Urine tests

Mid-stream urine (MSU) sample collection

• Wash hands; Introduce self; ask Patient’s name, DOB and what they like to be called; Explain procedure and obtain consent
• Explaining procedure
  • Patient must wash hands and genitals prior to sample collection
  • Before passing urine, men must retract foreskin and women part labia
  • Patient must urinate into the container you give them
  • However, only the middle part of the urine stream should be collected, i.e. they must pass the first part of the stream into the toilet, then collect the sample, then pass the rest of the urine into the toilet
  • They must not touch the inside of the container and must replace the lid as soon as the sample is in the collection pot
  • They should then place it in the bag you provide and bring it back
• Label the urine container and lab sample collection bag and give them to the patient
• Ask them to return after they have obtained the sample
• Thank patient
• Perform dipstick testing on urine if required (see below)
• Send the collected sample in the labelled collection bag to the lab for MC&S if required. Advise patient when to return for the result (usually 2-3 days).

Urine dipstick

• Collect MSU (as above)
• Wash hands
• Put on gloves and apron
• Check patient details on the sample are correct
• Note the features of the urine
  • Odour
    • Sweet: DKA/glycosuria
    • Pungent: infection
    • Ammonia-type smell: alkaline urine
  • Discolouration
    • Red: haematuria/haemoglobinuria/myoglobinuria, porphyria, beetroot, drugs (rifampicin)
    • Brown: bile pigments, myoglobin, methaemoglobin, drugs (levodopa, metronidazole, antimalarials, nitrofurantoin)
    • Green/blue: Pseudomonas UTI, biliverdin, drugs (amitriptyline, methylene blue, propofol)
    • Orange: bile pigments, drugs (phenothiazines)
  • Cloudiness: pus, pyuria, alkaline urine phosphate crystals
  • Sedimentation
• Check the date on the urine dipstick container, remove a dipstick and close container
• Open the urine sample pot with one hand
• Dip the dipstick into the sample so all of the coloured squares are immersed
• Remove the dipstick and hold it horizontally
• Close the urine sample pot
• Use a stopwatch/clock to keep time and read the relevant squares at the correct times
• Discard the urine sample in the hazardous waste bin or send it to the lab for MC&S if required
• Wash hands
• Record results in the patient’s notes
• Suggest further investigations you would do after a full history (if any abnormal findings)

24-hour urine sample collection

This may be taken to test for: catecholamines/metanephrines (phaeochromocytoma), free cortisol (Cushing’s syndrome), 5-HIAA (carcinoid), sodium/calcium/oxalate/uric acid/citrate (renal stone assessment), protein (nephrotic syndrome)

• Wash hands; Introduce self; ask Patient’s name, DOB and what they like to be called; Explain procedure and obtain consent
• Explaining procedure
  • When you wake up tomorrow, go to the toilet and empty your bladder fully
  • Note the time (e.g. Wednesday, 7am)
  • Collect all of the rest of your urine for the next 24 hours in the large urine container provided
  • Collect the last urine exactly 24 hours after starting (e.g. Thursday, 7am)
  • When it is finished, you must take the container to the hospital’s laboratory desk within 24 hours
• Label the urine container and give it to the patient
• Thank patient and advise them when to return for the result