Question

A 26 year old athlete is in the laboratory for a sports examination. He is training for a marathon and appears to be in good health overall. A screening midstream catch urinalysis is performed . Results revealed the following:

Color	Bright yellow	Glucose	Negative	Urobilinogen	0.2 mg/dL
Appearance	Hazy	Proteins	1+	Blood	Negative
Specific gravity	1.027	Ketones	Negative	Nitrite	Negative
pH	5.0	Bilirubin	Negative	Leukocyte Esterase	Negative

Microscopic Examination:

Squamous epithelial cells: Rare

Red blood cells (RBCs): 0-2/hpf

White blood cells (WBCs): 0-2/hpf
Bacteria: None seen
Hyaline casts: 0-1 /lpf

Crystals: None seen

Questions:

1. If you are the Medical Lab Technologist how do you inform/instruct the patient the proper way of collecting Midstream Catch urine sample?

2. In observing for the appearance or clarity/transparency of urine what is the most important procedure before you describe the appearance?

3. What is the importance or significance of determining the following tests:

1. specific gravity of urine
2. leukocyte esterase
3. ketones

4. What is the possible cause of his bright yellow urine?

5. Is the presence of hyaline cast significant ?   Yes or No.    Support your answer.

6. If hemoglobin is present in the urine , how can you differentiate it from myoglobin? ?

7. What are the causes of false negative Nitrite tests?

8. What are the possible changes in chemical analytes that may occur when the athlete’s urine is not preserved after having stood at room temperature for 6 hours? ( List all changes)

Answer 1

1.Instruction for the patient the proper way of collecting Midstream Catch urine sample

• Early morning urine specimens are preferred.
• Use an approved empty sterile container for collection, to avoid contamination, because a midstream catch urine sample is necessary for a culture.
• Wash and dry your hands thoroughly. Remove the cap of the container and set it aside.
• Wash your urogenital area., retract the foreskin, and clean the head of the penis.
• Pass a small amount of urine into the toilet. Then, urinate into the container.
• The container should only be 1/2 to 2/3 full.
• Replace the cap and tighten firmly.
• Wash your hands well after collecting the specimen.

2. In observing for the appearance or clarity/transparency of urine what is the most important procedure before you describe the appearance?

Macroscopic observation

3. What is the importance or significance of determining the following tests:

• specific gravity of urine: Determinates the concentration of particles or solutes in the urine. That means less solutes less specific gravity and vice-versa.
• leukocyte esterase: Determine the amount of leukocytes. Positive leukocyte esterase indicates an increase in the amount of leukocyte or pyuria. Pyuria is an indication of urinary tract infection, urethritis or cystitis.
• ketones: Ketones in the urine indicates that the body is using fat as a major source of energy. High levels ketone in the urine is seen in patients with uncontrolled diabetes, renal glycosuria, starvation, hyperthyroidism etc.

4..What is the possible cause of his bright yellow urine? Vitamin supplements especially vitamin B.

5. Is the presence of hyaline cast significant?   Yes

Increased amount of hyaline cast is associated with stress, physiological dehydration, exposure to heat, physical exercise and pathologic conditions like acute glomerulonephritis, pyelonephritis, renal diseases, congestive heart failure etc.

6 If haemoglobin is present in the urine, how can you differentiate it from myoglobin? hemoglobin  red colour

7. What are the causes of false-negative Nitrite tests? Severe bacterial infections may cause false-negative Nitrite tests

8 What are the possible changes in chemical analytes that may occur when the athlete’s urine is not preserved after having stood at room temperature for 6 hours? ( List all changes)

pH will increase

Amount of glucose decreases.

Cast,acetone will decrease.