1. Urinalysis
Course: IDPT 5005
School of Medicine, UCDHSC
Francisco G. La Rosa, MD
Francisco.LaRosa@uchsc.edu
Assistant Professor, Department of Pathology
University of Colorado at Denver Health Science Center, Denver, Colorado

2. Specimen
Collection
– First morning voiding (most concentrated)
– Record collection time
– Type of specimen (e.g. “clean catch”)
– Analyzed within 2 hours of collection
– Free of debris or vaginal secretions

3. Urine Specimens
 Collected for a number of tests:
– Clean voided specimens
 For routine urinalysis
– Clean-catch or midstream urine
specimens
 For urine culture
– Timed urine specimens
 For a variety of tests that depend of the
client’s specific health problem

4. Obtaining Samples
 Clients need varying degrees of instruction
and assistance to provide clean voided
specimens.
 About 120 ml (4 oz) of urine is generally
required.
 Clients who are seriously ill, physically
incapacitated, or disoriented may need to use
a bedpan or urinal in bed. Others may
require supervision and/or assistance in the
bathroom.

5. Directions for Collection
 The nurse should explain that all
specimens must be free of fecal
contamination, so voiding needs to
occur at a different time from
defection.
 Instruct female clients to discard toilet
tissue in the toilet or in a waste bag
rather than in the bedpan or hat, since
tissue in the specimen makes
laboratory analysis more difficult.

6. Obtaining Specimen
 When the specimen is obtained, put
the lid tightly on the container to
prevent spillage and contamination.
 Label the specimen.

7. Obtaining Timed
Specimens
 All timed urine specimens should be
refrigerated to prevent bacterial growth
and decomposition of the urine
components.
 Each voiding of urine is collected in a
clean container and then emptied
immediately into the large refrigerated
bottle.

8. Obtaining Timed
Samples
 Alert signs are placed in the client’s
room to remind staff of the test in
progress.
 Specimen identification labels need to
indicate the date and time of each
voiding in addition to the usual
identification information.

9. Obtaining Timed
Samples
 Clients need to be told why the test is being
done and how they can assist.
 Instructions should include the following:
– All urine must be saved and placed in the specimen
containers once the test starts.
– The urine must be free of fecal contamination and
toilet tissue.
– Each specimen must be given to the nursing staff
immediately so that it can be placed in the
appropriate specimen bottle.

10. Obtaining Timed
Samples
 The collection period is started by
having the client void in the toilet,
bedpan, or urinal.
– This urine is usually discarded, but check
facility procedure.
 All subsequent urine specimens are
collected.

11. Clean Catch

12. Specimen
Collection
Supra-pubic Needle Aspiration

13. Types of Analysis
− Macroscopic Examination
− Chemical Analysis (Urine
Dipstick)
− Microscopic Examination
− Culture (not covered in this lecture)
− Cytological Examination

15. Macroscopic Examination
Odor:
− Ammonia-like: (Urea-splitting bacteria)
− Foul, offensive: Old specimen, pus or inflammation
− Sweet: Glucose
− Fruity: Ketones
− Maple syrup-like: Maple Syrup Urine Disease
Color:
− Colorless Diluted urine
− Deep Yellow Concentrated Urine, Riboflavin
− Yellow-Green Bilirubin / Biliverdin
− Red Blood / Hemoglobin
− Brownish-red Acidified Blood (Actute GN)
− Brownish-black Homogentisic acid (Melanin)

16. Macroscopic Examination
Turbidity:
− Typically cells or crystals.
− Cellular elements and bacteria will clear by
centrifugation.
− Crystals dissolved by a variety of methods (acid or
base).
− Microscopic examination will determine which is
present.

