Urine Microscopy

Different findings in urine and what they clinically can mean.

RBC

Reported as average/10 HPF

RBC

Reported as average/10 HPF

RBC

Associated with glomerular membrane damage or vascular injury within the genitourinary tract

WBC

Reported as average/10 HPF

WBC

Reported as average/10 HPF

Pyuria

Increase in urinary WBC

Neutrophil

Predominant WBC found in urine sediment

Neutrophil

May produce a sparkling appearance “Glitter Cell”

Squamous Epithelial Cells

Reported on LPF or HPF

Transitional Epithelial Cells

Reported on HPF

Transitional Epithelial Cells

Clinical insignificant in small numbers but could increase viral infection (refer to pathologist)

Renal Tubular Epithelial Cells

Report HPF

RTE

Could Indicate Renal Tubule Necrosis (Not good)

Oval Fat Bodies

HPF

Oval Fat Bodies

RTE cells that have absorbed lipids present in the glomerular filtrate

Bacteria

HPF

Yeast

HPF

Candida albicans

Most common yeast in urine that is seen in diabetic or immunocompromised patients

Parasite

HPF

T. vaginalis

Most commonly encountered parasite in urine

Sperm

Sperm

Typically insignificant unless found in a patient who is a minor

Mucus

LPF

Mucus

Protein material made by the glands and epithelial cells

Hyaline Casts

LPF

Hyaline Casts

Almost completely made of uromodulin. Increased numbers after strenuous exercise, dehydration, or pathological causes (acute glomerulonephritis, pyelonephritis, chronic renal disease and CHF)

Hyaline Casts

Common in these pathological issues: acute glomerulonephritis, pyelonephritis, chronic renal disease and CHF

RBC Cast

LPF

RBC Casts

This can indicate bleeding within the nephron or glomerular damage

WBC Casts

Confirm on HPF

WBC Casts

Indicates nephron infection/inflammation and a marker for pyelonephritis (upper UTI) vs. cystitis (lower UTI)

Epithelial Cell Casts

Epithelial Cell Casts

May be present due to heavy metal toxicity, chemicals, drugs, viral infections, allograft rejection

Fatty Casts

Highly refractile

Fatty Casts

Seen with oval fat bodies in disorders causing lipiduria

Fatty Casts

Associated with Nephrotic syndrome, Sometimes toxic tubular necrosis, diabetes mellitus, and crush injuries

Granular Casts

HPF

Granular Casts

Could indicate disintegration of cellular casts, tubule cells, or protein aggregates filtered by the glomerulus

Waxy Casts

Waxy Casts

Indicates extreme urine stasis - chronic renal failure

Broad Casts

Broad Casts

“Renal Failure Casts” mold of the distal convoluted tubules

Amorphous Urates

Amorphous Urates

Normally seen in acidic urine with a pH of >5.5

Uric Acid Crystals

Uric Acid Crystals

Normally in urine, but increased amounts can be seen in gout, leukemic patients receiving chemo, or patients with Lesch-Nyhan syndrome

Hippuric Acid Crystals

No clinicial significance

Sodium Urate

Calcium Oxalate

Calcium Oxalate

Calcium Oxalate

In increased numbers it could indicate formation of renal calculi

Amorphous Phosphates

Triple Phosphate

Calcium Carbonate

Ammonium Biurate

“Thorny Apple”

Cystine Crystals

Cystine Crystals

Found in patients with cystinuria

Cholesterol Crystals

Highly birefringent

Cholesterol Crystals

Associated with disorders producing lipiduria (Nephrotic Syndrome)

Radiographic Dye Crystals

Bilirubin Crystals

Seen in patients with liver disorders

Leucine Crystals

Tyrosine Crystals

Bilirubin, Leucine, and Tyrosine Crystals

Three main crystals found in liver diseases

Sulfonamide Crystals

Ampicillin Crystals

Starch Crystals

Fibers

Starch Granules

Calcium Oxalate

Leucine Crystal