Chemical Examination

Chemical Examination of Urine
By: Ken Kawakami, RMT, MLS(ASCPi)CM

@japanesejuan
Several colors or intensities of a color for each substance being

tested appear on the chart.
A semi quantitative value of each can be reported.
An estimate of the milligrams per deciliter present is available
for some of the parameters.
A color-producing chemical reaction takes place when the

absorbent pad comes in contact with urine.
The color reactions are interpreted by comparing the color

produced on the pad with a chart supplied by the
manufacturer.
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Introduction
Routine chemical examination of urine has changed
dramatically since the early days of urine testing, owing to the
development of the reagent strip method for chemical analysis.
The introduction of the reagent strip currently provide a simple,
rapid screening means for performing medically significant
chemical analysis of urine.
Reagent Strip
An inert plastic strip onto which reagent impregnated test
pads are bonded.
The following are the parameters analyzed using the urinalysis
reagent strip.
pH
Protein
Glucose
Ketones
Blood
Bilirubin
Urobilinogen
Nitrite
Leukocytes
Specific Gravity
Reagent strips consist of chemical impregnated absorbent
pads attached to a plastic strip.
Reagent Strip Technique

Testing Methodology
Dip the reagent strip completely (but briefly) into a wellmixed specimen
Remove excess urine by running the edge of the strip on
the container, test tube or absorbent pad
Wait for the specified time for reactions to take place
Compare color reactions against manufacturers chart
using a good light source
TIPS!
Improper technique can result in error.
RBCs and WBCs sink to the bottom of the specimen
Do not allow the strip to remain too long with the
specimen as this may cause removal of reagents
Excess urine that remains on the strip may cause
chemical run over, hence, distortion of colors
Manufacturers timing should be followed for best results
A good light source is required

@japanesejuan
The strip must be placed very near the color chart but
not making contact with it
Specimens that have been refrigerated must be brought
to room temperature first before actual testing
(enzymatic reactions are temperature dependent)
MTs who are severely color blind should not perform
reagent strip testing
Color masking by drugs and other substances my
interfere with readings (perform chemical testing instead)
Although ascorbic acid has the potential to adversely
affect several reagent strip test results, most
manufacturers use an iodate overlay to prevent this.
Specimens must be tested within 2 hours of collection
Handling and Storage

Strips must be protected from moisture, volatile
chemicals, heat and light
Desiccants should not be removed from the bottle
Strips should be removed prior to testing only and bottle
should be tightly sealed immediately
Bottles should not be opened in the presence of volatile
fumes
Reagent strip bottles should be stored per manufacturer
instructions (usually RT)
All reagent strips used should not be beyond expiration
date
Care should be taken not to touch reagent pads when
removing the strips
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Reporting can be done by:

1. In concentration (mg/dL)
2. Descriptive (small, moderate, large)
3. Plus system
Negative
Trace
1+
2+
3+
4+
4. Positive or Negative

@japanesejuan
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Tablet and Chemical Tests

Each tablet or chemical test must follow manufacturers
directions to ensure reproducible and reliable results
The laboratorian should know the following for each test
and compare it with reagent strip testing
Sensitivity
Specificity
Potential interferences
Chemical and tablet tests are generally performed
1. To confirm results already obtained by reagent strip
2. As an alternative method for highly pigmented urine
3. Because some are more sensitive for the substance
(e.g. Ictotest)
4. Specificity of the test differs from that of the reagent
strip (e.g. SSA, Hoesch)
Quality Control
Each bottle should be checked with a positive and negative
control
minimum once every 24 hours or when a new bottle is
opened
When there are questionable results
Concern about strip integrity
All quality control results should be documented
Distilled water should never be used as a negative control.
All negative controls should read negative.
All positive controls should agree one color block.
All QC results that do not agree should be documented and
resolved before proceeding with urine testing.
pH
Introduction:
The renal system, the pulmonary system, and blood buffers are
major regulators of acid-base content in the body. Through
secretion of Hydrogen in the form of:
1. Ammonium ions
2. Hydrogen phosphate
3. Weak organic acids
4. Reabsorption of bicarbonate
Normal pH of urine of a healthy individual:
First morning/average person: pH 5.0-6.0
after a meal more alkaline (alkaline tide)
Normal range: pH 4.5-8.0
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Urinary pH must be considered in conjunction with other patient

information such as:
1. Acid-base content of blood
2. Renal function
3. Infections
4. Dietary intake
5. Age of the specimen
Clinical Significance
An aid in determining the existence of systemic acidbase disorders
o Metabolic
o Respiratory
Management of urinary conditions
Aids in evaluation of kidney reabsorption or secretion
abilities
Calculi formation
Management of infections
Specimen viability

@japanesejuan
NOTES:
pH of greater than 8.0 or less than 4.5 are physiologically
impossible, hence, investigation required
if greater than 8.0
highly alkaline medications
urease producing bacteria present
following improper preservation
No known substance is known to interfere with pH pads

@japanesejuan
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Reagent strip reaction

PRINCIPLE: Double Indicator System
Most reagent strip pH pads measure urine pH in 0.5 or 1
unit increments from pH 5.0 to 9.0
A double indicator system is used to differentiate the pH
range
Methyl Red produces a color change from red
to yellow from pH 4 6
Bromthymol blue turns from yellow to blue in the
range pH 6 9
Color ranges from ORANGE at pH 5.0 through yellow and
green(ph 7.0) to a final deep blue at pH 9
Care must be taken to prevent run over from the protein

area as the latter is acidic and may give a false low pH
(false acidic) when testing alkaline urine
Protein
Introduction:
Of all chemical tests performed on urine, the most indicative of
renal disease is the protein determination. Presence of protein in
urine or proteinuria is almost always associated with early renal
disease.
Normal urine:
Less than 10mg/dL or 100 mg per 24 hours is excreted
Protein excreted is mostly made up of low molecular weight
serum proteins (filtered by the glomerulus and some proteins in
the genitourinary tract)
(Pre renal proteinuria)

Not an actual renal disease
Also called overflow proteinuria
Caused by conditions affecting plasma protein
Increased filtration and exceeds capacity of the renal
tubules to reabsorb resulting in an overflow
Usually transient
Caused by increased levels of:
Low molecular weight plasma proteins
Hemoglobin (after hemolytic episode)
Myoglobin (following muscle injury)
Acute phase reactants (inflammation and
infection)
*Usually not discovered in routine urinalysis since
the protein pad detects primarily albumin
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Major protein in urine: ALBUMIN