17. Appearance
 Including color and clarity
 Color : normally , pale to dark yellow
(urochrome)
Abnormal color :
some drugs cause color changes
1. red urine : causes: hematuria
hemoglobinuria
myoglobinuria
2. yellow-brown or green-brown urine :
bilirubin
cause : obstructive jaundice

18. Red Urine
 Causes of Asymptomatic Gross Hematuria by
Incidence
 Acute Cystitis (23%)
 Bladder Cancer (17%)
 Benign Prostatic Hyperplasia (12%)
 Nephrolithiasis (10%)
 Benign essential hematuria (10%)
 Prostatitis (9%)
 Renal cancer (6%)
 Pyelonephritis (4%)
 Prostate Cancer (3%)
 Urethral stricture (2%)

19. Appearance
 Clarity : normally, clear
Abnormal color : cloudy urine
Causes: 1. crystals or nonpathologic salts
phosphate, carbonate in alkaline urine
(dissolve---add acetic acid)
uric acid in acid urine
(dissolve---warming to 60℃)
2. various cellular elements: leukocytes,
RBCs, epithelial cells

21. Urine volume
 The average adult : 1000ml to 2000ml/24h
 Increase
polyuria ---more than 2000ml of urine in
24
hours
1. physiological states: water intake, some
drugs, intravenous solutions
2. pathologic states: diabetes mellitus,
diabetes insipidus

22. Urine volume
 Decrease
Oliguria ---less than 400ml of urine in 24 hours
Anuria ---less than 100ml of urine in 24 hours
1. prerenal: hemorrhage, dehydration,
congestive heart failure
2. postrenal: obstruction of the urinary tract
(may be stones, carcinoma)
3. renal parenchymal disease:
acute tubular necrosis, chronic renal failure

23. Chemical Analysis

24. Chemical Analysis
Urine Dipstick
Glucose
Bilirubin
Ketones
Specific Gravity
Blood
pH
Protein
Urobilinogen
Nitrite
Leukocyte Esterase

25. Typical Test Strip
Test Sensitivity_
Glucose – 4 to 7 mmol/L
Bilirubin – 7 to 14 µmol/L
Ketone – 0.5 to 1.0 mmol/L (Acetoacetic acid)
Blood – 150 to 620 µg/L (Hemoglobin)
Protein – 0.15 to 0.3 g/L (Albumin)
Nitrite – 13 to 22 µmol/L
Leukocytes – 5 to 15 cells/ µL
pH – pH 5.0 to 8.5
Specific Gravity – 1.000 to1.030
Urobilinogen – 0.2 to 8 µmol/L
BioMedica Diagnostics Inc. / D. Jette / March 25
2003

26. The Urine Dipstick:
Glucose
Chemical Principle
Negative
Glucose Oxidase
Trace (100 mg/dL)
Glucose + 2 H2O + O2 --->
+ (250 mg/dL) Gluconic Acid + 2 H2O2
++ (500 mg/dL) Horseradish Peroxidase
3 H2O2 + KI ---> KIO3 + 3 H2O
+++ (1000 mg/dL)
Read at 30 seconds
++++ (2000+ mg/dL)
RR: Negative

27. Uses and Limitations of Urine Glucose
Detection
Significance
– Diabetes mellitus.
– Renal glycosuria.
Limitations
– Interference: reducing agents, ketones.
– Only measures glucose and not other sugars.
– Renal threshold must be passed in order for glucose to spill
into the urine.
Other Tests
– CuSO4 test for reducing sugars.

28. Detection of Reducing Sugars* by
CuSO 4
Sugar Disease(s)
- Galactose Galactosemias
- Fructose Fructosuria, Fructose
Intolerance, etc.
- Lactose Lactase Deficiency
- Pentoses Essential Pentosuria
- Maltose Non-pathogenic
* NOT Sucrose because it is not a reducing sugar

29. Urine versus Blood Glucose
Urinalysis Glucose Result
++
+
trace
Negative
200 400 600 800 1000
Blood Glucose (mg/dL)

30. The Urine
Dipstick: Bilirrubin
Negative Chemical Principle
+ (weak)
Bilirubin + Diazo salt Acidic Azobilirubin
--------->
++ (moderate)
Read at 30 seconds
+++ (strong) RR: Negative

