MICROSCOPIC

EXAMINATION
OF THE URINE

JLCMaaño, BDC 2021 1

URINE SEDIMENT PREPARATION p.1

To ensure accuracy and

reproducity of the urine
Appropriate specimen collection,
microscopic examination, each
preservation and handling – within
laboratory must establish a
an hour from voiding especially
protocol for the preparation of the
when let to stand in room
urine sediment. Factors to be
temperature
considered for the standardized
microscopic examination:

JLCMaaño, BDC 2021 2

URINE SEDIMENT PREPARATION p.2

Standard amount of urine –

Spun tube is decanted – leaves
usually 10 - 12 ml in test tube
approximately 1 ml fluid in
and spun for 5 min-10 min @
which to re-suspend the
400 centrifugal force or 2000-
urinary sediment if stain is
3000 rpm (should be well
used, it should be added this
mixed before placed in test
time
tube)

JLCMaaño, BDC 2021 3

URINE SEDIMENT PREPARATION
A small drop of well mixed sediment is placed unto a microscopic slide
shielded with a coverslip drop size determines the amount of sediment
viewed.

A consistent method should be used to examine the urinary sediment.

LPO to assess the overall composition and observe and count casts. The
light must be very low so hyaline casts will be seen. Other elements will
be viewed in HPO. An average of 10-20 fields is usually reported

Microscopic results should be correlated with the color, appearance and

dipstick reaction for each specimen

JLCMaaño, BDC 2021 4

URINE
PROCESSING

› CHECK amount of volume.

› A consistent method should be
used to examine the urinary
sediment. LPO to assess the
overall composition and
observe and count casts. The
light must be very low so
hyaline casts will be seen.
Other elements will be viewed
in HPO. An average of 10-20
fields is usually reported
› Microscopic results should be
correlated with the color,
appearance and dipstick
reaction for each specimen

JLCMaaño, BDC 2021 5

MICROSCOPIC SEDIMENT STAINS
JLCMaaño, BDC 2021 6
 7

Ø Supravital stains

Ø 1. Sterheimer-Malbin stain -
crystal violet and safranin O.
Provides detailed visualization of
the internal structure of cells and
casts

Ø 2. 0.5% toluidine blue –

differentially stains various cell
components (nucleus, cytoplasm)
to help distinguish cells that may
be similar in size, such as
leukocytes and renal cells

Ø 3. Sudan III or oil red O – confirm

the presence of neutral lipids.
Lipids or fats in renal cells or
MICROSCOPIC histiocytes (oval fat bodies) or
free floating triglycerides stain
SEDIMENT STAINS red or orange
JLCMaaño, BDC 2021
 8

Prussian blue – confirm the presence of

hemosiderin (iron) in epithelial cells and
casts, and free-floating hemosiderin. Iron
turns into characteristic blue color

Hansel stain
methylene blue and eosin Y in
methanol. Identify eosinophils

2% Acetic acid – 1-2 gtts of urine

MICROSCOPIC sediment to differentiate small WBCs or
SEDIMENT epithelial cells. RBC and yeast remains
intact. Internal structure of WBCs and the
STAINS epithelial cells are accentuated
JLCMaaño, BDC 2021
 9

NORMAL &
ABNORMAL CELLS
IN THE URINE

JLCMaaño, BDC 2021

 10

RBC

› small biconcave disks without nucleus. 7-10 um in diameter

› becomes crenated (crinkled border) in hypertonic urine
› Alkaline or hypotonic urine they swell and may lyse. They
are called the ghost cells or shadow cells and appear as faint,
colorless circles
› Normal 0-3 RBC/hpf.
› Increased – renal bleeding or glomerulonephritis
JLCMaaño, BDC 2021
 11

