urine microscopic examination

sediment

resuspended after spinning

alkaline

casts and RBCs may dissolve in acidic/alkaline urine

LPF

field used to visualize:

-casts

-crystals

-general composition

HPF

used to visualize:

-RBC

-WBC

-bacteria

-yeast

-epithelial cells

-crystals

polarized light

light for some crystal identification

0-5

normal WBC/HPF

0-2

normal RBC/HPF

0-2

normal hyaline casts/LPF

dysphoric

RBC that can be mistaken for budding yeast

oil droplets, urates, yeast

elements that can be confused with RBCs

swollen

RBCs are swollen/crenated in hypotonic urine

crenated

RBCs are swollen/crenated in hypertonic urine

ghost cells

empty RBC membrane in urine

swell

WBCs swell/crenate in dilute alkaline urine

glitter cells

used to describe granular WBCs in urine

pyuria

term meaning inc in WBCs in urine

squamous

-epithelial cells

-large cytoplasm

-small nucleus

-square-ish

-lining of vagina/lower urethra

-most frequent and least significant

transitional

-epithelial cell

-caudate and polyhedral shape

-central nucleus

-less cyto

-line renal pelvis, bladder, upper urethra

-UTI

-carcinoma (clumps)

renal tubular

-epithelial cells

-oblong egg shape

-large central or eccentric nuclei

-proximal and distal tubules

-tubular necrosis, renal graft rejection, kidney infection, heavy drug/metal tox

-most significant

oval fata bodies

-lipid contained in cells (renal tubular or WBCs)

-highly refractile→ maltese cross under polarised light

-nephrotic syndrome or terminal kidney disease

casts

-primarily Tamm-Horsfall mucoprotein (uromodulin)

-formed in renal tubule

hyaline

-casts formed in lumen of DCT/collecting ducts

-rounded ends

-low refractory index

-most frequent and nonpathogenic

-inc: glomerulonephritis, pyelonephritis, chronic renal disease, CHF, dehydration, exercise, stress

0-2/LPF

normal hyaline casts 

RBC

-hyaline casts with inclusion

-contact sports, nephron bleeding, acute glomerulonephritis

-yellow and brown

-refractile

-number/LPF

WBC

-hyaline cast with inclusions

-nephron infection or inflamm, pyelonephritis, glomerulonephritis

-granules and multilobed nuclei

-refractile

-also see free

renal tubular epithelial

-hyaline cast with inclusion

-renal tubular damage, kidney tox, viruses, kidney transplant rejection

-seen w RBC and WBC casts

-central nuclei 

granular

-hyaline cast with inclusions

-coarse or fine

-degenerating cast components

-prolonged renal disease

waxy

-hyaline cast with cracked/serrated edges

-highly refractile

-severe chronic renal failure, malignant hypertension, diabetic nephropathy, acute renal disease, kidney transplant rejection

broad

-clinically signif (diagnostic) casts

-large

-collecting tubules with decreased urine flow

-”renal failure casts”

bilirubin

-hyaline cast with inclusion

-orangey brown

-must check with chem

fatty

-hyaline cast with inclusion

-use polarizer to see maltese cross

bacteria

-urine pathogen

-rod shaped bacilli (E. coli) and cocci (staph spp.)

-semi quant

-first morning void best

-correlate with nitrate test

clue cells

-urine pathogen

-diagnostic

-squamous epithelial cells covered with coccobacilli

• G. vaginalis most common

Gardnerella vaginalis

most commonly seen coccobacili on clue cells

yeast

-urine pathogen

-colorless and ovoid

-budding or pseudohyphae

-can be confused w RBCs

-women and diabetics

Trichomonas vaginalis

-urine pathogen

-colorless

-turnip shaped tetra-flagellates with undulating membrane

-motility for diagnosis (do not call dead)

Schistosoma haematobium

-urine pathogen

-blood fluke

-not common in US

-true urinary parasite

-midday collection for max eggs

sperm

-male reproductive cells

-clinically insignificant UNLESS vulnerable population (pediatric (<16) or geriatric (esp nursing home))

mucus

-prod by glands and epithelial cells in GU tract

-not clinically signif

-threadlike struct

-primarily uromodulin

crystals

-precip of urinary salts

-all identified but not all significant

-some due to T, pH, concentration change

-most commonly seen in concentrated or refrigerated urine (warm to redissolve)

normal

normal/abnormal crystals are seen in acid urine or alkaline urine

acid urine

normal crystals seen in acid/alkaline/neutral urine

-uric acid

-amorphous urates

-calcium oxalate

alkaline

normal crystals seen in acid/alkaline/neutral urine

-triple phos

-calcium phos

-amorphous phos

-ammonium biurate

-calcium carbonate

acid or neutral

abnormal crystals are seen in acid/alkaline/neutral urine

acid or neutral

abnormal crystals seen in acid/alkaline/neutral urine

-cystine

-leucine

-tyrosine

-bilirubin

-cholesterol

uric acid

-normal crystals

-acid urine

-rhombic plates, rosettes, wedges, needles

-leukemia, chemo, fever, renal tube diseases, gout

amorphous urates

-normal crystals

-acid urine

-clumps of yellow/brown

-pink colored urine sediment

-old (>2 hr) or refrigerated samples (24 hr)

calcium oxalate

-normal crystals

-acid urine

-octahedral or dumbell shape

-kidney stones (high oxalic acid), chem tox, high ascorbic acid, ethylene glycol pois

triple phosphate

-normal crystals

-alkaline urine

-coffin lids

-high biref

-UTIs

ammonium biurate

-normal crystals

-alkaline urine

-yellow brown

-”thorny apple”

-insignif → old urine

calcium carbonate

-normal crystals

-alkaline urine

-dumbell or spherical

-not biref

cystine

-abnormal crystals

-acid or neutral urine

-colorless

-hexagonal

-not reabsorbed in PCT

-cystinuria or hereditary cystinosis

-diagnostic

leucine

-abnormal crystals

-acid or neutral urine

-yellow brown sphere

-MSUD

-liver failure (with tyrosine)

-pseudomaltese under polarized light

tyrosine

-abnormal crystals

-acid or neutral urine

-fine needles

-colorless to brown

-tyrosinemia

-liver failure (with leucine)

-strong biref

cholesterol

-abnormal crystals

-acid urine

-colorless

-rectangular with notched edges

-nephrotic conditions

-lymphatic damage

-not biref

bilirubin

-abnormal crystals

-acid urine

-yellow-brown needles

-diagnostic (pathogenic crystals)

-liver disorders

-cholitis

-hemolysis

-weak biref

angiofrafin

-crystals

-CT dye

-often mistaken for cholesterol crystals

sulfa drug

-crystals

-drug induced

-disappear when stop taking drug

-mistaken for tyrosine

-high biref

artifact

-not crystals

-starch

-fibers

-bubbles

-pollen

RBC, WBC, epithelials, casts, bacteria

things in urine that are graded