Urinary Sediments
Urinary Sediments
Urinary Sediments
ORGANIZED SEDIMENTS
EPITHELIAL CELLS A.SQUAMOUS CELLS B.TRANSITIONAL CELLS C.OVAL FAT BODIES MISCELLANEOUS STRUCTURES A.BACTERIA B.YEAST C.TRICHOMONAS D.MUCUS THREADS
ORGANIZED SEDIMENTS
FORMED ELEMENTS A.PUS CELLS B.GLITTER CELLS C.LEUKOCYTES D.RED BLOOD CELLS URINARY CASTS A.CELLULAR CASTS a.RBC CASTS b.WBC CASTS c.BACTERIAL CASTS d.EPITHELIAL CASTS
ORGANIZED SEDIMENTS
B. ACELLULAR CAST a.HYALINE CASTS b.GRANULAR CASTS c.WAXY CASTS d.FATTY CASTS e.BROAD CASTS
EPITHELIAL CELLS
SQUAMOUS CELLS
Largest cells in the sediment
anuclear or small central nucleus, present as single cells Correlation: Represent contamination
SQUAMOUS CELLS
urethra Variable size and shape: round or polygonal, pear-shaped, caudate, tailed, spindle, may develop refractile, fatty inclusions with storage Correlation: Clarity; Blood if malignancy associated
with highly refractile fat droplets Many of the fat droplets are birefringent and anisotrophic and with polarized light will give the distinctive "Maltese cross" pattern Correlation: extensive tubular degeneration and nephrotic syndrome
MISCELLANEOUS STRUCTURES
BACTERIA
Bacteria can be identified in unstained urine
sediments when present in sufficient numbers by their characteristic rod shapes Mistaken as amorphous urates or phosphates Correlation: Infection or contamination
BACTERIA
YEAST
Small, oval, refractile with buds and myceli,
colorless, in singles, chains or budding They often represent contaminants, and are especially suspect if the sample is voided and old Clinical Significance: may be seen in diabetics (since there is increased glucose in urine)
YEAST
TRICHOMONAS VAGINALIS
Pear-shaped, motile and flagellated
TRICHOMONAS VAGINALIS
MUCUS THREADS
Single or clumped threads with low refractive
index May be confused with hyaline casts or cylindroids Clinical Significance: In presence of urinary tract infection or irritation of the urinary tract, large amounts of mucous may be discharged in urine
MUCUS THREADS
PUS CELLS
Pus is formed of degenerated neutrophils
(pyocytes) and cellular debris compacted into a mass where cell identity is lost Spherical, slightly smaller than leukocyte , anucleated granular cytoplasm Clinical Significance: Urinary Tract Infection and kidney stones
PUS CELLS
GLITTER CELLS
If the urine density is lower than 1.019 this cell
will demonstrate a brownian movement of its granules which will give a glittering cytoplasm Results from degeneration of pus cells which are spherical, slightly larger than leukocyte
GLITTER CELLS
LEUKOCYTE
Normal value: 5 WBC/HPF
LEUKOCYTE
diluted urine or crenated by concentrated urine Both swollen, partly hemolyzed RBC's and crenated RBC's are sometimes difficult to distinguish from WBC's in the urine Clinical Significance: kidney trauma; urinary tract stones; dysmorphic RBC's in urine suggests a glomerular disease such as a glomerulonephritis
Normal red blood cells with some Dysmorphic red blood cells
URINARY CASTS
(CELLULAR CASTS) A.RBC CASTS B.WBC CASTS C.BACTERIAL CASTS D.EPITHELIAL CASTS
RBC CASTS
Yellowish-brown color and are generally
cylindrical with sometimes ragged edges Presence of red blood cells within the cast is always pathological Clinical Significance: glomerular damage; renal infarction and subacute bacterial endocarditis
RBC CASTS
WBC CASTS
WBCs inside matrix
from epithelial cells Clinical Significance: Indicative of inflammation or infection, the presence of white blood cells within or upon casts strongly suggests pyelonephritis, a direct infection of the kidney
WBC CASTS
BACTERIAL CASTS
Bacilli bound to protein matrix
BACTERIAL CASTS
EPTHELIAL CASTS
Formed by inclusion or adhesion of desquamated
epithelial cells of the tubule lining Cells can adhere in random order or in sheets and are distinguished by large, round nuclei and a lower amount of cytoplasm Clinical Significance: renal tubular damage; acute tubular necrosis and toxic ingestion
