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Examine urine samples from patients and suggest a diagnosis and treatment plan based on test results. Urinalysis is the analysis of urine using physical and chemical means to test for the presence of disease, drugs, or other health states in in individual.
In this investigation, you will use simulated urine and perform a variety of tests to develop a diagnosis for a fictional patient.
|If the urine is...||What it could indicate is...|
|Color||Dark yellow||dehydration or fever|
|Pale light yellow|
patient drank a lot of liquids prior
|Odor||Red with blood||damage to kidneys|
|Fruity||the presence of ketones (breakdown of fats), which is a product of diabetes or starvation, or specific type of diet (Atkins)|
|Transparency||Foul||the presence of bacteria|
|Clear||normal urine samples appear clear/transparent|
old samples could appear cloudy if bacteria has had time to grow
fresh samples could appear cloudy if a urinary tract infection (UTI) is present, or if there are blood cells or pus in the urine
|Presence of Substances|
Test with Benedict’s solution and hot water bath
Blue → orange means sugar is present
High amounts of sugar in diet or in recent meal
Test with Biuret Reagent
Blue → purple means protein is present
|an abnormal condition called proteinuria, that results from damage to kidneys; can also be caused by diabetes or high blood pressure|
Human Chorionic Gonadodotropin hCG
Test with Indicator Strips
Color change to blue indicates hCG is present
|Pregnancy if female, possible testicular cancer in males|
|Ketones||Test with indicator strip, color change to pink or red indicates ketones in urine|
High protein diet, such as Atkins diet
Starvation or diabetes can cause the body to burn fat for energy, releasing ketones
Procedure for Urinalysis
You will receive a urine sample and a patient chart for one of five possible patients in the office. Record your patient number and the results of each test in the chart.
Observe and describe the color, odor, and transparency of the four urine samples. Record physical observations.
Get approval from teacher before advancing.
To test for sugar, add approximately 6 ml of the Benedict’s solution to one test tube and 10 ml of the urine sample. Place the sample in a hot water bath and observe the color after five minutes. If the color has turned orange, that indicates the presence of sugar in the urine.
To test for protein content, add approximately 2 ml of the Biuret reagent to 10 ml of the urine sample. It does not need to be placed in a water bath. If the bright blue color changes to purple, protein is present in the urine.
To test for hCG, use a test strip provided and dip into a small sample of urine from your patient, a color change to blue indicates the presence of hCG.
To test for ketones, use a test strip provided and dip into a small sample of urine from your patient, a color change orange-red or yellow indicates the presence of ketones.
Urinalysis Results for Each Patient:
You only need to do your assigned patient.
|Patient 1||Patient 2||Patient 3||Patient 4||Patient 5|
|Presence of Sugar|
|Presence of Protein|
|Presence of hCG|
|Presence of Ketones|
Analysis and Diagnosis (CER)
CLAIM: Write a statement that includes a diagnosis for your patient.
EVIDENCE: Provide evidence that supports your diagnosis using data you gathered during the lab. This is a summary of your important findings that support the diagnosis (claim) that you wrote.
REASONING: Provide an explanation of why the evidence supports the claim (why the results support the diagnosis?). Include specific medical and anatomical terminology to explain why a particular result would indicate the problem in the patient.
Treatments: Provide recommendations for how to solve the problem indicated by the diagnosis. You may need to refer to your text or other resources.
|Accomplished (3)||Proficient (2)||Developing (1)|
|CLAIM||Makes an accurate and complete claim, uses complete and grammatically correct sentences||Makes an accurate, but incomplete claim, or grammatically incorrect||Claim is not accurate, incomplete, or unintelligible|
|EVIDENCE||Provides appropriate and sufficient evidence to support claim by referencing specific data, observations, or text evidence (for readings)||Provides appropriate data but insufficient data, too general or lacking in details||Provides evidence but it is insufficient, inaccurate, no details|
|REASONING||Provides thorough reasoning that links evidence to the claim, references scientific principles that are relevant to claim||Provides reasoning that links evidence to the claim, lacks scientific principles||Does not provide reasoning, or reasoning does not link evidence.|
|Treatment||Evidence of research to provide a typical treatment plan aligned to the patient diagnosis||Treatment plan is included, but not thorough or does not fully address patient’s problem||Treatment is not is inaccurate or incomplete|
Patient 1: Martin Manoogie
Chief Complaint: Patient has been urinating frequently, often waking up at night to go to the bathroom. He reports feeling thirsty all the time and has a decreased appetite.
