OS 214 [B]: Digestion and Excretion
1
Lab 01.2: Urinalysis
December 4, 2013
Pathology Faculty
TOPIC OUTLINE
I.
Urinalysis
A. History
B. Specimen Collection
C. Types of Specimen
D. Types of Analysis
II. Physical Examination
A. Volume
B. Colour
C. Odour
D. Turbidity
E. Specific Gravity
III. Chemical Examination
A. Glucose
B. Bilirubin
C. Ketones
D. Specific Gravity
E. Blood
F. pH
G. Protein
H. Urobilinogen
I. Nitrite
J. Leukocyte Esterase
IV. Microscopic Examination
A. Cells
B. Casts
C. Crystals
V. Flow Cytometry
VI. Disease Diagnosis
SUPRAPUBIC NEEDLE ASPIRATION
 Performed if the patient has spinal cord injury (cannot voluntarily
urinate)
 Collected by the external introduction of a needle to through the
abdomen into the bladder because the bladder is sterile under
normal conditions.
 The sample is for bacterial culture and can also be used for
cytologic examination.
Figure 3. Suprapubic Needle Aspiration
T/N: This is already the combined trans for the lecture from Dr. Lasap-Go and
from the lab session, and is also based on 2016’s urinalysis lab trans. Dr. LasapGo said that we should know how to diagnose based on urinalysis results for the
exam(s), so I suggest that you should read this trans in colour.
URINALYSIS
 Is the physical, chemical, and microscopic examination of the
urine.
 Can help find medical problems like renal disease, diabetes, liver
disease and urinary infections.
 It involves tests to detect and measure various compounds that pass
through the urine.
 Proper urine collection is very important
HISTORY
 Start of Laboratory medicine – one of the earliest and simplest
laboratory examinations
 Early physicians were seen examining urine in a bladder-shaped
flask (even during the medieval era)
 They obtain information from basic observation of color, turbidity,
odor, volume, viscosity, even sweetness (attracted ants)
 Though they may not know what is really wrong with the patient).
 Clinical microscopy would be essential test in a primary lab as
mandated by law.
SPECIMEN COLLECTION
 Should be the first morning voiding (most concentrated), midstream
specimen
 Take note of:
o Record collection time and the time the specimen was received in
the laboratory
o Type of specimen (e.g. “clean catch”)
 Should be analyzed within 2 hours of collection
 Free of debris or vaginal secretions
TYPES OF SPECIMEN
CLEAN CATCH
 Male patients should clean beginning at the urethra and withdrawing
the skin, if necessary.
 Female patients should separate the labia and clean the urinary
meatus and the surrounding area.
 Blood due to menstruation may contaminate the specimen
 Pediatric specimens are collected using clear plastic bags with
adhesives attached to the genital area. (since some still cannot
control their urination)
 Iodine scrub used to sterilized the area (see figure 1)
TYPES OF ANALYSIS
 Macroscopic (Gross) Examination
 Chemical Analysis (Urine Dipstick)
 Microscopic Examination
PHYSICAL EXAMINATION
 Evaluated by use of our senses.
 Parameters: volume, color, odor, turbidity & specific gravity
Table 1. Summary of Physical Examination Findings of Urine
Parameter
Normal
Abnormal
Polyuria (>2L/day)
600mL – 1,600mL
Volume
Oliguria (<500mL/day)
(adult)
Anuria (<100mL/day)
Hematuria… smoky urine
Color
Pale yellow or straw
Hemoglobinuria, etc
Odor
Aromatic
Fruity, rancid, etc
Turbidity
Clear
Turbid… Cells, organisms, etc
Specific
High: Diabetes mellitus
1.003 – 1.035
Gravity
Low: Diabetes insipidus
VOLUME
 Depends on the state of hydration, activity level, environmental
factors, weight, and individual’s health.
