The purpose of this Guideline is to highlight the conditions under which it is appropriate to order microscopic urinalysis in the community (non-hospital) setting. The Guideline also details the collection and handling methods for urine specimens that will ensure reliable test results.
Readers are reminded that OAML Guidelines cannot be applied to every clinical situation, nor can their content replace sound clinical judgment.
Microscopic urinalysis should NOT be requested for general screening purposes as it only rarely provides any additional valuable information. In most instances, a "dipstick" chemical urinalysis provides adequate information for management of the patient. However, there will be some circumstances where microscopic analysis does give additional and/or quantitative information that supplements the chemical analysis. Examples include determining whether hemorrhagic urine is as a result of cystitis or other non-infectious etiologies by the presence of WBC and bacteria in the urine and/or whether a positive leuckocyte esterase is of vaginal or urinary origin.

# Ordering Microscopic Urinalysis
While routine (chemical) urinalysis is found in the test list on the OHIP laboratory requisition, requests for microscopic urinalysis must be written in the "Other Tests" section. A clear abbreviation may be used (e.g. "urine micro").
Please note that because of the instability of unpreserved urine, and its potential for bacterial overgrowth, reflexive testing (to microscopic analysis) predicated on results of another test such as "do micro if dipstick is positive for blood" or "do C&S if WBCs, bacteria present" cannot be accommodated.

# Specimen Collection and Handling
Ideally, microscopic analysis should be performed on a first void urine, within 2 hours of its collection. This timeline cannot be achieved for most specimens submitted to community laboratories. In order to maximize recovery of elements such as casts, WBCs, and RBCs, which might otherwise disintegrate after 2 hours, specimens must be either:  stored refrigerated at 2oC to 8oC (for up to 24 hours) or  treated after collection with a stabilizing preservative (for up to 72 hours at room temperature)
The date and time of collection should be documented on the requisition in order to ensure that these targets can be achieved.

# Results Interpretation
Listed below are elements which may be found by the microscopic examination of urine sediments and some of the disease states/conditions associated with each of them.
Improperly collected and preserved specimens can yield false-negative results for the presence of RBCs, WBCs and casts, and false-positive results for bacterial presence.
Microscopic examination of fresh or properly collected and preserved urine can assist in the diagnosis and/or management of the disease states/conditions listed above. It is highly specific for these disease states/conditions and is therefore inappropriate as a routine screening test.
The OAML gratefully acknowledges the contribution of our external expert:
The following references were used in the preparation of this guideline:

# Laboratory Guidelines in Support of Clinical Practice
The OAML, through its Quality Assurance Committee, co-ordinates the development, dissemination, implementation and review of Guidelines for Clinical Laboratory Practice.
Guidelines are reviewed every 5 years or as the literature warrants. When consensus on the Guideline is achieved by the Committee, the Guideline is submitted to the OAML Board of Directors for approval before distribution to clinicians.
The comments of end users are essential to the development of guidelines and will encourage adherence. You are strongly encouraged to submit your comments on this or any other OAML Guideline to: This Guideline was prepared to assist clinicians who order tests from community laboratories. Users must ensure that their own practices comply with all specific government policies and specific legislative and accreditation requirements that apply to their organizations. The Guideline is not meant to be construed as legal advice or be all inclusive on this topic. Given the complexity of legal requirements, users are reminded that whenever there is uncertainty regarding whether some aspect of a Guideline is appropriate for their practice or organization, further direction should be obtained from the Laboratory Director, their own professional association, college and/or legal counsel or appropriate government ministry.