Diagnostics
Evolution of urinalysis: from dipstick to digital solution
Julie Elston provides an insight into the evolution of urinalysis. She argues that digital solutions could address some of the issues associated with urinalysis – such as improper handling, inconsistent dip times, subjective interpretation, and inefficient processes.
A urinalysis test is used to detect and manage a wide range of disorders – such as urinary tract infections, kidney disease, liver problems and diabetes – and is commonly used for several reasons: l To check overall health. A urinalysis might be part of a routine medical exam, pregnancy checkup or pre-surgery preparation, or to screen for a variety of disorders, such as diabetes, kidney disease or liver disease, upon admission to hospital.
l To diagnose a medical condition. A urinalysis might be requested if the patient has abdominal pain, back pain, frequent or painful urination, blood in the urine, or other urinary problems. A urinalysis can help diagnose the cause of these signs and symptoms.
l To monitor a medical condition. For patients diagnosed with a medical condition, such as kidney disease or a urinary tract infection, the doctor might recommend regular urine testing for monitoring purposes.
The urine dipstick test is a urine examination method that can be used for urinalysis. This examination is relatively cheap, easy, fast, and has good sensitivity and specificity.
Urinalysis by dipstick testing Urinalysis by dipstick testing began in the 1950s. Alfred Free of Miles Laboratories embedded reagents on a filter paper strip and the result was the invention of a dip-and-read strip, the first test specific for glucose, released in 1956.1 In 1957, Miles introduced another strip which was a dip-and-read test for protein in urine. The company now had diagnostic procedures for the
Figure 1: Dipstick result from urine sample.
two most common urine tests. The development of additional diagnostic
tests led to another breakthrough: combining reagents for two or more tests on one strip as a further convenience for the user (Fig. 1). Miles continued to add more tests to the strips for ketones, haemoglobin, bilirubin, urobilinogen, nitrite, leucocytes and pH. In 1981, the company added a specific gravity test and introduced the ten-reagent urine strip, Multistix 10 SG – a product still available today. Urine dipstick testing became a standard practice for patients seen in physicians’ offices, medical clinics and hospitals as an initial indicator of metabolic, kidney, and liver disorders. These multi-test strips have changed little in appearance, with only minor innovations in impregnation techniques, reagent pad material and colour
Testing should be carried out within 1-2 hours of sample collection to give the most accurate results. If testing cannot be completed within this time samples should be refrigerated.
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indicator stability (Fig. 1). Urine dipsticks can either be read visually by comparing the strip to a colour chart or by using automated or semi-automated urine analysers. The instruments facilitate the reading and interpretation of the test result and offer enhanced accuracy and consistency. These instruments are a type of reflectance photometer. They shine an LED light onto the test pads and measure the intensity of the light reflected back at specific wavelengths. An internal calibration is used to interpret the results based on the intensity of the colour change. There are limitations to consider when carrying out dipstick urinalysis. Simerville et al2 noted that “false-positive and false-negative results are not unusual in dipstick urinalysis”. Time: Testing should be carried out within 1-2 hours of sample collection to give the most accurate results. If testing cannot be completed within this time samples should be 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
Copyright: Freepik
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