Identification

Neutrophils are the most frequent leukocytes found in the sediment. They
are easily recognizable by their segmented nucleus and their granular
cytoplasm. The cells have a diameter of 12-15 microns. Leukocytes are
easily identified by Malbin Sternheimer staining. Fresh leukocytes are
living cells, bright and pale blue in color (Sternheimer Malbin cells or
bright cells). Their membrane is almost impermeable to dyes.

"Dark leukocytes" have lost this property. They are no longer alive. Typical
nuclear segmentation is easier to recognize. In our opinion, systematic
distinction between leukocytes from the kidney or leukocytes from the
urinary tract is not possible by their color after staining.

Dark cells are most often observed in infections of the lower genito-
urinary tract whereas "bright cells observed in hypotonic urine often
originate from diseases of the renal parenchyma. Since urinary tract
infections often also involve renal parenchyma, both cell types can be
found in the same urine.
Lymphocytes, monocytes, eosinophils and blasts (in case of
myeloproliferative disorders) are rarely observed in urine.

A round epithelial cell (UeZ) among numerous leukocytes and a few

erythrocytes .

Terminology
Leukocyturia: > 5 leukocytes/HPF (neutrophil polynuclear leukocytes).
A higher number indicates a moderate infection of the kidneys and/or
urinary tract.
Pyuria: urinary sediment shows large amounts of leukocytes per field
(over 50%) mostly of neutrophils, indicating an acute inflammatory
process.
Differentiation
In some instances, neutrophils may be mistaken for renal epithelial cells.
Renal epithelial cells have a larger, eccentric nucleus, and are often
loaded with fat droplets.
Stability
Leukocytes are stable during 24h in high density, acidic urine. Lysis can
occur within 3 hours in hypotonic and/or alkaline urine.