Editing Urine test

{{Short description|Medical test of urine}}
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|caption= A urine sample in a sterile container
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A '''urine test''' is any [[medical test]] performed on a [[urine]] specimen. The analysis of urine is a valuable diagnostic tool because its composition reflects the functioning of many body systems, particularly the [[kidney]]s and [[urinary system]], and specimens are easy to obtain.{{sfn|Brunzel|2018|pp=19–22}} Common urine tests include the routine [[urinalysis]], which examines the  physical, chemical, and microscopic properties of the urine; [[urine drug screen]]ing; and [[urine pregnancy test]]ing.

==Background==
The value of urine for diagnostic purposes has been recognized since ancient times. Urine examination was practiced in [[Sumer]] and [[Babylonia]] as early as 4000 BC, and is described in ancient [[Ancient Greek|Greek]] and [[Sanskrit]] texts.<ref name="ki2">{{cite journal | vauthors = Armstrong JA | title = Urinalysis in Western culture: a brief history | journal = Kidney International | volume = 71 | issue = 5 | pages = 384–387 | date = March 2007 | pmid = 17191081 | doi = 10.1038/sj.ki.5002057 | doi-access = free }}</ref> Contemporary urine testing uses a range of methods to investigate the physical and biochemical properties of the urine. For instance, the results of the routine [[urinalysis]] can provide information about the functioning of the [[kidneys]] and [[urinary system]]; suggest the presence of a [[urinary tract infection]] (UTI); and [[Screening (medicine)|screen]] for possible [[diabetes]] or [[liver disease]], among other conditions.<ref name="statpearls"/> A [[urine culture]] can be performed to identify the bacterial species involved in a UTI.{{sfn|Turgeon|2016|p=505}} Simple [[point-of-care test]]s can detect [[pregnancy]] by identifying the presence of [[beta-hCG]] in the urine{{sfn|Turgeon|2016|p=216}} and indicate the use of [[recreational drugs]] by [[Urine drug screen|detecting excreted drugs or their metabolites]].<ref name="mayo">{{cite journal | vauthors = Moeller KE, Kissack JC, Atayee RS, Lee KC | title = Clinical Interpretation of Urine Drug Tests: What Clinicians Need to Know About Urine Drug Screens | journal = Mayo Clinic Proceedings | volume = 92 | issue = 5 | pages = 774–796 | date = May 2017 | pmid = 28325505 | doi = 10.1016/j.mayocp.2016.12.007 | s2cid = 21260113 | doi-access = free }}</ref> Analysis of abnormal cells in urine ([[urine cytology]]) can help to diagnose some [[cancer]]s,{{sfn|McPherson|Pincus|2017|p=479}} and testing for [[Urine organic acids|organic acids]] or [[Aminoaciduria|amino acids]] in urine can be used to screen for some [[genetic disorder]]s.{{sfn|Rifai|Horvath|Wittwer|2018|p=1697}}

==Specimen collection==
[[File:Trace metal-free 24 hour urine container.jpg|thumb|Example of a container used for collecting 24-hour urine samples. This particular container is free of [[trace metal]]s to allow for accurate measurement of these substances in urine.]]
The techniques used to collect urine specimens vary based on the desired test. A random urine, meaning a specimen that is collected at any time, can be used for many tests. However, a sample collected during the first urination of the morning (first morning specimen) is preferred for tests like urinalysis and pregnancy screening because it is typically more concentrated, making the test more [[Sensitivity and specificity|sensitive]].{{sfn|Brunzel|2018|pp=19–22}}{{sfn|Mundt|Shanahan|2016|p=264}} Because the concentration of many substances in the urine varies throughout the day, some tests require timed urine collections, in which the patient collects all of their urine into a container for a given period of time (commonly 24 hours). A small amount of the specimen is then removed for testing. Timed collections are commonly used to measure [[Urine creatinine|creatinine]], [[urea]], [[urine protein]],  [[hormones]] and [[electrolytes]].{{sfn|Brunzel|2018|pp=19–22}}{{sfn|Mundt|Shanahan|2016|pp=75–6}} 

If urine is needed for [[microbiological culture]], it is important that the sample is not contaminated. In this case, the proper collection procedure involves cleaning the genital area, beginning to urinate into the toilet, and then filling the specimen container before completing the urination into the toilet. This is called a "midstream clean catch" collection.{{sfn|Brunzel|2018|pp=19–22}} Research has shown many women are unsure of how to take a midstream sample or why it is needed.<ref>{{cite journal |date=11 December 2022 |title=Do women know how to take a urine sample? |url=https://evidence.nihr.ac.uk/alert/do-women-know-how-to-take-a-urine-sample/ |journal=NIHR Evidence}}</ref><ref>{{cite journal | vauthors = Glogowska M, Croxson C, Hayward G | title = Women's information needs around urine testing for urinary tract infections: a qualitative study | journal = The British Journal of General Practice | volume = 72 | issue = 717 | pages = e244–e251 | date = April 2022 | pmid = 35190371 | pmc = 8869185 | doi = 10.3399/BJGP.2021.0564 }}</ref>

If the subject is not able to urinate voluntarily, samples can be obtained using a [[urinary catheter]] or by inserting a needle through the abdomen and into the bladder ([[suprapubic aspiration]]).<ref name="statpearls">{{cite journal| vauthors = Queremel Milani DA, Jialal I |title=Urinalysis|date=8 May 2022|journal=StatPearls|pmid=32491617 |url=https://www.ncbi.nlm.nih.gov/books/NBK557685/|access-date=13 July 2022|archive-date=5 April 2022|archive-url= https://web.archive.org/web/20220405015846/https://www.ncbi.nlm.nih.gov/books/NBK557685/|url-status=live}}</ref> In infants and young children, urine can be collected into a bag attached to the genital region, but this is associated with a high risk of contamination.{{sfn|Brunzel|2018|pp=19–22}}

