522 ABNORMAL CONSTITUENTS OF URINE. [BOOK n; 



328. Abnormal Constituents of Urine. The structural ele- 

 ments found in the urine under various circumstances are blood, 

 pus and mucus corpuscles, epithelium from the bladder and 

 kidney, and spermatozoa. To these may be added the so-called 

 4 casts ' which are either 4 epithelial casts,' that is to say cylinders 

 of more or less altered epithelial cells shed from the tubules, or 

 structureless ' fibrinous ' casts, which are cylinders of peculiar 

 material moulded in the lumina of the tubules ; the exact nature 

 of this material is at present a matter of doubt ; it is not always 

 the same but appears not to be fibrin. 



The most common and important abnormal constituents of 

 urine are albumin, giving rise to albuminuria, and sugar, giving 

 rise to glycosuria or diabetes. The soluble proteids generally 

 spoken of as 'albumin ' in the urine differ in different cases. The 

 exact determination of their nature is a matter of some diffi- 

 culty, since, as we have seen, we have in differentiating the 

 various proteids to trust largely to their behaviour as regards 

 precipitation upon the addition of certain saline bodies ; and 

 the presence of saline bodies in the natural urine introduces 

 complications. It would appear, however, that the proteids 

 usually present are serum-albumin and globulin ; these are not 

 however as a rule, if ever, present in the same relative propor- 

 tions as in blood-plasma ; and either the one or the other may 

 be present by itself. A form of albumose ( 181) called hemi- 

 albumose, is sometimes found, and indeed probably very many 

 distinct kinds of proteids are from time to time present. If egg- 

 albumin be injected into the blood it appears in the urine as 

 egg-albumin, and peptone similarly injected appears as peptone. 



The sugar which is found in the urine of diabetes is undis- 

 tinguishable from ordinary dextrose ; but whether it is abso- 

 lutely identical with that body, or whether the sugar in all 

 cases of diabetic urine is exactly the same, cannot perhaps as 

 yet be regarded as definitely settled. 



When blood is mingled with urine in the kidney and in the 

 urinary passages the constituents of the former are of course 

 added to those of the latter ; and when, as sometimes happens, 

 chyle from the lacteals makes its way into the kidneys the 

 urine contains the fats and other constituents of chyle. Fats, 

 however, may be present without the urine being distinctly 

 'chylous.' 



Cholesterin, bile-acids, bile-pigments, and one or other of a 

 large number of bodies arising from a disordered metabolism 

 of the body, such as leucin, tyrosin, acetone (in cases of dia- 

 betes), oxalic acid, taurin, cystin and many others are also found 

 more or less frequently ; some of these indeed have been re- 

 garded as normal constituents. Besides these the urine serves 

 as the chief channel of elimination for various bodies, not proper 

 constituents of food, which may happen to have been taken into 