Red Blood Cell

Normal hypotonic Crenated RBC

JLCMaaño, BDC 2021

 12

RBC

JLCMaaño, BDC 2021

 1
3

RBC
TNTC
 14

White Blood Cell/ PUS

› Usually NEUTROPHIL
› Larger than RBCs (10-15 um) contain distinct nucleus
› Increased – PYURIA – infection or inflammation of the genitourinary tract
› Bacterial infection (cystitis, pyelonephritis, prostatitis, urethritis)
› Non-bacterial infections (glomero-nephritis, LE, tumors)
› Glitter cells –” Brownian movement” of their internal granules produces
a sparkling appearance in dilute alkaline urine thus lyse or swell
› Eosinophils – identified with HANSEN stain, indicates acute interstitial
nephritis caused by hypersensitivity reactions to medications such as
PENICILLIN derivatives
› Mononuclear cells – histiocytes, lymphocytes or plasma cells –
JLCMaaño, BDC 2021
inflammatory process or renal transplantation rejection.
WBC / PUS CELLS

JLCMaaño, BDC 2021 15

WBC/PUS CELLS

JLCMaaño, BDC 2021 16

EPITHELIAL CELLS
JLCMaaño, BDC 2021 17
 18

Appearance
Epithelial cells Origin Indication

Squamous Lining of Frequently seen 30-40 um Not a middle

cells vaginal tract, abundant catch urine
lower portions cytoplasm, small
of female & centrally located
male urethra nucleus, irregular
cytoplasmic
border
Transitional or Renal pelvis to Seldom Characteristically Renal
caudate cells 2/3 proximal of pathologic only round or pear transplantation
urethra when in large shaped with rejection, acute
numbers and centrally located tubular necrosis,
unusual nucleus ischemic injury to
morphology kidney, renal
carcinoma

Renal tubular Renal tubules Oblong or round to Acute tubular

epithelial cells (proximal, oval, eccentric necrosis fro heavy
distal nucleus, 20-60 um metals and drug
JLCMaaño, BDC 2021
convoluted) toxicity
 19

EPITHELIAL CELLS
SQUAMOS TRANSITIONAL

JLCMaaño, BDC 2021

JLCMaaño, BDC 2021 20
TRANSITIONAL EPITHELIUM IN THE BLADDER

JLCMaaño, BDC 2021 21

JLCMaaño, BDC 2021 22
Epithelial Origin Appearance Indication
cells
Renal Collecting Pathologic when 12-20 um, cuboidal, Renal diseases
tubular ducts in large numbers polygonal or accompanied by
cells columnar, large dense granular, waxy, renal
nucleus tubular cell casts,
increased number of
cells
Oval fat Renal When present Can be stained with Glomerular dysfunction
bodies tubular cells accompanied by Sudan III or Oil Red O. with renal tubular cell
containing increased visualized with death
fat amounts of polarized light-
protein and cast maltese cross
formation

JLCMaaño, BDC 2021 23

 24

RENAL TUBULAR
CELLS

JLCMaaño, BDC 2021

RENAL TUBULAR CELLS

JLCMaaño, BDC 2021 25

RENAL CELLS

JLCMaaño, BDC 2021 26

 27

Oval fat bodies Epithelial cells

JLCMaaño, BDC 2021

JLCMaaño, BDC 2021

› Maybe found
TUMOR › Cytologic techniques are
CELLS, more sensitive than
PLATELETS conventional urine
OR microscopy in detecting
EPITHELIAL these kinds of cells
CELLS WITH
VIRAL
INCLUSIONS 28
TUMOR OR NEOPLASTIC CELLS

JLCMaaño, BDC 2021 29

URINARY CASTS
JLCMaaño, BDC 2021

› Formed in the distal and collecting tubule.

