Urinalysis, Complete, with Reflex to Culture

The Urinalysis, Complete, with Reflex to Culture test contains 1 test with 27 biomarkers.

Description: A Urinalysis complete test is a urine test that is used to screen for, diagnose, and monitor a variety of conditions and diseases urinary tract infections (UTIs) and kidney disorders.

A Urine Culture test is a test that is used to identify bacteria or foreign organisms in urine and test for antibiotic susceptibilities.

Also Known As: Urine Test, Urine Analysis Test, UA Test, urine microscopic examination, Urine Culture Test, Urine Culture and Sensitivity test, Urine C and S test, UTI test, Culture Urine test

Collection Method: Urine Collection

Specimen Type: Urine

Test Preparation: No preparation required

IMPORTANT - If initial testing results in a Reflex to Culture, the lab will add and charge for Culture, Urine, Routine #395 for $29.

If you need just a Urinalysis, Complete test, order Urinalysis (UA), Complete #5463

Culture, Urine, Routine #395 can Reflex to additional testing and charges, detailed below, if Culture is positive.

If culture is positive, CPT code(s): 87088 (each isolate) will be added with an additional charge.  Identification will be performed at an additional charge (CPT code(s): 87077 or 87140 or 87143 or 87147 or 87149).

Antibiotic susceptibilities are only performed when appropriate (CPT code(s): 87181 or 87184 or 87185 or 87186).

  • ORG ID 1. $ 12.45 
  • ORG ID 2. $ 23.95 
  • PRESUMPTIVE ID 1. $ 12.45 
  • PRESUMPTIVE ID 2. $ 23.95 
  • SUSC-1  $14.95 
  • SUSC-2  $28.95

When is a Urinalysis with Reflex to Culture test ordered?

A urinalysis test may be ordered when a person undergoes a routine wellness examination, is admitted into a hospital, will have surgery, or is having a prenatal checkup.

When a person visits a doctor with symptoms of a urinary tract infection or another urinary system ailment, such as kidney disease, a urinalysis will almost certainly be prescribed. The following are some possible signs and symptoms:

  • Pain in the abdomen
  • Backache
  • Urination that is painful or occurs frequently
  • Urine with blood in it

Testing may also be conducted at regular intervals to track the progress of a condition.

A urine culture may be administered in conjunction with a urinalysis or as a follow-up to abnormal urinalysis results.

Urinary tract infections can cause pressure in the lower abdomen as well as small quantities of blood in the urine. If the UTI is severe and/or has gone to the kidneys, it can cause symptoms such as flank pain, high fever, trembling, chills, nausea, and vomiting.

For young women with signs or symptoms of a UTI and an uncomplicated lower urinary tract infection, antibiotics may be administered without obtaining a urine culture. A urine culture is advised if there is a suspicion of a complex infection or if symptoms do not respond to first treatment.

Pregnant women without symptoms should be examined for bacteria in their urine during their first trimester or first prenatal appointment, as bacteria in the urine can harm the growing baby's health.

What does a Urinalysis with Reflex to Urine Culture test check for?

A urinalysis is a series of examinations done on urine that are physical, chemical, and microscopic. The tests identify and/or measure a number of elements in the urine, including cells, cellular fragments, and microbes. These elements include byproducts of healthy and unhealthy metabolism.

Urine is produced by the kidneys, two fist-sized organs located on either side of the spine near the base of the rib cage. The kidneys help the body regulate its water balance, filter wastes from the blood, and store proteins, electrolytes, and other molecules for later use. To get rid of everything unnecessary, urine travels from the kidneys to the ureters, bladder, and urethra before exiting the body. The color, amount, concentration, and content of urine will change slightly every time a person urinates due to the varied elements in urine, despite the fact that pee is normally yellow and clear.

By screening for components in the urine that aren't typically present and/or monitoring aberrant levels of specific substances, many illnesses can be caught early on. Glucose, bilirubin, protein, red and white blood cells, crystals, and germs are among examples. They could be present because of the following reasons:

  • The body responds to an elevated amount of the substance in the blood by attempting to remove the excess through urine.
  • There is a problem with the kidneys.
  • As with bacteria and white blood cells, there is a urinary tract infection present.

