Here are the key points about albumin and Bence Jones proteins in urine: - Albumin is the main protein normally found in small amounts in urine. Increased albumin is called albuminuria or proteinuria. - Bence Jones proteins are light chains of immunoglobulins that can be excreted in the urine in certain plasma cell dyscrasias like multiple myeloma. - Albumin can be detected by routine urine protein tests like heat test, sulfosalicylic acid test, or reagent strips. - Bence Jones proteins are detected by a special heat test - a coagulum forms on heating urine to 50-60°C that dissolves at 80°C and re

1. URINE EXAMINATION -
BASICS
1

2. 2
 Introduction
 Indications of urine Analysis
 Collection of urine
 Changes which occur in Urine sample at room
temperature
 Preservation of urine sample
 Examination of urine
-Macroscopic Examination
-Chemical Examination
-Microscopic Examination
-Cytological Examination

3. Introduction
3
 Urine is most easily obtained specimen
examined in the laboratory.
 Examination of urine not only provides
information of the kidneys and possible
abnormalities of the urinary tract, but also lead
to diagnosis of various systemic diseases of
the human body which are reflected by the
presence of various substances.
 Urine is formed in the kidneys, is a product of
ultra filtration of plasma by the renal glomeruli.

4. 4

5. 5
 In normal adults, appox 1200ml of blood
perfuses the kidney each minute (25% of
cardiac output)
 Ultimately about 180 litres of glomerular filtrate
is formed for every 24 hours
 Which is reduced to 1-2 litres depending on
the hydration status of the individual.

6. Indications of Urine Analysis
6
 Suspected renal diseases
 Detection of UTI (urinary tract infection)
 Detection and management of metabolic
disorders like Diabetes mellitus
 Differential Diagnosis of jaundice
 Detection and management of plasma cell
dyscrasias

7. Types of Urine samples
7
Sample type Sampling Purpose
Random specimen No specific time
most common, taken
anytime of day
Routine screening,
chemical & Microscopic
Examination
Morning sample First urine in the morning,
most concentrated
Pregnancy test,
microscopic test
Clean catch midstream Discard first few ml, collect
the rest
Culture
24 hours All the urine passed during
the day and night and next
day Ist sample is collected.
used for quantitative and
qualitative analysis of
substances
Postprandial 2 hours after meal Determine glucose in
diabetic monitoring
Supra-pubic aspiration Needle aspiration Obtaining urine without
contamination

8. How to collect urine sample of infants?
8
 A clean plastic
bag should be
attached around
the baby’s
genitalia.
 Supra pubic
aspiration-For
bacteriological
examination

9. URINE CONTAINER
9
 Collected in a wide
mouthed, clean dry
container and examined
fresh urine within 2 hour.
 delay in examination,
urine can be preserved
at 4°C.

10. Changes which occur in Urine
sample at room temperature
11
 Increase in PH
 Formation of crystals
 Loss of ketone bodies
 Decrease in Glucose
 Oxidation of urobilinogen to urobilin
 Bacterial proliferation
 Disintegration of cellular elements, especially
in alkaline PH

11. 12
 Therefore, Urine sample should
be tested within 2 hours of
collection to get correct results!!

12. Preservation of Urine
13
 It is necessary to add preservative to the urine to
prevent casts , prevent growth of contaminating
organisms and avoid false positive results.
 Different types of preservative used are:-
 Toluene
-forms thin layer on the surface
-Disadvantage- interfere with estimation of
protein
Boric acid-5gm/120ml
 Concentrated hydrochloric acid
-best preservative for chemical examination.

13. Continued………
14
 Formalin or chloroform
-1drop/30ml, best preserves the formed
elements.
-Disadvantage- both interfere with tests for
sugar
 Thymol
-preserves the sediment
-Disadvantage- Interfere with sugar, acetone
determination
 Sodium carbonate
- for preservation of urobilinogen

14. Macroscopic
Examination
15

15. Physical Examination
16
• Physical examination involves:
1. Color
2. Transparency
3. Odor
4. Volume
5. pH
6. Specific gravity

16. 17
1- Color:
• Many things affect color of urine such as diet, medicines and diseases
including fluid balance.
• Color intensity of urine correlates to concentration.
 Amber yellow Urochrome (derivative of urobilin,
produced from bilirubin degradation, is pigment found in normal
urine).
 Colorless due to reduced concentration.
 Red Brown Hematuria, Hemoglobinuria, Porphyria,
Myoglobinuria.
 Brown Alkaptonuria, Melanoma

17. 18
 Yellow-green Biliverdin
 Yellow with yellow foam Bilirubin
 Orange urobilinogen/Porphobilinogen
 Milky-white Chyluria
 Silver or milky appearance Pus, bacteria or
epithelial cells
 Orange, green, blue or red medications.
 Vitamin B supplements can turn urine bright yellow.

