2. – First morning voiding (most
concentrated)The morning sample is considered
best as it has higher specific gravity and lower
Ph and desirable for preservation of formed
element.
– Record collection time
Use clean, dry and wide mouth
container.
– Analyzed within 1hours of collection
– Free of debris or vaginal secretions

3. urinalyses are performed for several reasons:-
 General evaluation of health
 Diagnosis of metabolic or systemic diseases
that affect kidney function
 Diagnosis of endocrine disorders. Twenty-four-
hour urine studies are often ordered for these
tests
 Diagnosis of diseases or disorders of the kidneys
or urinary tract
 Monitoring of patients with diabetes
 Testing for pregnancy
 Screening for drug abuse

4.  Volume - 600-2500ml/24 hr(average-
1200ml)
 Specific gravity - 1.003-1.030
 Reaction - acidic(Ph 4.7-7.5)Average Ph
6.0
 Total solids - 30-70g/l

5.  Inorganic constituents of urine/24 hrs.-
 Iron=0.06-0.1 mg
 Chloride=9-16 gm
 Sodium=3-4 gm
 Phosphate=1.5-2.0 g
 Sulfur=0.7-3.5 gm
 Calcium=0.1-0.3 g

6.  Organic constituent of urine/24 hrs-
 Nitrogenous compound=25-35 gm
 Urea=15-30 gm
 Creatine=60-150 mg
 Ammonia=0.3-1.0 g
 Uric acid=0.3-1.0 g
 Protein=0-0.1 gm

7.  All the specimen for routine urinalysis
should be examined while fresh(within
one hr. of collection).when urine is kept
for longer than one hr. before analysis, to
avoid deterioration of chemical and
cellular material and to prevent
multiplication of bacteria, it should be
stored at 2-8 c in a refrigerator.

8. The expected changes in the composition
of urine stored at room temp. are as follow-
 Lysis of red blood cells by hypotonic urine.
 Decomposition of casts.
 Bacterial multiplication.
 Decrease in glucose level, due to bacterial
growth
 Formation of ammonia from urea by the
action of bacteria.

9. The recommended preservatives are as
follow-
 Toluene
 Formalin
 Thymol
 Chloroform
 Commercial preservatives tablets. These
release formaldehyde.

10. Types of Analysis
− Physical Examination
− Chemical Analysis (Urine Dipstick or
by manual methods)
− Microscopic Examination
− Culture
− Cytological Examination

11. It includes-
 Volume
 Color
 Appearance
 odour

12.  Volume - for adults normal average daily
volume of urine is about 1200-1500 ml. the
normal range of 24 hr. urine may be from
600-2000 ml.
 Color - the color of normal urine may vary
from pale yellow to dark amber. very pale
or colorless urine can result from high fluid
consumption, diuretic drugs, natural diuretic
such as alcohol and coffee and also in
clinical condition such as disbetes insipidus
and diabetes mellitus.

13.  Appearance - normal urine is usually clear.
urine may appear cloudy or turbid from the
presence of leukocytes and epithelial
cells.this can be confirmed by microscopic
examination. bacteria can also cause
cloudiness to urine.fat and chyle give urine
a milky colour. presence of RBCs may give
urine turbid and smoky appearance.
 Odour - presence of ketone bodies gives
urine a sweet or fruity smell.A contaminated
urin with bacteria may give pungent smell
due to the formation of ammonia

14. The routine urinalysis includes chemical
testing for-
 Protein
 Glucose
 Ketone bodies
 Occult blood
 Bile pigments
 Bile salts
 urobilinogen

15. URINE is formed through a combination of four basic processes:-
1) Glomerular filtration,
2) Tubular reabsorption,
3) Tubular secretion, and
4) Water conservation.
Blood is under high pressure in the glomerulus; thus, plasma
(except for plasma proteins) moves into the glomerular capsule. This
fluid is called filtrate. As the filtrate moves along the tubules, it is
referred to as tubular fluid. Most of the water and many other
molecules are reabsorbed into the blood, while some substances are
secreted into the tubular fluid. Once the fluid moves into the
collecting, duct it is called urine. While in the collecting duct,
additional water is removed from the urine, concentrating the
wastes.

