SEMINAR:

ROUTINE URINALYSIS

Brandon Bryan C. Balawen, RMT, MD

3 Components

1.Physical/Gross Examination
2.Chemical Examination
3.Microscopic Examination

2
1. Physical or Gross Examination

• Routine:
• Color
• Clarity or turbidity
• Specific Gravity

• Other characteristics:
• Odor
• Foam
3
2. Chemical Examination

• Routine: 4 parameter
1.pH
2.Glucose
3.Protein
4.Specific Gravity

4
• Special Cases: 10/11 parameter
1. pH
2. Glucose
3. Protein
4. Specific Gravity
5. Blood
6. Leukocyte Esterase
7. Nitrite
8. Ketones
9. Bilirubin
10.Urobilinogen
11.Ascorbic acid
5
3. Microscopic Examination

• Identification and enumeration of urinary sediments

6
1. Physical Examination

7
A. Color

• Normal color: Colorless to amber

8
A. Color

• Pigments:
1. Urochrome:
○ Excretion is directly proportional to metabolic rate
■ Thyrotoxicosis
■ Fever
■ Fasting states (starvation)
■ Long standing urine at room temperature
9
A. Color

2. Uroerythrin
○ Pink pigment
○ Brick red dust precipitate after refrigeration

2. Urobilin
○ Orange brown pigment
○ Oxidation product of urobilinogen
○ Imparts orange-brown color to urine that is not fresh

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11
Significance of Color

1. Reflects hydration state of an individual

2. Variations:
○ Indicate presence of a disease state
○ Metabolic abnormality
○ Ingestion of food or drug

12
How is urine color determined?

• Good light source

• Looking down through the container
• White background

13
B. Urine Clarity or Turbidity

• Transparency/turbidity of urine specimen

• Rapid quality check for the microscopic examination
• Normal clarity: Clear for a fresh “clean catch”
specimen

14
Reporting of Clarity

Description Reporting
No (or rare) visible particulates, Clear
transparent
Few particulates, print easily seen Hazy
through urine
Many particulates, print blurred through Cloudy
urine
Print cannot be seen through urine Turbid
May precipitate or be clotted Milky

15
How is urine clarity determined?

• Mixed specimen
• In front of a light source

16
17
C. SPECIFIC GRAVITY

• Ratio of urine density to the density of an equal volume

of pure water under specific conditions
• Number of solutes and their molecular sizes affects SG
• Normal SG:
• Random: 1.003-1.035
• 24 hour: 1.015-1.025

18
C. Specific Gravity

• Methods of Determination:
A.Direct
1. Urinometer
2. Harmonic Oscillation Densitometry
3. Falling Drop Method

A.Indirect
1. Refractometer
2. Reagent Strip
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A.1. Urinometer

• Aka Hydrometer
• It is a weighted glass float with a long, narrow,
calibrated stem
• Works on the principle of displacement
• The float displaces a volume of liquid (sink) equal to its
weight
• In distilled water, it is designed to sink to the 1.000 level
• In solutions of greater density (more solutes), it would
displace a smaller volume (sink less), and the SG reading is
greater than 1.000
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Disadvantages

• A large volume (10 to 15 mL) is required

• The container must be wide enough to allow it to float without
touching the sides and deep enough that it does not rest on the
bottom
• Must be calibrated daily
• Temperature corrections are needed for specimens with a
difference of 3˚C from the calibrated temp. (usually 20˚C)
• Corrections are required when large amounts of glucose or
protein are present

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Temperature Corrections

• For every 3˚C below calibration temperature

• Subtract 0.001 from the reading

• For every 3˚C above calibration temperature

• Add 0.001 to the reading

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Glucose and Protein Corrections

• For each g/dL of glucose present, SG is increased by 0.004

• 0.004 must be subtracted for each g/dL of glucose present

• For each g/dL of protein present, SG is increased by 0.003

• 0.003 must be subtracted for each g/dL of protein present

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A.2. Harmonic Oscillation Densitometry