Three separate phases make up a full urinalysis:

  • The color and clarity of the urine are assessed using a visual examination.
  • Chemical examination, which determines the concentration of urine and tests for roughly 9 chemicals that provide useful information about health and disease.
  • Microscopic inspection that identifies and counts the different types of cells, casts, crystals, and other components found in urine, such as bacteria and mucus.

When abnormal results are found, or if a healthcare provider requests it, a microscopic analysis is usually performed.

It may be essential to repeat the test if the findings of a urinalysis are abnormal, and further other urine and blood tests may be needed to help establish a diagnosis, if the results are abnormal.

Urine culture is a test that detects and identifies bacteria and yeast in the urine that could be the source of a urinary tract infection.

A small amount of urine is placed on one or more agar plates and incubated at body temperature for a urine culture. Any bacteria or yeast present in the urine sample will grow into little circular colonies during the next 24 to 48 hours. The number of colonies and the size, shape, and color of these colonies assist identify which bacteria are present in the urine sample, and the number of colonies shows the amount of bacteria that were initially present in the urine sample. A laboratory technician counts the total number of colonies on the agar plate and determines how many types have grown. If a good, clean catch sample was taken for the test, the only bacteria found should be from an infection. Typically, there will be only one variety of bacterium present in relatively significant quantities. More than one type of bacteria may be present at any given time. This could be the result of a multi-pathogen infection, although it's more likely owing to contamination from the skin picked up during the urine collection.

A gram stain will be performed on a colony from each type by the laboratory technician. The bacteria are examined under a microscope by the laboratory technician. Different species of bacteria will have distinct colors and forms. Under a microscope, the bacterium Escherichia coli, which is responsible for the majority of urinary tract infections, will appear as gram-negative rods. Lactobacillus, a frequent vaginal contaminant found in women's urine, will show up as gram-positive rods. Some bacteria, such as Lactobacillus, are easy to detect by a skilled lab technician, are nonpathogenic, and do not require additional research. Others, such as gram-negative rods, represent clusters of identical bacteria that will necessitate extra testing to determine which bacteria are present.

After 24 to 48 hours of incubation, if there is no or little growth on the agar, the urine culture is declared negative for pathogens and the culture is complete. If one or more pathogens are found, more testing is done. Testing is performed to determine which bacteria are present, as well as susceptibility testing to determine which antibiotics are most likely to cure the infection.

Lab tests often ordered with a Urinalysis with Reflex to Culture test:

  • Complete Blood Count (CBC)
  • Iron and Total Iron Capacity
  • Hemoglobin A1c
  • Lipid Panel
  • Comprehensive Metabolic Panel (CMP)
  • TSH
  • Bilirubin Fractionated
  • Glucose
  • C-Reactive Protein
  • ANA
  • Rheumatoid Factor

Conditions where a Urinalysis with Reflex to Culture test is recommended:

  • Diabetes
  • Kidney Disease
  • Liver Disease
  • Hypertension
  • Pregnancy
  • Hematuria
  • Urinary Tract Infection

How does my health care provider use a Urinalysis with Reflex to Culture test?

A urinalysis is a series of tests that can diagnose a variety of disorders. It can be used to screen for and/or diagnose a variety of illnesses, including urinary tract infections, renal abnormalities, liver diseases, diabetes, and other metabolic disorders, to name a few.

Urinalysis may be used in conjunction with other tests, such as urine albumin, to monitor the progress of treatment in patients with diseases or conditions like diabetes or kidney disease.

The urine culture is often used to diagnose a urinary tract infection and to identify the bacteria or yeast that is causing it. It can be used in conjunction with susceptibility testing to discover which drugs will stop the infection-causing bacterium from growing. The findings will aid a doctor in determining which treatments are most likely to be beneficial in treating a patient's infection.

The kidneys, a pair of bean-shaped organs positioned near the bottom of the ribcage on the right and left sides of the back, produce urine. To transport wastes out of the body, the kidneys filter waste from the blood and generate urine, a yellow fluid. Urine goes from the kidneys to the bladder, where it is briefly stored, and then via the urethra to be emptied. Urine is normally sterile, but bacteria or, more rarely, yeast can migrate up the urinary tract from the skin outside the urethra and produce a urinary tract infection.