History: Patient is a 34 year old male who is 5’10” and weighs 240 lbs. There is no major family history or heart disease, cancer, or diabetes. Patient also reports minor shortness of breath when doing minor exercise, like climbing stairs. Patient reports drinking alcohol “in moderation” and is a non-smoker.
Current medications: Patient is taking medically prescribed diet pills to lose weight.
Past Health: Patient had surgery at the age of 22 years to repair torn cartilage in the knee. Tonsils were removed at age 10.
Personal History: Mr. M works in the IT department of a major company. He is not married and lives with his mother. Household has four cats.
Pulse: 68 bpm
Blood pressure: 158/80
Patient 2: Amy Bailey
Chief Complaint: Patient reports frequent urination and abdominal pain. She feels like even after urinating, she still need to go to the bathroom.
History: Amy is a 21 year old female, weighing 130 lbs and is 5’5” tall. Amy is a non-smoker who drinks socially.
Current medications: Amy is on birth control pills.
Past Health: Amy had her tonsils removed at the age of 10, and had a miscarriage at the age of 18.
Personal History: Amy is a college student, studying to become a veterinarian, she lives in a dorm with two roommates.
Pulse: 62 bpm
Blood pressure: 120/65
Patient 3: Roshanda Kim
Chief Complaint: Patient is having trouble sleeping at night and is urinating more frequently than normal.
History: Roshanda is a 30 year old female, weighing 180 lbs and is 5’5” tall. Roshanda recently quit smoking and is using nicotine patches.
Current medications: Nicotine supplements
Past Health: Roshanda has a C section 8 years ago, baby boy was born healthy and recovery was normal for R.
Personal History: Roshanda is planning to get married in June and is trying to lose weight. She is using the Atkins diet plan, which is a high protein diet and reports she has lost 10 pounds in the past 3 weeks.
Pulse: 78 bpm
Blood pressure: 130/70
Patient 4: Enzo Marin
Chief Complaint: Loss of appetite, frequent and painful urination
History: Enzo is 14 years old and is involved in swimming, and baseball. Mother reports Enzo used to be very active, but has been feeling tired and run down and isn’t eating well.
Current medications: None
Past Health: Enzo experienced ear infections as a young child.
Personal History: Enzo lives with both parents and a dog, he walks to school every day and practices with the baseball team after school. In past years, he was rarely sick, but he is falling behind in school this year due to feeling sick and staying home. Parents and coaches are concerned.
Pulse: 58 bpm
Blood pressure: 122/65
Patient 5: Lori Grimes
Chief Complaint: Loss of appetite, nausea and general fatigue
History: Lori is 25 years old, 5’10” and weighs 160 pounds. No family history of heart disease, cancer, or diabetes.
Current medications: Birth control pills
Past Health: Lori had her appendix removed at the age of 18.
Personal History: Lori is married and lives with her husband and two dogs. She is an elementary school teacher.
Pulse: 70 bpm
Blood pressure: 118/56
Test Strips for Ketones and Pregnancy are simulated using pH paper and changing the recipe to make it more acidic or alkaline.
I assign each group a different patient, though you could have them do all the patients, that process may take a while and you’ll need a lot more materials. The recipes described below can be tweaked, sometimes I add a splash of coffee to darken the urine up because yellow food coloring looks to bright to be real urine. I create a large amount in 1 liter containers and then parse them out in specimen containers. I have a few fancy containers purchased from Amazon that look like the specimen jars seen in doctor’s offices, but beakers or jars also work.
You will need beakers, test tubes and hot water bath to do the Benedict’s test for sugar. Alternatively, you could order glucose test strips, but they are expensive.