• U-shaped glass container

• Electromagnetic coil & a motion detector
• A sound wave of fixed frequency: pass through the sample
• Detected: frequency attenuation
• Observed frequency is directly proportional to the specific
gravity of the urine sample

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26
A.3. Falling Drop Method

• More accurate than the refractometer

• More precise than urinometer
• Specially designed column filled with water-immiscible oil

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B.1. Refractometer

• Aka TS/Total Solids Meter

• Refractive index
• The concentration of dissolved particles present in urine
determines the velocity and angle at which light passes
through it
• Specific gravity scale is calibrated in terms of the angles at
which the light passes through the specimen

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Factors Affecting Refractive Index

1. Temperature of the solution

2. Concentration of the solution
3. Wavelength of light

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Advantages:

1. Needs a small amount of urine (1-2 gtt)

2. Temperature corrections are not necessary.
○ Corrections for glucose and protein still calculated.

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Glucose and Protein Corrections

• For each g/dL of glucose present, SG is increased by

0.004
• 0.004 must be subtracted for each g/dL of glucose present

• For each g/dL of protein present, SG is increased by

0.003
• 0.003 must be subtracted for each g/dL of protein present

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Other Notes

• Reading is generally slightly lower than that obtained

using a urinometer by about 0.002.
• The refractometer scale goes only to 1.035
• Dilute specimen with distilled water.
• Retake reading.
• Multiply reading by dilution factor.

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Calibrations

• Checked daily, or whenever it is in use

• Performed using:
a. Distilled water : 1.000
b. 3% NaCl : 1.015 ± 0.001
c. 5% NaCl : 1.022 ± 0.001
d. 9% sucrose : 1.034 ±0.001

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34
B.2. Reagent Strip

• Indirect colorimetric measurement estimation of urine density

• Based on the quantity of ionic or charged solutes (Na+, Cl-, K+, NH4+)
present
• Principle: based on the change in pKa (dissociation constant) of a
polyelectrolyte in alkaline medium.
• Polyelectrolyte
• pH indicator (Bromthymol blue)
• Buffer (maintain alkaline pH)
• Not affected by high amounts of glucose, protein, or radiographic
contrast media

35
 COOH COOH
COOH
POLYELECTROLYTE ON COOH
COOH REAGENT STRIP COOH

+- +-+-
IONS IN URINE
-+ -+-+

COOH COOH COO-H+ COO-H+

COO-H+ COO-H+ COO-H+ COO-H+
COOH COOH COO-H+ COO-H+
2H+ - Bromthymol Blue 6H+ - Bromthymol Blue

Blue-green in alkaline pH Yellow-green in acid pH

D. Odor

• Gives an idea of what metabolites may be present in

urine
• Freshly voided urine has a faint aromatic odor and as
the specimen stands, the odor of ammonia (due to
breakdown of urea) becomes more prominent

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E. Foam

• Take note of color or urine foam after vigorous shaking

of urine
• Stable white foam: Moderate to large amounts of
protein(albumin)
• Yellow foam: Bilirubin in sufficient amounts

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2. Chemical Examination

41
Reagent Strips

• Inert plastic strips with reagent-impregnated test pads

• A colorimetric reaction takes place when the test pads comes in
contact with urine
• Major brands:
• Multistix
• Chemstrips
• vChemstrips
• Aution Sticks
• Single or multiple testing areas
• Albustix
• Chemstrip 2LN and Multistix 2
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Reagent Strip Technique

1. The urine sample must be fresh or

adequately preserved.
○ Refrigerated specimens: return to room
temp

2. Test urine as soon as possible after receipt

3. Dip the reagent strip briefly into a well-

mixed uncentrifuged urine specimen at room
temp.

