sink. Set
Towelettes® and container so they can be reached while
urinating.
B. Holding back foreskin with 1 hand, if necessary, use first
Towelette® to wash end of penis. Discard Towelette® in
wastebasket.
C. Continue holding back foreskin and gently rinse end of penis
using second and third Towelette®, discarding them in
wastebasket when done.
D. Continue holding back foreskin and begin to urinate into
toilet.
Females
A. Prepare obstetrical Towelette® by opening packages (do not
remove Towelette® until ready to use), and place on sink. Take
top off of plastic urine container, and set on edge of sink. Set
Towelettes® and container so they can be reached while
urinating.
B. With 2 fingers of 1 hand, hold outer folds of vagina apart. With
other hand, gently wash vaginal area from front to back, using
first Towelette®. Discard Towelette® in wastebasket.
C. Still holding outer vaginal skin away from opening through which
urination takes place, rinse area from front to back using
Towelette® #2, discard, and repeat with Towelette® #3.
D. Continue holding outer vaginal folds apart and begin to urinate
into toilet. Lean slightly forward so that urine flows directly
down without running along skin.
2. After first few teaspoons, place screw-capped, sterile urine
container under stream of urine and collect as much urine as
possible (minimum volume: 12 mL).
3. After finishing, tighten cap on container securely, and wash
any spilled urine from outside of container.
4. Label container with patient’s name (first and last), date
and actual time of collection, and type of specimen.
5. Send specimen refrigerated. Maintain sterility and forward
promptly.
Note: Specimen source is required on request form for processing.
Suprapubic Aspirate
1. Be sure at least 4 to 6 hours have elapsed since last
urination.
2. Clean suprapubic skin with iodine followed by alcohol.
3. Insert 22-gauge needle attached to a 20-mL syringe into skin
at about a 30° angle to abdominal wall, immediately
superior to the symphysis in midline.
4. Aspirating as one penetrates, stop as urine is obtained.
Fill syringe with 12 mL of urine (infants may require a
smaller syringe and needle).
5. Place specimen in a screw-capped, sterile container.
6. Label container with patient’s name (first and last), date
and actual time of collection, and type of specimen.
7. Send specimen refrigerated. Maintain sterility and forward
promptly.
Note: Specimen source is required on request
form for processing.
U-Bag Collection
1. Carefully cleanse and dry urethral area.
2. Place U-bag urine specimen collector over child’s perineum.
3. Collect urine.
4. Transfer 12 mL of urine to a screw-capped, sterile container.
5. Label container with patient’s name (first and last), date and actual time of collection, and type of specimen.
6. Send specimen refrigerated. Maintain sterility and forward
promptly.
Note: Specimen source is required on request
form for processing.
Reference Values
Glucose: negative
Blood: negative
Bilirubin: negative
Ketones: negative
Protein: negative
Urobilinogen: 0.2-1.0 EU/dL
Nitrate: negative
Leukocyte esterase: negative
Interfering Substances:
Color: Drugs containing azo dyes (eg, pyridium, azo gantrisin, azo gantanol) nitrofurantoin (macrodantin, furadantin) and riboflavin, may affect the readability of reagent areas on urinalysis reagent strips. The color development on the pad may be masked, or a color reaction may be produced on the pad that could be interpreted visually and/or instrumentally as a false-positive result.
Glucose: Ascorbic acid concentrations of ≥50 mg/dL may cause a false-negative result for a specimen containing small amounts of glucose (75-125 mg/dL). Ketone bodies reduce the sensitivity of the test: moderately-high ketone levels (40 mg/dL) may cause a false-negative result for a specimen containing small amounts of glucose (75-125 mg/dL) but the combination of such ketone levels and low glucose levels is metabolically improbable in screening. The reactivity of the glucose test decreases as the specific gravity of the urine increases.
Bilirubin: Indican can produce a yellow-orange to red color response that may interfere with the interpretation of a negative or positive bilirubin reading. Metabolites of iodine may cause false-positive or atypical results: ascorbic acid concentrations of ≥25 mg/dL may cause a false-negative result.
Ketone: False-positive results (less than a trace) may occur with highly pigmented urine specimens or those containing large amounts of levodopa metabolites. Compounds such as mesna that contains sulfhydryl groups may cause false-positive results or an atypical color reaction.
Specific gravity: The chemical nature of the AMES specific gravity test may cause slightly different results from those obtained with other specific gravity methods when elevated amounts of certain urine constituents are present. Highly buffered alkaline urines may cause low readings relative to other methods. Elevated specific gravity readings may be obtained in the presence of moderate quantities (100-175 mg/dL) of protein.
Blood: Elevated specific gravity may reduce the reactivity of the blood contaminants, such as hypochlorite, may produce false-positive results. Microbial peroxidase associated with urinary tract infection may cause a false-positive reaction. Levels of ascorbic acid normally found in the urine do not interfere with this test.
Protein: False-positive results may be obtained with highly buffered or alkaline urines. Contamination of the urine specimen with quaternary ammonium compounds (from some antiseptics and detergents) or with skin cleansers containing chlorhexidine may also produce false-positive results.
Urobilinogen: Atypical color reactions may be obtained in
the presence of high concentrations of p-aminosalicylic acid.
False-negative results may be obtained if formalin is present.
Strip reactivity increases with temperature. The test is not a
reliable method for the detection of porphobilinogen. The absence
of urobilinogen cannot be determined with this test.
Nitrates: A negative result does not in and of itself
prove that there is no significant bacteriuria. Negative results
may occur when urinary tract infections are caused by organisms
that do not contain reductase to convert nitrate to nitrite; when
urine has not been retained in the bladder long enough (≥4
hours) for reduction of nitrate to nitrite to occur, or when
dietary nitrate is absent, even if organisms containing reductase
are present and bladder incubation is ample. Sensitivity of the
nitrate test is reduced for urines with high specific gravity.
Ascorbic acid concentrations of ≥25 mg/dL may cause
false-negative results with specimens containing small amounts of
nitrite ion (≤0.06 mg/dL).
Leukocytes: Elevated glucose concentration (≤3 g/dL) or high specific gravity may cause decreased test results. The presence of cephalexin, cephalothin, or high concentrations of oxalic acid may also cause decreased test results. Tetracycline may decrease reactivity, and high levels of this drug may cause a false-negative reaction.
Day(s) Test Set Up
Monday through Sunday
Test Classification and CPT Coding
81003