CLINICAL MICROSCOPY

RENAL PHYSIOLOGY

INTRODUCTION TO URINALYSIS ■ presence of glucose in the urine is an indication of overflow due

to disorder or dysfunctional tubule
KIDNEY ○ Other renal threshold substance: amino acids, sodium
● Major organ of the excretory system ■ These may be absorbed actively or passively.
● Aligning the spine, located in retroperitoneal space ○ Substance bound by plasma proteins cannot be filtered
● Bean-shaped, one pair
● About the size of a fist 2. Tubular reabsorption
● Each contains 1-1.5 million nephrons ● Initial start of renal concentration will begin in the descending
loop of Henle
Functions ● In what part of the nephron urine concentration begin? It
1. Removal of waste products of metabolism happens in distal convoluted tubules.
2. Regulation of plasma, water volume ● What part of the loop is said to be impermeable in water?
3. Maintain normal acid-base balance Ascending loop of henle
4. Regulation of blood pressure ○ Only part of nephron without water reabsorption
5. Endocrine function ● Crystals form initially in the ascending loop
● Descending loop of henle
Nephron ○ Concentration of urine starts here and ends in the DCT and
● Functional unit of kidney collecting duct.
○ Composed of 1-1.5 millions of nephrons and each
nephron is capable of making urine 3. Tubular secretion
○ Each nephron is capable of urine formation ● DCT (Distal Convoluted Tubules): Secretion
○ 2-3 millions of nephron ● Last stage of clearing the plasma
● Controls the ability of the kidney to clear waste products and ● There are some substances that are waste products
maintain the body’s water and electrolyte balance ○ Some are not allowed in the glomerulus because of their size
thus, they are not filtered in the glomerulus
JUXTAGLOMERULAR ● There will be some dissociation in the peritubular capillaries
CORTICAL NEPHRONS
NEPHRONS ● Urinary casts are starting to form in this portion (renal
Cortical nephrons are tubules) due to increased protein precipitation
Juxtaglomerular
located in the ● Final end product: Urine
nephrons extend
cortex of the kidney and ○ Collected in urinary bladder, if it is full, there will be a signal
deep into the medulla of
remove from our brain that you need to pee or urinate in order to empty
the kidney
waste products and the bladder
and concentrate in the
reabsorb ○ Urinate = complete emptying of the bladder
urine
nutrients ○ Term of volume of urine left in our bladder after peeing
voluntarily: Residual urine
URINE FORMATION ■ Prone to urinary tract infection
● Composed of three basic steps ■ Not a good indication which means that the bladder is empty
■ Removed in the means of catheterization
1. Glomerular filtration
● Starting from glomerulus at the glomerular capsule 4. Excretion
● Substances that are small enough to pass through the
glomerulus enters the afferent arteriole RENAL BLOOD FLOW
● Substances that are too big to be filtered will exit the efferent ● Renal artery → afferent arteriole → efferent arteriole → proximal
arteriole and be secreted going to your peritubular arterioles convoluted tubule capillaries → vasa recta/loop of Henle → distal
○ Eg. Macromolecules (>7000 kDa), red blood cells convoluted tubule capillaries → renal vein
● Product of glomerular filtration: glomerular filtrate / ultrafiltrate
/ primary urine GLOMERULAR FILTRATION
○ Same specific gravity: 1.010 The glomerulus consists of a coil of approximately eight capillary
○ Contains threshold substances which will be reabsorbed in lobes, the walls of which are referred to as the glomerular filtration
the peritubular capillary barrier. It is located within the Bowman’s capsule, which forms the
○ Primary/major renal threshold substance: glucose (absorbed beginning of the renal tubule.
in PCT) ● Capillaries drop off particles in the blood the body needs to get
■ 100% reabsorption rid of
● Nonselective filtration of plasma substances with MWs less
 CLINICAL MICROSCOPY
than 70,000 kd (MW of albumin is 67,000 kd). ○ Catheterized is only an alternative for urine bacteriology if
patient cannot void urine voluntarily
URINALYSIS
● Part of routine medical examination for check up Catheterized
● Simple test ● Can be used for urine culture as well but it is not really a good
● Non-invasive sample
● Collection of samples is easy ○ Very big chance that the sample is contaminated
● Provides medical information of the patient ○ Sample is taken from the collection bag and the sample
may be contaminated already
URINALYSIS (UA)
● Rapid 24 Hour (Timed)
○ Less than 10 minutes ● Ideal sample for hormone titer and quantitative glucose and
● Reliable protein determination
● Accurate ○ Timed specimen
● Safe ○ Whenever the method is quantitative the specimen of choice is
● Cost-effective the 24-hour urine