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 Reagent Strip Technique

4. Remove excess urine by touching

the edge of the strip to the
container as the strip is
withdrawn.
Blot the edge of the strip to an
absorbent paper.
Do not lay reagent strip directly on
workbench surface.

44
 Reagent Strip Technique

5. Wait for the specified amount of time for

the reaction to occur

6. Compare the color reaction of the strip

pads to the manufacturer’s color chart in
good lighting

7. Know source of error, sensitivity, and

specificity of each test on the reagent strip

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Heat and Acetic Acid Test

• Principle:
• Urinary protein is coagulated by heat and precipitated
by acetic acid and the degree of turbidity produced is
proportional to the amount of protein present.
• Lower part serves as control.

46
Heat and Acetic Acid Test

47
 Results and Interpretations

Result: Observations: Concentration:

(-) Absence of cloudiness
Trace ± Faint cloudiness (cloudiness is barely Less than 0.1g/L
visible)
(+) Cloudiness without granularity 0.1g/L
(++) Granular cloudiness 0.1-0.2g/L
(+++) Precipitation and flocculation (cloudiness is 0.2-0.4g/L
heavy with distinct floccule)
(++++) Thick solid precipitation (Cloudiness is ≥0.5g/L
dense with large floccule)
1. pH (DOUBLE INDICATOR SYSTEM)

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2. CHON (PROTEIN ERROR OF INDICATORS)

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3. GLUCOSE (DOUBLE SEQUENTIAL ENZYME
REACTION)

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4. KETONES (NA NITROPRUSSIDE REACTION)

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5. BILIRUBIN (DIAZO/AZOCOUPLING REACTION)

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6. UROBILINOGEN (EHRLICH / DIAZO REACTION)

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7. BLOOD (PSEUDOPEROXIDASE REACTION)

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8. LE (ESTER HYDROLYSIS & DIAZO REACTION)

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9. NITRITE (GRIESS REACTION)

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MICROSCOPIC EXAMINATION
OF URINARY SEDIMENTS

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OUTLINE
▪ STANDARDIZATION OF SEDIMENT PREPARATION
▪ A. URINE VOLUME
▪ B. CENTRIFUGATION
▪ C. SEDIMENT PREPARATION
▪ D. VOLUME OF SEDIMENT EXAMINED
▪ E. EXAMINING THE SEDIMENT
▪ F. REPORTING FORMATS
▪ G. CORRELATING RESULTS
STANDARDIZATION OF SEDIMENT PREPARATION

Factors: Require Standardization

Urine volume used
Speed of centrifugation
Time of centrifugation
Volume sediment examined
Concentration of sediment
prepared
Reporting of results
e.g. 10mL, 12mL, 15mL
400 0r 450 x g
5 minutes
0.02 mL
e.g. 12:1 (KOVA system)
Format, terminology, reference
intervals, magnification used
for assessment

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A. URINE VOLUME

▪ Recommended vol: 12 mL
▪ multi-parameter rgt strips: easily immersed
▪ capped centrifuge tubes: calibrated to 12 mL
▪ Vol: 10 – 15 mL can be used
▪ If not possible: pediatric patients
▪ reduced to 6 mL
▪ results x 2
▪ Actual vol. < routine vol.
▪ should be noted

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B. CENTRIFUGATION

▪ Speed and time of centrifugation: consistent

▪ 400 – 450 x g for 5 minutes
▪ optimal sediment concentration
▪ w/o damaging fragile formed elements
▪ Braking mechanism should not be used
▪ disruption of the sediment prior to decantation
▪ resuspension of sediments: Falsely ↓ formed elements
▪ Prevent biohazardous aerosols
▪ capped tubes

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C. SEDIMENT PREPARATION

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C. SEDIMENT PREPARATION

▪ Resuspension of sediments
▪ Thorough
▪ provide equal distribution of elements in the microscopic
examination fields
▪ Gentle agitation
▪ use of pipettes
▪ repeated tapping the tip of tube w/ finger
▪ Vigorous agitation: not allowed
▪ disrupt some cellular elements
▪ fragile and brittle formed elements: RBC and waxy casts

