URINE ANALYSIS

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URINE ANALYSIS

• DR.P.G.KONAPUR
• PROFESSOR OF PATHOLOGY
• V.M.K.V.MEDICAL COLLEGE
• SALEM

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• 1.Formation of Urine
• 2.Normal constituents and composition
• 3.Collection of urine specimens
• 4.Preservation of urine
• 5.Physical examination of urine
• 6.Chemical Examination of Urine
• 7. Microscopic Examination Of Urine Deposits

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• Urine --- most easily obtained
• Examination of urine
• Information--- about the functioning of the
  kidney
• diagnosis ---of urinary tract diseases
• diagnosis -----of certain metabolic and systemic
  diseases.

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• Urine is formed in the kidney.
• The functional unit of kidney is called nephrons,
• where in the ultrafilteration of plasma takes
  place,
• followed by absorption of most of the water and
  some of the solutes.
• The kidneys through the nephrons ---excrete many
  of the waste products of the body

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3 NORMAL CONSTITUENTS AND COMPOSITION OF URINE

• Constituents
  grams/litre
• A.Inorganic
• Chloride
  9.0
• Phosphorous
  2.0
• Sulfur
  1.5
• Sodium
  4.0
• Potassium
  2.0
• Calcium
  0.2
• Magnesium
  0.2
• Iron
  003
• B.Organic
• Urea
  25
• Uric acid
  0.6
• Creatinine
  1.5
• Ammonia
  0.6
• Sugar not detected by benedicts test
  trace
• Ketone bodies
  trace
• Carbonates, bicarbonates free carbonic acid
  trace
• Mucin mucin like substances Diastase

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COLLECTION OF URINE SPECIMENS

• In. Improper collection---- may invalidate the
  results
• Containers for collection of urine should be wide
  mouthed, clean and dry
• First morning sample concentrated urine ---
• chemical constituents
• casts and crystals
• Random specimen
• chemical screening
• microscopic examinations
• 24 hours urine sample
• quantitative estimation of proteins,
  sugars, electrolytes, and hormones.
• Urine specimen is collected in a clean 2
  liters bottle with a stopper. The first morning
  sample is not collected.
• All the urine passed during the rest of the
  day and night and next day I st sample is
  collected.
• Volume is measured and immediately sent to
  the laboratory.

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Midstream urine specimen

• Urine should be collected in a clean, dry and,
  preferably, sterilized container.
• urethral opening is cleaned with a moist cotton
  swab.
• first 10 25 ml of urine is not collected
  (discarded)
• since it contains urethral and prostatic
  secretions which may be required if investigating
  urethra and prostrate.
• First morning samples ---- these are the
  concentrated samples and casts, crystals etc .if
  present

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• Terminal urine sample patient voids the last
  portion of urine in an open container.
• Urine specimen collection using a catheter. This
  procedure is used for certain bacteriological
  tests
• Urine specimens from infants
• Urine can be collected into a plastic bag with an
  adhesive mouth.
• The bag is fixed around the genitalia and left
  in place for 1- 3
  hours, depending on the examination requested.
• Colostomy bags can be used

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PRESERVATION OF URINE

• Urine sample lt within 2 hours.
• If delay ----preservation.
• If more than 2 hours
• Keep the sample in the refrigerator without any
  preservative.
• Toluene add a few drops till it forms a thin
  layer on the surface of urine.
• Conc.HCL 1 ml of conc.HCL for 125-150mlof
  urine.
• Formaldehyde -1 drop for 15 ml of urine. Cells
  and casts are well preserved.

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PHYSICAL EXAMINATION

• Volume
• normal -- 1.2-2 L /day
• the day is 3-4 times gt night.
• night is lt 400 ml.
• polyuria gt2000ml / day.
• Oliguria lt500ml / day.
• Anuria is total suppression of urine lt100
  ml per day.
• Appearance color turbidity
• 1. Color - normal ---- amber yellow ( to the
  presence of urobilin,uroerythrin,and urochromes)

