**MANNERS OF REPORTING**

RCSs WBCs - ave / number HPF

Casts - ave / number LPF
Crystals - rare few mod plenty HPF
Squamous EC - rare few mod plenty LPF
Bacteria - rare few mod plenty HPF
Transitional - rare few mod plenty HPF
Renal EC - ave/number HPF
ABNORMAL CRYSTALS - may be reported ave/ LPF

Squamous Epith cells / LPF

- None : 0
- Rare : 0-5
- Few : 5-20
- Moderate 20-100
- Many : > 100

Casts / LPF
- 0 /lpf
- 0-5 /lpf
- -10 /lpf
- >10/lpf

RBCs/WBCs / HPF
- None 25-50
- 0-2 50-100
- 2-5 >100 (TNTC)
- 5 -10
- 10- 25

Crystals / HPF
- None: 0
- Rare: 0-2
- Few: 2-5
- Moderate: 5-20
- Many: >20
- ABNORMAL CRYSTALS ave/ LPF

Bacteria / HPF
- None: 0
- Rare: 0-10
- Few: 10-50
- Moderate: 50-20

URINE SEDIMENT PREPARATION

10 to 15 mL of Urine (ave. of 12mL)
V
Spin at 400 RCF for 5 minutes
V
Decant urine (0.5 or 1mL remains)
V
Transfer uL (0.02mL) sediment to glass slide with 22x22 coverslip
V
Examine microscopically 10 LPF, 10 HPF under reduced light

RBCs (Hematuria) - NV: 0-2 to 0-3/HPF

> Smooth, anucleated, biconcave
• HYPERTONIC =
• HYPOTONIC =
• GLOMERULAR DAMAGE =
SOURCES OF ERROR:
Yeasts Air Bubbles
Oil Droplets CaOx
REMDY: 2% AcetOH (RBC lysis)

SEQUENCE OF CAST FORMATION

Hyaline > Cellular > Coarse Gran > Fine Gran > Waxy

Cen-slide - closed system for performing fast, clean, accurate, microscopic urine
analysis.
- provides a specially designed tube that permits direct reading of the urine
sediment.

ADDIS COUNT - quantitative measure of formed elements of urine using

hemacytometer.
- Specimen: 12-hour urine
- Preservative: Formalin
Normal Values:
- RBC = 0 to 500,000/12hr
- WBC = 0 to 1,200,000/12hr
- Hyaline Casts = 0 to 5,000/12 hr

Phase-Contrast - Enhanced visualization of highly refractile elements

Polarizing - ID of chole in oval fat bodies, fatty casts and crystals

(maltese cross)

Dark-Field - ID of T. pallidum

Fluorescence - Visualization of fluorescent organism/substances

Interference
a.Normarsky
b. Hoffman
- 3D microscopy. And layer-by-layer imaging
- Differential/Bright field
- Modulation/Birght field

WBCs (Pyelonephritis) - NV: 0-5 to 0-8/HPF > Larger than RBCs

- NEUTROPHILS (Predominant) - Granulated and multilobes
- Hypotonic: Granules swell and undergo BROWNIAN MOVEMENT (Glitter Cells)
- EOSINOPHILS (<1% of Urine WBCs) - Significant if >1%
- Primarily associated with interstitial nephritis.
- Monouclear Cells (Lympho, Mono, Macro and Histiocytes)

SQUAMOUS EPITHELIAL CELLS

- LARGEST cell in the urine. Irregular cytoplasm.
- Form the lining of vagina, urethra of male and female.
VARIANT: CLUE CELLS – squamous epith cell
covered G. vaginalis. à assoc with Bacterial vaginosis.
TRANSITIONAL EPITHELIAL CELLS (UROTHELIAL)
- Spherical, polyhedral or caudate
- Centrally located tubules
- Derived from the linings of pelvis, ureter, urinary bladder and upper
portion of male urethra

RENAL TUBULAR CELLS

- Most clinically significant epithelial cells
- Originates for the NEPHRON
- Rectangular, polyhedral cuboidal or columnar
- Eccentric nucleus
- > 2 RTE/hpf à tubular injury

RTE CELL VARIANTS:

- OVAL FAT BODIES – lipid conraining RTEC. Seen in Lipiduria (ex. Nephrotic
syndrome)
- ID: Lipid stains and Polarizing Microscope.
- BUBBLE CELLS – RTEC with non-lipid vacuoles (Acute Tubular Necrosis)

BACTERIA : UTI = Bacteria + WBCs

- Not significant unless there is increased WBCs

YEAST – true infection in presence of WBCs

- May or not seen with mycelia
- Commonly mistaken as RBC

PARASITES
Trichomonas vaginalis
- Most frequent parasite encountered in urine.
- Pear-shaped flagellate with jerky motility.
- Agent of PING PREPARED & COMPILED BY: -PONG JAMES PATRICK PICAR, RMT
DISEASE

Schistosoma haematobium
- With terminal spine
- Hematuria and bladder cancer
- SPX: 24 hr UNPRESERVED urine Enterobius vermicularis
- Most common fecal contaminant

SPERMATOZOA – seen post-coitus/post#ejaculation

URINE SEDIMENTS: CASTS

CASTS (Cylindruria) – unique to the kidney
- Formed in the DCT and Collecting Ducts
- MAJOR CONSTITUENTS: Tamm-Horsfall Protein or UROMODULIN.
- Performed along the EDGES of the COVERSLIP with subdued light

FORMATION OF CASTS:
- Aggregation of Tamm-Horsfall CHON into individual protein fibrils attached
to the RTE cells.
- Interweaving of CHON fibrils to form a loose fibrillary network.
- Further CHON fibril interweaving to form a solid structure.
- Possible attachment of urinary constituents to the solid matrix
- Detachment of CHON fibrils from the epithelial cells
- Excretion of the cast

HYALINE CASTS – prototype cast

- NV: 0 to 2/LPF
- CLINICAL SIGNIFICANCE:
 - Physiologic: Stress, Strenuous Exercise, Dehydration and Heat exposre
- Pathologic: Glomerulo and Pyelonephritis, Congestive Heart failure and
Chronic Renal conditions.

RBC CASTS – indicative of bleeding in nephron.

- Glomerulonephritis and Strenous exercise.
WBC CASTS – inflammation in the nephron. May be mistake as EPITHELIAL CELLS casts.
To differentiate: Phase Microscopy and Supravital stain.
- Pyelonephritis and Acute Interstitial Nephritis (elevated urine
Eosinophils)

EPITHELIAL CAST – indicative of advanced tubular destruction. (RTE cell casts)

BACTERIAL CAST – indicative of pyelonephritis
GRANULAR CAST – granules are derived from lysosomes of RTE cells during normal
metabolism (non-pathologic)
- Glomerulonephritis, Pyelonephritis, Stress and Strenuous exercise

FATTY CASTS – not stained by Sternheimer-Malbin. For to identify:

- TG and Neutral Fats: Lipid Stains
- Cholesterol: Polarizing Microscope
- Nephrotic syndrome

WAXY CASTS – degenerative form of all types of casts.

- Urine flow stasis and Chronic renal failure.

BROAD CASTS – RENAL FAILURE CAST

- Indicates widening of the tubular walls. ANY TYPE OF

CASTS MAY BE BROAD.

- Extreme URINE STASIS
- Renal PREPARED & COMPILED BY: Failure