urine sediments
DESCRIPTION
Urine SedimentsTRANSCRIPT
Sediment constituents
LACASANDILE, RUSSEL M.
BMLS – III - 1
RED BLOOD CELLS CHARACTERISTICS
Smooth Non-nucleated Biconcave disks like
(7 mm - diameter) Identified using High
Power Objective Ave. # seen in 20 hpfs
CLINICAL SIGNIFICANCE Hyposthenuria Glomerular membrane
damage Vascular damage
(genitourinary tract) Hematuria
RED BLOOD CELLS
RED BLOOD CELLS
Frequently confused with yeast cells, oil droplets and air bubbles.
WHITE BLOOD CELLS CHARACTERISTICS
Larger than RBC (diameter – 12mm)
Nuetrophil – predominantly found in the urine sediment
Ave. # seen in 10 hpfs
CLINICAL SIGNIFICANCE Presence of Eosinophil
Drug-induced interstitial nephritis
Urinary Tract Infection Renal Transplant
rejection pyuria Presence of an infection
or inflammation in the genitourinary system
WHITE BLOOD CELLS
WHITE BLOOD CELLS
EPITHELIAL CELLS CHARACTERISTICS
Derived from the lining of the gastrourinary system
3 types Squamous EC Transitional EC Renal tubular EC
EPITHELIAL CELLS Squamous Epithelial
Cell Largest cells found in the
urine Contains abundant and
irregular cytoplasm and prominent nucleus like an RBC size
Often first structures observed when the sediment under LPO
Uses LPO and HPO magnification
Commonly reported as rare, few, moderate or many
Appear folded, possible resembling cast and will begin to disintegrate in urine that is not fresh
Originate – linings of the vagina and female urethra and lower portion of the male urethra
SQUAMOUS EPITHELIAL CELLS
Variation – clue cell (indicative of vaginal
infection by Gardnerella vaginalis)
Bacteria should most covered of e cell surface
CLINICAL SIGNIFICANCE Perineal or vaginal
contamination (female) Foreskin contamination
(males)
SQUAMOUS EPITHELIAL CELLS
SQUAMOUS EPITHELIAL CELLS
SQUAMOUS EPITHELIAL CELLS
EPITHELIAL CELLS Transitional Epithelial
Cells Smaller than squamous
cells Appear
Spherical Polyhedral Caudate
Uses HPO Reported as rare, few,
moderate or many
Originate – lining of renal pelvis Calyces Ureters Bladder Portion of the male
urethra
TRANSITIONAL EPITHELIAL CELLS
CLINICAL SIGNIFICANCE Malignancy Viral infection
TRANSITIONAL EPITHELIAL CELLS
EPITHELIAL CELLS Renal Tubular
Epithelial Cells vary in shape and size Proximal CT RTE
Larger Rectangular Referred as
columnar or convoluted cells
Distal CT RTE Smaller Round and oval Mistaken as WBC’s
and Spherical Transitional EC
Collecting Duct RTE Cuboidal Presence of at least
one straight edge
RENAL TUBULAR EPITHELIAL CELLS
Collecting Duct RTE Appear in groups
(renal fragments) Identified in HPO Reported as rare, few,
moderate or many
CLINICAL SIGNIFICANCE Tubular injury Necrosis of renal
tubules Pyelonephritis Salicylate intoxication Transplant rejection
RENAL TUBULAR EPITHELIAL CELLS
RENAL TUBULAR EPITHELIAL CELLS
EPITHELIAL CELLS Oval Fat Bodies
Lipid containing RTE cells
Usually seen in conjunction with free-floating fat droplets
Presence is confirmed by staining the sediments using Sudan III or Oil Red O fat stains and examing the sediment using polarized microscopy
CLINICAL SIGNIFICANCE Lipiduria Severe tubular
necrosis DM Trauma
OVAL FAT BODIES
OVAL FAT BODIES
BACTERIA CHARACTERISTICS
Not normally present Contaminant bacteria
multiply rapidly at room temperature for extended periods
Results in a pH of 8 and positive nitrite test (unacceptable)
Appear Spherical (cocci) Rods (rods)
Reported using HPO Reported in terms of few,
moderate or many Phase microscopy aids in
the visualization
BACTERIA CLINICAL
SIGNIFICANCE UTI
YEAST CHARACTERISTI
CS Appear
Small Refractile oval
structures (w/ or w/o bud)
Reported as rare, few, moderate or many per hpf
Candida albicans Yeast cell (seen in
urine of: Diabetic Immunocomprom
ised patients women
With vaginal moniliasis
YEAST CLINICAL
SIGNIFICANCE Diabetes Vaginal moniliasis infection
YEAST
PARASITES CHARACTERISTICS
Trichomonas vaginalis Most frequently
encountered Trophozoite –
flagellate with an undulating membrane
Rapid darting movement in in Wet preparations (identification)
Reported as rare, few, moderate or many per hpf
May resemble a WBC Transitional RTE cell
Phase microscopy enhance visualization of flagella or undulating membrane
PARASITES Schistisoma
haematobium Bladder parasite Ova (appear in the
urine) Feacal contamination –
can cause of ova fom intestinal parasites
Ova from pinworm (Enterobius vermicularis) Most common
contaminant
CLINICAL SIGNIFICANCE Vaginal inflammation Urethral infection Prostrate infection
PARASITES
SPERMATOZOA CHARACTERISTICS
Oval, slightly tapered heads
Long flagella-like tails Motile
CLINICAL SIGNIFICANCE Male infertility Retrograde ejaculation
SPERMATOZOA
MUCUS CHARACTERISTICS
Protein material produced by the glands and epithelial cells of the lower genitourinary tract and RTE cells.