The majority of UTIs are considered simple and treatable. The infection may spread up through the ureters and into the kidneys if they are not treated. A kidney infection is more hazardous and can result in renal damage that is irreversible. In some situations, a urinary tract infection can escalate to a life-threatening infection in the bloodstream.

People with renal disease or other illnesses that impact the kidneys, such as diabetes or kidney stones, as well as people with compromised immune systems, may be more susceptible to UTIs.

What do my Urinalysis test results mean?

There are numerous ways to interpret the results of a urinalysis. Unusual results are a warning sign that something isn't right and needs further testing.  To connect the urinalysis results with an individual's symptoms and clinical findings and to look for the causes of aberrant findings, other targeted tests must be done, such as a complete blood count, metabolic panel, or urine culture.

It is more likely that a problem must be addressed the higher the concentration of the atypical component, such as noticeably increased levels of protein, glucose, or red blood cells. On the other hand, the outcomes do not inform the medical professional as to what led to the finding or whether it is a transient or ongoing sickness.

A normal urinalysis does not rule out the possibility of disease. Early in a disease process, some persons will not release elevated amounts of a drug, and others will release them irregularly throughout the day, which means they could be overlooked by a single urine sample. Small amounts of substances may be undetectable in very dilute urine.

What do my Urine Culture test results mean?

Urine culture results are frequently interpreted in conjunction with urinalysis results, as well as how the sample was taken and whether symptoms are present. Because certain urine samples may contain bacteria that are ordinarily found on the skin, some culture results must be interpreted with caution.

A positive urine culture is usually defined as the presence of a single kind of bacteria growing at high colony counts. Cultures containing more than 100,000 CFU/mL of one species of bacteria in clean catch samples that have been correctly collected usually indicate infection. Even if an infection is present, there may not be a large number of germs present in some circumstances. Lower levels can sometimes suggest infection, particularly if symptoms are present. Similarly, values of 1,000 to 100,000 CFU/mL may be deemed significant for samples acquired using a technique that reduces contamination, such as a sample collected with a catheter.

Although UTIs can be caused by a variety of bacteria, the majority are caused by Escherichia coli, a kind of bacteria that is widespread in the digestive tract and frequently detected in stool. Proteus, Klebsiella, Enterococcus, and Staphylococcus are among the bacteria that can cause UTIs. A yeast infection, such as Candida albicans, can cause a UTI, but urethritis is more commonly caused by a sexually transmitted illness, such as herpes, chlamydia, or gonorrhea.

When a culture says "no growth in 24 or 48 hours," it usually means there isn't an infection. If the symptoms persist, a urine culture on a new sample may be performed to test for bacteria with reduced colony numbers or other microorganisms that could be causing the symptoms. Acute urethral syndrome is defined as the presence of white blood cells and low quantities of bacteria in a sick person's urine.

If multiple different species of bacteria thrive in a culture, the growth is almost certainly due to contamination. This is notably true in urine samples containing Lactobacillus and/or other prevalent nonpathogenic vaginal bacteria in women. If the symptoms persist, the healthcare provider may order a second culture on a more thoroughly collected sample. However, if one species of bacteria has considerably larger colony counts than the others, such as 100,000 CFUs/mL versus 1,000 CFUs/mL, further testing to determine the dominating bacterium may be required.

Susceptibility testing may be used to guide treatment if a culture is positive. Any bacterial infection can be dangerous and, if left untreated, can spread to other parts of the body. Pain is frequently the first sign of infection. Treatment as soon as possible, generally with antibiotics, will help to relieve the pain.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

NOTE: Only measurable biomarkers will be reported.

The following is a list of what is included in the item above. Click the test(s) below to view what biomarkers are measured along with an explanation of what the biomarker is measuring.

Also known as: UA, with Reflex to Culture, Urinalysis Complete with Reflex to Culture, Urine Analysis, with Reflex to Culture

Amorphous Sediment

Appearance

Bacteria

Bacteria are living things that have only one cell. Most bacteria won't hurt you - less than 1 percent of the different types make people sick. Many are helpful. Some bacteria help to digest food, destroy disease-causing cells, and give the body needed vitamins. But infectious bacteria can make you ill. They reproduce quickly in your body. Many give off chemicals called toxins, which can damage tissue and make you sick. Examples of bacteria that cause infections include Streptococcus, Staphylococcus, and E. coli.

