7. CHARACTERISTICS
Larger than RBC
(diameter – 12mm)
Nuetrophil –
predominantly found in
the urine sediment
Ave. # seen in 10 hpfs
CLINICAL SIGNIFICANCE
Presence of Eosinophil
Drug-induced
interstitial nephritis
Urinary Tract Infection
Renal Transplant
rejection
pyuria
Presence of an
infection or
inflammation in the
genitourinary system
8.
9.
10.
11. CHARACTERISTICS
Derived from the lining
of the gastrourinary
system
3 types
Squamous EC
Transitional EC
Renal tubular EC
12. Squamous Epithelial Cell
Largest cells found in the
urine
Contains abundant and
irregular cytoplasm and
prominent nucleus like
an RBC size
Often first structures
observed when the
sediment under LPO
Uses LPO and HPO
magnification
Commonly reported as
rare, few, moderate or
many
Appear folded, possible
resembling cast and will
begin to disintegrate in
urine that is not fresh
Originate – linings of the
vagina and female
urethra and lower portion
of the male urethra
13. Variation – clue cell
(indicative of vaginal
infection by
Gardnerella vaginalis)
Bacteria should most
covered of e cell
surface
CLINICAL SIGNIFICANCE
Perineal or vaginal
contamination (female)
Foreskin contamination
(males)
14.
15.
16.
17. Transitional Epithelial Cells
Smaller than squamous
cells
Appear
Spherical
Polyhedral
Caudate
Uses HPO
Reported as rare, few,
moderate or many
Originate – lining of
renal pelvis
Calyces
Ureters
Bladder
Portion of the male
urethra
20. Renal Tubular Epithelial
Cells
vary in shape and size
Proximal CT RTE
Larger
Rectangular
Referred as
columnar or
convoluted cells
Distal CT RTE
Smaller
Round and oval
Mistaken as WBC’s and
Spherical Transitional
EC
Collecting Duct RTE
Cuboidal
Presence of at least
one straight edge
21. Collecting Duct RTE
Appear in groups
(renal fragments)
Identified in HPO
Reported as rare, few,
moderate or many
CLINICAL SIGNIFICANCE
Tubular injury
Necrosis of renal tubules
Pyelonephritis
Salicylate intoxication
Transplant rejection
22.
23.
24. Oval Fat Bodies
Lipid containing RTE
cells
Usually seen in
conjunction with free-
floating fat droplets
Presence is confirmed
by staining the
sediments using Sudan
III or Oil Red O fat
stains and examing the
sediment using
polarized microscopy
CLINICAL SIGNIFICANCE
Lipiduria
Severe tubular necrosis
DM
Trauma
25.
26.
27.
28. CHARACTERISTICS
Not normally present
Contaminant bacteria
multiply rapidly at
room temperature for
extended periods
Results in a pH of 8 and
positive nitrite test
(unacceptable)
Appear
Spherical (cocci)
Rods (rods)
Reported using HPO
Reported in terms of few,
moderate or many
Phase microscopy aids in
the visualization
30. CHARACTERISTICS
Appear
Small
Refractile oval
structures (w/ or
w/o bud)
Reported as rare, few,
moderate or many per
hpf
Candida albicans
Yeast cell (seen in
urine of:
Diabetic
Immunocompromi
sed patients
women
With vaginal
moniliasis
33. CHARACTERISTICS
Trichomonas vaginalis
Most frequently
encountered
Trophozoite –
flagellate with an
undulating
membrane
Rapid darting
movement in in Wet
preparations
(identification)
Reported as rare, few,
moderate or many per
hpf
May resemble a
WBC
Transitional
RTE cell
Phase microscopy
enhance visualization
of flagella or
undulating membrane
34. Schistisoma haematobium
Bladder parasite
Ova (appear in the
urine)
Feacal contamination –
can cause of ova fom
intestinal parasites
Ova from pinworm
(Enterobius vermicularis)
Most common
contaminant
CLINICAL SIGNIFICANCE
Vaginal inflammation
Urethral infection
Prostrate infection
38. CHARACTERISTICS
Protein material
produced by the
glands and epithelial
cells of the lower
genitourinary tract and
RTE cells.
Tamm-horsfall protein
Major constituent of
mucus
Appears microscopically
as thread-like structures
with a low refractive
index
Reported as rare, few,
moderate or many per lpf
More frequently present
in female urine specimens
39.
40. CHARACTERISTICS
Only elements found in
the urinary sediment
Found within the
lumens of the tubules
and collecting duct
Detection: LPF
Identification: HPF
Reporting: average
number/ 10 lpfs
Dissolves quickly in
dilute, alkaline
Cast Composition
Major constituent:
Tamm-Horsfall protein
glycoprotein
excreted by the RTE
cells of the distal
convoluted tubules
and upper
collecting ducts
Other proteins:
albumin
immunoglobulins
41. Cast Formation
1. Aggregation of Tamm-
Horsfall protein into
individual protein fibrils
attached to the RTE
cells
2. Interweaving of protein
fibrils to form a loose
fibrillar network (urinary
constituents may
become enmeshed in
the network at this time)
3. Further protein fibril
interweaving to form a
structure
4. Possible attachment of
urinary constituents to the
solid matrix
5. Detachment of protein
fibrils from the epithelial
cells
6. Excretion of the cast
Cylindruria- presence of
urinary casts
42. Hyaline Casts
Most frequently seen
cast
Consist of Tamm-
horsfall protein
0-2 per lp
Colorless (unstained)
Easily overlooked
(subdued light)
f (normal)
Increased:
Strenuous exercise
Dehydration
Heat exposure
Emotional stress
Acute glomerular
nephritis
Pyelonephritis
Chronic renal disease
Congestive heart
failure
56. Bacterial Casts
Bacilli bound to protein
May be mixed with
WBC
CLINICAL SIGNIFICANCE
Pyelonephritis
57.
