Original question.
Under what several conditions is the Urine found to contain (1) Albumen, (2) Sugar, and (3) Pus globules ?
Urinary albumin, glucose and leukocytes represent different abnormalities, and none alone identifies one disease. A fresh, appropriately collected specimen and confirmation of the constituent are essential before interpreting it.
Persistent albuminuria commonly reflects increased passage of albumin across an injured glomerular filtration barrier. Examples include glomerulonephritis, diabetic kidney disease and other protein-losing glomerular disorders. Renal vascular congestion and severe systemic illness can also increase excretion. Transient albuminuria can accompany fever, strenuous exercise or a urinary tract infection; an upright-posture-related pattern may disappear in an early-morning specimen. Blood or inflammatory material added downstream can contribute protein, so a protein-positive specimen need not mean that every protein molecule crossed a diseased glomerulus.[ref]
Albuminuria by the National Kidney Foundation. Causes: temporary and persistent albuminuria; importance of repeat testing
Albuminuria should be distinguished from the broader term proteinuria. Reduced tubular recovery and overproduction of other small proteins can produce different urinary protein patterns. A modern urine albumin-to-creatinine measurement helps quantify albumin loss and reduce the effect of variable dilution.[ref]
Albuminuria: Albumin in the Urine by NIDDK. Detection: urine albumin measurement and albumin-to-creatinine ratio
The historical “albumen” category does not imply that every old heat or precipitation test was chemically specific for albumin.Glycosuria results either from an excessive filtered glucose load or reduced renal recovery. Diabetes with hyperglycaemia is the major systemic example. Transient hyperglycaemic states may also cause it; renal glycosuria, pregnancy-related changes and proximal tubular dysfunction can produce glycosuria without sustained diabetic hyperglycaemia. Modern drugs that deliberately reduce renal glucose recovery provide another mechanism, but should not be attributed to 1864 practice.[ref]
Renal Glucosuria by Merck Manual Professional Edition. Definition and etiology: glucose without hyperglycaemia; isolated or associated tubular defects
[ref]Glucosuria in Clinical Methods. Chapter 139, Basic Science: excessive filtered load, diminished tubular recovery and pregnancy
Urinary sugar is therefore a reason to examine blood glucose, not proof of one diabetes subtype. Historical reducing-sugar reactions also require care because chemical reduction is not uniquely specific to glucose.“Pus globules” correspond chiefly to leukocytes, especially neutrophils. Pyuria occurs with cystitis, pyelonephritis, urethral or prostatic infection and suppuration draining into the urinary tract. It can also occur with stones, urinary tuberculosis, interstitial nephritis and other inflammatory disorders, or through contamination by genital secretions. Previous antimicrobial treatment or organisms not recovered by a routine culture can leave apparently sterile pyuria.[ref]
Bacterial Urinary Tract Infections by Merck Manual. Urine testing: leukocytes, casts, noninfective causes and contamination
[ref]Living Donor Kidney Transplantation Guidelines by the British Transplantation Society and Renal Association (2011). §5.13, Pyuria: sterile pyuria and alternative causes
A wet sediment examined with a microscope can show leukocytes, red blood cells and urinary casts; urine culture addresses a different question about detectable organisms. White-cell casts suggest inflammation within the kidney rather than simply pus added in the bladder, but are not unique to bacterial pyelonephritis. “Pus in urine” neither localises every lesion nor proves an ordinary bacterial infection.
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