18. 19
2- Transparency:
• Urine is normally clear. Bacteria, blood, sperm, crystals, or
mucus can make urine look cloudy.
• Is classified as clear or turbid.
• In normal urine: the main cause of cloudiness is crystals and
epithelial cells.
• In pathological urine: it is due to pus, blood and bacteria.
• Degree of cloudiness depends on: pH and dissolved solids
 Turbidity: may be due to bacteria/pus ,
 Smoky appearance: is seen in hematuria .
 Thread-like cloudiness: is seen in sample full of mucus.

19. 20
3- Odor:
1. Aromatic odour------> Normal urine due to presence of volatile
aromatic acids.
2. Ammonical odour------> On standing due to decomposition of
urea to ammonia or in cases of UTI.
3. Fruity odour--------> ketoacidosis, starvation.
4. Mousy or musty-----> Phenylketonuria

20. 21
4- Volume:
 Is important part of assessment for fluid balance and
kidney functions.
 Normal = 600-2000ml
 Polyuria- >2000ml
 Oliguria- <400ml
 Anuria- complete cessation of urine(<100ml)

21. 22
 Causes of polyuria (>2000 ml)
 Diabetes mellitus
 Diabetes insipidus
 Polycystic kidney
 Chronic renal failure
 Diuretics

22. 23
 Causes of oliguria (<400 ml)
 Dehydration-vomiting, diarrhoea, excessive
sweating
 Renal ischemia
 Acute tubular necrosis
 Obstruction to the urinary tract
 Acute renal failure
 Causes of Anuria (<100 ml)
 Acute tubular necrosis(e.g.-shock etc.), complete
urinary tract obstruction

23. 24
5- pH:
 Reaction reflects ability of kidney to maintain normal
hydrogen ion concentration in plasma & ECF
• Normal urine pH: 4.5-8.
• Urine sample must be fresh
• A urine pH of <7 acidic, 7 is neutral (neither acidic nor
alkaline), and >7 is alkaline.
 Tested by - 1.litmus paper
2. dipsticks
3. pH paper

24. 25
 Acidic urine
 Ketosis-diabetes, starvation, fever
 Systemic acidosis
 UTI- E.coli
 Acidification therapy
 Alkaline urine
 Strict vegetarian
 Systemic alkalosis
 UTI- Proteus, pseudomonas
 Alkalization therapy

25. 26
6. Specific Gravity (SG):
• measures the amount of substances dissolved in urine.
• also indicates how well kidneys are able to adjust
amount of water in urine.
• Higher SG: more solid material is dissolved in urine
 Measured by - Urinometer
- Refractometer
- Dipsticks

26. URINOMETER
27


27. Urinometer
28
 Fill 2/3 of urinometer
container with urine
 Allow the urinometer to
float into the urine
 Read the graduation at the
lowest level of urinary
meniscus
 Correction of temperature
& albumin is a must.
 Urinometer is calibrated at
15-200c

28. 29
 Normal - 1.003-1.030
 Low specific gravity
 Excess water intake
 Diabetes insipidus
 High specific gravity
 Dehydration
 Albuminuria
 Glycosuria

29. 30
 Refractometer – it is based on the refractive
index of the urine
 It requires few drops of urine
 Reagent strip method- it is done with the help
of chemical reagents

30. 31
 Fixed specific gravity (isosthenuria)=1.010
 Seen in chronic renal disease when kidney
has lost the ability to concentrate or dilute
 Chronic kidney disease
 ADH deficiency

31. Chemical
examination
38

32. 39

33. Chemical examination
40
 Proteins
 Sugars
 Ketone bodies
 Bilirubin
 Bile salts
 Urobilinogen
 Blood
Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protein
Urobilinogen
Nitrite
Leukocyte Esterase