Bilirubin

Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. A small amount of older red blood cells are replaced by new blood cells every day. Bilirubin is left after these older blood cells are removed. The liver helps break down bilirubin so that it can be removed from the body in the stool.

Calcium Oxalate Crystals

Calcium oxalate is a chemical compound that forms envelope-shaped crystals. A major constituent of human kidney stones.

Casts

Urinary casts are cylindrical structures produced by the kidney and present in the urine in certain disease states. They form in the distal convoluted tubule and collecting ducts of nephrons, then dislodge and pass into the urine, where they can be detected by microscopy.

Color

Crystals

Abnormal crystals may appear in urine as a result of pathology or due to normal catabolism

Glucose

A blood glucose test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of the body, including those in the brain. The hormones insulin and glucagon help control blood glucose levels.

Granular Cast

The second-most common type of cast, granular casts can result either from the breakdown of cellular casts or the inclusion of aggregates of plasma proteins (e.g., albumin) or immunoglobulin light chains. Depending on the size of inclusions, they can be classified as fine or coarse, though the distinction has no diagnostic significance. Their appearance is generally more cigar-shaped and of a higher refractive index than hyaline casts. While most often indicative of chronic renal disease, these casts, as with hyaline casts, can also be seen for a short time following strenuous exercise

Hyaline Cast

Urinary casts are tiny tube-shaped particles. Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat. The most common type of cast, hyaline casts are solidified Tamm-Horsfall mucoprotein secreted from the tubular epithelial cells of individual nephrons. Low urine flow, concentrated urine, or an acidic environment can contribute to the formation of hyaline casts, and, as such, they may be seen in normal individuals in dehydration or vigorous exercise. Hyaline casts are cylindrical and clear, with a low refractive index,

Ketones

Ketones are substances produced in the liver when fat cells break down in the blood. A serum ketone test is a measurement of how many ketones are in the blood.

Leukocyte Esterase

Nitrite

Occult Blood

The test looks for hidden (occult) blood in a specimen sample. It can find blood even if you cannot see it yourself.

Ph

Level of acid

Protein

Body fluids contain many different proteins that serve diverse functions such as transport of nutrients, removal of toxins, control of metabolic processes, and defense against invaders. Protein electrophoresis is a method for separating these proteins based on their size and electrical charge. When body fluids are separated by electrophoresis, they form a characteristic pattern of bands of different widths and intensities, reflecting the mixture of proteins present. This pattern is divided into five fractions, called albumin, alpha 1, alpha 2, beta, and gamma. In some cases, the beta fraction is further divided into beta 1 and beta 2. Albumin, which is produced in the liver, accounts for about 60% of the protein in the blood. "Globulins" is a collective term used to refer to proteins other than albumin. With the exception of the immunoglobulins and some complement proteins, most of the globulins are also produced in the liver. Immunofixation electrophoresis (IFE) is a method used to identify abnormal bands seen on serum, urine, or CSF protein electrophoresis, as to which type of antibody (immunoglobulin) is present.

Rbc

RBCs contain hemoglobin, which carries oxygen. How much oxygen your body tissues get depends on how many RBCs you have and how well they work.

Reducing Substances

Renal Epithelial Cells

Specific Gravity

Squamous Epithelial Cells

Transitional Epithelial

Triple Phosphate Crystals

Struvite stones (triple phosphate/magnesium ammonium phosphate) - about 10–15% of urinary calculi are composed of struvite (ammonium magnesium phosphate, NH4MgPO4·6H2O).[44] Struvite stones (also known as "infection stones", urease or triple-phosphate stones), form most often in the presence of infection by urea-splitting bacteria

Uric Acid Crystals

Abnormal crystals may appear in urine as a result of pathology or due to normal catabolism

WBC

WBCs help fight infections. They are also called leukocytes. There are five major types of white blood cells: basophils, eosinophils, lymphocytes (T cells and B cells), monocytes and neutrophils

YEAST

Candida is the scientific name for yeast. It is a fungus that lives almost everywhere, including in your body. Usually, your immune system keeps yeast under control. If you are sick or taking antibiotics, it can multiply and cause an infection.
*Process times are an estimate and are not guaranteed. The lab may need additional time due to weather, holidays, confirmation/repeat testing, or equipment maintenance.

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