Tamm-horsfall protein Major constituent of
mucus
Appears microscopically as thread-like structures with a low refractive index
Reported as rare, few, moderate or many per lpf
More frequently present in female urine specimens
MUCUS
CAST CHARACTERISTICS
Only elements found in the urinary sediment
Found within the lumens of the tubules and collecting duct
Detection: LPF Identification: HPF Reporting: average
number/ 10 lpfs Dissolves quickly in
dilute, alkaline
Cast Composition Major constituent:
Tamm-Horsfall protein glycoprotein excreted
by the RTE cells of the distal convoluted tubules and upper collecting ducts
Other proteins: albumin immunoglobulins
CAST Cast Formation1. Aggregation of Tamm-
Horsfall protein into individual protein fibrils attached to the RTE cells
2. Interweaving of protein fibrils to form a loose fibrillar network (urinary constituents may become enmeshed in the network at this time)
3. Further protein fibril interweaving to form a structure4. Possible attachment of
urinary constituents to the solid matrix
5. Detachment of protein fibrils from the epithelial cells
6. Excretion of the cast Cylindruria- presence
of urinary casts
CAST Hyaline Casts
Most frequently seen cast
Consist of Tamm-horsfall protein
0-2 per lp Colorless (unstained) Easily overlooked
(subdued light) f (normal)
Increased: Strenuous exercise Dehydration Heat exposure
Emotional stress Acute glomerular
nephritis Pyelonephritis Chronic renal disease Congestive heart
failure
HYALINE CASTS
HYALINE CASTS
HYALINE CASTS
CASTS RBC Casts
Indicates bleeding (gastrourinary tract and nephron
Detection: LPO Fragile Fragments: more
irregular in shape Ages Color: Orange-red
CLINICAL SIGNIFICANCE Glomerulonephritis Proteinuria Dysmorphic
erythrocytes Strenuous exercise
RBC CASTS
RBC CASTS
RBC CASTS
CASTS WBC Cast
Signifies infection or inflammation (nephron)
Detection: LPO Appear granular Nucleus: multilobed Forms clumps
CLINICAL SIGNIFICANCE Pyelonephritis Acute interstitial
nephritis Inflammation
WBC CASTS
WBC CASTS
CASTS Bacterial Casts
Bacilli bound to protein
May be mixed with WBC
CLINICAL SIGNIFICANCE
Pyelonephritis
BACTERIAL CASTS
EPITHELIAL CELL CASTS CHARACTERISTICS
Associated with heavy metal and chemical or drug-induces toxicity, viral infection and allograft rejection
DCT Cells: Smaller Round/oval
CLINICAL SIGNIFICANCE Tubular destruction Drug-induced toxicity Viral infection Allograft rejection Renal tubular damage
EPITHELIAL CELL CASTS
EPITHELIAL CELL CASTS
FATTY CASTS CHARACTERISTICS
Seen in conjunction with oval fat bodies and free fat droplets
Highly refractile under bright-field microscopy
May contain few/many fat droplets
Confirmation: polarized microscopy and Sudan III or Oil Red O fat stains
CLINICAL SIGNIFICANCE Nephrotic syndrome Tubular necrosis Diabetis mellitus Crush injuries
FATTY CASTS
FATTY CASTS
MIXED CELLURAL CASTS
CHARACTERISTICS Most frequently
encountered include RBC and WBC
CLINICAL SIGNIFICANCE Glomerulonephritis Pyelonephritis
MIXED CELLURAL CASTS
MIXED CELLURAL CASTS
MIXED CELLURAL CASTS
GRANULAR CASTS CHARACTERISTICS
Coarse or Fine Pathologic or
Nonpathologic (origin) Lysosomes
excreated by RTE Granules represent
disintegration of cellular casts and tubule cell or protein aggragates filtered by the glomerulus
Visualized under low-power microscopy
Final Identification: high power
Cast matrix: waxy appearance
Structure: more rigid, jagged or broken and diameter becomes broader
GRANULAR CASTS CLINICAL
SIGNIFICANCE Strenuous exercise Pyelonephritis Glomerulonephritis
GRANULAR CASTS
GRANULAR CASTS
WAXY CASTS CHARACTERISTICS
Representative of extreme urine stasis