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• 1.Colorless---Very dilute urine
• ---Polyuria,diabetes
• 2.Yellow orange(high colored)--Concentrated
  urine
• -----------Excess
  urobilin
• ------------Bile
  pigments
• 
  ------------Intake of carrots
• 
  (Yellow foam )
• 3.Red/ smoky------Hemoglobin/
• ---- RBC
• ----MyoglobinBeetroot /
• ---------- anilinedyes
• -------Menstrual
  contamination
• -------porphyrins
• 4.Cloudy--------Phosphates carbonates,
  Urates uric acid Pus cells
• bacteria,yeast,spermatozoa
• 5.Milky-------Pyuria,Fat ,chyluria
• 6. Brown black----
• Methemoglobin,,Homogenesticacid(
  alkaptonuria),Melanin

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• 2. Turbidity normal urine----clear.
• Turbidity in urine may be due to
• a. amorphous phosphate and carbonates
  alkaline or
• neutral urine
• disappears on addition of
  dilute acetic acid
• b. crystals, cellular exudates,
  bacteria and fungus
• c. chyle and fat
• d. pus
• e. amorphous urates in acidic urine

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• b. Odour Normal-- aromatic odour
• On standing--- ammonical
• there is decomposition of urea
  forming ammonia which gives a strong ammonical
  smell..
• Abnormal odour of urine
• Fruity---- Ketonuria
• Mousy---- Phenylketonuria
• Rancid------ Tyrosinaemia
  

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pH

• ability to maintain normal hydrogen ion
  concentration
• Normal kidneys are capable of producing urine the
  pH of which varies from 4.5 to slightly higher
  than 8.0.
• A pH below 7 indicates acid urine and a pH above7
  alkaline urine
• PROCEDURE
• Dip the litumus paper strips in the urine,
  remove and read the color change immediately.
• Blue litmus turns red
  - acid
• Red litmus turns blue
  - alkaline
• Blue and red litmus turns purple -
  neutral
• nitrazine paper method The Ph---- nitrazine
  paper which are sensitive and specific in the pH
  range of 4.5 8.0 range.

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SPECIFIC GRAVITY

• degree of concentration or dilution of the
  specimen.
• specific gravity measures the concentrating and
  diluting abilities of the kidney.
• The normal --------------1.015 and 1.025 (in a 24
  hours specimen).
• ESTIMATION OF SPECIFIC GRAVITY BY URINOMETER
• urinometer This is a weighted bulb-shaped
• a scale calibrated----- from 1.000 to
  1.060

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PROCEDURE

• Urine is poured into a cylindrical or conical
  glass so that the vessel is nearly full.
• Froth-- removed with a filter
• The instrument is floated in the urine and care
  should be taken to see that it does not touch the
  slides.
• The depth to which it sinks in urine indicates
  the specific gravity of urine
• read on the urinometer scale at the junction of
  the urine with the air.
• The reading is taken at eye level, the lowest
  part of the meniscus being taken.
• In case the urine is insufficient, it may be
  diluted with an equal volume of distilled water
  and the last two figures of the reading are then
  multiplied by 2.

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• Correction for temperature-
• The urinometer is calibrated to read 1.000 in
  distilled water at a specific temperature,
  indicated on each instrument e.g. 15 C or 20 C.
• There is a change in the specific gravity of
  0.001 for each 3 C above and below this
  temperature. Therefore add 0.001 to the reading
  for each 3 C above the temperature for which the
  urinometer is calibrated,
• substract 0.001 for each 3 C, the temperature
  below the standard temperature.
• For example - urinometer calibrated for 20 C
• Specific gravity of urine at 32 C is 1.001
• Corrected specific gravity (32 20)/ 3 X 0.001
  1.001 1.005
• Correction is also recommended when glucose or
  protein are present. It is recommended that .003
  be subtracted from the urinometer reading for
  each 1000 mg / dl of glucose or protein.

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• 1. SUGARS IN URINE
• This is a non-specific test useful for
  semiquantitation of marked glucosuria
• Benedicts qualitative test
• This test is not specific for sugars and is
  affected by most of the reducing substances.
• Composition of Benedicts reagent
• Copper sulphate - 17.3 gms
• Sodium carbonate (anhydrous) 100 gms
• Or
• Crystalline sodium carbonate - 200 Gms
• Sodium citrate - 175 gms
• Or
• Potassium citrate

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• Dissolve crystalline copper sulphate in 100 ml of
  distilled water. Dissolve sodium carbonate and
  sodium citrate in 700 cc. of distilled water.
  Slowly add the latter to the former solution with
  constant stirring. When complete, make up the
  volume to 1000ml with distilled water.
• Procedure
• Take 5ml of benedicts reagent
• Boil for 3 5 minutes
• add to it 0.5ml (8 drops)of protein free urine.
• Cool and note the color.