High concentration in plasma but low in urine because of the
filtration process (Most albumin cannot pass glomerulus and
those that pass are reabsorbed by the tubules)
Other proteins:
1. Serum and tubular microglobulins
2. Tamm-Horsfall protein by tubules
3. Prostatic protein
4. Seminal protein
5. Vaginal secretions
Demonstration of urine protein does not always signify
renal disease additional testing is required
Clinical proteinuria (>30mg/dL or 300mg/L)
o Pre renal
o Renal
o Post renal

@japanesejuan
Bence Jones Protein

An example of pre renal proteinuria (due to
increased serum protein levels)
Found in patients with Multiple Myeloma (a
proliferative disorder of plasma cells)
Excretion of a unique type of protein called Bence
Jones Protein which are immunoglobulin light
chains
Low molecular weight protein which exceeds the
tubular reabsorption capacity and is excreted in
urine
When BJP is suspected, a screening test is
performed:
Principle:
BJP has a unique solubility characteristic.
BJP coagulates when heated to 40C-60C and
dissolves at 100C.
Positive result: Turbid urine at 40C-60C and clear at
100C
Not all patients with Multiple Myeloma excrete BJP
Diagnosis of Multiple Myeloma should be
confirmed through serum electrophoresis and
immunoelectrophoresis

@japanesejuan
(Renal Proteinuria)
Proteinuria associated with TRUE RENAL DISEASE
Classified as either:
1. Glomerular Proteinuria
Happens when the glomerular membrane is
damaged
Selective filtration is impaired
A large amount of serum protein, RBCs and WBCs
pass through and are excreted in urine
Conditions that damage the glomerulus
o Amyloid material
o Toxic substances
o Immune complexes found in Lupus
erythematosus and Streptococcal GN
Other conditions but are reversible:
o Increased blood pressure / Hypertension
o Strenous exercise
o Dehydration
o Pregnancy (Pre-eclamptic states)
2. Tubular Proteinuria
Happens when the tubules are no longer capable
of reabsorbing normally filtered albumin
Causes of tubular proteinuria:
o Toxic substances / Heavy metals
o Severe Viral infections
o Fanconi Syndrome
Protein levels found in urine are slightly above
normal to 4g/day
Markedly increased urinary protein is seldom seen
in tubular proteinuria
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@japanesejuan
(Post Renal Proteinuria)

Protein that is added to urine ultrafiltrate as it passes
through the lower urinary tract
Ureter
Bladder
Urethra
Prostate
Vagina
Examples of post renal urinary protein causes:
Bacterial infections
Fungal infections
Inflammation (exudates)
Menstruation
Prostatic fluid
Semen
Other Renal Proteinuria:

1. Orthostatic (Postural) Proteinuria
Persistent benign proteinuria
Functional proteinuria
Occurs frequently in young adults
Called ORTHOSTATIC or POSTURAL because urinary
protein increases following periods in vertical position.
Urinary protein returns to normal when horizontal
position is assumed
Caused by pressure on the renal vein
Testing procedure:
Patient is requested to empty bladder before going to
bed and collect a specimen immediately upon arising in
the morning
A second specimen is collected after remaining in
vertical position for several hours
Positive result:
1st specimen is negative for protein and 2nd specimen is positive
2. Microalbumin
A predictive indicator of renal complications
Useful test for diabetic patients
Diabetic nephropathy leads to reduced glomerular
filtration and ends in renal failure (Type I and II
diabetes)
Microalbuminuria is also associated with increased risk
of cardiovascular disease
Detection of microalbumin before needed a 24

hour urine sample
o Results were reported in mg of albumin / 24
hours or AER (Albumin excretion) in ug/min
Newer testing methods use Enzyme immunoassays or
Immunochromographics
o Sensitivity: 0-10 mg/dL for EIA
o Sensitivity: 1.2-8.0 mg/dL for
Immunochromographics
Microalbumin is considered significant if found in urine
at 30 to 300mg albumin secreted in 24 hours or AER is
20-200 ug/min.
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NOTE:
Discovery of protein from random samples is not always
pathologic. Several cases are benign.
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Reagent strip reactions

Principle: PROTEIN ERROR OF INDICATORS
Colorimetric
Changes color in the presence of a certain protein and
not due to pH (pH held constantly at pH 3.0)
Albumin accepts hydrogen ions from the indicator
The test is sensitive to albumin compared to other
proteins because it has more amino groups to accept
hydrogen ions given by the indicator
Reagents:
o Tetrabromphenol blue or
3,3,5,5 tetrachlorophenol -3,4,5,6tetrabromosulfonphthalein
o Acid buffer (to maintain at an acidic pH)
At pH 3.0, indicators are yellow
As protein concentration increases, the color progresses
through shades of green and finally blue
Reported as
o NEGATIVE
o TRACE (usually less than 30mg/dL)
o 1+, 2+, 3+, and 4+
Semiquantitative reporting:
o 30 mg/dL
o 100 mg/dL
o 300 mg/dL
o 2000mg/dL

@japanesejuan

@japanesejuan
10
NOTE: Chemical confirmation of protein results:

o A very high protein result
o Urine is very alkaline
o
2 tests that test for protein other than reagent strip:
1. Sulfosalicylic Acid Precipitation Test
Cold precipitation test
Reacts with all types of protein
Methods vary amongst laboratories
Specimen should be supernatant of urine to remove
any extraneous proteins
Examples of protein that are precipitated but are not
clinically important: (False turbidity)
o Radiographic dyes (high specific gravity)
o Tolbutamide metabolites (Px history)

o Cephalosporins (Px history)
o Penicillins
o Sulfonamides
Highly alkaline urine may overcome acidity of SSA
less turbidity than it should or False negative results
o Use more concentrated SSA
SSA is sensitive to 5mg/dL to 10mg/dL protein
regardless of the type of protein present
When SSA is crystalline, radiographic contrast media
could be present and reagent strip results should be
reported
SSA should never be used to confirm protein results
from reagent strip testing because it lacks protein
specificity
2. Heat and Acetic method
a. Place 5-10mL of urine in a clean test tube
b. Boil upper 1/3 of the tube (1-2 minutes)
c. Add 1-2 drops of glacial acetic acid (5%)
I.
Initial turbidity after flaming is due to
phosphates and carbonates glacial acetic
will clear it up
d. Reboil the specimen
e. Grade the turbidity
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Reaction Interference/Limitation
Highly buffered alkaline urine (Major interference)
o Overrides acidic environment of protein pad
o Produces a color change unrelated to protein
concentration
Prolonged contact with urine specimen
o May remove acid buffer
o False positive results when acid buffer is removed
Highly pigmented urine (False positive)
Contamination of quaternary ammonium compounds
(False positive)
Detergents (False positive)
Antiseptics (False positive)
A very high specific gravity (False positive)
Protein other than albumin (False negative)
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11

