URINARY SEDIMENTS
ORGANIZED SEDIMENTSEPITHELIAL CELLS A.SQUAMOUS CELLS B.TRANSITIONAL CELLS C.OVAL FAT BODIES MISCELLANEOUS STRUCTURES A.BACTERIA B.YEAST C.TRICHOMONAS D.MUCUS THREADS
ORGANIZED SEDIMENTSFORMED ELEMENTS A.PUS CELLS B.GLITTER CELLS C.LEUKOCYTES D.RED BLOOD CELLS URINARY CASTS A.CELLULAR CASTS a.RBC CASTS b.WBC CASTS c.BACTERIAL CASTS d.EPITHELIAL CASTS
ORGANIZED SEDIMENTSB. ACELLULAR CAST a.HYALINE CASTS b.GRANULAR CASTS c.WAXY CASTS d.FATTY CASTS e.BROAD CASTS
EPITHELIAL CELLS
SQUAMOUS CELLS Largest cells in the sediment
Thin, flat cells, with angular border,
anuclear or small central nucleus, present as single cells Correlation: Represent contamination
SQUAMOUS CELLS
TRANSITIONAL EPITHELIAL CELLS Urothelial cells
From renal pelvis, ureters, urinary bladder and
urethra Variable size and shape: round or polygonal, pear-shaped, caudate, tailed, spindle, may develop refractile, fatty inclusions with storage Correlation: Clarity; Blood if malignancy associated
TRANSITIONAL EPITHELIAL CELLS
OVAL FAT BODIES Are thought to be tubular epithelial cells laden
with highly refractile fat droplets Many of the fat droplets are birefringent and anisotrophic and with polarized light will give the distinctive "Maltese cross" pattern Correlation: extensive tubular degeneration and nephrotic syndrome
OVAL FAT BODIES
A Transitional epithelial cell B Oval Fat Body
MISCELLANEOUS STRUCTURES
BACTERIA Bacteria can be identified in unstained urine
sediments when present in sufficient numbers by their characteristic rod shapes Mistaken as amorphous urates or phosphates Correlation: Infection or contamination
BACTERIA
Arrows: Bacteria (Bacilli) Arrowhead: White Blood Cell
YEAST Small, oval, refractile with buds and myceli,
colorless, in singles, chains or budding They often represent contaminants, and are especially suspect if the sample is voided and old Clinical Significance: may be seen in diabetics (since there is increased glucose in urine)
YEAST
TRICHOMONAS VAGINALIS Pear-shaped, motile and flagellated
Usually, this cell comes from genital secretions
contaminating the specimen Clinical Significance: Trichomoniasis
TRICHOMONAS VAGINALIS
MUCUS THREADS Single or clumped threads with low refractive
index May be confused with hyaline casts or cylindroids Clinical Significance: In presence of urinary tract infection or irritation of the urinary tract, large amounts of mucous may be discharged in urine
MUCUS THREADS
PUS CELLS Pus is formed of degenerated neutrophils
(pyocytes) and cellular debris compacted into a mass where cell identity is lost Spherical, slightly smaller than leukocyte , anucleated granular cytoplasm Clinical Significance: Urinary Tract Infection and kidney stones
PUS CELLS
GLITTER CELLS If the urine density is lower than 1.019 this cell
will demonstrate a brownian movement of its granules which will give a glittering cytoplasm Results from degeneration of pus cells which are spherical, slightly larger than leukocyte
GLITTER CELLS
LEUKOCYTE Normal value: 5 WBC/HPF
Spherical, nucleated, granular cytoplasm Clinical Significance: Pyelonephritis, bladder
infections or cystitis and UTI
LEUKOCYTE
RED BLOOD CELLS Normal Value: 0-2 RBCs/HPF
RBC's may appear normally shaped, swollen by
diluted urine or crenated by concentrated urine Both swollen, partly hemolyzed RBC's and crenated RBC's are sometimes difficult to distinguish from WBC's in the urine Clinical Significance: kidney trauma; urinary tract stones; dysmorphic RBC's in urine suggests a glomerular disease such as a glomerulonephritis
RED BLOOD CELLS
Dysmorphic red blood cells
Normal red blood cells with some Dysmorphic red blood cells
URINARY CASTS(CELLULAR CASTS) A.RBC CASTS B.WBC CASTS C.BACTERIAL CASTS D.EPITHELIAL CASTS
RBC CASTS Yellowish-brown color and are generally
cylindrical with sometimes ragged edges Presence of red blood cells within the cast is always pathological Clinical Significance: glomerular damage; renal infarction and subacute bacterial endocarditis
RBC CASTS
WBC CASTS WBCs inside matrix
White cells sometimes can be difficult to discern
from epithelial cells Clinical Significance: Indicative of inflammation or infection, the presence of white blood cells within or upon casts strongly suggests pyelonephritis, a direct infection of the kidney
WBC CASTS
BACTERIAL CASTS Bacilli bound to protein matrix
Due to the infection-fighting efficiency
of neutrophils Mistaken as fine granular cast Clinical Significance: pyelonephritis
BACTERIAL CASTS
EPTHELIAL CASTS Formed by inclusion or adhesion of desquamated
epithelial cells of the tubule lining Cells can adhere in random order or in sheets and are distinguished by large, round nuclei and a lower amount of cytoplasm Clinical Significance: renal tubular damage; acute tubular necrosis and toxic ingestion