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• Recording results
• The color varies from blue through green
  yellow- orange- brick red.
• Negative no change in color.
• Trace - solution appears pale green to slightly
  cloudy.
• 1 - Definite cloudy green (0.5 sugar)
• 2 - Yellow to orange precipitate, supernatant
  fluid pale blue (1 sugar)
• 3 - Orange to red precipitate, supernatant
  fluid pale blue (1.5 sugars)
• 4 - Brick red precipitate, supernatant fluid
  decolorizes (2 sugar)

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• COLORIMETRIC REAGENT STRIP TEST
• Principle this test is based on a double
  sequential enzyme reaction.
• One enzyme, glucose oxidase, catalyzes the
  formation of gluconic acid and hydrogen
  peroxide from the oxidation of glucose.
• A second enzyme, peroxides catalyzes the reaction
  of hydrogen peroxide with potassium iodide
  chromogen to oxidize the chromogen to colors
  ranging from green to brown.

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KETONES IN URINE (ketonuria)

• fats--------carbon dioxide and water.
• inadequate carbohydrate in the diet or a defect
  in carbohydrate metabolism or absorption,
• fatty acids------------metabolized.
• When the fatty acid utilization is
  incomplete------- the intermediary products of
  fat metabolism appear in the blood and the urine.
• These products -------- acetone,
• diacetic acid
  (acetoacetic acid)
  betahydroxybutyric acid.
• Diabetes mellitus,
• Other Causes of Ketonuria
• Fever
• Anorexia
• Gastrointestinal disturbances
• Fasting
• Starvation
• Severe vomiting

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• Rotheras Test for Acetone and Acetoacetic Acid
• Procedure
• Take 5ml of urine in a test tube and saturate it
  with ammonium sulphate.
• Add 1 crystal of sodium nitroprusside.Run liquor
  ammonia carefully at the side of the tube so as
  to form a layer on top of the saturated urine.

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• Result a permanganate calomel red (pink
  purple) ring forms at the junction of the two
  layers------positive.
• Negative result shows no ring or a brown ring.
• Ferric Chloride Test for Diacetic Acid
  Gerhardts Test
• Harts Test for Beta-Hydroxybutyric Acid
• Colorimetric Reagent Strip Test

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• 3. Proteins in urine
• Normal lt30 mgms / 100 ml (30 50 mgms/24
  hours)
• Tests for Detection of Proteins
• Semiquantitative precipitation tests
• 1.The heat and acetic acid method,
• 2.sulfosalicyclic acid method and
• 3.the concentrated nitric acid protein
  precipitation method precipitation.

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• Negative No turbidity or cloudiness.
• Trace - A faint precipitate visible against a
  black background, equivalent to about 5 mg / dl
  protein.
• 1 - Definite cloud without flocculation
  equivalent to 10 30 mg / dl.
• 2 - Heavy and granular cloud without
  flocculation equivalent to 40 100 mg / dl.
• 3 - dense cloud with marked flocculation
  equivalent to 200 500 mg / dl .
• 4 - cloudiness with precipitation
  equivalent to 500 mg / dl or more.

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• Heat and Acetic Acid Method
• Procedure
• Take a long test tube and fill ¾ the tube with
  clear urine.
• Boil the upper portion over a flame .the lower
  portion serves as the control.
• If proteins, phosphates or carbonates are present
  in the urine a white cloud develops.
• Add 1-3 drops of glacial acetic acid. Any
  turbidity due to phosphate precipitation will
  clear or if it is due to carbonates they
  disappear with effervescence.
• If it persists, it is due to albumin .
• precipitates due to mucin or nucleoproteins will
  disappear on addition of 2 drops of nitric acid.

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• Sulphosalicylic acid method
• Procedure
• Take 2 ml of clear urine in a test tube.
• Add an equal volume of 30 sulphosalicylic acid.
• Mix thoroughly, allow it to stand for 10 minutes
  and estimate the amount of turbidity.

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• Nitric acid method
• Procedure
• Take 2 3 ml of concentrated nitric acid in a
  test tube.
• Carefully pour 5ml of clear urine down the inner
  side of the inclined test
• tube so that the urine forms a layer over
  the nitric acid.
• A ring of white precipitated protein will form
  at the interface. Estimates the amount of
  precipitate.

