Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician

Collection of the urine sample

For routine analysis, the first morning urine is preferred along with the genitals.
properly washed to avoid contamination by external agents.

For chemical tests, the first urine is preferred because it contains

more concentrated the substances

The samples can be refrigerated if their analysis will be deferred, the crystals
formed can be eliminated by heating the entire sample to 37°C

Obtaining urinary sediment

The well-mixed urine sample (usually 10 to 15 ml) is centrifuged at a

relatively low speed (2,000 to 3,000 rpm) for 5 minutes, the supernatant liquid is
decanted, leaving 0.2 to 0.5 ml of liquid. The sediment is mixed in the liquid
residue through agitation. A drop of resuspended sediment is deposited
about a slide and a coverslip is placed on top of it. There is a stain for
to dye sediment which is called Sternheimer-Malbin which is a mix of violet
of methylene with safranin.

The general urine test (GUT) is divided into three parts:

PHYSICAL EXAMINATION

CHEMICAL EXAMINATION

MICROSCOPIC EXAMINATION

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Physical examination

This exam determines 3 values:

Color

Normal urine presents a wide range of colors, which is determined by its

concentration. The color can range from a pale yellow to a dark amber, depending on the
concentration of urochrome pigments. However, there are many factors and
constituents that can alter the normal color of urine, including medication
and diets, as well as various chemical products present in pathological situations

Color Pathological causes Causes for

medications or
foods
Murky aspect Uric acid, bacteria, stones, High food diet
contamination by fecal matter, rich in purines
erythrocytes, spermatozoa,
yeasts, pus, mucus, liquid
prostatic.
Milky appearance Vaginal creams, pyuria, lipuria,
fats.
Coffee Bile pigments, myoglobin Legumes, levodopa,
metronidazole
nitrofurantoin
Chestnut or black Phenol, melanin, myoglobin, Iron compounds,
bile pigments, levodopa
methemoglobin, porphyrins, acid metronidazole
homogentisic acid resorcinol, quinine
parahydroxyphenylpyruvic. alpha-methyl dopa
nitrofurantoin.
Green or blue Biliverdin, infection by Acriflavine,
Pseudomonas. amitriptyline, blue of
methylene, complex of
vitamin B, thymol.
Strong yellow or Bile pigments (bilirubin), Concentrated urine,
orange urobilin. serotonin, acriflavine
azogastrin
dyes of
foods
phenazopyridine
carrot

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
 Red or brown Porphyrins, porphobilinogen, Phenolphthalein,
purple uroporphyrins beet
rifampicin
blackberry
Pink or red Hematuria, hemoglobinuria, Amiodarone,
myoglobinuria, porphyrins, antipyramine
profobilina. colorants of
food
diphenylhydantoin
beetroot.
White Push, boy. Phosphates or urates.
(Germán Campuzano Maya and Mario Arbeláez Gómez, 2007)

Smell

The normal smell of urine is 'sui generis', it is described as urinoid, this smell can
be stronger in concentrated samples without this implying infection.

Smell Clinical importance

Alcohol Ethanol intoxication
Ammoniacal Urinary tract infections by
bacteria that break down urea
Fecaloid vesico-intestinal fistulas
Fresh fruit or acetone In the presence of ketonuria, acidosis
metabolic
Humidity Phenylketonuria
Rancio Hypermethioninemia, thyroxinemia
Foot sweat Excess of butyric or hexanoic acid
Sulfuric Cystatin decomposition
Hydrogen sulfide Urinary tract infections with
proteinuria
German Campuzano Maya and Mario Arbeláez Gómez, 2007

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Aspect

Normal urine is clear or transparent but can become cloudy due to precipitation.
of crystals, bacteria, or epithelial cells.

Density or specific weight

It is the ratio or quotient between the weight of a volume of urine and the weight of the same.
volume of distilled water. It constitutes an index of the concentration of the material
dissolved in urine; however, it does not only depend on the amount of particles but
also of the weight of these in the solution.

Los valores normales de una muestra de 24 horas son de 1.015 a 1.025 y en muestras
Taken at any time of the day varies from 1.003 to 1.035 this depends on the level of
hydration of the individual.

Chemical exam

This exam assesses 8 parameters which are:

urinary pH

One of the functions of the kidneys is to maintain the acid-base balance in the
organism. To maintain a constant pH in the blood, the kidney must modify the pH
from urine to compensate for the diet and metabolic products. On average the
pH is around 6.

