This document provides a summary of urine sediment characteristics and their clinical significance. It discusses 14 groups of items that may be present in a urine sediment examination including cells, casts, crystals, and other findings. For each item, the document describes morphological characteristics, associated clinical conditions, and potential correlations with urine dipstick testing. It aims to equip medical technologists with the terminology and clinical relevance of urine sediment analysis findings.

1. Urine sediment short note : Kridsada Sirisabhabhorn, MT.
Division of Microscopy, Department of Medical Technology Laboratory
Thammasat University Hospital, Thailand
Groups of urine sediment
1. Cells : RBC, WBC, Epi., Bact., Parasite, Oval fat body
2. Cast : Pathogenic cast, Non pathogenic cast
3. Crystal : Non specific disease crystal, Specific disease crystal
4. Other : mucous, amorphous, budding yeast, pseudohyphae, artifact
Home work: Terminology
1. Ghost rbc 2. Creanated rbc 3.Swollen rbc 4.Dysmorphic rbc
5.Glitter cell 6. Macrophage 7. Myelin form 8. Hyaline cast
9. Broad cast 10. Cylindroids 11.Cell cast 12. Coarsely granular cast
13.Fine granular cast 14. Waxy cast 15. Hb cast 16. Pigment cast
17. Oval fat body 18. Transitional epi. 19. Urothelial cell 20. PMN, MN
21. Pyuria 22. Chyuria 23. Hematuria 24. Hemoglobin uria
25. Glusouria 26. Proteinuria 27. Telescopic urine sediment 28. Maltase cross
29. GI cell 30. Cath urine

2. No. Sediment Characteristics Significant Urine strip
correlation
1. RBC ‐Biconcave, without
nucleus
‐ Ghost rbc, Swollen
rbc & Creanated rbc
‐Ghost rbc
‐Creanated rbc
‐Swollen rbc
‐Dysmorphic rbc or
bizarre rbc or
pleomorphic rbc***
Normal < 3 cells/HPF; Isotonic
urine
‐Insignificant for disease
‐Hb leaked; long time urine
remaining
‐Rbc membrane wither;
hypertonic urine, Sp.gr., pH.
‐Large rbc membrane, hypotonic
urine Sp.gr., pH.
‐ Indicated glomerulonephritis
with need to report*** &
sometime found with RBC cast
‐Erythrocyte
Homogeneous on
strip: Hemoglobin
uria
Scatter point on
strip: Hematuria
‐ Protein by
sometime

3. No. Sediment Characteristics Significant Urine strip
correlation
2. WBC ‐PMN, mostly
neutrophil
‐MN, mostly
lymphocyte
‐Glitter cells
‐Worm like or
myelin form
‐Macrophage***
‐Inflammation, if found with
bacteria UTI
‐Allergy, Kidney transplant
rejection
‐Hypotonic urine, Sp.gr.
‐Hypertonic urine, Sp.gr, pH.
‐Long time infection*** need to
report
‐Leukocyte
‐some leukocyte
3. Squamous
epithelial
1.Simple squamous
epithelial (large size)
2.Transitional epi.
(middle size)
2.1 bladder cell
2.2 polygonalcell
2.3 caudate cell
3. Renal tubular
(smallest size) epi.(N:C
, Nucleus eccentric,
seem like as wbc,
prominence edge of
nucleus)
‐No specific pathogenicity ; if > 10
cells/HPF contamination
‐Tran. Epi. & Renal epi. Pathogenic
epithelial
‐superficial cell
‐intermediated layer cell
‐deep layer cell
‐Found over 2 cells/HPF indicated
kidney disease.
‐Lining on renal tubular
‐Produce Tamm‐Horsfall protein
‐Active transport activity
‐Usually form to renal epithelial cell
cast (RET cast: renal epithelial cell
cast)
‐Associate with renal tubular necrosis
or failure disease.
‐ Non specific

