URINE ANALYSIS

Urine Analysis
Dept of Urology
Govt Royapettah Hospital
Kilpauk Medical College
Chennai 1

Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2

Urinalysis
“The testing of urine with procedures commonly performed in an
expeditious, reliable, accurate, safe, and cost-effective manner.”
3
Dept of Urology, GRH and KMC, Chennai.

The Beginning
• Color,
• Turbidity,
• Odour,
• Volume,
• Viscosity, and even
• Sweetness (by noting that certain
specimens attracted ants)
4

Fredrick Dekker (1648-1720)
• Boiled a spoon of urine with
candle.
• It became milky.
• It smelled like milk.
• It tasted like milk.
• So Urine is a nutritious body fluid.
5

Richard Bright-1827
• Bright’s Disease
• Albumin and Dropsy
• Acute and Chronic Nephritis
• Routine Urine examination
6

Thomas Addis (1881-1949)
• Introduced a quantitative approach
to urinary microscopy,
• His practice of counting red and
white cells and cast became known
as the “Addis count.”
7

Urine Composition
• 95% Water, 5% Solutes
• Urea forms almost 50%
of dissolved solutes.
• Followed by Chloride.
8

24 Hr Urine excretion
9

24 Hr Urine excretion
10

Specimen Collection
11

Specimen Container
• Clean, dry, leak-proof (Screw top lids)
disposable containers.
• Wide mouth to facilitate collection and
wide, flat bottom to prevent overturning.
• Made of a clear material to allow for
determination of color and clarity.
• The recommended capacity is 50 mL,
which allows 12 mL of specimen needed
for microscopic analysis, additional
specimen for repeat analysis
12

Specimen Labelling
• Patient’s name, identification number, the
date and time of collection, and any
additional information.
• On container, not to the lid.
• Accompanied by a proper requisition form.
• The information on the form and container
must match.
13

Specimen Transport and Testing
• Following collection, specimens tested
within 2 hours.
• If not possible, should be refrigerated
or have an appropriate chemical
preservative added.
14

Specimen Care
• Not much care and importance is
given like blood/CSF/synovial fluid in
many labs.
• Why?
• Urine is readily available.
• This leads to faulty and spurious
results.
15

Urine changes > 2 hours
16

Urine changes > 2 hours
17

Specimen Preservation-Physical Method
• Routine method- refrigeration at 2C
to 8C
• Decreases bacterial growth and
metabolism.
• For culture, it should be refrigerated
during transit and held refrigerated
until cultured up to 24 hours.
18

Refrigeration-problems
• Increase the specific gravity if measured by Urinometer.
• Amorphous phosphates and urates precipitate, which may obscure
the microscopic sediment analysis.
• The specimen must return to room temperature before chemical
testing by reagent strips.
19

Specimen Preservation-Chemical Method
• Transport over long distance and refridgeration not possible.
• Preservative can be added.
• Ideal Preservative:
1. Bactericidal,
2. Inhibit urease,
3. Preserve formed elements in the sediment,
4. Should not interfere with chemical tests.
20

Thymol
Advantages
• Preserves Glucose and
sediments well.
Disadvantages
• Interferes with acid precipitation
tests for proteins.
21

Boric Acid
Advantages
• Preserves protein and formed
elements well
• Does not interfere with routine
analyses other than pH.
• Is bacteriostatic (not
bactericidal) at 18 g/L; can use
for culture transport.
Disadvantages
• May precipitate crystals when
used in large amounts.
• Interferes with drug and
hormone analyses
22

Formalin
Advantages
• Excellent sediment preservative
Disadvantages
• Acts as a reducing agent.
• Interferes with chemical tests for
glucose, blood, leukocyte
esterase, and copper reduction
23

Toluene
Advantages
tests.
Disadvantages
• Floats on surface of specimens
and clings to pipettes and testing
materials.
24

Sodium Fluoride
Advantages
• Prevents glycolysis.
• Is a good preservative for drug
analyses
Disadvantages
• Inhibits reagent strip tests for
glucose, blood, and leukocytes
25

Phenol
Advantages
tests.
Disadvantages
• May cause change in odour.
26

Specimen Types
27

Random Specimen
• Most commonly received specimen
• Collected at any time, but the actual time of voiding should be
recorded on the container.
• Useful for routine screening tests.
• May also show erroneous results resulting from dietary intake or
physical activity just before collection.
28

