1. PATHOLOGICAL
COMPONENTS
OF URINE

2. PHYSICAL CHARACTERISTICS OF URINE VOLUME DENSITY and OSMOLARITY COLOR
PHYSICAL CHARACTERISTICS OF URINE
VOLUME
DENSITY and OSMOLARITY
COLOR
ODOR
FOAM
CHEMICAL COMPOSITION OF URINE pH
PROTEINS
HEMOGLOBIN
GLUCOSE
KETONE BODIES
BILIRUBIN
UROBILINOGEN
MORPHOLOGY OF URINE
URINE SEDIMENT - ORGAN
- NONORGAN

3. pH NORMAL RANGE: pH 5 - 6 MAXIMAL RANGE: pH 4,5 - 8
ACIDURIA pH permanently < 5,4
- Metabolic or respiration acidosis
- Diabetes
- Starving
ALKALIURIA pH permanently > 6,5
- Metabolic or respiratory alkalosis
- Vegetable diet
- Bacterial infection

4. PROTEINS PROTEINURIA < 0,15 – 0,2 g/day - PHYSIOLOGICAL
PROTEINURIA < 0,15 – 0,2 g/day - PHYSIOLOGICAL
< 0,5 g/day MILD DEGREE
0,5 - 1,5 g/day MIDDLE DEGREE
1,5 - 4 g/day EXPRESSIVE
> 4 g/day HEAVY   
A) PHYSIOLOGIC PROTEINURIA (LESS THAN 500 mg/d)
- SEVERE EXERCISE
- A HIGH PROTEIN MEAL
- SOME TEMPORARY IMPAIRMENT IN RENAL CIRCULATION
- PREGNANCY (30 – 40%)
B) PATHOLOGIC PROTEINURIAS
  - PRERENAL, WHEN THE PRIMARY CAUSES ARE FACTORS OPERATING BEFORE KIDNEY IS REACHED
- RENAL, WHEN THE LEASON IS INTRINSIC TO THE KIDNEY
- POSTRENAL, WHEN PROTEINURIA IS DUE TO INFLAMMATION
IN THE LOWER URINARY TRACT
TESTS: SULFOSALICYLIC ACID, HELLER´S
QUANTITY: BIURET REACTION

5. URINE HEMOGLOBIN
BLOOD MAY APPEAR IN THE URINE AS INTACT RED CELLS OR AS A FREE HEMOGLOBIN
HEMOGLOBINURIA IS USUALLY REALATED TO A CONDITION OUTSIDE THE
URINARY TRACT AND OCCURES WHEN THERE IS SUCH
EXTENSIVE OR RAPID DESTRUCTION OF RED BLOOD CELLS
(HEMOLYSIS).
HEMOGLOBINURIA IS FOUND IN - EXTENSIVE BURNS
- CRUSHING INJURIES
- MALARIA
- TRANSFUSION REACTION WITH INCOMPATIBLE
BLOOD PRODUCTS…
ERYTHROCYTURIA – WHEN INTACT RED CELLS ARE PRESENT IN THE URINE.
THE TERM IS USED TO INDICATE BLEEDING IN THE URINARY TRACT.
ERYTHROCYTURIA IS FOUND IN: LOWER URINARY TRACT INFECTION
URINARY TRACT OR RENAL CANCER
HEMOPHYLIA …
ERYTROCYTURIA (HEMATURIA) > 5 Ery/l ( mil./day)
HEMOGLOBINURIA - 0,15 - 0,45 mg Hb/l

6. GLUCOSE NORMAL RANGE: 0.06 – 0.83 mmol/L (0.01 – 0.15 g/L)
PATHOLOGICAL GLUCOSURIA: > 1.67 mmol/L (0.3 g/L)
GLUCOSURIA IS INDICATED, WHEN MORE THAN mmol/L IS FOUND
TRANSIENT GLUCOSURIA MAY BE NOTED AFTER
- EMOTIONAL STRESS
- EXCITING ATHLETIC CONTEST
15 % OF CASES ARE NOT DUE TO DIABETES
OTHER SUGARS:
GALACTOSURIA AND LACTOSURIA MAY OCCURE OCCASIONALLY IN INFANTS AND IN THE MOTHER DURING PREGNANCY LACTATION AND WEANIG PERIOD.
PENTOSURIA MAY OCCURE TRANSIENTLY AFTER INGESTION OF FOODS CONTAINING LARGE QUANTITIES OF PENTOSES (PLUMS, CHERRIES, GRAPES).
TESTS: FEHLING’S (FROM 11 mmol/L ~ 2 g/L)
BENEDICT’S (FROM 5.5 mmol/L ~ 1g/L)

7. KETONE BODIES 3 – HYDROXYBUTYRATE 60 - 70% ACETACETATE 30 - 35%
ACETONE %
NORMALLY, ONLY 3 TO 15 mg/d
THE QUANTITY IS INCREASED IN
- STARVATION
- IMPAIRED CARBOHYDRATE METABOLISM (e.g. DIABETES)
- PREGNANCY
EXCESS FAT METABOLISM WILL ALSO INDUCE A KETONURIA.
ACIDOSIS IS ACCOMPANIED WITH KETONURIA.
TESTS: LEGAL’S
LESTRADET’S

8. TRANSFORMATION AND TRANSPORT OF BILE PIGMENTS

9. URINE BILIRUBIN NORMAL RANGE: 0 - 0,5 mol/l IN SERUM:
IN SERUM:
BILIRUBIN + ALBUMIN = INDIRECTLY REACTING BILIRUBIN
BILIRUBIN IS NOT CONJUGATED
BILIRUBINDIGLUKOSIDURONATE = DIRECLY REACTING BILIRUBIN
CONJUGATED BILIRUBIN
URINE BILIRUBIN IS AN EARLY SIGN OF HEPATOCELLULAR DISEASE OR BILIARY OBSTRUCTION.
INCREASED LEVEL OCCURES IN
- HEPATITIS
- LIVER DISEASE CAUSED BY INFECTION OR EXPOSURE
TO TOXIC AGENTS
- OBSTRUCTIVE BILIARY TRACT DISEASE
TESTS: ROSIN'S
GMELIN'S

10. UROBILINOGEN (UROBILINOIDS)
NORMAL: < 4 mol/day (2,5 mg); max. 17 mol/l
URINE UROBILINOGEN IS ONE OF THE MOST SENSITIVE TEST AVAILABLE
TO DETECT LIVER DISFUNCTION
URINARY UROBILINOGEN IS INCREASED BY
- ANY CONDITION THAT CAUSES AN INCREASE IN THE PRODUCTION
OF BILIRUBIN
- ANY CONDITION THAT PREVENTS THE LIVER FROM REMOVING
THE NORMALLY REABSORBED UROBILINOGEN FROM THE PORTAL
CIRCULATION
TESTS: EHRLICH'S
EHRLICH POSITIVE SUBSTANCES:
Urobilinogen, sterkobilinogen
SCHLESINGER'S
SCHLESINGER POSITIVE SUBSTANCES:
Urobilin, sterkobilin

11. HYPRBILIRUBINEMIA BILIRUBIN UROBILINOGEN
IN URINE IN URINE
HEMOLYTIC NEG
(prehepatal)
HEPATAL
OBSTRUCTIVE NEG.
(posthepatal)

12. URINARY SEDIMENT

13. THE MOST FREQUENT NONORGAN SEDIMENT

14. Organ sediment - 1

15. Organ sediment - 2

16. Organ sediment - 3

17. Organ sediment - 4