34. 41

35. 42
Strip include the tests:
• Glucose
• Bilirubin
• Ketone
• Specific Gravity
• Blood
• Protein
• Urobilinogen
• Nitrite
• Leukocyte
• pH

36. How to detect abnormal
constituents:
43
Urinestrip:
• Strip is filter paper or plastic which has
chemical substance (reagent) coated on it
on different pads.
• It gives color when react with substance
in urine.
• The produced color is compared with
chart color visually.
Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protein
Urobilinogen
Nitrite
Leukocyte

37. 44
Results are reported as:
 In concentration (mg/dl)
 As small, moderate, or large
 Using the plus system (1+, 2+, 3+, 4+)
 As positive, negative, or normal
Automated Urine Testing
Machine
Urinalysis test
strip

38. 45
 This method is rapid, easy and used for qualitative estimation.
 Reaction in strip is effected by time, to reduce timing errors
and to limit variations in color interpretation; automated
instrument is used to read the reaction color on each test pad.

39. Proteins in
urine(Proteinuria)
47
 is the presence of abnormal amount of protein in urine.
 The main protein in urine is albumin therefore, proteinuria
=albuminuria
 Normal – up to 150 mg/day.

40. 48
Protein % of Total Daily Maximum
Albumin 40% 60 mg
Tamm-Horsfall 40% 60 mg
Immunoglobulins 12% 24 mg
Secretory IgA 3% 6 mg
Other 5% 10 mg
TOTAL 100% 150 mg
Proteins in “Normal” Urine

41. 49
Detection:
 Qualitative test:
 Heat Coagulation test
 Sulphosalicylic acid test
 Heller’s test
 Reagent strips
 Quantitative test:
 Esbach’s albuminometer
 Turbidimetric method
 Most assays are performed on urine sample of 12-24h.

42. Quantitative estimation
50
 Esbach’s method
 R mark above for reagent
 U mark below for urine
 Graduated in between.
 Esbach’s reagent – picric acid +
Citric acid + distilled water.

43. Method
51
 24hr urine is collected.
Filtered if hazy. Acidified with
10% acetic acid.
 Albuminometer is filled up to
‘U’ mark with urine.
 Esbach’s reagent is added
up to ‘R’ mark & mixed well.
 Tube is corked and kept in
stand vertically for 24 hrs.
Level of precipitate is
measured and read in gm/lit.

44. 52
 Qualitative tests :-
 Heat Coagulation test
 Sulphosalicylic acid test
 Heller’s test
 Reagent strips

45. 53
 Heat Coagulation test
 Principle: Heat coagulates proteins in urine.
 Take urine in a test tube (up to 2/3rd ).
 Boil the upper portion of test tube by holding
bottom portion.
 If turbidity develops, add 1-2 drops of glacial
acetic acid. If turbidity disappears it is due to
phosphates and if persists it is due to albumin.

46. 54

47. 55
 Interpretation
 Negative – No turbidity or cloudiness.
 Trace – Cloudiness visible against a black background (
<100 mg / dl).
 1+ - Definite cloudiness without flocculation and granularity
(100 mg / dl ).
 2+ - Heavy and granular cloudiness without flocculation. (
100 – 200 mg / dl).
 3+ - Dense opaque cloud with marked flocculation (200 –
500 mg / dl) .
 4+ - Thick cloudiness with precipitation ( > 500 mg / dl ).

48. 56
 Sulphosalicylic acid test
 Principle: Acid precipitates protein in urine
with turbidity that is proportionate to the protein
concentration in urine.
 Procedure:
 Take 2 ml of urine in a clean test tube and
acidify by adding few drops of acetic acid
 Add equal volume of 20% sulphosalicylic acid.
 Take readings within 10 min. Formation of
cloudiness indicates proteinuria.