TYPES OF COMMON URINE SPECIMENS Three-glass collection

● Random ● Specimen of choice for ruling out prostatic disease or
● First morning bladder infection
● Midstream clean-catch ● Applicable only for males
● Catheterized
● 24 Hour (timed) Suprapubic Aspiration
● Drug screening ● Can be used for culture but ideal for anaerobic urine culture
● Three-glass collection (sample of choice) and sometimes bladder cytology
● Suprapubic aspiration ● CFU less than 100,000 but is still considered significant
● Pediatric specimen ○ Since the environment inside is supposed to be
sterile, so any presence of CFU would mean infection
OVERVIEW OF THE URINE SPECIMENS ● Invasive
Fasting Urine ● Critical quantitative bacteriology
● Not included in the new edition of Strasinger
● Fasting Specimen aka second voided/second voided Pediatric samples
● Infants: cannot communicate time of urination
Random ● Prone to contamination
● Most commonly used for routine urinalysis ● Urologists prefer to collect urine from infants by catching directly
○ No needed preparation using a urine container
○ Can be collected through midstream method ○ Wait 20 minutes after milk intake then try to catch urine in sterile
○ Can be collected anytime container
○ Can detect an obvious renal disorder ■ Technique is also applied to patients with “shy bladder”
■ Even if the sample is diluted the result is significant ● In urine drug screening, if the patient fails to collect after 40
minutes or so of drinking water it must be indicated in the incident
First Morning report (something like the patient is refusing to collect urine for
● Most preferred sample for routine urinalysis drug testing)
○ Concentrated
● Most ideal urine specimen PRESERVATION OF URINE SPECIMENS
● Ideal for pregnancy testing ● Test specimens within 2 hours of collection
● Can be collected through midstream method ○ Numerous changes may occur if not preserved
○ Many changes may happen in the urine sample if not processed
Midstream Clean Catch immediately
● Neither most commonly used nor preferred for routine urinalysis ● Refrigerate specimens that cannot be tested within 2 hours
because it is a technique of obtaining urine samples. ○ Can be valid for the next 4-6 hours; recommended to examine
○ Random and first morning specimens may be collected using specimen immediately
midstream clean catch. ○ If beyond 6 hours, you may request for another sample
■ May be labelled as: First morning collected through midstream ○ Chest box with dry ice during transportation preserves specimen
clean catch or Random collection through midstream clean catch integrity
■ Discard first fraction → collect the middle → discard ○ Addition of chemical preservatives may also be used
the last fraction
● Clean Catch: Specimen of choice for routine urine culture
○ Preferred specimen for urine bacteriology
 CLINICAL MICROSCOPY
CHANGES IN UNPRESERVED URINE
FALSE INCREASE FALSE DECREASE Urobilinogen
Glucose ● Destroyed by light oxidized to urobilin
Sp. Gravity
Clarity ● Inversely proportional: increase in urobilin, decrease in
pH
Urobilinogen urobilinogen
Urobilin
Bilirubin ○ Relationship between urobilin and urobilinogen
Nitrite
Ketone bodies
Bacteria
Trichomonas Bilirubin
Odor (more ammoniacal)
Casts ● Photosensitive
● Oxidized upon exposure to light into other compounds
Usually due to: ○ Biliverdin, bilicyanin
● Bacteria (most common agent)
○ Glucose, nitrite, pH, odor, clarity Ketones
● Exposure to light or air ● Highly Volatile
○ Bilirubin, urobilinogen, ketone bodies ● Volatilization - negative result if sample stands for a long period
○ Light: There is a decrease in melanogen but an increase in melanin of time esp if it is not properly covered
○ Air: Ketone bodies because they are highly volatile ● Volatilized if not examined immediately