Proteins

In the normal kidney, only a small amount of low molecular weight proteins is
they are filtered in the renal glomerulus. The structure of the glomerular membrane prevents that

high molecular weight proteins including albumin. Most of the

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
filtered protein is reabsorbed in the tubules and only less than 150 mg/24H is excreted.
If these increase in the urine, it may indicate a kidney disease.

Glucose

The amount of glucose that appears in urine depends on the level of blood sugar (glucose in
blood) and the glomerular filtration rate. Generally, there is no glucose in
urine.

Ketones

Ketone bodies are formed during the catabolism of fatty acids and by
Generally, they are not found in urine; their presence may be due to fasting.
prolonged, fever, and patients with metabolic disorders.

Blood

This test detects erythrocytes, hemoglobin, and myoglobin that are usually not present.
they find red blood cells in urine but 1-2 red blood cells is not something abnormal.

Bilirubin

Generally, its presence is not found in urine; it may be due to diseases.

related to the liver.

Urobilinogen

This compound is formed by the catabolism of bilirubin. It is normal to find 1-

4 mg/24h its elevated presence in urine may be due to an intestinal obstruction

Nitrite

This test is used for the diagnosis of bacteriuria caused by bacteria that
they reduce nitrate to nitrite (enterobacteria) an example of these is: E. coli,
Enterobacter, Citrobacter, Klebsiella, etc. (Laurine Graff, 2007)

Carlos Martínez Figueroa

Iguala de la independencia Guerrero on January 28, 2013 Clinical Laboratory Technician
Microscopic examination

Microscopic examination is an essential part of the Uroanalysis, the identification of

cylinders, cells, crystals, and microorganisms help guide the diagnosis of
diseases

Cells

It is possible to identify two types of cells in urinary sediment, those that come from
of the urinary tract and those that come from the blood.

Squamous epithelial cells

They are easily recognized by being large, flat, and irregularly shaped.
They contain a central nucleus and abundant cytoplasm. They mainly come from the
The urethra and the vagina have little diagnostic significance.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Transitional epithelial cells or uroepithelium

They are two to four times larger than leukocytes. They can be rounded,
pear-shaped or with appendicular projections. Occasionally they have two nuclei.
They review the urinary tract from the renal pelvis to the proximal portion of the urethra,
when its presence increases it is indicative of inflammation.

Carlos Martínez Figueroa

Iguala de la independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Epithelial cells of the renal tubule

They are slightly larger than leukocytes and have a large, round nucleus.
They can be flat, cubic, or cylindrical. The elevated presence of these cells indicates
tubular damage and pyelonephritis.

Erythrocytes

They can originate from any point of the urinary tract from the glomerulus to the
urinary meatus. They can appear in various forms, depending on the medium of the urine;
when the sample is fresh, the red blood cells appear normal in color
pale or yellowish biconcave discs. In diluted or hypotonic urine, the red blood cells
They swell and can be lysed. The lysed cells, which are formed as corpuscles
ghosts. In hypertonic urines, there is cremation of the red blood cells (they become
toothy). Normally, red blood cells do not appear in the urine; however, the presence
1-2 red blood cells/high power field (40x)

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
 Dysmorphic erythrocytes

Leukocytes

They can enter at any point of the urinary tract. On average, urine can
contain up to 2 white blood cells per high power field (40x). The leukocytes
they generally have a spherical shape and dark gray or yellow-green color. They can
to appear in isolation or forming aggregates. When the leukocytes expand
In diluted urine, its granules may exhibit Brownian motion.
Lulas are called "sparkling cells." They appear in large quantities in case
of infections, when there is an elevation of leukocytes and no bacteriuria indicates
mycobacterial infection, Chlamydia trachomatis, Mycoplasma ssp .

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013, Clinical Laboratory Technician
Crystals

Usually, crystals are not found in freshly emitted urine, but they appear
letting it rest for a while. When the urine is oversaturated with a
particular crystalline compound, or when its solubility properties are
they are altered, the result is the formation of crystals. In some cases this
precipitación se produce en el riñón o en el tracto urinario, y puede dar lugar ala
formation of urinary calculi.

Acidic urine

The crystals found in acidic urine are uric acid, calcium oxalate and
amorphous urates.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013, Clinical Laboratory Technician
Uric acid

They can appear in very diverse shapes, the most characteristic ones are in the shape of a diamond or

rhombic prism and that of rosette. They are often tinted by pigments.
urinary and consequently have a yellow or red-brown color. The presence of these
Crystals can constitute an abnormal fact. They occur in pathological states.
like: gout, increased purine metabolism, acute febrile illnesses,
chronic nephritis and Lesch-Nyhan syndrome.

