BLOOD AND HEMOGLOBIN IN THE URINE. 497 



is acetic acid, which produces a flocculent sediment also in clear filtered urine. 

 Mucin, however, is not precipitated by boiling. The mucoid substance, nucleo- 

 albumin, which is precipitated by an excess of acetic acid in dilute urine, occurs 

 as a sign of renal irritation. 



In the presence of disorders of the bladder, there rarely occurs in the urine 

 an admixture of a peculiar ropy, gum-like substance, consisting of transformed 

 mucus, which is thought to be the product of an anaerobic bacterium gliscro- 

 genum. Nucleoalbumin also has been found, derived partly from the bladder, 

 partly from the urinary tubules of the medullary structure; it is precipitable by 

 acetic acid. Kolisch and Burian found histon in a case of leukemia, and Jolles 

 nucleohiston. According to Morner, the urine contains substances that precipitate 

 albumin, such as chondroitin-sulphuric acid, nucleinic acid, rarely taurocholic acid, 

 in larger amount in association with jaundice. If acetic acid be added to normal 

 urine, these substances are eventually precipitated out. 



BLOOD AND HEMOGLOBIN IN THE URINE: HEMATURIA, 

 HEMOGLOBINURIA. 



In case of hematuria the blood may be derived from any portion of the urinary- 

 apparatus. ( i) In case of hemorrhage from the kidney, the blood is generally admixed 

 with the urine in small amount and is well distributed. The erythrocytes under 

 such circumstances often exhibit peculiar alterations in shape, and processes of 

 division, which may be brought about by the action of the urea, and which have 

 been attributed by Friedreich to independent ameboid movement (Fig. 159). 

 The blood-cylinders present in the sediment are pathognostic of renal hemorrhage, 

 that is, elongated microscopic coagula of blood, which must be considered as 

 actual casts of the collecting tubules of the kidneys, and which are washed thence 

 into the urine (Fig. 166). (2) In case of hemorrhage from the ureters, long, worm- 

 like strings of coagulated blood are occasionally observed in the urine as casts 







o 



o*r 



FIG. 157. Thorn-apple shaped Blood-corpuscles in FIG. 158. Peculiar Changes in the Shape of the Rod 

 the Urine. Blood-corpuscles in Case of Renal Hematuria 



(after Friedreich). 



of the ureter. (3) Relatively the largest coagula of blood occur in cases of hemor- 

 rhage from the bladder. (4) Blood is present in the urine as an admixture at every 

 menstrual period. 



Urine containing blood should always be examined microscopically for blood- 

 corpuscles. In addition, attention should be given to ribrin-coagula. In acid 

 urine, erythrocytes can be recognized for as long as two or three days; though 

 never arranged in rouleaux. If the hemorrhage has been considerable, the cor- 

 puscles are generally normal in shape. If, however, the urine is concentrated, 

 they appear mulberry or thorn-apple shaped (Fig. 157). 



The blood-corpuscles always settle gradually to the bottom in urine at rest. 

 If the blood is slowly admixed with the urine and in small amount from ruptured 

 capillaries, the erythrocytes appear of variable size, some not larger than between 

 one-eighth and one-half of the normal (Fig. 159). At the same time, their pig- 

 ment has become brownish yellow in color (methemoglobin) . If, in a case of 

 hemorrhage of this kind, there exists catarrhal inflammation of the bladder, 

 numerous leukocytes, at times adherent to one another (Fig. 160), which, 

 32 



