URINALYSIS

By

Roderick D. Balce, RMT

ANATOMY OF THE KIDNEY
RENAL FUNCTIONS
1. Renal Blood Flow
Afferent arterioles
Efferent arterioles
Peritubular capillaries
Proximal convoluted tubule
Distal convoluted tubule
Vasa recta
Ascending loop of Henle
Descending loop of Henle
2. Glomerular Filtration
Glomerulus
GFR = 120 ml/min
Factors Affecting Glomerular Filtration
a. Cellular structure
Capillary Wall Membrane
Basement Membrane
Visceral Epithelium
b. Hydrostatic pressure
Blood Colloidal Oncotic Pressure
Capsular Pressure
c. Renin-Angiotensin-Aldosterone
Mechanism
3. Tubular Reabsorption
Mechanisms involved:
a. Active Transport
Actively transported: Glucose,
Amino acids
Salts
Chloride
Sodium
Renal threshold important in distinguishing
between:
Excess solute filtration
Renal tubular damage
b. Passive Transport
Passively Transported: Water
Urea
Sodium

c. Counter-Current Mechanism
Osmotic Gradient of Medulla
Vasopressin
4. Tubular Secretion
Major Functions:
a. Elimination of waste products not
filtered by the glomerulus

b. Regulation of acid-base balance

through secretion of H ions
Renal Function Tests
1. Glomerular Filtration Test
Clearance test
a. Urea
b. Radioisotope
c. B2 microglobulin
d. Creatinine
C = UV/P
Normal values:
Creatinine Clearance: F = 75-112 ml/m
M = 85-125 ml/m
Plasma Creatinine = 0.5-1.5 mg/dl
e. Inulin
2. Tubular Reabsorption Tests
a. Fishberg Test
b. Mosenthal Test
c. Osmometry

3. Tubular Secretion and Renal Blood Flow

Tests
a. PAH
b. PSP
c. Indigo Carmine Test
Renal Diseases
A. Glomerular Disorders:
1. Glomerulonephritis blood, protein, and casts
in urine
a. Acute Poststreptococcal caused by
deposition of immune complexes and
antibodies in the glomerular membrane
following group A streptococcal
infection.
b. Rapidly Progressive ( Crescentic) more
serious, can lead to renal failure;
arises as a result of another form of
glomerulonephritis or an immune
systemic disorder.
c. Good Pastures Syndrome attachment of
cytotoxic autoantibody (anti-glomerular
basement membrane antibody) to the
glomerular and alveolar basement
membranes during viral respiratory
infections.
Lab Findings:proteinuria, hematuria, RBC
casts
2. Vasculitis
- immune-mediated disoders affecting the
systemic vascular system resulting to
glomerular damage.
a. Wegeners granulomatosis granuloma-
producing inflammation of the small blood
vessels in the lungs and kidney.The
antibody causing the damage is the anti-
neutrophilc cytoplasmic antibody (ANCA)
Labfindings: hematuria, proteinuria, rbc casts,
and increased BUN and crea
b. Henoch-Schonlein Purpura characterized
by a decrease in platelets that causes
disruption of vascular integrity
Lab findings: heavy proteinuria and hematuria
with rbc casts
Wegeners Granulomatosis
3. Immunoglobulin A nephropathy
- deposition of immune complexes on
the glomerular membrane resulting
from increased levels of serum IgA
Lab
findings: macroscopic/microscopic
hematuria and increased IgA

4. Membranous Glomerulonephritis
- thickening of the glomerular
membrane due to deposition of IgG
immune complexes.
Lab findings: microscopic hematuria and
increased IgG and protein excretion
5. Membranoproliferative Glomerulonephritis
immune mediated disorder characterized
by cellular proliferation in capillary walls or
glomerular basement membrane.
Lab findings: hematuria, proteinuria, and decreased
serum complement levels
6. Chronic Glomerulonephritis glomerular
damage as a result of other renal disorders
leads to marked decrease in renal functions
and eventually to renal failure
Lab findings: hematuria, proteinuria, glucosuria,
varieties of casts including broad cast, markedly
decreased GFR with increased BUN and crea
levels, and electrolyte imbalance
7. Nephrotic Syndrome disruption in the
electrical charges in the basal lamina and
podocytes, producing a less tightly
connected barrier.
Lab Findings: massive proteinuria, low albumin, high
serum levels of lipids, and pronounced edema