First Morning Specimen
• Ideal screening specimen.
• First morning specimen or 8-hour specimen, is a concentrated
specimen.
• Assures detection of chemicals and formed elements that may
• not be present in a dilute random specimen.
• Specimen should be collected immediately on arising and should be
delivered to the laboratory within 2 hours.
29

Fasting Specimen (Second Morning)
• Differs from a first morning specimen by being the second voided
specimen after a period of fasting.
• Will not contain any metabolites from food ingested before the
beginning of the fasting period.
• Recommended for glucose monitoring.
30

2 hour Postprandial specimen
• Instructed to void shortly before consuming a routine meal.
• Specimen is collected 2 hours after eating.
• The specimen is tested for glucose,
• Used primarily for monitoring insulin therapy.
31

24 hour Timed specimen
• Provide patient with written instructions.
• Proper collection container and preservative should be given.
• Day 1: 7 a.m - Patient voids and discards specimen; collects all urine
for the next 24 hours.
• Day 2: 7 a.m - Patient voids and adds this urine to previously collected
urine.
• On arrival at laboratory, the entire 24-hour specimen is thoroughly
mixed, and the volume is measured and recorded.
• An aliquot is saved for testing and additional or repeat testing; discard
remaining urine.
32

Catheterised Specimen
• Collected under sterile conditions by passing a hollow tube (catheter)
through the urethra into the bladder.
• Most commonly requested test on a catheterized specimen is a
bacterial culture.
• If a routine urinalysis is also requested, the culture should be
performed first to prevent contamination.
33

Mid Stream Clean Catch Specimen
• Alternative to the catheterized specimen
• Provides a safer, less traumatic method
• Less contaminated by epithelial cells and bacteria and, therefore, is
more representative of the actual urine than the routinely voided
specimen.
34

Mid Stream Clean Catch Specimen
• Patients should wash hands before beginning the collection.
• Glans should be cleaned and foreskin should be withdrawn.
• Female patients should separate the labia and clean the urinary
meatus and surrounding area.
• Patients void first into the toilet, then adequate amount of urine
collected in the sterile container, and
• Voiding should be finished into the toilet.
• Care should be taken not to contaminate the specimen container.
35

Mid stream clean catch
Povidone
Iodine/Chlorhexidine
should not be used
for cleaning.
36

Suprapubic Aspiration
• Occasionally collected.
• Provides a sample for bacterial culture that is completely free of
extraneous contamination.
• Can also be used for cytologic examination
37

Prostatitis Specimen-3 Glass specimen
• Similar to the midstream clean-catch collection,
• Instead of discarding the first urine passed, it is collected in a sterile
container.
• Next, the midstream portion is collected in another sterile container.
• The prostate is then massaged so that prostate fluid will be passed
• With the remaining urine in the 3rd container.
38

3 Glass Specimen
• The first and third specimens are examined microscopically.
• In prostatic infection, the third specimen will have a WBC/HPF and a
bacterial count 10 times that of the first specimen.
• Macrophages containing lipids may also be present.
• The second specimen is used as a control for bladder and kidney
infection.
• If it is positive, the results from the third specimen are invalid because
infected urine has contaminated the specimen.
39

4 glass method-Stamey Mears
• Initial voided urine (VB1),
• Midstream urine (VB2),
• Expressed prostatic secretions (EPS), and
• Postprostatic massage urine specimen (VB3).
40

Types of Analysis
• Macroscopic Examination
• Chemical Analysis (Urine Dipstick)
• Microscopic Examination
• Culture
• Cytological Examination
41

Macroscopic Examination
Volume:
May range from anuria to many liters.
Minimum volume needed per day is 600 ml to excrete urea and other
solutes.
Normal daily output is 1200-1500 ml/day
Oliguria < 400 ml.
Anuria- No urine output or <50 ml/day
42

Odour:
Ammonia-like (Urea-splitting bacteria)
Foul, offensive Old specimen, pus or inflammation
Sweet Glucose
Fruity Ketones
Maple syrup-like Maple Syrup Urine Disease
43

Turbidity:
Typically cells or crystals.
Cellular elements and bacteria will clear by centrifugation.
Crystals dissolved by a variety of methods (acid or base).
Microscopic examination will determine which is present.
44

Turbidity:
Typically cells or crystals.
Cellular elements and bacteria will clear by centrifugation.
Crystals dissolved by a variety of methods (acid or base).
Microscopic examination will determine which is present.
45

Urine Colour
• Colourless
• Cloudy
• Red
• Orange
• Yellow
• Green-Blue
• Brown
• Brown-black
• Very dilute urine
• Overhydration
46

