ANALISIS ORINA AILAS COLOR x GRAFFTitulo del original en inglés A HANDBOOK OF ROUTINE URINALYSIS © 1983, by Sister Laurine Grat 2* reimpresién, marzo de 2007 Traduccién de EDITORIAL MEDICA PANAMERICANA S.A. efectuada por ol Dr. PALO RUBEN KOVAL Supervision a cargo dela Dra. AIDA V. WASSERMAN ISBN 950-06-0841-3 IMPRESO EN MEXICO/PRINTING IN MEXICO Todos los derechos reservados Este libro 0 cualquiera de sus partes No podran ser reproducidos ni archivacos en sistemas recuperables, ni transmitidos en ninguna forma o por ningtin medio. ya sean mecanicos o electrénicos, fotocopiadoras, grabaciones © cualquier otro, sin el permiso previo de Editorial Mécica Panomericana. $.A. de CV. © 1987. EDITORIAL MEDICA PANAMERICANA, S.A Junin 831, Ter. piso - Buenos Aires Esta adicién sa torminé de imprimir en el mes de morzo de 2007, en los tallares de Servicios Promocionales DAOH S.A. de C.V. Diligencias No. 98 Col. San Pedro Mértir C.P 14650, México D.F.Prefacio soe Agradecimientos .......0.c:.0 1 Introduccién al andlisis de orina .. Formacién de le orine .. Recoleccién de la muestra Métodes ... Conservacion Momento de obtencién de la muestra oss " Examen de las caracteristicas fisicos Caracteristicas .. Color .. Aspecto Peso especifico Urinémetro Refractometro Tiras reactivas para determina cién de! peso especifico Peso especifico vs. osmolali- dad 2 Examen quimico PH urinario Tiros reactivas. .. Protefna .... Pruebas selectivas ... Tiros reactivas .. Acido sulfosalicilico Prueba con calor y dcidoccético Prueba del anillo de Heller ... Proteina de Bence-lones .... Prueba de precipitacién con ca- lor. sissas a Prueba del acido toluensulfeni- co Glucosa y otras sustancios reducto- 108 . Prueba de la glucosa oxidaso Determinacién de sustancias re- ducioras . Tabletos Clinitest .. Reaccién cualitativa de Bene- ict se Cetonas Tiras reactivas Tabletas Acetest ...... Reaccién de Rothera Reaccién de Gerhardt Reaccién de Hart Sangre oculta Hemoturia Hemoglobinurio Mioglobinuria Pruebas selectivas Tiros reactivas Hematest .. Pruebe con sulfato de amonio Bilirrubina y urobilinégeno Pruebas selectivas para bilirrubi- no (bilis) ae Tiras reactivas Ictotest .... sane Pruebo de la espuma Reaccién del yodo de Smi' Reoccion de Harrison .. Pruebas selectivas para urobiliné- geno..... see 41 43 44 44 45 46 47 48 48 48 496 Andlisis de orina Tiras reactivas .. Reaccién cualitativa de Ehrlich Nitrito .. N-Multistix Chemstrip 8 Control de calidad e instrumenta- cién Examen microscépico del sedimento urinario 7 Prepara-i in del sedimento y usodel microscopio ... Células ..... Eritrocitos Leucocitos Célulos epiteliales .. Células epiteliales del tubulo renal : Células epiteliales de transi- cién .. Células epiteliales pavimento- sas 0 escamosas Cristales .. Orinas écidos Cristales de 6cido rico eevee Cristales de oxalato de calcio Urato omorfo .. Cristales de écido hip! Uratos de sodio . Cristales de sulfato de calcio « Cristales de cistina .. leucine Tirosina Colesterol Cristales de su otros férmacos Orinas alcalinas Triple fosfato Fosfato amorfo Carbonato de calcio Fosfato de calcio « Biurato de amonio .. Cilindros ... Cilindros hialinos ..... Cilindros eritrocitarios Cilindros leucocitarios Cilindros granulosos .. Cilindros de células epiteliales .. S$ 88 8 8s S 8 S Skea Gilindros céreos . Cilindros grasos . Estructuras diversos .. Bocterios Hongos .. Cilindroides Espermatozoides Filamentos de moco Cuerpos ovales grasos y gotitas: de Procedimientos selectivos especia- les Acido ascérbico CStix Stix . Reaccién de Rous para hemosideri- na (reaccién de azul de Prusia) Tiras reactivas para leucocitos ...... Prueba de lignina para sulfomidas Acido homogentisico ....... 