URINE ANALYSIS - PowerPoint PPT Presentation

Loading...

PPT – URINE ANALYSIS PowerPoint presentation | free to view - id: f4f0f-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

URINE ANALYSIS

Description:

... with potassium iodide chromogen to oxidize the chromogen to colors ranging from green to brown. ... or else urobilinogen is oxidized on exposure to air ... – PowerPoint PPT presentation

Number of Views:6531
Avg rating:3.0/5.0
Slides: 76
Provided by: drmans
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: URINE ANALYSIS


1
URINE ANALYSIS
  • DR.P.G.KONAPUR
  • PROFESSOR OF PATHOLOGY
  • V.M.K.V.MEDICAL COLLEGE
  • SALEM

2
  • 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

3
  • 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.

4
  • 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

5
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

6
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.

7
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

8
  • 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

9
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.

10
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)

11
  • 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

12
  • 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

13
  • 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

14
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.

15
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

16
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.

17
(No Transcript)
18
  • 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.

19
  • 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

20
  • 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.

21
(No Transcript)
22
  • 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)

23
  • 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.

24
(No Transcript)
25
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

26
  • 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.

27
(No Transcript)
28
  • 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

29
  • 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.

30
  • 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.

31
  • 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.

32
(No Transcript)
33
  • 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.

34
  • 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.

35
  • 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.

36
  • 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

37
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.

38
  • 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

39
  • 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.

40
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.

41
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.

42
  • 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)

43
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

44
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.

45
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.

46
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.

47
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.

48
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.

49
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.

50
  • 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.
  • .

51
  • 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

52
  • NORMAL SEDIMENT
  • Normal sediment contains a limited number of
    formed elements. it can be divided into two
    classes.
  • unorganized sediment
  • Organized sediment

53
  • 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.

54
  • 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.

55
  • 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.

56
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

57
  • 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

58
Acid, Neutral or Slightly Alkaline Urine
  • Calcium oxalate--?Colorless? Octahedral
    Dumbbells,Often small
  • Hippuric acid? Colorless-? Rhombic plates Four
    sided prisms

59
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 - - - -

60
  • 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.

61
  • A and B--highly magnified urinary deposits, which
    indicate different degrees of impairment of the
    digestive functions are represented.

62
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.

63
(No Transcript)
64
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.

65
(No Transcript)
66
(No Transcript)
67
  • varieties of cancer.

68
  • 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.

69
  • 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.

70
  • 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

71
  • 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.

72
  • 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.

73
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.

74
  • 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.

75
THANK YOU
About PowerShow.com