Microscopic examination of urine
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This document discusses microscopic examination of urine sediment. It describes how to prepare and examine a urine sample under the microscope. The deposits seen are divided into organic and inorganic categories. Organic deposits include cells, casts, crystals and other abnormal elements. Common cell types like red blood cells, white blood cells and epithelial cells are described. Different types of casts are defined along with their clinical significance. Various crystals that may be present in normal and abnormal urine are also outlined.
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Microscopic examination of urine
- 1. MICROSCOPIC EXAMINATION OF URINE SUNIL KUMAR.P Haematology& Transfusion medicine 12/19/2017 1SUNIL KUMAR.P
- 2. • Microscopic examination of urinary deposit or sediment is an essential part of urine examination. • The deposits are divided into two main groups. • 1. Organized deposits ( organic) • 2. Un organized deposits ( In organic) 12/19/2017 2SUNIL KUMAR.P
- 3. Normal Reference ranges for Cells and casts 12/19/2017 3SUNIL KUMAR.P
- 4. PROCEDURE • 1. Centrifuge 10 mL of urine in a graduated conical centrifuge tube and centrifuge at a speed of 1500 – 2000 RPM for 5 min. • 2. The supernatant is poured off. • 3. Resuspend the sediment in 1 mL of urine. • 4.Take a small drop of the suspended urine on a glass slide • 5. mount with a cover slip and examine under the microscope. 12/19/2017 4SUNIL KUMAR.P
- 5. ORGANIC DEPOSITS • Organic deposit consist of • 1. Cells – a. Red blood cells b. White Blood Cells C. Epithelial cells • 2. Casts – ( with or without inclusions) • 3. crystals • 4.Other abnormal cells or formed elements 12/19/2017 5SUNIL KUMAR.P
- 6. • Cells : They are expressed as number of cells per low power or high power field. 12/19/2017 6SUNIL KUMAR.P
- 7. Red Blood Cells • Presence of RBC’s > 2 /hpf in the urine indicates bleeding at any point in the urinary system from the glomerulus to the urethra. • In glomerular diseases , the urine show red cell with cellular protrusions or fragmentation and are named as dysmorphic RBC’s. • Causes : Hematuria 12/19/2017 7SUNIL KUMAR.P
- 8. White Blood Cells ( WBC’s) Pus Cells • Increased number of WBC’s ( mainly neutrophils > 5 / hpf) in urine is known as pyuria. It is indicative of urinary tract infections. Causes of Pus cells In urine ( Pyuria) • (a). Pyelonephritis • (b). Urethritis • (c) . UTI 12/19/2017 8SUNIL KUMAR.P
- 9. Epithelial Cells • These are derived from the urinary tract (Transitional & renal) or genital tract (Squamous). • A few ( 0-2/hpf) transitional cells from the bladder may be present in the normal urine and Squamous cells from the vulva and vagina usually contaminate a routine specimen from women. 12/19/2017 9SUNIL KUMAR.P
- 11. CASTS • They are one of the organized elements which are formed only in the kidney and are indicative of renal disease. • They are formed by solidification of Tamm Horsfall protein, a glycoprotein secreted in the distal convoluted tubules and collecting tubules. 12/19/2017 11SUNIL KUMAR.P
- 12. • Casts are cylindrical structures with parallel sides and rounded ends. • They vary in size, shape and appearance. • Cylindroids probably represents abortive casts. 12/19/2017 12SUNIL KUMAR.P
- 13. • The casts may have only proteins – hyaline Casts and Waxy casts. • Trapped Granular Debris – Granular casts • Epithelia cells – Epithelial casts • Leukocytes – Leukocyte casts • Red blood cells – RBC casts • Fat Droplets – Fatty Casts 12/19/2017 13SUNIL KUMAR.P
- 14. WBC’s Casts 12/19/2017 14SUNIL KUMAR.P
- 15. Red Cells Casts 12/19/2017 15SUNIL KUMAR.P
- 16. Epithelial Cells casts 12/19/2017 16SUNIL KUMAR.P
- 17. Waxy casts 12/19/2017 17SUNIL KUMAR.P
- 20. • These are not usually present in urine. • Crystals of oxalates, urates and cystine are present in patients with history of renal stone. • While urates alone present in gout. 12/19/2017 20SUNIL KUMAR.P
- 21. Crystals Found in urine Crystal found in acidic urine • 1. Amorphous urates • 2.Crystalline urates • 3.Crytalline uric acid • 4.Calcium oxalate Crystal found in alkaline urine • 1.Amorphous phosphates • 2.Crystalline phosphates – triple phosphates • 3.Calcium carbonate • 4.Ammonium biurate crystals 12/19/2017 SUNIL KUMAR.P 21
