MICROSCOPIC EXAMINATION OF URINARY SEDIMENTS

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UNORGANIZED ELEMENTS

Normal Acid Crystals 1.Amorphous urates

Pink to red dust or aggregate or ppt. of certain chemicals

Cause turbidity

2.Uric acid

Highly birefringent in polarized light

Increase amount are associated with inrease levels of purine and nucleic acids

In in patients with leukemia receiving therapy, Lesch-Nyhan syndrome and gout

Exists in many forms Whetstone, Rhombic

shaped or lemon shaped

3. Sodium urates Slender prism arranged

in “fan-like” manner Peacock-tail

4. Calcium sulfates 2 forms

A. elongated prismatic tablet

Cigarette-butt B. long thin needle

arranged in star-like manner

Star like crystals

5. Calcium oxalate Birefringent in polarized

light Associated with foods

high in ascorbic acid, oxalic acid such as tomatoes and asparagus

2 forms A. small square with 2

diagonal lines Enveloped shaped

B. Dumbbell-shaped

Normal Alkaline Crystals

1. Amorphous Phosphates Colorless

aggregates or precipitate of CHON

2. Calcium carbonates Tiny spheres or

dumbbells

3. Triple phosphates A.3-6 sides (coffin lid B. fern –leaf

appearance

4. Ammonium biurates 2 forms

A. with spicules (thorny apple appearance

B. Without spicules

Abnormal Crystals Cystine

Found in persons who inherit a metabolic disorders that prevents reabsorption or cystine by the renal tubules(cystinuria)

Confirmation may be made by using cyanide-nitroprusside test

Hexagonal plates (thick or thin)

2. Cholesterol crystals Rarely seen unless

specimen have been refrigerated

Associated with disorders producing lipiduria( nephrotic syndrome)

Seen in conjunction with fatty acids and oval fat bodies

Resembles a rectangular plate with a notch in one or more corners

Crystals associated with liver disease

1. TyrosineMay be seen in

conjunction with leucine

Maybe encountered in in inherited disorders of amino-acid metabolism

Appears as fine colorless to yellowish needle that forms clumps or rosettes

2. Leucine Appears as yellow-brown

spheres that demonstrate concentric circles and radial striations

3. Bilirubin Present in persons with

hepatic disorders Appear as clumped

needle or granules with characteristics yellow color of bilirubin

Sulfonamide crystals Its appearance in fresh

urine can suggest the possibility of tubular damage if crystals are forming in the nephron.

Common in persons treated for UTI

Varried shapes( rhombic, whetstones, sheaves of wheat and even rosettes

Ampicillin crystals

Appears during massive doses of penicillin crystals without proper hydration

colorless needles that tend to form bundle following refrigeration

Urinary sediment artifacts Strach Oil doplets Air bubbles Pollen grains Fibers fecal contamination

Organized elements

1. epithelial cells A. Squamous epithelial

cells – with small centrally

located nucleus with thin edges

From the superficial lining of the urinary tract

B. Transitional or caudate Tail-like projection Big nucleus(sometimes bi-

nucleated)

C. Renal Tubular or Renal failure cells

Polyhedral or cuboidal or egg-shaped

Big nucleus along the side

2. Red blood cells Associated with

glomerular bleeding 6-8 microns in dm Pale disc, with out nucleus

or granules “shaow cell “ or “ghost

cell” 0-2 NV

3. White blood cell 12-15 microns

predominantly neutrophils

Granulated spheres (exhibits “brownian movement”)

Glitter cells Associated with

pyuria 0-5 NV

4. Eosinophils Associated with drug-induced interstitial

nephritis

Small numbers maybe associated with UTI and renal transplant rejection

Preferred stain is “Hansels Stain”

5. Mononuclear cells Lymphocytes resembles that of RBC Seen in increase numbers in the early

stage of renal transplant rejection

RTE seen larger than WBC

Mucus

A protein material produced by the glands and epithelial cells of lower genitourinary tract and the RTE

Tamm-Horsfall CHON is the major constituents of mucus

CASTS

Formed within the lumen of the distal convoluted tubules and collecting duct provides a microscopic view of the conditions of the nephron

Formation Tamm-horsfall CHON is the major

constituents 2/3 albumin & globulin 1/3 tamm-horsfall protein

1. Hyaline casts

Forms the basis of all types of casts

Type of casts wit refractive index similar to that of urine

Uses Sternheimer-Malbin stain which produces pink color

Increase in glomerulonephritis, pyelonephiritis, chronic renal disease and congestive heart failure

2. Waxy casts

Final degenerative type of casts Representative of extreme urine stasis,

indicating chronic renal failure Uses KOVA stain

3. Broad casts

Type of cast which denotes bad prognosis

Seen in distended tubules Often referred to as “renal Failure

casts” Indicates destruction (widening) of

tubular walls.

4. Granular casts

Coarsely and finely granular casts are frequently seen in the urinary sediments

5. Red blood cell casts

Shows bleeding within the nephron Associated with damage to the

glomerulus(glomerulonephritis) Also associated with proteinuria and

dysmorphic erythrocytes

6. White blood cell casts

Signifies infection or inflammation within the nephron

Associated with pyelonephritis

Primary marker for pyelonephritis(Upper UTI) form lower UTI.

Most frequently are composed of neutrophils thus appears granular

Epithelia casts

Casts containing RTE cells represents advance tubular destruction, producing urinary stasis along with disruption of the tubular lining.

Bilirubin-staind RTE seen in cases of hepatitis

Fatty casts

Seen in conjunction with oval fat bodies and free fat droplets in disorders causing lipiduria.

ConfirmII or Oil red O fat stains.

Mixed Cellular casts

RBC and WBC casts seen in glomerulonephritis while WBC and RTE cell casts , or WBC AND Bacterial casts in pyelonephritis

The end!!!