Definition

A complete urinalysis analyzes urine sample to evaluate the various components and chemical compounds it contains. Urine, a fluid produced by the body, plays a crucial role in eliminating waste substances. The kidneys filter these substances, retaining what the body needs and excreting what it does not.

This test assesses several aspects of urine, including its color, microscopic components, and chemical composition.

The complete urinalysis is a routine procedure commonly used for early detection, diagnosis of diseases, and monitoring of medical conditions. Its advantages include affordability, ease of administration, and quick results. However, the accuracy of the test can be compromised if the urine sample is contaminated or improperly collected.

Indications

A complete urinalysis is indicated for various conditions, such as:

• Early detection of diseases or organ issues, including kidney or liver disease and diabetes.
• Identifying pregnancy-related problems or pre-surgical disorders.
• Assisting in diagnosing symptoms like lower abdominal pain, back pain, painful urination, or frequent urination.
• Monitoring the progression and severity of existing diseases.
• Determining the presence of bacteria in the urine.

Contraindications

A complete urine test is generally simple, safe, and painless, with no specific contraindications preventing someone from undergoing this test.

However, certain medical conditions may interfere with test accuracy or sample collection, such as an inability to urinate, difficulty holding urine, or other conditions affecting normal urination. In such cases, a urinary catheter may be inserted into the urinary tract to obtain a sample.

Preparation Prior to Test

No special preparation is needed for a complete urine test, and fasting is not required. However, staying hydrated by drinking sufficient water beforehand is recommended to facilitate urination during the test.

It is advisable to consult a doctor before the test, as certain medications, including vitamin C, metronidazole (antibiotic), riboflavin, and laxatives, can interfere with laboratory results and lead to inaccuracies.

Test Procedure

The test requires a urine sample collected in a sterile container. Follow these steps to ensure a clean and accurate sample:

• Clean the area around the urethra with clean water.
• Discard the first stream of urine for a few seconds, as it may contain bacteria, fungi, or other contaminants.
• Collect the midstream urine into the sterile container. Aim to collect about 30–60 ml or half the container.
• Tightly close the container and wash your hands thoroughly.
• Immediately deliver the sample to the laboratory for analysis.
• Results are typically available within a few hours after submission.

Normal and Abnormal Values

A complete urinalysis evaluates various components, including urine appearance, microscopic elements, and chemical compounds.

• Normal urine has a clear yellow and transparent. Meanwhile, abnormal urine is either cloudy, red, or foul-smelling and this may indicate health issues. The presence of excessive foam or bubbles could also signify abnormalities.

Urine microscopic test includes several components, namely:

• Leukocytes, or white blood cells, are produced by the body to combat infection. Normally, the number of leukocytes in the urine is no more than 3 to 5. However, elevated levels of urine leukocytes can suggest urinary tract infections.

• Red blood cells are normally around 3–5 or less in the urine. Higher counts may indicate infections, kidney malignancies, or kidney stones.

• Bacteria, fungi, and parasites. Normally, these microbes are not found in the urine. So, the presence of bacteria, fungi and parasites in the urine can indicate an infection.

• Hyaline is one of protein components. Normally, there is no more than 4 in the urine. Excess levels may point to kidney disorders.

• Crystal is normally not present in the urine. Their presence in the urine suggests kidney stones.

The following are the key compounds assessed in a urine test and their normal values:

• Urine pH: The normal range is 4.5–7.8. Alkaline urine, indicated by a higher pH, may suggest a urinary tract or kidney infection.
• Specific Gravity: Normal values range from 1.005–1.025, reflecting the concentration of solutes in the urine.
• Protein: Typically absent or present only in trace amounts. High protein levels in urine suggest kidney-related issues.
• Sugar (Glucose): Normally not present in urine. Its presence may indicate high blood sugar levels, as seen in diabetes, or kidney disorders.
• Ketones: Absent in normal conditions. Detected ketones may suggest diabetes or other conditions like urinary tract infections.
• Bilirubin: A byproduct of red blood cell breakdown, normally not present in urine. Its presence may indicate liver dysfunction.
• Urobilinogen: Normal levels are 0.5–1 mg/dL. Elevated levels suggest liver issues.
• Leukocyte Esterase: Normally absent. Its presence indicates infection.
• Nitrite: Normally negative. If detected, it suggests bacterial infection, as nitrites are byproducts of bacterial activity.

Results and Recommendations (Follow-up Tests)

Abnormal findings in the urine test, as described above, can indicate underlying health conditions, including urinary tract infections, liver diseases, kidney disorders, diabetes, or other medical problems.

If abnormalities are detected, further testing may be required to confirm the diagnosis and guide treatment. These may include urine culture to identify specific bacteria causing a urinary tract infection, liver function test, kidney function test, abdominal ultrasound (USG), complete blood count or blood sugar test.

Consult the Right Doctor

The results of a complete urine test in adults should be discussed with a general practitioner for further evaluation or to initiate treatment based on the findings. For specific concerns, consulting a urologist or an internist may be necessary. Pediatric patients with abnormal results should be evaluated by a pediatrician.

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