- 1 What happens to urine when urine left at room temperature
- 2 How much urine do you need for a UTI sample
- 3 Does temperature affect volume of urine
- 4 How do you know if a urine sample is contaminated
- 5 What cancers can be detected in urine
- 6 Should I not drink coffee before a urine test
- 7 What not to do during 24-hour urine collection
What happens to urine when urine left at room temperature
The Wizz Quiz: Understanding Urinalysis
- April 2019
- By Brandy Kastl, DVM
- Importance of a Urinalysis:
|Figure 1. Vesicoureteral Reflux|
A urinalysis provides information about the overall health status of our patients. It is easy to remember that diseases in the kidneys and urinary bladder can be detected on a urinalysis. But diseases in the liver, pancreas, heart, blood vessels, adrenal glands or brain may also cause abnormal urinalysis results.
- A properly collected and performed urinalysis is a recommended part of the minimum diagnostic work-up.
- Reaching a correct diagnosis in our patients requires not only an understanding of animal diseases, but also how urinalysis results can be affected by sample handling and collection methods.
- In some instances, results are so severely affected that an accurate diagnosis cannot be made.
Sample Collection: Preferred sample collection methods depend on the suspected disease process, patient species and temperament, technical skills of the collector, and available technology or resources (See Table 1.) Regardless of method used, always collect as much urine as possible, preferably at least 5 mL.
Sample collection methods can sometimes affect urinalysis results. For instance, urine collected from voided samples has the highest risk of bacterial contamination. Often, voided urine samples are collected from floors, exam tables, reused collection containers (ladles, pie tins, cups, etc.), or litter pans which can all contain bacteria.
Also, voided urine samples may pick up bacteria from the skin or fur of veterinary patients increasing the risk of contamination. In cases of suspected urinary bladder infections or high urine protein concentrations in small animals, samples collected via cystocentesis are best.
- Bacteria present in cystocentesis samples represent bacteria in the urinary bladder (i.e.
- Bladder infection).When a cystocentesis cannot be performed, sterile urinary catheterization is recommended.
- Manual bladder expression is not recommended as a routine urine collection method due to vesicoureteral reflux (Figure 1).
When a full urinary bladder is squeezed, urine will flow up the ureters toward the kidneys before exiting the body via the urethra. If a urinary bladder infection is present, bacteria is pushed up into the kidneys and could result in a severe kidney infection (i.e.
|Table 1. Comparison of Urine Collection Methods|
|Voiding||EasyLittle patient risk||High risk of bacterial contaminationUncooperative patients|
|Catheterization||Less risk of bacterial contaminationRelatively safe||Technical skill neededMay need sedation|
|Cystocentesis||Best sample type for a bladder infectionRelatively safe Often no sedation needed||Technical skill neededBlood contamination common Risk of bladder rupture or bleeding|
|Manual Expression||Not recommended due to vesicoureteral reflux (Figure 1)||High risk of pushing bacteria from the bladder up to the kidneys|
3 T’s of Urine Sample Handling:
- Tubes: A new sterile container should be used for every sample. If a urinalysis will be completed in house, the sample may be placed into a conical urine sediment tube immediately after collection (estimated cost/tube ~$0.03). In the author’s experience, pouring off unwanted urine after centrifugation is easier with a conical tube than a red top tube (estimated cost/tube ~$0.10). Alternatively, urine should be placed in a red top tube and stored immediately in the refrigerator. If a urine culture is wanted, remember to remove needles from syringes and tops from tubes before putting in the urine in order to prevent accidental bacterial contamination.
- Time: Completing a urinalysis within 1 hour of sample collection will give the most accurate results. If testing cannot be completed within one hour, samples should be placed in a red top tube and refrigerated. Any bacteria or cells present in a urine sample kept at room-temperature for more than one hour will continue to use glucose (sugar) in the urine. This may result in a falsely decreased urine glucose measurement. Also, bacteria produce ammonia which makes the urine more alkaline (increases pH). Finally, this increase in urine pH causes cells, like white blood cells, to degrade and may become unrecognizable.
Figure 2. Amorphous Crystals in Urine
- Temperature: Every urinalysis should be performed on room-temperature urine. If urine was refrigerated, allow the sample to sit at room temperature for 30 minutes before performing the urinalysis. Cold urine can cause a false increase in the urine specific gravity measurement potentially resulting in an incorrect diagnosis in our patients. Refrigerated urine samples, even those allowed to return to room temperature, may have amorphous crystals on the urine sediment (Figure 2). These crystals are a temperature artifact and do not indicate disease.