› Except for a few hyaline or granular casts which
can accompany strenuous exercise (athletic
psuedonephritis) or severe stress
› Casts are not normally present in the urine
› Presence is termed as CYLINDROIDURIA
URINARY › cylindrical with parallel sides and rounded ends

CASTS › Casts formed in the collecting ducts are broader

than those formed in the proximal and distal
convoluted tubule
› Number and type of casts reflect the extent of
renal tubule involvement in disease processes.
› Often accompanied by proteinuria

31
 URINARY
CAST

• TAMM-HORSFALL
PROTEIN – a mucoprotein
secreted only by renal tubular
cells. From the matrix of the
casts. As the tubular lumen
contents become
concentrated (due to stasis of
urine flow). Protein casts
with long, thin tails formed at
the junction of Henle's loop
and the distal convoluted
tubule.

JLCMaaño, BDC 2021 32

TYPE APPEARANCE 33 CLINICAL SIGNIFICANCE
HYALINE Colorless, homogenous Strenuous exercise, stress
protein matrix with rounded Inflammation of the urogenital tract
ends, various sizes and shape Often found with other casts
RED BLOOD CELL Protein matrix filled with red Glomerulonephritis
blood cells Acute interstitial nephritis
Often many free red cells in Strenuous exercise
microscopic field
WHITE BLOOD Protein matrix filled with Pyelonephritis
CELL white blood cells Kidney infection (accompanied by
bacteria, protein, red blood cells)
Glomerulonephritis (accompanied by
rbc cast
EPITHELIAL CELL Protein matrix filled with Rarely seen in urine
renal epithelial cells may be Renal tubular damage, necrosis and
arranged haphazardly vary in degeneration
size & shape Severe renal chronic disease
FINE or COARSELY Protein matrix filled with Urine flow stasis
GRANULAR CAST degenerating cells, Urogenital tract infections
amorphous crystals or JLCMaaño,
Strenuous exercise, BDC 2021
stress
bacteria; colorless to
yellowish, many size &
JLCMaaño, BDC 2021
TYPE APPEARANCE
FATTY Protein matrix containing oval fat
bodies
WAXY OR BROAD Homogenous with way, thick
appearance often with a blurred,
uneven, brittle-looking edges, high
refractive index, yellow-gray or
colorless
PIGMENTED Hyaline matrix with coloration due
to pigment incorporation
MIXED Two or more cell types enmeshed in a
protein matrix, part granular and part
waxy
Any combination is possible
CLINICAL SIGNIFICANCE
Nephrotic syndrome
Renal tubular cell death
Severe crush injury with disruption of body
fat accompanied by significant proteinuria
Toxic renal poisoning
Tubular obstruction or disease with
extreme urine flow stasis
Severe nephron damage
Nephrotic syndrome
Poor prognosis with large numbers present
Result from degeneration of granular cast
Incorporated bilirubin (golden-brown)
Hemoglobin or myoglobin
(yellow to red-brown)
Two cell types in filtrate during cast
formation, initial cast formation in one
tubule followed by stasis in another wider
lumen and further cast formation
34
HYALINE CAST
JLCMaaño, BDC 2021 35
 36

WBC CAST

JLCMaaño, BDC 2021

 37

WBC CAST

JLCMaaño, BDC 2021

RBC CAST

JLCMaaño, BDC 2021 38

 HEMOSIDERIN/
Hgb CAST

JLCMaaño, BDC 2021 39

WAXY CAST

JLCMaaño, BDC 2021 40

 FINE
GRANULAR
CAST

JLCMaaño, BDC 2021 41

 COARSE
GRANULAR
CAST

JLCMaaño, BDC 2021 42

JLCMaaño, BDC 2021 43
 44

WAXY CAST

JLCMaaño, BDC 2021

URINE CRYSTALS
NORMAL URINARY CRYSTALS

JLCMaaño, BDC 2021 45

 46

NORMAL ACIDIC URINE CYRSTALS

1. URIC ACID CRYSTALS – different shapes, 4 sided & flat,
yellow or reddish brown, diamond, rhombic plates,
prisms, ovals with pointed ends. Rosettes, wedges &
needles. Under polarized light they are multicolored.
2. AMORPHOUS URATES - yellow brown granules often
found in clumps and may obscure other urine sediments.
When n gross amount they make the urine appear pink-
orange or reddish –brown and turbid. Easily made soluble
by heating the urine specimen.
3. CALCIUM OXALATE - seen in acidic or neutral urine,
rarely in alkaline urine. Small colorless octahedrals that
resemble envelopes, with a cross on their surface or may
appear dumb bell shape
JLCMaaño, BDC 2021
 47

