For microscopic examination of urine sediment sucked off the eye-dropper bottle with the bottom of the bottle, postavka 1-2 hours, and centrifuged 5-7 minutes at 1500 rpm, the Liquid is poured fast rollover test tubes, a drop of sediment transfer on a glass slide and top cover. Mikroskopiruyut in dark field initially in a small increase, mainly for searching and counting cylinders, then great.
Of the cellular elements of sediment in the urine find leukocytes ( Fig. 1, 1) - rounded grayish granular cells. 1 - 5 of leukocytes in the field of vision occur in any urine, large number of them (see Peoria) indicates inflammation in the urinary tract.
Fig. 1. Leukocytes and erythrocytes in urine sediment: 1 - leukocytes; 2 fresh red blood cells; 3 - leached erythrocytes.Fig. 2. Epithelial cells in urine sediment: 1 - flat epithelium; 2 - polymorphic urinary tract epithelium; 3 renal epithelium.
Fig. 3. Cylinders in urine sediment: 1 - hyaline cylinder; 2 - hyaline cylinder with the imposition of erythrocytes and leukocytes; 3 - waxy cylinders.
Fig. 4. Cylinders in urine sediment: 1 - grained cylinders; 2 - epithelial cylinder; 3 - blood cylinder.
Fig. 5. Salt in the Deposit acidic urine: 7 - crystals of uric acid; 2 - crystals of calcium oxalate calcium).
Fig. 6. Salt in the Deposit alkaline urine: 1 - crystals carbonic lime; 2 - crystals of uric acid ammonium; 3 - crystals tripolifosfat; 4 - amorphous phosphates.
Fig. 7. Rare salt in urine sediment: 1 - crystals tyrosine; 2 - crystals leucine; 3 - crystals of bilirubin. Jaundice cell staining of urine.
Fig. 8. Crystals of sulfa drugs in the urine.
Red blood cells are found in the urine as unchanged (fresh) and leached (Fig. 1, 2 and 3). First a little less of leukocytes, round, homogeneous, greenish-yellow, in clusters orange. Leached erythrocytes (lost hemoglobin) have the form of colorless one - or two-circuit rings.
The nature of the epithelium depends on the location of its branch (Fig. 2).
Squamous epithelium - large polygonal cells with a small core - clusively from the walls of the urethra and external genital organs and diagnostic does not matter.
Polymorphic urinary tract epithelium - oval, pear-shaped, "tailed" cells several smaller, but with a larger engine than squamous epithelium. In a small number is in the urine always, in the large - inflammation of the urinary tract (anesthetic, pielit).
Renal epithelium - round or polygonal cells, a few more cells, with a grained cytoplasm and large puzirkoviy kernel. Comes from the renal tubules and occurs when the lesions (e.g., nefroticescom syndrome).
Cylinders - coagulated protein or subjected dystrophy cell renal epithelium, representing casts tubules (Fig. 3 and 4). Distinguish
cylinders hyaline is a colourless, transparent, visible only in the dark field; granular - well visible, consisting of large or small grains, often yellow-brown, waxy - homogeneous opaque with sharply defined contours; epithelial comprising of renal epithelial cells; erythrocyte (blood)that consists of red blood cells, often leached; leucocytes, consisting of leukocytes. The emergence of cylinders in the urine observed in the kidney disease (principally, jade and other), as well as fever, circulatory failure, etc. In healthy people hyaline cylinders may appear after physical strain. In the Deposit urine taken after intercourse, and when spermatorrhea meet the sperm, and prostateria (allocation secret of the prostate during urination or defecation) - lecithin (lipid) of grain - small, shiny, highly refracting the light of education and their conglomerates - amyloid Taurus.
Salt crystal and amorphous fall in the urine with great concentration, and depending on the reaction of urine. In acidic urine (Fig. 5) there are crystals of uric acid, oxalic lime (see Oxaluria), amorphous urates (see), which gives a tight pink sediment; in alkaline urine ( Fig. 6) fall carbonic lime, urine acid ammonium, tripoliphosphate and amorphous phosphates (see the Phosphaturia). Most salts urine special diagnostic doesn't matter except leucine and tyrosine (Fig. 7)that appear in the urine in acute degeneration of the liver and phosphorus poisoning. When taken large doses of sulfonamides their crystals fall in urine (Fig. 8).