INCREASE Trichomonas
Specific Gravity ● Recover alive in order to identify trichomonas (jerky tumbling
● Might be due to multiplication of bacteria motility)
○ bacteria are composed of protein (membrane) ● Hard to differentiate with macrophages if already dead
● Precipitation of crystals
Casts
pH ● May disintegrate over time
● Catabolism of Urea by bacteria causing formation of Ammonia ● Poorly preserved if urine sample is alkaline
○ Proteus vulgaris or Proteus mirabilis ○ add preservatives so that it does not alkalize
○ Proteus mirabilis is more closely associated with pH change and
triple phosphate crystal URINE VOLUME
● Becomes alkaline over time ● Normal: 600-2000 mL/day
● Average: 1200-1500 mL/day
Odor
● Normal odor: faintly aromatic ● Oliguria: Decreased output, less than 400 mL/day [may be
○ ammoniacal: catabolized urea caused by diarrhea, renal failure, dehydration or burns]
○ Physiologic Oliguria → observed due to certain physiologic
Urobilin factors
● Exposed to light oxidizing urobilinogen ■ Ex: Decreased water intake

Nitrite ○ Pathologic Oliguria

● Due to bacteria that are capable of reducing nitrate to nitrite
○ Nitrate reducing: E.coli
○ if nitrite test is + we should expect we’ll be able to see
bacteria specifically bacilli
○ over time bacteria will increase in number
○ when you receive a sample that is already
ammoniacal and has lots of bacteria but negative for
Leukocyte Esterase must request for a new one bc
the sample may be old
DECREASE
Glucose
● Glycolysis will decrease the level of glucose
○ Continuous glycolysis
● Bacteria utilizes glucose as an energy source
■ Ex: severe diarrhea, dehydration, or burns
● Anuria: no urine output
○ Pathologic only, there is no such thing as physiologic anuria
○ Can mean renal failure or there is a complete obstruction
● Nocturia: increased urine output at night (volume excreted
more than 1L)
○ Something to do with renal blood flow or sometimes due to
blood pressure
● Residual urine: a few milliliters of urine left in the bladder after
the patient voids voluntarily
○ Common in UTI because it promotes a medium for bacteria to
grow