NORMAL ALKALINE URINE

CRYTALS
1. TRIPLE PHOSPHATE – distinct colorless, 3 to 6 sided prism shape
with oblique ends and are often called coffin lids
2. AMORPHOUS PHOSPHATES – granular in appearance, gives
urine a white turbidity appearance when found in large numbers.
Can mask other elements in urine present. Dilute HAc dissolves
some of the crystals but can also lyse other RBCs when present
3. CALCIUM PHOSPHATES – colorless, thin prisms, plates, or
needles. Not frequently seen in urine but are confused with
abnormal sulfonamide crystals. CaPO4 soluble in dilute HAc.
Sulfonamides are insoluble.
4. AMMONIUM BIURATE – yellow brown spheres with irregular
projections or thorns or thorny apple
5. CALCIUM CARBONATES – small colorless dumbbells or spheres.
Often appear in clumps and can be confused with amorphous PO4.
distinguished with the formation of CO2 gas after addition of HAc
JLCMaaño, BDC 2021
 48

SUMMARY OF NORMAL URINE

CRYSTALS
CRYSTALS pH COLOR SOLUBILITY
uric acid acid yellow-brown alkali or heat
amorphous urates Acid Brick-dust or yellow Alkali and heat
brown
Calcium oxalate Acid, neutral, Colorless Dilute HCl
(CaOx) alkaline (envelopes)
Amorphous Alkaline, neutral White colorless Dilute HAc
phosphate (APO4)
Calcium phosphate Alkaline, neutral Colorless Dilute HAc
(CaPO4)
Triple phosphate alkaline Colorless Dilute HAc
(TriPO4)
Ammonium biurate Alkaline Yellow-brown HAc with heat
JLCMaaño, BDC 2021
(NH4Bi) (thorny apples)
Calcium carbonate Alkaline Colorless Gas from HAc acid
AMMONIUM BIURATE (NH4Bi)

JLCMaaño, BDC 2021 49

 50

AMORPHOUS PHOSPAHATE
(APO4)

JLCMaaño, BDC 2021

JLCMaaño, BDC 2021 51
CALCIUM CARBONATE
(CaCO3)

JLCMaaño, BDC 2021 52

CALCIUM
OXALATE
(CaOx)

5
3
JLCMaaño, BDC 2021 54
 CALCIUM
OXALATE
(CaOx)

JLCMaaño, BDC 2021 55

 56

CALCIUM PHOSPHATE (CaPO4)

JLCMaaño, BDC 2021

 57

TRIPLE PHOSPHATE (TriPO4)

JLCMaaño, BDC 2021

58

JLCMaaño, BDC 2021

 59

URIC ACID

JLCMaaño, BDC 2021

 60

URIC ACID

JLCMaaño, BDC 2021

 61

ABNORMAL CRYSTALS FOUND IN URINE

CRYSTALS APPEARANCE SOLUBILITY INDICATION

CYSTINE Colorless, thin precipitates in acidic Result from inherited metabolic

hexagonal plates urine defect that prevents the
Soluble in HCl and reabsorption of cystine by the
proximal tubule (Amino Acid)
NH4

CHOLESTEROL resembles seen when urine Nephritis, nephrotic conditions,

rectangular plates specimen are excessive tissue breakdown
with a notch in one or refrigerated
more corners Soluble in chloroform or
hot alcohol

LEUCINE yellow-brown oily looking Appear in association with

spheres that contain
concentric circles with Tyrosine crystals
radial striations Severe liver disease