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D. VOLUME OF SEDIMENT EXAMINED

▪ Consistent for each specimen

▪ Conventional glass-slide method/ “Drop on a slide”
▪ recommended vol: 20 µL (0.02 mL)
▪ covered by 22 x 22 mm glass cover slip
▪ Disadvantages of using cover slip:
▪ Heavier components (i.e. casts): pushed near the edges
▪ Uneven distribution of sediments
▪ Flowing of specimen outside of cover slip
▪ may result to loss of heavier elements (i.e. casts)
▪ Bubbles may form

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E. EXAMINING THE SEDIMENT

▪ Performed in a consistent manner

▪ Minimum of 10 fields lpf and hpf
▪ Examine under the low power first
▪ to detect casts
▪ ascertain the general composition of the sediment
▪ Unstained preparations:
▪ reduced/subdued light: must be used
▪ to detect entities w/ low refractive index

67
F. REPORTING FORMATS

▪ Terminology and methods of reporting: consistent

▪ Routinely:
▪ casts: average no. / lpf
▪ RBCs and WBCs: average no. / hpf
▪ Epithelial cells, crystals and other elements
▪ semi-quantitative terms
▪ rare, few, moderate, and many
▪ 1+, 2+, 3+ and 4+
▪ Reference ranges for each microscopic element: included in the
report form

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TERMS Description

Rare (1+) Present, but hard to find

Few (1+) One (or more) present in almost every field of

view (FOV)
Moderate Easy to find; number present in FOV varies
(2+) “more than few, less than many”

Many (3+) Prominent: large number present in all FOVs

Packed (4+) FOV is crowded by or overwhelmed with the

elements
G. CORRELATING RESULTS

▪ Microscopic observation
▪ correlated w/ physical and chemical findings
▪ to ensure accuracy of report

▪ Specimens in w/c results do not correlate

▪ rechecked for both technical and clerical errors

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Microscopic Physical Chemical
RBCs Turbidity + Blood
Red color + Protein
WBCs Turbidity + Protein
+ Nitrite
+ LE
Epithelial cells Turbidity
Bacteria Turbidity ôpH
+ Nitrite
+ LE
Crystals Turbidity pH
OUTLINE

▪ ORGANIZED SEDIMENTS
▪ A. Epithelial cells
▪ B. Miscellaneous structures
▪ C. Formed elements
▪ D. Urinary casts
▪ UNORGANIZED SEDIMENTS
▪ A. Normal crystals
▪ B. Abnormal crystals

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A. EPITHELIAL CELLS

▪ A.1. Squamous epithelial cells

▪ A.2. Transitional epithelial cells
▪ A.3. Renal tubular epithelial cells
▪ A.4. Oval fat bodies

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A.1. SQUAMOUS EPITHELIAL CELLS

▪ Largest cells in the sediment

▪ Thin, flat single cells w/ angular border
▪ may be anucleated
▪ Correlation: contamination
▪ Clue cells:
▪ indicative of vaginal infection: Gardnerella vaginalis
▪ SEC studded w/ bacteria

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A.2. TRANSITIONAL EPITHELIAL CELLS
▪ AKA Urothelial cells
▪ From renal pelvis, ureters, urinary bladder, urethra
▪ Variable size and shape
▪ superficial cells: round or pear-shaped
▪ intermediate cell: polygonal (smaller)
▪ basal cell: cuboidal
▪ ↑presence: urologic procedures (catheterization)
▪ not clinically significant
▪ ↑ cells w/ abnormal morphology
▪ vacuoles and irregular nuclei
▪ viral infection or malignancy
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A.3. RENAL TUBULAR EPITHELIAL CELL

▪ Most clinically significant

▪ Originate from the nephrons (renal tubules)
▪ > 2 RTE cells/hpf
▪ indicative of renal tubular injury