8. Minimal Change Disease podocytes appear

to be less tightly fitting allowing increased
filtration of protein; seen in children
following allergic reaction and immunization.
Lab Findings: edema, heavy proteinuria, transient
hematuria
9. Focal Segmental Glomerulosclerosis
- only a certain number and areas of
glomeruli are affected. The disease is
caused by disruption of the podocytes
associated with analgesics and heroin
abuse and AIDS. Immunoglobulins M
and C3 are seen in undamaged
glomeruli.
Lab Findings: heavy proteinuria, microscopic
hematuria
II. Tubulointerstitial Disorders
1. Acute Tubular Necrosis damage to the
renal tubular cells by toxic agents or
ischemia

2. Fanconis Syndrome generalized failure

of tubular reabsorption in the PCT; may
be hereditary or acquired
3. Cystitis ascending bacterial infection of
the bladder
4. Acute Pyelonephritis infection of the upper
urinary tract involving the interstitium and
tubules due to interference of urine flow
to the bladder, reflux of urine from the
bladder, or untreated cystitis
5. Chronic Pyelonephritis recurrent infection
of the tubules and interstitium caused by
structural abnormalities affecting urine
flow
6. Acute Interstitial Nephritis inflammation of
the renal interstitium associated with
allergic reaction to medications
C. Vascular Disorders
1. Renal Failure may be gradual progression
from the original disorder to chronic renal
failure or end-stage renal disease.

2. Renal Lithiasis deposition of renal calculi or

kidney stones in the calyces and pelvis of
the kidney, ureters and urinary bladder.
 Chemical Composition of Renal Calculi:

a. Calcium oxalate or phosphate

b. Magnesium ammonium phosphate
c. Uric acid
d. Cystine

Lab Findings: microscopic hematuria

Composition of Urine
1. water
2. analytes
organic
inorganic
3. hormones, vitamins, medications,
formed elements, etc.
 Types of Urine Specimens
Timed Specimen:
24-hour Quantitative chemical tests,
hormone studies
12-hour Addis count
2-hr Postprandial Diabetic monitoring
Afternoon Specimen Urobilinogen determination
Glucose Tolerance Test Accompaniment to blood
samples in GTT
Random Routine screening
First Morning Routine screening
Pregnancy Tests
Orthostatic Proteinuria
Fasting/Second Morning Diabetic screening /
monitoring
Catheterized Bacterial culture
Midstream clean-catch Routine screening
Bacterial culture
Suprapubic aspiration Bladder urine for bacterial
culture
Cytology
Three-glass collection Prostatic infection
Drug Specimen Drug testing
 Voiding cystourethrogram
Examining bladder function by injecting dye that is
visible on X-rays through a catheter to fill the
bladder. X-rays are taken while the bladder is full
and while the patient is urinating to determine if
fluid is forced out of the bladder through the
urethra (normal) or up through the ureters into the
kidney (vesicoureteral reflux).
DRUG SPECIMEN COLLECTION
Chain of Custody (COC) Form
the process that provides the
documentation of proper sample
identification from the time of collection to
the receipt of laboratory results
a standardized form that documents that
the specimen collected by the patient is
the same one that is analyzed and
reported
Urine Specimen Collection
- the most vulnerable part of a drug testing program
- may be witnessed or unwitnessed; a same-gender
collector is required in witnessed collection