 Important to note especially in timed specimen collection (ex. 24h
urine collection)
o Low urine output – dehydration, renal failure
o High urine output – diabetes mellitus, diabetes insipidus
COLOUR
 Urine color is a transparent solution ranging from colorless to amber
but it is usually pale yellow (however in diabetes mellitus, color is
light (polyuria) but there is increase in specific gravity due to
glucose)
 Urine color is directly proportional to concentration of solutes
 Urochrome/urobilin gives urine its color
Table 2. Urine color and interpretation
Color
Interpretation
Colorless
Diluted urine
Deep yellow
Concentrated urine, riboflavin
Yellow/light orange
Removal of excess vitamin B
Orange
Rifampicin, phenazopyridine
Yellow-green
Bilirubin/Biliverdin
Red
Blood/Hemoglobin
Dark orange-brown
Jaundice,
rhabdomyolysis,
syndrome
Brownish-red
Acidified Blood (Acute GN)
Brownish-black
Homogentisic acid (Melanin)
Gilber’s
ODOUR
Figure 1. Preparing for a clean
catch specimen
Marz, Micah, Kit
Figure 2. Urine bag in a
pediatric patient.
Table 3. Urine odor and interpretation
Odor
Interpretation
Aromatic
Normal
Ammonia-like
Presence of urea-splitting bacteria
Foul, offensive
Old specimen, pus, or inflammation
Sweet
Presence of glucose
Fruity
Presence of ketones
Page 1 / 10
OS 214
Lab 01.2: Urinalysis
Maple syrup-like
Maple Syrup Urine disease
Mousy
Phenylketonuria
Rancid
Tyrosinuria/tyrosinemia
Rotting fish
Trimethylenuria
Sweaty feet
Isovaleric acidemia, glutaric acidemia
*Freshly voided urine has a faint aromatic odor as the specimen’s odor
of ammonia becomes prominent.
TURBIDITY
 Turbid urine is usually due to crystal formation in the bladder

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(maybe due to high concentration of solutes or unusual pH) or in the
collection vessel due to reduction in temperature when the
specimen stands.
Can also indicate a symptom of bacterial infection but can also be
due to crystallization of salts such as calcium phosphate
Clarity of the urine should be visualized in a clear container.
Cellular elements and bacteria (some causes of turbidity) will clear
by centrifugation.
Crystals dissolved by a variety of methods.
Microscopic examination will determine which specific entities are
present.
SPECIFIC GRAVITY
 Important in measuring kidney’s concentrating ability
CHEMICAL EXAMINATION
URINE DIPSTICK can measure:
1. Glucose
2. Bilirubin
3. Ketones
5. Blood
6. pH
7. Protein
8. Urobilinogen
9. Nitrite
10. Leukocyte Esterase
GLUCOSE
URINOMETER
 Consists of a weighted float attached to a scale that has been
calibrated in terms of urine specific gravity.
 Displaces a volume of liquid equal to its weight and has been
designed to sink to a level of 1.000 in distilled water.
 Less accurate than other methods
 Not recommended
 Disadvantage: requires large volume of urine, affected by
temperature (needs to be calibrated at 20 degrees Celsius), and
affected by protein and glucose
Chemical
Principle
Figure 4. Urinometer inside a test tube of urine
REFRACTOMETER
 Determines the concentration of dissolved particles (specific gravity)
by measuring the refractive index
 It is a comparison of the velocity of light in air with the velocity of
light in a solution.
 The specific gravity scale is calibrated in terms of the angles at
which the light passes through the specimen.
 It uses a small amount of urine (1-2 drops).
 Disadvantage: affected by glucose and protein, needs calibration
(using distilled water: specific gravity = 1.00)
Figure 5. Refractometer
Directions of use: Simply dip the
dipstick into the specimen and
wait for 10 - 30 seconds. It should
be read horizontally and
universal precautions should be
practiced. Don’t read it vertically
since “run-off” will happen.
4. Specific Gravity
Significance
Limitations
Other Tests
Negative
blue
Trace
100 mg/dL
+
250 mg/dL
++
500 mg/dL
+++
1000 mg/dL
++++
2000+ mg/dL
Glucose Oxidase
Glucose + 2 H2O + O2  Gluconic Acid + 2 H2O2
Horseradish Peroxidase
3 H2O2 + KI  KIO3 + 3 H2O
Read at 30 seconds
RR: Negative
Renal threshold: 160 mg/dL
o Diabetes mellitus
o Renal glycosuria
o Interference: reducing agents, ketones.
o Only measures glucose and not other sugars
o Renal threshold must be passed in order for
glucose to spill into the urine
o CuSO4 test for reducing sugars.
