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Analysis of Urine
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MICROSCOPIC EXAMINATION OF URINARY SEDIMENTS
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UNORGANIZED ELEMENTS
Normal Acid Crystals 1.Amorphous urates
Pink to red dust or aggregate or ppt. of certain chemicals
Cause turbidity
2.Uric acid
Highly birefringent in polarized light
Increase amount are associated with inrease levels of purine and nucleic acids
In in patients with leukemia receiving therapy, Lesch-Nyhan syndrome and gout
Exists in many forms Whetstone, Rhombic
shaped or lemon shaped
3. Sodium urates Slender prism arranged
in “fan-like” manner Peacock-tail
4. Calcium sulfates 2 forms
A. elongated prismatic tablet
Cigarette-butt B. long thin needle
arranged in star-like manner
Star like crystals
5. Calcium oxalate Birefringent in polarized
light Associated with foods
high in ascorbic acid, oxalic acid such as tomatoes and asparagus
2 forms A. small square with 2
diagonal lines Enveloped shaped
B. Dumbbell-shaped
Normal Alkaline Crystals
1. Amorphous Phosphates Colorless
aggregates or precipitate of CHON
2. Calcium carbonates Tiny spheres or
dumbbells
3. Triple phosphates A.3-6 sides (coffin lid B. fern –leaf
appearance
4. Ammonium biurates 2 forms
A. with spicules (thorny apple appearance
B. Without spicules
Abnormal Crystals Cystine
Found in persons who inherit a metabolic disorders that prevents reabsorption or cystine by the renal tubules(cystinuria)
Confirmation may be made by using cyanide-nitroprusside test
Hexagonal plates (thick or thin)
2. Cholesterol crystals Rarely seen unless
specimen have been refrigerated
Associated with disorders producing lipiduria( nephrotic syndrome)
Seen in conjunction with fatty acids and oval fat bodies
Resembles a rectangular plate with a notch in one or more corners
Crystals associated with liver disease
1. TyrosineMay be seen in
conjunction with leucine
Maybe encountered in in inherited disorders of amino-acid metabolism
Appears as fine colorless to yellowish needle that forms clumps or rosettes
2. Leucine Appears as yellow-brown
spheres that demonstrate concentric circles and radial striations
3. Bilirubin Present in persons with
hepatic disorders Appear as clumped
needle or granules with characteristics yellow color of bilirubin
Sulfonamide crystals Its appearance in fresh
urine can suggest the possibility of tubular damage if crystals are forming in the nephron.
Common in persons treated for UTI
Varried shapes( rhombic, whetstones, sheaves of wheat and even rosettes
Ampicillin crystals
Appears during massive doses of penicillin crystals without proper hydration
colorless needles that tend to form bundle following refrigeration
Urinary sediment artifacts Strach Oil doplets Air bubbles Pollen grains Fibers fecal contamination
Organized elements
1. epithelial cells A. Squamous epithelial
cells – with small centrally
located nucleus with thin edges
From the superficial lining of the urinary tract
B. Transitional or caudate Tail-like projection Big nucleus(sometimes bi-
nucleated)
C. Renal Tubular or Renal failure cells
Polyhedral or cuboidal or egg-shaped
Big nucleus along the side
2. Red blood cells Associated with
glomerular bleeding 6-8 microns in dm Pale disc, with out nucleus
or granules “shaow cell “ or “ghost
cell” 0-2 NV
3. White blood cell 12-15 microns
predominantly neutrophils
Granulated spheres (exhibits “brownian movement”)
Glitter cells Associated with
pyuria 0-5 NV
4. Eosinophils Associated with drug-induced interstitial
nephritis
Small numbers maybe associated with UTI and renal transplant rejection
Preferred stain is “Hansels Stain”
5. Mononuclear cells Lymphocytes resembles that of RBC Seen in increase numbers in the early
stage of renal transplant rejection
RTE seen larger than WBC
Mucus
A protein material produced by the glands and epithelial cells of lower genitourinary tract and the RTE
Tamm-Horsfall CHON is the major constituents of mucus
CASTS
Formed within the lumen of the distal convoluted tubules and collecting duct provides a microscopic view of the conditions of the nephron
Formation Tamm-horsfall CHON is the major
constituents 2/3 albumin & globulin 1/3 tamm-horsfall protein
1. Hyaline casts
Forms the basis of all types of casts
Type of casts wit refractive index similar to that of urine
Uses Sternheimer-Malbin stain which produces pink color
Increase in glomerulonephritis, pyelonephiritis, chronic renal disease and congestive heart failure
2. Waxy casts
Final degenerative type of casts Representative of extreme urine stasis,
indicating chronic renal failure Uses KOVA stain
3. Broad casts
Type of cast which denotes bad prognosis
Seen in distended tubules Often referred to as “renal Failure
casts” Indicates destruction (widening) of
tubular walls.
4. Granular casts
Coarsely and finely granular casts are frequently seen in the urinary sediments
5. Red blood cell casts
Shows bleeding within the nephron Associated with damage to the
glomerulus(glomerulonephritis) Also associated with proteinuria and
dysmorphic erythrocytes
6. White blood cell casts
Signifies infection or inflammation within the nephron
Associated with pyelonephritis
Primary marker for pyelonephritis(Upper UTI) form lower UTI.
Most frequently are composed of neutrophils thus appears granular
Epithelia casts
Casts containing RTE cells represents advance tubular destruction, producing urinary stasis along with disruption of the tubular lining.
Bilirubin-staind RTE seen in cases of hepatitis
Fatty casts
Seen in conjunction with oval fat bodies and free fat droplets in disorders causing lipiduria.
ConfirmII or Oil red O fat stains.
Mixed Cellular casts
RBC and WBC casts seen in glomerulonephritis while WBC and RTE cell casts , or WBC AND Bacterial casts in pyelonephritis
The end!!!