Clarity ● Polyuria: increased urine output greater than 2.5 mL/day (2000
● Clear to slightly cloudy or turbid mL according kay sir) [non pathologic causes: increased water,
● May be due to increase in bacterial cells caffeine, alcohol or diuretic intake]
● May be precipitation of some crystals ○ Physiologic Polyuria → observed due to certain
 CLINICAL MICROSCOPY
physiologic factors
● s: increased urine output to excrete excess in
urine glucose
○ Hyperglycemia - increased blood glucose
○ Polyuria - excessive passage of large volumes of urine
○ Polyuria and glycosuria
○ Polyphagia - excessive hunger
○ Polydipsia - excessive thirst
○ There is an increased urine output because you need to
eliminate those excess urine in the body
■ Elimination of glucose must come along with water (urine)
■ Remember: water follows salt so in order to remove solute
(glucose), then you are removing too much of the water.
○ Higher specific gravity
● Diabetes insipidus: increased output caused by lack or
dysfunction of antidiuretic hormone (ADH)
○ ADH aka vasopressin
○ No hyperglycemia
○ Polydipsia - excessive thirst
○ Polyuria - excessive passage of large volumes of urine
■ Polyuria and NO glucosuria
○ Diuresis (eliminating too much water) → because ADH
or the hormone that will prevent diuresis is nonfunctional
○ Dysfunctional or nonfunctional ADH can induce a pathologic
reason like suffering with this type of diabetes insipidus
○ Physiologic type of suppressing ADH: alcohol intake and caffeine
intake
■ Lead to temporarily less functional ADH; hence, why you are
voiding or releasing too much urine
■ If you have dehydration, you are not allowed to drink coffee
because it will make you more dehydrated
● Results in polydipsia (excessive thirst) due to removal of excess
Water
● Diabetes Mellitus
○ 3 Polys (polyuria, polydipsia, polyphagia)
○ Has high specific gravity because of excessive
amount of glucose
■ Remember: How much is to be added to
our urine specific gravity for every 1 g/dL of
glucose?
● Add 0.004 to the initial specific gravity (that much is added by
the glucose in the urine sample)
○ Glucosuria → presence of glucose in urine
○ Hyperglycemia → high glucose level in the blood
● Diabetes Insipidus
○ 2 Polys (polyuria and polydipsia, no polyphagia)
○ Has low specific gravity because urine is highly diluted, failed to
concentrate because there is no ADH or vasopressin
● Specific gravity is arbitrarily in physical exam
○ Reagent strip chemical testing
○ Refractometer counted as physical examination
○ A simple test that can give us an idea that a polyuric patient is
suffering from insipidus and not mellitus
○ S.G. of patient suffering from diabetes insipidus may be as
low as 1.003
■ Remember: No human urine has an S.G.
less than 1.003 and higher than 1.035
■ If a urine has an S.G. of 1.001, then that is
water. Sometimes, if the S.G. is really high,
then it may be contaminated
● Volume
○ In some laboratories, volume is not part of the official lab result
form, although there are still some laboratories who put volume.
○ For the lecturer, volume has no clinical significance if the only
basis is the volume of the container submitted
○ What will we put as the result for the volume?
■ The volume of the urine that you received placed in a urine
container
■ Usually, if a typical urine container is full, then it is 50 mL. If half,
then that is 25 mL. If a little higher than that, then that is 30 mL.
These are approximations
PHYSICAL EXAMINATION OF URINE
● Physical examination of urine consists of describing its:
○ Color
○ Clarity
○ Specific Gravity
○ Note:
■ pH is part of the chemical examination
■ Odour is not reported or part of the result form. Although, in the
textbook, odour is part of the physical testing, in the clinical
laboratory, any clinical sample, odour testing is not part of the
testing process. In other words, we don’t include odour as routine
part of the physical testing
URINE COLOR
● Normal urine is yellow
● Shades of yellow are based on fluid consumption and vary from
pale (dilute) to dark yellow (concentrated)
● Colors other than yellow or red are commonly caused by
contamination or medication.