Table 4. Detection of Reducing Sugars by CuSO4
Type of Sugar
Disease(s)
Galactose
Galactosemias
Fructose
Fructosuria, Fructose Intolerance, etc.
Lactose
Lactase Deficiency
Pentoses
Essential Pentosuria
Maltose
Non-pathogenic
*Sucrose is not included because it is not a reducing sugar.
REAGENT STRIP
 Advantage: urine protein and glucose has no effect on reagent-strip
specific gravity measurements
 Disadvantage: increments at 0.05; visual interpretation of color
change on the reagent strip often difficult and very subjective;
always recalibrated
Figure 6. Urine vs. Blood Glucose
If urine glucose is high, blood glucose is high as well.
Marz, Micah, Kit
Page 2 / 10
OS 214
Lab 01.2: Urinalysis
BILIRUBIN
Other Tests
Negative
Light yellow
glucose)
o Refractometry
o Hydrometer
o Osmolality measurement (typically used with water
deprivation test) – not commonly used
+ (weak)
BLOOD
++ (moderate)
Peach
+++ (strong)
Pink
Bilirubin + Diazo salt  Azobilirubin
Chemical
Principle
Significance
o
Limitations
o
o
Other Tests
o
o
Read at 30 seconds
RR: Negative
Increased direct bilirubin (correlates with
urobilinogen and serum bilirubin)
o Usually when the doctor prescribes urinalysis
and blood chemistry to correlate bilirubin levels
Interference: prolonged exposure of sample to light
Only measures direct bilirubin--will not pick up
indirect bilirubin
Ictotest (more sensitive tablet version of same
assay)
Serum test for total and direct bilirubin is more
informative
Negative
Yellow
Trace (non-hemolyzed)
Speckled appearance
Moderate (nonhemolyzed)
Speckled appearance
Trace (hemolyzed)
Yellow-green
+ (weak)
++ (moderate)
Dark green
+++ (strong)
Darker green, almost
black
Chemical
Principle
KETONES
Negative
Light tan
Trace (5 mg/dL)
+ (15 mg/dL)
Significance
++ (40 mg/dL)
Pink
Limitations
+++ (80 mg/dL)
++++ (160 mg/dL)
o
Dark violet
o
Chemical
Principle
Significance
Limitations
Other Tests
o
o
o
o
Other Tests
o Diabetic ketoacidosis
o Prolonged fasting
o Interference: expired reagents (degradation with
exposure to moisture in air)
o Only measures acetoacetate not other ketone
bodies (such as in rebound ketosis).
o Ketostix (more sensitive tablet version of same
assay)
o Serum glucose measurement to confirm DKA
o
o
Hematuria (nephritis, trauma, etc)
Hemoglobinuria (hemolysis, etc)
Myoglobinuria (rhabdomyolysis, etc)
Interference:
reducing
agents,
microbial
peroxidases
Not diagnostic of any disease, will not tell you the
cause of the hematuria
Cannot distinguish between the above disease
processes
Urine microscopic examination
Urine cytology (smear on the button after
centrifugation then papanicolau stain)
 Myoglobin reacts as well. So how do we determine if myoglobin or
hemoglobin?
o Correlate with microscopic.
 If red cell is found: hemoglobin
 If no red cell, get clinical history of the patient
o If no clinical history is obtained, centrifuge.
 Pink: hemoglobin
 Clear: myoglobin
o Add ammonium sulfate:
 If the urine is still pink, it is hemoglobin
SPECIFIC GRAVITY
pH
1.000
Dark blue
5.0
Red
6.0
Orange
6.5
Yellow
7.0
Yellow-green
7.5
Green
8.0
Dark green
8.5
Darker green, almost black
1.005
1.010
1.015
Green
1.020
1.025
1.030
Yellow
Chemical
Principle
Significance
Limitations
Chemical
Principle
o Diabetes Insipidus
o Interference: alkaline urine
o Does not measure non-ionized
Marz, Micah, Kit
solutes
(e.g.