Test each sample for desired results. Because using pH strips for ketones and pregnancy, there might be unexpected results. Ketones present in urine is not necessarily a problem and can be based on diet. Only patient 5 should have an alkaline (basic) positive test.
|Patient 1||Apple juice + water|
Water + yellow food coloring
+ milk to create cloudy appearance
+ ammonia or vinegar to create foul odor
|Patient 3||Water + yellow food coloring + a drop of sodium hydroxide (makes solution alkaline)|
Water + yellow food coloring + egg beaters
+red food coloring to simulate blood
|Patient 5||Water + yellow food coloring + a drop of HCL to make solution acidic|
Introduction to urinalysis: historical perspectives and clinical application
Urinalysis was the first laboratory test performed in medicine and has been used for several thousand years. Today urinalysis continues to be a powerful tool in obtaining crucial information for diagnostic purposes in medicine. Urine is an unstable fluid, and changes to its composition begin to take place as soon as it is voided. As such, collection, storage, and handling are important issues in maintaining the integrity of this specimen. In the laboratory, urine can be characterized by physical appearance, chemical composition, and microscopically. Physical examination of urine includes description of color, odor, clarity, volume, and specific gravity. Chemical examination of urine includes the identification of protein, blood cells, glucose, pH, bilirubin, urobilinogen, ketone bodies, nitrites, and leukocyte esterase. Finally, microscopic examination entails the detection of crystals, cells, casts, and microorganisms.
Standardizing the experimental conditions for using urine in NMR-based metabolomic studies with a particular focus on diagnostic studies: a review
The metabolic composition of human biofluids can provide important diagnostic and prognostic information. Among the biofluids most commonly analyzed in metabolomic studies, urine appears to be particularly useful. It is abundant, readily available, easily stored and can be collected by simple, noninvasive techniques. Moreover, given its chemical complexity, urine is particularly rich in potential disease biomarkers. This makes it an ideal biofluid for detecting or monitoring disease processes. Among the metabolomic tools available for urine analysis, NMR spectroscopy has proven to be particularly well-suited, because the technique is highly reproducible and requires minimal sample handling. As it permits the identification and quantification of a wide range of compounds, independent of their chemical properties, NMR spectroscopy has been frequently used to detect or discover disease fingerprints and biomarkers in urine. Although protocols for NMR data acquisition and processing have been standardized, no consensus on protocols for urine sample selection, collection, storage and preparation in NMR-based metabolomic studies have been developed. This lack of consensus may be leading to spurious biomarkers being reported and may account for a general lack of reproducibility between laboratories. Here, we review a large number of published studies on NMR-based urine metabolic profiling with the aim of identifying key variables that may affect the results of metabolomics studies. From this survey, we identify a number of issues that require either standardization or careful accounting in experimental design and provide some recommendations for urine collection, sample preparation and data acquisition.
Keywords: Biomarker Diagnosis Human diseases Metabolites profiling Metabolomics Metabonomics NMR Recommendations Standardization Urine.
Urine Luck: The Diagnostic Value of Urine Dipstick Testing
A major challenge to providing diagnostic laboratory services in resource-limited settings, like the refugee camps discussed in last month’s post, is lack of infrastructure. Without running water, electricity, and even access to good phlebotomy supplies, specimen collection and preparation can be difficult, let alone the actual testing. I’ve found that in many instances, going back to the basics can often help determine a means of providing useful laboratory results. This post focuses on the humble, yet powerful, urine dipstick.
The urine dipstick is lightweight, easily portable, requires no special handling or storage and most have long shelf lives. These characteristics make the dipstick a great tool for use in the field. The specimen–simply urine–is also easy to collect and requires no special preparation. Dipstick testing can serve as a screening tool for some diseases and a diagnostic test for others. Urine dipstick measures pH, specific gravity, nitrites, leukocyte esterase, peroxidase activity, glucose, ketone, bilirubin, protein, and urobilinogen all performed within about a minute.
Urine is slightly acidic fluid and its pH is maintained essentially by the kidney. Any acid-base imbalance affects urinary pH. Urinary pH levels are helpful in the evaluation of nephrolithiasis, infection, and renal tubular acidosis. Kidney’s ability to concentrate urine is readily assessed by measuring the specific gravity of urine and the measurement generally correlates with urine osmolality.