Required Volume - 30-45 ml taken within 4 minutes

Temperature - 32.5C to 37.7C

Procedure:
The collector washes hands, wears
gloves, adds bluing agent or dye to the
toilet water reservoir, and tapes the toilet
lid and faucet handles.
The donor provides identification from
employer.
The collector completes step 1 COC
Form and has the donor sign the form.
 The donor leaves all his belongings outside,
washes hands, and receives a specimen cup.
The collector remains in the restroom, outside
the stall (unwitnessed) listening for
unauthorized water use.
The donor hands specimen cup to the
collector and the latter checks the urine for
abnormal color and for the required amount.
The collector checks the temperature using a
temperature strip, records the reading on the
COC Form (step 2). If the temperature is out of
range, recollection is needed.
 With the donor watching, the collector seals
the capped bottle with identification strips
(COC step 3) covering both sides of the cup.
The seals contain the date and time.
The donor initials the seals and completes
COC step 4 after which, the collector
accomplishes COC step 5.
Each time the specimen is handled,
transferred or stored, every individual must be
identified, the date and purpose of the change
must be recorded, and specific instructions on
labeling, packaging or transport must be
followed.
Methods of Preservation
1. Physical (Refrigeration)
2. Chemical
Phenol causes an odor change
Toluene not effective for bacteria and molds
Thymol crystals preserves glucose and
sediments well
Formalin excellent sediment preservative
Boric acid preserves protein well
Sodium fluoride good for drug analysis
Sacomannos fixative preserves cellular
elements
Changes in Unpreserved Urine
Color - modified Decreased:
or darkened Clarity
Glucose
Increased:
Ketones
Odor
Bilirubin
pH
Urobilinogen
Nitrite
Red blood cells
Bacteria
White blood cells
Casts
Clinical Utilities of Routine Urinalysis
Indicators of the State of the Kidney
or Urinary Tract
Appearance
SpecificGravity
Chemical tests
Leukocyte Esterase
Urinary Sediment
Indicators of Metabolic and Other
Conditions or Disease
pH
Appearance
Glucose and Ketones
Bilirubin
Urobilinogen
Indications of Other Systemic
(Nonrenal) Conditions or
Disease
Hemoglobin
Myoglobin
Light-chainproteins
Porphobilinogen
 PHYSICAL
EXAMINATION
I. Volume
Average daily output: 1,200-1,500 ml
Variations:
a. Polyuria
Indications: Diabetes mellitus
Diabetes insipidus
b. Diuresis
c. Oliguria
d. Anuria
e. Nocturia
II. Specific Gravity
Performed using:
a. Urinometer
Corrections done
b. Refractometer
Instrument Calibration
c. Reagent strip
d. Harmonic Oscillation Densitometry
 Variations in S.G.:
a. Hypersthenuria
b. Hyposthenuria
c. Isosthenuria
III. pH
IV. Color
Pigments
Variations in Color:
Colorless Yellow green/
Pale yellow Yellow brown
Dark yellow Green
Orange Red/ Blue green
Reddish brown Milky white
Amber/Orange Pink/Red
Brown/Black
V. Odor
Normal: Aromatic
Variations in Urine Odor:
Amoniacal/Putrid/ Mousy
Foul Rancid
Mercaptan Sweaty feet
Fecaloid Rotting fish
Fruity, sweet Cabbage
Maple syrup Bleach
Sulfur odor
VI. Transparency
Urine Clarity
Clear No visible particulates, transparent
Hazy Few particulates, print easily seen
through urine
Cloudy Many particulates, print blurred
through urine
Turbid Print cannot be seen through urine
Milky May precipitate or be clotted
Nubecula
Nonpathologic Causes of Urine
Turbidity
Epithelial cells
Normal crystals
Bacteria (old urine)
Semen, prostatic fluid
Fecal contamination
Radiographic contrast media, mucus,
talcum powder
Vaginal creams
Pathologic Causes of Urine
Turbidity
Red blood cells
White blood cells
Bacteria
Yeasts
Nonsquamous epithelial cells
Abnormal crystals
Casts
Lymph fluid/Chyle
Lipids
Fecal matter
CHEMICAL
ANALYSIS
I. pH
Normal values: average-6; random-4.5-8.0;
fasting-5.5-6.5
Clinical Significance
a. respiratory or metabolic acidosis/ketosis
b. respiratory or metabolic alkalosis
c. renal tubular acidosis
d. renal calculi formation
e. treatment of UTI
f. precipitation/identification of crystals
g. determination of unsatisfactory specimen
Causes of Acid and Alkaline Urine
Acid Urine Alkaline Urine
Emphysema Hyperventilation
Diabetes mellitus Vomiting
Starvation Renal tubular acidosis
Dehydration Presence of urease-
producing bacteria
Diarrhea Vegetarian diet
Presence of Old specimens
acid-producing
bacteria
High protein diet
Cranberry juice
Medications
 II. Protein
Most indicative of renal disease
Normal urine contains <10 mg/dl or 100 mg/24
hours
Types of Proteinuria (according to the amount of
protein excreted per day)
Degree of Grams Excreted
Proteinuria per 24 hours
Mild <1 g/day
Moderate 1- 4 g/day
Heavy >4 g/day
Types of Proteinuria
(according to cause)
1. Pre-renal
Intravascular hemolysis
Muscle injury
Severe infection and inflammation
Multiple myeloma
2. Renal
a. Glomerular
Conditions that cause damage to the
glomerulus
Orthostatic or Postural Proteinuria

