MJ del Barrio

Components of Urinalysisy Physical Examination y Chemical Examination y Microscopic Examination

Microscopic Examination

y Urine microscopy is important in detecting and

evaluating renal and urinary tract disorders y Microscopy was traditionally performed after physical and chemical examination y Today, many laboratories perform urine microscopy if the initial exams indicates the need for one.

y Microscopy can be done either with bright field

microscopy or phase contrast

Castsy They are cylindrical bodies formed in DCT or CD y The cast matrix is composed of Tamm-Horsfall

Protein y Cast are usually indicative of Renal Disease y Normal individuals w/o Renal Disease may secrete cast in some cases

Factors Promoting Casts Formationy Increased amounts of Plasma CHON y Decreased pH y Decreased Urinary Flow y Increased Urine Concentration

Hyaline Casty The type most

commonly found in normal urine y Strenous exercise, Fever and Diurectic Therapy y CHF y Maybe seen together with other casts in Renal Disease

Cellular Castsy Consists of THP containing cellular elements in its

matrix y They originate from the DT y The presence of Cellular casts is ALWAYS ABNORMAL.

White Blood Cell Castsy WBC casts/Leukocyte

Cast/Pus Cast y Found in Patients with Inflammation/Infection of the Nephron

Red Blood Cell Castsy Casts that contain RBCs y Indicates bleeding of the

nephrons y RBC within the casts are rapidly lysed and then cast become Haemoglobin casts

Renal Tubular Epithelial Cell Castsy Epithelial cell casts

appear as clear cylinders containing renal epithelial cells y Tubular Damage y Difficult to distinguish with WBC casts

Granular Castsy Cast with coarse or fine granules y Believed to be the product of cellular casts degradation

Granular CastCoarse Granular Cast Fine Granular Casts

Waxy Castsy Waxy casts appear as

cylinders of smooth, highly refractive material y yellow, homogeneous and their ends may be square or broken off y Final stage of cellular cast degeneration y CRF, Transplant Rejection

Broad Castsy Renal Failure Casts y Formed in the collecting

ducts as a result of renal stasis y 2x-6x bigger than other casts

Fatty Castsy Clear cylinders with fat

droplets y Originate from the breakdown of the tubular epithelium containing oval fat bodies y Degenerative tubular disease

Cylindroidsy Formed in DCT y With tapered end y Same clinical

significance as casts y Frequently Hyaline

Cell Types in Uriney Epithelial Cells y White Blood Cells y Red Blood Cells y Yeast Cell y Bacteria

Epithelial Cellsy Squamous Epithelial y Renal Tubular y Transitional Epithelial

Squamous Epithelialy Largest cells y Quadrangular/polygonal

shaped with small central nucleus y Urethra and Vagina y Increase amounts means urine not properly collected

Renal Tubular Cellsy Are round to oval cells

with eccentric nucleusy Tubular Damage , Viral

Infxns, Nephrotoxic Drugs

Transitional Epithelial Cellsy Shape and Nuclear

Location may vary y Urothelial Cells y Bladder/Ureter/Renal Pelvis y Urolithiasis, Bladder CA, Hydronephrosis, after placements of bladder catheters

Red Blood Cellsy Round non-nucleated

cells with a central pallor y Glomerular membrane damage, Vascular injury of the Urinary Tract, Menstruation

Glomerular vs Non-GlomerularDysmorphic RBCs Non-Dysmorphic

Crenated RBCy Concentrated acid urine y Jagged cell wall which

are equally distributed and blunt

Ghost Celly Dilute alkaline urine y Dim or poorly defined

cell wall that appears empty

Yeast Cellsy Are unicellular organism

that reproduce by budding y Candida albicans are the most commonly found species y Vaginitis, DM, Catheters, Antibiotic Tx, Immunosuppresion

Bacteriay Maybe rods or cocci y UTI, Prolonged standing y Nitrite

Crystalsy ID of crystal needs knowledge of the Urine pH y Crystal can precipitate in the urinary system or after

voiding due changes in temperature or prolonged standing y Phase Contrast is better than BF y Polarizing microscope can be used y Solubilty Properties of crystals are helpful in doubful cases.

Crystals in Normal Acid Uriney Uric Acid y Amorphous Urate y Calcium Oxalate

Uric Acidy pH < 6 y Amber coloured and comes in a wide variety of shapes y y y y

and sizes (rhombic, barrel, rosettes, needles, etc Polychromatic under polarized light Dissolve by heating or by adding alkali Insoluble in Alcohol, HCl, Acetic Acid Increased in Uric Acid Nephropathy, Chemotheraphy, Leukemia

Uric Acid

Amorphous uratesy Amorphous urates are

tiny granules than can be found singly or in aggregates y Morphologically identical to Phosphates y They polarize y Solubility same with UA

Calcium Oxalatey Octahedral y Most common cause of

renal stones y Soluble in HNO3, NaOH, HCl but insoluble with Acetic Acid

Crystals in Alkaline Uriney Triple Phosphate y Amorphous Phosphate y Calcium Carbonate y Ammonium Biurate

Triple Phosphatey Ammonium Magnesium y y y y

Phosphate Coffin Lid appearance UTI Caused by urea splitting organisms Bladder stasis Soluble with HCl, Acetic Acid but insoluble with NaOH and heat

Amorphous Phosphatey Granular ppt of of

calcium and phosphate y Can be mistaken sometimes as bacteria y Soluble in HCl and Acetic but not in NaOH and heat y Vegetarians/ Diet rich in Phosphates

Calcium Carbonatey Dumbell shaped/spheres y Difficult to distinguish

with amorphous PO4 but same significance

Ammonium Biuratey Thorny apple y Old specimens y Solublein NaOH + NH3,

HCl, Acetic, Heat

Cystiney Hexagonal crystal y Urine ph must be

lowered to 4.0 and stored at 4 C y Cystinuria

Leuciney spheres with concentric

striationsy Liver Failure

Tyrosiney They appear as thin

needles often aggregated in bundles or rosettes y Liver failure

Trichomonas Vaginalis

Schistosoma haematobium

Entorobius Vermicularis

Spermatozoa

Mucus Threads

Air Bubbles

Starch Granules

Fibers

Referencey y y y y y y y y

http://www.comprehensive-kidney-facts.com/kidney-anatomy.html Fogazzi, et al, The Urinary Sediment 2nd Edition Moore. Clinically Oriented Anatomy 3rd Ed www.biologycorner.com www.medialabinc.net www.agora.crosemont.qc.ca http://missinglink.ucsf.edu www.irvingcrowley.com www.wikipedia.com