17.  General consideration - The microscopic
examination is a valuable diagnostic tool
for the detection and evaluation of renal
and urinary tract disorders and other
systemic diseases.
 Principle - The microscopic elements
present in urine(in suspension)are collected
in the form of deposit by centrifugation. A
small drop of the sediment is examined by
making a coverslip preparation under
microscope.

18. Requirements - Centrifuge tube or test
tube(10*15mm)
 Glass slide
 Cover slips
 Pasteur pipettes
 Centrifuge
 Microscope
 Specimen - Freshly voided urine is
required

19. Procedure - Mix the urine and pour into a
centrifuge tube(or small test tube)until it is ¾ fill(5
ml)
 Centrifuge with another balanced test tube for 5 min at 2500
rpm.
 Pour off the supernatant quickly and complete into another test
tube.This can be used for protein determination
 Resuspend the deposits by shaking the tube.
 Place one drop of the deposits on a glass slide.
 Cover it with coverslip and mark it with identification number.
 Observe it first under low power objective in partially closing the
diaphragm and then adjusting the condenser downward until
satisfactory contrast is obtained.Note the content of various
fields.
 Switch to high dry objective and observe at least 10 to 15
different fields

23. Organised elements- Unorganised elements-
 RBC’s In acidic urine-
 WBC’s  Calcium oxalate
 Epithelial cells  Uric acid
 Casts-Hyaline  Amorphous urate
 Cellular  Sodium urate
 Granular  Calcium sulphate
 Waxy and fatty casts  Cystine crystals
 Tyrosine
 Leucine

24. IN ALKALINE URINE-
 Triple phosphate
 Amorphous phosphate
 Calcium carbonate
 Calcium phosphate
 Ammonium biurates

25.  Starch crystals
 Fibers
 Oil droplets
 Hair
 Air bubbles

26.  In fresh urine these cells have a normal,
pale or yellow appearance.
 They appear smooth, biconcave disks
about 7 um in diameter and 2um thick.
 They do not contain nuclei.
 In hypotonic urine the red cells swell up
and lyse.
 In hypertonic urine the red cells crenate.

27. Microscopic Examination
RBCs Crenated RBC

28.  The pus cells can enter in urine anywhere
from the glomerulus to the urethra.
 Normal urine can contain 2-3 pus
cells/per h.p.f.
 These are mostly neutrophils.
 Approximate diameter:10-12 um

29. Microscopic Examination
WBCs

30.  Originate from any site in the
genitourinary tract from the proximal
convoluted tubule to the urethra or from
vagina.
 Normally few cells(3-5) per h.p.f from
these sites can be found in the urin.
 Three types of epithelial cells may be
recognised-Tubular
 Transitional
 Squamous

31.  These are slightly larger then leucocytes
and contain large round nucleus.
 They may be cuboidal, flat or columnar

32. Microscopic Examination
Tubular Epithelial Cells

33.  These are two to four times as large as
white cells
 They may be pear shaped or round.
 Occasionally these cells may contain
two nuclei.

34. Microscopic Examination
Transitional Cells

35.  These are large, flat and irregular in
shape.
 They contain abundant cytoplasm and
small central nuclei.

36. Microscopic Examination
Squamous Cells

37.  Urinary castes are formed in the lumen of the tubule of the
kidney. The renal tubules secrete a mucoprotein called Tamm-
Horsfall protein which is believed to form the basis matrix of all
casts.
 Casts dissolve in alkaline urine
 Castes have nearly parallel sides and rounded or blunted ends.
These are of followings types-
1. Granular
2. Hylaine
3. Red cell casts
4. White cell casts
5. Epithelial cell casts
6. Waxy casts
7. Fatty casts

38.  These always indicate significant renal
disease.The casts are present due to the
degeneration of cellular casts or due to
direct aggregation of serum protein in a
Tamm-horsfall mucoprotein matrix.