b. Tubular
Fanconis Syndrome
Toxic agents/Heavy metals
Severe viral infections
3. Post-renal
a. lower UTI/inflammation
b. injury/trauma
c. menstrual contamination
d. prostatic fluid/spermatozoa
e. vaginal secretions
Tests for Albumin
Heat and Acetic Acid Test
Positive Results: 1+ - diffused cloud
2+ - granular cloud
3+ - distinct flocculi
4+ - large flocculi
Reagent Strips
SSA/Cold Protein Precipitation
Correlation of Reagent Strip and SSA
Results
(+) Rgt. Strip, (-) SSA = albumin present
(+) Rgt. Strip, (+)SSA = proteinuria
(-) Rgt. Strip, (+) SSA = BJP, globulins, etc.
III. Glucose
Normal concentration: 15 mg/dl
Melituria
Glycusoria
Clinical significance
a. DM
b. endocrine disorders
c. pancreatitis, carcinoma, cystic fibrosis,
hemochromatosis
d. CNS disorders
e. disturbance in metabolism
f. liver disease
g. renal glycusoria
h. drugs
 Glycusoria without hyperglycemia
a. renal tubular dysfunction
b. tubular necrosis
c. Fanconis syndrome
Tests for Glucose
1. Benedicts Test general test for glucose and
other reducing sugars
2. Clinitest subject to interference from other
reducing sugars
Pass-though phenomenon
3. Glucose Oxidase specific for glucose
Correlation of Glucose Oxidase and Clinitest
GOD Clinitest Interpretation
1+ neg small amount of glucose
present

4+ neg possible oxidizing agent

interference on rgt
strip

neg 1+ non-glucose reducing

substance present
IV. Ketones
Represents 3 intermediate products of fat
metabolism:
a. acetone
b. acetoacetic acid
c. -hydroxybutyric acid

Accumulation in blood leads to:

a. electrolyte imbalance
b. dehydration
c. acidosis
d. diabetic coma
 Clinical significance:
a. DM
b. insulin dose monitoring
c. diabetic acidosis
d. starvation/fasting
e. weight reduction/dieting/strenuous exercise
f. vomiting
g. malabsorption/pancreatic disorders
h. inborn error of amino acid metabolism
V. Blood
Hematuria
Clinical Significance:
a. renal calculi
b. glomerulonephritis
c. tumors
d. trauma
e. pyelonephritis
f. toxic chemicals
g. strenuous sxercise
h. menstrual contamination
 Hemoglobinuria

Clinical significance:
a. hemolytic anemia
b. transfusion reaction
c. PNH
d. severe burns and infections
e. malaria
f. strenuous exercise
 Myoglobinuria
Clinical significance:
a. muscular trauma/crush syndrome
b. prolonged coma
c. convulsions
d. muscle-wasting diseases
e. alcoholism/overdose
f. drug abuse
g. extensive exertion
Tests to Differentiate Hemoglobin
and Myoglobin
Ammonium Sulfate Method
Hb is precipitated by ammonium sulfate
Absorption Spectrophotometry
Immunodiffusion Technique
Protein Electrophoresis
 Differentiation of Hematuria,
Hemoglobinuria, and Myoglobinuria
Finding Red Cells Hemoglobin Myoglobin
Rgt. Strip Positive Positive Positive
Microscopic Present Absent or Absent or
(RBCs) few few
Urine Appearance Cloudy red Clear red Clear red
Plasma Normal Pink to red Normal
Appearance
Total serum CK Normal Slight Marked
elevation elevation
Total serum LD Normal Elevated Elevated
LD1 and LD2 Normal Elevated Normal
LD4 and LD5 Normal Normal Elevated
VI. Bilirubin
Clinical Significance
Hepatitis, cirrhosis, other liver disorders
Biliary obstruction

Tests
Foam-Shake Test
Oxidation Test acidic oxidation of bilirubin
into rainbow array of colors
Diazotization Test
Ictotest
Reagent Strip
VII. Urobilinogen
found in urine in small amounts

Clinical Significance
Early detection of liver disease
Hemolytic disorders
Hepatitis, cirrhosis, carcinoma
Tests
Ehrlichs Tube Test
Schwartz-Watson Differentiation Test
Reagent Strip
 Watson-Schwartz Test Interpretation
Urobilinogen Ehrlich-reactive Porphobilinogen
Substances

Chloroform Extraction

Urine Colorless Red Red

(Top layer)

