A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
(1) Mucous Threads.--Mucus frequently appears in the form of long
strands which slightly resemble hyaline casts (Fig. 46). They are,
however, more ribbon-like, have less well-defined edges, and usually
show faint longitudinal striations. Their ends taper to a point or are
split or curled upon themselves, and are never evenly rounded, as is
commonly the case with hyaline casts.
(2) Cylindroids.--This name is sometimes given to the {120} mucous
threads just described, but is more properly applied to certain
peculiar structures more nearly allied to casts. They resemble hyaline
casts in structure, but differ in being broader at one end and
tapering to a slender tail, which is often twisted or curled upon
itself (Fig. 46). They frequently occur in the urine along with
hyaline casts, and have no definite pathologic significance.
(3) Masses of amorphous urates or phosphates or very small crystals
(Fig. 47), which accidentally take a cylindric form, or shreds of
mucus covered with granules, closely resemble granular casts.
Application of gentle heat or appropriate chemicals will serve to
differentiate them. When urine contains both mucus and granules, large
numbers of these "pseudo-casts," all lying in the same direction, can
be produced by slightly moving the cover-glass from side to side. It
is possible--as in urate infarcts of infants--for urates to be molded
into cylindric bodies within the renal tubules.
[Illustration: FIG. 47.--Calcium-oxalate crystals, showing a
pseudo-cast of small crystals (Jakob).]
(4) Hairs and fibers of wool, cotton, etc. These could be mistaken for
casts only by beginners. One can easily {121} become familiar with
their appearance by suspending them in water and examining with the
microscope (Fig. 57).
(5) Hyphæ of molds are not infrequently mistaken for hyaline casts.
Their higher degree of refraction, their jointed or branching
structure, and the accompanying spores will differentiate them (Fig.
58).
[Illustration: FIG. 48.--Renal epithelium from nephritic urine: _a_,
Polyhedral epithelium in nephritis of scarlet fever; _b_ and _c_,
different grades of fatty degeneration in renal epithelium in chronic
nephritis (X400) (after Bizzozero).]
2. Epithelial Cells.--A few cells from various parts of the urinary
tract occur in every urine. A marked increase indicates some
pathologic condition at the site of their origin. It is sometimes, but
by no means always, possible to locate their source from their form.
Any epithelial cell may be so granular from degenerative changes that
the nucleus is obscured. They are usually divided into three groups:
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