TYROSINE Refractile sheaths Soluble in NH4OH Rare but occur in individuals

of fine needles Found in acidic or who have severe
JLCMaaño, liver
BDC 2021
neutral urine. disease, tyrosinosis
 62

ABNORMAL CRYSTALS FOUND IN URINE

CRYSTALS APPEARANCE INDICATION
BILIRUBIN can precipitate in acidic urine as
yellowish spheres with spicules

SULFONAMIDES colorless or yellow brown Depending on the form of drug the

bundles/shocks of wheat with central
bindings in acidic or neutral urine that
has been refrigerated
rosettes, arrowheads, needles, petals, or
round forms with striations.
patient has taken in it forms in
Usually appear when patients are
not well hydrated.
Tends to form renal calculi thus
renal tubular damage

AMPICILLIN long fine colorless needles or form

coarse sheaves after refrigeration

RADIOGRAPHIC DYES many colorless forms can be When they are present specific
confused with uric acid crystals. gravity is high > 1.040

HIPPURIC CRYSTALS Elongated prisms or plates, No clinical significance.

yellow brown or colorless Soluble in water
JLCMaaño, BDC 2021
CALCIUM SU;FATE Soluble in HAc No clinical significance
CRYSTALS
 63

CYSTINE CRYSTALS

JLCMaaño, BDC 2021

 64

CHOLESTEROL CRYSTALS

JLCMaaño, BDC 2021

65

JLCMaaño, BDC 2021

 66

LEUCINE
CRYSTALS

JLCMaaño, BDC 2021

67

SULFON
AMIDES
(sulfagin,
sinomin,
sulfameth
oxazol)

JLCMaaño, BDC 2021

68

JLCMaaño, BDC 2021

 69

TYROSINE
CRYSTALS
• Pins and needles in rosette
form

JLCMaaño, BDC 2021

 70

TYROSINE CYRSTAL
JLCMaaño, BDC 2021
71

?
CRYSTALS

JLCMaaño, BDC 2021

 72

BILIRUBIN
CRYSTALS

JLCMaaño, BDC 2021

 73

BILIRUBIN CRYSTALS
JLCMaaño, BDC 2021
74

JLCMaaño, BDC 2021

75

Calcium
sulfate
CaSO4
crystal

JLCMaaño, BDC 2021

76

JLCMaaño, BDC 2021

 77

HIPPURIC
ACID
CRYSTAL

JLCMaaño, BDC 2021

78

RADIOGRAPHIC
DYES
(angiograph)

JLCMaaño, BDC 2021

 79

RADIOLOGIC
DYE
CRYSTAL

JLCMaaño, BDC 2021

80

JLCMaaño, BDC 2021

81

JLCMaaño, BDC 2021

 MICRO
ORGANISMS,
ARTIFACTS

JLCMaaño, BDC 2021

82
 83

Artifacts - muscle fibers, vegetable cells with

fecal
• contamination, hair, cotton fibers from
• diapers & cloth materials, wooden
• sticks (mixing urine) starch granules
• (gloves), oil droplets (lubricants)

MUCUS – no clinical significance, observed in

• subdued light differentiating it from

• hyaline

SPERMATOZOA – women – after sexual

intercourse
• men – after ejaculation

HEMOSIDERIN – granules – maybe seen as

coarse yellow
• brown granules as a result of ferritin
• degradation, confused with amorphous PO4
JLCMaaño, BDC 2021
• Prussian blue stain
 84

>usually found in
patient’s urine
with diabetes &
from areas like
skin, vaginal
tract
> airborne
yeasts when left
uncovered
> maybe confused
with RBC,
> presence of
budding.
YEASTS (Candida > Dilute HAc will lyze
RBC
albicans) JLCMaaño, BDC 2021
JLCMaaño, BDC 2021 85
This Photo by Unknown Author is licensed under CC BY-SA
 This Photo by Unknown Author is licensed under CC BY

JLCMaaño, BDC 2021 86

 YEAST CULTURE

This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY

JLCMaaño, BDC 2021 87

YEASTS
(Candida
albicans)