EPTHELIAL CASTS
URINARY CASTS
(ACELLULAR CASTS) A. HYALINE CASTS B.GRANULAR CASTS C.WAXY CASTS D.FATTY CASTS E.BROAD CASTS
HYALINE CASTS
Normal value: 0-2/
LPF most common type of urinary casts Colorless, homogenous matrix, non-refractive Formed in the absence of cells in the tubular lumen, hyaline casts are solidified Tammhorsefall mucoprotein secreted from the tubular epithelial cells of individual nephrons Clinical Significance: may be seen in normal individuals in dehydration or vigorous exercise
HYALINE CASTS
GRANULAR CASTS
Coarse and fine granules inside matrix
casts can result either from the breakdown of cellular casts or the inclusion of aggregates of plasma proteins Clinical Significance: chronic renal disease; glumerulonephritis; stress and exercise
GRANULAR CASTS
WAXY CASTS
Highly refractile with jagged ends and notches
renal failure
WAXY CASTS
FATTY CASTS
Fat droplets and oval fat bodies inside matrix
cells, these are hyaline casts with fat globule inclusions, yellowish-tan in color Clinical Significance: nephrotic syndrome; toxic tubular necrosis and diabetes mellitus
FATTY CASTS
BROAD CASTS
Renal Failure Cast
urinary stasis and are two to six times the size of other types of casts Clinical Significance: extreme urine stasis and renal failure
BROAD CASTS
UNORGANIZED SEDIMENTS
NORMAL CRYSTALS A. URIC ACID B. AMORPHOUS URATES C. CALCIUM SULFATE D. SODIUM URATES E. ACID URATES F. CALCIUM OXALATES G. AMORPHOUS PHOSPHATES H. TRIPLE PHOSPHATES I. AMMONIUM BIURATE J. CALCIUM CARBONATE
UNORGANIZED SEDIMENTS
ABNORMAL CRYSTALS A. CYSTINE B. CHOLESTEROL C. LEUCINE D. TYROSINE E. BILIRUBIN
NORMAL CRYSTALS
URIC ACID
pH lower than 5.5
under polarized light Clinical Significance: increased in fresh specimen associated with leukemic patients and increased levels of purine and nucleic acid
URIC ACID
AMORPHOUS URATES
Brick dust or yellow brown granules
AMORPHOUS URATES
CALCIUM SULFATE
Cigarette butt colorless long prism with beveled
ends Rarely seen Identical in appearance to an alkaline crystal calcium phosphate in its prism form No significance
CALCIUM SULFATE
SODIUM URATE
Rarely encountered
SODIUM URATE
ACID URATES
Brown larger granules, may have spicules similar
ACID URATES
CALCIUM OXALATES
Major component of renal calculi / lithiasis
(most common) Monohydrate is oval or dumbbell-shaped Clinical Significance: calculi formation and ethylene glycol poisoning
CALCIUM OXALATES
Dehydrate
Monohydrate
AMORPHOUS PHOSPHATES
White, colorless, granule
AMORPHOUS PHOSPHATES
TRIPLE PHOSPHATE
Colorless coffin lid which when disintegrated
forms feathery appearance Birefrigent under polarized light Associated with urea- splitting bacteria and chronic urinary inflammation
TRIPLE PHOSPHATE
AMMONIUM BIURATE
Thorny apple appearance
AMMONIUM BIURATE
CALCIUM CARBONATE
Colorless dumb bells or spherical birefrigent
CALCIUM CARBONATE
ABNORMAL CRYSTALS
CYSTINE
Colorless, refractile, hexagonal plates, may be
thick or thin Disintegrating forms maybe found in the presence of ammonia Clinical Significance: Congenital cystinosis or cystinuria and renal calculi
CYSTINE
CHOLESTEROL
Large, flat, transparent
Notched corners
Highly birefringent Clinical Significance: lipiduria and nephrotic
syndrome
CHOLESTEROL
LEUCINE
Oily, highly refractile, yellow or brown spheroids
and concentric striations Clinical Significance: Maple syrup urine disease and severe liver disease
LEUCINE
TYROSINE
Very fine, highly refractile needles
Black, yellow
In sheaves or clusters (rosette formation) Clinical Significance: Severe liver disease and
tyrosinosis
TYROSINE
BILIRUBIN
yellowish brown in the shape of small needle-like
crystals, and often are phagocytized by white blood cells Clinical Significance: hepatic disorders
BILIRUBIN
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