5 Prueba del cloruro fértico Prueba alcaline Prueba de la pelicula .. Melanina Prueba del cloruro férrico Prueba del bromo ..... Reaccin de Thormahlen para me- lanégeno... Fenilcetonuria Phenistix ...... Prueba del cloruro férrico .. Errores congénitos del metabolismo Aminoaciduria 195 195 196 196 196 196 197 197 197 197 198 199 199 200aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.aa You 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have either reached a page that is unavailable for viewing or reached your viewing limit for this book.Examen microscépico del sedimento urinario 101 co om Fig. 3-52, Celulas micoticas. Obsérvese la gemacion y las paredes de doble refraceion (1.000 *). Fig. 3-53. Cilindroide. Obsérvese la cola afinada (400 x).102 Andlisis de orina Fig. 3-54. Espermatozoides (500 x). Sessa 4 Fig. 3.55. Filamentos de moco. Vistos con un filtro 80A (100 >}Examen microscépico del sedimento urinario linos. Los filamentos de moco espeso tienden a incorporar leucocitos. Cuerpes ovales grases y gotitas de grasa libre En la orina puede existir grasa en forma de gotitas 0 de glébulos libres, en el interior de células en proceso de degeneracién o necréticas (cuerpos ovales grasos) 0 incorporada en cilin- dros. Por lo comin los cuerpos ovales grasos se definen como células del tibulo renal que con- tienen gotitas de grasa altamente refringentes (fig. 3-56). Su presencia se debe a la incorpora- cin de grasa filtrada a través del glomérulo en el interior de la célula o a la degeneracién grasa de células tubulares. Los cuerpos ovales grasos pueden ser también macréfagos 0 leucocitos polimorfonucleares (Weller, 1979; Latner. 1975) que han incorporado lfpidos 0 células de- generadas en su interior oque han sufrido dege- neracion grasa. Los Ifpidos pueden aparecer en la orina tam. bién como gotitas de grasa libre (fig. 3-57), que con frecuencia varfan de tamaiio por coalescen- cia de los globules. Las gotitas de grasa son altamente refringentes, de forma globular y con q Fig. 3-56. Cuerpo oval graso y una fibra (500 *). 103 frecuencia de color amarillo-castafio, aunque con poco aumento o con luz atenuada pueden ser negros debido a su elevado indice de refrac cién. En los casos de lipuria (excrecién de If dosen la orina), las gotitas de grasa libre pueden flotar en la superficie de la muestra. ‘Cuando las gotitas de grasa, ya se encuentren flotando libremente, ya incorporadas en una célula o cilindro, estén compuestas por ésteres de colesterol 0 por colesterol libre son anisotré- picas (Zimmer y col., 1961) y forman imagenes en “cruz de Malta” bajo luz polarizada (fig 3-58), peronose tiften con los colorantes espect- ficos para grasa. Si estén formadas por triglicés dos, o por grasa neutra, no polarizan la luz, pero se tifien con Sudan IIT 0 con Oil Red O (Bradley y col., 1979). Los glébulos de grasa anisotrépica que se ma- nifiestan en formacién de “cruz de Malta” se denominan “‘cuerpos grasos de doble refringen- cia” (Schreiner, 1963). Puede haber grasa en la orina como conse- cuencia de la degeneracion grasa de los tubulos. Esto se observa con frecuencia en el sindrome nefrético, y también puede verse en los siguien- tes cuadros patolégicos: diabetes mellitus, eclampsia, intoxicacién renal, glomerulonefri- tis crénica, nefrosis lipoidea, embolia grasa104 Anflisis de orina Fig. 3-58. Gotitas de grasa anisotr6pica polarizadas. Obsérvese la formacién en “cruz de Malta” (160 x).Examen microscépico del sedimento urinario (Hansen y col., 1973) y después de lesiones superficiales extensas con aplastamiento de la grasa subcuténea (Latner, 1975). También puede aparecer lipuria después de fracturas de huesos largos o de la pelvis y en casos de fractu- ras multiples por liberacién de grasa de lamédu- la 6sea en la circulacién con filtracién posterior a través de los glomérulos. ARTIFICIOS Una variedad de objetos