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 Proximal convoluted Distal convoluted tubular Collecting duct cells
tubular cells cells

Shape: Oblong or cigar- Shape: Oval to round Shape: cuboidal,

shaped polygonal or columnar
(Resembles granular cast) (Look for a flat edge)

Nucleus: eccentric, can be

multinucleated Nucleus: small dense, Nucleus: large, covers 60-
eccentric 70% of the cell
Cytoplasm: grainy
Cytoplasm: grainy Cytoplasm: less grainy
85
A.4. OVAL FAT BODIES

▪ RTE cells laden w/ highly refractile fat droplets

▪ Fat droplets: birefringent and anisotrophic
▪ polarized light: “Maltese cross appearance”
▪ Correlation:
▪ extensive tubular degeneration
▪ nephrotic syndrome

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91
B. MISCELLANEOUS STRUCTURES

▪ B.1. Bacteria
▪ B.2. Yeast
▪ B.3. Parasites
▪ B.4. Mucus threads
▪ B.5. Spermatozoa

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B.1. Bacteria

▪ Identified by their characteristic rod shape

▪ Can be mistaken as amorphous urate/phosphate
▪ Correlation:
▪ infection
▪ contamination

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B.2. YEAST

▪ colourless, small, oval, refractile

▪ w/ buds and mycelia
▪ in singles, chains, or budding
▪ Often found in patients w/ DM
▪ can be mistaken as RBCs
▪ Primary yeast: Candida albicans
▪ A true yeast infection
▪ accompanied w/ ↑ WBCs

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B.3. PARASITES

▪ Most common: Trichomonas vaginalis

▪ pear-shaped, motile and flagellated
▪ from genital secretions
▪ Clinical significance: Trichomoniasis
▪ Schistosoma haematobium
▪ large terminal spine
▪ Enterobius vermicularis eggs
▪ fecal contaminants

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B.4. MUCUS THREADS

▪ Single or clumped threads w/ low refractive index

▪ can be mistaken as hyaline casts or cylindroids
▪ Clinical significance:
▪ UTI
▪ Irritation of the urinary tract

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B.5. SPERMATOZOA

▪ Not reported in routine UA

▪ Found in urine: sexual intercourse or emission
▪ Rarely considered clinically significant
▪ except in cases of fertility and retrograde ejaculation

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C. FORMED ELEMENTS

▪ C.1. Pus cells

▪ C.2. Glitter cells
▪ C.3. Leukocyte /WBC
▪ C.4. Erythrocyte /RBC

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C.1. PUS CELLS

▪ Degenerated neutrophils
▪ cellular debris compacted into a mass
▪ spherical, slightly smaller than WBC
▪ Anucleated granular cytoplasm
▪ Clinical Significance:
▪ UTI
▪ Kidney stones

106
C.2. GLITTER CELLS

▪ urine SG < 1.019

▪ WBCs in hypotonic urine
▪ Formation:

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C.3. WBCs

▪ Normal value: ≤5 WBC/hpf

▪ Spherical, nucleated, granular cytoplasm
▪ Clinical Significance:
▪ pyelonephritis, UTI
▪ Neutrophil: most predominant type
▪ Eosinophil: drug-induced interstitial nephritis
▪ Lymphocytes: early stages transplant rejection
▪ WBC Vs RTE cell
▪ RTE cells are larger and more polyhedral in shape
110
C.4. RBCs

▪ Normal value: ≤2 RBC/hpf

▪ Shape: depends on the urine concentration
▪ swollen: diluted urine
▪ crenated: concentrated urine
▪ swollen, partly hemolyzed, crenated RBCs
▪ sometimes difficult to distinguish from WBCs
▪ Dysmorphic RBCs: glomerular bleeding
▪ Clinical Significance:
▪ Kidney trauma, UT stones, glomerulonephritis

