Urinalysis Examinations _____________________________________________Urinalysis

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Urinalysis Examinations _____________________________________________Urinalysis

Macroscopic Examination )1(

Volume – 1 Color – 2 Smell – 3 Aspect – 4

Physical Examination )2(

PH Value – 1 Specific Gravity – 2

Biochemical Examination )3(

Albumin – 1 Nitrites – 2 Ketone bodies – 3 Bilirubin – 4

Urobilinogen – 5 Glucose – 6 Leukocyte Esterase – 7 Blood – 8

Microscopic Examination )4(

Pus Cells – 1 Red Blood Cells – 2 Epithelial Cells – 3 Casts – 4

Crystals – 5 Fat Droplets – 6 Mucus Threads – 7 Organisms – 8

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Urinalysis Examinations _____________________________________________Urinalysis

Macroscopic Examination )1(

Volume (Diuresis) – 1

■ Significance:
- The urine volume (Diuresis) represents the urine volume eliminated per 24 hours.
- It varies depending on water balance status and ratio between fluid volume intake and water
volume eliminated.
.Its value means the kidney capacity to secrete and reabsorb water -

.Normal Urine Volume: 1 – 2 Liter per day ■

:Abnormal Urine Volume ■

Abnormal Urine Urinary Disease

Medical Causes (Indications)
Volume Name

Functional acute renal failure (ARF) -1

Less Than 0.5 Liter Decrease water intake -2
1 Oliguria
Per day Dehydration -3
Kidney diseases -4

Intrinsic ARF -1
Less Than 100 ml Kidney stones -2
2 Anuria
per day Parasitic eggs such as schistosoma eggs -3
Tumors (Prostatic tumors) -4

1- Chronic renal failure

2- Diabetes mellitus (glucose presence in urine)
More Than 2.5 Liter
3 Polyuria 3- Nephritic syndrome (proteins presence in urine)
per day
4- Hyperhydration (diabetes insipidus)
5- Diuretics therapy

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Urinalysis Examinations _____________________________________________Urinalysis

Color – 2
■ Significance:
- Normal urine color ranges from pale yellow to amber yellow as a result of presence of a pigment
called urobilin which is a final waste product resulting from the breakdown of heme from hemoglobin
during the destruction of aging blood cells.
- the color of the urine can be an indicator of what you have been ingesting and the condition of your
health.
- Color changes depending on density, composition, urine pH (diluted or alkaline urine is lighter in
color, while concentrated or acid urine is darker), nutrition, and medication.

■ Normal Urine Color: Pale yellow or Amber yellow color.

■ Abnormal Urine Color:

Abnormal
Medical Causes (Indications)
Urine Color
Hyperhydration -1
Drinking an excess of water -2
1 Colorless Renal Failure -3
Diabetes Insipidus and mellitus -4
Diuretics use -5
2 Yellow Excess sweating without drinking enough liquids
Dehydration -1
Hepatitis (bilirubin disease) -2
3 Dark Yellow
Jaundice Syndrome -3
4- Hemoglobinuria
Urinary Tract Infection -1
Bile Problems -2
Yellowish
4 Bilirubin disease -3
Green
Taking certain drugs -4
5- Taking an excess of vitamin B
Jaundice Syndrome -1
Hepatitis -2
Yellowish Melanoma Cancer -3
5
Brown Copper Poisoning -4
Taking beans -5
6- Taking a laxative
Yellowish A pseudomonas Bacterial Infection -1
6
Blue 2- High levels of calcium
Hematuria -1
Hemglobinuria -2
bladder infection -3
7 Red kidney stones or bladder stones -4
An injury to the bladder or kidney causing bleeding into urine -5
Eating certain foods such as beets, blackberry, and candy or bills with a dye -6
7- Taking lead or mercury poisoning
Eating too many carrots -1
8 Orange
2- Taking too much vitamin C
Brownish
9 Methemoglobinuria
Black

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Urinalysis Examinations _____________________________________________Urinalysis

Smell – 3
■ Significance:
:The smell of urine may be changed as a result of either the following causes -
Eating certain foods -1
Taking certain tablets -2
Urinary diseases -3
The normal urine smell is aromatic smell due to presence of urinoid substances (volatile acids) -

Normal Urine Smell: Aromatic Smell ■

:Abnormal Urine Smell ■

Abnormal Urine Smell Medical Causes (Indications)

Urinary Tract Infection (UTI), such as bladder Infection, kidney -1

Foul – Smelling
infection (pyelonephritis) and pyuria
1 or
Taking Multivitamin tablets (especially vitamin B6 supplements) -2
Putrid
Eating certain foods, such as asparagus and garlic -3