@japanesejuan
Introduction:
The glucose test is the most frequent chemical analysis
performed on urine. Its value in the detection and monitoring of
Diabetes mellitus is unchallenged.
More than half of the cases in the world are undiagnosed.
Early diagnosis is the key to improved prognosis.
Gestational diabetes
Hyperglycemia that occurs during pregnancy
Disappears after delivery
Onset is during the 6th month of pregnancy
Due to action of hormones secreted by the
placenta which blocks insulin resulting in
resistance of insulin and hyperglycemia
Detection is important as glucose crosses the
placenta and insulin does not
Glucose will be absorbed by the babys pancreas
will produce a lot of insulin converting all glucose
into fat and stored.
Baby will be at risk for obesity and type 2 diabetes
Women who have gestational diabetes are also
prone to developing type 2 diabetes
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The kidneys PROXIMAL CONVOLUTED TUBULE (PCT)
reabsorbs glucose almost completely
Reabsorption rate is at 160-180mg/dL (renal threshold)
Should glucose in the blood be too high, renal tubular
reabsorption will be difficult and glucose will appear in
urine
Used for diabetes screening fasting prior to the
collection of samples is recommended
Blood glucose levels fluctuate especially after
meals
2 hours after a meal is recommended
First morning specimens are not recommended
because they do not represent an actual
representation of the bodys ability to clear
glucose (evening meal glucose still in bladder)
Urine glucose should be correlated with FBS
OGTT is used to confirm diabetes
12
Glucose

@japanesejuan

PRINCIPLE: DOUBLE SEQUENTIAL ENZYME REACTION
2 different tests used by laboratories
Glucose oxidase
Specific for glucose
Used in reagent strips/impregnated in
reagent strips
Copper reduction
Detects glucose and other reducing
substances
Reagent strip for glucose employ glucose oxidase by
impregnating the test area with a mixture of (refer below)
to produce a double sequential enzyme reaction
1. Glucose oxidase
2. Peroxidase
3. Chromogen
4. Buffer
st
1 step: Glucose oxidase rapidly catalyzes the reaction of
glucose to produce gluconic acid and hydrogen peroxide.
2nd step: Peroxidase catalyzes the reaction between the
hydrogen peroxide formed and chromogen to form an oxidized
colored compound that represents the presence of glucose.
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13
Examples of hyperglycemia of non diabetic origin which

also produces glycosuria
Pancreatitis
Pancreatic cancer
Acromegaly
Cushings syndrome
Hyperthyroidism
Pheochromocytoma
Drugs
Liver diseases
CNS damage
Hormonal disorders
Hormones associated with the disorders of
hyperglycemia of non diabetic in origin
Glucagon (increased)
Epinephrine (increased)
Cortisol (increased)
Thyroxine (increased)
GH (increased)
*all of the hormones mentioned oppose insulin function
*Glycogen (fat) is converted into glucose
Glycosuria in the absence of hyperglycemia (Renal
Glycosuria)
Caused by failure of tubules to reabsorb glucose
Seen in:
1. ESRD
2. Cystinosis
3. Fanconi Syndrome

@japanesejuan
Reaction Interference
Glucose oxidase is specific for glucose only
o other sugars are not detected
Peroxide and strong oxidizing detergents give False
positive reactions
Strong reducing agents give False negative reactions;
(oxidation will not proceed)
Example:
o Ascorbic acid
Ascorbic acid interference can be minimized by
incorporating iodate into glucose pads; iodate oxidizes
ascorbic acid
@japanesejuan
High specific gravity and low temperature decrease test

sensitivity
Unpreserved specimens give false negative results
o Rapid glycolysis of glucose
Other tests for urine glucose:

1. Copper Reduction Test
One of the earliest chemical test performed on urine
Test relies on the ability of glucose and other
substances to reduce copper sulfate to cuprous
oxide in the presence of alkali and heat
Reducing sugars include:
a. Glucose
b. Fructose
c. Galactose
d. Maltose
e. Pentose
Color change progressing from a negative blue
(CuSO4) through green, yellow, and orange/red
(Cu2O) occurs when the reaction takes place
The best example of Copper reduction is the

Benedicts Test
14
Reagent strip manufacturers use several different

chromogens
Potassium iodide(green to brown)
Tetramethylbenzidine (yellow to green)
Urine glucose is reported in terms of:
NEGATIVE
Trace
1+
2+
3+
4+
Color charts also provide semi-quantitative
measurements
Ranges from 100mg/dL to 2g/dL
The American Diabetes Association recommends
quantitative reporting
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@japanesejuan
IMPORTANT NOTE:
Care must be taken to observe the reaction closely
as it is taking place
High glucose OR reducing substances could cause a
PASS THROUGH phenomenon
PASS THROUGH PHENOMENON happens when the color
produced passes through the orange/red stage and returns to
a green-brown color, and if not observed, a high glucose level
may be reported as NEGATIVE
An alternate method uses 2 drops instead of 5 drops
of urine can minimize the occurrence of pass
through
A separate color chart must be used for this
alternate method
The chart provides up to 5g/dL
semiquantitation whereas the regular (5 drops
urine) provides only up to 2g/dL
Sensitivity of Clinitest is 200 mg/dL
Clinitest is still a nonspecific test for reducing
substances and subject to interference from several
other reducing sugars:
1. Galactose
2. Lactose
3. Fructose
4. Maltose
5. Pentoses
6. Ascorbic acid
7. Drug metabolites
8. Antibiotics (Cephalosporins)
Clinitest is not a confirmatory test for urine glucose
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The Benedict solution was developed in 1908 and

contains:
o Copper sulfate
o Sodium carbonate
o Sodium citrate buffer
Procedure:
Urine + Benedict Solution + Heat = Precipitate
2. Clinitest
A tablet version of the Benedicts Test
Makes use of the ability of the reducing sugars ability
to convert cupric sulfate to cuprous oxide
The test is based on the ability of reducing substances
to convert cupric sulfate to cuprous oxide
Makes use of a tablet and contains
o Anhydrous copper sulfate
o Sodium carbonate
o Sodium citrate / citric acid
o Sodium hydroxide
Upon addition of the tablet to water and urine, heat is
produced by the hydrolysis of sodium hydroxide and
its reaction with sodium citrate Carbon dioxide is
released from the sodium carbonate to prevent room
air interfering with the reduction reaction
Tubes should be placed on a rack and should not be
held by hand because the heat reaction could
cause a burn
After the effervescence reaction, the tube is gently
shaken and the color ranging from blue to
orange/red can be compared with the
manufacturers color chart
15
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16
Clinitest tablets are hygroscopic and should be stored

in tightly packed packages
A strong blue color suggests deterioration of
the tablet due to moisture and should not be
used

@japanesejuan
Introduction: The term ketones and ketone bodies represent

three intermediate products of fatty acid metabolism.
1. Acetoacetic acid (1st Ketone formed)
2. Acetone
3. Beta-hydroxybutyric acid
Normally, measurable amounts are not detected in urine
because all the metabolized fat are converted into CO2 and
H2O. However, when the use of available CHO as the major
source becomes compromised, body stores of fat must be
metabolized to supply energy. Ketones are then detected in
urine.

