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UMG/UDL Point of Care Policy D:\493712447.doc 6/28/2017 University Diagnostic Laboratories POCT Program PROCEDURE Procedure: Microscopic Examination of Urine Prepared by Evan Cadoff, M.D. Revision Date 6/8/99 10/10/01 Date Adopted 7/7/97 Supersedes Procedure # Revision summary Updated procedure to Word format. Remove references to outpatient services. Added lot to lot verification requirement Update formatting Review Date Revision Date Signature # of Copies Distributed to UDL POCT sites Distributed to # of Copies 1 PRINCIPLE Analysis of urine may be used for either one of two purposes. One is to determine the presence of body disturbances, such as endocrine or metabolic abnormality in which the kidneys function normally and excrete abnormal amounts of metabolic end products specific for a particular disorder. The second purpose is to detect intrinsic conditions that may affect the kidneys or urinary tract. Diseased kidneys cannot function normally in regulating the volume and composition of body fluids and maintain homeostasis. Therefore, substances normally retained by the kidneys or excreted in small amounts may appear in the urine in large quantities and substances normally excreted may be retained. Structural elements, such as red blood cells, cells from the urinary tract, leukocytes, bacteria, and casts from the impaired kidneys or lower urinary tract may appear in the urine. Page 1 of 3 UMG/UDL Point of Care Policy D:\493712447.doc 6/28/2017 SPECIMEN COLLECTION The optimal container for collecting urine is the plastic screw top cup. For patients bringing specimens collected at home, small glass jars with screw caps (i.e. baby food jars), are acceptable but must be well cleansed and thoroughly dried before the specimen is collected. Other containers are not acceptable. Specimens from infants and young children may be collected in a disposable collection apparatus consisting of a plastic bag with an adhesive backing around the opening to fasten it to the child allowing the specimen to be voided directly into the bag. After removal, the top of the bag is rolled down to close and then placed into a plastic screw top urine container to be transported to the laboratory. The procedure most commonly used for obtaining urine for urinalysis along with bacteriologic examination and culture is the clean catch or midstream specimen. To avoid contamination of the voided specimen by organisms in areas adjacent to the urethral meatus, this area must be cleansed thoroughly before the patient voids. To avoid contamination of the specimen with organisms normally located in the distal urethra, the initial stream of voided urine which clears these organisms from the urethra is discarded and the subsequent midstream urine is collected. A description of the optimal technique for the clean catch urine collection can be found as an addendum to this procedure. Bladder catheterization and percutaneous suprapubic aspiration of the bladder may be used, but only in rare and unusual circumstances. Most testing is done on a random specimen of urine, freshly voided by the patient, although a first morning specimen is preferable. The specimen is collected in a clean, dry container and should be examined within one hour as to avoid changes or deterioration in the urine. If the specimen is to be kept more than one hour before the analysis, it should be refrigerated at 2 - 8oC and returned to room temperature before analysis. All collection containers and testing vessels should be free of any disinfectants or detergents. Specimens must be labeled with the patient’s name. The container should be labelled in advance, or the patient should be provided with a means of labelling the sample (ie, a pen or pencil available in the bathroom). At least 10 ml. of urine is required for an optimal evaluation. If less than 5 ml is received, a microscopic evaluation should not be performed. REAGENTS AND EQUIPMENT Centrifuge Tubes Plain Glass Slides Cover Slips, 22x22 mm Timer Centrifuge Page 2 of 3 UMG/UDL Point of Care Policy D:\493712447.doc 6/28/2017 URINALYSIS PROCEDURE Centrifuged urinary sediment is examined microscopically first under the 10X objective to tabulate casts and get an overview of the sediment. Then changed to the 40X objective to tabulate the cellular elements and to identify any crystals seen. URINE MICROSCOPIC PROCEDURE 1. Ascertain that a microscopic examination is necessary based on your findings during the chemistry phase of the urinalysis. 2. Transfer 10 ml. of urine to a labeled conical urine centrifuge tube. 3. Centrifuge the tube for five minutes at 2400 RPM. A longer duration or faster speed will result in the cellular elements being damaged making identification difficult. 4. Decant the supernatant and resuspend the sediment by gently vortexing the tube with your finger. 5. Place a drop of the resuspended sediment on a clean slide, and coverslip with a 22x22 mm coverglass. 6. Observe and tabulate your findings of 10 fields each at 10X and 40X power. REPORTING RESULTS: Record your findings in the patients record. Record in the patient log the information required. Since testing is physician performed, further reporting of results or documentation is not necessary. LIMITATIONS Despite care in specimen collection, various artifacts and contaminants may occasionally be found in a sample, such as talcum powder, starch particles, Vaseline, glass particles, clothing fibers, etc. Careful examination is required to correctly identify the artifact. If necessary, a repeat specimen may be required. REFERENCES Haber, Meryl H., M.D., Primer of Microscopic Urinalysis, Fountain Valley, Ca.: Scientific; 1978 ICL Ames Co., Div. Miles Laboratories, Inc., Modern Urinalysis, Chicago, III.: Stern's Printers; 1974 Page 3 of 3