Urine Colour
• Colourless
• Cloudy
• Red
• Orange
• Yellow
• Green-Blue
• Brown
• Brown-black
• Phosphaturia
• Pyuria
• Chyluria
47

Urine Colour
• Colourless
• Cloudy
• Red
• Orange
• Yellow
• Green-Blue
• Brown
• Brown-black
• Hematuria
• Hemoglobinuria/myoglobinuria
• Anthocyanin in beets and
blackberries
• Chronic lead and mercury
poisoning
• Phenolphthalein (in bowel
evacuants)
• Phenothiazines (e.g., Compazine)
• Rifampin
48

Urine Colour
• Colourless
• Cloudy
• Red
• Orange
• Yellow
• Green-Blue
• Brown
• Brown-black
• Dehydration
• Phenazopyridine (Pyridium)
• Sulfasalazine (Azulfidine)
49

Urine Colour
• Colourless
• Cloudy
• Red
• Orange
• Yellow
• Green-Blue
• Brown
• Brown-black
• Normal
• Phenacetin
• Riboflavin
50

Urine Colour
• Colourless
• Cloudy
• Red
• Orange
• Yellow
• Green-Blue
• Brown
• Brown-black
• Biliverdin
• Indicanuria
• Amitriptyline (Elavil)
• Indigo carmine
• Methylene blue
• Phenols,
• promethazine [Phenergan])
• Resorcinol
• Triamterene (Dyrenium)
51

Urine Colour
• Colourless
• Cloudy
• Red
• Orange
• Yellow
• Green-Blue
• Brown
• Brown-black
• Urobilinogen
• Porphyria
• Aloe, fava beans, and rhubarb
• Chloroquine and primaquine
• Furazolidone (Furoxone)
• Metronidazole (Flagyl)
• Nitrofurantoin (Furadantin)
52

Urine Colour
• Colourless
• Cloudy
• Red
• Orange
• Yellow
• Green-Blue
• Brown
• Brown-black
• Alcaptonuria (homogentisic acid)
• Hemorrhage
• Melanin
• Tyrosinosis
(hydroxyphenylpyruvic acid)
• Cascara, senna (laxatives)
• Methocarbamol (Robaxin)
• Methyldopa (Aldomet)
• Sorbitol
53

Specific Gravity of urine
• Specific gravity is defined as the density of a solution compared with
the density of a similar volume of distilled water at a similar
temperature.
• Specific gravity of the plasma filtrate entering the glomerulus is 1.010.
• The term isosthenuric is used to describe urine with a specific gravity
of 1.010.
• Specimens below 1.010 are hyposthenuric, and those above 1.010
are hypersthenuric.
• Normal random specimens may range from 1.003 to 1.035,
depending on the patient’s amount of hydration.
54

Urinometer
• It consists of a weighted float attached to
a scale that has been calibrated in terms
of urine specific gravity.
• The weighted float displaces a volume of
liquid equal to its weight and has been
designed to sink to a level of 1.000 in
distilled water.
55

Urinometer
• The additional mass provided by the
dissolved substances in urine causes the
float to displace a volume of urine
smaller than that of distilled water.
• The level to which the urinometer sinks,
represents the specimen’s mass or
specific gravity.
56

Chemical Analysis
57

Urine Dip stick
Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protein
Urobilinogen
Nitrite
Leukocyte Esterase
58

Glucose
Negative
Trace (100 mg/dL)
+ (250 mg/dL)
++ (500 mg/dL)
+++ (1000 mg/dL)
++++ (2000+ mg/dL)
Glucose + 2 H2O + O2 --->
Gluconic Acid + 2 H2O2
Glucose Oxidase
3 H2O2 + KI ---> KIO3 + 3 H2O
Horseradish Peroxidase
Chemical Principle
Read at 30 seconds
RR: Negative
59

Uses and Limitations
Significance
• Diabetes mellitus.
• Renal glycosuria.
Limitations
• Interference: reducing agents, ketones.
• Only measures glucose and not other sugars.
• Renal threshold must be passed in order for glucose to spill into
the urine.
Other Tests
• CuSO4 test for reducing sugars.
60

CuSO4 and Reducing Sugars
Sugar Disease(s)
Galactose Galactosemias
Fructose Fructosuria, Fructose Intolerance, etc.
Lactose Lactase Deficiency
Pentoses Essential Pentosuria
Maltose Non-pathogenic
* NOT Sucrose because it is not a reducing sugar
61