JLCMaaño, BDC 2021 88

 89

Trichomonas vaginalis
confused with WBC, with characteristic undulating flagella

JLCMaaño, BDC 2021

 90

Trichomonas
vaginalis

https://www.youtube.com/watch?v=YxA
x3AirKrA

JLCMaaño, BDC 2021

Schistosoma
haematobium
• shed directly into urine

JLCMaaño, BDC 2021 91

92

Enterobius
vermicularis

JLCMaaño, BDC 2021

Entamoeba
histolytica
• accompanied with RBC & WBC

JLCMaaño, BDC 2021 93

JLCMaaño, BDC 2021 94
95

JLCMaaño, BDC 2021

METABOLIC
PRODUCTS IN
URINE

96 JLCMaaño, BDC 2021

 97

HOMOGENTESIC ACID -
patients with ALKAPTONURIA
backbone disease

FERRIC CHLORIDE TEST SILVER NITRATE TEST

› Transient dark blue › Black color develops

color is seen after 2 after several gtts of
gtts of 10% FeCl3 to 2 NH4OH added to 0.5
ml of urine ml urine containing
4ml of 3% AgNO3

JLCMaaño, BDC 2021

ALKAPTONURIA URINE
JLCMaaño, BDC 2021 98
 99

Alkaptonuria

JLCMaaño, BDC 2021

ALKAPTONURIA
JLCMaaño, BDC 2021 100
101

JLCMaaño, BDC 2021

 102

TYROSINE- production of melanin,

turns black when exposed to light
FERRIC CHLORIDE TEST SILVER NITRATE TEST

› Gray or black › Red color is produced

precipitate will form with melanin and
NaNitroprusside

JLCMaaño, BDC 2021

 Metabolic
deficiencies
detected in

NEW-BORN
SCREENING

JLCMaaño, BDC 2021 103

 › Also known
104 as AMINOACIDURIA
› 1 : 15,000 births
› Severe mental retardation, autosomal
recessive gene
› Increased amount of phenylalanine
gives its characteristic MOUSY odor
› Gene production enzyme for PHENYL-
ALANINE HYDROLASE
› First detected in blood due to urinary
PHENYLKETONURIA accumulation of phenyl-pyruvic acid (2-
(PKU) 6 weeks)
› Phenylalanine, a major constituent of
milk
› BACTERIAL INHIBITION TEST by
GUTHRIE – using Bacillus subtilis
streaked into media
› G6PD test – glucose 6 phosphate
dehydrogenase JLCMaaño, BDC 2021

› HERIDITARY
JLCMaaño, BDC 2021 105
JLCMaaño, BDC 2021 106
JLCMaaño, BDC 2021 107
 108

JLCMaaño, BDC 2021

 JLCMaaño, BDC 2021

PKU patient

109
 HERIDITARY TYROSINEMIA -
Cirrhosis of the liver, renal
dysfunction, low birth weight infants,
should be distinguished with PKU

TYROSINE crystals – screening test

of NITROSONAPHTHOL, forming red
complexes with tyrosine and
tyramine, nonspecific

Disorders of CHROMATOGRAPHY – confirmatory

for the presence of tyrosine in urine
TYROSINE because it is normally seen in urine
metabolism
JLCMaaño, BDC 2021 110
 111
JLCMaaño, BDC 2021
JLCMaaño, BDC 2021

› Failure to inherit the gene enzyme in

producing oxidative decarboxylation of
the keto acids in metabolic pathways of
leucine, isoleucine, valine
› Maple syrup color
MAPLE SYRUP › 2,4 dinitrophenylhydrazaline (DNPH) –
URINE DISEASE yellow turbidity or precipitate
(MSUD)/
HOMOCYSTINURIA › a rare genetic disorder characterized by
deficiency of an enzyme
complex (branched-chain alpha-keto acid
dehydrogenase) that is required to break
down (metabolize) the three branched-
chain amino acids (BCAAs) leucine,
isoleucine and valine, in the body.