31. Uses and Limitations of Urine Bilirrubin
Detection
Significance
- Increased direct bilirubin (correlates with urobilinogen and serum
bilirubin)
Limitations
- Interference: prolonged exposure of sample to light
- Only measures direct bilirubin--will not pick up indirect bilirubin
Other Tests
- Ictotest (more sensitive tablet version of same assay)
- Serum test for total and direct bilirubin is more informative

32. The Urine
Dipstick: Ketones
Negative
Chemical Principle
Trace (5 mg/dL)
+ (15 mg/dL) Acetoacetic Acid + Nitroprusside
------> Colored Complex
++ (40 mg/dL)
+++ (80 mg/dL) Read at 40 seconds
RR: Negative
++++ (160+ mg/dL)

33. Uses and Limitations of Urine Ketone Detection
Significance
- Diabetic ketoacidosis
- Prolonged fasting
Limitations
- Interference: expired reagents (degradation with exposure to
moisture in air)
- Only measures acetoacetate not other ketone bodies (such as in
rebound ketosis).
Other Tests
- Ketostix (more sensitive tablet version of same assay)
- Serum glucose measurement to confirm DKA

34. The Urine
Dipstick: Specific
Gravity
1.000
Chemical Principle
1.005
X+ + Polymethyl vinyl ether / maleic anhydride
1.010 --------------->
X+-Polymethyl vinyl ether / maleic anhydride + H+
1.015
H+ interacts with a Bromthymol Blue indicator to
1.020 form a colored complex.
1.025 Read up to 2 minutes
RR: 1.003-1.035
1.030

35. Uses and Limitations of Urine Specific Gravity
Significance
- Diabetes insipidus
Limitations
- Interference: alkaline urine
- Does not measure non-ionized solutes (e.g. glucose)
Other Tests
- Refractometry
- Hydrometer
- Osmolality measurement (typically used with water deprivation test)

36. The Urine
Dipstick: Blood
Negative
Chemical Principle
Trace (non-hemolyzed)
Lysing agent to lyse red blood cells
Moderate (non-hemolyzed)
Diisopropylbenzene dihydroperoxide +
Tetramethylbenzidine
Trace (hemolyzed)
Heme
------------> Colored Complex
+ (weak)
++ (moderate) Read at 60 seconds
RR: Negative
Analytic Sensitivity: 10 RBCs
+++ (strong)

37. Uses and Limitations of Urine Blood Detection
Significance
- Hematuria (nephritis, trauma, etc)
- Hemoglobinuria (hemolysis, etc)
- Myoglobinuria (rhabdomyolysis, etc)
Limitations
- Interference: reducing agents, microbial peroxidases
- Cannot distinguish between the above disease processes
Other Tests
- Urine microscopic examination
- Urine cytology

38. The Urine
Dipstick: pH
5.0
6.0 Chemical Principle
H+ interacts with:
6.5
Methyl Red (at high concentration; low pH) and
Bromthymol Blue (at low concentration; high
7.0
pH), to form a colored complexes
(dual indicator system)
7.5
8.0 Read up to 2 minutes
R.R.: 4.5-8.0
8.5

39. Uses and Limitations of Urine pH Detection
Significance
- Acidic (less than 4.5): metabolic acidosis, high-protein diet
- Alkaline (greater than 8.0): renal tubular acidosis (>5.5)
Limitations
- Interference: bacterial overgrowth (alkaline or acidic),
“run over effect” effect of protein pad on pH indicator pad
Other Tests
- Titrable acidity
- Blood gases to determine acid-base status

40. pH Run Over Effect
Glucose
Bilirubin
Ketones
Specific Gravity Buffers from the protein area of
the strip (pH 3.0) spill over to the
Blood pH area of the strip and make the
pH pH of the sample appear more
acidic than it really is.
Protein
Urobilinogen
Nitrite
Leukocyte Esterase