@japanesejuan
When CHO are available, ketone synthesis is inhibited
and blood ketone levels are below 3mg/dL
Any condition that causes increased fat metabolism
leads to ketonuria and ketonemia. Clinical reasons for
increased fat metabolism:
Inability to metabolize CHO (as in DM)
Increased loss of CHO from vomiting
Inadequate intake of CHO associated with
Starvation
Malabsorption
Testing for urinary ketones is most valuable in the
management and monitoring of insulin dependent
(type 1) DM because of the inability to use CHO
If patient has ketonuria, it shows a deficiency in
insulin and the need to regulate dosage
Ketonuria is an often an early indicator of
insufficient dosage in type 1 Diabetes
Increased amounts of ketone in the blood leads to
Electrolyte imbalance large amount of H20 lost
Dehydration large amount of H20 lost
Acidosis due to ketoacids
Diabetic coma
All kinds of reagent multi-strips have ketone pads
incorporated because it provides valuable information
when correlated with glucose
Ketone renal threshold is 70mg/dL.
When blood ketone is more than 70mg/dL,
ketonuria happens.
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Ketones
17

The 3 ketone compounds present are not in equal amounts in
urine and blood. The average distribution is as follows:
1. Acetoacetic (20%)
a. Acetone (2%)
b. beta-hydroxybutyric acid (78%)
PRINCIPLE: SODIUM NITROPRUSSIDE (NITROFERRICYANIDE)
REACTION
Acetoacetic acid (in an alkaline medium) reacts with
sodium nitroprusside to produce a purple color.
The test does not measure beta-hydroxybutryric and is
only slightly sensitive to acetone (only when glycine is
present)
Not necessary to perform individual testing for
acetone and beta-hydroxybutyric acid

@japanesejuan
Results are reported qualitatively or semi quantitatively

as:
NEGATIVE
Trace (5mg/dL)
Small (1+) (15mg/dL)
Moderate (2+) (40mg/dL)
Large (3+) (80-160mg/dL)
Reaction:
Chemical Tests for Ketone bodies:

1. Legals Test or Rotheras Test
Developed by Legal in 1883 and modified by Rothera in
1908
A nitroprusside reaction test
15 20 times more sensitive to acetoacetate than
acetone
Does not react to beta hydroxybutyric acid
No longer performed in clinical laboratories
More sensitive to acetoacetate and acetone than
reagent strip ketone pads
18
Patients with ketonuria have fruity or acetonic breath

odors because acetone is also eliminated by the lungs
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Reaction interference
Patients who undergo special diagnostic procedures (i.e.
CT scan guided with contrast) using dyes may produce
an interfering red color in the alkaline medium
Phenolsulfonphthalein
Bromsulphalein
Highly pigmented urine interfere with color reactions
Medications
Levodopa (large amounts)
Sulfhydryl group drugs (atypical color reactions)
Mercaptoethane sulfonate sodium
(MESNA)
Captopril
Improperly timed readings
Improperly preserved specimens
Volatilization of acetone (False decrease or
negative)
Breakdown of acetoactic acid by bacteria (False
decrease or negative)
Deterioration of nitroprusside reagent (both pad and
tablets)
Due to heat, moisture, or light
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19
Acetest tablets
A type of chemical test for ketones performed when
there is severe ketosis and serial dilutions are done to
provide a more accurate amount on ketones
Performed using a tablet which consists of:
o Sodium nitroprusside
o Glycine (for acetone and color enhancement)
o Disodium phosphate
o Lactose (provides better color differentiation)
Specimen that can be used with Acetest
o Serum
o Urine
o Other body fluids (ex. CSF, pleural, ascitic fluid,
etc)
Acetest tablets are hygroscopic
If the specimen is not absorbed in 30 seconds, a new
tablet should be used
Sensitivity of the test is 5mg/dL acetoacetate (lower limit)
Any pink, tan, or yellow color is ignored

@japanesejuan
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20

@japanesejuan

@japanesejuan
2. Hemoglobinuria
Hemoglobinuria is the result of either
a. Lysis of red blood cells in the urinary tract
(particularly in dilute alkaline urine)
b. Intravascular hemolysis
c. Subsequent filtering of hemoglobin through the
glomerulus
Lysis of red blood cells usually present hematuria and
hemoglobinuria
Intravascular hemolysis does not show red cells in
urine
21
Introduction:
Blood can enter the urinary tract anywhere from the glomeruli
to the urethra or can be a contaminant.
Blood found in urine may be in the form of:
1. Intact (hematuria) red blood cells
2. Free (hemoglobinuria) products of red blood cells
Blood present in large quantities can be detected visually.
Hematuria produces a cloudy red specimen.
Because any amount of blood greater than 5 cells/L urine is
considered clinically significant, visual examination cannot be
relied upon to detect the presence of blood.
Chemical tests for hemoglobin provide the most accurate
means for determining presence of blood in urine because
microscopic analysis may appear negative because some
patients possibly have hemolytic disorders and/or lysis of red
blood cells in which free hemoglobin is produced.
The finding of a positive reagent strip test result for blood
indicates
Presence of red blood cells
Hemoglobin
Myoglobin
Each of which has its own clinical significance
1. Hematuria
Closely related to disorders of renal or genitourinary
origin
Bleeding which is the result of TRAUMA or damage to
the organs of these systems
Major causes of hematuria

a. Renal calculi
b. Glomerular diseases
c. Tumors
d. Trauma
e. Pyelonephritis
f. Exposure to toxic chemicals
g. Anticoagulant therapy
Urinalysis is frequently requested when patients
present with certain signs and symptoms like:
a. Severe back pain
b. Severe abdominal pain
Hematuria of nonpathologic significance is observed
following
a. Strenuous exercise
b. menstruation
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Blood