extrafios pueden en- trar en la muestra de orina durante la recolec- cién, al transportarla, mientras se realiza el estudio 0 estando sobre el portaobjetos. Es im- portante que el técnico pueda reconocer estos objetos como estructuras extrafias. Cristales de almidén Aparecen con frecuencia en la orina. Ticnen forma redondeada u oval, son altamente reftin- gentes y de tamafo variable. El tipo de almidén mas comin que se observa en la orina es el de mafz, posiblemente porque algunas marcas de talco lo contienen. Los cristales de almidén de mafz (maicena) son casi hexagonales y presen- tan en el centro una indentacion irregular (fig. 3-59). Bajo luz polarizada toman la forma de “cruz de Malta” (fig, 3-60), La grasa antisotrSpi- “a Fig. 3-59. Cristal de alinidén (600 x). 105 ca y el almidon son las tinicas estructuras que dan esta forma bajo luz polarizada. El licopodio es similar en aspecto a la maice- na, y se utiliza como taleo. Fibras Las fibras de tela son, sin duda, el tipo de cuerpo extrafio que se observa con mayor fre- cuencia en la orina. Provienen de ropas, pafia- les, papel higiénico, o pueden ser hilachas del aire. Las fibras largas y planas se reconocen con facilidad (fig. 3-61), pero las cortas y aproxima- damente del mismo tamaiio que los cilindros pueden ser confundidas con éstos, incluso por algunos “expertos en el andlisis de orina” La autora considera que este crror puede evi tarse exponiéndose al técnico los diferentes ti- pos de fibras’ porque hay ciertas caracterfsticas que pueden reconocerse con facilidad. Layauto- ra recomienda al estudiante o al lector tomar un paiial descartable, cortar un trozo pequefio, mojarlo con agua y escurrirlo en un tubo de ensayo para Iuego examinar el sedimento (fig. 3-62). Este es el mismo tipo de sedimento que se observa cuando el personal de enfermerfa escu- rre el pafial para obtener una muestra de orina. El pafial descartable contiene muchos de los diferentes tipos de fibras que aparecen como contaminantes en la muestra. : %106 Anilisis de orina Fig. 461. Fibras de género (160 x).Examen microscépico del sedimento urinario 107 Fig. 3-62. Fibra. Esta es una muestra real recibida en el laboratorio para su examen microscdpico (200 x). Alobservar las diferentes fibras pueden apre- ciarse con facilidad algunas caracterfsticas. En primer lugar, por lo general tienen bordes oscu- tos; los bordes de los cilindros no son oscuros. En segundo lugar, la mayorfa de las fibras son planas;|os cilindros son cilfndricos. La fibra que se presenta en la figura 3-63 se encuentra con frecuencia en el sedimento de orina, pero puede reconocerse por sus bordes gruesos y nodulares y por las indentaciones nodulares en sus extre- mos, Esta fibra es mas gruesa en sus bordes que en la parte central (clave), y generalmente plana (otra clave). En el capftulo 4 se observan mas laminas de diferentes tipos de fibras. Gotitas de aceite Las gotitas de aceite en la orina son conse- cuencia de la contaminacién por lubricantes. Tienen forma esférica y tamaio variable (fig, 3-64). Estructuras diversas Entre los demas tipos de detritos ode material extrafie que puede encontrarse en el sedimento pueden mencionarse: cabellos (fig. 3-65); frag- mentos de vidrio (fig. 3-66), asf como marcas 0 rayas cn el portaobjetos; burbujas de aire (fig. 3-67); grénulos de polen y particulas de talco, por lo general formadas por silicatos; tienen, por lo tanto, formas anguladas (fig. 3-68). La orina puede estar contaminada por mate- ria fecal, en consecuencia puede contener fi- bras de vegetales, fibras de muisculoy hebras de tejido (fig. 3-69). Deben reconocerse estas es- tructuras como contaminacién fecal. PARASITOS Ocasionalmente pueden encontrarse parési- tos en la orina, sea porque ocupan el tracto urinario, sea como resultado