Both nitrites and leukocyte esterase are used to evaluate urinary tract infection (UTI). A specific group of bacteria with reductase enzyme reduces nutritional nitrates in urine to nitrites which is detectable by urine dipstick testing. Some bacteria are not capable of converting nitrates to nitrites and therefore patients with UTI could still be negative for nitrite. Patients on a nitrate-deficient diet could be negative for nitrite despite the presence of bacteria with reductase enzyme in urine. In addition, the conversion of nitrate to nitrite requires time as well as at least 10,000 bacteria in milliliter of urine for the chemical reaction on the pad to occur. Thus, first morning urine is a specimen of choice for nitrite test. Outdated dipstick or a dipstick exposed to air could also cause a false positive reaction for nitrite. In the context of these limitations, nitrite test is only specific (92-100%) for bacteria capable of converting nitrate to nitrates and has very poor sensitivity (19-48%).
Leukocyte esterase is an enzyme produced by neutrophils. This enzyme is released from lysed neutrophils. The presence of esterase enzyme in the urine may imply UTI. However, white blood cells could present in the urine secondary to bacterial and viral infections, or because of other conditions such as tumor in the bladder. Unlike nitrite, leukocyte esterase is somewhat sensitive (72-97%) but not as specific (41-86%).
The presence of glucose or ketone in the urine is not normal. Glucose is detected in the urine when the blood glucose level is greater or equal to 180 mg/dL. In this level of glucose in blood, the kidney readily overwhelms its ability to re-absorb by filtering excess glucose. The presence of ketone in urine is suggestive of poorly managed blood glucose level, starvation, and prolonged fasting. When used combined, both measurements can be used to identify and monitor diabetic patients.
Detectable protein (only detects albumin, not other proteins) in urine is indicative of renal disease. The normal protein level in urine is less than 150 mg/dL and is below the threshold a urine dipstick can detect. Significant proteinuria with 96% sensitivity and 87% specificity is detected when urine protein level exceeds 300 mg/dL. Because of its insensitivity to microalbuminuria, dipstick test has limited clinical utility in screening diabetic patients.
Urine dipstick is used to identify the peroxidase activity of red blood cells, not for the presence of intact erythrocytes. Therefore, urine dipstick alone cannot be used to diagnose hematuria unless combined with microscopy finding. Hematuria is defined by American Urological Association the presence of at least 3 red blood cells per high power field. Positive peroxidase activity in the absence of red blood cells under microscope could mean myoglobinuria (e.g. caused by rhabdomyolysis), hemoglobinuria (e.g. caused by hemolytic condition and infections), or false positives. False-positives could arise from urine contamination with oxidizing agents, semen in the urine, blood contamination from hemorrhoids or vaginal bleeding, or from foods and medications such as beets, hydroxocobalamin, and phenazopyridine.
The presence of detectable conjugated bilirubin and/or urobilinogen is suggestive of liver disease, in vivo hemolysis, and/or biliary obstruction. Low concentration of urobilinogen in urine is normal. Bilirubin is converted to urobilinogen by bacteria in the intestine.
The chemical analysis of urine provides valuable information about the function of multiple organs or systems within a very short analytical time. If the limitations and inferences of the chemical reactions are properly addressed during interpretation, the diagnostic utility of urine chemical test is high. In situations where access to laboratory testing is low, the dipstick can provide clues to aid diagnosis.
-Merih Tewelde, PhD, contributed to this post.
–Sarah Riley, PhD, DABCC, is an Assistant Professor of Pediatrics and Pathology and Immunology at Washington University in St. Louis School of Medicine. She is passionate about bringing the lab out of the basement and into the forefront of global health.
Frequently Asked Question
Can Urine Luck withstand extreme temperatures?
No, Urine Luck cannot withstand extreme temperatures. For example, exposing it to extreme heat can damage the active ingredients, and this exposure prevents the product from working at optimum levels for the test.
Can Urine Luck be reheated?