41. The Urine
Dipstick: Protein
Chemical Principle
“Protein Error of Indicators Method”
Negative Pr
H Pr
H Pr
Trace H
Pr Pr
+ (30 mg/dL) H H
H Pr
++ (100 mg/dL) Tetrabromphenol Blue
H+ H H
+ +
(buffered to pH 3.0)
H+ H H
+ +
+++ (300 mg/dL) Pr Pr
Pr
Pr Pr
++++ (2000 mg/dL) Pr
Read at 60 seconds
RR: Negative

42. Causes of
Proteinuria
Functional Renal
- Severe muscular exertion - Glomerulonephritis
- Pregnancy - Nephrotic syndrome
- Orthostatic proteinuria - Renal tumor or infection
Pre-Renal Post-Renal
- Fever - Cystitis
- Renal hypoxia - Urethritis or prostatitis
- Hypertension - Contamination with vaginal
secretions

43. Nephrotic Syndrome (> 3.5 g/dL in 24
h)
Primary
- Lipoid nephrosis (severe)
- Membranous glomerulonephritis
- Membranoproliferative glomerulonephritis
Secondary
- Diabetes mellitus (Kimmelsteil-Wilson lesions)
- Systemic lupus erythematosus
- Amyloidosis and other infiltrative diseases
- Renal vein thrombosis

44. Uses and Limitations of Urine Protein
Detection
Significance
- Proteinuria and the nephrotic syndrome.
Limitations
- Interference: highly alkaline urine.
- Much more sensitive to albumin than other proteins
(e.g., immunoglobulin light chains).
Other Tests
- Sulfosalicylic acid (SSA) turbidity test.
- Urine protein electrophoresis (UPEP)
- Bence Jones protein

45. Proteins in “Normal” Urine
Protein % of Total
Daily Maximum
Albumin 40%
60 mg
Tamm-Horsfall 40%
60 mg
Immunoglobulins 12%
24 mg
Secretory IgA 3%
6 mg
Other 5%

46. The Urine
Dipstick: Urobilinogen
0.2 mg/dL Chemical Principle
1 mg/dL Urobilinogen + Diethylaminobenzaldehyde
(Ehrlich’s Reagent)
2 mg/dL -------> Colored Complex
4 mg/dL
Read at 60 seconds
8 mg/dL RR: 0.02-1.0 mg/dL

47. Uses and Limitations of Urobilinogen
Detection
Significance
- High: increased hepatic processing of bilirubin
- Low: bile obstruction
Limitations
- Interference: prolonged exposure of specimen to oxygen
(urobilinogen ---> urobilin)
- Cannot detect low levels of urobilinogen
Other Tests
- Serum total and direct bilirubin

48. The Urine
Dipstick: Nitrite
Chemical Principle
Acidic
Negative Nitrite + p-arsenilic acid -------> Diazo compound
Diazo compound + Tetrahydrobenzoquinolinol
Positive
----------> Colored Complex
Read at 60 seconds
RR: Negative

49. Uses and Limitations of Nitrite Detection
Significance
- Gram negative bacteriuria
Limitations
- Interference: bacterial overgrowth
- Only able to detect bacteria that reduce nitrate to nitrite
Other Tests
- Correlate with leukocyte esterase and
- Urine microscopic examination (bacteria)
- Urine culture

50. The Urine
Dipstick: Leukocyte
Esterase
Chemical Principle
Derivatized pyrrole amino acid ester
Negative
Esterases
------------> 3-hydroxy-5-phenyl pyrrole
Trace
+ (weak) 3-hydroxy-5-phenyl pyrrole + diazo salt
-------------> Colored Complex
++ (moderate)
Read at 2 minutes
+++ (strong) RR: Negative
Analytic Sensitivity: 3-5 WBCs