Page 3 / 10
OS 214
Lab 01.2: Urinalysis
o Acidic (less than 4.5): metabolic acidosis, highprotein diet
o Alkaline (greater than 8.0): renal tubular
acidosis (>5.5)
o Interference: bacterial overgrowth (alkaline or
acidic), “run over effect” effect of protein pad
on pH indicator pad (false acidic reading)
o Titrable acidity
o Blood gases to determine acid-base status
Significance
Limitations
Other Tests
pH: RUN OVER EFFECT
Glucose blue green
Bilirubin  light tan
Ketones  light brown
Specific Gravity  navy blue
Blood  yellow
pH  orange
Protein  yellow
Buffers from the protein
area of the strip (pH 3.0)
spill over to the pH area of
the strip and make the pH of
the sample appear more
acidic than it really is.
 keep strip horizontal after
dipping in urine
NEPHROTIC SYNDROME (>3.5 g/dL in 24 hr) ↑ urine albumin levels
Primary
Lipoid nephrosis (severe)
Membranous glomerulonephritis
Membranoproliferative glomerulonephritis
Secondary
Diabetes mellitus (Kimmelsteil-Wilson lesions)
Systemic lupus erythematosus
Amyloidosis and other infiltrative diseases
Renal vein thrombosis
Table 5. Proteins in the “normal” urine
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
UROBILINOGEN
Urobilinogen  light cream
Negative
Yellow
Peach
2 mg/dL
Light pink
Trace
Yellow green
+ (30 mg/dL)
Light green
++ (100 mg/dL)
Green
+++ (300 mg/dL)
Blue green
++++ (2000 mg/dL)
Dark blue
Dark pink
Chemical
Principle
Significance
Limitations
Chemical
Principle
o High: increased hepatic processing of bilirubin
o Low: bile obstruction
o Interference: prolonged exposure of specimen to
oxygen (urobilinogen ---> urobilin)
Cannot detect low levels of urobilinogen  still
need blood chem
o Serum total and direct bilirubin
Table 6. Urobilirubinogen and/or bilirubin in the urine
Urobilirubinogen
Bilirubin
Implication
+
Normal or hyperbilirubinemia
(secondary to hemolytic anemia
or malaria)


Other Tests
1 mg/dL
8 mg/dL
Esterase
PROTEIN

Other Tests
Significance
Limitations
Light tan
4 mg/dL
Nitrite  Dirty white
Leukocyte
mustard
0.2 mg/dL
o Proteinuria and the nephrotic syndrome.
o Interference: highly alkaline urine.
o Much more sensitive to albumin than other
proteins (e.g., immunoglobulin light chains)
o Can’t distinguish particular disease
o Cannot detect microalbuminuria
o Sulfosalicylic acid (SSA) turbidity test.
