Lesson 1Instrumented urine analysers: calibration, maintenance, electronic result verification and interfacing with LISThis section covers automated urine analysers, including calibration, routine maintenance, internal checks, electronic result verification, flag review, and secure interfacing with the laboratory information system in local facilities.
Principles of automated strip readersCalibration procedures and frequencyDaily and periodic maintenance tasksInternal checks and electronic QC flagsResult validation and delta checksLIS connectivity, mapping, and downtimeLesson 2Reagent strip analytes: detailed physiology, analytical principles, and clinical significance of leukocyte esterase, nitrite, protein, glucose, ketones, blood, bilirubin, urobilinogen, pHThis section reviews each major reagent strip analyte, linking renal and systemic physiology to analytical principles, expected performance, and clinical interpretation, with emphasis on limitations, false results, and result correlation in diverse populations.
Leukocyte esterase: source, reaction, false resultsNitrite: bacterial conversion, sensitivity limitsProtein: albumin bias, pH and salt effectsGlucose: renal threshold and strip chemistryKetones: acetoacetate focus and omissionsBlood: hematuria, hemoglobinuria, myoglobinuriaLesson 3Documentation and reporting standards for physical and chemical results, including critical value notification proceduresThis section defines documentation and reporting standards for physical and chemical urinalysis, including reference intervals, result comments, critical values, notification procedures, and regulatory record retention for Botswana standards.
Standardized units and reference intervalsStructured reporting of color and clarityUse of interpretive and cautionary commentsDefining and listing critical urine valuesCritical value notification and escalationRecord retention and audit trail needsLesson 4Interferences and artefacts in chemical testing (oxidising agents, ascorbic acid, highly concentrated urine) and how to detect/mitigate themThis section addresses common interferences and artefacts in chemical testing, such as oxidising agents, ascorbic acid, pigments, and highly concentrated urine, and provides strategies to detect, confirm, and mitigate their impact in tropical settings.
Oxidizing cleaners and peroxide residuesAscorbic acid impact on blood and glucose padsPigmented drugs and food color interferenceHighly concentrated or dilute urine effectsConfirmatory tests to resolve discrepanciesPreventive measures in specimen collectionLesson 5Protein semi-quantitation limitations and use of protein/creatinine ratio; interference and false positives/negativesThis section examines limitations of protein semi-quantitation by strips, sources of false results, and the role of protein/creatinine ratio for better assessment of proteinuria in various clinical and preanalytical contexts in Botswana.
Protein error of indicators: strip chemistrypH, concentration, and drug interferencesFalse positives from disinfectants and mucusFalse negatives in nonalbumin proteinuriaSpot protein/creatinine ratio principlesClinical use in monitoring kidney diseaseLesson 6Measurement of specific gravity: manual refractometer technique, urinometer basics, and calibration proceduresThis section explains specific gravity measurement using refractometers and urinometers, covering principles, calibration, temperature and protein/glucose corrections, limitations in extreme osmolality, and comparison with osmometry under local conditions.
Physical basis of urine specific gravityManual refractometer operation and readingRefractometer calibration and maintenanceUrinometer technique and common errorsProtein and glucose correction factorsComparison with osmolality measurementLesson 7Stepwise reagent strip testing workflow: correct strip handling, sequence of reading timepoints and interpretation windowsThis section outlines the complete reagent strip workflow, including specimen mixing, strip immersion, timing of readings, avoidance of contamination, interpretation windows, and documentation of invalid or questionable results.
Specimen mixing and preanalytical checksCorrect strip storage and handling practicesImmersion depth, time, and excess removalTiming each pad and avoiding cross contaminationReading color changes within set windowsCriteria for repeating or rejecting a testLesson 8Standardised visual inspection: assessment of colour, clarity/turbidity, odour descriptors and documentationThis section standardises visual urine inspection, defining colour scales, clarity and turbidity categories, odour descriptors, and proper lighting and containers, while stressing consistent documentation and correlation with chemical findings.
Standard lighting and background requirementsColor terminology and reference chartsClarity and turbidity grading criteriaCommon causes of abnormal urine colorsOdor descriptors and clinical relevanceRecording visual findings in the LISLesson 9Quality control for reagent strips: lot verification, daily QC materials, control limits, recording and corrective actionsThis section details quality control for reagent strips, including new lot verification, selection and storage of QC materials, establishing control limits, documentation, trend review, and appropriate corrective actions in resource settings.
New lot parallel testing and acceptanceSelection of levels and types of QC materialFrequency of QC and run acceptance rulesLevey–Jennings charts and trend detectionDocumentation of QC failures and actionsStaff training and competency in QCLesson 10Glucose and ketones: clinical thresholds, interference, and impact of preservation and timingThis section focuses on urine glucose and ketones, describing renal thresholds, diagnostic cutoffs, major interferences, specimen handling, timing of collection, and how preservation and delays alter measured concentrations in diabetic patients.
Renal threshold and tubular handling of glucoseClinical ranges for glycosuria interpretationKetone production in fasting and ketoacidosisChemical principles of glucose and ketone padsEffects of storage time and temperatureAscorbic acid and other interfering substances