51. Uses and Limitations of Leukocyte Esterase Detection
Significance
- Pyuria
- Acute inflammation
- Renal calculus
Limitations
- Interference: oxidizing agents, menstrual contamination
Other Tests
- Urine microscopic examination (WBCs and bacteria)
- Urine culture

52. Microscopic Examination
General Aspects
Preservation
- Cells and casts begin to disintegrate in 1 - 3 hrs. at room temp.
- Refrigeration for up to 48 hours (little loss of cells).
Specimen concentration
- Ten to twenty-fold concentration by centrifugation.
Types of microscopy
- Phase contrast microscopy
- Polarized microscopy
- Bright field microscopy with special staining
(e.g., Sternheimer-Malbin stain)

53. Microscopic Examination
Abnormal Findings
Per High Power Field (HPF) (400x)
– > 3 erythrocytes
– > 5 leukocytes
– > 2 renal tubular cells
– > 10 bacteria
Per Low Power Field (LPF) (200x)
– > 3 hyaline casts or > 1 granular cast
– > 10 squamous cells (indicative of contaminated specimen)
– Any other cast (RBCs, WBCs)
Presence of:
– Fungal hyphae or yeast, parasite, viral inclusions
– Pathological crystals (cystine, leucine, tyrosine)
– Large number of uric acid or calcium oxalate crystals

54. Microscopic Examination
Cells
Erythrocytes
- “Dysmorphic” vs. “normal” (> 10 per HPF)
Leukocytes
- Neutrophils (glitter cells) More than 1 per 3 HPF
- Eosinophils Hansel test (special stain)
Epithelial Cells
- Squamous cells Indicate level of contamination
- Renal tubular epithelial cells Few are normal
- Transitional epithelial cells Few are normal
- Oval fat bodies Abnormal, indicate Nephrosis

55. Microscopic Examination
RBCs

56. Microscopic Examination
RBCs

57. Microscopic Examination
WBCs

58. Microscopic Examination
Squamous Cells

59. Microscopic Examination
Tubular Epithelial
Cells

60. Microscopic Examination
Transitional Cells

61. Microscopic Examination
Transitional Cells

62. Microscopic Examination
Oval Fat Body

63. Microscopic Examination
LE Cell

64. Microscopic Examination
Bacteria & Yeasts
Bacteria
- Bacteriuria More than 10 per HPF
Yeasts
- Candidiasis Most likely a contaminant
but should correlate with
clinical picture.
Viruses
- CMV inclusions Probable viral cystitis.

65. Microscopic Examination
Bacteria

66. Microscopic Examination
Yeasts

67. Microscopic Examination
Yeasts

68. Microscopic Examination
Cytomegalovirus

69. Microscopic Examination
Casts
Erythrocyte Casts: Glomerular diseases
Leukocyte Casts: Pyuria, glomerular disease
Degenerating Casts:
- Granular casts Nonspecific (Tamm-Horsfall protein)
- Hyaline casts Nonspecific (Tamm-Horsfall protein)
- Waxy casts Nonspecific
- Fatty casts Nephrotic syndrome
(oval fat body casts)

70. Microscopic Examination
Casts

71. Microscopic Examination
RBCs Cast -
Histology

72. Microscopic Examination
RBCs Cast

73. Microscopic Examination
RBCs Cast -
Histology

74. Microscopic Examination
WBCs Cast

75. Microscopic Examination
Tubular Epith. Cast

76. Microscopic Examination
Tubular Epith. Cast

77. Microscopic Examination
Granular Cast

78. Microscopic Examination
Hyaline Cast

79. Microscopic Examination
Waxy Cast

80. Microscopic Examination
Fatty Cast

81. Significance of Cellular
Casts
Erythrocyte Casts
Leukocyte Casts
Bacterial Casts
Single Erythrocytes
Single Leukocytes
Single Bacteria
Verrier-Jones & Asscher, 1991.