11
2
113

JLCMaaño, BDC 2021

Child suffering
from Maple
Syrup urine
Disease (MSUD)
with progeria

JLCMaaño, BDC 2021 114

Maple syrup disease
JLCMaaño, BDC 2021 115
JLCMaaño, BDC 2021

Child
diagnosed
with
MSUD

11
6
117

JLCMaaño, BDC 2021

JLCMaaño, BDC 2021 118
 119

MARFAN’S
SYNDROME
/PECTUS
EXCAVATUM

› an inherited disorder
that affects
connective tissue —
the fibers that support
and anchor your
organs and other
structures in your
body. Marfan
syndrome most
commonly affects the
heart, eyes, blood
vessels and skeleton JLCMaaño, BDC 2021
JLCMaaño, BDC 2021

• TRYTOPHAN
• increase of indican or 5
hydroxyindolacetic acid (5-
HIAA);
• intestinal disorder including
MISCELLANEOUS obstruction, presence of
TESTS FOR abnormal bacteria,
METABOLIC malabsorption syndromes,
PRODUCTS Hartnup disease
• Converted to INDOLE I the
intestine
• Converted by the argentaffin
cells of the intestines

12
0
 121

TRYPHTOPHAN
converted to SEROTONIN

Malignant tumors

Excess indole reabsorbed in blood converted

into indican by liver & excreted in the urine

Urinary indican is detected by acidic ferric

chloride solution which reacts with indican to
form a deep blue or purple color
JLCMaaño, BDC 2021
 122

CYSTINURIA

Defective tubular
reabsorption of
CYANIDE- cystine and amino
NITROPRUSSIDE acids arginine
- red purple color ornithine &
glomerular
filtration

Fresh first
Tends to form
morning urine
calculi
specimen

JLCMaaño, BDC 2021

 HEMOCYSTINURIA

Deficiency in liver enzyme cystathione B

synthase

Children affected with these experience seizures

& thromboses & eventually mental retardation

Homocystine is labile - fresh urine specimen

CYANIDE-NITROPRUSSIDE positive reaction

 124
JLCMaaño, BDC 2021
MALAR RASH, OPTIC
DISLOCATION

JLCMaaño, BDC 2021 125

JLCMaaño, BDC 2021 126
 127

SULKOWITCH’s test – qualitative test

for increase level of calcium in urine

Reagent : oxalic acid, NH4Oxalate,

glacial HAc

Hyper-parathyrodism

Osteoporosis

URINE Multiple myeloma

CALCIUM JLCMaaño, BDC 2021

 URINE PORPHYRINS

› Intermediate compounds in the production of heme

› Cannot re-enter the heme pathway thus must be excreted
› Rare
› Common type North America – CUTANEOUS TARDA
› Uroporphyrin, coproporphyrin & protoporphyrin
› “port wine” or dark red urine

JLCMaaño, BDC 2021 128


Screening test for PORPHYRINURIA
EHRLICH’S REACTION
› p-dimethylamino
benzaldehyde producing
cherry-red color
› Increased ALA common test
for lead poisoning
› Fluorescent under ultraviolet
light from Wood’s lamp
› Fluoresces as pink, violet or
red depending in the
porphyrin concentration
129
WATSON-SCHWARTZ
TEST
› Differentiate urobilinogen
& porphobilinogen based
on solubility
› Chloroform added to urine
tube to extract
urobilinogen (red in
chloroform layer)
porphobilinogen remains in
aqueous state ( red in
aqueous layer)
JLCMaaño, BDC 2021
 PORPHYRIA
CUTANEOUS
TARDA

JLCMaaño, BDC 2021 130

 13
1

PORTWINE
COLOR
URINE

This Photo by Unknown Author is licensed under CC BY-SA

 132

This Photo by Unknown Author is licensed under CC BY-NC

JLCMaaño, BDC 2021