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• Colorimetric reagent strip test
• PRINCIPLE the colorimetric reagent strip test
  is based upon the ability of proteins to alter
  the color of some acid-base indicators without
  altering the pH. When an indicator such as
  tetrabromphenol blue is buffered at pH 3.it is
  yellow in solutions without protein. But in the
  presence of protein the color will change to
  green and then to blue with increasing protein
  concentration.
• PROCEDURE protein is determined by dipping the
  strip into well mixed un centrifuged urine and
  immediately comparing the resultant color with
  the chart provided on the reagent strip bottle.
• RESULTS the results are reported as negative
  (yellow color), trace, 1 to 4.trace readings
  may detect 5 to 20 mg of protein/dl. Albumin
  reacts more strongly than the other proteins.
  Highly buffered alkaline urine and contamination
  of the urine specimen with quaternary ammonium
  compounds or skin cleansers containing
  chlorohexidine may produce false results.

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• Bence Jones Proteinuria
• Bence Jones protein is soluble at room and body
  temperatures.
• It precipitates upon heating between 45 C and 60
  C
• redissolves when the urine is further heated to
  the boiling point.
• Reappear on cooling

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OCCULT BLOOD IN URINE

• red blood cells
• or
• haemoglobin
• When hemolysis occurs
• in circulation
• urine
• Normally an occasional red cell may be found on
  microscopic examination of the urine sediment. In
  women during menstruation, the urine may get
  contaminated with menstrual blood and hence
  examination of urine should not be done during
  that period.

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• Haematuria Denotes the presence of red blood
  cells in urine. It is seen in various renal
  disorders, infectious or neoplastic or trauma
  related to any part of urinary tract.
• Hemoglobinuria is the presence of blood pigments
  in the urine without the presence of red blood
  cells. It is associated with certain hemolytic
  anemias that cause hemolytic anemia, transfusion
  reactions, malaria, and paroxysmal nocturnal
  hemoglobinuria

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• Tests for Detection of Blood
• 1. Microscopic Examination
• sediment------------RBCS/HPF
• 2. Benzidine Test
• PRINCIPLE
• Heme acts as a catalyst when hydrogen
  peroxide is mixed with benzidine.
• REAGENTS
• A Saturated solution of benzidine in
  glacial acetic acid
• B Hydrogen peroxide
• PROCEDURE
• Mix equal parts of A and B in a test
  tube and an equal amount of the mixed reagent.
• RESULTS
• A blue color indicates the presence of
  hemoglobin.

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Colorimetric reagent strip method

• Principle the reagent area is impregnated with
  tetramethylbenzidine and buffered organic
  peroxide. This forms a green to dark blue
  compound when hemoglobin catalyzes the oxidation
  reaction of tetramethylbenzidine with a peroxide.

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BILE IN THE URINE

• The constituents
• bilirubin (bile pigments),
• bile salts,
• urobilin and urobilinogen.
• Bilirubin in appears IN JAUNDICE
• Bilirubin in Urine bilirubin in the
  urine indicates the presence of
  hepatocellular disease or intra or extrahepatic
  biliary obstruction
• in the reticuloendothelial cells
• breakdown of hemoglobin.
• linked to albumin----------? liver.
  This albumin-bound form, which is also known as
  unconjugated bilirubin( indirect bilirubin)
  insoluble in water and does not appear in the
  urine.
• In the liver cells,--?conjugated with
  glucuronic and sulfuric acids to form water
  soluble conjugated bilirubin (direct bilirubin).
  
• It is secreted into the bile and then
  excreted into the intestinal tract through the
  bile duct.
• This conjugated bilirubin
  -------------?to urobilinogen.

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• certain liver diseases --?unable to conjugate
  all the bilirubin-----?an increase in both
  conjugated and unconjugated bilirubin
  --?bilirubinuria.
• obstructive biliary tract disease--?bilirubinuria
  .
• hemolytic anemias? unconjugated
  bilirubin--------? urine free from
  bilirubin(Acholuric)

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Tests for detection of bile salts

• Hay Test
• Procedure
• flowers of sulphur --sprinkled on the surface of
  the urine,
• Resultsif bile salts are present they sink to
  the bottom.
• Otherwise they float on the surface.
• This is due to the property of bile salts to
  lower surface tension

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Tests for detection of bile pigments

• 1. Foam Test
• Shake urine in a test tube. If the foam on top is
  yellow, bile pigments are present.
• 2. Gmelins test
• PROCEDURE
• 1. Place ½ inch column of yellow nitric
  acid in a test tube.
• 2. Overlay with equal amounts of urine
  
• RESULT
• A play of colored rings, the most distinct
  being green indicates the presence of bile
  pigments.

