A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
is best, however, to examine several drops; and, when the sediment is
abundant, drops from the upper and lower portions should be examined
separately.
In examining urinary sediments microscopically no fault is so common,
nor so fatal to good results, as improper illumination (see Figs. 2
and 3), and none is so easily corrected. The light must be central and
very subdued. The two-thirds objective should be used as a finder,
while the one-sixth is reserved for examining details.
It is well to emphasize that _the most common errors which result in
failure to find important structures, when present, are lack of care
in transferring the sediment to the slide, too strong illumination,
and too great magnification_.
{103} In order to distinguish between similar structures it is often
necessary to watch the effect upon them of certain reagents. This is
especially true of the various unorganized sediments. They very
frequently cannot be identified from their form alone. With the
structures still in focus, a drop of the reagent may be placed at one
edge of the cover-glass and drawn underneath it by the suction of a
piece of blotting-paper touched to the opposite edge; or a small drop
of the reagent and of the urine may be placed close together upon a
slide and a cover gently lowered over them. As the two fluids mingle,
the effect upon various structures may be seen.
Urinary sediments may be studied under three heads: A. Unorganized
sediments. B. Organized sediments. C. Extraneous structures.
A. UNORGANIZED SEDIMENTS
In general these have little diagnostic or prognostic significance.
Most of them are substances normally present which have been
precipitated from solution either because present in excessive amounts
or, more frequently, because of some alteration in the urine (as in
reaction, concentration, etc.) which may be purely physiologic,
depending upon changes in diet or habits. Various substances are
always precipitated during decomposition, which may take place either
within or without the body. Unorganized sediments may be classified
according to the reaction of the urine in which they are most likely
to be found:
In acid urine: uric acid, amorphous urates, sodium urate, calcium
oxalate, leucin and tyrosin, cystin, and fat-globules. Uric acid, the
urates, and calcium oxalate are {104} the common deposits of acid
urines; the others are less frequent, and depend less upon the
reaction of the urine.
In alkaline urine: phosphates, calcium carbonate, and ammonium urate.
Other crystalline sediments (Fig. 32) which are rare and require no
further mention are: calcium sulphate, cholesterin, hippuric acid,
hematoidin, fatty acids, and indigo.
[Illustration: FIG. 32.--Unusual urinary crystals (drawn from various
authors): 1, Calcium sulphate (colorless); 2, cholesterin (colorless);
3, hippuric acid (colorless); 4, hematoidin (brown); 5, fatty acids
(colorless); 6, indigo (blue); 7, sodium urate (yellowish).]
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