Urine Microscopy Pics

from Urinalysis and Body fluids Strasinger (2021) 7th edition

RBC in urine

Nonnucleated biconcave disks

Crenated in hypertonic urine

Ghost cells in hypotonic urine

Dysmorphic with glomerular membrane damage

Dysmorphic RBC in urine

Altered shape of red blood cells, often seen due to glomerular injury and indicative of renal pathology.

WBC in urine

Presence of white blood cells in urine, often indicating infection or inflammation in the urinary tract.

Squamous Epithelial cells in urine

Flat cells originating from the lining of the urinary tract, typically indicating contamination of the urine sample.

Transitional Epithelial Cells in urine

Cells that line the bladder and ureters, resembling cuboidal or columnar cells, often indicating bladder or urinary tract conditions.

Renal Tubular Epithelial (RTE) Cells in urine

Cells derived from the renal tubules, often indicating kidney injury or disease.

Oval Fat Bodies in urine

Lipid-laden renal tubular cells or free fat droplets, often associated with nephrotic syndrome.

Bacteria in urine

Presence of bacteria in the urine, often indicating a urinary tract infection (UTI) or other infection in the urinary system.

Rod - Bacilli

Spherical - Cocci

Yeast in Urine

Presence of yeast organisms in urine, commonly indicating a yeast infection or contamination.

Mycelial form - branching

Budding form - round

(often associated with Candida infections)

Trichomonas Vaginalis (T. vaginalis) in urine [parasite]

A protozoan parasite that can cause urinary tract infections and vaginitis, often identified through urine microscopy.

Schistosoma Haematobium (S. haematobium) in urine [parasite]

A parasitic worm that can cause hematuria and urinary tract infection, often found in urine samples. It is transmitted through contaminated water and can lead to serious complications if untreated.

Spermatozoa in urine

The presence of sperm cells in urine, which can occur after ejaculation or due to retrograde ejaculation. Spermatozoa can indicate recent sexual activity or other reproductive health issues.

No clinical significance - reporting depends on lab protocols.

Enterobius Vermicularis (E. vermicularis) in urine [parasite]

A pinworm that primarily infects the intestines but may appear in urine samples, especially in cases of severe infection. It is transmitted through the fecal-oral route and is known for causing anal itching.

Mucus (clump) in urine

A gel-like substance that can appear in urine, often resulting from inflammation or irritation of the urinary tract. Mucus may indicate underlying conditions but can also be a normal finding.

Hyaline Cast in urine

A type of urinary cast formed from the protein matrix, typically indicating concentrated urine or dehydration. Hyaline casts are often benign but can be associated with kidney conditions.

RBC cast in urine

A type of urinary cast that contains red blood cells, indicating possible kidney injury or glomerular damage. The presence of RBC casts often suggests conditions like glomerulonephritis.

WBC cast in urine

A type of urinary cast that contains white blood cells, indicating inflammation or infection in the kidney, such as pyelonephritis or interstitial nephritis.

RTE cast in urine

A type of urinary cast made up of renal tubular epithelial cells, indicating tubular damage or injury. The presence of RTE casts often suggests conditions like acute tubular necrosis.

Fatty cast in urine

A type of urinary cast that contains lipids, typically seen in conditions such as nephrotic syndrome. Fatty casts are indicative of significant renal damage and proteinuria.

Granular cast in urine

A type of urinary cast composed of degenerated renal tubular cells or protein, often associated with various kidney diseases and conditions such as acute kidney injury.

Waxy cast in urine

A type of urinary cast characterized by a smooth, waxy appearance, indicating advanced renal disease or chronic kidney dysfunction. Waxy casts are often seen in conditions such as chronic renal failure.

Broad cast in urine

A type of urinary cast that is wider than normal casts, often associated with severe kidney disease or renal failure. Broad casts indicate significant tubular damage and are commonly found in conditions such as chronic nephropathy.

Uric Acid Crystal in urine

A type of crystal that forms in urine due to high uric acid levels, often associated with conditions like gout or dehydration. These crystals can vary in shape, commonly appearing as hexagonal or rhomboid shapes.

Acidic - Yellow-Brown Rosettes/Wedges

Amorphous Urate Crystals in urine

A type of urinary crystal formed from uric acid and its salts, often indicating excess uric acid in the urine. These crystals are usually found in acidic urine and can be associated with gout or metabolic disorders.

Acidic - Brick dust/Yellow Brown

Sodium Urate Crystal in Urine

A type of crystal formed from sodium urate, commonly associated with hyperuricemia and conditions like gout. These crystals typically appear needle-shaped and are found in acidic urine.

Acidic - Colorless

Calcium Oxalate Crystals in urine

A type of urinary crystal formed from calcium and oxalic acid, often indicating hypercalciuria or metabolic disorders. These crystals can appear as dumbbell-shaped or envelope-like structures and are typically found in acidic or neutral urine.

Acidic/Neutral - Colorless Envelopes/Ovals/Dumbbells

Amorphous Phosphate Crystals in Urine

A type of urinary crystal formed from phosphate compounds, often indicating alkaline urine. These crystals can appear as irregular shapes or granular deposits and are usually associated with urinary tract infections or other metabolic disorders.

Alkaline/Neutral - White-Colorless

Calcium Phosphate Crystals in urine

Generally considered non-pathological and often present in the urine of healthy individuals, especially in alkaline urine.

Alkaline/Neutral - Colorless

Triple Phosphate Crystal in urine

Can be seen in healthy individuals with no clinical significance. Can be associated with urinary stones and UTI

Alkaline - Colorless “Coffin Lid”

Ammonium Biurate Crystal in urine

Can be found in normal urine and are associated with renal stones

Alkaline - Yellow-brown “Thorny Apples”

Calcium Carbonate Crystals in urine

No clinical significance

Alkaline - Colorless Dumbbells

Cystine Crystals in urine

Clinically significant and indicate a metabolic hereditary disorder called cystinosis or cystinuria.

Acidic - Abnormal - Colorless Hexagonal Plates

Cholesterol Crystals in urine

Can be seen in patients with nephrotic syndrome, chyluria, and disorders producing lipiduria.

Acidic - Abnormal - Colorless (notched Plates)

Leucine Crystals in urine

Can appear in patients with severe liver disease, terminal cirrhosis, viral hepatitis, and maple syrup disease

Acidic/Neutral - Abnormal - Yellow Concentric Circles

Tyrosine Crystal in urine

Associated with liver disease and with inherited disorders of amino acid metabolism

Acidic/Neutral - Abnormal - Colorless/Yellow needles

 Bilirubin Crystal in urine

Associated with hepatic disease, producing large amounts of bilirubin

Acidic - Abnormal - Yellow (virus looking)

Sulfonimide Crystals in urine

Patients with UTIs are treated with sulfonamides

Acidic/Neutral - Abnormal - Varied (fan shaped)

Radiographic Dye Crystals

Radiographic procedure.

Acidic - Abnormal - Colorless Flat Plates

Ampicillin Crystals in urine

Indicative of large doses of ampicillin without adequate hydration (medication)

Acidic/Neutral - Abnormal - Colorless Needles

Feces w/ Oil droplets in urine

Contaminant/Artifact

Starch Granules in urine

Contaminant/Artifact

Pollen Granule in urine

Contaminant/Artifact

Fiber/Hair in urine

Contaminant/Artifact

Vegetable Fiber in urine

Contaminant/Artifact

Diaper artifact in urine

Contaminant/Artifact