Urinalysis – OSCE Guide

Urinalysis (urine dipstick testing) frequently appears as an OSCE station, so you need to get familiar with the process to look competent in the exam. It’s actually a very simple process, but people often fail to revise this station and lose marks unnecessarily. With a little practice, you can ensure you get full marks every time.

Check out the urinalysis OSCE mark scheme here.

Gather equipment

  • Alcohol gel
  • Gloves
  • Apron
  • Urine dipsticks
  • Urine sample
  • Paper towels
  • Gather urinalysis equipment
    Gather equipment

Inspect urine

1. Wash hands, don gloves and apron

2. Confirm patient details are correct on the sample bottle – name / DOB / hospital number

3. Inspect the colour of the urine:

  • Straw coloured – normal
  • Dark concentrated urine dehydration
  • Red macroscopic haematuria / rifampicin / porphyria / beetroot
  • Brown – bile pigments / myoglobin / antimalarials 

4. Inspect the clarity of the urine:

  • Clear normal
  • Cloudy / debris  urinary tract infection (UTI)
  • Frothy – nephrotic syndrome

5. Remove the sample bottles’ cap and assess urine odour:

  • Offensive urine UTI
  • Sweet – glycosuria
  • Wash hands
    Wash hands

Perform dipstick testing

1. Check urine dipsticks’ expiry date

2. Remove a testing strip from the container (avoiding touching the testing zones)

3. Insert test strip into urine sample (ensuring all test zones are immersed)

4. Remove the strip, ensuring to tap off residual urine before removing from the sample bottle

5. Ensure test strip remains in a horizontal orientation (to avoid cross contamination of testing zones)

6. Use the dipstick analysis guide on the side of the testing strip container to interpret the findings

7. Different tests on the strip are required to be read at different times, so ensure you interpret the appropriate test at the correct time interval – e.g. 60 seconds for protein

8. Once you have interpreted all of the tests, discard the strip into the clinical waste bin along with your gloves and apron

9. Wash hands

  • Urinalysis
    Check urine dipstick expiry date

To complete the procedure

Summarise findings

Document urinalysis results

Indicate that depending on the results, further investigations may be required:

  • ↑ WCC / Leukocytes – ?UTI –  send urine for culture (MSU/CSU)
  • ↑ Glucose – ?Diabetes  capillary blood glucose

Urine dipstick tests explained

pH – indicates acidity of urine – e.g. ↓pH in systemic acidosis

Specific gravity – indicates amount of solute dissolved in urine – ↓ in diabetes insipidus

Blood  – indicates number of red blood cells in urine – ↑ in haematuria

Protein – indicates level of protein in the urine – ↑ nephrotic syndrome

Leukocyte esterase – enzyme produced by neutrophils (WCC in urine) – ↑ in UTI

Nitrites – breakdown products caused by Gram -ve organisms – Gram -ve UTI e.g. Ecoli

Ketones – breakdown product of fatty acid metabolism – ↑ starvation / ↑DKA

Glucose – ↑ hyperglycaemia e.g. poorly controlled diabetes

Bilirubin – Indicates ↑ conjugated bilirubin (water soluble) – ↑ biliary tract obstruction

Urobilinogen – if raised indicates ↑ bilirubin turnover – ↑malaria / ↑haemolytic anaemia 

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