82. Microscopic Examination
Crystals
- Urate
Ammonium biurate
Uric acid
- Triple Phosphate
- Calcium Oxalate
- Amino Acids
Cystine
Leucine
Tyrosine
- Sulfonamide

83. Microscopic Examination
Calcium Oxalate Crystals

84. Microscopic Examination
Calcium Oxalate Crystals
Dumbbell
Shape

85. Microscopic Examination
Triple Phosphate Crystals

86. Microscopic Examination
Urate Crystals

87. Microscopic Examination
Leucine Crystals

88. Microscopic Examination
Cystine Crystals

89. Microscopic Examination
Ammonium Biurate Crystals

90. Microscopic Examination
Cholesterol Crystals

91. Cytological Examination
Staining:
– Papanicolau
– Wright’s
– Immunoperoxidase
– Immunofluorescence

92. Cytology: Normal

93. Cytology: Normal

94. Cytology: Reactive

95. Cytology: Reactive

96. Cytology: Polyoma (Decoy
Cell)

97. Cytology: Polyoma (Decoy
Cell)
Immunoperoxidase to SV40 ag

98. Cytology: TCC Low Grade

99. Cytology: TCC Low Grade

100. Cytology: TCC High
Grade

101. Cytology: TCC High
Grade

104. Cytology: Squamous Cell
Ca.

105. Cytology: Renal Cell Ca.

106. Cytology: Prostatic
Carcinoma

107. Urinalysis
Disease Diagnosis

108. Case Diluted urine, request a voided urine in the morning
If persisting low SG, possible diabetes insipida
1 A microscopic may give negative results
Glucose Negative
Bilirubin Negative
A 35-year old man undergoing routine pre
employment drug screening.
Ketones Negative
Physical characteristics: Clear.
S.G. 1.001 Microscopic: Not performed.
Drugs Identified: None.
Blood Negative
pH 5.5
Questions:
Protein Negative - What is your differential diagnosis?
- What would you do next to confirm your
Urobilinogen 0.2 mg/dL suspicion?
- Would you order a microscopic analysis
Nitrite Negative on this sample?
L.E. Negative

109. Case Possible gallbladder or hepatic disease.
No hemolytic anemia. Perform bilirubins in serum
2 Microscopic unlikely to provide additional info
Glucose Negative
Bilirubin +++
A 42-year old woman presents with “dark urine”
Ketones Negative
Physical characteristics: Red-brown.
S.G. 1.020 Microscopic: Not performed.
Blood Negative
Questions:
pH 5.5
- What is your differential diagnosis?
Protein Negative - Could this be a case of hemolytic anemia?
- How would you rule it out?
Urobilinogen 0.2 mg/dL - What tests would you order next? Why?
Nitrite - Would you order a microscopic analysis?
Negative
L.E. Negative

110. Case Possible UTI, request culture and antibiotic sensitivity
Negative Nitrite test: Gram positive bacteria
3 Lower SG may show less number of cells and bacteria
Un-common diagnosis in this type of patient
Glucose Negative
A 42-year old man presents painful urination
Bilirubin Negative
Ketones
Physical characteristics: dark red, turbid
Negative
Microscopic: leukocytes = 30 per HPF
S.G. 1.030 RBCs = >100 per HPF
Bacteria = >100 per HPF
Blood +++
Questions:
pH 6.5 - What is your suspected diagnosis?
- What would you do next?
Protein Trace
- What do you make of the nitrite test?
Urobilinogen 1.0 mg/dL - How would the microscopic exam differ if
the S.G. were 1.003?
Nitrite Negative - Is this a common diagnosis for this type of
patient?
L.E. +++