o Urine protein electrophoresis (UPEP)
o Bence Jones protein

+
+
Liver pathology (hepatitis/viral)
-
+
Obstructive
Urobilirubinogen is a bile pigment that results from the degradation
of hemoglobin
Produced in the intestine from the reduction of bilirubin by intestinal
bacteria
Watson-Schwartz and Hoesch screening test is used for
detection of porphobilinogen
NITRITES
Negative
White
Positive
Pink
CAUSES OF PROTEINURIA
 Functional
o Severe muscular exertion
o Pregnancy
o Orthostatic proteinuria
 Renal
o Glomerulonephritis
o Nephrotic syndrome
o Renal tumor or infection
 Pre-Renal
o Fever
o Renal hypoxia
o Hypertension
 Post-Renal
o Cystitis
o Urethritis or prostatitis
o Contamination with vaginal secretions
Marz, Micah, Kit
Chemical
Principle
Significance
Limitations
o Positive suggests presence of gram negative
bacteriuria
o Negative does not indicate absence of bacteria,
must still correlate with microscopy
o Interference: bacterial overgrowth
o Only able to detect bacteria that reduce nitrate to
nitrite
Page 4 / 10
OS 214
Lab 01.2: Urinalysis
Other Tests
o Correlate with leukocyte esterase and
o Urine microscopic examination (bacteria)
o Urine culture
LEUKOCYTE ESTERASE
Negative
Trace
+ (weak)
++ (moderate)
Yellow
Gray
Lavender
+++ (strong)
Purple
Chemical
Principle
 “Dysmorphic” vs. “normal” (> 10 per HPF)
o with cellular protrusions or fragmentation
o reflect glomerular origin
 Crenated RBCs
o Wrinkled
o Due to difference in osmolality of the cytoplasm and the outside
environment, or an artifact or (2016B) contamination of hypotonic
solution
Figure 7. Normal RBCs –
biconcave in isotonic solution
Figure 8. Dysmorphic RBCs
with some normal RBCs
LEUKOCYTES
Significance
Limitations
Other Tests
o
o
o
o
Pyuria
Acute inflammation
Renal calculus
Interference: oxidizing agents, menstrual
contamination
o Urine microscopic examination (WBCs and
bacteria)
o Urine culture
MICROSCOPIC EXAMINATION
 Preservation
o Cells and casts begin to disintegrate in 1 - 3 hrs. at room temp
o Refrigeration for up to 48 hours (to allow only a little loss of cells)
 Specimen concentration
o Ten to twenty-fold concentration by centrifugation then get sample
from the bottom
 Types of microscopy
o Phase contrast microscopy
o Polarized microscopy
o Bright field microscopy with special staining (e.g., SternheimerMalbin stain)
 Formed elements of urine:
o Cells (erythrocytes, leukocytes, epithelial cells)
o Casts (hyaline, RBC, WBC, renal tubular epithelial, granular,
fatty, waxy, broad casts)
o Crystals
 Normal (calcium oxalate, uric acid)
 Abnormal (cysteine, acetyl sulfadiazine, cholesterol,
bilirubin)
o Organisms (bacteria, fungus, parasite, yeast etc)
o Contaminants (starch granule, spermatozoa)
ABNORMAL FINDINGS
 Per High Power Field (HPF) (400x)
o > 3 erythrocytes
o > 5 leukocytes
o > 2 renal tubular cells
o > 10 bacteria
 Per Low Power Field (LPF) (200x)
o > 3 hyaline casts or > 1 granular cast
o > 10 squamous cells (↑ sq cell count indicates not clean catch
collection ≈ contamination )
o Any other cast (RBCs, WBCs)
 Presence of:
o Fungal hyphae or yeast, parasite, viral inclusions
o Pathological crystals (leucine, tyrosine, cystine)
o Large number of uric acid or calcium oxalate crystals
 Neutrophils (glitter cells): More than 1 per 3 HPF
 Eosinophils: Hansel test (special stain)
 Increased:
o Infection
o Inflammation
o Strenuous exercise
Figure 9. Arrows pointing to PMNs
EPITHELIAL CELLS
1. Renal tubular epithelial cells (RTE)
 Few are normal
 From renal tubules (proximal, distal, collecting)
 Must be enumerated using HPF
 The presence of > 2 RTE/HPF indicates tubular injury and
specimens should be referred for cytologic urine testing.
 Difficult to identify due to variability in appearance
 With small, dense, eccentrically placed nucleus
Figure 10. Benign tubular epithelial cells
2. Transitional epithelial cells (TC)
 Few are normal
 Smaller than squamous epithelial cells
 An increase in TC number exhibiting abnormal morphology such
as vacuoles and irregular nuclei may be indicative of malignancy
or viral infection
CELLS
ERYTHROCYTES
 Normal: 0-2 RBC/HPF
 Pathologic: >3 RBC/HPF
 Increased RBC:
o Renal diseases
o Lower urinary tract diseases
o Extrarenal diseases
o Toxic reaction
o Physiologic
Marz, Micah, Kit
Figure 11. Benign Transitional Epithelial Cells from Bladder
L – w/o stain; R – w/ stain
3. Oval fat bodies (oil-like droplets)
 Abnormal
Page 5 / 10
Lab 01.2: Urinalysis
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OS 214
Indicate nephrosis
A type of RTE that absorbs lipids
Seen in free floating fat droplets
Stained by Sudan III or Oil Red O fat stains
Examined in a Polarized microscope
Produces Maltese cross appearance on Polarized light
Figure 17. LEFT: Casts forming in the cortical collecting duct.