● Color of urine is influenced by the pigments urobilinogen
(colorless), urobilin, urochrome (major pigment), and uroerythrin
○ Urobilinogen is colorless but when exposed to light, it will be
oxidized into urobilin
○ Uroerythrin binds to amorphous urate crystals and causes pink
coloration the more crystals are present.
● As urine volume increases the color turns pale (higher s.g.)
○ In case of diabetes mellitus, urine volume is high, colour may be
pale, and S.G. is high or concentrated, but in a normal condition,
urine volume is decreased, the colour is darker, and the specific
gravity is higher
● As urine volume decreases the color turns dark (lower s.g.)
○ Not applicable for diabetes mellitus.
○ Diabetes mellitus will always result in high s.g regardless of the
volume or color.
● We can classify urine color into two: abnormal pathologic and
abnormal non-pathologic
● Most of the time, if the color is abnormal, non-pathologic, it is
caused by medication, food and drinks, and most of the time, due
to contaminants.
● Abnormal pathologic- due to disorders or diseases that the
patient is suffering from.
 CLINICAL MICROSCOPY
COLOR CAUSE CORRELATION ○ Caramel-like/ maple syrup-like/ burnt sugar
Orange Bilirubin Produces yellow foam when ○ Observed in Maple Syrup Urine Disease (MSUD)
shaken, abnormal liver function ● Mousy - phenylketonuria
Pyridium Produces thick orange pigment ○ High level of phenylalanine
that can interfere with reagent ○ Perform confirmatory test (ferric chloride test, ...)
strip tests ● Rancid - tyrosinemia
Red RBCs Cloudy urine, positive tests for ● Sweaty feet - isovaleric acidemia
blood, microscopic RBCs ● Cabbage - methionine malabsorption
Hemoglobin Clear urine, positive tests for ● Rotten fish - trimethylaminuria
blood ● Amino acid disorders
Myoglobin Clear urine, positive test for ● Normal urine odor is aromatic
blood, need further testing ● Fecaloid: contaminated by fecal material
Porphyrins Negative tests for blood, needs ● Odor can also be affected by diet (i.e. garlic odor)
further testing
Black Oxidized Clear urine, positive test for CHEMICAL EXAMINATION OF URINE
RBCs, blood ● 2nd component of routine urinalysis
denatured ○ Physical examination
Hgb ○ Chemical examination
Melanin Clear urine, darkens on standing ○ Microscopic examination
● In other references, there are 4 components of routine urinalysis
○ Specimen examination
URINE CLARITY
■ Checks whether or not the specimen is valid or not
● Clarity is judged in the conical container. A well mixed urine
■ Examples: specimens with feces, specimen
sample is placed in a clean, conical centrifuge tube and observed
contaminated with water, overflowing
with a well-lit background, to properly describe the specimen.
specimen, specimen without proper request
● Terminology: clear, hazy, cloudy, turbid, milky
form/physician request, improper labeling
○ Clear - no floating particulates, clear print
○ Physical examination
○ Hazy - few floating particles, print not clear but still readable; at
○ Chemical examination
least 200 wbc per mm3
○ Microscopic examination
○ Cloudy - suspended particles, blurry print, moderate amount of
● Can be done in routine quantity macro method, and wet
particles
laboratory testing
○ Turbid/Milky - Print no longer readable, lipid present (too much
● The chemical examination results is always correlated with the
chylous or lipid present in the urine)
microscopic findings before releasing the results
● Freshly voided normal urine is clear
● Sulfosalicylic testing (SSA) is performed as a confirmatory test
● Refrigerated normal urine
● Can be classified further:
○ White turbidity in urine with an alkaline pH from amorphous
○ Qualitative: reported as +/ - ; present / absent (presumptive)
phosphates and carbonates
○ Pink turbidity in urine with an acid pH from amorphous urates ○ Quantitative: reported in numbers with units (quantity)
(uroerythrin has the ability to bind to amorphous urates crystals)
REAGENT STRIPS
○ It is hard to perfect the description of urine clarity because at first,
● Procedure:
you cannot immediately determine if it is either clear or hazy.
● Non-pathogenic turbidity ○ Mix specimen well
○ Bring specimens to room temperature prior to testing