Things to Remember:
- Urinalysis results give information not only about the kidneys, but about the body as a whole.
- Urine collection preference order: cystocentesis > sterile urinary catheterization > clean void > contaminated void
- In-house urinalysis should be completed within one hour. Otherwise, refrigerate until ready.
- Allow urine sample to return to room-temperature before performing urine specific gravity.
- Dip the urine dipstick.
- Try an air-dried, Diff-Quik® stained urine sediment smear to see cells and bacteria better.
Next: : The Wizz Quiz: Understanding Urinalysis
How much urine do you need for a UTI sample
Culture and sensitivity – urine A urine culture is a lab test to check for bacteria or other germs in a urine sample. It can be used to check for a urinary tract infection in adults and children, A clean-catch urine sample is performed by collecting the sample of urine in midstream. Men or boys should wipe clean the head of the penis. Women or girls need to wash the area between the lips of the vagina with soapy water and rinse well. A small amount of urine should initially fall into the toilet bowl before it is collected (this clears the urethra of contaminants). The female and male urinary tracts are relatively the same except for the length of the urethra. The male and female urinary tracts are relatively the same except for the length of the urethra.
How long do dried urine samples last?
The benefits of dried urine samples include: –
Accurate lab analysis – Most labs certified under the Clinical Laboratory Improvement Amendments (CLIA) consider dried urine samples the best for urinalysis when tracking the effectiveness of hormone treatments, or detecting illicit drugs and anabolic steroids in athletes or other subjects. Convenience and ease of use – Subjects can spot wet urine onto a urine filter paper card or the absorbent tip of a Mitra ® device. These are “microsamples,” which are dried before sending to the lab for analysis. Ease of shipment – Once the Mitra device tips are dipped into the urine cup to collect a sample, they are enclosed in their plastic cartridge and sealed in a small specimen pouch that has a packet of drying desiccant (gel silica) inside. The specimen pouch is then slipped into a mailing envelope and sent to the lab that will perform the urine testing. Less messy – Handling wet urine samples can be messy, awkward and inconvenient—both at home and in the lab. Dried urine sampling is less messy, more convenient, and less likely to be diluted, contaminated, or altered by the test subjects. Sample stability – Dried urine samples are shelf-stable and can remain for up to 30 days at room temperature.
Many healthcare practitioners are switching to DUTCH (dried urine testing for comprehensive hormones) testing. This approach provides an extensive profile of adrenal and sex hormones in addition to their metabolites. More clinical labs are also beginning to adopt the DUTCH test, which is the leading approach in hormone panels.
It accurately identifies symptoms of hormonal imbalances by creating the complete picture of the hormone levels, which serum or saliva testing cannot provide. While dried urine sampling offers many benefits, the adoption rate is still somewhat slow among labs. This can be attributed to the fact that most labs are simply more accustomed to wet sampling methods.
The process of transitioning from wet to dried urine sampling will require some time, training and practice, but is worth the effort.
What foods to avoid before 24 hour urine test?
Patient must have diet free of avocados, bananas, tomatoes, plums, eggplant, hickory nuts, walnuts, pineapple and mollusks for 2 days prior to and during the collection. If advised by a physician, the patient should be off all drugs for 3 days. Restrict caffeine, nicotine and alcohol for 24 hours prior to collection.
Which is affected if a urine specimen sits at room temperature for more than 2 hours?
Unrefrigerated, unpreserved urine specimens greater than two hours old may be subject to overgrowth with organisms normally present in the urethra and periurethral areas, and may yield inaccurate or misleading results.
Does temperature affect volume of urine
Water Balance The kidneys play an important role in water homeostasis. Water is mainly resorbed in the proximal convoluted tubule and loop of Henle, but fine adjustments are made in the distal tubule under the influence of antidiuretic hormone (ADH). For instance, water is lost by the body in hot weather in sweat.
- This triggers the release of ADH into the blood which acts on the cells of the distal tubule and collecting duct to increase water resorption thus reducing the amount excreted.
- You might notice that in hot weather, you only produce small volumes of urine as the body is fighting to conserve water.
- If water is in excess, ADH levels are reduced limiting the amount of water resorbed back into the blood but increasing the volume eliminated in the urine.
If you drink a pint or so of fluid you will notice that within an hour your urine volume will increase and the excess water will therefore be eliminated. : Water Balance
How many hours is considered first morning urine?
1. Morning urine. The recommended time to take a urine sample is as soon as you wake up, i.e. urine after an overnight 8-hour rest or if it is impossible, after at least 4 hours from the previous urination.
Does it matter if you use first morning urine?