@japanesejuan
22
Patients taking cholesterol lowering statin

medications also present with rhabdomyolysis as a
side effect
Heme portions of both Hemoglobin and Myoglobin
are toxic to the renal tubules; therefore, high
concentrations will lead to acute renal failure.
Page
Under normal conditions, haptoglobin captures

hemoglobin and forms complexes but when the
amount of free hemoglobin exceeds haptoglobin
levels, hemoglobin appears in urine. As occurs in:
a. Hemolytic anemias
b. Transfusion reactions
c. Severe burns
d. Brown recluse spider bites
e. Infections
f. Strenuous exercise
When large yellow brown granulated renal tubular
epithelial cells or urine sediments are found in urine,
these are usually due to reabsorption of filtered
hemoglobin and are called FERRITIN and
HEMOSIDERIN
3. Myoglobinuria
Myoglobin is a heme-containing protein found in
muscle tissue
Reacts positively with the reagent strip
Also gives urine a red-brown color
Presence of myoglobin is suspected in patients with
rhabdomyolysis (muscle destruction)
a. Trauma
b. Crush syndromes
c. Prolonged coma
d. Convulsions
e. Muscle wasting diseases
f. Alcoholism
g. Heroin abuse
h. Extensive exertion
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23
Hemoglobin vs Myoglobin
The laboratory is uncommonly requested to differentiate
between the presence of hemoglobin and myoglobin in
a urine specimen
Myoglobin is more toxic to the renal tubules than
hemoglobin
Reasons for differentiation:
Diagnosis
Predicting risk for renal failure
Treatment options
Diagnosis of myoglobinuria is usually based on:
Patient history
Elevated CK (Creatinine kinase)
Elevated LDH (Lactic dehydrogenase)
The appearance of patients plasma can also aid in the
differentiation (but of limited value)
Myoglobin clear plasma (myoglobin is rapidly
cleared by kidneys)
Hemoglobin red plasma (haptoglobinhemoglobin complex imparts a red color)
Myoglobin in the urine must be at least 25 mg/dL before
red pigmentation can be visualized
At concentrations 25 mg/dL or more, a precipitation test
called Blondheim Test may be performed to screen for
myoglobin.

@japanesejuan
Positive for Myoglobin: Supernatant tests positive on reagent

strip and retains a red color
Positive for Hemoglobin: Red precipitate and supernatant tests
negative on blood reagent strip
Principle of Blondheim Test:
Based on the fact that the larger hemoglobin molecules are
precipitated by the ammonium sulfate and myoglobin remains
in the supernatant.
*Clinically no longer useful because of latest testing procedures
NOTE:
Myoglobin is not stable in very acidic urine and, if denatured,
may precipitate with ammonium sulfate.
In cases where specimen processing is delayed, neutralization
and freezing it would be proper.
Immunoassay procedures are available to measure serum
myoglobin levels.

@japanesejuan
Blood testing areas are incorporated with

Peroxide
Tetramethylbenzidine
Buffer
Color charts for differentiation are provided
Hematuria
Hemoglobinuria/ Myoglobinuria
Free myoglobin/hemoglobin give a uniform color ranging
from a negative yellow to green to a strongly positive
green blue appear on the pad
Intact RBCs are lysed when they come in contact with
the pad and liberating hemoglobin showing an isolated
reaction which is a speckled/dotted/mottled pattern
Reagent strips can detect concentrations as low as 5
cells/L
Must be correlated with microscopic analysis
Reporting of results:
NEGATIVE
Trace
Small / 1+
Moderate / 2+
Large / 3+
24

PRINCIPLE: PSEUDOPEROXIDASE ACTIVITY OF HEMOGLOBIN
Hemoglobin peroxidase catalyzing a reaction between H2O2
and the chromogen TETRAMETHYLBENZIDINE to produce an
oxidized chromogen, which is blue-green (from yellow)
Page
Blondheim Test procedure:

- Add 2.8g of 80% ammonium sulfate to 5mL urine (freshly
voided)
o Hemoglobin is precipitated out of the solution
o Myoglobin stays dissolved in supernatant
- Mix
- Allow the specimen to sit for 5mins.
- Centrifuge specimen mixture
- Test the supernatant using the blood reagent pad
Page
25
False positive reactions may be seen in:
Menstruating women
Strong oxidizing reagents in specimen containers
Vegetable peroxidase
Bacterial enzymes (E. coli peroxidase)
False negative reactions
High ascorbic acid (25 mg/dL)
Directly reacts with H2O2 and removes it
Can be minimized when an iodate mesh or an
iodate scavenger pad is used
High specific gravity
Red cells crenate and do not lyse when
they come in contact with the pad
Decreased reactivity of pad
Formalin used as preservative
Patient taking Captopril
High concentrations of nitrite (greater than
10mg/dL)
Failure to mix specimen properly
Red cells settle to the bottom of the
specimen ensure proper mixing
If hemoglobin is present, supernatant urine
and uncentrifuged specimens will still react
with the test pad

@japanesejuan
Production of Bilirubin
- Under normal conditions, RBC life span is 120 days
- After 120 days, RBCs are sequestered in the spleen and
liver by phagocytic cells of the RES(reticuloendothelial)
- Liberated hemoglobin is broken down into its component
parts;
1. Iron (body reuses)
2. Protein (body reuses)
3. Protoporphyrin (converted to bilirubin by RES)
- Bilirubin (water - insoluble) is released into blood
circulation
- Bilirubin binds with ALBUMIN and transported to the LIVER
- Bilirubin then undergoes conjugation with GLUCURONIC
ACID by the action of GLUCURONYL TRANSFERASE to
@japanesejuan
Hemoglobin degradation
NOTE: Kidneys cannot clear bilirubin bound to albumin (large
and water insoluble)
26
Introduction:
Bilirubin is an intensely orange yellow pigment that when
present in significant amount causes a characteristic coloration
of plasma and urine.
The principal source of bilirubin (85%) is hemoglobin released
from the breakdown of senescent red blood cells in the RES.
Other sources come from RBC precursors from bone marrow
and other heme containing proteins such as myoglobin and
cytochromes.
Presence of bilirubin in urine can provide an early indication of
liver disease. It is often detected long before the development
of jaundice.
form water soluble bilirubin diglucuronide (conjugated

bilirubin)
Conjugated bilirubin directly passes through the bile
ducts and into the intestine
In the intestine, intestinal bacteria reduce bilirubin to
urobilinogens
Urobilinogens are oxidized and excreted in the feces in
the form of UROBILIN
Page
Bilirubin