de contaminacién fecal 0 vaginal La Trichomonas vaginalis es el parésito que més a menudo se observa en la orina. Es un organismo flagelado que tiene aproximadamen- te el mismo tamaiio de un leucocito grande (fig. 3-70). En el extendido mojado y sin tincién su presencia no debe informarse a menos que ten- gan movilidad. A veces, cuando existen bacte- rias proximas a un leucocito, éste pucde ser confundido con Trichomonas; por eso la mo- vilidad es la caracterfstica diagnéstica. Este organismo puede observarse en la orina de hom- bres; pero es mas comtin en la mujer; con fre-108 = Andlisis de orina Fig. 9-63. Fibra. Este tipo de fibra es un contaminante comin de la orina (400 x). o #8 @& )e.@ . Fig. 3.64, Gotta de aceite, En el campo también se observan leucocitos y eélulas del epitelio pavimentoso (400 X |. Copyrighted materiExamen microscépico del sedimento urinario 109 Fig. 3-65. Cabello y un cilindro granuloso de particulas gruesas. Vistos con filtro 80A (400 x), Fig. 3-66, Fragmentos de vidrio. Esto se observa con frecuencia si se utiliza pipeta de vidrio para transferir el sedimento al portaobjeto (400 x). Copyrighted material110 Anélisis de orina peat Ca Fe Boge eh ee Stee “ et a foge el Re he ne hs a bape on: i wet a? Pe Fig, 3-68. Particulas de talco (160 x),Examen microscépico del sedimento urinario 111 +t * ; i a Fig. 3-70. Trichomonas vaginalis. Obsérvense los cuatro flagelos (1.000 x).112 Andlisis de orina Fig. 3-71. Huevo de Enterobius vermicularis y levcocitos (500 X). Fig. 3-72, Cabeza de adulto hembra de Enterobius vermicularis (100 x).4 Sedimento urinario. Atlas € Fig. 4-1. Orina hipot6nica que contiene leucocitos, un hematie, dos células del epitelio renal y una célula del epitelio de transicién. Obsérvese el tamaiio de los leucecitos hinchados. La flecha indica un leucocito préximo a sufrir su lisis (500 x),Sedimento urinario. Atlas Ms Fig. 42. Céluleopitelise,leucoitos, hematiery bacteras. Las cuatro ols epitlales pueden sr do origon tubular, pero los nticleos son indistinguibles en este plano focal (500 x). tee Sf we ee e - Khe See an ' 8 SS we * . ee oF * Fig, 4-3. Gran numero de hematies y una oélula del epitelio pavimentoso (160 x).__ Sediment urinario. Atlas 7 46, Se agrego dcido acético (2%) al portaobjeto con el fin de redlzar los nticleos, confir- mls ene Saioqeele aucune eucocitos. La razén de esta deformacién se desconoce (400 x). Fig. 4-7. Masa de leucocitos y cuatro células epiteliales; todas las estructuras estn tetidas con bilirrubina (200 x).118 Anilisis de orina 7 Fig. 4-9. Células del epitelio renal (500 x).Sedimento urinario. Atlas ng it ; : « *, ow +, ‘ a 7 ‘ ut ¢, 4 \ as 4 ; ie Fig. 4-10, Liminade células del epitelio pavimentoso y leucacitos. Las células epiteliales probablemente represen ten contaminacion vaginal (160 X) Fig. 4-11. Numerosos leucocitos y unas pocas células del epitelio de transicién (flecha). (200 X.)120 AnGlisis de orina Fig. 4.13. Partfoular de urato amorfo (100 x). Copyrighted materialFig. 4-14. Particulas de urato amorfo. Las particulas on este campo aparecen més agrupadas que en la figura 4-13. Obsérvese el color caracteristico (100 x). ala as + yf & teu Cristales de dcido trico, deforma de diamante o de rombo. Estos cristales son muy delgados y casi incoloros a Copyrighted material122 Andlisis de orina os ee me wot is g un & Ooe 4 sey ‘y a oh ’ e . ie . oe A % bs a See ence aa zt Fig. 4-17. Cilindro leucocitario, cilindro granuloso de particulas finas y cristales de écido tirico. Es el mismo paciente de la figura 4-16 (400 x). materialSedimento urinario. Atlas 125 = ’ ds 3 | | Fig. 4.22. Densaformacién en roseta con mayor aumento, Obsérvese el gran ntimero de capas de loscristales de écido tirico (500 x). ‘A ¢ Fig. 4-23. Cristales de dcido trico y de oxalato