49. 57
 Negative : No cloudiness
 Trace: Barely visible cloudiness.
 1+ : definite cloud without granular
flocculation
 2+ : heavy and granular cloud without
granular flocculation
 3+ : dense cloud with marked flocculation.
 4+ : Cloudiness with precipitation

50. 58
 Causes of Proteinuria
 Asymptomatic (Functional proteinuria) –
 Exercise induced,
 Orthostatic (postural proteinuria).
 Mild proteinuria (<1gm/day)
 Chronic pyelonephritis,
 Hypertension
 UTI
 Fever
 Polycystic kidney

51. 59
 Moderate proteinuria (1-3gm/day)
 Diabetic nephropathy
 Multiple myeloma
 Malignant nephrosclerosis
 Massive proteinuria (>3gm/day)
 Nephrotic syndrome
 Renal vein thrombosis
 Diabetes mellitus
 SLE

52. 60
Functional Renal
- Severe muscular exertion - Glomerulonephritis
- Pregnancy - Nephrotic syndrome
- Orthostatic proteinuria - Renal tumor or infection
-Polycystic kidney disease
Pre-Renal Post-Renal
- Fever - Cystitis
- Renal hypoxia - Urethritis or prostatitis
- Hypertension - Contamination with vaginal
- Eclampsia secretions
-Tuberculosis
Causes of Proteinuria

53. Microalbuminuria
61
 It is defined as urinary excretion of 30-
300mg/day of albumin in urine.
 The level of albumin protein produced by
microalbuminuria cannot be detected by urine
dipstick methods.
 Microalbuminuria is diagnosed from a 24-hour
urine collection

54. Significance of microalbuminuria
62
 an indicator of subclinical cardiovascular disease
 Earliest sign of kidney disease in diabetes
mellitus & hypertension
 increasing microalbuminuria during the first 48
hours after admission to an intensive care unit
predicts elevated risk for acute respiratory failure
, multiple organ failure , and overall mortality

55. Bence jones proteins
63
 Light chains of immunoglobulin excreted in
urine in conditions like multiple myeloma,
primary amyloidosis & lymphoma.
 Test – A coagulum forms on heating urine to
50-60ºC, which dissolves when further heating
urine to 80ºC, on cooling the precipitate
reappears at 50-60ºC.
 Best method - protein electrophoresis.

56. 64
 What if both albumin and bence jones proteins
are present is present ?
 Heat the urine sample first, the coagulum
formed is due to albumin and is filtered out
 Then test for bence jones proteins is repeated
by heating.

57. Sugar in Urine
65
 Glucose and other reducing substances in
urine are detected by –
 Copper reduction test – Benedict’s test,
Fehling’s test
 Enzymatic test – Glucose oxidase method,
reagent strips. (Glucose specific).

58. Benedict’s qualitative test
66
 Benedict’s reagent – cupric sulfate, sodium
carbonate, sodium citrate, distilled water.
PRINCIPLE
Reducing substances convert soluble
blue cupric sulfate to insoluble red
cuprous oxide. Thus there is color
change and precipitate formation.

59. Procedure
67
 Take 5ml of benedict’s reagent
 Add 8 drops of urine
 Heat for 2 mins
 Cool in running tap water or water bath and
look for change of colour and precipitate
formation

60. 68

61. 69
 Many reducing agents can give a positive
benedict’s test. E.g.: Hexoses (Glucose,
fructose, lactose), pentose,
 non-carbohydrate substances like vit.C, uric
acid, ascorbic acid, salicylates, antibiotics, L-
dopa.

62. Other tests for reducing sugars
70
 Fructose – Seliwanoff’s test
 Differentiates fructose (immediate reaction on
heating) and glucose(weak and slow reaction)
 Pentoses – bial’s test
 Molisch test – to rule out non carbohydrate
elements

63. Reagent strip method
71
 Based on glucose oxidase and peroxidase
method
 Specific for glucose
Any change in colour of strip is matched with
standard colour chart provided on the reagent
strip bottle

64. Causes of glycosuria
72
 Diabetes mellitus
 Renal glycosuria
 Alimentary glycosuria
 Severe burns
 Corticosteroid administration
 Severe sepsis
 Pregnancy

65. 73
 GLYCOSURIA WITH
HYPERGLYCEMIA – Diabetes mellitus,
Cushing’s syndrome, chronic pancreatitis, CNS
tumors, Corticosteroids.
 GLYCOSURIA WITHOUT
HYPERGLYCEMIA – Renal tubular
dysfunction, pregnancy.