@japanesejuan
27
No urobilinogen enters the intestine

negative urine urobilinogen
Stool is acholic (pale white or tan)
bilirubinuria and bilirubinemia is detected long before
Jaundice (blood bilirubin levels 2-3mg/dL) is seen
Differentation of jaundice cases
Results be correlated with urobilinogen
Page
Disturbances in any aspect of bilirubin formation, hepatic
uptake, metabolism, storage or excretion can cause
bilirubin to appear in urine (bilirubinuria)
Healthy individual bilirubin in urine (0.02 mg/dL)
Increased bilirubin in urine indicates distruption or
an increase in hemoglobin catabolism
Three principal mechanisms of altered bilirubin
metabolism occur
Prehepatic
Due to an increase breakdown of RBCs or
overproduction of heme to bilirubin
Unconjugated bilirubin cannot pass
through kidney glomerulus
Liver function is normal
Urine bilirubin is negative; Urine Urobilinogen
high due to reabsorption from intestine
Hepatic
Due to hepatocellular disorders or disease
Conjugated bilirubin leaks and readily
passes glomerulus positive urine bilirubin
Urine urobilinogen depends on extent of
liver damage normal or increased
Post hepatic obstruction
Blockage of bile duct or biliary system
Liver function is normal
Overflow of conjugated bilirubin and
reverts backs into blood circulation and
cleared by kidneys positive bilirubin

Chemical tests for bilirubin
Ictotest tablets are used for questionable results
Ictotest consist testing mats and tablets containing
1. P-nitrobenzene-diazonium-p-toluenesulfonate
2. SSA
3. Sodium carbonate
4. Boric acid
Less subject to interference
Sensitive to 0.05 mg/dL or 0.10 mg/dL of bilirubinuria
sometimes requested to detect early stages of
liver disease
Reagent strip has a lower sensitivity of 0.40 mg/dL
The mat has special absorbent properties which allow

bilirubin to stick to the surface as urine is absorbed
Page
28
Reagent Strip Reactions

Routine testing for bilirubin using reagent strip uses the
diazo reaction or azo coupling reactions
Bilirubin combines with a diazonium salt
2,4-dichloroaniline diazonium salt
OR
2,6-dichlorobenzene-diazonium-tetrafluoroborate
Uses an acid medium to produce an azo dye
Color ranges from light tan to beige or pink to violet
Qualitative test results are reported as
NEGATIVE
1+ / Small
2+ / Moderate
3+ / Large
Most difficult to read amongst others
Pigments of other substances
Color overlapping
Lower limit of detection is 0.5 mg/dL of conjugated
bilirubin
A 25 fold increase of urine bilirubin must be
present in order for the test to be positive
Reaction:

@japanesejuan

@japanesejuan
29
Free unconjugated bilirubin is less reactive

on reagent strips
High concentrations of ascorbic acid (greater
than 25 mg/dL) and nitrite medications
Combines with diazonium salt and prevents
reaction with bilirubin
Page
If interfering substances are suspected, adding water

directly to the mat after urine has been added fixes the
problem.
POSITIVE REACTION: A blue to purple color appears on the mat
when bilirubin is present
NEGATIVE REACTION: Any other color
*Interferences of Ictotest are same with reagent pad for bilirubin
since they share the same principle
Other Bilirubin Methods
1. Shake test
a. Performed when urine is beer brown or dark
yellow brown in color
b. Characteristic YELLOW foam appears when urine
is agitated or shaken
False positive
Other urine pigments such as from
phenazopyridine compounds thick pigment
chlorpromazine metabolites can react to
diazonium salts
Indican
Metabolites of Lodine (medication)
False negative
Improperly preserved specimens (most frequent)
Photo-oxidized specimens
When specimens are exposed to light and
bilirubin is converted to biliverdin (does not
react with diazo tests)
Hydrolysis of bilirubin diglucuronide (conjugated
bilirubin)
Urobilinogen
Introduction:
Urobilinogen is one of the products of bacterial reduction of
conjugated bilirubin. The other is Stercobilinogen, which cannot
be reabsorbed and further reduced to UROBILIN, which is
responsible for the characteristic color of stool.
Some of the urobilinogen is reabsorbed from the intestine into
the blood, recirculates to the liver, and is excreted back into the
intestine through the bile duct.
Urobilinogen appears in the urine because as it circulates in
blood en route to the liver, it passes through the kidneys and is
filtered by the glomerulus. Therefore, a small amount of
urobilinogen less than 1mg/dL or Ehrlich unit is normally
found in the urine.
Page
30
Measurement of urine urobilinogen can be valuable in
the detection of early liver disease
1% of nonhospitalized patients and 9% of
hospitalized patients exhibit high results owing to
constipation
Increased urine urobilinogen (greater than 1 mg/dL) is

seen in:
Liver disease
Liver impairment decreases the ability of
the liver to process urobilinogen
recirculated from the intestines
Excess urobilinogen shows up in urine
Hemolytic disorders
Jaundice due to excess unconjugated
bilirubin and leads to high conjugated
bilirubin entering the intestines
Cycle goes on in which urobilinogen is
reabsorbed
Liver is overworked and by time is unable to
process urobilinogen at a normal rate
More urobilinogen will circulate and be
presented to the kidneys for excretion
Absence of urobilinogen in urine and feces is clinically
significant
Cannot be detected using reagent strip
Represents bile duct obstruction
Absence of urobilin also indicates bile duct
obstruction

@japanesejuan
REAGENT STRIPS CANNOT DETERMINE THE ABSENCE OF

UROBILINOGEN
Important indicator of biliary obstruction

@japanesejuan
31
Azo coupling (diazo) reaction

Urobilinogen reacts with 4methoxybenzene-diazoniumtetrafluoroborate
Colors produced range from white to pink
More specific for urobilinogen compared to
Ehrlich
Results are in mg/dL
Ehrlich reaction is subject to a variety of interferences
called Ehrlich reactive compounds
False positive reactions due to:
1. Porphobilinogen (clinically significant)
2. Indicant
3. P-aminosalicylic acid
4. Sulfonamides
5. Methyldopa
6. Procaine
7. Chlorpromazine compounds
*Reagent strip cannot differentiate or screen for
presence of PBG
Sensitivity increases with temperature (RT)
Highly pigmented urine cause atypical readings for both
methods
Urobilinogen is high after meals because of bile
salt excretion
False negative readings for both methods
Occur in improperly preserved specimens
Urobilinogen is photo-oxidized to Urobilin
Formalin used as preservative
High concentrations of nitrite interfere with azo
coupling reactions
Page
Reagent Strip Reactions and Interference