2 Sweet – Smelling Diabetic ketoacidosis (presence of high level of ketones or sugar)

1- Urinary infections with bacteria which decomposing urea into

3 Ammonia – Smelling ammonium
2- Dehydration

Phenylketonuria (a rare disorder where the body is incapable of -1

4 Musty – Smelling .breaking down certain proteins)
Liver failure -2

5 Strong – Smelling Dehydration

Eating certain foods, such as garlic, onions, fish and asparagus -1

6 Sulfur – Smelling
Cystine Decomposition -2

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Urinalysis Examinations _____________________________________________Urinalysis

Aspect –4
Normal Urine Aspect: Clear or Transparent aspect ■

:Abnormal Urine Aspect ■

Abnormal Urine Aspect Medical Causes (Indications)

Crystalluria (presence of phosphates, oxalates, or urates) -1

Turbid Pyuria -2
1 or Lipiduria -3
Semi – Turbid Mucus -4
Epithelial Cells -5

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Urinalysis Examinations _____________________________________________Urinalysis

Physical Examination )2(

PH Value -1
■ Significance:
- Urine PH reflects kidney capacity to acidify urine.
:The PH value of urine may be changed as a result of either the following causes -
Eating certain foods -1
Taking certain tablets -2
3- Urinary diseases
- The PH value can help to distinguish between different crystals in sediment analysis.
- The pH value of fresh urine from healthy people varies between pH 5 and pH 6.8.
- The PH value is measured by using screening dipstick strip in which the color scale gives a clear
distinction of pH values between pH 5 and pH 9.
- The pH should always be measured in fresh urine, since bacterial decomposition may increase the
pH of the urine to values > 9.

Normal Urine PH: PH = 5 – 6.8 (Acidic Reaction) ■

:Abnormal Urine PH ■

Abnormal Urine PH Medical Causes (Indications)

ketoacidosis (presence of Ketone bodies in urine) -1
Diabetes mellitus -2
Urinary infection with Escherichia Coli -3
PH < 5.0 Starvation -4
1
Aciduria Acidic fruits (Cranberry) -5
6- Drugs (e.x. Ammonium chloride)
7- Crystalluria (precipitation of uric acid crystals and amorphous
urates in urine) causing kidney stones
PH = 7.0
2 Renal failure (decreased renal capacity for acidification of urine)
Neutraluria

Renal failure (renal tubular acidosis) -1

Bacteriuria (Proteus urinary infection) -2
3- Crystalluria (precipitation of calcium and magnesium phosphates
PH > 7.0
3 and calcium carbonate and ammonium urates) causing kidney
Alkalinuria
stones
4- Drugs (antibiotics and bicarbonate)
5- Vegetarian diet

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Urinalysis Examinations _____________________________________________Urinalysis

Specific Gravity (Density) -2

■ Significance:

It is defined as the kidney capacity to concentrate and dilute the urine -

It has an inverse relationship with the hydration state and diuresis and proportional with the amount -
of solutes excreted by kidneys. (High density means high amount of solutes causing high
.dehydration (low hydration) and low diuresis)

Normal Urine Specific Gravity: "Normosthenuria" = 1.01 – 1.02 g/cm³ ■

:Abnormal Urine Specific Gravity ■

Abnormal Urine Density Medical Causes (Indications)

Dehydration causing fever, vomiting, and diarrhea -1

Density > 1.02 g/cm3 Glucosuria due to Diabetes mellitus -2
1 Proteinuria causing Nephritic syndrome -3
"Hypersthenuria" Decreased blood flow to kidney as a result of heart failure -4
Excessive sweating -5

Hyperhydration -1
Density < 1.01 g/cm3 Diabetes insipidus -2
2
Renal failure (loss of urine concentration capacity) -3
"Hyposthenuria" Diuretics use -4

Impairment of renal tubular function as in nephritis to excrete -1

3 Density = 1.01 g/cm3 the urine with a higher or lower specific gravity than the
"Isothenuria" specific gravity of plasma or glomerular filtrate (1.01 g/cm3)