66. Ketone bodies
74
 Ketonuria is the presence of abnormal amount of ketone
bodies in urine.
 Body normally uses carbohydrates as source of energy.
 If carbohydrate source depleted or there is defect in
carbohydrate metabolism, body use fat as a source of
energy.
 ketone bodies are breakdown products of fatty acids.
 Three ketone bodies
 Acetone
 Acetoacetic acid
 β-hydroxy butyric acid
Oxidation
Fat Fatty
Acids
H2O+CO2+energy

67. Tests for ketone bodies
75
 Rothera’s test
 Gerhardt’s test
 Reagent strip test

68. Rothera’s test
76
 Detects acetone and acetoacetic acid
 Principle: Acetone & Acetoacetic acid
develops purple coloured complex with
sodium nitroprusside in alkaline medium.
 Gerhardt’s test: For detection of
betahydroxybutyric acid.

69. 77
 Procedure:
 Take 2ml of urine in a test tube and saturate it
with ammonium sulphate.
 Add 1 tiny crystal of sodium nitroprusside.
 Mix.
 Run 1ml of liquid ammonia carefully at the side
of the tube so as to form purple ring on top of
the saturated urine.
 POSITIVE- Formation of purple ring at junction
of two fluids.

70. 78

71. Causes of Ketonuria
79
 DKA
 Fever
 Anorexia
 Fasting
 Starvation
 Severe vomiting
 Cachexia
 PEM
 Glycogen storage disorders

72. BLOOD
80
Presence of abnormal number of intact RBCs in urine
is called hematuria.
Cause of Hematuria :-
• Pre renal- bleeding diathesis, hemoglobinopathies,
malignant hypertension, anticoagulants, quinine,
renal vein thrombosis.
• Renal- trauma, calculi, acute & chronic
glomerulonephritis, renal TB, renal tumors, Post
streptococcal glomerulonephritis, lupus nephritis,
pyelonephritis, PAN
• Post renal – severe UTI, calculi, trauma, cancers of
ureter, bladder, urethra.

73. 81

74. 82
 Causes of hematuria
 Renal disease- infections, TB kidney, Nephritic
syndrome
 Bleeding disorders- thrombocytopenia, scurvy,
haemophilia
 Anticoagulant drugs
 Causes of hemoglobinuria (presence of free
hemoglobin)
 Hemolytic anemia- cold AIHA, PNH
 Snake venom, spider bite, bacterial toxins
 Mismatched blood transfusion

75. Tests for detection of Blood in
Urine
83
BENZIDINE TEST :-
PRINCIPLE :-
• Haeme proteins in haemoglobin act as
peroxidase, which reduces hydrogen
peroxide to water. Oxidation of hydrogen
donor leads to development of colour.
• This process needs a hydrogen donor [benzidine,
orthotoludine] .
• Intensity of colour produced is proportional to the
amount of haemoglobin present.

76. 84
BENZIDINE TEST –
 Take 1ml of urine
 Add 1ml of glacial acetic acid
 Add pinch of benzidine powder
 Add 1ml of H202
 Inference :-
 Green or blue colour development within 5 min
indicates positive test.

77. 85
 Other tests
 Orthotoluidine test
 Reagent Strip Test
 Orthotoulidine test
• Take 2ml of urine
• Add 1ml of orthotoulidine in glacial acetic acid
• Add few drops of H202
• Blue or green indicated presence of blood in
urine

78. BILE PIGMENT ( BILIRUBIN )
86
 Undetectable in urine normally.
 Presence of bilirubin in urine is called
BILIRUBINURIA
 2 forms – Conjugated & Unconjugated.
 Unconjugated is not water soluble, bound to
albumin, doesn’t appear in urine.
 Conjugated is water soluble, appears in
urine.

79. Tests for detection of bilirubin in urine
87
1. Fouchet’s test
2. Foam test
3. Gmelin’s test
4. Lugol’s iodine test
5. Reagent Strip test

80. 88
 Fouchet’s test :-
• Ferric chloride oxidises bilirubin to green
biliverdin
• 5ml fresh urine in a test tube + 2.5 ml 10 %
BaCl2. Mix well.
• Filter to obtain ppt. on filter paper.
• To precipitate add few drops of fouchet’s
reagent. (ferric chloride + trichloroacetic
acid)

81. 89
 Interpretation
Immediate blue green colour indicates positive
test.