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3. Fouchets Test

• FOUCHETS REAGENT
• Trichloroacetic acid 25 gms
• Distilled water - 100 ml
• 10 Ferric chloride solution
  10 ml.
• PROCEDURE
• 1. Place 10 ml of acidified
  urine in a test tube.
• 2. Add 2.5ml of 10 barium
  chloride.
• 3. Mix and filter.
• 4. Unfold the filter paper and
  spread it on a dry filter.
• 5. Add 1 drop of Fouchets
  reagent to the residual precipitate.
• RESULT A green or blue color indicates the
  presence of bilirubin.

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Colorimetric Strip Reagent Test

• Principle this test is base on the coupling of
  bilirubin with diazotized 2, 4-
• dichloroaniline in a strong acid
  medium to form a brown purple azobilirubin
• Compound. The color ranges
  through various shades of tan.
• Procedure the reagent strip is dipped into
  fresh, uncentrifuged urine tapped to
• remove excess urine and after
  20 seconds, compared to the color chart
• on the reagent strip bottle
• Result the results are interpreted as negative,
  small (), moderate (), and large () amounts
  of bilirubin.

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Tests for detection of urobilinogen

• 1. Qualitative Ehrlichs Test
• EHRLICHS REAGENT
• Paradimethylaminobenzaldehyde
  2 gms
• 205 HCL
  - 100 ml
• PROCEDURE
• a. Place 10 ml of urine in a
  test tube.
• b. Add 2.5 ml of barium
  chloride (to remove
• bilirubin).
• c. Mix well and filter.
• d. Add 0.5 ml of Ehrlichs
  reagent
• e. Allow it stand for 3 5
  minutes.

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Results

• pink color
• observable when viewed from the top of the
  test tube. Against a white background placed
  beneath the bottom of the test tube.
• cherry red color
• Abnormally high amounts of This test must be
  done with fresh urine or else urobilinogen is
  oxidized on exposure to air urobilin. Excessively
  cold water should
  not be used in diluting the urine.

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MICROSCOPIC EXAMINATION

• Qualitative technique
• the urine must be freshly voided
• examined without excessive delay in order to
  prevent cellular deterioration.
• Cellular debris from the urethral meatus and
  secretions from the vagina may contaminate the
  urine specimen.

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• 10-15 ml of urine ----?from freshly mixed urine
  specimen and centrifuged at a standard speed,
• usually 1500 to 2000 rpm for 5 minutes.
• This is sufficient to bring to the bottom
  casts, pus cells, blood and crystals. For
  bacteria however a higher speed of 3,000 rpm is
  required.
• the sediment resuspended in 1 ml.of the same
  fluid.
• A drop of resuspended sediment is placed
  directly on a microscope slide and covered with a
  cover slip.
• .

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• low power-?
• Casts tend to congregate at the edges of the
  cover slip.
• A minimum of 10 15 high power fields should
  be scanned for this examination.
• Red blood cells, leucocytes,epithelial
  cells---? per high power field(/hpf)
• casts ---? per low power fields(/lpf).
• Other elements such as bacteria, parasites,
  crystals and spermatozoa are reported as well

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• NORMAL SEDIMENT
• Normal sediment contains a limited number of
  formed elements. it can be divided into two
  classes.
• unorganized sediment
• Organized sediment

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• A. Unorganized sediment - these are the crystals
  of various substances present in the urine and
  they vary with the pH of the urine .crystals of
  normal urine is formed as the specimen cools.
• 1. Crystals in acidic urine
• Uric acid and Urates
• crystals are seen when the urine is allowed
  to stand for sometime and
• are not seen in freshly passed urine.
• Amorphous urates appear as red granules and
  are dissolved by heat and sodium hydroxide but
  not acetic acid.
• Uric acid crystals vary in shape and are
  yellow brown in colour and are not dissolved by
  heat, acetic acid or HCL but are soluble when
  heated with sodium hydroxide.
• disturbances of uric acid metabolism
• fevers where the urine is concentrated.

