UA 4A (Crystals)

What is the recommended volume?

10-15 ml (12 ml preferred)

What is the centrifugation time?

5 minutes

What is the centrifugation speed for microscopic urinalysis?

400-450 g (in our lab this is 1800 rpm)

How to properly prepare a sediment for microscopic examination

- Mix specimen and pour aliquot of 10-12 mL into urine centrifuge tube

- Centrifuge for 5 minutes at 400-450 g

- After the specimen comes to a complete stop, decant the tube with a smooth but quick tilting motion

- Mix the remaining sediment well (approx.. 0.4 ml)

- Deliver the well mixed sediment to the slide using a disposable pipet

enumerating casts

Low 10x -> 40x may be used for ID

Mucous

Low 10x

Crystals

high 40x

WBCs

high 40x

RBCs

high 40x

Yeast

high 40x

Other particles that compose urine sediment

high 40x

RBCs in Hypertonic urine

Crenated cells

RBCs in hypotonic urine

Swelled, lysed, or ghost cells (pale outline of plasma membrane)

What happens to RBCs in Acetic Acid

They will lyse

What is pyuria?

WBCs in urine

WBCs in hypertonic urine will

Shrink but will not crenate

WBCs in Hypotonic urine will

enlarge and may lyse

Evidence of WBC degeneration

Lysing and bleb formation

Clinical significance of WBCs

- Infections, autoimmune, lupus, TB

- Pyuria seen with WBC casts, cellular casts, or granular casts then an upper urinary tract infection is suspected. Protein is usually positive.

- If pyuria is seen without casts and low protein (0-10 mg/dl) a lower urinary tract infection is suspected

- Proportion of types of WBC can be indictive of disease process

o Neutrophils are the most common type of WBC seen in urine

o Predominance of eosinophils

 Drug induced acute interstitial nephritis

 Renal transplant rejection

o Predominance of lymphs = early renal transplant rejection

Clinical Significance of RBCs

- Hematuria indicates damage to the kidney or urinary tract

o RBCs with RBC casts and protein indicate renal origin; either glomerular or tubular

 Glomerulonephritis

 Pyelonephritis

 Tumors

 Calculi

 Trauma

o RBCs without casts and without clinical proteinuria indicate bleeding “below” the kidney (inflammation due to cystitis) or contamination (menstrual or hemorrhoidal)

Squamous epithelial cells are…

- Most common and largest epi cells found in urine

o Often evidence of vaginal contamination

- 30-50 um in diameter

- Flat with irregular shapes

- Central round nucleus

- Rarely have diagnostic significance report as #/hpf

Transitional epithelial cells are…

- Urothelial cells

- Round, pear-shaped, or with tail like projection

- 20-30 um diameter

- Central round nucleus

- Originate in the renal pelvis, calyces, ureter, urinary bladder

o And upper part of urethra in males

- Report as #/hpf

- Normal: few per entire microscopic evaluation

- Expect to see increased numbers

o UTI

o Viral infections

o Catheterization: sheets of transitional epis (syncytia)

o Malignancy

 Transitional cell carcinoma- clue is the presence of sheets of transitional epis without recent catheterization; may also be vacuolated

Renal tubular epithelial cells are…

MOST SIGNIFICANT

- Polyhedral-flat, cuboidal, columnar

- Eccentric nucleus

- BIG nucleus (2/3 size of the cell)

- 20-30 um in diameter

- Do not swell in water (used to extreme environments, not impacted by hyper/hypo)

- Originate in the lining of renal tubules and collecting ducts

- Most significant of epithelial cells

- Report as #/hpf

- Normal – a few per entire microscopic evalutation

- May be more prevalent in healthy infants than helathy adults

- May be pathogenic

o Pyelonephritis

o Kidney damage from medications or toxins

o Tubular necrosis

o Renal Transplant Rejection

o Viral Infections (Hep B)

- RTE absorbs solutes in the filtrate

o Bilirubin may be absorbed uring viral hepatitis; look for deep yellow color

o Hemoglovin may be absorbed following hemoglobinuria; look for yellow-brown hemosiderin grnaules in RTE and free floating

 Use Prussian Blue for confirmation

What is the origin of an oval fat body

RTE cells with absorbed lipids/fats

Cholesterol is…

birefringent

Neutral fats such as triglycerides and fatty acids are…

not birefringent but can be stained for ID with Sudan Red or Oil Red O (cholesterol does not stain)

What do oil fat bodies look like?

