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Microscopic Urine Exam Chapter 47 What are we looking for? Cells Casts Crystals Yeast Bacteria Parasites These things form sediment in the urine Cells High power magnification Count Classify 3 types Epithelial WBC RBC Epithelial Cells • Renal • • • Transitional • • • • Round/oval, eccentric nucleus Few of these may appear normally in urine but several may indicate tubular damage Line the urinary tract from the renal pelvis to the upper portion of the urethra Round/oval, may have tail, two nuclei Few may appear normally in urine but several indicate tubular damage Squamous • • • • Line the lower portion of the urinary tract Large, flat, irregular with small round, centrally located nucleus Occur in clumps or sheets Can easily be seen under low power White Blood Cells • • • • • Larger than RBC Granular appearance Multi-lobed nucleus Large numbers of them if urinary tract inflamed or if the specimen is contaminated Normal count 0-8 per high powered field Red Blood Cells • • • • Can be pale, round, nongranular, or flat, biconcave No nucleus Count 0-3 under high power field is normal Numerous may indicate infection, obstruction, inflammation, trauma or tumor Casts Cylinder shaped with flat, round ends Form when protein from the breakdown of cells accumulates in the kidney tubules and wash into the urine Hyaline Granular RBC WBC Epithelial Waxy Hyaline and Granular Casts Pale, transparent, parallel sides Present in patients with kidney disease or after strenuous exercise Few in urine is normal Red Blood Cell Cast Always indicate an abnormality Hyaline casts embedded with RBCs Can appear brown in color White Blood Cell Cast Hyaline cast with WBCs Multi-lobed nucleus May indicate pyelonephritis Epithelial Cell Cast Contain embedded renal tubular epithelial cells Indicate excessive kidney damage Shock, renal ischemia, heavy metal poisoning, allergic reactions, drugs toxic to kidneys Confused with WBC casts Waxy Cast Rare, yellow, glassy, brittle, smooth, homogeneous Cracks and fissures, broken ends Severe renal disease Crystals Commonly seen Usually do not indicate a significant disorder Can be found in large numbers with kidney stone Yeast Oval Budding Confused with RBCs Associated with UTI Seen in patients with diabetes Bacteria Few seen are normal Indicates UTI if associated with WBCs and foul odor Parasites UTI or contamination with external genitalia Trichamonas vaginalis most common