What time should I take a pregnancy test? – In general, the best time is when you have your first morning pee. However, some pregnancy tests are sensitive enough to detect HCG no matter what time of day you take the test. When possible, try to wait until it’s been three hours since your last pee before you take the test. You could also take two pregnancy tests to confirm you get the same result.
How do you know if a urine sample is contaminated
Interpreting test results – Results of a urine culture are often interpreted in conjunction with the results of a urinalysis and depend on how the sample was collected and whether symptoms are present. Some urine samples have the potential to be contaminated with bacteria normally found on the skin (normal flora).
For clean catch samples that have been properly collected, cultures with greater than 100,000 colony forming units (CFU)/milliliter of one type of bacteria usually indicate infection. In some cases, there may not be a significantly high number of bacteria even though an infection is present. Sometimes lower numbers (1,000 up to 100,000 CFU/mL) indicate infection, especially if symptoms are present. For samples collected using a technique that minimizes contamination, such as a sample collected with a catheter, results of 1,000 to 100,000 CFU/mL are generally considered significant.
Results from a urinalysis can be used to help interpret the results of a urine culture. For example, a positive leukocyte esterase (a marker of white blood cells) and nitrite (a marker for bacteria) can indicate a UTI. Occasionally, a UTI may be due to yeast, such as Candida albicans.
Proteus Klebsiella Enterobacter Staphylococcus Enterococcus
If a culture is positive, susceptibility testing may be performed to guide treatment. Negative urine culture: A culture reported as “no growth in 24 or 48 hours” usually indicates no evidence of infection. But if symptoms persist, a urine culture may be repeated on another sample to look for the presence of bacteria at lower colony counts or other microorganisms that can cause symptoms.
- For example, if you are symptomatic, the presence of white blood cells and low numbers of microorganisms in your urine is known as acute urethral syndrome.
- Contamination: If a culture shows several types of bacteria, the growth is likely due to contamination, especially in voided urine samples if the organisms include Lactobacillus and/or other common vaginal bacteria in women.
If symptoms persist, your doctor may order a culture on a more carefully collected sample. But if one type of bacteria has significantly higher colony counts (like 100,000 versus 1,000 CFUs/mL), more testing can find the predominant bacteria. A doctor can address detailed questions about UTIs, getting a urine culture, and your test results.
If my test is positive, how quickly should I feel relief after beginning treatment? Are there any follow-up tests that may be beneficial given my test result? What puts me at risk for recurring UTIs?
Kidney Stone Testing Learn More Gram Stain Learn More Blood Culture Learn More
What cancers can be detected in urine
Feeling anxious around needles is common. The NHS estimates that around 1 in 10 people experience trypanophobia, a fear of medical procedures that involve needles or injections. Unfortunately, in medicine, the use of needles is often necessary to check on a person’s health.
But looking in the blood may not be the only way to find clues left behind by disease. Other bodily fluids, like urine, also have the potential to reveal what’s going on in our bodies. “Urine gives a great insight into what’s going on inside our bodies,” says Mr Richard Bryan from the University of Birmingham, a Cancer Research UK-funded bladder cancer surgeon who’s working on a test to detect the disease in its early stages.
“The beauty of urine is that it is abundant, and nobody really wants it other than people like me. It’s very helpful when patients give permission for us to use their urine for research.” Bladder cancer is perhaps the most obvious cancer to find in urine, but evidence suggests that remnants of other cancers – like kidney, prostate and cervical cancer – can also get into pee.
What should not be found in urine?
Normal Results – Normal urine varies in color from almost colorless to dark yellow. Some foods, such as beets and blackberries, may turn urine red. Usually, glucose, ketones, protein, and bilirubin are not detectable in urine. The following are not normally found in urine:
HemoglobinNitritesRed blood cellsWhite blood cells
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your provider about the meaning of your specific test results.
What is the Dutch urine test?
What Does DUTCH Test? 4 Groups of Hormones, Metabolites, & Other Biomarkers DUTCH exists to make it easier for patients and their healthcare providers to find answers to complex clinical questions through industry-leading functional hormone testing and education.
The DUTCH Test is a comprehensive sex and adrenal hormone test that includes metabolites and organic acids to bring patient hormone status into focus. In their active form, hormones act as chemical messengers to control, facilitate, or trigger various processes in the body. As active hormones complete their work and new hormones are produced, active hormones need to be cleared from the body via the urine.