No, Urine Luck cannot be reheated, because it comes in vials that need to be added to your pee. It should also not be added to a sample before you arrive at the test facility, as the success rate will drop after a short time.
Does Urine Luck’s package hold a temperature strip?
No, Urine Luck’s package doesn’t hold a temperature strip because it is a product that is added to your pee. This process should be done at the testing facility, which means your pee should be at the right temperature, hence a temperature strip isn’t necessary.
How long does Urine Luck become futile?
Urine Luck becomes futile after a couple of hours, but even within the first hour, it’s success rate will drop. That’s why you should add it to a fresh sample at the test facility where it will be tested within minutes after you submitted it.
Do urine additives work?
Yes, a urine additive may work for your drug test, but it doesn’t have the same success rate as some other premade samples. While they do change the chemical structure of individual elements that can be associated with drugs and alcohol, testing equipment has also become more sensitive, so you’re not guaranteed a pass.
Can a diluted urine test positive?
Yes, diluted urine can test positive, and this is something that is checked thoroughly by modern test facilities. If the chemical composition of individual elements is not within the specific normal human range, then a fake pee sample result will be issued.
Can you put Urine Luck in the freezer?
No, you should not put Urine Luck in the freezer, as it won’t extend the expected shelf life. As the product is added to your pee when you submit the sample, you also want to avoid reducing the temperature of the sample with a frozen additive.
Can you buy Urine Luck in chain stores?
No, you can’t buy Urine Luck in chain stores, but there are a few online retailers that sell it. As with any synthetic urine products, the best place to buy Urine Luck is directly from the makers where you have maximum peace of mind that you’re getting the real deal.
Does Urine Luck have a pungent smell?
No, Urine Luck doesn’t have a pungent smell unlike fake pee products. Once you add it to your pee, it will not change the odor, but it will just smell like your pee. This is important because changing the scent could trigger a fail or at least an immediate retest.
What elements can be found in Urine Luck?
The elements in Urine Luck are a proprietary secret, but I can say that it contains two vials of the active ingredients. This is enough to clean about 3 ounces of urine, which is usually what is submitted at a testing facility.
Checking molecules for trouble signs
Unlike other smart toilets, Coon’s will use a mass spectrometer, a tool he describes as a “scale for molecules.” By sorting out the weight of thousands of molecules in a one microliter urine sample, the mass spectrometer can give users a thorough molecular analysis of their urine, and alert them to anything amiss, in about 10 minutes.
Michael Snyder, professor and chair of genetics at Stanford University, has done similar work in personal health profiling. In 2019, he concluded a years-long study that followed the personal biology of a 109-person group. As part of the study, participants wore glucose monitors and smartwatches, and they intermittently gave samples of stool and blood.
Over the course of the study, Snyder and other researchers discovered instances of high blood pressure, cardiomyopathy, and even early-stage cancer, before any of the participants showed symptoms.
When talking about wearable health monitors, Snyder points to his own research as proof that the way medicine is practiced needs to change.
“We measure people very infrequently, so the more information we can get with little effort the better,” said Snyder. “It’s kind of a no-brainer.”
Another feature of a health monitoring smart toilet is the potential to learn about the nature of diseases, and how signs of illness can show up in urine. Part of the challenge, or hope, is discovering what those clues could be on a molecular level. There could be signs of any number of diseases, even cancer, that show up in urine. But as of now, there isn't enough data to find out.
Like Apple's heart study using Apple Watches, a smart toilet could provide data that leads to the discovery of new diagnostic information.
"We need more markers for significant disease," Snyder said. "Even diabetes is probably 50 diseases."
Though Synder feels “very positive” about smart toilets and their potential for health monitoring, he believes that smartwatches are still the best, cheapest way to monitor one’s health, given the technology available now.
The challenge of health-monitoring smart toilets is making them accessible. While a mass spectrometer is about as complicated to make as a car engine, according to Coon, they aren’t made on the same scale, which is why they are far more expensive. As technology stands right now, Coon said that one of his smart toilets would cost anywhere between $5,000-$10,000.
“We know the technology exists,” Coon said. “It’s just a matter of building it.”