Download CLINICAL PATHOLOGY LABORATORY – Urinalysis

CLINICAL PATHOLOGY LABORATORY 6 – Urinalysis and Fecalysis
USTMED ’07 Sec C – AsM
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URINARY SEDIMENTS
1. Cells
cells present in urinary sediment include WBCs, RBCs and epithelial cells. These cells can be anywhere in the urinary tract from
the tubules to the urethra.
Type
Description
Normal
Clinical
Values
implications
Red blood
Uniform colorless
0-3/hpf
Can originate from
cells
smooth
any part of the
biconcave disks
urinary tract
7um
Glomerulonephritis
Trauma
Systemic and renal
diseases
White
blood cells
Spherical with
dull gray
color.
Tend to be
neutrophils.
10-12 um
0-5/hpf (M)
0-8/hpf (F)
Acute infection of
kidney
(pyelonephritis)
Cystitis (bladder)
Urethritis (urethra)
Urinary tract
infections
Squamous
epithelial
Large, flat, irreg
shaped cells
that contain
small central
nucleus
Abundant
cytoplasm
Cell size:23-40um
Slightly larger
than WBC with
round central
nucleus
Cell size: 20 um
Few
Occur in urethra and
vagina
Vaginal
contamination
Occasional
Transitional
epithelial
Can be round or
pear shaped
with tail like
projections
Rare
Oval fat
bodies
Renal epithelial
cells with lipid
that are highly
refractive,
coarse
droplets in
various sizes
Negative
Originate in
convoluted and
collecting tubules
Increased numbers
indicate tubular
injury and
damage to
epithelial BM
Line urinary tract
from urinary
pelvis to upper
portion of urethra
Increased amounts
indicate disease
of bladder or
renal pelvis
Result from tubular
epithelial
degeneration of
nephron
Are associated with
large amounts of
protein
Nephrotic syndrome
Renal
epithelia
2. Casts
Casts are cylindric structures formed primarily within the lumen of the distal convoluted tubule and collecting duct. The major
constituent of casts is Tamm-Horsfall protein, a glycoprotein excreted by the renal tubular cells.
Type
Description
N. Values
Clinical Implications
Hyaline
Colorless,
0-2/lpf
Can indicate mild to
homogenous,
severe renal disease
semi-transparent
when increased in
numbers
Can be found in healthy
individuals after heavy
exercise
Red blood
cell cast
RBCs in hyaline
matrix.
Extremely fragile,
degenerate to
granular casts
Negative
Intrinsic renal disease
Acute glomerulonephritis
Acute interstitial
nephritis
Severe nephritis
White blood
cell cast
WBCs in hyaline
matrix
Usually neutrophils
Negative
Renal Inflammation
Renal infection
Pyelonephritis
Chronic renal disease
Acute glomerulonephritis
Renal
tubular
epithelial
cell
Renal Tubular
epithelial cells in
hyaline matrix
Negative
Interstitial tubular
disease
Vascular disease
Toxins
Glomerulonephritis
Granular
Cast
Waxy
Cylindroid
May be coarsely or
finely granular
Disintegration of
cellular casts or
from tubule
lysosomes or
protein
aggregates
Homogenous with
well defined
edges that are
sharp and have
blunt irregular
ends
Cracks on lateral
edges
Resemble casts but
have one end
that tapers to a
tail
Nonpathologic (seen with
Hyalin casts) – after
strenuous exercise in
stress
Pathologic –
Glomerulonephritis
Pyelonephritis
Negative
0-2/hpf
Tubular obstruction with
prolonged stasis
Called renal failure casts
Severe chronic renal
failure
Malignant hypertension
Acute renal disease
Diabetes mellitus
Found in conjunction
with casts and have
same significance
Fatty casts
Associated with
oval fat bodies
and urinary lipids
Highly refractile,
contain yellowbrown fat
droplets
Negative
Seen in disorders causing
lipiduria (nephritic
syndrome)
Mucous
threads
Long thin waxy
threads, very
transparent
Occasional
Can be found in small
number in normal
urine
Increased numbers
indicate inflammation
or irritation of the
urinary tract
3. Microorganisms and Parasites
Type
Description
Normal
Values
Free of
bacteria in
kidney and
bladder
Significance
Bacteria
Color: colorless
Shape: Rods or cocci
may be found
single or in chains
Yeast
Color: colorless cells
Shape: ovoid smooth
cells with doubly
refractile walls
Often show budding
and pseudohyphae
Sometimes mistaken
for RBCs
Oval heads with long
thin tails
Negative
Can be found
in both male
and female
urine
Male: nocturnal emission,
ejaculation and disease
of the genital organs
Female: after coitus
Turnip shaped
flagellates with
three anterior
flagella and one
anterior flagellum
Confused with WBCs
Needs to be mobile
for identification
Ova have one flat and
one round side
with transparent
shell. Developing
larvae can be seen
Negative
Transmitted sexually,
frequently infection of
vagina and vulva in
females
In males, the organisms
infects urethra
Negative
Ovium measures 50150 um
Clear and colorless
with characteristic
terminal spine
Negative
Usually found in children
and in fecal
contamination
Female worm lays her eggs
in perirectal region, and
during collection they
can be carried into urine
specimen
Inhibits veins in urinary
bladder
Endemic in Africa, Nile
Valley and Middle East
Spermatozoa
Trichomonas
vaginalis
Enterobius
Vermicularis
Schistosoma
Hematobium
Can be contamination from
external sources
Rapidly multiply in
improper stored
specimen
With increased WBCs,
indicative of urinary
tract infection
Found in urinary tract
infections, especially
from diabetic parents
Immunosuppressed patient
Skin or vaginal infection
4. Crystals
Crystals are frequently found in the urine. They are formed by the precipitation of urine salts subjected o changes in pH,
temperature or concentration, which affect their solubility. Crystals are identified by their appearance, solubility and pH.
