Pathological urine refers to urine that contains abnormal constituents that are not normally present or are present in abnormal amounts. The presence of these abnormal constituents can provide important clues to underlying diseases or conditions affecting the kidneys or other organs.

1. Pathology of blood and urine

2. Blood
• Connective tissue
• Fluid in nature
• Circulates in closed system of vessels
• Total volume approximately 6 ltrs
• pH of blood- 7.4 (slightly alkaline)
• Specific gravity- about 1.055

3. Functions of blood
• Transports oxygen and nutrients
• Transports waste products
• Carries hormones from glands
• Redistributes water
• Contains Ab and WBC – protects body from
diseases
• Clotting of blood protects against
hemorrhage

4. Composition of blood
• Plasma
• Cellular elements
RBC, WBC, Platelets

5. Plasma
• Occupies 55% of blood
• Fluid component of blood in which the cellular
elements are suspended
• Composition of plasma-
»water 91%
»Non diffusible constituents- albumin,
globulin, fibrinogen, enzymes
»Diffusible constituents-
• Hormones and vitamins
• Anabolic const- glucose, AA, FA, TG
• Electrolytes- Na, K, Ca, Mg
• Catabolic products- Urea, Uric acid,
creatinine

6. Erythrocytes (RBCs)
• Circular, biconcave, disc shaped
• No nucleus
• Respiratory pigment- hemoglobin
• Function- carry oxygen
acid base balance
• Produce from bone marrow
• Normal count– 4.5-5 million
Life span- 120 days

7. Diseases of Erythrocytes
• Polycythemia
• Iron deficiency anemia
• Megaloblastic anemia
• Sickle cell anemia
• Hemolytic anemia
• Thalasemia

8. Polycythemia
• Increase in number of RBC
• Causes-
– High attitude
– Congenital diseases
– Hyperplasia of bone marrow
Manifestations-
Headache, weakness, tiredness
Red face & red eyes
Thromboembolic complications
Haemorrhagic complications

9. Iron deficiency anemia
• Microcytic anemia
• Decreased hemoglobin content
• Iron is necessary for hemoglobin synthesis
• Symptoms
– Weakness
– Tiredness
– Shortness of breath
Diagnosis
Paleness of tongue, conjunctiva of nails
Estimation of hemoglobin

10. Megaloblastic anemia
• Macrocytic anemia
• Defective maturation of RBC’s
• Maturation- Vit B12 & folic acid necessary
• Characterized by megaloblasts
• Symptoms-
• Glossitis, anorexia, diarrhoea, loss of weight
• Parasthesia, weakness of limbs
• Retrobulbar neuritis
• Haemorrhagic manifestations

11. Pernicious anemia
• Absence of intrinsic factor
• IF secreted in gastric mucosa
• Necessary for absorption of Vit B12
• Maturation & development affected
• Symptoms are similar to megaloblastic anemia
• Occurs in atrophy of gastric mucosa

12. Sickle cell anemia
• Hereditary blood disorder,
• Characterized by red blood cells that assume
an abnormal, rigid,sickle shape.
• Mutation in the haemoglobingene.

13. Hemolytic anemia
• Anemia due to hemolysis,
• Abnormal breakdown of red blood cells (RBCs),
either in the blood vessels (intravascular
hemolysis) or elsewhere in the human body
(extravascular).
• Hemolytic anemia is eitherinherited or acquired.
• Symptoms-
– fatigue and shortness of breath,
– Breakdown of red cells leads to jaundice and increases
the risk of particular long-term complications, such
as gallstones and pulmonary hypertension.

14. Thalasemia
• Inherited autosomal recessive blood disorders
• Symptoms-
– Iron overload
– Bone deformities
– Enlarged spleen

15. Erythrocyte sediment rate (ESR)
• Rate at which RBCs sink to the bottom (when placed
in a vertical column after adding an anticoagulant).
• ESR determined by two methods
• Westergreen method
• Wintrobe method
• Normal values- male- 5 to 15 mm in 1 hr
female- 2 to 20 mm in 1 hr
ESR - Anemia, RA, chronic pulmonary TB, acute myocardial infarction
ESR - Polycythemic vera, CHF

16. Leucocytes (WBCs)
• Colorless
• Contains nucleus
• Larger than RBC
• Normal count– 4000-
11000 per cu mm

17. Diseases of Lecocytes
• Leucocytosis
• Leucopenia
• Leukemia
• Eosinophilia

18. Leucocytosis
• Increase in the total WBC count (above 11000
per cu mm of blood)
• Causes-
– Pyogenic infections
– Myeloid leukemia
– Myocardial infarction
– Acute hemorrhage
– Malignancy of liver or intestine

19. Leucopenia
• Decrease in total WBC count (Below 4000 per
cu mm of blood)
• Causes-
– Infections
– Aplastic anemia
– Malignant lymphoma
– Multiple myeloma
– Sensitivity to drugs (sulpha drugs)

20. Leukemia
• Abnormal increase in production of WBC
• Malignant disorder
• Causes-
– Radiation (X rays)
– Chemicals like benzene
– Drugs used in cancer
– Retroviruses
– Genetic disorders

21. Eosinophilia
• Increase in number of eosinophils
• Causes-
– Allergic asthma
– Skin diseases
– Drug allergy
– Parasitic infections

22. Lymphocytes
• Lymphocytes are non-granular leucocytes.
• Present in blood and Lymph, lymphoid organs
and many tissues.
• Constitute 20-25% of leucocytes.
• Immunological classification-
• B cells
• T cells

23. Functions of Lymphocytes
• T cells
• Have thymus specific antigen on surface.
• Undergo blast transformation with
phytohemaglutinin.
• B cells
• Have immunoglobulins on their surface.
• Have microvilli on their surface.
• Undergo blast transformation with endotoxins.

24. Abnormalities of Lymphocytes
• Lymphocytosis
• Lymphopenia
• Leukemias of lymphocytes
• Lymphoma

25. Lymphocytosis
• Absolute count exceeds 4*106/ml
• Associated with-
• Pertussis
• Lymphatic leukemias
• Chronic infections
• Measles, mumps, rubella and chickenpox

26. Lymphocypenia
• Absolute count less than 1.5*106/ml
• Associated with-
• Administration of ACTH
• Advanced hodgkin’s disease
• Excessive radiation

27. Platelets (Thrombocytes)
• Round shaped cells with biconcave surface.
• Having diameter of 2-4 microns.
• Do not have nucleus.
• Average lifespan of 5-10 days and are
destroyed by spleen.
• Normal count-
2-5 lakhs/cumm

29. Abnormalities of Platelets
• Thrombocytosis
• Idiopathic thrombocythemia
• Thrombocytopenia
• Idiopathic thrombocytopenic purpura

30. Abnormal Constituents of Urine
and their significance in diseases

36. Define pathological Urine