○ Squamous epithelial cells (initially, it can be considered as non-
○ Dip strip completely but briefly into specimen
pathologic but IF upon microscopic examination, there is the
○ Remove excess urine by blotting the edge of the strip
presence of intracellular short bacilli inside it - that is when you
○ Compare reaction colors with the manufacturer's chart at
consider it as a significant structure. It is also called CLUE CELLS. The
specified time
short rod bacteria is usually
○ Relate findings to each other and to the physical and microscopic
Gardnerella vaginalis (which is a sign of vulvovaginitis)
urinalysis results
○ Mucus (threads)
● Most commonly used testing for chemical components present
○ Amorphous phosphates, carbonates, urates
○ Semen (seminal fluid) in urine
○ The use of reagent strip is the most performed method in chemical
○ Feces
examinations
● The use of reagent strips are very easy (basic)
ODOR
● One on one approach
● Urinod and organic volatile acids
● Bring the sample to room temperature before testing
● Foul - bacterial decomposition (UTI)
● Do not immerse the sample for more than 10 seconds
● Fruity - ketone bodies (plastic balloon/acetone like)
○ Quick dip only
○ High ketone bodies (acetone, acetoacetic acid)
○ The colors of the pads may run over to the other pads
● Burnt sugar - MSUD (branch chain amino aciduria)
● Clean edges with the use of a tissue paper
 CLINICAL MICROSCOPY
● pH
○ Dipping the reagent strip for a prolonged period may cause
runover from adjacent strips
■ For example, protein may runover
● Protein has the same indicator as pH, thus increased protein in
the sample may cause the urine pH to be falsely alkaline (blue
colored result in the reagent pad)
○ Old specimens may cause falsely elevated pH
■ Urea converted to Ammonia
● Makes the sample alkaline
○ High pH & High nitrite
■ Expect high count of bacterial cells
○ Leukocyte esterase and Nitrite would suggest Urinary Tract
Infection (bacteriuria)
○ Should not reach pH 9.0, it indicates an old specimen
● Protein
○ If WBC and nitrite are positive, protein is most likely POSITIVE.
○ Microalbuminuria, Bence Jone proteins, and incomplete
immunoglobulins CANNOT be detected by an ordinary reagent strip,
only for macroalbuminuria
■ The reagent strip has low sensitivity
■ The strip is designed to detect macromolecular protein
● Thus, microalbumin is not detected by the strip and additional
tests must be performed.
○ Micral test
■ Separate and specific strip designed to detect the presence of
microalbumin
■ Optimum reagent strip for proteins
○ Sulfosalicylic Acid (SSA) test
■ Can precipitate almost all types of proteins in a urine sample.
■ Overrides the protein (-) result in the reagent strip.
■ Thus it is performed in common laboratories
○ Heat and acetic acid test
■ Can be done if SSA and other tests are not available
■ Heat + 3% acetic acid (reagent)
● Glucose
○ Oxidizing agents and detergents will give false-positive results.
○ Principle involved: Glucose oxidase test
○ Increased ascorbic acid inhibits enzymatic reactions (glucose
oxidase) that results in false-negative reactions.
■ Ascorbic acid is included in the reagent strip to serve as a control
to explain negative glucose results for diabetic patients (false
negative due to ascorbic acid inhibition).
○ There is a continuous glycolysis in old samples upon standing and
will give out false-negative results.
■ Bacteria will utilize glucose as an energy source.
○ Low temperature also inhibits enzymatic reactions (false-negative
results).
■ One of the factors that speeds up the reaction is the temperature
(enzymes are more reactive in warm temperatures).
○ If the level of glucose is significantly high, this may indicate
uncontrolled diabetes and possible kidney damage.
■ Significantly high glucose and ketones could be a marker for
diabetic ketoacidosis (DKA).
● Ketones
○ Test for ketones: Sodium Nitroprusside test
■ Positive result: Red
■ False-positive result: Red urine
○ Positive glucose usually comes with positive ketones
■ May be due to uncontrolled diabetes mellitus and diabetic
ketoacidosis (DKA)
○ Ketones may be present in cases of starvation