RTE cells with absorbed lipids

What do air bubbles look like

floating most in focus; black edges (you introduce)

What do starch granules look like

Maltese cross pattern under polarized light.

Under normal light → no spherical, but highly refractile, and has a dimple in center (you introduce with powder gloves)

ID spermatozoa in urine

Head with a tail

What is the significance of spermatozoa in MALES

indicates recent ejaculation or nocturnal emission

What is the significance of spermatozoa in FEMALES

vaginal contamination

If sperm is found in a female under ____ years old, follow protocol of institution

16

Is sperm mostly dead or alive in our urine specimens

Dead 💀

Define Glitter cells

when neutrophils swell in a hypotonic solution; refractile cytoplasmic granules move by Brownian movement and “glitter”

Define lipiduria

fat in urine

Uric acid (Rhomboid/Rossette) yellowish brown

Uric acid (Barrel) yellowish brown

Acidic normal crystals

• Uric Acid

• Amorphous urates

• Monosodium Urate

• Calcium oxalate

• Hippuric Acid

Acidic Abnormal Crystals

• Tyrosine

• Leucine

• Bilirubin

• Cystine

• Cholesterol

• Sulfonamide

• Radiographic dye

Alkaline normal crystals

• Amorphous phosphates

• Triple phosphates

• Calcium carbonates

• Calcium phosphates

• Ammonium biurates

Uric acid clinical significance

normal but…

• Chemotherapy

• Gout

• Acute febrile conditions

• Chronic renal disease

• Lesch-Nyhan syndrome

Amorphous urates (yellow brown, pink sediment “brick dust”) junk looking

Amorphous urates clinical significance (hint: what do you do to the specimen)

No clinical signifcance, but…

Soluble in heat (warm it up)

Monosodium urates (colorless to light yellow) needle like prisms

Calcium oxalate (Dihydrate envelope)

Calcium oxalate (Monohydrate form; smaller and ovid or dumbbell shaped)

Calcium oxalate clinical significance (pathologic)

ingestion of ethylene glycol (antifreeze) usually monohydrate

Hippuric acid (six sided prisms, needles, diamonds) fat needles

Tyrosine (needle-like, thin, usually clustered) yellow

Tyrosine crystals are normally seen with

leucine crystals

Tyrosine clinical significance

Severe liver disease, urine stirp will often indicate the presence of bilirubin as well

Significant

Tyrosinemia

Severe liver disorder

o Viral hepatitis, hepatocellular poisons

Leucine (sphere with concentric striations → bullseyes)

Clinical significance of leucine

Sever liver disorder

• liver disease, viral hepatitis, hepatocellular poisons

  • Maple syrup urine disease (MSUD)

Bilirubin (small clusters of fine needles) yellow-brown

Clinical significance of bilirubin crystals

liver disease that leads to jaundice

Cystine (colorless, thin hexagonal plates; sometimes with two sides shorter or longer than the other four sides)

Clinical significance of cystine crystals

Metabolic disorders: cystinosis, cystinuria

Cholesterol (notched corner “Utah” flat plate)

Clinical significance of cholesterol crystals

Nephrotic syndrome

Renal disease

Deposition of lipids in the kidneys (chyluria)

Sulfanomide (varies from granules to plates)

Sulfmethoxazole → brown rossettes or spheres with irregular radial striations

Sulfanomide (varies from granules to plates)

Sulfadiazine → shocks of wheat, needles, fans

clinical significance of sulfanomide crystals

Medication → sulfanomides

Crystals may cause renal tubular damage

Radiographic Dye (pleomorphic needles, single or in sheaths, or in long flat rectangular plates)

What is the specific gravity when there are radiographic dyes

>1.040 (often >1.050) by refractometer

Clinical significance of radiographic dye

Patient history will indicate recent administration of radiographic dye or contrast media

Amorphous phosphates (fine, colorless to slt brown granules) white precipitate when centrifuged

Acetic acid good for clearing

Significance of amorphous phosphates

alkaline tide after eating

Triple phosphate (coffin lids, colorless)

Significance of Triple phosphate

May cause calculi

Infection with urea splitting bacteria

Calcium carbonate (colorless granules; often form in pairs to give appearance of dumbbells)

significance of calcium carbonate

May be seen after ingesting a large amount of vegetables

Calcium phosphates (granular, amorphous, or crystalline prisms with one pointed end; “foam finger”)

Significance of calcium phosphates

more likely found in patines with cystitis

may form calculi

Ammonium biurates (yellow brown spheres with radiating spicules; “thorny apples”)

significance of ammonium biurates

May be seen with ammonia producing bacteria