111. Case Diabetes
May be decompensated and with ketoacidosis
4 Ketones should become negative after treatment
Glucose ++
Bilirubin Negative
Ketones Trace A 27-year old woman presents with severe
abdominal pain.
S.G. 1.015
Physical characteristics: clear-yellow.
Blood Negative Microscopic: Not performed.
pH 6.0
Questions:
Protein Negative - What is the most likely diagnosis?
- What do you make of the ketone result?
Urobilinogen 1.0 mg/dL - What do you expect to happen to the ketone
measurement when treatment begins?
Nitrite Negative
L.E. Negative

112. Case Glomerulonephritis
RBC casts reveals renal cortex involvement
5 RBC cast are not always present in GN
Glucose Negative
8-year old boy presents with discolored urine
Bilirubin Negative
Ketones Physical characteristics: Red, turbid.
Negative
Microscopic: erythrocytes = >100 per HPF
S.G. 1.015 (almost all dysmorphic)
Red cell casts present.
Blood +++
Questions:
pH 6.5 - What is the most likely diagnosis in this
Protein case?
+
- Does the presence of red cell casts help you
Urobilinogen 1.0 mg/dL in any way?
- If the erythrocytes were not dysmorphic
Nitrite Negative would that change your diagnosis?
L.E. Negative

113. Case “Functional” proteinuria?
Microscopic may reveal a few leukocytes
6 Request protein concentration in 24 h urine
Glucose Negative
22-year old man presenting for a routine
Bilirubin Negative
physical required for admission to medical
Ketones Negative school
S.G. 1.010 Physical characteristics: Yellow
Microscopic: Not performed
Blood Negative
Questions:
pH 5.0
- What is your differential diagnosis?
Protein + - Would you order a microscopic analysis on
this sample?
Urobilinogen 0.2 mg/dL - What would you do next to confirm the
diagnosis?
Nitrite Negative
L.E. Negative

114. Common Findings in:
Acute Tubular Necrosis
Glucose
Bilirubin
Ketones
S.G. Decreased Microscopic:
Blood +/-
• Renal tubular epithelial cells
pH
• Pathological casts
Protein +/-
Urobilinogen
Nitrite
L.E.

115. Common Findings in:
Acute Glomerulonephritis
Glucose
Bilirubin
Ketones
Microscopic:
S.G.
Blood Increased • Erythrocytes (dysmorphic)
pH • Erythrocyte casts
• Mixed cellular casts
Protein Increased
Urobilinogen
Nitrite
L.E.

116. Common Findings in:
Chronic
Glomerulonephritis
Glucose
Bilirubin
Ketones
Decreased
Microscopic:
S.G.
Blood Increased • Pathological casts
pH (broad waxy casts, RBCs)
Protein Increased
Urobilinogen
Nitrite
L.E.

117. Common Findings in:
Acute Pyelonephritis
Glucose
Bilirubin
Ketones Microscopic:
S.G.
• Bacteria
Blood
• Leukocytes
pH • Leukocyte, granular, and
Protein Trace
waxy casts
• Renal tubular epithelial
Urobilinogen
cell casts
Nitrite Positive
L.E. Positive

118. Common Findings in:
Nephrotic Syndrome
Glucose
Bilirubin
Ketones
S.G. Microscopic:
Blood
• Oval fat bodies
pH
• Fatty casts
Protein ++++ • Waxy casts
Urobilinogen
Nitrite
L.E.

119. Common Findings in:
Eosinophilic Cystitis
Glucose
Bilirubin
Ketones
S.G. Microscopic:
Blood +
• Numerous eosinophils
pH
(Hansel’s stain)
Protein • NO significant casts.
Urobilinogen
Nitrite
L.E.

120. Common Findings in:
Urothelial Carcinoma
Glucose
Bilirubin
Ketones
S.G. Microscopic:
Blood +
• Malignant cells on
pH
urine cytology (urine
Protein sample should be submitted
separately to cytology, void
Urobilinogen
or 24 hrs.)
Nitrite
L.E.

121. Acknowledgment:
Dr. Brad Brimhall

122. Questions ?