Protein
• Principle: protein error of indicators.
• Certain indicators change color in the presence of protein.
• Protein (primarily albumin) accepts hydrogen ions from the indicator.
• The test is more sensitive to albumin because albumin contains more
amino groups to accept the hydrogen ions than other proteins.
• Tetrabromphenol blue or 3′, 3′′, 5′, 5′′-tetrachlorophenol-3, 4, 5,
• 6-tetrabromosulfonphthalein and an acid buffer.
• At a pH level of 3, both indicators appear yellow in the absence of
protein.
62

Protein
• The color progresses through various shades of green and finally to
blue.
• Readings are reported in terms of negative, trace, 1, 2, 3, and 4
63

Sulfosalicylic acid Precipitation test
64

Bilirubin
Negative
+ (weak)
++ (moderate)
+++ (strong)
Bilirubin + Diazo salt ---------> Azobilirubin
Acidic
Chemical Principle
Read at 30 seconds
65

Significance
Increased direct bilirubin (correlates with urobilinogen and serum
bilirubin)
Limitations
Interference: prolonged exposure of sample to light
Only measures direct bilirubin--will not pick up indirect bilirubin
66

Ketones
Negative
Trace (5 mg/dL)
+ (15 mg/dL)
++ (40 mg/dL)
+++ (80 mg/dL)
++++ (160+ mg/dL)
Acetoacetic Acid + Nitroprusside
------> Colored Complex
Chemical Principle
Read at 40 seconds
67

Significance
Diabetic ketoacidosis
Prolonged fasting
Limitations
Interference: expired reagents (degradation with exposure to moisture
in air)
Only measures acetoacetate not other ketone bodies (such as in
rebound ketosis).
68

Specific Gravity
1.000
1.005
1.010
1.015
1.020
1.025
1.030
X+ + Polymethyl vinyl ether / maleic anhydride
--------------->
X+- Polymethyl vinyl ether / maleic anhydride + H+
H+ interacts with a Bromthymol Blue indicator to
form a colored complex.
Chemical Principle
Read up to 2 minutes
RR: 1.003-1.035
69

Significance
Diabetes insipidus
Limitations
Interference: alkaline urine
Does not measure non-ionized solutes (e.g. glucose)
70

Urine Dipstick-Blood
Negative
Trace (non-hemolyzed)
Moderate (non-hemolyzed)
Trace (hemolyzed)
+ (weak)
++ (moderate)
+++ (strong)
Diisopropylbenzene dihydroperoxide +
Tetramethylbenzidine
------------> Colored Complex
Heme
Chemical Principle
Lysing agent to lyse red blood cells
Read at 60 seconds
RR: Negative
Analytic Sensitivity: 10 RBCs
71

Significance
Hematuria (nephritis, trauma, etc)
Hemoglobinuria (hemolysis, etc)
Myoglobinuria (rhabdomyolysis, etc)
Limitations
Interference: reducing agents, microbial peroxidases
Cannot distinguish between the above disease processes
72

pH
5.0
6.0
6.5
7.0
7.5
8.0
8.5
H+ interacts with:
Methyl Red (at high concentration; low pH)
and
Bromthymol Blue (at low concentration; high
pH), to form a colored complexes
(dual indicator system)
Chemical Principle
Read up to 2 minutes
R.R.: 4.5-8.0
73

Significance
Acidic (less than 4.5): metabolic acidosis, high-protein diet
Alkaline (greater than 8.0): renal tubular acidosis (>5.5)
Limitations
Interference: bacterial overgrowth (alkaline or acidic),
“run over effect” effect of protein pad on pH indicator pad
74

Urobilinogen
0.2 mg/dL
1 mg/dL
2 mg/dL
4 mg/dL
8 mg/dL
Urobilinogen + Diethylaminobenzaldehyde
-------> Colored Complex
Chemical Principle
Read at 60 seconds
RR: 0.02-1.0 mg/dL
75

Significance
High: increased hepatic processing of bilirubin
Low: bile obstruction
Limitations
Interference: prolonged exposure of specimen to oxygen (urobilinogen
---> urobilin)
Cannot detect low levels of urobilinogen
76

Nitrite
Negative
Positive
Diazo compound + Tetrahydrobenzoquinolinol
----------> Colored Complex
Nitrite + p-arsenilic acid -------> Diazo compound
Acidic
Chemical Principle
Read at 60 seconds
RR: Negative
77