13
Urinalysis Examinations _____________________________________________Urinalysis

Biochemical Examination )3(

Proteins (Albumin) -1
■ Significance:
- The detection of proteins in urine is the most indicative biochemical test of renal and liver
diseases.
- Albumin is the most main protein made by the liver and secreted through the glomerular
capillary wall into urine ,
While most of the other proteins (low molecular weight proteins) are reabsorbed in the
tubules.
- The presence of an increased amount of proteins in urine is called "Proteinuria"
- The presence of an increased amount of albumin in urine is called "Albuminuria"
- The detection of proteins in urine is carried out by using chemical reagent dipstick, but in
some cases (such as, highly alkaline PH, highly turbidity, or certain medical drugs intake) the
dipstick may give a falsely positive results. So, a confirmation test (Heat Cognition Test)
must be done as follows:
1- Prepare 1 ml of Centrifuged urine in a test tube then heat gently until boiling.
2- If the urine color becomes white with turbid aspect that indicates probability of
presence of albumin in urine.
3- To insurance, add 3 – 5 drops of acetic acid and mix gently
4- Again heat the test tube until boiling with shaking
5- Check the test tube:-
- If the turbidity and the white precipitate are still appeared, this indicates that
the urine sample contains albumin.
- If the turbidity and the white precipitate are disappeared, this indicates that
the urine sample doesn’t contain albumin.
- The result also may be falsely negative in cases of:
Concentrations of protein
by using screen dipstick
1- Low specific gravity < 1.015
2- Urine protein concentration < 10 mg/dl
3- Low PH value (acidic) Negative : <10 mg/dl

■ Normal Urine Proteins: Nil or Trace Trace: 10 – 20 mg/dl

■ Abnormal Urine Proteins: "Proteinuria" or "Albuminuria" Protein (+): 30 mg/dl

Protein (++): 100 mg/dl

■ Medical Causes (Indications) of Proteinuria:
Protein (+++): 500 mg/dl
-:Physiologic Causes (Transient) )A(
1) Physical strain, after strong emotions Protein (++++): 1000 mg/dl
,Prolonged orthostatic position )2
Strenuous physical exercise )3
Cold exposure )4
Fever )5
During pregnancy (Pre – eclampsia) )6
-:Pathologic Causes (Persistent) )B(

1- Renal diseases such as pyelonephritis, Nephritis, and bacterial infection of kidney

2- Urinary tract inflammation
3- Acute infectious diseases and acute clinical disorders, such as pains, epilepsy, myocardial

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Urinalysis Examinations _____________________________________________Urinalysis
infarction, stroke, trauma, and after surgery
Kidney-damaging drugs (nephrotoxic drugs) -4
Bladder tumor -5
6- Liver cirrhosis
7- Cardiac disease
8- Thyroid disorders
9- Certain drugs and chemicals intake

Nitrites -2
■ Significance:

- The detection of nitrites in urine can indicate bacterial infection of the kidneys and the urinary
tract.
- Some microorganisms are able to reduce nitrate to nitrite.

Normal Urine Nitrites: Nil ■

"Abnormal Urine Nitrites: "Nitrituria ■

:Medical Causes Of Nitrituria ■

.Bacterial infection of kidneys and urinary tract -

Ketone Bodies -3
:Significance ■
The detection of ketones in urine can indicate diabetic ketoacidosis (one of the cases of diabetes -
.mellitus)
When the body cannot use glucose as a fuel source because there is little or no insulin, the -
body will break down fats and fatty acids to use as fuel causing production of ketones.
- The decrease in carbohydrate metabolism will increase the fat metabolism resulting in
.Production of ketones

Normal Urine Ketone Bodies: Nil ■

"Abnormal Urine Ketone Bodies: "Ketonuria ■

:Medical Causes (Indications) Of Ketonuria ■

.Diabetic Ketoacidosis -1
.Dangerous metabolic abnormalities during pregnancy -2
Concentrations of Ketones by
3- Lipids-rich diet (high amounts of proteins and fats intake).
using screen dipstick
4- Disturbance of carbohydrate metabolism (Low carbohydrates diet).
5- Starvation.
Ketones
6- Acetonemic vomiting of infants (Nil): with
and fever 0 mg/dl
diarrhea caused especially by infections.

Ketones (+): 25 mg/dl

Ketones (++): 100 mg/dl

15
Ketones (+++): 300 mg/dl
Urinalysis Examinations _____________________________________________Urinalysis

Glucose -4
:Significance ■
The detection of glucose in urine can indicate diabetes mellitus -

Normal Urine Glucose: Nil or Normal ■

"Abnormal Urine Glucose: "Glucosuria ■

:Medical Causes (Indications) Of Glucosuria ■

-:Physiologic Causes -1
a) Pregnancy
b) Ingestion of large amounts of carbohydrates
c) Emotional stress

-:Pathologic Causes -2
Hyperglycemia (Diabetes mellitus) (more than 180 mg/dl of glucose in blood) -

Concentrations of Glucose by
using screen dipstick

Negative: 0 mg/dl

Negative or Normal: 20 mg/dl

Glucose (+): 50 mg/dl

Glucose (++): 150 mg/dl

Glucose (+++): 500 mg/dl

Glucose (++++): 1000 mg/dl

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Urinalysis Examinations _____________________________________________Urinalysis

Bilirubin -5
:Significance ■

.The detection of Bilirubin in urine can indicate liver diseases and different forms of jaundice -
Only conjugated (direct) bilirubin (water soluble) is excreted by the kidneys into the urine while -
The Unconjugated (indirect) bilirubin, which is detectable in serum, is not excreted by the
kidneys and is absent from urine

Normal Urine Bilirubin: Nil ■

"Abnormal Urine Bilirubin: "Bilirubinuria ■

:Medical Causes (Indications) Of Bilirubinuria ■

1- Hepatitis (liver cirrhosis and liver cell damage)

2- Biliary obstruction
3- Hemolytic Jaundice
4- Hemolysis (increased breakdown of red blood cells) (Hemolytic Anemia)
5- Drugs use
6- Neonatal hyperbilirubinaemia (the presence of bilirubin in its insoluble form often accumulates
in the child’s brain and causes seizures, visual problems, and mental retardation).