2 different urobilinogen reactions exist and are used by
different manufacturers
Ehrlichs aldehyde reaction
Urobilinogen reacts with pdimethylaminobenzaldehyde (Ehrlichs
reagent)
Colors produced are from light to dark pink
Results are reported as Ehrlich units (EU)
which are equal to mg/dL
Normal value: 0.2-1.0 EU
Page
2. Hoesch Screening Test for PBG

Rapid screening for urinary PBG
2 drops of urine added to 2mL Hoesch reagent (Ehrlichs
reagent dissolved in 6M HCl)
6M HCl inhibits urobilinogen
POSITIVE TEST: Top solution shows red color
The test detects approximately 2mg/dL of PBG
False positive tests
Methyldopa (high concentrations)
Indican (high concentrations)
Highly pigmented urine
3. Watson Schwartz Differentiation Test

The classic test for differentiating PBG, urobilinogen and
Ehrlich reactive compounds
Procedure:
Tube 1
Tube 2
2mL urine
2mL urine
2mL chloroform
2mL butanol
4mL sodium acetate
4mL sodium acetate
Tube 1
Chloroform will extract UROBILINOGEN producing a
colorless URINE TOP layer and a red CHLOROFORM
BOTTOM
PBG nor other ERC are soluble in chloroform
Tube 2
Butanol will extract both UROBILINOGEN and ERCs
producing a red BUTANOL TOP layer and a colorless
bottom urine layer if PBG is present
PBG is not soluble in butanol
Before reporting the test as positive for both substances, an
additional chloroform extraction should be performed on
the red urine (upper) layer in Tube 1
To make sure its not due to an excess of urobilinogen
32
Chemical Tests for Urobilinogen and other Ehrlich reactive

substances
Introduction:
Urobilinogen or other Ehrlich reactive tests were not done
before because they were time consuming and nonspecific.
When necessary, the following 3 were performed.
1. Ehrlich Tube Test
Normally, addition of Ehrlich reagent to urine produces a
cherry red color and adding sodium acetate enhances
color reaction (when urobilinogen is present)
Using the Ehrlich Tube method, one part Ehrlich reagent is
added to 10 parts urine. Tube is mixed and examined for red
color.
This test is subject to false positive results when
porphobilinogen and Ehrlich reactive compounds were
present.

@japanesejuan
Page
33

@japanesejuan

@japanesejuan
The nitrite test is a valuable test for detecting initial

bladder infection (cystitis) because most patients are
asymptomatic and that would not lead the physician to
order a urine culture.
PYELONEPHRITIS, a complication of cystitis, is the inflammatory

process of the kidney and adjacent renal pelvis.
Pyelonephritis can lead to:
1. Renal tissue damage
2. Impairment of renal function
3. Hypertension
4. Septicemia
The nitrite test can also be used to evaluate:
1. Success of antibiotic therapy
2. Screen people who have recurring infections
3. Diabetic patients
4. Pregnant women (high risk for UTI)
Many laboratories use the nitrite test in conjunction with the
leukocyte esterase test to determine necessity of performing a
urine culture.
34
Introduction and Clinical Significance:

The reagent pad for nitrite provides a rapid screening
test for the presence of urinary tract infections (UTI)
UTI can involve the bladder (cystitis), the renal pelvis and
tubules (pyelonephritis), or both
2 possible routes for UTI:
1. Movement of bacteria up the urethra into the bladder
(ascending infection)
2. Movement of bacteria from the bloodstream into the
kidneys and urinary tract
Most common infecting microorganisms
1. Escherichia coli
2. Proteus species
3. Enterobacter species
4. Klebsiella species
UTI is 8 times more common in females than in males
UTI can begin as the result of urinary obstruction
1. Tumor
2. Bladder dysfunction
3. Urine stasis
The test is designed to detect cases in which the need for
a culture may not be apparent but not to replace it as
the primary test for diagnosing and monitoring bacterial
infections.
Most UTI cases start in the bladder as a result of external
contamination and move upward to the tubules, renal
pelvis and kidney. (ascending infection)
Page
NITRITE
To prevent false positive reactions by externally

contaminated specimens
Test sensitivity is standardized to 100,000
organisms/mL
The test does not measure degree of bacteriuria
Any shade of pink is considered to represent a clinically
significant amount of bacteria
Positive Test: Pink reagent pad
Negative Test: White reagent pad
Page
Several major factors influence reliability of nitrite test
Tests with negative results in the presence of vaguely
suspicious clinical symptoms should always be thoroughly
investigated
The following are major considerations when interpreting
the nitrite test.
1. Bacteria that lack the enzyme reductase
a. Cannot reduce nitrate to nitrite
b. Enzyme found in some gram negative bacteria
(Enterobacteriaceae)
c. Most bacteria that cause UTI are gram negative
d. Gram positive and yeast also cause infection but
do not reduce nitrate to nitrite
2. Bacteria must remain long enough in urine
a. Nitrite test should be performed on first morning
urine
b. Urine that remained in the bladder for at least 4
hours is another alternative for first morning urine
3. Enough nitrate diet
a. Green vegetables are a good source of nitrate
b. This is seldom a problem
c. False negative if nitrate is not enough
4. Further reduction
a. Nitrate to nitrite to nitrogen
b. Occurs when large amounts of bacteria present
35
Reagent Strip Reactions

PRINCIPLE: GREISS REACTION
Chemical basis of the nitrite test is the ability of certain
bacteria to reduce nitrate (from diet) into nitrite (not
normally found in urine)
Bacteria must produce nitrate reductase to convert
nitrate
Nitrite is detected using Greiss reaction
Nitrite, at an acidic pH, reacts with an aromatic
amine (para-arsanilic acid or sulfanilamide) to
form a diazonium compound that then reacts with
tetrahydrobenzoquinolin compounds (azo
coupling reaction )to produce a pink colored
azo dye

@japanesejuan
Page
36
5. Miscellaneous
a. When patient is already under antibiotic therapy
i. Antibiotics inhibit bacteria action of
reduction
b. Large quantities of ascorbic acid
i. Interferes with diazo reaction
c. High specific gravity decreases test sensitivity
d. All give false negative results