Chloroform Red Colorless Colorless

(Bottom layer)
Butanol Extraction

Butanol Red Red Colorless

(Top layer)

Urine Colorless Colorless Red

(Bottom layer)
 Laboratory Findings in Various Types of
Jaundice
Blood Urine Urine
Bilirubin Bilirubin Urobilinogen

Normal 01.3 mg/dL Negative 1 mg/dL

Hemolytic Increased Negative +++

Hepatic Increased + or - ++

Obstructive Normal +++ Normal

 Urobilin brown pigment which result from
oxidation of urobilinogen upon
exposure to light; tested when
urobilinogen is negative
Porphyrins cyclic compounds derived from ALA
Clinical Significance: Porphyrias
Tests for Porphyrinuria
Ehrlich Test requires the addition of acetylacetone
prior to performing the test
Fluorescence involves extraction into a mixture of
glacial HAc and ethyl acetate and
examination of solvent layer
faint blue fluorescence = (-)
violet, pink, or red = (+)
VIII. Nitrite
Clinical Significance
Cystitis
Pyelonephritis
Evaluation of antibiotic therapy
Monitoring of patients at high risk for
UTI
Screening of urine culture specimens
IX. Leukocyte Esterase
Clinical Significance
Bacterial
and nonbacterial UTI
Inflammation of the urinary tract
Screening of urine culture
specimens
 Urine Reference Values
Property Reference Value
Color Yellow
Transparency Clear
pH 5-7
Specific Gravity 1.001-1.035
Protein (albumin) Negative or Trace
Blood (hemoglobin) Negative
Nitrite Negative
LE Negative
Glucose Negative
Ketones Negative
Bilirubin Negative
Urobilinogen 1 mg/dL
 Confirmatory Urinalysis Tests
Substance Test
Protein SSA Test
Blood Microscopic Examination
Hemoglobin, Myoglobin Centrifugation; then test
supernatant with rgt.
strip for blood
Hemosiderin Rous Test
Glucose Clinitest
Bilirubin Ictotest
Urobilinogen Watson-Schwartz Test
Porphobilinogen Hoesch Test
Ascorbic Acid EM Quant
 SPECIAL URINALYSIS
SCREENING TESTS
Amino Acid Disorders
1. Phenylalanine-Tyrosine Disorders
a. Phenylketonuria
Tests:
Ferric Chloride Test
Phenistix
DPNH
Robert Guthrie Bacterial Inhibition
Test
b. Tyrosyluria
Tests:
Millons Test
Nitrosonaphthol Test

Ferric Chloride Test

Phenistix

DPNH
c. Melanuria
Tests:
Sodium nitroprusside Test
- interference due to a red color from
acetone and creatinine can be
avoided by adding glacial HAc
Ferric Chloride Test
Acetest

Blackberg and Wanger Test

Ehrlichs Test
d. Alkaptonuria
Tests:
Ferric chloride Test
Alkali Test
Addition of silver nitrate or ammonium
hydroxide
Benedicts Test or Clinitest
2. Branched Chain Amino Acid Disorders
a. Maple Syrup Urine Disease
Tests:
DNPH
Amino Acid Chromatography

Ferric Chloride Test

Nitrosonaphthol

Acetest
b. Organic Acidemias
Isovaleric Acidemia
DNPH
Acetest

Chromatography

Propionic Acidemia
DNPH

Acetest

Methylmalonic Acidemia
DNPH

Acetest

p-nitroaniline
3. Tryptophan Disorders
a. Indicanuria
Clinical Significance:
Obstruction
Presence of bacteria

Malabsorption syndrome

b. Hartnups Disease
production of blue color when indican
is oxidized upon exposure to air
c. 5-HIAA
Tests:
Ferric Chloride Test
Sjoerdsma Test.

Clinical Significance:
Elevated in malignancy involving
Argentaffin cells
4. Cystine Disorders
a. Cystinuria
Tests:
+ Cystine crystals
Cyanide nitroprusside
b. Cystinosis
Tests:
Cyanide nitroprusside
Clinitest
c. Homocystinuria
Tests:
Cyanide nitroprusside
Silver nitroprusside
Mucopolysaccharide Disorders
Hurlers Syndrome
Hunters Syndrome
San Filippos Syndrome