==Types==
Some examples of urine tests include:

===Chemistry===
[[File:Urine_Quicktest.jpg|thumb|right|upright=0.5|Urine dipstick used in [[urinalysis]]]]
*[[Urinalysis]] — assessment of the visual properties of the urine, chemical evaluation using [[urine test strips]], and microscopic examination{{sfn|McPherson|Pincus|2017|pp=441–3}}
*[[Urine creatinine]], [[creatinine clearance]] — used to assess [[Assessment of kidney function|kidney function]]{{sfn|McPherson|Pincus|2017|pp=167–8}}
*[[Albumin/creatinine ratio]] — used to diagnose [[microalbuminuria]]{{sfn|Turgeon|2016|p=255}}
*[[Urine osmolality]] — measure of the [[solute]] concentration of urine{{sfn|Brunzel|2018|pp=51–3}}
*[[Urine specific gravity]] ― another measure of urine concentration{{sfn|Brunzel|2018|pp=51–3}}
*[[Urine electrolyte levels]] — measurement of [[electrolytes]] such as [[sodium]] and [[potassium]] in urine<ref name="wu">{{cite journal | vauthors = Wu X | title = Urinalysis: a review of methods and procedures | journal = Critical Care Nursing Clinics of North America | volume = 22 | issue = 1 | pages = 121–128 | date = March 2010 | pmid = 20193886 | doi = 10.1016/j.ccell.2009.10.012 }}</ref>
*[[Urine anion gap]] — used to distinguish between some causes of [[metabolic acidosis]]{{sfn|Reddi|2014|pp=13−4}}

===Hormones===
*[[Urine pregnancy test]] ― detects [[human chorionic gonadotropin]] in urine{{sfn|Turgeon|2016|p=216}}
*[[Urine cortisol]] ― used to investigate disorders of the [[adrenal gland]]s{{sfn|McPherson|Pincus|2017|p=391}}
*[[Urine metanephrines]] ― used to help diagnose some rare [[tumour]]s{{sfn|Rifai|Horvath|Wittwer|2018|p=1421}}

===Microbiology===
[[File:Urine cultured on Oxoid Brilliance UTI Agar plate.jpg|thumb|upright=0.5|right|Two urine specimens [[Microbiological culture|cultured]] on chromogenic [[Agar plate|agar]], which changes colour based on the bacterial species present]]
*[[Urine culture]] — [[microbiological culture]] of urine samples, used to identify bacteria causing [[urinary tract infection]]s{{sfn|Turgeon|2016|p=505}}

===Miscellaneous===
*[[Urine drug screen]] — screen for usage of [[recreational drug]]s<ref name="mayo"/>
*[[Urine cytology]] — [[cytopathological]] examination of cells in the urine, used to screen for cancer<ref name="xing">{{cite journal | vauthors = Xing J, Reynolds JP | title = Diagnostic Advances in Urine Cytology | journal = Surgical Pathology Clinics | volume = 11 | issue = 3 | pages = 601–610 | date = September 2018 | pmid = 30190143 | doi = 10.1016/j.path.2018.06.001 | s2cid = 52171396 }}</ref> 
*[[Urine protein electrophoresis]] — classification and measurement of different [[protein]]s in the urine; used to help diagnose [[monoclonal gammopathies]]{{sfn|McPherson|Pincus|2017|p=253}} 
*[[Urine organic acids]], [[urine amino acids]] — used to test for some [[inborn errors of metabolism]]{{sfn|Rifai|Horvath|Wittwer|2018|p=1697}}
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== References ==
{{reflist|30em}}

==Works cited==
{{refbegin}}
* {{cite book | vauthors = Brunzel NA |title=Fundamentals of Urine and Body Fluid Analysis|date=2018|publisher=[[Elsevier]]|edition=4th|isbn=978-0-323-37479-8|url=https://books.google.com/books?id=_D5yDQAAQBAJ}}
* {{cite book| vauthors = McPherson RA, Pincus MR |title=Henry's Clinical Diagnosis and Management by Laboratory Methods|url=https://books.google.com/books?id=xAzhCwAAQBAJ|year=2017|publisher=Elsevier Health Sciences|isbn=978-0-323-41315-2|edition=23}}
* {{cite book | vauthors = Mundt LA, Shanahan K |title=Graff's Textbook of Urinalysis and Body Fluids|edition=3|date=2016|isbn=978-1-4963-2016-2|publisher=[[Wolters Kluwer]]}}
* {{cite book| vauthors = Reddi AS |title=Fluid, electrolyte, and acid-base disorders: clinical evaluation and management|date=2014|publisher=[[Springer (publisher)|Springer]]|isbn=978-1-4614-9082-1|pages=13−4|url=https://books.google.com/books?id=kC3ABAAAQBAJ&dq=978-1-4614-9082-1&pg=PP1}}
* {{cite book | vauthors = Rifai N, Horvath AR, Wittwer CT |title=Tietz Textbook of Clinical Chemistry and Molecular Diagnostics|edition=6th |publisher=Elsevier|date=2018|isbn=978-0-323-35921-4|url=https://books.google.com/books?id=3mRgDwAAQBAJ}}
* {{cite book| vauthors = Turgeon ML |title=Linné & Ringsrud's Clinical Laboratory Science: Concepts, Procedures, and Clinical Applications|url=https://books.google.com/books?id=QyvRoQEACAAJ|year=2016|publisher=Elsevier Mosby|isbn=978-0-323-22545-8|edition=7}}
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{{Urine tests}}

[[Category:Urine tests]]