- 23. Uric acid crystals and urates • Not found when urine is freshly passed, tend to develops when the urine has been standing. • Amorphous urates appear as reddish granules and are dissolved by heating and by addition of sodium hydroxide, not by acetic acid. • Uric acid crystals vary in shape and are usually stained a yellowish color, • UA Crystals not dissolved by heat, acetic acid, or Hcl, but soluble when heated with NaOH. • Shape- rhomboids, wedge shaped, hexagonal. 12/19/2017 23SUNIL KUMAR.P
- 25. Calcium oxalate • Commanly found when the diet includes lots of tomatoes, spinach etc.., • Typical envelope shape, and dumb bells, refractile, octahedral. • insoluble in strong Hcl. • Tendancy to clump together, may form stones. 12/19/2017 25SUNIL KUMAR.P
- 27. Hippuric acid crystals • Enlongated prisms or plates. • Yellow brown or colorless, soluble in water. • Rarely seen. • No clinical significance. 12/19/2017 27SUNIL KUMAR.P
- 28. Leucine and tyrosine crystals. • Usually occur together, found in condition associated with sever liver damage. • Leucine crystals, appear as slightly yellow, oily looking spheres with radial and concentric striations. • Not soluble in Hcl or ether. • Tyrosine crystals: appear in the forms of very fine needles arranged in sheaves or clumps, colourless or yellow • Soluble in ammonia and Hcl, insoluble in alcohol or ether. 12/19/2017 28SUNIL KUMAR.P
- 30. Crystal found in alkaline urine • 1.Amorphous phosphates • 2.Crystalline phosphates –triple phosphates • 3.Calcium carbonate • 4.Ammonium biurate crystals 12/19/2017 30SUNIL KUMAR.P
- 32. Crystals found in alkaline urine • Ammonium magnesium phosphate( triple phosphate crystals). • colourless, appear as coffin lid or as feathery or leaf like forms. prismatic(3-6 sided) • In freshly passed urine they may indicate the presence of stones in the kidney or bladder. • Phosphate may occur as an amorphous deposit in alkaline urine and are soluble in acetic acid. 12/19/2017 32SUNIL KUMAR.P
- 34. Dicalcium phosphates • Appear in neutral or slightly acid urine as well as alkaline urine • are colourless prisms arranged in stars or rosettes • Because of the shape of the crystals, also called as stellar phosphates. • The individual prisms are usually slender with one bevelled, wedge like end, sometimes needle like. • Sometime found as large, thin irregular, usually granular plates. • Soluble in acetic acid. 12/19/2017 34SUNIL KUMAR.P
- 36. Calcium carbonate • Sometime mixed with the phosphate deposite, usually as amorphous granules, or more rarely, as colourless spheres and dumbells, • Soluble in acetic acid with gas formation. 12/19/2017 36SUNIL KUMAR.P
- 37. Ammonium biurate • Found along with phosphate in decomposing when free ammonium is present. • Appear as opaque, yellow crystals in the form of spheres, often covered with fine or coarse spicules. ‘Thorn apple.’ 12/19/2017 37SUNIL KUMAR.P
- 38. Cholesterol crystals • Rare • Colourless • Appear as flat plate with corner notch. • Soluble in chloroform, ether, and hot alcohol. 12/19/2017 38SUNIL KUMAR.P
- 39. Organic sediment • Much more important than inorganic • The organic structures are: tubular cast, granular cast, hyaline cast, waxy cast, RBC cast, WBC cast, epithelial cast, fatty cast, epithelial cells, WBC’s, RBC’s, spermatozoa, bacteria and various parasites. 12/19/2017 39SUNIL KUMAR.P
- 40. Crystals found in Abnormal urine • 1.Cystine • 2.Tyrosine 12/19/2017 40SUNIL KUMAR.P
- 41. Crystals found in Abnormal urine 12/19/2017 41SUNIL KUMAR.P
- 42. Other Abnormal Cells & Other formed elements • 1.Malignant cells • 2.Fungi • 3.Parasites • 4.Spermatozoa 12/19/2017 42SUNIL KUMAR.P
- 43. Bacteria • Normal urine- when fresh doesn’t contain bacteria. - But some bacteria from the lower urethra and at the meatus, and if the urine is allowed to stand for some time, they will multiply. - If a patient has a urinary tract infection, bacteria will be present in greater numbers. - Urine collection- aseptically , midstream clean catch specimen. - Well mixed uncentrifuged urine also be examined with Gram’s stain. - If bacteria are identified in uncentrifuged urine 100,000 organism per ml are present i,e siginificant bacteriuria. 12/19/2017 43SUNIL KUMAR.P
- 44. Cont.., • Yeast cells (candida) are found in urinary tract infection ( diabetes mellitus), but yeast are common contaminants from skin and air. • Parasites and parasitic ova may seen in urine sediments as a results of fecal or vaginal contamination. • Trichomonas vaginalis • Ova – Schistosoma haematobium • Larvae- microfilaria. (Helminthis) 12/19/2017 44SUNIL KUMAR.P