Urine FEME

The doctor will advise on which urine test or analysis to be done.

1. Urine dispstick

So many urine samples by 12 noon at OPD Lab (85 samples).

Urine dipstick test strip with 3 test patches.

Photos taken at OPD Lab, HUSM. 27 Nov 2018.

Purpose of doing Urine dipstick test

This is done at the first appointment when the doctor wishes to know if there is renal involvement and if the urine content is affected.

If the urine test is just to test for normal or abnormal urine, Urine dipstick is done. The lab report is that based on the test strip findings - positive, negative or trace, for each element tested.

In urine dipstick test, the urine test strips can contain 3 or more test patches. A basic test strip will contain patches for protein, glucose, ketones.

The usual urine test for finding out if a patient has renal involvement is a urine dipstick with 3 patches, in order to save cost.

This 3-patch test strip Urine dipstick test is usually done at the Outpatient Department (OPD) lab.

For more detailed urine test, the test strips may contain more test patches. Some will contain up to 13 test patches. This adds to cost of each test strip.

In hypertensive patients (patient with hypertension), the renal system is monitored. This is because, doctors will need to detect kidney involvement in hypertension. Hypertension is a disease affecting the blood vessels to all vital organs. In hypertension, these small vessels will be damaged (burst or busted), leading to abnormal urine, which is detected by urine dipstick.

Doctors will request hypertensive patients to do "urine test" (dipstick) before coming to see the doctor at the next appointment (ie To Come Again  or TCA). If there is renal involvement (eg protein in urine or microalbuminuria), the doctor will advise the patient accordingly, ie there is renal involvement, ie the disease or condition has worsened, and now the kidneys are affected.


2. Urine FEME

Fixed-angle rotor

Centrifuge

Urine sample after centrifugation

Examination of urinary sediment

Urine FEME test results

Photos above taken at OPD Lab, HUSM 27 Nov 2018.

Purpose of doing Urine FEME

If the doctor wishes to know whether there is infection of the renal system and needs to know the region of origin in the renal system, then the doctor will request for Urine FEME. Urine FEME will involve Urine dipstick test and Microscopic Examination of the urine. Meaning 2 tests will be done on a single urine specimen.

If the doctor wishes to know whether the urine is clear or cloudy (berkeladak) or dark coloured (warna merah kehitaman), the doctor will order Urine FEME.

In the case of bacterial infection (eg severe cough and cold that does not seem to subside in a week), and the patient complains of severe bouts of coughing, sore throat (gatal tekak), nausea (rasa loya nak muntah), loss of appetite (LOA, tak lalu nak makan), and pain (renal colic) in the kidney region (right or left kidney or both) in the back (not back pain), then the doctor will order Urine FEME to be done at OPD lab.

Urine FEME is a walk-in test performed at the OPD lab. The patient takes the green requisition slip from the doctor's office and then walks over to OPD to have it done. The test takes less than 20 minutes. Urine is collected in a small container (10-20 ml) in the toilet. The lab technologist will process and perform Urine FEME. The urine is pipetted and placed in a 10 ml clear glass test-tube. The tube is then centrifuged. Much of the supernatant (cecair bahagian atas) is removed and the sediment mixed and examined under the microscope (high and lower power fields). The lab technologist will look for "formed elements" inside the urine debris. The urine debris or sediment will contain nothing or some "elements". These "elements" can include cells (rbc, wbc) and epilthelial casts (which indicate their origin within the renal system). The lab technologist then fills in the results slip (same green slip) and returns that to the patient to take back to the doctor. The patient then walks back to the doctor's office to have the Urine FEME test results interpreted and explained properly.

In cases where there is renal involvement (of the kidneys, renal tubes and urinary bladder), there will be wbc, rbc, epithelial casts observed in the urine tested for Urine FEME. Otherwise the urine stays normal without any indication (ie negative Urine FEME).

The Urine FEME test is very important because in bacterial infection, the bacteria can go to the kidneys and infect the kidneys, causing excruciating pain. Sometimes breathing is affected. Sometimes sleep at night is impossible because of the excruciating pain. Upon inspection of the urine, rbc, wbc and epithelial casts can appear in the urine. There may also be bacteria present. All these elements will change urine composition and will be detected in Urine FEME.