Examination of urine sediment for Chukovskomu - Addis used for accurate accounting allocation of formed elements of urine. Counting elements sludge fields of view inaccurate, because it depends on some reasons: the amount of urine, the time of its assertion, centrifugation , etc.
At 8 o'clock. in the evening the patient urinates, urine was poured. At 6 am collect urine (10 hours). Women take urine catheter. Urine accurately measure, mix well and 1/50 part poured into graduated centrifuge tube. Centrifuged 5 minutes at 2000 rpm Urine over the sediment gently sucked off a pipette with a balloon leave 0.5 ml of sediment, well CSOs stir and put 1 drop in the counting chamber.
At the larger (about. 40x, about 10x) count the erythrocytes and leukocytes (separately) in the entire grid Goryaeva. Multiplying these values by 66 000, find out the number of erythrocytes and leukocytes, allocated for the day. When a large number of cells can be counted 15 large squares (1 row) and multiply the result by 1 000 000 or to dissolve the precipitate, taking into account the dilution in the computation. Cylinders count low magnification on two grids Goriaev, multiply the result by 33 000. A healthy person produces per day of red blood cells to 1 000 000, of cells to 2 000 000, cylinders to 2000.
Fig. 1. Cellular elements in the urinary sediment: 1 - group squamous cells of the lower divisions urinary tract; 2 - "tails" of the cell; 1 - polygonal cells of the renal epithelium; 4 - cell renal epithelium undergone a "fat" rebirth; 5 - leukocyte.
Fig. 2. Cylinders in urinary sediment: 1 - hyaline cylinders, partly with the imposition of salts, single leukocytes, erythrocytes and granular collapse; 2 - hyaline cylinder, painted urinary pigments; 3 - grained cylinder; 4 - hyaline cylinder with the imposition of salts and detritus; 5 - leukocytes.
Fig. 3. Cylinders in urinary sediment: 1 - grained cylinder; 2 - blood cylinder; 3 - a waxy cylinder; 4 - epithelial cylinder; 5 - leukocyte.
Fig. 4. Precipitation in acidic urine: 1 and 2 - amorphous urates, consisting of uric acid sodium; 3-5 - crystals of uric acid; 6 and 7 - the crystals of calcium oxalate.
Fig. 5. Precipitation in alkaline urine: 1-5 - phosphate crystals ammonia-magnesia.
Fig. 6. Rare crystal precipitation in urine: 1 -"balls" leucine; 2 - tyrosine; 3 - cholesterol crystals; 4 - sulphate calcium.
Fig. 7. Precipitation in urine: 1 - crystals bilirubin; 2 - cylinders painted bile pigments; 3 - cell renal epithelium,
painted bile pigments.
Fig. 8. Crystals of sulfonamides: 1 - white crystals of streptocide; 2 - crystals sulfadiazine; 3 - crystals acetylsulfapyridine; 4 - crystals sulfatiazola (sulfate).
Fig. 9. Precipitation in urine: 1 - cholesterol crystals; 2 - cylinder with the imposition of fat
(color Sudan III).
Fig. 10. Newly transparent urine healthy person (color yellow, beats. century 1,016).
Fig. 11. Slightly yellowish, transparent urine in nesharnom diabetes (beats. century 1,001 -1,002).
Fig. 12. Rich transparent urine orange-brown color with heart stagnation (beats. century 1,026-1,030). Fig. 13. Urine type "meat slops", muddy, dirty-brown precipitate acute glomerulonephritis.
Fig. 14. Urine is dark brown with mechanical jaundice.
Fig. 15. Rich in urine postcritically stage lobar pneumonia. Seen a rich sediment uratov.
Fig. 16. Almost black, containing melanin cloudy urine with melanoma liver.
Fig. 17. Milk-white, opalescent urine with a rich white precipitate when phosphaturia.