Nitrite
Significance
Gram negative bacteriuria
Limitations
Interference: bacterial overgrowth
Only able to detect bacteria that reduce nitrate to nitrite
78

Leucocyte esterase
Negative
Trace
+ (weak)
++ (moderate)
+++ (strong)
Derivatized pyrrole amino acid ester
------------> 3-hydroxy-5-phenyl pyrrole
Esterases
3-hydroxy-5-phenyl pyrrole + diazo salt
-------------> Colored Complex
Read at 2 minutes
RR: Negative
Analytic Sensitivity: 3-5 WBCs
Chemical Principle
79

Significance
Pyuria
Acute inflammation
Renal calculus
Limitations
Interference: oxidizing agents, menstrual contamination
80

Microscopic Examination
Preservation
Cells and casts begin to disintegrate in 1 - 3 hrs. at room temp.
Refrigeration for up to 48 hours (little loss of cells).
Specimen concentration
Ten to twenty-fold concentration by centrifugation.
Types of microscopy
Phase contrast microscopy
Polarized microscopy
Bright field microscopy with special staining
(e.g., Sternheimer-Malbin stain)
81

Abnormal Findings
Per High Power Field (HPF) (400x)
– > 3 erythrocytes
– > 5 leukocytes
– > 2 renal tubular cells
– > 10 bacteria
Per Low Power Field (LPF) (200x)
– > 3 hyaline casts or > 1 granular cast
– > 10 squamous cells (indicative of contaminated specimen)
– Any other cast (RBCs, WBCs)
Presence of:
– Fungal hyphae or yeast, parasite, viral inclusions
– Pathological crystals (cystine, leucine, tyrosine)
– Large number of uric acid or calcium oxalate crystals
82

Erythrocytes
- “Dysmorphic” vs. “normal” (> 10 per HPF)
Leukocytes
- Neutrophils (glitter cells) More than 1 per 3 HPF
- Eosinophils Hansel test (special stain)
Epithelial Cells
- Squamous cells Indicate level of contamination
- Renal tubular epithelial cellsFew are normal
- Transitional epithelial cells Few are normal
83

RBCs
84

RBCs
• Biconcave disks measuring approximately 7 mm in diameter.
• Identified using high-power (40) objective (400 magnification).
• RBCs are routinely reported as the average number seen in 10 hpfs.
• Hypersthenuric urine, the cells shrink due to loss of water and may
appear crenated or irregularly shaped.
• Hyposthenuric urine, the cells absorb water, swell, and lyse rapidly,
releasing their hemoglobin and leaving only the cell membrane.
Ghost cells.
85

RBCs
86

Yeasts and Air bubbles
87

WBCs
88

WBCs
• Larger than RBCs, measuring an average of about 12 mm in diameter.
• The predominant WBC is neutrophil.
• Neutrophils contain granules and multilobed nuclei and are easy to
identify.
• Neutrophils lyse rapidly in dilute alkaline urine and begin to lose
nuclear detail.
• Glitter cells- Neutrophils in hypotonic saline.
• Fewer than five leukocytes per hpf are found in normal urine.
89

Neutrophils
90

Epithelial cell
• Three types of epithelial cells are seen in urine:
• Squamous,
• Transitional (urothelial), and
• Renal tubular
91

Squamous epithelial cell
• Squamous cells are the largest cells found in the urine sediment.
• They contain abundant, irregular cytoplasm and a prominent nucleus
about the size of an RBC.
• Originate from the linings of the vagina and female urethra and the
lower portion of the male urethra.
• They represent normal cellular sloughing and have no pathologic
significance.
92

Squamous Cells
93

Transitional Epithelial Cells
• Transitional epithelial cells originate from the lining of the renal
pelvis, calyces, ureters, and bladder, and from the upper portion of
the male urethra.
• They are usually present in small numbers in normal urine,
representing normal cellular sloughing
• Increased numbers of transitional cells seen singly, in pairs, or in
clumps (syncytia) are present following invasive urologic procedures
such as catheterization.
• No clinical significance.
94

Transitional Cells
95

Renal Tubular Epithelial Cells
• Vary in size and shape depending on the area of the renal tubules
from which they originate.
• These lipid-containing RTE cells are called oval fat bodies
• RTE cells are the most clinically significant of the epithelial cells.
• The presence of more than two RTE cells per highpower field
indicates tubular injury.
96

Renal Tubular Epithelial Cells
97

Oval Fat Body
98

Bacteria and Yeasts
Bacteria
- Bacteriuria More than 10 per HPF
Yeasts
- Candidiasis Most likely a contaminant
but should correlate with
clinical picture.
Viruses
- CMV inclusions Probable viral cystitis.
99

