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Test Code RUA Urinalysis, Complete, Includes Microscopic

Reporting Name

Urinalysis Complete w/ Microscopic

Useful For

Screening for urinary tract diseases and some nonrenal diseases

Profile Information

Test ID Reporting Name Available Separately Always Performed
SRC3 Source No Yes
APP4 Appearance No Yes
UOSMU Osmolality, U Yes Yes
PHU_ pH, U Yes Yes
GLUC Glucose Yes, (Order RGLUR) Yes
PRO5 Protein Yes, (Order RPTU) Yes
PR_OS Protein/Osmolality No Yes
P24HP Predicted 24 Hr Protein No Yes
P_RGE Predicted Range No Yes
UBIL Bilirubin Yes, (Order UBILU) No
HGBQL Hemoglobin, QL Yes, (Order HGB_Q) Yes
CMT51 Comment No Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
MICA Microscopic Automated No No
MICM Microscopic Manual No No

Testing Algorithm

When this test is ordered, either automated or manual microscopic examination will always be performed at no additional charge.

Method Name

UOSMU: Freezing Point Depression

PHU_: pH Meter

GLUC: Glucose Hexokinase

PRO5: Turbidimetry

UBIL: Ictotest

HGBQL: Dipstick

MICA, MICM: Microscopic

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type


Specimen Required

Container/Tube: Plastic urine container

Specimen Volume: 20 mL

Collection Instructions:

1. Collect a random urine specimen.

2. No preservative.

Specimen Minimum Volume

4 mL

Specimen Stability Information

Specimen Type Temperature Time
Urine Refrigerated 72 hours

Reject Due To










Reference Values

Descriptive report

Day(s) and Time(s) Performed

Monday through Sunday; Continuously

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
RUA Urinalysis Complete w/ Microscopic 24356-8


Result ID Test Result Name Result LOINC Value
PHU_ pH, U 2756-5
UOSMU Osmolality, U 2695-5
SRC3 Source 31208-2
APP4 Appearance 5767-9
GLUC Glucose 2339-0
PRO5 Protein 5804-0
PR_OS Protein/Osmolality In Process
P24HP Predicted 24 Hr Protein In Process
P_RGE Predicted Range In Process
UBIL Bilirubin 5770-3
HGBQL Hemoglobin, QL 5794-3
CMT51 Comment 48767-8



RBCs, WBCs, renal tubular epithelial (RTE) cells, transitional epithelial cells, squamous epithelial cells, casts, sperm, free fat, oval fat bodies, bacteria, and pathologic crystals are reported. RBC casts are almost always indicative of glomerulonephritis. White cell casts are typically an indication of acute interstitial nephritis or pyelonephritis, but can also be seen in glomerulonephritides because there is often a component of accompanying interstitial nephritis. Fatty casts and free fat are often seen in patients with nephrotic syndrome or other glomerular diseases associated with significant proteinuria. Granular casts are observed in a number of disorders and are thought to be formed from partially degraded cellular casts, or are protein-derived casts. Hyaline casts are not thought to be indicative of any disease process, but increased numbers may be seen in concentrated urine specimens. Waxy casts and broad casts are most often observed in advanced renal failure. Increased numbers of RTE cells are indicators of renal tubular injury. Increased numbers of RTE may be caused by drugs with renal tubular toxicity (eg, cyclosporine A, aminoglycosides, cisplatin, radio-contrast media, acetaminophen overdose), interstitial nephritis, hypotension (surgical, sepsis, obstetric complications), or heme pigments from hemoglobinuria or myoglobinuria from rhabdomyolysis (eg, alcoholism, heat stroke, seizures, sickle cell trait). Newborns often shed RTE cells in their urine. The presence of squamous cells suggests that the specimen may not have been an optimal clean-catch specimen and could be contaminated with skin flora.