Concentrations of Bilirubin by
using screen dipstick

Negative: 0 mg/dl

Bilirubin (+): 1 mg/dl

Bilirubin (++): 2 mg/dl

Bilirubin (+++): 4 mg/dl

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Urinalysis Examinations _____________________________________________Urinalysis

Urobilinogen -6
:Significance ■

.The detection of urobilinogen in urine can indicate liver diseases and different forms of jaundice -
The urobilinogen is usually converted into two other substances known as -
Stercobilin (responsible for the brown color of feces) -1
Urobilin (responsible for the pale yellow color of urine) -2

Normal Urine urobilinogen: Normal ■

"Abnormal Urine urobilinogen: "Urobilinogenuria ■

:Medical Causes (Indications) Of Urobilinogenuria ■

1- Hepatitis (liver cirrhosis and liver cell damage)

2- Hemolytic Anaemia
3- Poisonings intake
4- Neonatal hyperbilirubinaemia
5- Biliary obstruction

Concentrations of Urobilinogen by
using screen dipstick

Normal: 0 – 1 mg/dl

Urobilinogen (+): 2 mg/dl

Urobilinogen (++): 4 mg/dl

Urobilinogen (+++): 8 mg/dl

Urobilinogen (++++): 12 mg/dl

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Urinalysis Examinations _____________________________________________Urinalysis

Leukocyte Esterase -7
:Significance ■

The detection of leukocyte esterase in urine can indicate presence of leukocytes in urine as a -
.result of renal and urinary tract infection
.The leukocyte esterase is a lysosomal enzyme excreted by leukocytes (Neutrophils) -
The Leukocyturia is the presence of high number of white blood cells in urine, while the pyuria is -
.The presence of high number of pus cells (leukocyte + bacteria) in urine
In medical terminology, leukocytes in urine are referred as pyuria which can indicate not only -
.urinary tract infection but also indicates the presence of pus in urine
Presence of leukocyte esterase in urine refers to presence of white blood cells either as whole -
cells or as lysed cells, while pyuria in urine refers to presence of damaged or lysed white blood
.cells (Pus Cells)

Normal Urine Leukocyte Esterase: Nil ■

"Abnormal Urine Leukocyte Esterase: "Leukocyturia" or "Pyuria ■

:Medical Causes (Indications) Of Leukocyturia ■

Urinary Tract Infection (UTI) -1

Chronic pyelonephritis -2
Cystitis and urethritis -3
Bladder Infection -4
Prostatitis -5
Kidney stones in the urinary tract -6

:Interferences ■

:The following may create a false positive result -

Bacteria and trichomoniasis -1
Vaginal secretions (such as blood and heavy mucus Concentrations
discharge) -2of Leukocyte Esterase by
using screen dipstick
:The following may create a false negative result -
High levels of protein -1 Negative: 0 leukocytes / μl
High levels of vitamin C -2
High levels of glucose -3 Leukocyte Esterase (+): 25 leukocytes / μl

Leukocyte Esterase (++): 75 leukocytes / μl

19
Leukocyte Esterase (+++): 500 leukocytes / μl
Urinalysis Examinations _____________________________________________Urinalysis

Blood -8
:Significance ■

The detection of erythrocytes and hemoglobin in urine can indicate hematuria and hemoglobinuria -
.as a result of serious diseases of the kidneys and the urinary tract
- In case of Hemoglobinuria, the urine will be red, while in case of Hematuria the urine color may be
seen normal.
- Hemoglobinuria occurs as a result of hemolysis of erythrocytes within the vascular system.
- The minimum sensitivity of the test strip is 5 to 10 erythrocytes / μl urine corresponding to approx.
0.015 mg hemoglobin.