Bacteria
• Bacteria are not normally present in urine.
• A few bacteria are usually present as a result of vaginal, urethral,
external genitalia, or collection-container contamination.
• To be considered significant for UTI, bacteria should be accompanied
by WBCs.
100

Bacteria
101

Yeasts
• Appear as small, refractile oval structures 0that may or may not
contain a bud.
• In severe infections, may appear as branched, mycelial forms.
• Candida albicans is the most common.
102

Yeasts
103

Yeasts
104

Casts
Erythrocyte Casts: Glomerular diseases
Leukocyte Casts: Pyuria, glomerular disease
Degenerating Casts:
-Granular casts Nonspecific (Tamm-Horsfall protein)
-Hyaline casts Nonspecific (Tamm-Horsfall protein)
-Waxy casts Nonspecific
-Fatty casts Nephrotic syndrome
(oval fat body casts)
105

RBC Casts
• Primarily associated with damage to the glomerulus
(glomerulonephritis)
• Any damage to the nephron capillary structure can cause their
formation.
• Usually associated with proteinuria and dysmorphic erythrocytes.
• Also been observed in healthy individuals following participation in
strenuous contact sports
106

RBCs Cast - Histology
107

RBCs Cast - Histology
108

RBCs Cast
109

WBC Casts
• Signifies infection or inflammation within the nephron.
• Most frequently associated with pyelonephritis and are a primary
marker for distinguishing pyelonephritis (upper UTI) from lower UTIs.
• Also seen in acute interstitial nephritis.
110

WBCs Cast
111

Epithelial Cell cast
• Represent the presence of advanced tubular destruction, producing
urinary stasis along with disruption of the tubular linings.
• Associated with heavy metal and chemical or drug-induced toxicity,
viral infections, and allograft rejection.
• Also accompany WBC casts in cases of pyelonephritis.
112

Tubular Epith. Cast
113

Tubular Epith. Cast
114

Granular Cast
• May be of pathologic or nonpathologic significance.
• Non pathological-Sternuous exercise.
• Pathological- Disintegration of cellular casts.
• Urinary stasis allowing the casts to remain in the tubules must be
present for granules to result from disintegration of cellular casts.
115

Granular Cast
116

Waxy cast
• Waxy casts are representative of extreme urine stasis, indicating
chronic renal failure.
117

Waxy Cast
118

Hyaline Casts
• Most frequently seen cast is the hyaline type,
• Consists almost entirely of Tamm-Horsfall protein.
• The presence of zero to two hyaline casts per lpf is considered
normal.
• Physiological: strenuous exercise, dehydration, heat exposure, and
emotional stress.
• Pathological: acute glomerulonephritis, pyelonephritis, chronic renal
disease, and congestive heart failure.
119

Hyaline Cast
120

Fatty Cast
• Seen in conjunction with oval fat bodies and free fat droplets in
disorders causing lipiduria.
• Most frequently associated with the nephrotic syndrome,
• Also seen in toxic tubular necrosis, diabetes mellitus, and crush
injuries.
121

Fatty Cast
122

Crystals
-Urate
Ammonium biurate
Uric acid
- Triple Phosphate
- Calcium Oxalate
- Amino Acids
Cystine
Leucine
Tyrosine
- Sulfonamide
123

Calcium Oxalate Crystals
Envelope
shaped
124

Calcium Oxalate Crystals
Dumbbell Shape
Dumb bell
shaped
125

Triple Phosphate Crystals
Coffin lid
shaped
126

Urate Crystals
Amorphous
127

Cystine Crystals
Benzene ring
shaped
128

Ammonium Biurate Crystals
Thorn apple
shaped
129

Cholesterol Crystals
Rectangular
plate shaped
130

Cytological Examination
1. Papanicolau
2. Wright’s
3. Immunoperoxidase
4. Immunofluorescence
131

Cytology: Normal
132

Cytology: Normal
133

Cytology: Reactive
134

Cytology: Reactive
135

Cytology: Polyoma (Decoy Cell)
136

Cytology: Polyoma (Decoy Cell)
Immunoperoxidase to SV40 ag
137

Cytology: TCC Low Grade
138

Cytology: TCC High Grade
139

Cytology: Squamous Cell Ca.
140

Cytology: Renal Cell Ca.
141

Thank you
142

URINE ANALYSIS

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