urine examination
TRANSCRIPT
![Page 1: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/1.jpg)
Laboratory Medicine Workshop
![Page 2: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/2.jpg)
Cells Casts CrystalsCells Casts Crystals.
Casts are formed within nephron.
Casts Suggest Kidney pathology.
Casts can be made up of Protein, lipid, cells or mixed .
Crystals suggest high concentration or altered solubility .
Urine Microscopy:
![Page 3: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/3.jpg)
WBC in Urine:
![Page 4: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/4.jpg)
Seen in interstitial disease most commonly
Also seen in glomerulonephritis
White blood cell cast
![Page 5: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/5.jpg)
WBC Cast Urine:
![Page 6: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/6.jpg)
Mixed Cast Urine:
![Page 7: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/7.jpg)
Thought to result from the degeneration of cellular casts
Waxy cast
![Page 8: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/8.jpg)
Uro-epithelium is columnar
•If there are a lot of these it means there is
sloughing of the system
Skin is squamous•If there are a lot of
squamous it is a contaminated specimen
Non-renal epithelial cells
![Page 9: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/9.jpg)
Urine Oxalate Crystals:
![Page 10: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/10.jpg)
White blood cells/red blood cells in urine
This is a photograph of urinary sediment under brightfield microscopy (250X magnification). The sediment contains two red blood cells (right) and one white blood cell (left). The white blood cell appears to have a lobulated nucleus.
![Page 11: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/11.jpg)
Red blood cells in urine
These are red blood cells found in urinary sediment under bright field microscopy (160x magnification).
![Page 12: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/12.jpg)
White blood cells and bacteria
These are white blood cells and bacteria found in urinary sediment using interference-contrast microscopy. The cell in the center has a pseudopod extending from its cytoplasm indicating amoeboid motion.
![Page 13: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/13.jpg)
Squamous epithelial cells
Shown here is a group of squamous epithelial cells in urine sediment. Interference-contrast microscopy was used to enhance surface characteristics of the cells (200X magnification). A few white blood cells and bacteria are visible in the periphery.
![Page 14: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/14.jpg)
Squamous epithelial cell in urine
This is a squamous epithelial cell under brightfield microscopy (250X magnification).Squamous epithelial cells are characterized by a small, round, central nucleus with a large amount of granular or wrinkled cytoplasm (a "fried egg" appearance).
![Page 15: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/15.jpg)
Renal Epithelial Cells
A group of attached renal tubular epithelial cells are seen in the center of this slide. The background contains white blood cells and red blood cells (bright field microscopy, 250X magnification)
![Page 16: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/16.jpg)
Bacteria and white blood cells
This is a low power view (100X magnification) of urine with bacteria and several leukocytes in the field. Bacteria are bacillary and diffusely scattered throughout. The urine is stained with Sternheimer-Malbin stain.
![Page 17: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/17.jpg)
Mucus
This slide shows mucus in urine with two entrapped white cells. There are also two red cells present, one within the mucus and one above it. Mucus fibers are fibrillar and delicate. They have a very low refractive index. (Bright field microscopy, 160X magnification.)
![Page 18: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/18.jpg)
Budding yeast cells
Budding yeast are visible on the left side of this slide with a squamous epithelial cell on the right. There are no segmented neutrophils seen. This suggests the yeast are a contaminant and not causing a urinary tract infection (bright field microscopy, 200X).
![Page 19: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/19.jpg)
Hyaline cast
Hyaline casts are difficult to see due to their low refractive index. This one is granular, which makes it easier to visualize. (Bright field microscopy, 200X magnification.)
![Page 20: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/20.jpg)
Red blood cell cast
This slide shows a red blood cell cast with red blood cells concentrated at one end.(Bright field microscopy, 160X magnification)
![Page 21: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/21.jpg)
White blood cell cast
This is a white blood cell cast with intact leukocytes. The leukocytes have multilobed nuclei. (Bright field microscopy)
![Page 22: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/22.jpg)
Coarsely granular cast
This coarsely granular cast is easily seen with interference-contrast microscopy at 160X magnification.
![Page 23: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/23.jpg)
Waxy cast
This is a waxy cast seen in urine with interference-contrast microscopy at 160X magnification. The cast is surrounded by red blood cells and segmented neutrophils.
![Page 24: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/24.jpg)
Waxy cast
This is a waxy cast seen in urine with interference-contrast microscopy at 160X magnification. The cast is surrounded by red blood cells and segmented neutrophils.
![Page 25: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/25.jpg)
Amorphous urates in urine
Amorphous urates appear as fine pink or brownish-tan granules (brightfield microscopy, 200X magnification). They are salts of uric acid and are normally found in acid or neutral urine.
![Page 26: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/26.jpg)
Uric acid crystals in urine
Uric acid crystals exhibit extreme pleomorphism in size and in shape. They appear readily in acid urine allowed to stand at room temperature. (Bright field microscopy, 160X magnification)
![Page 27: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/27.jpg)
Calcium oxalate crystals in urine
Calcium oxalate crystals are usually found in acid urine. They commonly appear octahedral.(Brightfield microscopy, 100X magnification.)
![Page 28: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/28.jpg)
Amorphous phosphates in urine
Amorphous phosphates appear in neutral to alkaline urine as fine, colorless or slightly brown granules. White precipitate is observed on centrifugation. (Brightfield microscopy, 160X magnification.)
![Page 29: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/29.jpg)
Triple phosphate crystals in urine
Triple phosphate crystals, viewed here with interference-contrast microscopy (160X magnification), resemble prisms or "coffin lids". They are found normally in alkaline or neutral urine. They are colorless.