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• B.Calcium Oxalate
• They are commonly found in diets rich in
  tomatoes, spinach etc. they are typically
  envelope shaped crystals but occasionally appear
  dumb- bell shaped .they are insoluble in strong
  Hcl.
• c. Cystine Crystals
• highly refractile, hexagonal plates and are
  soluble in Hcl but insoluble in acetic acid. They
  are seen cystinosis which is an inborn error of
  metabolism in which cystine crystals are found in
  the urine, reticuloendothelial system and eyes.
• d.Leucine
• slightly yellow, oily looking spheres with
  radial and concentric striations .they are not
  soluble in Hcl or ether .they are found in liver
  disorders.

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• e.Tyrosine
• fine needles arranged in concentric
  sheaves, constriction at the middle.
• liver disorders.
• f.Sulpha crystals -
• patients taking sulphonamides.
• 2. Crystals in alkaline urine
• a. Ammonium Magnesium Phosphates
• ( triple phosphate)
• coffin lid, feathery or leaf like forms.
• In freshly passed urine they indicate
  stones in the bladder or kidney.
• Phosphates may occur as amorphous
  deposits in alkaline urine and are dissolved in
  acetic acid.
• b. Dicalcium Phosphates hey are also seen in
  slightly acid or neutral urine. They are
  colorless prisms arranged in stars and rosettes
• They are soluble in acetic acid.
• c. Calcium carbonate amorphous granules or
  colorless spheres and dumb-bells which are
  soluble in acetic acid with gas formation.

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Crystals in acid urine

• Amorphous urates-?Brick Red-? Granules
• Uric Acid -?Yellow Brown--?Polymorphous
  Whetstones,Rosettes of prisms,Rhombohedral
  prisms, hexagonal plate
• Sodium urate?Colorless to Yellow?Fan of slender
  prisms
• Cystine (rare)?1. Colorless2.Highly
  refractile?Flat hexagonal plates with well
  defined edges singly or in clusters

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• Cholestrol (rare) -?ColorlessBroken window panes
  with notched corners ,Flat plates
• Leucine (rare)-?1. Yellow or Brown2.Highly
  refractile-?Spheroids with striations pure form
  hexagonal
• Tyrosine (rare)? Colorless or YellowFine silky
  needles in sheaves or rosettes
• Bilirubin-?Reddish Brown--?Cubes, Rhombic
  plates, Amorphous needles

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Acid, Neutral or Slightly Alkaline Urine

• Calcium oxalate--?Colorless? Octahedral
  Dumbbells,Often small
• Hippuric acid? Colorless-? Rhombic plates Four
  sided prisms

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Alkaline Urine

• Calcium Carbonate-?Colorless --?Needles,Spheres,Du
  mbbells
• Ammonium biurate-?Yellow Opaque BrownThorn
  apple,Spheres,Dumbbells,Sheaves of needles
• Calcium Phosphate-?Colorless-? Prisms, Plates,
  Needles - - - -

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• A- represents the residue of normal human urine,
  as seen under the microscope.
• B is represented oxalate of urea. An excess of
  this element indicates indigestion
• Nitrate of urea is represented in division C.

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• A and B--highly magnified urinary deposits, which
  indicate different degrees of impairment of the
  digestive functions are represented.

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epithelial cells

• In division A is represented pus and mucus, the
  presence of which indicates suppuration of the
  kidneys (Bright's disease). In B pus globules are
  alone represented. In the division marked C are
  shown blood corpuscles as they are arranged in
  blood drawn from a vein or artery. D represents
  the same separated, as they always are when
  present in the urine. In E highly magnified oil
  globules are represented. If present in the
  urine, they indicate disease of the kidneys. In
  the division marked F are represented epithelial
  cells, the presence of which in large numbers is
  indicative of disease of the mucous lining of the
  urinary organs.

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Uric acid

• In division A are represented the mixed urates as
  they appear during idiopathic fevers, as
  intermittent, remittent, etc. When appearing as
  seen in division B, a less violent affection of
  the same character is indicated. Division C
  represents urate of ammonia, occasionally
  observed when there is a tendency towards
  albuminuria, In division D which is present in
  the urine of persons suffering from gout. The
  crystals shown in division E consist of the same
  salt.

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• varieties of cancer.