Carlos Martínez Figueroa

Iguala de la Independencia, Guerrero, January 28, 2013 Clinical Laboratory Technician
Calcium oxalate

Son incoloros, de forma octaédrica o de “sobre”, parecen cuadrados pequeños

crossed by intersecting lines. They can normally exist in the urine, in
especially after consuming foods rich in oxalate. High amounts of this
crystals in urine, especially when freshly emitted, suggest the possibility of kidney stones.
of calcium oxalate. The pathological states in which these crystals are found
in high amounts are; ethylene glycol poisoning, diabetes mellitus,
liver disease and severe chronic kidney disease.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Amorphous urate

Often there are urate salts (of sodium, potassium, magnesium, and calcium) in the urine.
a non-crystalline, amorphous form. They have a granular appearance and yellow-red color.
They lack clinical significance.

Hipuric acid

They are yellow-brown or colorless elongated prisms or plates. They can be as thin as...
they look like needles and are often grouped. They lack clinical significance.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero on January 28, 2013 Clinical Laboratory Technician
Sodium urate

They can exist as amorphous substance or as crystals. The crystals are needles or
thin, colorless or yellowish prisms that appear in groups or clusters.
They lack clinical significance.

Calcium sulfate

They are thin, long, colorless needles or prisms, identical in appearance to crystals.
calcium phosphate (alkaline urine) the pH of the urine is what helps to
differentiate them. They lack clinical significance.

Carlos Martínez Figueroa

Iguala de la Independencia, Guerrero, January 28, 2013, Clinical Laboratory Technician
Cystine

They are hexagonal, refractive, and colorless plates whose sides can be equal or not.
They have a stratified or laminated appearance. They appear in patients with cystinosis or
with congenital cystinuria and can form stones

Leucine

They are oily spheroids, highly refractive, yellow or brown in color with
radial or concentric striations. They have significant clinical importance. They are found
in the urine of patients with maple syrup urine disease, with syndrome
by Smith and Strang and with severe liver diseases such as terminal cirrhosis,
severe viral hepatitis and acute yellow liver atrophy.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Tyrosine

They are very fine, highly refractive needles that appear in groups or clusters.
Accumulations of needles often appear black. They appear in diseases.
severe liver disease, in tyrosinemia and in Smith and Strang syndrome.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Cholesterol

They are large, flat, and transparent plates with jagged edges. The presence
cholesterol plaques in the urine are an indication of excessive tissue destruction; these
crystals are observed in nephritic and nephrotic syndromes, and also in cases of
quiluria.

Bilirubin

In some cases, bilirubin can crystallize in the form of needles or granules.

red color to reddish-brown. Its presence only indicates the presence of bilirubin in urine.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
 Alkaline urine

Among the crystals that can be found in urines are the following:

Carlos Martínez Figueroa

Iguala de la independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Triple phosphate

They can exist in neutral and alkaline urines. They are colorless prisms of three to six.
faces that often have oblique extremes. They are found in normal urines.
although they can also form kidney stones. They can appear in the following
pathological processes; chronic pyelitis, chronic cystitis, prostate hypertrophy and in the
cases in which there is urinary bladder retention

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Amorphous phosphate

They are often present in the urine in a non-crystalline form, that is, as
amorphous substance. They are indistinguishable from amorphous urates; the pH of the urine helps to
distinguish them. They lack clinical significance.

Calcium carbonate

They are small and colorless, appearing in spherical form or like gym weights or in
large granular masses. They lack clinical significance.

Calcium phosphate

They are long, thin, and colorless prisms with a pointed end, arranged
forming rosettes or stars or in the shape of needles. They can also form plates
granular, large, thin, and irregular floating on the surface of the
urine. They appear in normal urine but also form stones.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013, Clinical Laboratory Technician
Ammonium biurate or ammonium urate

Their spherical bodies are chestnut yellow. With long and irregular spines.
They can also appear without spicules. They are abnormal if found in urine.
recently issued

Carlos Martínez Figueroa

Iguala de la Independencia, Guerrero, January 28, 2013, Clinical Laboratory Technician
Cylinders

They form in the light of the kidney tubules. They can form by precipitation and
gelatinization of Tamm-Horsfall mucoprotein, by clustering of cells or of
other materials within a protein matrix. The factors involved in the
the formation of cylinders is: urinary stasis, increased acidity, elevated
concentration of solutes and the presence of abnormal ionic constituents or
proteins

Hyaline cylinder

They are formed by the gelled Tamm-Horsfall protein and can have
inclusions. They are colorless, homogeneous and transparent and generally have extremes.
rounded ones are not associated with any disease.

