1. APPERANCE: Non-nucleated biconcave disks,
Crenated in hypertonic urine, Ghost cells in hypotonic
urine, Dysmorphic with glomerular membrane
damage
IDENTIFIED USING: HPO
SOURCE OF IDENTIFICATION ERROR: Yeast cells, Oil
droplets, Air bubbles
CLINICAL SIGNIFICANCE: Presence of RBC in urine
associated with damage to the (macroscopic
hematuria) glomerular membrane or vascular injury
within the genitourinary tract (trauma, acute
infection or inflammation and coagulation disorders)
-Early diagnosis of glomerular disorders and
malignancy of the urinary tract and to confirm the
presence of renal calculi (microscopic hematuria)
-RBC casts may be seen following strenuous exercise
(non pathologic)
-menstrual contamination from female patients
Most dominant wbc in urine is Neutrophil
APPERANCE: Larger than RBCs, Granulated,
multilobed neutrophils, Glitter cells in hypotonic
urine, Mononuclear cells with abundant
cytoplasm
IDENTIFIED USING: HPO
SOURCE OF IDENTIFICATION ERROR: Renal tubular
epithelial cells
CLINICAL SIGNIFICANCE:
EOSINOPHIL- drug-induced intestinal nephritis, small
numbers can be seen with UTI and renal transplant
rejection, >1% eosinophil is considered significant
-Increase WBC is called pyuria indicates presence of
infection or inflammation in the genitourinary
system. Bacterial infections like pyelonephritis,
cystitis, prostatitis and urethritis are frequent cause
of pyuria. However, pyuria is also present in
nonbacterial disorders such as glomerulonephritis,
lupus erythematosus, intestinal nephritis, and
tumors.
3 types of epithelial cells seen in urine: squamous,
transitional and renal tubular.
APPERANCE:
Squamous: Largest cells in the sediment with
abundant, irregular cytoplasm and prominent nuclei
Transitional: Spherical, polyhedral, or caudate with
centrally located nucleus
Renal tubular: Rectangular, columnar, round, oval or,
cuboidal with an eccentric nucleus possibly bilirubin
stained or hemosiderin-laden
IDENTIFIED USING:
Squamous: LPO
Transitional: HPO
SOURCE OF IDENTIFICATION ERROR:
Squamous: Rarely encountered, folded cells may
resemble casts
Transitional: Spherical forms resemble RTE cells
Renal tubular: Spherical transitional cells, Granular
casts
SQUAMOUS EPITHELIAL CELLS:
Originate from the linings of vagina and female
urethra and lower portion of male urethra.
(Nonpathologic),
Clue cell- variation of Squamous EC indicative of
vaginal infection by bacterium Gardnerella vaginallis
TRANSITIONAL EPITHELIAL (UROTHELIAL) CELLS:
Originate from the lining of the renal pelvis, calyces,
ureters and bladder and from the upper portion of
male urethra. Present in small numbers.
Increased in numbers seen singly, pairs or clumps
(syncytia) are present following invasive urologic
procedures such as catheterization (non pathologic)
RENAL TUBULAR CELLS:
PCT- larger than other RTE
DCT- smaller than PCT cells
Collecting Duct- cuboidal never round, appears in
group called renal fragments
CLINICAL SIGNIFICANCE:
RTE- increase amount indicates necrosis of renal
tubules with the possibility of affecting overall renal
function.
-Tubular necrosis includes exposure to heavy metals,
drug-induced toxicity, hemoglobin and myoglobin
toxicity, viral infections (hepatitis B), pyelonephritis,
allergic reactions, malignant infiltrations, salicylate
poisoning, and acute allogenic transplant rejection.
- renal fragments indicates severe tubular injury with
basement membrane disruption.
OVAL FAT BODIES-Lipid containing RTE cells
Lipiduria- associated damage to the glomerulus
caused by nephrotic syndrome.
2. APPERANCE: Small spherical and rod-shaped
structures
IDENTIFIED USING: HPO
SOURCE OF IDENTIFICATION ERROR: Amorphous
phosphates and urates
CLINICAL SIGNIFICANCE:
UTI- bacteria should be accompanied by WBC,
Enterobacteriaceae (gram negative rods, cocci
shaped Staph and Enterococcus
APPERANCE: Small, oval, refractile structures with
buds and/or mycelia, may or many noy have buds
IDENTIFIED USING: HPO
SOURCE OF IDENTIFICATION ERROR: RBCs
CLINICAL SIGNIFICANCE:
In severe infections, they may appear as branched,
mycelial forms.
Candida albicans seen in the urine of diabetic patient,
immunocompromised patient and women with
vaginal moniliasis.
The acidic, glucose containing urine of patients with
diabetes provides an ideal medium for the growth of
yeast.
True yeast infection should be accompanied by the
presence of WBC
APPERANCE:
Trichomonas- Pear-shaped, motile, flagellated
SOURCE OF IDENTIFICATION ERROR:
Trichomonas- WBCs, renal tubular epithelial cells
CLINICAL SIGNIFICANCE:
T. vaginalis- sexually transmitted disease associated
primarily with vaginal inflammation. Infection of the
male urethra and prostate is asymptomatic. Male are
often asymptomatic carriers.
S. haematobium- associated in bladder cancer in
other countries.
APPERANCE: Tapered oval head with long, thin tail
CLINICAL SIGNIFICANCE:
Spermatozoa are occasionally found in the urine both
men and women following sexual intercourse,
masturbation and nocturnal emission. (Non
pathologic)
Male infertility or retrograde ejaculation in which
sperm is expelled into the bladder instead of urethra.
APPERANCE: Single or clumped threads with a low
refractive index
IDENTIFIED USING: LPO
SOURCE OF IDENTIFICATION ERROR: Hyaline casts
Mucus is a protein material produced by glands and
epithelial cells of the lower genitourinary tract and
the RTE cells. Uromodulin is the major constituent of
mucus, it is a glycoprotein excreted by the RTE cells
of the distal convoluted tubules and upper collecting
ducts.
Mucus is most frequently seen in female urine
specimen. No clinical significance in male and female.