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• Organized Sediment the components of organized
  sediment include casts, red blood cells, white
  blood cells, epithelial cells, bacteria, yeast,
  parasites, spermatozoa and artifacts.
• a. Casts
• Casts are formed in the tubules and is composed
  of proteinaceous material. They are washed out by
  the glomerular secretion into the collecting
  tubules and the bladder. They are cylindrical in
  shape with round or broken ends with uniform
  diameter but varying in length. They require
  acidic conditions, high salt concentration,
  reduced urine flow and protein to be formed.
  Practically all casts have a hyaline matrix,
  which may or may not contain inclusions such as
  desquamated cells.
• The casts are named according to the matrix of
  the inclusions contained in them e.g. red blood
  cell casts.

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• 1. Hyaline casts
• are colorless,
• semi-transparent and
• occasionally refractile cylinders and are
  soluble in acetic acid. They are seen when there
  is damage to the glomerular capillary membrane,
  permitting leakage of proteins through the
  glomerular filtrate. They are seen in fever,
  orthostatic proteinuria, and emotional stress or
  strenuous exercise.
• 2. Granular casts are casts containing large
  or fine granules embedded in coagulated protein.
  They are not found in normal urine and their
  presences indicate pyelonephritis. They are also
  seen in chronic lead poisoning.
• 3. Epithelial casts are formed of fused
  desquamated tubular cells. They are coagulated
  protein in which are embedded desquamated
  epithelial cells from the renal tubules .they are
  seen in diseases where there is damage to the
  tubular epithelium as in nephrosis, eclampsia,
  amyloidosis and heavy metal poisoning.

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• 4. Red Blood Cell Casts
• are casts with red blood cells embedded in
  the coagulated protein in the tubule. Their
  presences indicate acute inflammation or vascular
  disorder in the glomerulus causing hematuria.
  They are seen in pathological conditions such as
  acute glomerulonephritis, renal infarction and
  collagen vascular disorder.
• 5. White Blood Cell Casts (Pus cell)
• 6. Fatty Casts
• 7. Waxy Casts

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• CELLS
• a. Red blood cells Normally 1-2 red blood cell
  are found per high power field
• .they appear pale , light refractive, biconcave
  discs when viewed under high power magnification
  .they have no nuclei. Red blood cells in fresh,
  unstained sediment appear pale in color in urine
  that is not fresh, they are pale or colorless
  shadow cells .in concentrated urine, they may be
  small and crenated and in dilute urine, they are
  large and swollen and sometimes rupture to
  produce ghost cells.
• b. White cells
• c. Epithelial Cells Normally a few epithelial
  cells occur in the urine .A marked increase
• is these cells in the urine is seen
  destruction of the tissues in the urinary tract.

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• Quantitative Evaluation of the urine sediment
  Addis count
• The Addis count is a quantitative measurement of
  the excretion of red cells, leucocytes and casts
  in the urine during a 12 hour period.
• e. Bacteria
• Bacteruria is considered significant when there
  is the presence of 100,000 or more bacteria per
  ml of urine specimen.

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DETECTION OF BACTERIA

• Microscopic Examination
• sediment -? gt20 or more bacteria per high
  power field may indicate a urinary tract
  infection
• Reagent strips
• PRINCIPLE
• This test depends upon the conversion of nitrate
  to nitrite by the action of gram negative
  bacteria in urine. At the acid pH of the reagent
  area, nitrite in the urine reacts with
  p-arsanilic acid to form diazonium compound. This
  compound in turn couples with 1, 2, 3, 4-tetra
  hydrobenzoquinolin-3-ol to produce pink color.
• Procedure The strip is dipped in the urine
  specimen for 5 seconds.

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• Results
• uniform pink color --?positive result
• the presence of 100,000 or more organisms per ml,
  
• A negative result should never be interpreted as
  indicating absence of bacteruria.
• There are several reasons for this.
• First morning urine or urine that has remained in
  the bladder for several hours is more likely to
  yield a positive nitrite test result in the
  presence of significant bacteruria than a random
  urine sample that may have been in the bladder
  for short time. in the latter type of specimen
  there may have been insufficient time(less than 4
  hours) for conversion of nitrate to nitrite to
  have occurred.
• When dietary nitrate is absent, even if organisms
  containing reductase are present and bladder
  incubation is ample.
• Ascorbic acid concentrations of more than 25 mg /
  dl or greater may cause false negative results
  with specimens containing small amounts of
  nitrate.

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