Steroid hormones do not dissolve well in water so they cannot pass directly into the urine. Instead, they must be broken down in the liver and kidneys to form smaller, water-soluble particles (known as metabolites) which can be excreted. Certain metabolites can be harmful if they are produced in excess, which is one important reason to test. The DUTCH Test evaluates metabolites and biomarkers derived from estrogens, progesterone, and androgens.
|Estrogen Analytes||Progesterone Analytes||Androgen Analytes|
|Estriol (E3, aka 16-OHE2)||Etiocholanolone|
The estrogen analytes measured on the DUTCH Test indicate a patient’s phase 1 estrogen detoxification status (also called hydroxylation) and phase 2 estrogen detoxification (methylation) status. Understanding both estrogen and progesterone in the body can help providers understand estrogen-related cancer risk, autoimmunity, PMS, and fertility issues in their patients.
Nowing these pathways can also assist the practitioner with potential suggestions for diet and lifestyle modification, supplementation, or hormone replacement therapy. Androgen metabolites and biomarkers help determine the activity of 5a- and 5b-reductase. The more androgenic 5a-pathway can be useful to understand when working with men who experience male pattern baldness, cystic acne, and prostate issues.
Women might experience cystic acne, female pattern baldness, hirsutism and PCOS when their metabolism favors the 5a- pathway. DUTCH adrenal testing includes many more important markers than tested in blood or saliva. The DUTCH Test includes eight adrenal analytes so providers can evaluate the health of their patients’ HPA axis.
|Cortisol awakening response (CAR)|
|Diurnal pattern of free cortisol|
|Diurnal pattern of free cortisone|
|Optional extra cortisol sample|
|Metabolized cortisol (THF+THE)|
Free cortisol is the active form of the hormone which binds to receptors and turns them on. Testing free cortisol helps understand the circadian rhythm and answers questions about a patient’s low energy and sleep trouble. Metabolized cortisol is an indication of total cortisol production and metabolized through the liver in one day.
- This marker is specific to urine testing and cannot be found in blood or saliva testing.
- The DUTCH Test includes metabolized cortisol because it can be greatly influenced by cases of hypothyroidism, hyperthyroidism, long-term stress, inflammation, insulin resistance, infection, poor liver function, anorexia, critical illness, and more.
Cortisone is the inactive form of cortisol. Testing this hormone provides a secondary look at the circadian rhythm. It is also helpful to understand as some people are more prone to the deactivation of cortisol into cortisone which can further their symptoms of fatigue.
By looking at the entire adrenal picture with DUTCH testing, healthcare practitioners have a much more comprehensive look into the health of their patient’s cortisol production and response to help them achieve their goals. make up the last portion of the DUTCH Test. They include nutritional and neurotransmitter metabolites, as well as markers for neuroinflammation, oxidative stress, gut health, and melatonin.
OATs can round out hormone testing in a way that provides additional information about the nutritional status, gut, and brain health of a patient. Testing organic acids gives healthcare practitioners an even more comprehensive understanding of their patients’ overall health. : What Does DUTCH Test? 4 Groups of Hormones, Metabolites, & Other Biomarkers
How accurate are Dutch tests?
Key Takeaways –
- DUTCH testing assesses male and female sex hormones, as well as other markers of hormonal health like cortisol and melatonin.
- The DUTCH test offers a detailed look at hormone levels by assessing hormones and their metabolites, and may give insight into reproductive disorders, fertility issues, and other hormonal imbalances.
- DUTCH cortisol testing is difficult to use in a clinical setting, as cortisol levels don’t appear to correlate with patients’ symptoms, including fatigue.
- “Adrenal fatigue” is currently not a valid medical diagnosis, and cortisol levels may not correlate with adrenal dysfunction.
- Correcting lifestyle, gut health, and nutrient deficiencies is likely more effective than a single test at resolving chronic fatigue and other non-specific health symptoms.
Many of us struggle with symptoms of low energy, sleep issues, anxiety, joint pain, and decreased motivation. In the functional medicine world, these symptoms can often result in a diagnosis of “adrenal fatigue.” While there’s no standardized way to evaluate this type of adrenal dysfunction, cortisol tests are often the “go-to” method.
- The Dried Urine Test for Comprehensive Hormones (DUTCH) is unique in that it assesses cortisol levels and patterns by sampling dried urine.
- The DUTCH test is not limited to cortisol testing, and evaluates other hormones, such as male and female sex hormones and their metabolites.
- DUTCH testing evaluates hormonal patterns that may be linked to reproductive disorders, infertility, and non-specific symptoms of a hormonal imbalance, like fatigue, weight gain, and brain fog.