RIGHT: Casts forming in the thick ascending limb
Figure 12. LEFT: oval fat body with Maltese cross appearance.
RIGHT: regular oval fat body
4. Squamous cells
 Indicates level of contamination
Table 7. Types of casts and disease associated
Type of Cast
Disease Associated
Erythrocyte cast
Glomerular diseases
Leukocyte cast
Pyuria, glomerular disease
Degenerating casts
Granular cast
Non-specific (Tamm-Horsfall protein)
Hyaline cast
Non-specific (Tamm-Horsfall protein)
Waxy cast
Non-specific
Fatty cast (oval fat body cast)
Nephrotic syndrome
RBC CASTS (formed inside a tubule)
Figure 13. Transitional epithelial cells
BACTERIA AND YEASTS
1. Bacteria (Bacteriuria: more than 10 per HPF)
Figure 18. L - RBC Cast in urine; R - RBC Cast embedded within
renal tubule
WBC CASTS
Figure 14. Bacteria around the cast
2. Yeasts (Candidiasis)
 Most likely a contaminant but should correlate with the clinical
picture.
Figure 19. WBC cast stuck together by Tamm Horsfall protein;
also known as Glitter Cells (but don’t expect them to look glittery
under the microscope)
TUBULAR EPITHELIAL CASTS
Figure 15. Yeast (Candida) in branched, mycelial form
Figure 20. Epithelial cast with cuboidal to low columnar
morphology
GRANULAR CAST (non-specific)
 Non-pathologic if it came
from the lysosomes
excreted by RTE during
normal metabolism (e.g. in
extreme physical work)
 Pathologic if it represents
disintegration of cellular
casts and tubule cells or
protein aggregates filtered
by the glomerulus.
Figure 16. Yeast exhibiting budding (High power view) + Crenated
RBC
3. Viruses
 CMV inclusions: probable viral cystitis
CASTS
 Casts are the only urine sediment unique to the kidney.
 Dissolve quickly in dilute alkaline urine.
 Major constituent of a Cast is Tamm-Horsfall protein, a glycoprotein
excreted by the RTE of the DCT (distal convoluted tubule) and CD
(collecting duct).
 Formed within the lumens of the distal convoluted tubules and
collecting ducts.
Marz, Micah, Kit
Figure 21. Granular Cast
Page 6 / 10
OS 214
Lab 01.2: Urinalysis
HYALINE CAST (non-specific)
 Frequently
seen
cast,
consists almost entirely of
Tamm Horsfall protein
 Normal 0-2/LPF
 Can be seen in Acute
Glomerulonephritis,
pyelonephritis, CRD and
CHF.
 Or dumbbell shaped.
TRIPLE PHOSPHATE




Figure 22. Hyaline Cast
WAXY CAST (non-specific)
Normal crystal
Alkaline pH
Colorless
Coffin lid appearance
 Represent Extreme Urine Stasis,
Indicating CRF
 Derived From The Degenerating
Hyaline And Cellular Cast.
URATE
Figure 23. Waxy Cast
FATTY CAST
 Seen in conjunction with oval
fat bodies and free fat droplets
in disorders causing lipiduria.
 Frequently associated with
nephrotic
syndrome, toxic
tubular necrosis, DM, and
crash injuries
 May consist of numerous
Maltese crosses
 Normal crystals
 Most commonly seen as amorphous urates, uric acid, acid urates
and sodium urates.
 Appear reddish to brown and are the only normal crystals found in
acidic urine that appear colored.