39. Microscopic Examination
Granular Cast

40.  They are colorless,
homogeneous,Transparent and with
rounded ends.
 These casts can be seen in increased
number even in the mildest kind of renal
disease.
 A few hyaline casts may be present in
normal urine.

41. Microscopic Examination
Hyaline Cast

42.  The cast may contain only a few RBC’s in
protein matrix or may be many cells
packed close together with no visible
matrix.
 Presence of red cell is always
pathogenic.
 They are usually diagnostic of glomerular
disease being found in acute
glomerulonephritis and also in renal
infarction.

43. Microscopic Examination
RBCs Cast

44.  The majority of white cells that appear in
casts are polymorphonuclear
neutrophils.
 The cells may be few or many, tightly
packed together.
 These casts may be present in renal in
renal infection and in glomerular disease.

45. Microscopic Examination
WBCs Cast

46.  The epithelial cells may be arranged
hephazardly and vary in size and
shape.These casts are rarely seen in urine
.
 Presence of these casts indicate tubular
degeneration and necrosis.
 Present in severe chronic renal disease.

47. Microscopic Examination
Epith. Cast

48.  Have high refractive index.
 These are yellow grey or colorless and
have a homogenous appearance
 These result from the degeneration of
granular casts.

49. Microscopic Examination
Waxy Cast

50.  Fatty casts are formed by incorporated
free fat droplets or oval fat bodies.
 These are frequently seen in nephrotic
syndrome and toxic renal poisoning.

51. Microscopic Examination
Fatty Cast

52.  Crystals present in acidic urine…….
 Uric acid crystals -These can occur in
most charactristic diamond rhombic or
rosette form.These are usually stained
with urinary pigments as yellow or red
brown.These are soluble in sodium
hydroxide and insoluble in hcl.
 Pathological conditions - Gout, chronic
nephritis, acute febrile condition.

53. Uric acid crystals in urine

54.  These are colorless and envelop shaped.
They also appear as oval, sphere or
biconcave disks which have a dumb bell
shape(when viewed from side).
 These are found in acid or neutral
urine.These can be present in urine after the
ingestion of tomatoes, oranges and vitamin
c.
 Pathological condition-They can be present
in diabetes mellitus, liver disease and
chronic liver disease.

55. Calcium oxalate crystals in urine
Calcium oxalate crystals are usually found in
acid urine. They commonly appear octahedral.

56.  These are urate salts of sodium,
potassium, megnesium and calcium.
 Usual form is non crystalline and
amorphous and appearance is yellow-
red granular.
 These are soluble in alkali at 60 c.
 They have no clinical significance.

57. Amorphous urates in urine
Amorphous urates appear as fine pink or
brownish-tan granules. They are salts of uric
acid and are normally found in acid or neutral
urine.

58.  These may be present as amorphous or
as crystals.
 These crystals are colorless or yellowish
needles occurring in clusters.
 They are soluble at 60 c.
 They have no clinical significance.

59. Sodium urate crystals in urine

60.  These are long, thin and colorless
needles or prisms.
 These are soluble in acetic acid.
 These are rarely seen in the urine and
they have no clinical significance.

61. Calcium sulfate crystals in urine

62.  These are in the form of elongated prisms
or plates.
 The color may be yellow brown or
colorless.
 These are soluble in water.
 They are rarely seen in urine and have no
clinical significance.

63. Hippuric acid crystals in urine

64.  These are colorless, hexagonal plates
with equal or unequal sides.
 These are soluble in hydrochloric acid
and ammonia.
 Pathological condition-They occur in
patients with either congenital cystinosis
or congenital cystinuria.They can form
calculi.

65. Cystine crystals in urine
Cystine, an amino acid, is an abnormal finding
in urine. Rarely seen, these crystals are found
in acid urine and are seen as thin, colorless,
hexagonal plates.

66.  These appear in the form of fine,
refractile needles, occurring in clusters.
 These are soluble in ammonium
hydroxide.
 Pathological conditions-severe liver
disease and tyrosinosis.