More easily visualized than hyaline casts because of higher refractive index
Supervital stain: they stain homogeneous, dark pink
CLINICAL SIGNIFICANCE Chronic renal failure Stasis of urine flow
WAXY CASTS
WAXY CASTS
BROAD CASTS CHARACTERISITCS
Renal failure casts Represent urine stasis Granular and waxy
Most common broad cast
CLINICAL SIGNIFICANCE Destruction of tubular
walls Rena failure Extreme urine stasis
BROAD CASTS
BROAD CASTS
URINARY CRYSTALS CHARACTERISTICS
Crystals found in normal urine
Crystals found in abnormal urine
liver disease inborn errors of
metabolism renal damage
Reporting: rare, few, moderate,
or many/ hpf Average/ lpf
(Abnormal crystals)
URINARY CRYSTALS Precipitation of urine
solutes inorganic salts,
organic compounds, and medications (iatrogenic compounds)
subject to changes in temperature, solute concentration, and pH
Low temperatures/ref temp majority of crystal
formation takes place Presence of crystals in
freshly voided urine associated with
concentrated (high specific gravity) specimens
URINARY CRYSTALS Acidic pH
organic and iatrogenic compounds readily precipitates
*** All abnormal crystals are found in acidic urine
Neutral and alkaline pH inorganic salts
Calcium oxalate precipitates in both
acidic and neutral urine
NORMAL CRYSTALS SEEN IN ACIDIC URINE
NORMAL CRYSTALS SEEN IN ACIDIC URINE
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
Cystine Crystals found in the urine of
persons who inherit a metabolic disorder that prevents reabsorption of cystine by the renal tubules (cystinuria)
Persons with cystinuria have a tendency to form renal calculi, particularly at an early age.
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
Cholesterol Crystals associated with
disorders producing lipiduria, such as the nephrotic syndrome
seen in conjunction with fatty casts and oval fat bodies.
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
Radiographic Dye Crystals Contrast media Colorless long pointed
needles or flat rectangular plates (resemble cholesterol crystals)
Multicolored when polarized
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
Tyrosine crystals positive chemical test
results for bilirubin Inherited disorders of
amino-acid metabolism
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
Leucine crystals yellow-brown spheres
that demonstrate concentric circles and radial striations
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
Bilirubin crystals disorders that produce
renal tubular damage, such as viral hepatitis
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
Sulfonamide Crystals urine of patients
being treated for UTI due to inadequate
patient hydration appearance in fresh
urine can suggest the possibility of tubular damage if crystals are forming in the nephron
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
Ampicillin Crystals Following massive
doses of this penicillin compound without adequate hydration
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
ABNORMAL CRYSTALS SEEN IN ACIDIC URINE
URINARY SEDIMENT ARTIFACTS
Starch granule contamination may
occur when cornstarch is the powder used in powdered gloves
URINARY SEDIMENT ARTIFACTS
Oil droplets may result from
contamination by immersion oil or lotions and creams
URINARY SEDIMENT ARTIFACTS Air bubbles
occur when the specimen is placed under a cover slip
URINARY SEDIMENT ARTIFACTS
Pollen grains seasonal
contaminants that appear as spheres with a cell wall and occasional concentric circles
URINARY SEDIMENT ARTIFACTS
Hair and fibers from clothing and diapers mistaken for casts
URINARY SEDIMENT ARTIFACTS
URINARY SEDIMENT ARTIFACTS Vegetable fiber
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