82. 90
URINE TEST HEMOLYTIC
JAUNDICE
HEPATOCELLUL
AR JAUNDICE
OBSTRUCTIVE
JAUNDICE
Bilirubin Absent Present Present
Urobilinogen Increased Increased Absent

83. BILE SALTS
91
 Salts of 4 different types of bile acids : cholic,
deoxycholic, chenodeoxycholic & lithocholic.
 They combine with glycine or taurine to form
complex salts.
 Test for detection: Hay’s surface tension test
Principle: Bile salts if present in urine, lowers the
surface tension thus the sulphur particles sinks
down

84. 92
 Hay’s surface tension test :-
• Take some fresh urine in conical glass tube.
• Urine should be at room temp.
• Sprinkle particles of sulphur on the surface.

85. 93
• Inference :-
• If bile salts are present,
sulphur particles sink to the
bottom, due to lowering of
surface tension by bile
salts.
• If sulphur particles remain
on surface of urine, bile
salts are absent.

86. 96
 All of the following are tested positive by
benedict test, except.
a) Lactose
b) Glucose
c) Sucrose
d) Maltose
e) salicylates

87. 97
 Unconjugated bilirubin is water soluble.
Yes/No
 Name the principle of detecting the urine
glucose by reagent strip method.
 What are the tests to detect ketone bodies

88. 98
 Name the test for bilirubin
 Why benedict’s test is called semi-quantitative
test?

89. Microscopic
Examination
99

90. MICROSCOPIC
EXAMINATION
100
We look for :-
1) Cells
2) Casts
3) Crystals
4) Organisms

91. 101
URINARY
SEDIMENT
Cells
RBCs
WBCs
Epithelial cells
Oval fat bodies
Casts
Cellular
NON CELLULAR :
Hyaline, Granular,
Waxy, Fatty

92. 102
URINARY
SEDIMENT
Crystals
NORMAL :- Uric acid, Calcium oxalate, Amorphous
Urates, Calcium Carbonate, Phosphates, Urate
ABNORMAL :- Cysteine, Cholesterol,
Bilirubin, Leucine, Tyrosine, Sulfonamide
OTHER: SPERM
Organisms
Bacteria
Yeast cells
T. vaginalis
Microfilaria
S.
hematobium

93. Normal reference range
103

94. Procedure
104
 Centrifuge 10 mL of urine in a graduated
centrifuge tube at a speed of 1500-2000 RPM
for 5 minutes. The supernatant is poured off.
Resuspend the sediment in 1mL of urine.
 Take a small drop of the suspended urine on a
glass slide.
 Mount with a coverslip and examine under the
microscope

95. 105

96. 106
 RBC – In cases of haematuria
 WBC – In cases of pyuria. (Infection- Acute
glomerulonephritis).
 Epithelial cells – Transitional cells can be seen
in bladder cancer.
Microscopic Examination
Cells

97. Microscopic Examination
RBCs
107

98. Microscopic Examination
WBCs
108

99. Microscopic Examination
Squamous Cells
109

100. Microscopic Examination
Tubular Epithelial Cells
110

101. Microscopic Examination
Transitional Cells
111

102. Microscopic Examination
Transitional Cells
112

103. Microscopic Examination
Oval Fat Body
113

104. 114
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.
Microscopic Examination
Bacteria & Yeasts

105. Significant bacteriuria
115
 It is said when there are
 > 105 bacterial colony forming units/ml of urine in
a clean catch mid-stream sample
 > 104 bacterial colony forming units/ml of urine in
a catheterised sample
 > 103 bacterial colony forming units/ml of urine in
a suprapubic aspiration sample

106. Microscopic Examination
Bacteria
116

107. Microscopic Examination
Yeasts
117

108. Organisms in Urine
118

109. 119
CASTS IN URINE

110. Pathogensis of casts
120
• Stasis, low ph and high concentration of filtrate in renal tubules
• Denaturation and precipitation of Tamm-horsfall protien
• Hyaline cast
• Entrapment of cellular elements in hyaline cast matrix to form cellular cast
• Degenaration of cells within cast to form coarse granular casts
• Prolong stay in tubules with further degenration of cells to form waxy cast
• Broad casts