de calcio (500 x). Copyrighted material126 Andlisis de orina Fig, 4-24. Cristales polarizados de fcido tirico. Obsérvese el cristal més pequeiio (400 x’) 4-25. Cristal polarizado de dcido tirico (400 x).130 Andlisis de orina Fig. 492. Cristales de deido hiptirico (400 *). Fig. 4-33. Cristales de urato de sodio. Obsérvese el extremo del cristal de forma de aguja (400 x)Sedimento urinario. Atlas 131 Fig. 4-34. Cristales de urato de sodio y un leucocito. Obsérvese que se trata de cristales muy delgados (400 x), Fig. 4.25. Cristales de urato de sodio (400 x). Copyrighted material192 Andilisis de ering Fig 424, Gristales de cistina (160 x) - Fig 4:2, Cristal de citing de cares desiguates (1.000 x).13 Anélisis de orina a . . . Fig. 440, Cristes de cistina, unos pocos leucocitos y eélulas del epitelio pavimentoso (160 x). © C- 2 @) 4 e gt Fig. 441. Cristales de cistinay una célula del epitelio pavimentoso. Algunos cristales poseen caras laminadas y otros son bastante gruesos. La lecha muestra un grueso cristal en proyecci6n lateral (400 x),Sedimento urinario. Atlas 135 eo Fig. 4-42, Cristales de cistina, Se demuestran las dos formas en que pueden presentarse: uno encima del otro y en % ste @ o re o-, % actimnulos (160 x), 443, Cristales de cistina de diverso tamafio. En el campo también se observan algunas células del epitelio pavimentoso (160 X).136 Andlisis de orina pa tise sane pA ea 4 i &. = SO dbl hk kd ee Fig. 444. Cristal de cistina con superficie pieada (400 x). wie ke wey oe Le 8 * a e Dy o ‘ a oes ‘ CES ° . oe oe aie 8 ein fo e 6 x ‘ wo ° e . ® ¢ . * @ ° . ‘ fg ou Fig. 445. Cristales de cistina formando un seudocilindro. En el campo también se observan cristles de cistina muy ppequetios y oélulas epiteliales (160%),Sedimento urinario. Atlas 137 “~ Fig. 4-46, Cristales de tirosina. Obsérvese su color negro bajo poco aumento (160 x). Wadd, Wy WW Whe Wi Oa Fig. 4-47. Cristales de tirosina. Obsérvense las finas agujas (1.000 x). Copyrighted materialSedimento urinario. Atlas 139 Fig. 4-50. Cristales de tirosina (1.000 x), Fig. 4-51, Cristales de medio de contraste radiogréfico, La densidad de la orina era de 1,070 (160 x)Fig. 4-58. Cristales de fosfato triple (400 x) Sedimento urinario. Atlas 143144 AnGlisis de oring ‘aaa ‘sd ro at : Rig, +41, estes de ln angle, ‘Cuando los. cristales toman este coli negro-grisices, por ks general ‘estén comenzando a dsolverse (200 Xx). stanticn que146 AnGlisis de orina e Fig, 4-64, Cristal de fosfato tiple. Esta estructura puede confundirse con un cristal de oxalato de ealeio, pero kas amas de la “X” no se cruzan exactamente en el medio (400 » \. Fig. 4-65. Cristales de fosfato de calcio (400 x). Copyrighted material148 — Andlisis de orina ’ Fig. 4-68. Cristales de biurato de amonio (200 x). Fig. 4-69. Cristales de biurato de amonio (200 x).Sedimento urinario. Atlas 149 * Fig, 4-70, Cristales de biurato de amonio (500 x). Fig. 4-71. Cristales de biurato de amonio, moco y un leucocito (500 x).150 Andlisis de orina Fig. 4-12. Cristales de biurato de amonio (500 x). Fig. 4-73. Cristal de biurato de amonio y una célula del epitelio pavimentoso (500 x). Copyrighted material152 Andlisis de orino Fig. 4-77, Gilindro bialino, leucocitos, 4 hematies y bacterias. ¢Puede ver el cilindro plegado? (600 x.) Copyrighted materialFig. 