Normal Urine blood: Nil ■

"Abnormal Urine blood: "Hematuria" or "Hemoglobinuria ■

:Medical Causes (Indications) of Hematuria and hemoglobinuria ■

1- Urinary tract infection

2- Kidney and bladder stones (calculus)
3- Serious poisonings intake
4- Heart attack
5- Hemolysis after transfusion incident
6- Serious hemolytic anemias.
7- Urinary tract tumors
8- Urinary schistosomiasis caused by schistosoma haemtobium
Prostatitis -9

Concentrations of hemolytic erythrocytes Concentrations of total erythrocytes in urine

(Hemoglobin concentration out of by using screen dipstick
erythrocytes) by using screen dipstick
Negative: 0 erythrocytes / μl
Negative: 0 erythrocytes / μl
Erythrocytes (+): 5 – 10 erythrocytes / μl
Erythrocytes (+): 10 erythrocytes / μl
Erythrocytes (++): 50 erythrocytes / μl
Erythrocytes (++): 50 erythrocytes / μl
20 Erythrocytes (+++): 250 erythrocytes / μl
Erythrocytes (+++): 250 erythrocytes / μl
Urinalysis Examinations _____________________________________________Urinalysis

Microscopic Examination )4(

Pus Cells -1
:Significance ■

.The detection of high numbers of pus cells in urine can indicate renal and urinary tract infection -
Pus cells are produced as a result of defense action of white blood cells toward the invasive -
.bacteria

".Normal Urine Pus cells: "0 – 5 Cell / H.P.F ■

"Abnormal Urine Pus cells: "Pyuria ■

:Medical Causes (Indications) of Pyuria ■

Urinary Tract Infection (UTI) -1

Chronic pyelonephritis -2
Cystitis and urethritis -3
Bladder Infection -4
Kidney stones -5
Prostatitis -6
Urinary Tract Tuberculosis -7
Tumors or cancers of the bladder or kidney -8

Red Blood Cells -2

:Significance ■

The detection of high numbers of red blood cells in urine can indicate serious renal and urinary -
.diseases

".Normal Urine RBCs cells: "0 – 5 Cell / H.P.F ■

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Urinalysis Examinations _____________________________________________Urinalysis

"Abnormal Urine RBCs cells: "Hematuria ■

:Medical Causes (Indications) of Hematuria ■

1- Urinary tract infection

2- Kidney and bladder stones (calculus)
3- Serious poisonings intake
4- Heart attack
5- Hemolysis after transfusion incident
6- Serious hemolytic anemias.
7- Urinary tract tumors
8- Urinary schistosomiasis caused by schistosoma haemtobium
Prostatitis -9

Crystals -3
:Significance ■

The detection of crystals in urine can indicate metabolic disorders, renal calculus (kidney stones) -
.formation, and the regulation of medication
-:The formation of crystals in urine depends on a number of factors which are -
Urine PH -1
Dietary minerals intake -2
Body metabolism -3
Ionic strength of urine -4
Chemical composition of solute components of crystals -5
6- Concentration and solubility of the individual salts
Low fluid intake -7
The crystals precipitated on the kidney can aggregate to form renal calculus (kidney stone) -
The urinary stones can form in the kidney (Nephrolithiasis), the ureter (Ureterolithiasis), or the -
.bladder (Cystolithiasis)
:The urinary stones can cause -
Renal Colic -1
Urinary Urgency -2
Hematuria -3
Sweating, nausea and vomiting -4

”Normal Urine Crystals: “Nil ■

”Abnormal Urine Crystals: “Crystalluria ■

:Types of crystals ■

The crystals can be classified into three types according to urine PH value -

Acidic Crystals Alkaline Crystals Neutral Crystals

Triple Phosphate Crystals Triple Phosphate Crystals

Uric Acid Crystals
(Struvite crystals) (Struvite crystals)

Calcium Oxalate Crystals Calcium Oxalate Crystals Calcium Oxalate Crystals

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Urinalysis Examinations _____________________________________________Urinalysis
Amorphous Urates Ammonium Urates (Biurates) Ammonium Urates (Biurates)

Cystine Crystals Amorphous Phosphates Cholesterol Crystals

Cholesterol Crystals

Bilirubin Crystals

Tyrosine Crystals

Leucine Crystals

-:The crystals can be classified into two types according to their shapes -
.Amorphous Crystals: They are finely aggregating granules without any defining shape -1
.Such as, amorphous urates, Phosphates, and ammonium urates

Organized Crystals: They are crystals having a characteristic shape -2

.Such as, uric acid, calcium oxalate, and struvite crystals

:Properties of crystals ■

Crystals Properties

Uric Acid Crystals It is multiple forms with colorless, yellow, or brown color -

:It is divided into two types -

Calcium Oxalate Crystals Monohydrate: (having dumbbell shape) -1
Dihydrate: (having octahedral or envelope shape) -2

Triple Phosphate Crystals It is similar as colorless prisms (coffin – lids ) or feathery -