@japanesejuan
Introduction:
Prior to the development of LE, urinary leukocytes were
detected only by microscopy using urine sediments.
Microscopy can be subject to variation depending on the
method used to prepare the sediment and the technical
personnel examining the sediment.
Chemical testing for leukocytes in urine standardized the means
for detection.
The test is not designed to measure the concentration of
leukocytes quantitation should be done by microscopy
An advantage in using LE is that it detects the presence of
leukocytes that have been lysed, particularly in dilute,
hypotonic, alkaline urine, in which would not appear in
microscopy.
Normal value: 0 2 /hpf up to 0 5 / hpf or 0-8/hpf
Women tend to have higher numbers than men as a
result of vaginal contamination
Increased urinary leukocyte is an indicator of UTI
The test detects the presence of ESTERASE in azurophilic
granules of granulocytic white blood cells (in cytoplasm)
Neutrophils
Eosinophils
Basophils
Monocytes and macrophages have granules as well,
although they are not entirely granulocytic
@japanesejuan
Lymphocytes are not detected using LE because they

are agranular
Esterases are also present in Trichomonas
RBCs, bacteria, and renal tissue cells do not contain
esterases
A positive LE test result is most frequently accompanied
by the presence of bacteria
Bacteria may or may not produce a positive nitrite
reaction
Infections caused by the following cause leukocyturia
without bacteriuria
Trichomonas
Chlamydia
Yeast infection (Moniliasis)
Inflammation of renal tissue (interstitial nephritis)
Screening urine specimens using LE and nitrite determine
the necessity of performing urine cultures
This can be a cost effective measure
LE test has more reliability in the practice of medical
diagnosis than nitrite
37
Page
Leukocyte Esterase (LE)
Page
LE reaction requires the longest time of all the reagent

strip reactions
2 minutes or 120 seconds
Reactions are reported as
NEGATIVE
TRACE
SMALL / 1+
MODERATE / 2+
LARGE / 3+
Trace results may not be significant
Repeat test with a fresh specimen
Advantages of the LE screening test
Detect the presence of intact and lysed WBCs
Serve as a screening for WBC that is independent
of procedural variations for sediment preparation
The LE Test detects 10 to 25 WBCs/L
False positive reactions
Formalin in the collection container
Strong oxidizing reagents
Phenazophyridine
Beets
Atypical color reactions
Highly pigmented urine
Nitrofurantoin
False negative reactions
High concentration of protein (greater than 500
mg/dL)
High glucose (greater than 3g/dL)
Oxalic acid
Ascorbic acid (combines with diazonium salt)
High specific gravity
Leukocytes crenate and prevent esterase
release
Strong oxidizing agents
Interfere with reaction pH
Antibiotics (decreased sensitivity)
Gentamicin
Cephalosporins
Cephalexin
Cephalothin
Tetracycline
38

PRINCIPLE: LEUKOCYTE ESTERASE
The action of LE to catalyze the hydrolysis of an acid
ester embedded on the reagent pad to produce an
aromatic compound and acid
The aromatic compound then combines with a
diazonium salt present on the pad to produce a purple
dye

@japanesejuan
Page
39

@japanesejuan
Specific Gravity
The polyelectrolyte ionizes, releasing hydrogen ions in

proportion to the number of ions in the solution
The higher the concentration of urine, the more
hydrogen ions are released, thereby lowering the pH
Incorporation of the indicator bromthymol blue on the
reagent pad measures the change in pH.
As the specific gravity increases, the indicator changes
from blue (1.000 [alkaline]), through shades of green to
yellow (1.030 [acid])
Readings can be made in 0.005 intervals by careful
comparison with the color chart.
Page
40
Introduction:
Specific gravity is a physical property of urine and an expression
of solute concentration.
The ultrafiltrate that enters the Bowmans space of the glomeruli
has the same SG as protein free plasma (1.010) isosthenuria
As the ultrafiltrate passes through the nephrons, solutes and
water are selectively absorbed and secreted thus increasing or
decreasing SG.
Normal SG is from 1.002 to 1.035. Values greater or lesser than
these require further investigation.
SG that is 1.000 or 1.040 is physiologically impossible.
The addition of SG to the test strip has eliminated a time
consuming step in routine urinalysis and has provided a
convenient method for routine screening.
Osmometry and Refractometry should never be replaced for
fluid monitoring as these are more accurate compared to
reagent strip testing for SG.

PRINCIPLE:
CHANGE IN pKa (dissociation constant) OF A POLYELECTROLYTE
IN AN ALKALINE MEDIUM

@japanesejuan

Reasons for a 1.000 SG:
1. Specimen might not be urine
a. Check urea and creatinine. Urine always has urea
and creatinine while ordinary water does not.
2. Check QC of reagent strip
a. Strip might be outdated or deteriorated
Reasons for a 1.040 SG
1. Mannitol IV
The use of refractometry or osmometry usually resolves problems
with very high or low SG (counterchecking)
Page
41
Measures only ionic solutes
Thereby, eliminating interference by large organic
molecules such as:
Urea
Glucose
Radiographic contrast media
Plasma expanders
Analysts should consider what type of method is used
when testing for SG
Elevated concentrations of protein slightly increase the
readings as a result of protein anions
Specimens with a pH of 6.5 or higher have decreased
readings
Interference with the bromthymol blue indicator
Bromthymol blue reacts best with alkaline pH and
low specific gravity
Manufacturers recommend adding 0.005 to SG
when pH is 6.5 or higher
Correction is performed when using
automated strip readers

@japanesejuan

Overview
System Description
Semi-automated urine chemistry analyzer
Tests Measured
Automatic Measurement
Leukocyte, Nitrite, Protein, Blood, Glucose, Ketone, Bilirubin,

Urobilinogen, pH, Specific Gravity, Creatinine,* and Protein-to-Creatinine
Ratio*
Urine color
Test Format
Dry chemistry reagent strips
Test Measurement
Color change measured by reflectance photometry

Dual readings at reactive and reference wavelengths
Automatically adjusts for urine color
Sample Clarity
Results entered via keyboard or bar code reader

- Identification and reporting for validated Siemens strip
types
- Humidity exposure tested on every strip with leukocyte
pad
- Sample interferences, availability dependent upon strip
type**
Automatic Checks
(Auto-Checks)
You can fail at something you dont want, so might as

well take a chance doing what you love.
~James Eugene Carrey
@japanesejuan
42
Respond to demands for higher productivity and high quality

with the CLINITEK Advantus Analyzer. Streamline your workflow
with flexible operation.
Immediate start-up.
Automatic calibration.
Network ready.
A wide range of options.
Added QC features.
Flexible operation to meet your needs.
Page
(CLINITEK Advantus Analyzer)
Sources:
1. Urinalysis and Body Fluids by Susan King Strasinger and
Marjorie Schaub Di Lorenzo 5th edition
2. Urine and Body Fluid Analysis by Nancy A. Brunzel 3rd
edition

Chemical Examination

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Chemical Examination

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Chemical Examination of Urine

By: Ken Kawakami, RMT, MLS(ASCPi)CM

Several colors or intensities of a color for each substance being

A color-producing chemical reaction takes place when the

The color reactions are interpreted by comparing the color