TYROSINE
 Abnormal crystal needles
 Acidic/neutral urine
 Fine colorless to yellow
needles that frequently form
clumps or rosettes
 Associated
with
liver
disorders.
Figure 24. Fatty Cast
CYSTINE
 Abnormal crystal
 Acid urine
 Colorless, hexagonal plates may be
thick or thin.
 Associated with hereditary cystinuria.
SIGNIFICANCE OF CELLULAR CASTS
Erythrocyte Casts
Leukocyte
Casts
Endothelial Casts
Individual Erythrocytes
Individual
Leukocytes
Individual Bacteria
AMMONIUM BIURATE
 Normal Crystal
 Alkaline Urine
 Yellow brown crystals (“thorny apple”)
CRYSTALS
1. Urate (Ammonium biurate, uric acid)
2. Triple Phosphate
3. Calcium Oxalate
4. Amino Acids (Leucine, Cysteine, Tyrosine)
5. Sulfonamide
CALCIUM OXALATE
 Normal crystal
 Present in Acid/neutral pH
 They are colorless, folded envelope
shape
Marz, Micah, Kit
CHOLESTEROL
 Abnormal crystal
 Acid urine
 Colorless rectangular
with
notched
edges/plates
 Disorders
producing
lipiduria-like nephrotic
syndrome
 Crystals
are
very
delicate so be very
careful with handling
the specimen
Page 7 / 10
Lab 01.2: Urinalysis
FLOW CYTOMETRY
OS 214
URINALYSIS: DISEASE DIAGNOSIS
ACUTE TUBULAR NECROSIS
Urine Dipstick
Microscopic
 Renal tubular epithelial
cells
Glucose (blue-green)
 Pathological casts
Bilirubin (light yellow)
Ketones (tan)
S.G.: Decreased (dark blue)
Blood: +/- (yellow)
pH (orange)
Figure 25. Fluorescence Flow Cytometry
 Providing accurate and precise information in minimum turnaround
time
 Better workflow with UF: no special pre-analytical handling for
sample turbidity or volume, and no image review or sub
classification necessary
 Precise and selective testing of bacteria, saving time and
unnecessary testing
 Comprehensive data management and work areas, with an initiative
user interface clearly presenting the required information for
clinicians
 Easy to use and learn
 Added flexibility: interfaces with ‘best of breed’ workstations, all
printers and added systemization, automation, or network support
capabilities via Sysmex Network Communication System (SNCS)
 Unmatched support with SYSMEX, with the SNCS enabling the
network-ready UF-1000 to easily integrate into lab networks and
providing remote access diagnostic support, daily online QC
management & scientific web information services.
Protein: +/- (neon green)
Urobilinogen (tan)
Nitrite (cream)
L.E.
ACUTE GLOMERULONEPHRITIS
Urine Dipstick
Microscopic
 Erythrocytes
Glucose (blue-green)
(dysmorphic)
 Erythrocyte casts
Bilirubin (light yellow)
 Mixed cellular casts
Ketones (tan)
S.G.(dark blue)
CRITERION URINE ANALYZER
Blood: Increased (dark blue)
pH (orange)
Protein: Increased (neon green)
Urobilinogen (tan)
Nitrite (cream)
L.E. (yellow-tan)
Figure 26. Criterion
 Standardizes measurements via selective light emitting diodes
(LEDs) at wavelengths designated to coordinate closely with the
chemical reaction occurring in the reagent test area of the test strip
 LEDs illuminate the test area at a 60° angle from the longitudinal
axis of the test strip. The LED flashes light of a defined wavelength
at an optimal angle onto the surface of the test area. The light that
reaches the surface of the test area is reflected at an intensity
dependent upon the test area color. This reflected light is received
by a photodiode detector directly above the test area.
 The detector sends an electrical measurement signal to an
analog/digital converter to convert the signal into a digital reading. A
microprocessor converts the digital reading into a concentration
value. The reflected light is, therefore, an indirect measurement of
the color change reaction. Results can be printed out, stored, or
transferred to a laboratory.
