Does the Exposure of Urine Samples to Air Affect Diagnostic Tests for Urine Acidification?

Abstract

Background and objectives For accurate measurement of pH, urine collection under oil to limit the escape of CO2 on air exposure is recommended. This study aims to test the hypothesis that urine collection under oil is not necessary in acidic urine in which bicarbonate and CO2 are minor buffers, because loss of CO2 would have little effect on its pH. Design, setting, participants, & measurements One hundred consecutive random urine samples were collected under oil and analyzed for pH, pCO(2), and HCO3- immediately and after 5 minutes of vigorous shaking in uncovered flasks to allow CO2 escape. Results The pH values in 97 unshaken samples ranged from 5.03 to 6.83. With shaking, urine pCO(2) decreased by 76%, whereas urine HCO3- decreased by 60%. Meanwhile, urine baseline median pH (interquartile range) of 5.84 (5.44-6.25) increased to 5.93 (5.50-6.54) after shaking (Delta pH=0.12 [0.07-0.29], P<0.001). Delta pH with pH <= 6.0 was significantly lower than the Delta pH with pH>6.0 (0.08 [0.05-0.12] versus 0.36 [0.23-0.51], P<0.001). Overall, the lower the baseline pH, the smaller the Delta pH. Conclusions The calculation of buffer reactions in a hypothetical acidic urine predicted a negligible effect on urine pH on loss of CO2 by air exposure, which was empirically proven by the experimental study. Therefore, exposure of urine to air does not substantially alter the results of diagnostic tests for urine acidification, and urine collection under oil is not necessary. Clin J Atn Soc Nephrol 7: 1211-1216, 2012. doi: 10.2215/CJN.03230312