113
D. URINARY CASTS

▪ D.1. ACELLULAR ▪ D.2. CELLULAR

▪ D.1.1. Hyaline cast ▪ D.2.1. RBC cast
▪ D.1.2. Granular cast ▪ D.2.2. WBC cast
▪ D.1.3. Waxy cast ▪ D.2.3. Bacterial cast
▪ D.1.4. Fatty cast ▪ D.2.4. Epithelial cast
▪ D.1.5. Broad cast

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D.1.1. HYALINE CAST

▪ Normal value: ≤2 hyaline cast/lpf

▪ Most common type
▪ Colourless, homogenous, non-refractive
▪ Solidified Tamm-horsfall mucoprotein
▪ Correlation:
▪ dehydrated states
▪ vigorous exercise

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D.1.2. GRANULAR CAST

▪ Coarse and fine granules inside a matrix

▪ 2nd most common type
▪ Results from:
▪ breakdown of cellular cast
▪ inclusion of aggregates of plasma proteins
▪ Clinical Significance:
▪ Chronic renal disease
▪ Glomerulonephritis
▪ Stress and exercise

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D.1.3. WAXY CAST

▪ Highly refractile w/ jagged ends and notches

▪ End product of cast evolution
▪ Clinical Significance:
▪ urine stasis
▪ chronic renal failure

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D.1.4. FATTY CASTS

▪ Breakdown of lipid-rich epithelial cells

▪ Fat droplet and oval fat bodies in a matrix
▪ Hyaline casts w/ fat globule inclusions
▪ Yellowish-tan in colour
▪ Clinical Significance:
▪ nephrotic syndrome
▪ toxic tubular necrosis
▪ DM

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D.1.5. BROAD CASTS

▪ AKA “renal failure cast”

▪ Formed in the collecting ducts
▪ 2-6 times the size of other cast
▪ Clinical Significance:
▪ Extreme urine stasis
▪ Renal failure

125
D.2.1 RBC CAST

▪ Yellowish-brown in colour
▪ Cylindrical w/ sometimes jagged ends
▪ Presence of RBC w/in the cast
▪ always pathological
▪ Clinical Significance:
▪ glomerular damage
▪ renal infarction
▪ subacute bacterial endocarditis

127
129
D.2.2. WBC CAST

▪ WBCs w/in a cast

▪ May be confused w/ epithelial cast
▪ Clinical Significance:
▪ inflammation or infection
▪ suggestive: pyelonephritis

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D.2.3 BACTERIAL CAST

▪ Bacilli bound to a protein matrix

▪ Mistaken as fine granular cast
▪ Clinical Significance:
▪ Pyelonephritis

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D.2.4 EPITHELIAL CAST

▪ Desquamated RTE cells w/in a cast

▪ Distinguished by their large, round nuclei, small amount of
cytoplasm
▪ Clinical Significance:
▪ renal tubular damage
▪ acute tubular necrosis
▪ toxic ingestion

134
UNORGANIZED SEDIMENTS

▪ CRYSTALS
▪ precipitation of solutes
▪ inorganic salts, organic compounds, medications
▪ pH of the specimen
▪ valuable aid in the identification

136
 NORMAL CRYSTALS

▪ A.1. URIC ACID

▪ A.2. AMORPHOUS URATES
▪ A.3. CALCIUM SULFATE
▪ A.4. SODIUM URATE
▪ A.5. ACID URATE
▪ A.6. CALCIUM OXALATE
▪ A.7. AMORPHOUS PHOSPHATE
▪ A.8. TRIPLE PHOSPHATE
▪ A.9. AMMONIUM BIURATE
▪ A.10. CALCIUM CARBONATE

137
A.1. URIC ACID

▪ pH lower than 5.5

▪ Yellow-brown or colourless
▪ Highly birefringent under polarized light
▪ Clinical Significance:
▪ leukemic patients
▪ ↑ purine and nucleic acid degradation