Cystine Crystals It is colorless highly refractile hexagonal plates -

Cholesterol Crystals It is colorless plates with broken or “cut-off” corners -

It is granules, needles or rhombic plates having yellow to brown -

Bilirubin Crystals
colors

It is concentric spherical circles with highly refractile shapes and -

Leucine Crystals
having yellow to brown colors

It is fine needles in sheaves which may cross and having colorless -

Tyrosine Crystals
to pale yellow colors

23
Urinalysis Examinations _____________________________________________Urinalysis
It is pinkish – brown granules causing (pink sediment) -
Amorphous Urates
They are passed more often in patients having gout -

Amorphous Phosphates It is colorless or white granules causing (white sediment) -

Ammonium Urates (Biurates) It is similar as “thorn apples” with Yellow – brown color -

Epithelial Cells -4
:Significance ■

The detection of high number of epithelial cells in urine can indicate urinary tract infection, -
inflammation, and malignancies
The epithelial cells are produced as a result of a pathological process from abnormal exfoliation -
.in the renal, urinary, or reproductive origin
.The epithelial cells are produced from epithelial tissues present in the human body -

:Types of Epithelial cells ■

-:The epithelial cells can be divided into three types -

)2(
)1( )3(
Transitional
Squamous Renal Tubular
Epithelial Cells
Epithelial Cells Epithelial Cells
)Urothelial Cells(

The urinary tract

(They transit from the pelvis
The skin
of the kidney to the base of
Location The vagina The nephrons of the kidney
the bladder in females and to
The urethra
the proximal urethra in
males).

More smaller and -1

rounder than transitional
Small swollen renal or -1
epithelium
Large flat cells -1 round – shaped cells
The nucleus occupies -2
The nucleus is small, -2 The nucleus is big, round -2
Properties more of the total cell
round, and centrally and centrally located
.volume
located The cell borders are more -3
Rarely seen in the urine -3
regular
Ability to absorb lipids -4
”calling “Oval Fat Bodies

24
Urinalysis Examinations _____________________________________________Urinalysis
Nephrotic syndrome -1
Vaginal or urethral urine -1 Acute tubular necrosis -2
.contamination Urinary tract infection -1 Viral infections -3
Indication
Squamous metaplasia -2 Malignancy (Neoplasia) -2 Chemical toxins intake -4
.of the bladder Neoplasia -5
lipiduria and proteinuria -6

:Normal Urine Epithelial Cells ■

"Squamous Epithelial Cells: "Nil or Few -

"Transitional Epithelial Cells: "Nil or Few -
"Renal Tubular Epithelial Cells: "Nil -

Casts -5
:Significance ■

.The detection of casts in urine can indicate serious renal diseases -

The urinary casts are cylindrical structures formed in the lumen of the distal convoluted tubules -
.of the kidney and collecting nephrons ducts of the kidney, then dislodge and pass into the urine
- The casts are formed by precipitation of Tamm-Horsfall mucoprotein which is secreted
by renal tubule cells, and sometimes also by albumin in conditions of proteinuria.
- The cast formation process often is associated with proteinuria, and dehydration (low flow,
concentrated salts, low pH).

:Types of Urinary Casts ■

:Hyaline Casts )1(

Composition: Tamm – Horsfall Mucoprotein -

.Formation: They are secreted from the tubular epithelial cells of individual nephrons -
.Shape: Clear, colorless, homogenous, and transparent with rounded ends -
Indication: 1- Vigorous exercise 2- Dehydration 3- Fever -
Diuretics 5- Renal disease 6- Proteinuria -4

:Granular Casts )2(

.Composition: Degenerating cellular casts or aggregated proteins -

.Formation: The breakdown of cellular casts or the inclusion of aggregates of plasma proteins -
.Shape: more cigar-shaped with higher refractive index than hyaline casts -
Types: (a) Fine Granular Casts: Contain fine gray or pale – yellow granules -
Coarse Granular Casts: Contain dark large granules (black appearance) )b(
Indication: 1- Vigorous exercise 2- Chronic renal disease -
3- Glomerular disease 4- Renal Tubular disease
Pyelonephritis 6- Viral infections -5

:Red Blood Cell Casts )3(

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Urinalysis Examinations _____________________________________________Urinalysis
Composition: Red Blood Cells -
.Formation: The inclusion of red blood cells into the tubular cast -
.Shape: cylindrical with sometimes ragged edges and yellowish – brown colored -
Indication: 1- Tubulointerstitial nephritis 2- Glomerulonephritis -
Acute tubular injury (Necrosis) -3

:Pus Cell Casts )4(

Composition: Pus Cells -
.Formation: The inclusion of pus cells into pus cells -
.Shape: cylindrical without cell membranes -
Indication: 1- Pyelonephritis 2- Glomerulonephritis -
Tubulointerstitial nephritis 4- Renal infection or inflammation -3

