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Cells in The Urine Sediment: Chemistry
Cells in The Urine Sediment: Chemistry
After reading this article, the reader should be able to describe the primary cells found in the urine sediment in terms of their origin
and clinical relevance.
Cells of Hematologic Origin Leukocytes (WBCs) seen in many urinary tract disorders. The
Erythrocytes (RBCs) Theoretically, any of the WBCs presence of neutrophils is often associated
A few (<5) RBCs per high-power found in blood might be present in the with bacterial infection; however, either
field (hpf) may be present in the urine of urine sediment. Neutrophils are most neutrophils or bacteria may be present
healthy persons. RBCs may be present in common, but lymphocytes and without the other.
the urine as a result of bleeding at any eosinophils have clinical significance and The presence of neutrophils is indi-
point in the urogenital system from the should be identified, if possible. The pres- cated by a positive reagent-strip test result
glomerulus to the ureter. Various morpho- ence of a few (up to 5) WBCs per hpf is for leukocyte esterase. However, a positive
logic forms may be present [I1]. The use considered normal. They may be difficult reaction requires 5 to 15 cells per hpf in
of stains or phase-contrast microscopy is to distinguish from RBCs [I2]. Stains or concentrated sediment; therefore, a nega-
helpful in their identification. To deter- phase-contrast microscopy are helpful in tive leukocyte esterase test result does not
mine the cause and site of origin of the their identification. rule out disease. The reaction is specific
RBCs, other information, both laboratory for esterase, which is present in granulo-
and clinical, is needed. Information about Neutrophils cytic leukocytes (primarily neutrophils)
other sediment findings, such as the pres- The term leukocyte or WBC usually and is not found in lymphocytes. The 153
ence of casts, and the presence of blood refers to the presence of a neutrophil presence and degree of proteinuria (seen
and protein on the reagent strip, is helpful. (polymorphonuclear neutrophil, or PMN). as a positive reagent-strip test result for
The presence of dysmorphic (or distorted) It is assumed that this is the cell type pres- protein) is also helpful. Generally, nega-
RBCs, especially when accompanied by ent unless otherwise specified. tive or lower levels of protein are more
proteinuria and RBC casts, is an indica- Neutrophils in the urine sediment indicate consistent with lower urinary tract infec-
tion of glomerular involvement, as is seen inflammation at some point along the uro- tions, while protein levels of 100 mg/dL
with acute glomerular nephritis. genital tract, and increased numbers are or more indicate renal involvement.
urine are the result of perineal or vaginal tion from female patients with yeast in-
contamination in females or foreskin fections. It is also associated with dia-
contamination in males. A few are com- betes mellitus owing to the presence of
monly seen in most urine specimens, urinary glucose. Yeast is a common con-
and they are of little clinical importance taminant, from skin and the environment,
[I3]. The presence of large numbers of and infections are a problem in debili-
squamous cells in females generally in- tated and immunosuppressed or immuno-
dicates vaginal contamination. compromised patients.