Tests:
Acid Albumin
CTAB Turbidity Test
Metachromatic Staining Spot Test
Purine Disorders
Lesch-Nyhan Disease
lack
of the enzyme HGPT
Manifestations: severe motor defects,
mental retardation, tendency toward
self-destruction, gout and renal calculi,
orange sand in diapers
MICROSCOPIC
EXAMINATION
 Types of Microscope
Bright Field objects appear dark against a light
background
Phase Contrast works by retardation of light
rays diffused by the object in
focus
Polarizing used to confirm the identification of
fat droplets, oval fat bodies, and
fatty casts
Interference Contrast object appears bright
against a dark background but
without the diffraction halo
associated with Phase Contrast
Microscope
Microscopic Sediment Stains
Sternheimer-Malbin
0.5% Toluidine Blue
Sudan III
Oil Red O
Prussian Blue
Hansel Stain
 Reference Values for Urine Sediment
Constituent Reference Value
Red Blood Cells 0-2/hpf
White Blood Cells 0-5/hpf (female>male)
Casts 0-2 hyaline/hpf
Squamous Epithelial Cells Few/hpf
Transitional Epithelial Cells Few/hpf
Renal Tubular Epithelial Cells Few/hpf
Bacteria Negative
Yeast Negative
Abnormal crystals Negative
Standardization of Procedure
1. Urine Volume 12 mL
2. Time of Centrifugation 5 minutes
3. Speed of Centrifugation
Relative Centrifugal Force of 400 g
4. Volume of Sediment Examined 20 L
5. Reporting Format
 Reporting System for Urine Sediment
Average Number per Low-Power Field
Casts Neg 0-2 2-5 5-10 10-25 25-50 >50
Abnormal crystals Neg 0-2 2-5 5-10 10-25 25-50 >50
Squamous ECs Few Moderate Many
Mucus Present
Average Number per High-Power Field
Red Blood Cells 0-2 2-5 5-10 10-25 25-50 50-100 >100
White Blood Cells 0-2 2-5 5-10 10-25 25-50 50-100 >100
Normal Crystals Few Moderate Many
Epithelial Cells Few Moderate Many
Miscellaneous Few Moderate Many
Sperm Present
Organized
Sediments
 Red Blood Cells

Normal appearance
N.V.
Variations in shape and
appearance
Clinical Significance
Non-glomerular hematuria: RBCs
are uniform in size and shape but
show two populations of cells
because a small number have lost
their hemoglobin pigment.
 Glomerular hematuria: RBCs are
small and vary in size, shape, and
hemoglobin content.
White Blood Cells
Bacteria

Amoeboid

Normal appearance
N.V.
Clinical Significance
Glitter cells
Eosinophils
Mononuclear cells
Squamous Epithelial Cells
 Clue Cells
Transitional Epithelial Cells
smaller than squamous cells, spherical,
caudate, or polyhedral with central
nucleus

Clinical Significance
Transitional that appear singly, in pairs,
or in clumps
Transitional cells with abnormal
morphology
Renal Tubular Epithelial Cells

Clinical Significance
Oval Fat Bodies
Bubble Cells
 Casts

Mechanisms of Cast Formation

 Hyaline Cast

Strenuous exercise, dehydration, heat

exposure, emotional stress
Acute glomerulonephritis, pyelonephritis,
chronic renal disease, CHF
Red Blood Cell Cast
 WBC Cast

Epithelial Cell Cast

Coarsely Granular Cast
Finely Granular Cast
Waxy Cast

Fatty Cast
Broad Cast
Bacteria
 Yeast Cells

There are no PMNs seen

suggestive of contamination and
not of UTI.
Mucus Thread
Unorganized
Sediments
Crystals
Normal Crystals in Acidic Urine
1. Amorphous Urates
2. Uric Acid
3. Sodium Urates
4. Calcium Sulfates
5. Calcium Oxalate
6. Hippuric Acid
Amorphous Urates
Uric Acid
Dihydrate Calcium Oxalate
Normal Crystals in Alkaline Urine

1. Amorphous Phosphate
2. Calcium Carbonate
3. Ammonium biurate
4. Calcium Phosphate
5. Triple Phosphate
Amorphous Phosphate
Calcium Carbonate
Ammonium biurate
Calcium phosphate
Triple phosphate
Abnormal Crystals of Abnormal Crystals of
Metabolic Origin Iatrogenic Origin
Cystine Sulfonamides
Cholesterol Radiographic
Leucine contrast media
Tyrosine Ampicillin
Bilirubin Acyclovir
Hemosiderin Indinavir sulfate
Cystine
Cholesterol
Leucine
Tyrosine
Sulfa Crystals
Starch