:Epithelial Cell Casts )5(

Composition: Renal Tubular Epithelial Cells -
.Formation: the stasis and desquamation of renal tubular epithelial cells -
Shape: The epithelial cells in the cast may either be arranged in parallel rows, or in random -
.order
Indication: 1- Acute tubular injury (Necrosis) 2- Toxins intake -
Tubulointerstitial nephritis 4- Cytomegalovirus and viral hepatitis -3
Glomerulonephritis -5

:Fatty Casts )6(

Composition: Lipid – containing renal tubular cells -
Formation: The breakdown of lipid – rich epithelial cells (Fatty degeneration of tubular -
epithelium)
Shape: Hyaline casts with fat globules or oval fat bodies inclusions and having yellow – brown -
.color
Indication: 1- high urinary protein nephrotic syndrome -
Severe necrosis or epithelial cells death -2

:Waxy Casts )7(

Composition: Degenerated granular casts -
Formation: The degeneration of granular casts -
Shape: Broad cylindrical, having a higher refractive index and more rigid with demonstrating -
.sharp edges, fractures, and broken-off ends
Indication: 1- Chronic renal failure -
Hyperdehydration -2

:Normal Urinary Casts ■

.Hyaline Casts: Nil or 0 – 1 / L.P.F -

.Granular Casts: Nil or 0 – 1 / L.P.F -
RBCs Casts: Nil -
Pus Cell Casts: Nil -
Epithelial cell casts: Nil -
Fatty Casts: Nil -
Waxy Casts: Nil -

”Abnormal Urinary Casts: “Cylindruria ■

26
Urinalysis Examinations _____________________________________________Urinalysis

Mucus Threads -6
:Significance ■

.The detection of mucus in urine can indicate urinary tract infection -

Mucus is a yellow – coloured viscous colloidal substance produced from the mucous membrane -
in various organs of the body, including the lungs and the large intestine
The mucus protects the inner wall of the intestine and lubricates the passage of stool for -
.easy elimination
-:The presence of mucus in urine will cause -
Cloudy urine -1
Pain while passing urine -2
Frequent urge to urinate -3

”Normal Urinary Mucus: “Nil ■

:Medical causes (Indications) of urinary mucus ■

Urinary Tract Infection (UTI) -1

Certain sexually transmitted diseases (STD), such as infection caused by the bacteria gonorrhea -2
or chlamydia
Renal stones -3
Malignant tumors of the urinary tract (bladder cancer) -4
Irritable Bowel Syndrome (IBS) (a gastrointestinal disorder that causes temporary damage -5
to the large intestine)
Ulcerative Colitis (Damage of the mucous membranes of the intestine causing formation of ulcers) -6

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Fat Droplets -7

:Significance ■

.The detection of high number of fat droplets in urine indicates Lipiduria (Lipuria) -
.The fat droplets are micro aggregates of (mainly) triglycerides visible within cells -

”Normal Urinary fat droplets: “Nil ■

”Abnormal Urinary fat droplets: “Lipiduria ■

:Medical causes (Indications) of urinary lipiduria ■

Obesity -1
Diabetes Mellitus -2
Hypothyroidism -3

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Organisms -8

”a) Bacteria “Microbial Flora

:Significance ■

.The detection of bacteria in urine can indicate urinary tract infection -

The vast majority of the bacteria in the body are considered harmless by the protective effects of -
the immune system and a few are beneficial. However, a few species of bacteria are pathogenic
.and cause infectious diseases
.Bacteria have a wide range of shapes, ranging from spheres to rods and spirals -
Most bacterial species are either spherical, called “Cocci” or rod-shaped, called “Bacilli”. Bacilli -
.bacteria are more likely to present in urine than cocci bacteria
.Escherichia Coli is the most common bacilli bacterium isolated from urine samples -
Streptococcus and staphylococcus species is the most common cocci bacterium isolated from -
.urine samples
Cocci bacteria must be distinguished from small amorphous crystals, cellular debris, and small -
.fat droplets, all of which show brownian motion in urine
:Bacteriuria may be either the following types -
Symptomatic Bacteriuria: It is accompanied with certain symptoms such as frequent )1
.urination, painful urination, or fever
.It occurs due to bacterial infection in urinary tract
Asymptomatic Bacteriuria: It occurs without symptoms such as in cases of pregnant )2
.women and in patients with diabetes
.It occurs due to contamination in external urethra or vagina
Bacteria can be detected by a urine dipstick test for urinary nitrite or by urinary microscopy and -
.there specific types can be detected by making a bacterial culture

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Staphylococci Streptococci Cocci Bacilli

Bacteria Bacteria Bacteria Bacteria

”Normal Urinary Bacteria: “Nil ■

”Abnormal Urinary Bacteria: “Bacteriuria ■

:Medical causes (Indications) of Bacteriuria ■

Urinary Tract Infection (Cystitis, pyelonephritis or prostatitis) (symptomatic Bacteriuria) -1
External contamination in urethra or vagina (Asymptomatic Bacteriuria) -2