Carlos Martínez Figueroa

Iguala de la Independencia, Guerrero, January 28, 2013, Clinical Laboratory Technician
Erythrocyte cylinders

The presence of these means hematuria of renal origin. They are brown in color or
colorless they can to contain few erythrocytes o many.

Leukocyte cylinders

They are observed in kidney infection and in inflammatory processes of non-infectious causes.
It may contain few or many polymorphonuclear cells.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013, Clinical Laboratory Technician
Granular cylinders

They can be formed from the degeneration of cellular cylinders or by the

direct aggregation of serum proteins in a mucoprotein matrix. They indicate
kidney disease.

Cylinders of epithelial cells

They are formed as a consequence of urinary stasis and the shedding of cells from the
tubular epithelium. They are mainly found in diseases that affect the
tubules or after exposure to nephrotoxic agents or viruses (cytomegalovirus,
hepatitis virus.

Carlos Martínez Figueroa

Iguala de la independencia Guerrero, January 28, 2013, Clinical Laboratory Technician
Cylindrical cores

These have a very high refractive index, are yellow, gray, or colorless and
they have a uniform and homogeneous appearance with blunt or cut ends. It has been
postulates that are formed from the degeneration of granular cylinders. We
they present in patients with severe chronic renal failure, malignant hypertension,
renal amyloidosis and diabetic nephropathy, acute kidney disease, inflammation and
tubular degeneration.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013, Clinical Laboratory Technician
Grease cylinder

They are those that incorporate droplets of fat or oval fatty bodies. They are observed
when there is fatty degeneration of the tubular epithelium as in tubular disease
degenerative. They are frequently observed in nephrotic syndrome,
diabetic glomerulosclerosis, lipoid nephrosis, chronic glomerulonephritis, etc.

Carlos Martínez Figueroa

Iguala de la independencia Guerrero January 28, 2013 Clinical Laboratory Technician
Diverse structures

Bacteria

Normally, there are no bacteria in the urine at the renal and bladder levels, but it can
to get contaminated by bacteria present in the urethra or in the vagina. These are reported
depending on their quantity as scarce, abundant, or moderate. When there are
moderate bacteria with the presence of elevated leukocytes indicates infection of the
urinary tract.

Mushrooms

Mycotic cells are uniform, colorless, generally ovoid in shape with

double refractive wall. They can show budding. They can be found in
urinary tract infections, especially in diabetics. The most common fungus
find Candida albicans.

Carlos Martínez Figueroa

Iguala de la Independencia, Guerrero, January 28, 2013 Clinical Laboratory Technician
Spermatozoids

They are normal in male urine and occur after an epileptic seizure.
nocturnal emissions, diseases of the genital organs and in spermatorrhea and
also after intercourse in both sexes.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero January 28, 2013 Clinical Laboratory Technician
Mucus filaments

They are elongated, thin, and wavy structures. They exist in the urine.
usually in small amounts, but can be very abundant in cases of
inflammation and irritation of the urinary tract.

Fat oval bodies

They are necrotic renal tubule cells with droplets of fat inside them as well.
They can be macrophages or leukocytes. It is often observed in the syndrome.
nephrotic, diabetes, eclampsia, renal intoxication, fat embolism, etc.

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013 Clinical Laboratory Technician
Artifices

Starch crystals

They are rounded or oval in shape, highly refringent, and of variable size.

Fibers

They are the most common type of artifact. They come from clothing, diapers, toilet paper or
when the slides or cover slips are cleaned.

Carlos Martínez Figueroa

Iguala de la Independencia, Guerrero, January 28, 2013, Clinical Laboratory Technician
Parasites

Trichomonas vaginalis

The parasite that is most frequently observed is very commonly seen in urine.
woman

Enterobius vermicularis

Schistosoma haematobium

Carlos Martínez Figueroa

Iguala de la Independencia Guerrero, January 28, 2013, Clinical Laboratory Technician
Bibliography

Germán Campuzano Maya, Mario Arbeláez Gómez, 2007. The Uroanalysis: A great ally of
doctor. Colombian urology 67–92.
Laurine Graff, 2007. Urinalysis: Color Atlas. Médica Panamericana Publishing, Mexico.

Carlos Martínez Figueroa

Iguala de la independencia Guerrero on January 28, 2013 Clinical Laboratory Technician