4-79. Cilindro hialino plegado sobre s{ mismo, y gran niimero de hematies. Visto con un filtro 80A (400 x). Copyrighted materialSedimento urinario. Atlas 155 Fig. 4-82. Cilindro hialino (160 x). lea nai Fig 4-63. Gran cantidad de cilindros hialinos y leucocitarios, y excaso ndimero de hematfes (200%).Sedimento urinario. Atlas 157 > i Fig. 486. Cilindro ertracitario contornesdo (600 x). . : s 2. © . * . @ ; +e r os sca he i J . " ‘ : ; r « ies 5 "og ; * he oeen © * te ay y » s ° ay é 4 . e ‘ ° ee ane | > as 4) * a? an - ter, . | ° re % . % y ° * . ze eg ie a s - fhe ms o* oe i me ts os = oo 2 Pos . wm” yc if Fig. 4-87. Cilindro eritrocitario y gran ndmero de hematfes. Las células presentes en el cilindro se encuentran ain intactas (160 x).158 — Anidlisis de orina Fig. 488, Cilindro eritrocitario. Existen ain células intactas en el clindro (flecha), pero muchas han comenzado el proceso de degeneracién (500 %). Fig. £89. Cilindro eritrocitario. Cuando se observa el cilindro de la figura 4-88 bajo poco aumento su color se torna mds acentuado (200 x).Sedimento urinario. Atlas 159 Fig.4-91. _Cilindroleucocitario, leucocitos, células del epitelio pavimentoso y moco. {Puede ver el tinico gl6bulo rojo presente en el cilindro? (400 x.) Copyrighted materialSedimenio urinario. Atlas 163 a Fig. 4-99. 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viewing or reached your viewing limit for this book.aa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.220 = Andlisis de orina M Maltosa, 42 Manosa, 42 Marea alcalina, 34 Medios de contrasie radiografico, cristales, 73, 83, 85-87, 139, 140 Melanina, 26, 196 prucha del bromuro, 197 del clorure férrico, 197 Melanoge:.., 26, 196 reaccion de Thormahlen, 197 Melanoma maligno, 196 color de Ja orina, 26 Metabolismo, errores congénitos, 199 Acetest, 204 aminoaciduria, 200 rmanifestaciones, 199 prueba de la dinitrofenilhidracina, 203 de la ninhidrina, 205, del bromuro de cetiltrimetilamonio, 203, del cianuro-nitroprusiato, 204 del cloruro férrico, 202 del nitroronaitol, 204 selectivas, 200, 201 Microhematuria, 50 Microscopio de campo claro, 63 de contraste de fase, 63 por interferencia, 63 foco, 64 uz amortiguada, 64 magnificacién, 64 técnica on filtro de color, 64 de luz polarizada, 63 uso, 64, 65 Mieloma miltiple, 40 Miogbbinuria, 26, 52 prueba del sulfato de amonio, 54 Moco, 145, 149, 159, 178 Mucopolisicaridos, niveles aumentados, 203 Muestra del chorro medio, limpia, 23 momento de recoleceiin, 24 Multiplicacién por contracorriente, 21 N Necrosis tubular, 96 Nefritis, 22, 50 Nefrén,” 19. 21 Nefrosis, 22 Nios y recoleccién de las muestras, 22 N-Multistix, 32 SG, 30 o Gcronosis (cartflago oscuro), 196 Gligofrenia fenilpirivica, 197 liguria, 22 Glor de ia orina, 27 cristales, 70, 74, 75 ‘cristales, 86, 88 conservacién, 23 cconstituyentes, 22 densidad, 27, 28, 61 formacicn, 19 hipoténicas, 67, 68, LLt momento de recelecciin, 24 olor, 27 receleccién, 22 volumen normal, 22 Osmelalidad densidad vs., 30 disminucién de la presién del vapor, 30 unto crioscépico, 31 Osmémeto, 31 Oxalato de calc Oxiuros, 12. 113, eristales, 72-74, 120, 125, 127-129 192, 183 P Pardsitos, 102 Enterobius vermicularis, L12, 113 Schistosoma haematobium, 113 Trichomonas vaginalis, 102, LLL p-Dimetilaminobenzaldehide, 59, 208 Pentesas, 42 Peso espectticn, 27-31 aumentado vs. disminuido, 27 correccién de proteinas y ghucosa, 27 hiperstenuria, 27 hipostenuria, 27, intervalos normales, 27 isostenuria, 27 método de le cafda de la gota, 61 osmolalidad vs., 30. retractémetro, 28, 29 tiras reactivas, 30 urinémetro, 28 pH dela orina, 33 azul de bromotimol y. 34 regulacisn, 34 rojo de metilo y, 34 tiras reactivas, 34 Phenistix errores congénitos del metabolismo, 201 fenilcetnuria, 198, 201 Picdras (céleulos), 70 Piclonefritis, 22 Placa de fosfato, 91, 147, 167, 191 de calcio, 88, 91. 147, 167 Polen, grémulos, 107 Porfirina, 205, 206 precursores, 206 pruebas selectivas, 207 Porfiinuria, 26 Porfobilinsgeno, 59, 205 reaccién de Hoesch, 208 de Watson-Schwartz, 207 Principio del error proteico de los indicadores, 36 Procedimientos selectivos especiales, 194 Proteina(s), 35 de Bence'Jores, 39 ‘mieloma miiltiple y. 40 prueba de precipitacién con calor, 40 del écido toluensulfénico, 41 de Tamm-Horsfall, 35, 90, 94