Type
Description
pH
Solubility
Significance
Uric acid
Color: yellow-brown
Acid
AlkaliAssociated with renal
Shape: different
soluble,
stones, gout, high
shapes, most
sodium
purine metabolism,
common are
hydroxide
acute febrile
diamond, rhombic
conditions, chronic
plates in clusters,
nephritis
lemon shape
Calcium
oxalate
Colorless
Envelope with
intersecting
diagonal lines
Birefringent
Acid/
Neutral
HClsoluble
Acetic
acid
insoluble
Hippuric
acid
Color: yellow-brown
to colorless
Shape: elongated
prisms/plates
with pyramidal
ends
Acid/
Neutral
Soluble in
water,
alkali
Insoluble
in acetic
acid
Sodium
urate
Color: yellow to
colorless
Shape: needle or
slender prisms in
sheaves or
clusters
Acid
Soluble at
60oC
Report as urate
crystals
No clinical
significance
Color: brick-dust,
yellow brown
Shape: small
granular pink
precipitation at
refrigeration
Salts of Na,Ca,K,Mg
Triple
Colorless
Phosphate
Shape: three to six
(ammoniumsided prisms
magnesium
described as
phosphate)
coffin-lid shaped
Acid/
Neutral
Soluble at
60oC and
alkali
Acetic
acidinsoluble
No clinical
significance
Alkaline
Soluble in
dilute
acetic
acid
Associated with renal
calculi, chronic
pyelitis, enlarged
prostate, urinary
tract infection
Found in normal urine
Amorphous
phosphates
Colorless
Shape: granular
patches with no
definite shape
Alkaline
Soluble in
acetic
acid
Insoluble
at 60oC
No clinical
significance
Calcium
carbonate
Colorless
Shape: small
dumbbells or
spherical forms;
can be found in
granular masses
or in pairs
Alkaline
Soluble in
acetic
acid
No clinical
significance
Calcium
Phosphate
Colorless
Shape: long, thin
prisms with one
pointed and
arranged as
rosettes or
clusters of
needles
Thin irregular plates
that float on
surface of urine
Color: yellow to
brown
Shape: Spherical
bodies with long
irregular spicules
Alkaline
Soluble in
acetic
acid
Associated with renal
calculi
Can be found in
normal urine
Alkaline/
Neutral
Soluble in
acetic
acid and
warming
Usually indicates old
urine
Amorphous
urates
Ammonium
Biurate
Neutral
Can be found in
normal individuals
after ingestion of
oxalate rich food
and large doses of
vitamin C
Associated with renal
stones, diabetes
mellitus, liver
disease and
chronic renal
disease
Associated with diets
high in fruits and
vegetables
containing large
quantities of
benzoic acid
Abnormal Crystals
Cystine
Colorless and
refractile
Shape: hexagonal
with equal and
unequal sides
Appear single or in
clusters
Leucine
Color: yellow to
brown
Shape: spheroids
with radial
concentric
striations
Highly refractile
with oil-like
appearance
Tyrosine
Color: black or
yellow with
presence of
bilirubin
Shape: highly
refractile needles
occurring in
sheaves or
clusters
Cholesterol Color: transparent
Shape: regular to
irregular flat
plates with one
corner notched
out, may be single
or in larger #s
Most often found
after refrigeration
Bilirubin
Color: yellow to
brown to reddish
Shape: Granules or
clusters
Sulfa
Ampicillin
Color: brown to
yellow
Shape: needle-like
shapes seen in
bundles or
sheaves
Stacks of wheat
Colorless
Shape: elongated
long thin needles
Acid
Soluble in
HCl,
alkali,
and
ammonia
Amino acid crystal,
inherited as a
metabolic defect
that prevents
reabsorption of
cystine
Acid
Soluble in
hot acetic
acid, hot
alcohol
and alkali
Maple syrup disease
Severe liver disease
Acid
Soluble in
HCl,
NH4OH,
dilute
mineral
oil
Severe liver disease
and tyrosinosis
Acid/
Neutral
Soluble in
chlorofor
m, ether,
hot
alcohol
Insoluble
in alcohol
Excessive tissue
breakdown
Seen in nephritis and
nephritic syndrome
Lipiduria, lipidemia
and lymphatic
obstruction due to
neoplasms
acid
Soluble in
chlorofor
m,
acetone,
acid and
alkali
Obstructive jaundice
Bilirubin must be
present in urine
acid
Soluble in
acetone
Most sulfonamide
drugs are more
soluble than older
types
acid
Administration of
large parenteral
doses
Radiographic Color: hypaque
media
(opaque?), appear
dark and thick
Shape: pleomorphic
needles, single or
sheaves
acid
Soluble in
10% NaOH
Intravenous injection
for radiography
Can appear up to 3
days after
injection
Hemosiderin Color: yellow to
brown to red
Shape: heavy large
granules
Prussian blue stain
for iron
Acid/
alkaline
Insoluble
granules
Associated with
anemia and
destruction of RBC
Demo Slides
Pus Cells
Squamous Cells
Granular Cast
Hylaline Cast
Uric Acid crystal
Yeast Cells
RBCs