But is this dried urine testing panel actually helpful? DUTCH test results are likely as accurate as blood testing when it comes to measuring basic hormone levels. However, when it comes to the more unique aspects of the DUTCH test that most people are paying for (like evaluating cortisol patterns), the results are not likely to be very useful.
- In fact, research shows that cortisol testing, in general, doesn’t appear to correlate with symptoms of adrenal dysfunction.
- With cortisol test results being speculative at best, what’s really occurring behind the scenes in those experiencing chronic fatigue? The cause of chronic fatigue is likely more complex than what a single lab test can offer, and often results from our lifestyle habits or gut health imbalances.
Fortunately, there are several common triggers that may be contributing to your symptoms.
How long do Dutch test results take?
Results will be returned to your provider 5-10 days after they are received by the lab. WHEN TO COLLECT? While adhering to your most common wake/sleep schedule, collect as close as possible to the below time-line.
Should I not drink coffee before a urine test
Observing Dietary Restrictions Avoids False Urine Test Results Certain foods and drugs ingested before or during the collection of a urine specimen can interfere with the accurate results of some tests. In general, you should observe the dietary restrictions listed here if you have one of these tests.
If, however, your test is not listed here, there are no dietary restrictions you need to observe. Consult your doctor before discontinuing any medications, or if you are unsure whether a drug you are taking is listed here. In any case, always follow your doctor’s specific instructions for the test ordered.
Metanephrine Urine Test If your doctor has ordered a test for metanephrine in your urine, you should avoid caffeine for 24 hours and during collection of your specimen. In addition, the following drugs should be avoided for one week prior to the collection, if clinically feasible:
Phenothiazines (used to treat mental or emotional disorders) Tricyclic antidepressants including imipramine, as well as labetalol, sotalol and monoamine oxidate inhibitors (MAOIs) Chlorpromazine (used to treat psychosis)
Caution: do not stop taking any medications without prior approval from your physician. Vanillylmandelic Acid (VMA) Urine Test If your doctor has ordered a test for VMA in your urine, you should avoid high doses (as determined by your physician) of the following substances for a minimum of 24 hours before, as well as during, collection of your specimen:
Triamterene (used to treat high blood pressure and fluid retention) Octopamine (found in drugs such as Norfen, Norden and Epirenor) Phenolic amines (found in fruit juices and bananas) Phenylpyruvic acid
You also should avoid the drugs labetalol and methyldopa, both of which are used to treat high blood pressure. Caution: do not stop taking any medications without prior approval from your physician. Hydroxyindoleacetic Acid (5HIAA) Urine Test If your doctor has ordered a test for 5HIAA in your urine, you should avoid the following foods and drugs for at least a 48-hour period before and during collection of your specimen:
Bananas Avocadoes Plums Cantaloupe and honeydew melon Dates Hickory nuts Grapefruit Kiwi Eggplant Tomatoes Pineapples Walnuts Plantain Pain relievers (specifically those containing acetaminophen, salicylates or phenacetin) Cough syrups containing glyceryl guaiacolate Muscle relaxants containing mephenesin or methocarbamol Antidepressants including imipramine and monamine oxidase inhibitors (MAOIs) Isoniazid (antibiotic used to fight tuberculosis and other diseases) Methenamine (antibiotic used to fight urinary tract infections) Methyldopa (used to treat high blood pressure) Phenothiazines (used to treat mental or emotional disorders)
Caution: do not stop taking any medications without prior approval from your physician. Catecholamines Urine Test If your doctor has ordered a test for catecholamines in your urine, it is preferred if you take no medications for three days prior to collecting a specimen.
Acetaminophen Alcohol Antihistamines Aspirin Caffeine Vitamin B
Caution: do not stop taking any medications without prior approval from your physician. Michigan law requires that a valid order signed by an authorized person be presented before any laboratory test or procedure can be conducted. Authorized persons are defined as physicians, physician assistants, or nurse practitioners.
Can eating affect urine test?
How you prepare – If you’re having only a urinalysis, you can eat and drink before the test. If you’re having other tests, you might need to fast before the test. Your health care provider will give you specific instructions. Many drugs, including nonprescription medications and supplements, can affect the results of a urinalysis.
What not to do during 24-hour urine collection
During the urine collection period, do not drink alcohol or beverages that have caffeine or eat food that have avocado, banana, eggplant, tomato, plum, pineapple, or walnuts. Do not use tobacco during this period.
Can you reuse a specimen cup?
They are designed as single-use plastic containers and reusing them can affect lab results. If you have no other option, wash the urine specimen cup with dish soap, rinse it at least 10 times with tap water and allow it to air dry. To make sure you never run out of collection cups again, buy them as a set.