[AUBF] Chapter 6 - Microscopic Examination of Urine

URINE SEDIMENT CONSTITUENTS

URINE SEDIMENT CONSTITUENTS

can be NORMAL or PATHOLOGIC

URINE SEDIMENT CONSTITUENTS

EASILY DISTORTED BY CONCENTRATIONS, pH, presence of METABOLITES

RBCs

NV = 0-2 or 0-3/HPF

RBCs

appear as smooth, non-nucleated, biconcave discs

RBCs

CLINICAL SIGNIFICANCE:

HEMATURIA

MACROSCOPIC: HEMATURIA

Advanced glomerular damage

MICROSCOPIC: HEMATURIA

Early diagnosis of glomerular dsd

CRENATED RBCs

seen in HYPERSTHENURIC (concentrated urine)

HYPERSTHENURIC

the cells shrink due to LOSS OF WATER

CRENATED RBCs

rough appearance may resemble the GRANULES seen in WBCs - much smaller

GHOST CELLS

seen in HYPOSTHENURIC (diluted urine)

HYPOSTHENURIC

the cells swell due to ABSORPTION OF WATER

lysed rapidly

release of Hgb, leaving only the cell membrane

Large EMPTY CELLS

must be examined under reduced light

GHOST CELLS

Large EMPTY CELLS

DYSMORPHIC RBCs

seen in GLOMERULAR MEMBRANE DAMAGE

glomerular bleeding

strenuous exercise

DYSMORPHIC RBCs

vary in SIZE

DYSMORPHIC RBCs

have cellular protrusions (ACANTHOCYTE/Blebs)

FRAGMENTED(hypochromic)

YEAST CELLS

[ SOURCE OF ERROR ] budding

AIR BUBBLES

[ SOURCE OF ERROR ] highly refractile

OIL DROPLETS

[ SOURCE OF ERROR ] highly refractive

Ca OXALATE

[ SOURCE OF ERROR ] 4

YEAST CELLS

AIR BUBBLES

OIL DROPLETS

Ca OXALATE

2% ACETIC ACID

[ REMEDY ] causes RBCs to LYSE

SUPRAVITAL STAINING

[ REMEDY ] #2 FOR RBCs

WRIGHT’S STAIN:

[ REMEDY ] for dysmorphic RBCs

COLOR

[ CORRELATIONS ] #1

REAGENT STRIP (BLOOD RXN)

[ CORRELATIONS ] (BLOOD RXN)

WBCs

NV = 0-5 or 0-8/HPF

WBCs

larger than RBCs

WBCs

CLINICAL SIGNIFICANCE: PYURIA

or LEUKOCYTURIA

NEUTROPHILS

Most predominant: Granulated & multilobed

HYPOTONIC URINE

swell & granules undergo Brownian movement

Brownian movement

sparkling appearance “GLITTER CELLS”

EOSINOPHILS

NV = 1%

EOSINOPHILS

associated w/ DRUG- INDUCED INTERSTITIAL NEPHRITIS (>1%)

MONONUCLEAR CELLS

LYMPHOCYTES

MONOCYTES

MACROPHAGES

HISTIOCYTES

MONONUCLEAR CELLS

normally present in small numbers

Increased Lymphocytes

Renal Transplant Rejection

Increased MONOCYTES/HISTIOCYTES

Chronic inflamm & Radiation therapy

RTE CELLS

[ SOURCE OF ERROR ]

larger than WBCs

ECCENTRICALLY located nucleus

EPITHELIAL CELLS

[ SOURCE OF ERROR ] if WBCs in the process of AMEBOID MOTION = irregular shape

ACETIC ACID

[ REMEDY ] enhance nuclear details

Pale Blue

SUPRAVITAL STAINING

STEINHEIMER-MALBIN STAIN

GLITTER CELLS:

Pale Pink

SUPRAVITAL STAINING

STEINHEIMER-MALBIN STAIN

LEUKOCYTES:

WBCs

[ CORRELATIONS ]