4. No. Sediment Characteristics Significant Urine strip
correlation
4. Bacteria ‐Rod shape
‐ Cocci shape
‐Found with WBC UTI
‐Found without WBC
contamination
‐Nitrite
‐Non correlated
with nitrite
5. Mucous ‐ Spindle shape insignificant ‐Non specific or
protein sometime
6. Amorphous ‐ Non specific form pH < 7; Amorphous urate
pH > 7; Amorphous phosphate
Usually present after eating meal
‐Non specific
7. Budding yeast
&
Psedohyphae
‐Oval or budding
shape
‐Not size equally
‐May be associate with fungal
infection
‐May be concern with specimen
overnight
‐Mostly is Canida albicans
‐Non specific
8. Parasite ‐ Trichomonas vaginalis
‐Schistosoma
haematobium
‐Intestinal parasite;
E. vermicularis,
Strongyloides i.e.
‐Vaginitis; usually found with
WBC
‐ Macrohematuria or bloody
present
‐Should be reject specimen
because contaminated
collection
‐Non specific
9. Sperm ‐Seem like lotus ‐ Orifice disorder in sometime ‐ Protein sometime

5. No. Sediment Characteristics Significant Urine strip
correlation
10. Cast 1. Hyaline cast
2. Cell cast
2.1 RBC cast
2.2 WBC cast
2.3 RET cast
2.4 Fatty cast
2.5 Bacterial cast
2.6 Mixed cell
cast
‐Normal or healthty; < 3 / LPF
‐Tamm‐Horsfall protein content
‐Over express in stress, fever,
extremely exercise, dehydration,
burn, shock i.e.
‐Over 3 cells and Over 1/3 of cast
contain each cell.
‐Acute glomerulonephritis may
be present with dysmorphic RBC
‐Pyelonephritis
‐Renal tubular cells form to cast
‐Associate with renal tubular
failure or necrosis
‐Fat cell or adepocyte form to
cast
‐Usually found with oval fat
body
‐Specific with nephrotic
syndrome
‐ Contamination / UTI??? And
usually found in baby.
‐Over 2 cell types contain in cast
‐Usually protein
strip positive but
non specific
‐Mostly present
with heavy protien
(albumin); 3+ to 4+

6. No. Sediment Characteristics Significant Urine strip
correlation
Cast
(continue)
3. Granular cast
3.1 Coarse
granular cast
3.2 Fine granular
cast
4. Waxy cast or
renal failure cast
5. Pigment cast
‐Non homogeneous feature by
cells degraded in cast; cell +
granular in stick.
‐ Homogeneous feature by cell
degradation or completely
degraded of cell cast; granule all
cast stick.
‐Long time period stay in renal
tubular capillary.
‐Associate with renal failure
‐Usually present in broad cast ,
convoluted cast and debris cast
‐Usually present in telescopic
urine sediment
‐Hemoglobin cast is waxy cast of
RBC cast
‐Predominant observe by 10x
‐Bilirubin cast associate with liver
disease and usually observe with
bilirubin crystal and leucine
crystal; brown pigment
‐Bile cast associate with bile
obstruction; green pigment
‐Mostly present
with heavy protien
(albumin); 3+ to 4+
but non specific
‐ Biliurbin 3+ to 4+

7. No. Sediment Characteristics Significant Urine strip
correlation
11. Crystal 1. Non specific
disease crystal
1.1 pH < 7; acid
crystal
‐ Uric crystal
‐ Calcium
oxalate
‐ Drug crystal
(Sulfa,
Amoxyciclin
etc.)
1.2 pH >7; base
crystal
‐ Triple
phosphate
‐ Ammonium
biurate
‐ Ammonium
biurate
‐ Calcium
phosphate
‐15% associate with gout disease
‐Usually present with pH value as
5.0 to 6.0
‐Associate with nutrition and gall
bladder
‐Over 4 hr. urine collection
‐Usually present with bacteria
numerous and some amorphous
‐Seem like as apple thrown
image
‐Present in new born baby
‐Seem like as Gerbera flower
‐ pH strip

8. No. Sediment Characteristics Significant Urine strip
correlation
‐ Calcium carbonate pH
11. Crystal
(continue)
2. Specific crystal;
mostly contain in
pH<7
‐ Bilirubin crystal,
Leucine crystal
‐Tyrosine, Cystine,
Hipuric crystal
‐Cholesteral crystal
‐Associate with liver disease
‐Associate with metabolic
disorder
‐The largest of all urine crystal
‐Associate with hyperlipidemia