58.
59. CHARACTERISTICS
Associated with heavy
metal and chemical or
drug-induces toxicity,
viral infection and
allograft rejection
DCT Cells:
Smaller
Round/oval
CLINICAL SIGNIFICANCE
Tubular destruction
Drug-induced toxicity
Viral infection
Allograft rejection
Renal tubular damage
60.
61.
62.
63. CHARACTERISTICS
Seen in conjunction
with oval fat bodies
and free fat droplets
Highly refractile under
bright-field microscopy
May contain
few/many fat droplets
Confirmation: polarized
microscopy and Sudan
III or Oil Red O fat stains
CLINICAL SIGNIFICANCE
Nephrotic syndrome
Tubular necrosis
Diabetis mellitus
Crush injuries
64.
65.
66.
67. CHARACTERISTICS
Most frequently
encountered include
RBC and WBC
CLINICAL SIGNIFICANCE
Glomerulonephritis
Pyelonephritis
68.
69.
70.
71. CHARACTERISTICS
Coarse or Fine
Pathologic or
Nonpathologic (origin)
Lysosomes
excreated by RTE
Granules represent
disintegration of
cellular casts and
tubule cell or protein
aggragates filtered by
the glomerulus
Visualized under low-
power microscopy
Final Identification: high
power
Cast matrix: waxy
appearance
Structure: more rigid,
jagged or broken and
diameter becomes
broader
76. CHARACTERISTICS
Representative of
extreme urine stasis
More easily visualized
than hyaline casts
because of higher
refractive index
Supervital stain: they
stain homogeneous,
dark pink
CLINICAL SIGNIFICANCE
Chronic renal failure
Stasis of urine flow
77.
78.
79.
80. CHARACTERISITCS
Renal failure casts
Represent urine stasis
Granular and waxy
Most common
broad cast
CLINICAL SIGNIFICANCE
Destruction of tubular
walls
Rena failure
Extreme urine stasis
81.
82.
83.
84. CHARACTERISTICS
Crystals found in
normal urine
Crystals found in
abnormal urine
liver disease
inborn errors of
metabolism
renal damage
Reporting:
rare, few, moderate, or
many/ hpf
Average/ lpf
(Abnormal crystals)
85. Precipitation of urine
solutes
inorganic salts, organic
compounds, and
medications
(iatrogenic
compounds)
subject to changes in
temperature, solute
concentration, and pH
Low temperatures/ref
temp
majority of crystal
formation takes place
Presence of crystals in
freshly voided urine
associated with
concentrated (high
specific gravity)
specimens
86. Acidic pH
organic and iatrogenic
compounds readily
precipitates
*** All abnormal crystals
are found in acidic
urine
Neutral and alkaline pH
inorganic salts
Calcium oxalate
precipitates in both
acidic and neutral
urine
87.
88.
89. Cystine Crystals
found in the urine of
persons who inherit a
metabolic disorder
that prevents
reabsorption of cystine
by the renal tubules
(cystinuria)
Persons with cystinuria
have a tendency to
form renal calculi,
particularly at an early
age.
90.
91. Cholesterol Crystals
associated with
disorders producing
lipiduria, such as the
nephrotic syndrome
seen in conjunction
with fatty casts and
oval fat bodies.
92.
93. Radiographic Dye
Crystals
Contrast media
Colorless long pointed
needles or flat
rectangular plates
(resemble cholesterol
crystals)
Multicolored when
polarized
94.
95. Tyrosine crystals
positive chemical test
results for bilirubin
Inherited disorders of
amino-acid
metabolism
96.
97. Leucine crystals
yellow-brown spheres
that demonstrate
concentric circles and
radial striations
98. Bilirubin crystals
disorders that produce
renal tubular damage,
such as viral hepatitis
99. Sulfonamide Crystals
urine of patients being
treated for UTI
due to inadequate
patient hydration
appearance in fresh
urine can suggest the
possibility of tubular
damage if crystals are
forming in the nephron
100.
101. Ampicillin Crystals
Following massive
doses of this penicillin
compound without
adequate hydration
102.
103.
104.
105. Starch granule
contamination may
occur when cornstarch
is the powder used in
powdered gloves
106. Oil droplets
may result from
contamination by
immersion oil or lotions
and creams
107. Air bubbles
occur when the
specimen is placed
under a cover slip
108. Pollen grains
seasonal contaminants
that appear as spheres
with a cell wall and
occasional concentric
circles
109. Hair and fibers from
clothing and diapers
mistaken for casts