138
142
A.2. AMORPHOUS URATE

▪ Brick dust or yellow brown granules

▪ Brick red dust ppt (macroscopic)
▪ pH: 5.5

143
A.3. CALCIUM SULFATE

▪ “Cigarette butt” appearance

▪ colourless long prism w/ bevelled ends
▪ Rarely seen
▪ identical in appearance
▪ alkaline crystal: calcium phosphate (prism)
▪ No clinical significance

145
A.4. SODIUM URATE

▪ Rarely seen
▪ Blunt-ended needle-like
▪ sheaves/clusters: peacock tail
▪ Slender prisms
▪ Colourless or yellowish
▪ No clinical significance

147
A.5. CALCIUM OXALATE

▪ Major component of renal calculi

▪ Found in acidic or neutral urine
▪ 2 forms
▪ Calcium oxalate dehydrate
▪ colourless envelope or two-pyramid shape
▪ more common
▪ soluble in dilute HCl
▪ Calcium oxalate monohydrate
▪ oval or dumbbell
▪ ethylene glycol poisoning

149
A.6. AMORPHOUS PHOSPHATES

▪ Microscopically indistinguishable from amorphous urates

▪ Differentiated:
▪ pH
▪ solubility characteristics
▪ macroscopic appearance
▪ If refrigerated: white precipitates
▪ Found in alkaline urine

152
A.6. TRIPLE PHOSPHATE

▪ Colourless “coffin lid” appearance

▪ disintegrated: feathery form
▪ Birefringent under polarized light
▪ Found in alkaline or neutral urine
▪ Clinical Significance:
▪ urea-splitting bacteria
▪ chronic urinary inflammation

154
A.7. AMMONIUM BIURATE

▪ “Thorny apple” appearance

▪ Large, amber, rounded crystals
▪ pointed protruberances
▪ Clinical Significance:
▪ urea-splitting bacteria

157
A.8. CALCIUM CARBONATE

▪ Dumbbell or spherical in shape

▪ birefringent and colourless
▪ Found in alkaline urine

159
ABNORMAL CRYSTALS

▪ B.1. CYSTINE
▪ B.2. CHOLESTEROL
▪ B.3. LEUCINE
▪ B.4. TYROSINE
▪ B.5. BILIRUBIN
▪ B.6. RADIOGRAPHIC CONTRAST MEDIA
▪ B.7. AMPICILLIN

161
B.1. CYSTINE

▪ Colourless, refractile, hexagonal plates

▪ Disintegrated forms: presence of NH3
▪ Clinical Significance:
▪ congenital cystinosis
▪ cystinuria
▪ renal calculi

162
B.2. CHOLESTEROL

▪ Large, flat and transparent

▪ notched corners
▪ Highly birefringent
▪ Clinical significance:
▪ lipiduria
▪ nephrotic syndrome

164
B.4. LEUCINE

▪ Oily and highly refractile

▪ Yellow or brown spheroid
▪ concentric striations
▪ Clinical Significance:
▪ maple syrup urine disease
▪ severe liver disease

166
B.5. TYROSINE

▪ Very fine, highly refractile needles

▪ Black or yellow in colour
▪ In sheaves/clusters: rosette formation
▪ Clinical significance:
▪ severe liver disease
▪ tyrosinosis

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B.6. BILIRUBIN

▪ Yellowish-brown small needle-like crystals

▪ Often phagocytized by WBCs
▪ Clinical Significance:
▪ hepatic disorder

170
B.7. RADIOGRAPHIC CONTRAST MEDIA

▪ Found in acidic urine

▪ Similar in appearance w/ cholesterol
▪ plates
▪ no notched corners
▪ highly birefringent
▪ Patient history

172
B.8. AMPICILLIN

▪ Found in acidic urine

▪ Forms bundles when refrigerated
▪ Long colourless, thin prisms
▪ Cause:
▪ massive dose intake
▪ inadequate patient hydration

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THANK YOU!!

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