

HEMATURIA AND HEMOGLOBINURIA. 411 



Test. Separate the albumin by boiling and the addition of acetic acid. Treat the nitrate 

 with three volumes of alcohol ; this precipitates the peptone, which, when dissolved in water, 

 gives the characteristic reactions for peptone ( 166, I.). 



4. Propeptone, or Hemialbumose, occurs very rarely, e.g., in osteomalacia and intestinal 

 tuberculosis (Bence Jones). The urine is treated to saturation with NaCl and a large quantity 

 of acetic acid added, and filtered while hot, to separate the albumin and globulin. In the cold 

 filtrate propeptone forms a turbidity, which is redissolved by heat. The precipitate thrown 

 down by HC1 and HN0 3 is soluble by heat (Kilhne). The precipitate is isolated by filtration, 

 and dissolved in a little warm water, when it gives with HN0 3 a yellow reaction; like peptone 

 the solution gives the biuret-reaction (p. 248). 



5. Egg-albumin appears in the urine when much egg-albumin is taken in the food, and also 

 when it is injected into the blood-vessels ( 192, 4). According to Semmola, the albumin 

 present in the urine in Bright's disease has undergone a molecular change (similar to egg- 

 albumin), and hence it is excreted. 



6. Mucus is present in large amount, especially in catarrh of the bladder. It contains 

 numerous mucus corpuscles, which are scarcely distinguishable from pus corpuscles. They con- 

 tain albumin, so that urine containing much mucus is albuminous ; mucin is not precipitated 

 by heat, but acetic acid gives a flocculent precipitate in clear urine. [Minute traces of mucin 

 occur normally in urine. If clear normal urine be set aside for a short time, a flocculent hazi- 

 ness, like a cloud of cotton wool, is seen floating in the urine. This is mucus entangling a few 

 epithelial cells from the genito-urinary tract. . Mucin Reaction. According to W. Roberts, 

 the addition of a concentrated solution of citric acid to urine, as in Heller's test ( 264, a), 

 where the two fluids meet, causes an opalescent zone gradually to be formed above the layer of 

 acid.] 



265. BLOOD IN URINE (HJEMATURIA) HEMOGLOBINURIA. I. Source of the 

 Blood. (1) In haematuria, the blood may come from any part of the urinary apparatus. 1. 

 In haemorrhage from the kidney, the amount of blood is usually small and well mixed with the 

 urine. The presence of "blood-cylinders," long microscopic blood coagula, casts of the urini- 

 ferous tubules, washed out of them by the urine, is characteristic when they are found in the 

 urine (fig. 275). The urine usually has a smoky appearance. [The urine slowly dissolves out 

 the colouring matter, the stroma of the corpuscles after a time being deposited as a brownish 

 sediment. The smoky hue occurs only in acid urine; if the urine becomes alkaline, the hue 

 becomes brighter red.] The blood-corpuscles show peculiar changes of form, [they become 

 crenated] (fig. 264), and exhibit evidence of division, due to the action of urea on them ( 5). 

 Large coagula are never found in urine mixed with blood derived from the kidney. 2. In 

 haemorrhage from the ureter, we occasionally find worm-like masses of clotted blood, casts of 

 the canal of the ureter. 3. The relatively largest coagula occur in haemorrhage from the 

 bladder. In all cases where blood is present, we jg&m-** 



must examine microscopically for the blood-cor- j&^SmSfc&Q 



puscles, and it may be for coagula of fibrin. In llSp^S^** ^ /1 



acid urine, blood-corpuscles, but never arranged in 4jL*^^ .-^ f\ s-\ 



rouleaux, may be found after two to three days. j|||l ^^^ ^-^ ^ ,3 



The blood-corpuscles settle as a red sediment at jlj&ik^S' i^^^^^L f ~) r~\ CP 



the bottom. If the haemorrhage is copious many ^^%^S^4k^W &&*^ ^^"^ iO o r> 

 retain their original shape, but if the urine is ^.. ^|^^ k ^ & rj 



very concentrated, they may become crenated. ifmj!^ W^W^W^R? S) S) f\ 



When there is a small and slow haemorrhage *|||! Jifr^fe^ C/ ^' 



from ruptured small capillaries, the red blood- <wjyS^^F^ 



corpuscles are of unequal size, many \ to ^ the ^^^~ 



size of normal, while the pigment has become pj tr> 2(34. Fig. 265. 



^^mSifSf thkkindbeaccwBpamedby Fig. .264. -Crenated red blood-corpuscles in 

 catarrhal inflammation of the bladder, there is u f> x **>' *"* 265. -Peculiar changes 

 found between the red, numerous shrivelled leuco- f t . he red Wood-corpuscles in renal haema- 

 cytes (fig. 265), which in freshly passed urine uria " 



often exhibit lively amoeboid movements. If the urine be alkaline, as it usually is, crystals 

 of triple phosphate also occur. 



If the remains of the red blood-corpuscles become very pale, their presence may be frequently 

 ascertained by adding iodine in a solution of KI (fig. 265). Blood is constantly present in the 

 urine during menstruation. 



II. Hemoglobinuria is quite distinct from haematuria. It depends upon the excretion of 

 haemoglobin as such through the kidneys, and it is produced when haemoglobin occurs free 

 within the blood-vessels, as in cases where the coloured blood-corpuscles have been dissolved 

 inside the blood-vessels (haemocytolysis). It occurs when foreign blood is transfused, e.g., when 

 lamb's blood is transfused into man. The foreign blood-corpuscles are dissolved in the blood 

 of the recipient, and the haemoglobin appears in the urine ( 102). In addition, microscopic 