Recommendations by an American Urological Association panel, based upon careful review of all available published outcome studies that contained results of detailed hematuria workups within actual patient populations, are that patients with more than 3 RBCs per high-power field in 2 out of 3 properly collected urine specimens should be considered to have microhematuria and, hence, evaluated for possible pathologic causes. However, the panel also noted that there is no absolute lower limit for hematuria, and risk factors for significant disease should be taken into consideration before deciding to defer an evaluation in patients with only 1 or 2 RBCs per high-power field. High-risk patients, especially those with a history of smoking or chemical exposure, should still be considered for a full urologic evaluation even after a properly performed urinalysis documented the presence of at least 3 RBCs per high-power field. In certain patients, even 1 or 2 RBCs per high-powered field might merit evaluation.(1)



Osmolality is an index of the solute concentration of osmotically active particles, principally sodium, chloride, potassium, and urea; glucose can contribute significantly to the osmolality when present in substantial amounts. The ability of the kidney to maintain both tonicity and water balance of the extracellular fluid can be evaluated by measuring the osmolality of the urine. More information concerning the state of renal water handling or abnormalities of urine dilution or concentration can be obtained if urinary osmolality is compared to serum osmolality. Normally, the ratio of urine osmolality to serum osmolality is 1.0 to 3.0, reflecting a wide range of urine osmolality.


In a random urine specimen, a protein/creatinine or protein/osmolality ratio can be used to roughly approximate 24-hour excretion rates. The normal protein-to-creatinine ratio for adult males is less than 0.11 mg/mg creatinine and for adult females is less than 0.16 mg/mg creatinine. The normal protein-to-osmolality ratio for adults is less than 0.42.(1) For patients under 18 years of age no reference range has been established.


Reference values for osmolality:

-0-12 months: 50-750 mOsm/kg

->12 months: 150-1,150 mOsm/kg

-Please note above the age of 20 there is an age-dependent decline in the upper reference range of approximately 5 mOsm/kg/year.



This test detects the presence of overt proteinuria (>300 mg/day). However, normal urinary protein excretion is less than 30 mg/day. The presence of microalbuminuria (30-300 mg/day) is not detected by this method. Overt proteinuria is seen in both renal (eg, glomerulonephritis, renal tubular diseases, pyelonephritis) and nonrenal diseases (eg, myeloma, congestive heart failure, dehydration).


Reference values for protein:

<26 mg/dL

Reference values have not been established for patients under 18 years of age.



The test is specific for glucose. No other substance excreted in urine is known to give a positive result, including other reducing substances (eg, galactose, fructose, and lactose). This test may be used to determine whether the reducing substance found in urine is glucose. Glucosuria occurs when the renal threshold for glucose is exceeded (typically >180 mg/dL); this is most commonly, although not exclusively, seen in diabetes.


Reference values for glucose:

<16 mg/dL



Urine pH is affected by diet, medications, systemic acid-base disturbances, and renal tubular function. pH may affect urinary stone formation. For example, urine pH below 6.0 may help reduce the tendency for calcium phosphate stones and pH greater than 6.0 may reduce the tendency for uric acid stone formation.



Produced during metabolism of fat, increased ketones may occur during physiological stress conditions such as fasting, pregnancy, strenuous exercise, and frequent vomiting. In diabetics who are unable to efficiently utilize glucose due to a lack of insulin, starvation, or with other abnormalities of carbohydrate or lipid metabolism, ketones may appear in the urine in large amounts before serum ketone is elevated.



Bilirubinuria is an indicator of liver disease and biliary tract obstruction.



Hemoglobinuria is an indicator of intravascular hemolysis. The test is equally sensitive to myoglobin as to hemoglobin. The presence of hemoglobin, in the absence of RBCs, is consistent with intravascular hemolysis. RBCs may be missed if lysis occurred prior to analysis; the absence of RBCs should be confirmed by examining a fresh specimen. The presence of myoglobin may be confirmed by MYGLU / Myoglobin, Urine.



-Urine glucose monitoring for the management of diabetes mellitus has essentially been replaced by more accurate and reliable fingerstick blood glucose determination. Also, as a screening test for diabetes mellitus, urine glucose testing has a low sensitivity (though reasonably good specificity).