67. Tyrosine crystals in urine
Tyrosine crystals are not normally found in urine. They are products of protein
metabolism and appear in urine of people with tissue degeneration or necrosis (acute
liver disease, severe leukemia, typhoid fever, and smallpox). They are present only
when urine is acid. They are colorless to yellowish brown, needle shaped crystals and
have a fine silky appearance. The needles may be single or arranged in sheaves or
rosettes. Tyrosine crystals usually appear in urinary sediment together with leucine
crystals

68.  These crystals are oily, highly refractile
spheroids .
 They have yellow or brown color.
 These crystals are soluble in hot alcohol
and acetic acid.
 Pathological conditions-severe hepatitis,
acute yellow atrophy.

69. Leucine crystals in urine
Leucine crystals are not normally found in urine They appear in urine in
association with tyrosine and are manifestations of the same clinical conditions.
When found, leucine crystals are in acid urine in the form of spheroids with
concentric striations. They are dense, highly refractive and appear as yellowish
brown bodies.

70.  These crystals are large flat and in the
form of transparent plates with notched
corners.
 These are soluble in either chloroform
and hot alcohol.
 Pathological conditions- Nephritis,
Nephrotic conditions, excessive tissue
breakdown.

71. Microscopic Examination
Cholesterol Crystals

72.  Most of the sulfa drugs precipitate out as
sheaves of needles.
 They may be clear or brown in color and
usually appear with eccentric binding.
 These drugs are soluble in acetone.

73. Sulfa crystals in urine
Sulfonamide crystals form primarily in acid urine. The shape and color of these
crystals are extremely variable, depending on the particular sulfonamide being
administered to the patient. The most common forms encountered include rosettes, fan
shapes and those resembling shocks of wheat. Sulfa crystals have pathologic
significance, since they tend to form renal calculi that may damage renal tubules.

74.  Crystals found in alkaline urine.
 The crystals are colorless prisms with
three to six sides and frequently with
oblique end.
 Soluble in acetic acid.
 Frequently found in normal urine.
 Pathological conditions-chronic cystitis,
chronic pyelitis, enlarged prostate.

75. Triple phosphate crystals in urine
Triple phosphate crystals, resemble prisms or
"coffin lids". They are found normally in
alkaline or neutral urine. They are colorless.

76.  These are present in amorphous,
granular form.
 They have no clinical significance.

77. Amorphous phosphates in urine
Amorphous phosphates appear in neutral to alkaline urine as fine, colorless
or slightly brown granules. White precipitate is observed on centrifugation.

78.  These appear as small, colorless and in
the form of spherical, dumbbell shape or
as granular type.
 They have no clinical significance.

79. Calcium carbonate crystals in urine
Calcium carbonate crystals are small and
colorless and appear in alkaline urine as
granules or as small dumbbells. Bacteria are
also present in this field.

80.  These are long, thin and colorless.The
appearance is like prisms with one
pointed end, arranged as rosettes or
stars.
 Soluble in dilute acetic acid.
 May be present in normal urine and
have no clinical significance.

81. Calcium phosphate crystals in urine
Calcium phosphate crystals assume various
forms including the rosette and pointed finger
forms. They appear most often in alkaline
urine.

82.  These are yellow brown or
spherical bodies with or without
long, irregular spicules.
 Presence is abnormal if they are
found in fresh urine.

83. Ammonium biurate crystals in urine
Ammonium urate crystals are easily
distinguished by their golden brown color and
"thorn apple" shape. They are the only urate
crystals that appear in alkaline urine.

84.  Starch crystals - These are found in urine as
round or oval and highly refractile crystals.
 Fibres - they may come from clothing, toilet
paper or may be lint from the air.
 Oil droplets - these are present as the result of
contamination from lubricants.they are
spherical and vary in size.
 Hair
 Air bubbles
 parasites

85. A
R
T
Starch crystals I Oil droplets
F
A
C
T
Air bubbles
S Hair