111. Types of casts
 Acellular casts
Hyaline casts [fever,
glomerular capillary
damage]
Granular casts [ Chronic
renal disease]
Waxy casts [Severe
longstanding kidney
disease- Renal failure]
Fatty casts [Nephrotic
syndrome, ATN]
Pigment casts [ Hb in
haemolytic anaemia]
 Cellular casts
Red cell casts [ Nephritic
disease]
White cell casts
[Infection,
pyelonephritis]
Epithelial cell cast [ATN]
121

112. Microscopic Examination
Hyaline Cast
122
Transparent and
cylindrical
• Acute
glomerulonephritis
• Chronic
glomerulonephritis
• Congestive heart
failure
• Fever

113. Microscopic Examination
Granular Cast
123
• Cylindrical with fine or
coarse granules
• Granules are derived
from protein
aggregates/
degenerating RBCs,
WBCs or tubular cells
• Tubular damage
• Chronic
glomerulonephritis
• Renal failure

114. Microscopic Examination
Waxy Cast
124
Opaque compared to
hyaline casts
• End stage kidney
• Chronic renal
failure
• Amyloidosis

115. Microscopic Examination
Fatty Cast
125
Casts admixed with
fat droplets
Nephrotic syndrome

116. Microscopic Examination
RBCs Cast
126
Hyaline or granular
casts with adherent
RBCs
• Acute
glomerulonephritis
• Lupus nephritis
• Goodpasture
syndrome
• SABE
• Renal infarction

117. Microscopic Examination
WBCs Cast
127
Hyaline or granular
cast with adherent
WBCs
• Acute
glomerulonephritis
• Acute pyelonephritis

118. Microscopic Examination
Tubular Epith. Cast
128
Hyaline or granular
casts with adherent
cells from renal
tubules
• Acute tubular
necrosis
• Viral disease (CMV
infection)
• Drugs

119. 129
CRYSTALS IN URINE

120. 130

121. 131

122. Microscopic Examination
Calcium Oxalate Crystals
132
Colourless, refractile,
envelop shaped
crystals
• Normal acidic
urine
• Nephrolithiasis
• Ethylene glycol
poisoning

123. Microscopic Examination
Triple Phosphate Crystals
133
• Normal alkaline urine
• Struvite stone due to
urease positive
bacteria
• UTI
• Colourless, prism
shaped crystals
• Coffin-lid, knife-rest or
star appearance

124. Microscopic Examination
Ammonium Biurate Crystals
134
Normal alkaline urine
Yellow thorn
apple
appearance

125. Microscopic Examination
Tyrosine Crystals
135
• Tyrosinemia
• Cirrhosis
Fine needle like crystals

126. Microscopic Examination
Cystine Crystals
136
Cystinuria
Colourless refractile
hexagonal plates with
unequal sides

127. Microscopic Examination
Cholesterol Crystals
137
Colourless, refractile,
flat rectangular plates
with notched(missing)
corners and stair-step
arrangement
• Nephrotic syndrome
• hypercholesterolemi
a

128. Microscopic Examination
Bilirubin Crystals
138
Small ,brown, variable
shape
• Obstructive liver
disease

129. Microscopic Examination
leucine Crystals
139
Refractile, yellow or
brown, spheres with
radial concentric
striations
• Cirrhosis

130. CYTOLOGICAL
EXAMINATION
OF URINE
140

131. 141
Normal urothelial cells. The large cells are from the superficial
and the small cells from the basal layers

132. Superficial cells, with a multinucleated cell in an umbrella
configuration
142

133. 143
Large superficial and smaller pyramidal or basal cells.
Some of
the superficial cells are binucleated and contain nucleoli

134. Columnar cells in voided urine
144
A large multinucleated
urothelial cell

135. 145
Normal squamous cells
and urothelial cells

136. Abnormal cells
146
 Malignant cells- from malignancies of kidney
and bladder
 Fungi (candida)- immunosuppressed patients,
diabetes, cytotoxic drugs
 Parasites- Trichomonas, entamoeba
histolytica, ova of schistosoma hematobium,
microfilaria
 Spermatozoa

137. Poorly differentiated urothelial carcinoma of
bladder.
147

138. Urinary diseases and its
abnormalities
148

139. 149

140. 150

141. 151
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