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
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