CHRONIC GLOMERULONEPHRITIS
Urine Dipstick
Microscopic
 Pathological casts
Glucose (blue-green)
(broad waxy casts,
RBCs
Bilirubin (light yellow)
Ketones (tan)
S.G.: decreased (dark blue)
Blood: Increased (dark blue)
pH (orange)
Protein: Increased (neon green)
Urobilinogen (tan)
Nitrite (cream)
L.E. (yellow-tan)
Marz, Micah, Kit
Page 8 / 10
Lab 01.2: Urinalysis
OS 214
ACUTE PYELONEPHRITIS
Urine Dipstick
Microscopic
 Bacteria
Glucose (blue-green)
 Leukocytes
 Leukocyte, granular,
Bilirubin (light yellow)
and waxy casts

Renal tubular epithelial
Ketones (tan)
cell casts
UROTHELIAL CARCINOMA
Urine Dipstick
Microscopic
 Malignant cells on urine
Glucose (blue-green)
cytology (urine sample
should be submitted
Bilirubin (light yellow)
separately to cytology,
void or 24 hours
Ketones (tan)
S.G. (dark blue)
S.G. (dark blue)
Blood (yellow)
Blood: + (yellow)
pH (orange)
pH (orange)
Protein: Trace (neon green)
Protein: (yellow)
Urobilinogen (tan)
Urobilinogen (tan)
Nitrite: Positive (pink)
Nitrite (cream)
L.E.: Positive (yellow-tan)
L.E. (yellow-tan)
NEPHRITIC SYNDROME
Urine Dipstick
Microscopic

Oval
fat bodies
Glucose (blue-green)
 Fatty casts
 Waxy casts
Bilirubin (light yellow)
Ketones (tan)
S.G. (dark blue)
Blood (yellow)
pH (orange)
END OF TRANSCRIPTION
Marz: YEHEY. NATAPOS RIN. Nakakaloka pala ang lab trans. HI
MICAH AND KIT woooo =)) Hi Geoff onti na lang estudyante ka na ulit
hahaha! Hi Jeff and MSK :)) Hi researchmates, alam nyo na gagawin
sa susunod na birthday HAHAHAHAHA. iMed! Tuloy natin yung
Christmas thing please haha :D Lean and Angeli, alam nyo na kung
anong gusto ko for Christmas hahahaha =))))
TRP na sa Friday! Push natin to 2017! Go chorale! Alto-mates! Abutin
natin yung notes kahit wala na tayong boses harhar =)) Go dancers
kaya nyo yan! :D
And dahil baka last trans na namin ito before Christmas…. Merry
Christmas! :D
Protein: ++++ (yellow)
Urobilinogen (tan)
Nitrite (cream)
L.E. (yellow-tan)
EOSINOPHILIC CYSTITIS
Urine Dipstick
Microscopic
 Numerous eosinophils
Glucose (blue-green)
(Hansel’s stain)
 NO significant casts.
Bilirubin (light yellow)
Ketones (tan)
S.G. (dark blue)
Blood: + (yellow)
pH (orange)
Protein: (yellow)
Urobilinogen (tan)
Nitrite (cream)
L.E. (yellow-tan)
Marz, Micah, Kit
Page 9 / 10
SUMMARY OF URINALYSIS INDICATORS
Disease
Sp. Gravity
Blood
Acute TN
↓
+/-
Acute GN
↑
+
+
Dysmorphic RBC
Erythrocyte casts
Mixed cellular casts
Chronic GN
↓
+
+
Broad waxy casts,
RBC
Acute
Pyelonephritis
Blood
Pro. Trace
Protein +1
Protein +2
Protein +4
L.E.
Mircoscopy Notes
Renal Tubular
epithelial cells
Pathological casts
+/-
+
Nephrotic
Syndrome
Nitrite
+
+
+
Bacteria
Leukocytes
Leukocyte, granular,
waxy casts
Renal tubular
epithelial cell casts
Oval fat bodies
Fatty casts
Waxy casts
Eosinophilic
Cystitis
+
No significant casts
Numerous eosinophils
Urothelial CA
+
Malignant cells on
urine cytology