■ The body takes nutrients from non-carbohydrate sources
(gluconeogenesis), thus forming acetoacetic acid
○ Old specimens will give false-negative results since it will volatilize
● Blood
○ RBCs contain peroxidases (oxidizing agents) which can cause false
positive results.
○ Samples with menstrual contamination may only be accepted
during emergency situations
■ Take note that the sample has menstrual contamination (presence
of RBCs with peroxidase)
○ NOTE: Whenever the test is enzymatic and there is elevated
ascorbic acid, most of the time the result will be false-negative due
to enzymatic inhibition caused by the peroxidase or
pseudoperoxidase effect of ascorbic acid
○ The presence of ascorbic acid can be validated by the reagent pad
○ Test for the presence of blood: Tetramethylbenzidine or ortho
toluidine
● Bilirubin
○ Pyridium - makes sample slightly viscous and highly pigmented
(false-positive)
■ Also invalidates the results of other parameters in the test stirp
■ Thus if the specimen is viscous and highly pigmented, the test strip
is usually not used.
○ Correlation with urobilinogen: If a patient is suffering from
complete bile duct obstruction (post-hepatic jaundice) what is the
relationship between urine bilirubin and urine urobilinogen?
■ There will be an increased bilirubin and decreased or negative
urobilinogen
■ Urobilinogen is formed in the small intestine; if there is a complete
bile duct obstruction, bile cannot be released.
■ Complete obstruction in bile duct due to gallstone will result in B2
being not metabolized into urobilinogen in the small intestine
(remains unchanged).
● There will be regurgitation and B2 will be present in the blood and
urine.
■ Stercobilinogen (stool urobilinogen) during complete bile duct
obstruction is decreased, resulting in a gray/clay-colored stool
(acholic stool), due to lack of pigment.
○ Check results with the level of urobilinogen
● Urobilinogen
○ Complete urinary obstruction causes decreased urobilinogen, due
to the obstruction of the common bile duct.
○ Old specimens causes false-negative results, because urobilinogen
is already transformed into urobilin
■ Urobilinogen decrease = urobilin increased because it is the
oxidized form of urobilinogen upon light exposure
 CLINICAL MICROSCOPY
● Tyrosine
● Nitrite ● Cystine
○ Old specimen produces false-positive results due to bacterial ● Bilirubin
contamination ● Cholesterol
○ Non-reductase-containing bacteria yields negative results (NOT ● Sulfonamide
false-negative results) ● Radiopaque Dye
○ Note: A negative nitrite does NOT always say that the patient is Organisms/Artifacts 1. Yeast
NOT suffering from bacteriuria or UTI. 2. Parasite
■ Non-reductase containing bacteria 3. Sperm
● Urine: (-) nitrite; (+) bacteria 4. Bacteria
● Ex: Trichomonas vaginalis, Staphylococcus saprophyticus 5. Fibers - Cotton fibers, are solid and
■ Maybe there are no nitrates present that can be converted to sometimes even have color
nitrite. ● May be mistaken for mucus threads
■ The patient may also be taking antibiotics. which are low refractile, almost
translucent
● Specific gravity ● Mucus threads: Byproducts of RTE
○ High alkaline urine can cause falsely-decreased specific gravity ● Fibers: Contaminant
(false -) 6. Starch
○ pH 6.5 or higher urine → add 0.005 to urine specific gravity
■ Dark colored urine might mask color in strip
■ Indicator: Bromthymol blue
■ High pH → less hydrogen ions are released
→ bromothymol blue turns dark in color.
○ Increased protein can yield false-positive results.

MICROSCOPIC EXAMINATION OF URINE

URINE SEDIMENTS
Cells 1. White Blood Cells
2. Red Blood Cells
3. Epithelial Cells
4. Oval Fat Bodies - RTE cells that absorb
fat
Casts Based on Inclusion:
1. White Blood Cells
2. Red Blood Cells
3. Granular - fine or coarse
4. Fatty
5. Renal

Based on matrix:
6. Waxy - final degenerative form
7. Hyaline - earliest form of casts
Crystals 1. Normal
● Uric Acid
● Hippuric Acid
● Calcium Oxalate
● Triple Phosphate
● Calcium Carbonate
● Calcium Phosphate
● Ammonium Biurate
Can be divided between normal crystals in
acidic urine and normal crystals alkaline
urine

2. Abnormal (Most are found in acidic

urine)
● Leucine