LE

NITRITE

SG

PH

EPITHELIAL CELLS

Derived from linings of the Genitourinary system

EPITHELIAL CELLS

represents normal sloughing of old cells

SQUAMOUS EPITHELIAL CELLS

Largest cell w/ abundant, irregular cytoplasm & prominent nucleus (size of an RBC)

“CLUE CELLS”

SEC covered w/ Gardnerella vaginalis

“CLUE CELLS”

associated w/ Bacterial vaginosis

TRANSITIONAL EPITHELIAL CELLS

“Urothelial EC”

TRANSITIONAL EPITHELIAL CELLS

centrally located nucleus

TRANSITIONAL EPITHELIAL CELLS

SPHERICAL

POLYHEDRAL

CAUDATE

TRANSITIONAL EPITHELIAL CELLS

SYNCTIA (clumps of TEC)

SYNCTIA (clumps of TEC)

associated w/ invasive urologic procedure (↑ ff catheterization)

Malignancy/viral infxn

ABNORMAL MORPH of SYNCTIA:

RENAL TUBULAR EPITHELIAL CELLS

MOST CLINICALLY SIGNIFICANT EC

RENAL TUBULAR EPITHELIAL CELLS

Rectangular, polyhedral, cuboidal, columnar w/ Eccentric nucleus

RENAL TUBULAR EPITHELIAL CELLS

ORIGIN: Nephron

RENAL TUBULAR EPITHELIAL CELLS

>2 RTE/HPF = TUBULAR INJURY

RENAL TUBULAR EPITHELIAL CELLS

Sometimes BILIRUBIN- STAINED or HEMOSIDERIN- LADEN

OVAL FAT BODY

Lipid-containing RTE cells

OVAL FAT BODY

seen in LIPIDURIA (Nephrotic syndrome)

LIPIDURIA

(Nephrotic syndrome)

LIPID STAIN: TAG & Neutral fats

OVAL FAT BODY is identified by LIPID STAIN:

“Maltese cross” formation

OVAL FAT BODY is identified by POLARIZING MICROSCOPE:

BUBBLE CELL

RTE cells w/ non-lipid vacuoles

BUBBLE CELL

seen in ACUTE TUBULAR NECROSIS

BUBBLE CELL

Injured cells in w/c the endoplasmic reticulum have dilated prior to cell death

BACTERIA

usually present in spx collected under sterile conditions as a result of contamination

vaginal, urethral, external genitalia

collection-container

TRUE UTI

Bacteria + WBCs = ?

E. coli

most common cause of UTI

TRUE UTI

Staphylococcus

Enterococcus

Enterobacteriaceae

YEAST

small, refractile oval structure that may

or may not bud

Branched, mycelia forms

Severe Yeast infxn = ?

TRUE YEAST INFXN

Yeast + WBCs = ?

Candida albicans

seen in DM & Vaginal moniliasis

TRICHOMONAS VAGINALIS

Most frequently encountered parasite in urine

TRICHOMONAS VAGINALIS

pear-shaped flagellate w/ jerky motility

TRICHOMONAS VAGINALIS

agent of PING PONG DSX

ENTEROBIUS VERMICULARIS EGG

Most common fecal contamination

SCHISTOSOMA HAEMATOBIUM EGG

Blood fluke w/ terminal spine

SCHISTOSOMA HAEMATOBIUM EGG

causes Hematuria

SCHISTOSOMA HAEMATOBIUM EGG

associated w/ BLADDER CANCER

SPERMATOZOA

Oval, slightly tapered head

SPERMATOZOA

Long, flagella-like tail

SPERMATOZOA

after sexual intercourse

MUCUS THREADS

has low refractive index

MUCUS THREADS

MAJOR CONSTITUENT:

UROMODULIN (Tamm-

Horsfall protein)

CASTS

Excretion is termed CYLINDRURIA

Unique to the kidney

casts

represents biopsy of an individual tubule

represents biopsy of an individual tubule

primarily formed in the DCT & CT

CASTS

The MOST DIFFICULT & MOST

IMPORTANT sediment constituent

CASTS

MAJOR CONSTITUENT: UROMODULIN

(THP)