![Page 30: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/30.jpg)
Ammonium biurate crystals in urine
Ammonium urate crystals are easily distinguished by their golden brown color and "thorn apple" shape. They are seen here under bright field microscopy (160X magnification). They are the only urate crystals that appear in alkaline urine.
![Page 31: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/31.jpg)
Calcium phosphate crystals in urine
Calcium phosphate crystals assume various forms including the rosette and pointed finger forms shown here with bright field microscopy (160X magnification). They appear most often in alkaline urine.
![Page 32: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/32.jpg)
Calcium carbonate crystals in urine
Calcium carbonate crystals are small and colorless and appear in alkaline urine as granules or as small dumbbells. Bacteria are also present in this field (brightfield microscopy, 250X magnification).
![Page 33: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/33.jpg)
Cystine crystals in urine
Cystine, an amino acid, is an abnormal finding in urine. Rarely seen, these crystals are found in acid urine and are seen as thin, colorless, hexagonal plates. (Brightfield microscopy, 160X magnification.)
![Page 34: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/34.jpg)
Tyrosine crystals in urine
Tyrosine crystals are not normally found in urine. They are products of protein metabolism and appear in urine of people with tissue degeneration or necrosis (acute liver disease, severe leukemia, typhoid fever, and smallpox). They are present only when urine is acid. They are colorless to yellowish brown, needle shaped crystals and have a fine silky appearance. The needles may be single or arranged in sheaves or rosettes. Tyrosine crystals usually appear in urinary sediment together with leucine crystals
![Page 35: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/35.jpg)
Leucine crystals in urine
Leucine crystals are not normally found in urine They appear in urine in association with tyrosine and are manifestations of the same clinical conditions. When found, leucine crystals are in acid urine in the form of spheroids with concentric striations. They are dense, highly refractive and appear as yellowish brown bodies. (Brightfield, 160X magnification)
![Page 36: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/36.jpg)
Cholesterol crystals in urine
Cholesterol crystals are seen in the center of this field with squamous epithelial cells on either side. Cholesterol crystals are found in acid or neutral urine. They appear as regular or irregular transparent plates. They may occur singly or in large numbers. Usually one or more corners are cut off or notched, justifying their description as "stair step crystals". They are not commonly seen and are always considered pathological. They can be found in various renal diseases. (Brightfield microscopy, 160X magnification.)
![Page 37: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/37.jpg)
Sulfa crystals in urine
Sulfonamide crystals form primarily in acid urine. The shape and color of these crystals are extremely variable, depending on the particular sulfonamide being administered to the patient. The most common forms encountered include rosettes, fan shapes and those resembling shocks of wheat. Sulfa crystals have pathologic significance, since they tend to form renal calculi that may damage renal tubules. (Brightfield microscopy, 160X magnification.)
![Page 38: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/38.jpg)
Fecal material in urine
Fecal material can usually be identified by its brown coloration, and the assortment of bizarre shapes and sizes of component elements. Fecal contamination of urine most often occurs in incontinent babies or elderly persons. (Brightfield microscopy, 40X magnification)
![Page 39: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/39.jpg)
Talc in urine
Talcum powder, commonly used as a dusting powder to prevent chafing or heat rash, appears as a contaminant in urine as crystals. (Brightfield microscopy, 128X magnification.)
![Page 40: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/40.jpg)
Starch in urine
A derivative of cornstarch is used as a dusting powder for surgical gloves. It can enter the urine during catheterization. The starch granules are usually identifiable by their size, shape and high refractive index. (Brightfield microscopy, 100X magnification.)
![Page 41: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/41.jpg)
Cotton fiber in urine
A cotton fiber is easily identified by its size. A cotton fiber is seen here with squamous epithelial cells and white blood cells.(Brightfield microscopy, 51X magnification.)
![Page 42: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/42.jpg)
Fiber in urine
This slide depicts a fiber artifact found in urine under brightfield microscopy at 200X magnification.
![Page 43: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/43.jpg)
Protein based cylindrical molds of the renal tubule
Form in distal tubules and collecting ducts
Result of damage to the renal tubule
Can contain cells and other material
Dehydration and acidic urine especially predisposes to cast formation
So…what is a cast???
![Page 44: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/44.jpg)
Formation of Casts:
![Page 45: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/45.jpg)
Almost always associated with glomerulonephritis or vasculitis
Virtually exclude extra-renal causes of bleeding
Red cell cast
![Page 46: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/46.jpg)
Red cell Casts in Urine:
![Page 47: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/47.jpg)
Epithelial Casts in Urine:
![Page 48: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/48.jpg)
Granular Casts in Urine:
![Page 49: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/49.jpg)
Non-specific but usually pathologic
Usually the ‘granules’ are from the degeneration of cellular
casts
Granular cast
![Page 50: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/50.jpg)
Seen in interstitial disease most commonly
Also seen in glomerulonephritis
White blood cell cast
![Page 51: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/51.jpg)
WBC Cast Urine:
![Page 52: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/52.jpg)
Mixed Cast Urine:
![Page 53: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/53.jpg)
Thought to result from the degeneration of cellular casts
Waxy cast
![Page 54: Urine Examination](https://reader030.vdocument.in/reader030/viewer/2022020919/543f84e8b1af9fd9168b47c1/html5/thumbnails/54.jpg)
Uro-epithelium is columnar
•If there are a lot of these it means there is
sloughing of the system
Skin is squamous•If there are a lot of
squamous it is a contaminated specimen
Non-renal epithelial cells