EPTHELIAL CASTS
URINARY CASTS(ACELLULAR CASTS) A. HYALINE CASTS B.GRANULAR CASTS C.WAXY CASTS D.FATTY CASTS E.BROAD CASTS
HYALINE CASTS Normal value: 0-2/
LPF most common type of urinary casts Colorless, homogenous matrix, non-refractive Formed in the absence of cells in the tubular lumen, hyaline casts are solidified Tammhorsefall mucoprotein secreted from the tubular epithelial cells of individual nephrons Clinical Significance: may be seen in normal individuals in dehydration or vigorous exercise
HYALINE CASTS
GRANULAR CASTS Coarse and fine granules inside matrix
Second-most common type of cast, granular
casts can result either from the breakdown of cellular casts or the inclusion of aggregates of plasma proteins Clinical Significance: chronic renal disease; glumerulonephritis; stress and exercise
GRANULAR CASTS
WAXY CASTS Highly refractile with jagged ends and notches
represent the end product of cast evolution Clinical Significance: urine stasis and chronic
renal failure
WAXY CASTS
FATTY CASTS Fat droplets and oval fat bodies inside matrix
Formed by the breakdown of lipid-rich epithelial
cells, these are hyaline casts with fat globule inclusions, yellowish-tan in color Clinical Significance: nephrotic syndrome; toxic tubular necrosis and diabetes mellitus
FATTY CASTS
BROAD CASTS Renal Failure Cast
Formed in the collecting ducts as the result of
urinary stasis and are two to six times the size of other types of casts Clinical Significance: extreme urine stasis and renal failure
BROAD CASTS
UNORGANIZED SEDIMENTS NORMAL CRYSTALS A. URIC ACID B. AMORPHOUS URATES C. CALCIUM SULFATE D. SODIUM URATES E. ACID URATES F. CALCIUM OXALATES G. AMORPHOUS PHOSPHATES H. TRIPLE PHOSPHATES I. AMMONIUM BIURATE J. CALCIUM CARBONATE
UNORGANIZED SEDIMENTS ABNORMAL CRYSTALS A. CYSTINE B. CHOLESTEROL C. LEUCINE D. TYROSINE E. BILIRUBIN
NORMAL CRYSTALS
URIC ACID pH lower than 5.5
Yellow brown, may be colorless; highly birefrigent
under polarized light Clinical Significance: increased in fresh specimen associated with leukemic patients and increased levels of purine and nucleic acid
URIC ACID
AMORPHOUS URATES Brick dust or yellow brown granules
Urine sediment has pink color due to the pigment
uroerythrin attaching on surface of granules Found in acidic urine (pH 5.5)
AMORPHOUS URATES
CALCIUM SULFATE Cigarette butt colorless long prism with beveled
ends Rarely seen Identical in appearance to an alkaline crystal calcium phosphate in its prism form No significance
CALCIUM SULFATE
SODIUM URATE Rarely encountered
Blunt ended needle - like or slender prisms
occurring in sheaves or clusters (peacock tail) Colorless or yellowish No significance
SODIUM URATE
ACID URATES Brown larger granules, may have spicules similar
to amorphous biurates No significance
ACID URATES
CALCIUM OXALATES Major component of renal calculi / lithiasis
Dehydrate is envelope or two-pyramidshaped
(most common) Monohydrate is oval or dumbbell-shaped Clinical Significance: calculi formation and ethylene glycol poisoning
CALCIUM OXALATES
Dehydrate
Monohydrate
AMORPHOUS PHOSPHATES White, colorless, granule
If refrigerated, this will produce white precipitates Granular precipitate containing calcium and
phosphate in an alkaline urine
AMORPHOUS PHOSPHATES
TRIPLE PHOSPHATE Colorless coffin lid which when disintegrated
forms feathery appearance Birefrigent under polarized light Associated with urea- splitting bacteria and chronic urinary inflammation
TRIPLE PHOSPHATE
AMMONIUM BIURATE Thorny apple appearance
Large, amber, rounded crystals with pointed
protuberances along their surface Associated with urea- splitting bacteris
AMMONIUM BIURATE
CALCIUM CARBONATE Colorless dumb bells or spherical birefrigent
Usually found in alkaline urine
CALCIUM CARBONATE
ABNORMAL CRYSTALS
CYSTINE Colorless, refractile, hexagonal plates, may be
thick or thin Disintegrating forms maybe found in the presence of ammonia Clinical Significance: Congenital cystinosis or cystinuria and renal calculi
CYSTINE
CHOLESTEROL Large, flat, transparent
Notched corners Highly birefringent Clinical Significance: lipiduria and nephrotic
syndrome
CHOLESTEROL
LEUCINE Oily, highly refractile, yellow or brown spheroids
and concentric striations Clinical Significance: Maple syrup urine disease and severe liver disease
LEUCINE
TYROSINE Very fine, highly refractile needles
Black, yellow In sheaves or clusters (rosette formation) Clinical Significance: Severe liver disease and
tyrosinosis
TYROSINE
BILIRUBIN yellowish brown in the shape of small needle-like
crystals, and often are phagocytized by white blood cells Clinical Significance: hepatic disorders
BILIRUBIN
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