”b) Fungi “Yeasts

:Significance ■

An infection with the fungus Candida in the vaginal area, also called a vaginal yeast infection, stems
from an overgrowth of the fungus Candida albicans, a naturally occurring fungus in the body. It is
important to have a yeast infection verified by a doctor before treating it at home if you've never had a
Candida infection before, since many other vaginal diseases can have similar symptoms. For individuals
who have had vaginal Candida infections previously, the symptoms may be recognizable enough to
allow them to treat themselves with over the counter medications. Candida can also cause oral thrush, an
infection in the mouth. When oral thrush infects a breastfeeding infant, it may also be passed on to the
nipples of the nursing mother. Symptoms may vary slightly from person to person, but there are some
common symptoms that most people with a vaginal yeast infection or thrush experience.

Because yeasts in a urine sample are often contaminants, verification of their presence is a logical first
step. Contamination can be differentiated from colonization or infection by obtaining a new urine
sample to verify funguria. A carefully performed, clean-voided, midstream sample is usually
satisfactory. Occasionally, however, it will be necessary to obtain a catheterized specimen. This is the
case most often in older women or in patients who are unable to comply with directions for obtaining a
clean-voided specimen. For those patients who have an indwelling bladder catheter, it is suggested that
the catheter be replaced with a new device and then the second urine specimen be obtained. If the
second specimen yields no yeasts, then further diagnostic workup is unnecessary.
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Most patients with candiduria are asymptomatic, and yeasts are noted in the urine as a serendipitous
finding on a routine urinalysis or urine culture. Most of these patients do not have a Candida urinary
tract infection (UTI). However, in those individuals who do have symptomatic Candida infections, the
symptoms are indistinguishable from those caused by bacterial infections. Cystitis is associated with
dysuria, urgency, suprapubic discomfort, and rarely fever; pyelonephritis leads to fever, chills, and flank
pain, with or without lower tract symptoms. Oliguria, strangiuria (difficult and painful urination), the
passage of particulate matter, and/or pneumaturia suggest a complication such as the presence of a
fungus ball.

A yeast infection is commonly associated with a weak immune system. Get plenty of rest and know the
triggers that cause your own yeast infections. When taking an antibiotic, consider eating more yogurt or
other foods with probiotics. A low sugar diet can also help avoid yeast infections. Avoid tight jeans or
clothing around the vaginal area. Dry off quickly after bathing and swimming. An increase in heat and
moisture raises the risk of yeast infections. Vaginal yeast infections can be treated with anti-fungal
medicines that are inserted into the vagina as cremes or suppositories.

c) Parasites

Schistosoma Haematobium Eggs -1

:Significance ■

The detection of schistosoma haematobium eggs in urine indicates “Schistosomiasis” which -

is caused as a result of penetration of the infective cercariae inside the skin of human and
then development to adult worm which deposits its eggs in small blood veins in the bladder
.and ureters and then elimination with urine

”Normal Urinary Schistosoma eggs: “Nil ■

:Medical causes (Indications) of urinary schistosomiasis ■

.Ureteritis with hematuria -1

.Bladder cancer -2

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Enterobius Vermicularis Eggs -2

:Significance ■

The detection of enterobius vermicularis eggs in urine indicates “Enterobiasis” which is caused -
as a result of transferring of the infective eggs from the environment contaminated with pinworm
.eggs to the mouth and then these eggs will hatch to give the larvae in the small intestine

”Normal Urinary enterobius vermicularis eggs: “Nil ■

:Medical causes (Indications) of urinary Enterobiasis ■

Urinary tract infection -1

Irritation around the anus -2
Anorexia, irritability, and abdominal pain -3

Trichomonas Vaginalis -3

:Significance ■

The detection of trichomonas vaginalis in urine indicates “Tricohomonasis” which is a sexually -

.transmitted infection (STI) of the urogenital tract
.The trichomonas vaginalis is an anaerobic motile parasitic flagellated protozoan organism -
The organism is most commonly isolated from vaginal secretions in women and urethral -
secretions in men
Trichomoniasis in Women may be asymptomatic or may be associated with symptoms, -
:including
A greenish-yellow, frothy vaginal discharge with a strong odor -1
Painful urination -2
.Vaginal itching and irritation and vulvar irritation -3
.Trichomoniasis in Men may be associated with urethritis but are usually asymptomatic -

”Normal Urinary trichomonas vaginalis: “Nil ■

:Medical causes (Indications) of urinary Trichomoniasis ■

A sexually transmitted infection (STI) in the urogenital tract caused by trichomonas vaginalis -

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