-Drugs: No interference was found at therapeutic concentrations using common drug panels.

-Normal neonatal infants during the first 10 to 14 days of life may excrete urine giving a positive reaction due to glucose, galactose, lactose, and fructose.(2) The hexokinase method on the chemistry analyzer is specific for glucose only.



-Substances causing false-positive results are bromsulphalein, phenolsulfonphthalein, phenylketone, cephalosporin, aldose-reductive antienzyme, and L-Dopa.

-Fasting or starvation diets may cause positive results.



-Elevated specific gravity, elevated protein, and large amounts of ascorbic acid may cause false-negative results.

-Oxidizing substances such as hypochlorite and chlorine may cause false-positive results.

-The test is equally sensitive to hemoglobin and myoglobin. The presence of hemoglobin, in the absence of RBCs, is consistent with intravascular hemolysis. RBCs may be missed if lysis occurred prior to analysis; the absence of RBCs should be confirmed by examining a fresh specimen. The presence of myoglobin may be confirmed by MYGLU / Myoglobin, Urine.



False-proteinuria may be due to contamination of urine with menstrual blood, prostatic secretions, or semen. The urinary protein concentration may rise to 300 mg/24 hours in healthy individuals after vigorous exercise.

Normal newborn infants may have higher excretion of protein in urine during the first 3 days of life. The presence of hemoglobin elevates protein concentration. Samples should be collected before fluorescein is given or not collected until at least 24 hours later.


Protein electrophoresis and immunofixation may be required to characterize and interpret the proteinuria.

-Microalbumin tests are necessary to pick up early increases in urine protein excretion.

Clinical Information

The kidney plays a key role in the excretion of by-products of cellular metabolism and regulation of water, acid-base, and electrolyte balance. Urine is produced by filtration of plasma in the renal glomeruli, followed by tubular secretion and reabsorption of water and other compounds.


Abnormalities detected by urinalysis may reflect either urinary tract diseases (eg, infection, glomerulonephritis, loss of concentrating capacity) or extrarenal disease processes (eg, glucosuria in diabetes, proteinuria in monoclonal gammopathies, bilirubinuria in liver disease).

Analytic Time

1 day

Specimen Retention Time

2 days

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

Method Description


Benzethonium Chloride.(Package insert: Protein (TPUC3) application sheet. Roche Diagnostics, Indianapolis, IN 46256)



Glucose hexokinase.(Package insert: Glucose/HK application sheet. Roche Diagnostics, Indianapolis, IN 46256)



Dipstick.(Package insert: AUTION Sticks 9EB for urine chemistry, ARKRAY Inc., Japan, Distributed by ARKRAY USA, INC. 5182 W. 76th St. Minneapolis Minnesota 55439 USA)



Ictotest.(Package insert: Ictotest tablet for Urinalysis. Bayer Corporation, Diagnostics Division, Elkhart, IN 46515)



pH meter.



Freezing point depression.



Dipstick.(Package insert: AUTION Sticks 9EB for urine chemistry, ARKRAY Inc., Japan, Distributed by ARKRAY USA, INC. 5182 W. 76th St. Minneapolis Minnesota 55439 USA)



A microscopic examination is performed on urine sediments by conventional microscopy or by automation using the IRIS iQ200 Sprint. Determination of which method to use is made by visual inspection. If the urine is a clear, normal color and the amount is adequate (20 mL), the urine is analyzed on the IRIS iQ200 Sprint. All remaining urines have a manual microscopic examination performed on the sediment after centrifuging for 5 minutes at 1,400 RPM.(Instruction manual: Aution MAX AX-4280, Iris Diagnostics, Chatsworth, CA, rev D-7/2003; Operators Manual, IQ 200, Iris Diagnostics, Chatsworth, CA, version 7, revised 07/2012; Brunzel NA: Fundamentals of Urine and Body Fluid Analysis. Third edition, WB Saunders Company, Philadelphia, PA, 1994)