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URINARY SEDIMENTS. 829
As previously mentioned (page 674), the urine of healthy individuals
may sometimes, even on voiding, be cloudy on account of the phosphates
present, or become so after a little while because of the separation of
urates. As a rule, urine just voided is clear, and after cooling shows
only a faint cloud (nubecula) which consists of urine mucoid, a few epithe-
lium-cells, mucous corpuscles, and urate particles. If an acid urine is
allowed to stand, it will gradually change; it becomes darker and deposits
a sediment consisting of uric acid or urates, and sometimes also calcium-
oxalate crystals, in which yeast-fungi and bacteria are often to be seen.
This change, which the earlier investigators called " acid fermenta-
tion of the urine," is generally considered as an exchange of the dihy-
drogen alkali phosphates with the urates of the urine. Monohydrogen
phosphates besides acid urates, quadriurates (page 708) or free uric acid
or a mixture of both, according to conditions, 1
are thus formed.
Sooner or later, sometimes only after several weeks, the reaction
of the original acid urine changes and becomes neutral or alkaline. The
urine has now passed into the " alkaline fermentation," which con-
sists in the decomposition of the urea into carbon dioxide and ammonia
by means of lower organisms, micrococcus ureae, bacterium ureae, and
other bacteria. Museums 2
has isolated an enzyme from the micro-
coccus ureae which decomposes urea, which is soluble in water and is called
urease. During the alkaline fermentation volatile fatty acids, especially
acetic acid, may be produced, chiefly by the fermentation of the car-
bohydrates of the urine (Salkowski 3
). A fermentation by which
nitric acid is reduced to nitrous acid, and another where sulphuretted
hydrogen is produced, may sometimes occur.
When the alkaline fermentation has advanced only so far as to render
the reaction neutral, there often occur in the sediment fragments of uric-
acid crystals, sometimes covered with prismatic crystals of alkali urate;
dark-colored spheres of ammonium urate, crystals of calcium oxalate,
and sometimes crystallized calcium phosphate are also found. Crystals
of ammonium-magnesium phosphate (triple phosphate) and spherical
ammonium urate are specially characteristic of alkaline fermentation.
The urine in alkaline fermentation becomes paler and is often covered
with a fine membrane which contains amorphous calcium phosphate
and glistening crystals of triple phosphate and numerous micro-organisms.
1
See Huppert-Xeubauer, 10. Aufl., and A. Ritter, Zeitschr. f. Biologie, 35.
5
Museulus, Pfliiger’s Arch., 12.
1
Salkowski, Zeitschr. f. Physiol. Chem., 13.
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