Microscopic

Examination
Epithelial Cells
Yeast
Parasites
Mucus
 Epithelial Cells
• It is not unusual to find epithelial cell in urine
because they are derived in the lining of the
genitourinary system.
• Unless they are present in large numbers or in
abnormal form, they represent normal sloughing
of old cells.
• 3 Types
– Squamous
– Transitional (Urothelial)
– Renal Tubular
 SQUAMOUS
Appearance:
EPITHELIAL CELLS
largest cells in the urine
sediments with abundant,
irregular cytoplasm and
prominent nuclei
Sources of Error:
rarely encountered,
folded cells may resemble casts
Reporting:
rare, few, moderate, or
many per lpf
Complete urinalysis
correlations:
clarity
 SQUAMOUS EPITHELIAL CELLS
• Originate from the lining
of the vagina and the
female urethra and the
lower portion of the male
urethra.
• Increased amount are
more frequently in female.
• CLUE CELLS – indicative of
vaginal infection by the
bacterium Gardnerella
vaginalis.
• They appear as SEC
covered with the
Gaednerella cocobacillus.
Appearance: TRANSITIONAL
spherical, polyhedral, or EPITHELIAL CELLS
caudate with centrally located
nucleus
Sources of Error:
spherical forms resemble
RTE cells
Reporting:
rare, few, moderate, or
many per hpf
Complete urinalysis correlations:
clarity
blood, if malignancy-
associated
 TRANSITIONAL EPITHELIAL CELLS
• Originates from the lining
of the renal pelvis, calyces,
ureters, and bladder and
from the upper portion of
the male urethra.
• Usually present in small
numbers
• Increased TEC exhibiting
abnormal morphology (
vacuoles and irregular
nuclei) may be indicative
of malignancy or viral
infection.
Appearance: RENAL TUBULAR
PCT - larger, rectangular, EPITHELIAL CELLS
columnar
DCT- smaller, round, oval (RTE)
CD - cuboidal ( 1 straight edge)
eccentric nucleus possibly
bilirubin-stained or hemosiderin-
laden
Sources of Error:
PCT - granular cast
DCT- spherical transitional
epithelial cells, WBCs
Reporting:
average number per 10 hpfs
Complete urinalysis correlations:
leukocyte esterase and nitrite
color, clarity, protein, bilirubin,
blood
RENAL TUBULAR EPITHELIAL CELLS (RTE)
• RTE cells are often present
as a result of tissue
necrosis so the nucleus is
not easily visible in
unstained sediments
• Renal fragments- cells
from CD that appears in
groups of 3 or more.
• The presence of more
than 2 RTE cells per hpf
indicates tubular injury
 Clinical Significance
• The most clinically significant EC. The presence of
increase amount indicates necrosis of renal tubules
with the possibility of affecting overall renal function.
• Conditions
– Exposure to heavy metals
– Drug induced toxicity
– Hemoglobin and myoglobin toxicity
– Hepa B infection
– Pyelonephritis
– Allergic reactions
– Malignant infiltration
– Salicylate poisoning (single cuboidal cells are particularly
noticeable)
– Acute allogenic transplant rejection
 Clinical Significance
• May also be seen as secondary effects of
glomerular disorders
• Renal fragments are indication of severe
tubular injury with basement membrane
disruption.
• Absorb bilirubin present in the filtrate as the
results of liver damage (viral hepatitis, deep
yellow in color)
 OVAL FAT
Appearance: BODIES
highly refractile RTE cells
Sources of Error:
confirm with fat stains
and polarized microscopy
Reporting:
average number per hpf
Complete urinalysis
correlations:
clarity, protein, blood,
free fat droplets/fatty casts
 OVAL FAT BODIES
• Lipid containing RTE cells
• Lipiduria is most frequently associated damage to
the glomerulus caused by nephrotic syndrome
• It is also seen with severe tubular necrosis,
diabetes mellitus, and in trauma cases that cause
release of bone marrow fat from the long bones.
• In lipid storage diseases, large fat-laden histiocytes
may also be present. (larger in size)
• In acute tubular necrosis, RTE cells containing
large, nonlipid-filled vacuoles may be seen along
the normal renal tubular cells and oval fat bodies.
• Bubble Cells - appear to represent injured cells in
which the ER has dilated prior to cell death.
 Yeasts
Appearance:
small, oval, refractile structures with buds,
and/or mycelia
Sources of Error:
RBCs
Reporting:
rare, few, moderate, or many per hpf,
presence of WBCs may be required
Complete urinalysis correlations:
glucose, LE, WBCs
 Yeasts
• Candida albicans are primarily seen in the
urine of diabetic patients,
immunocompromised patients and women
with vaginal moniliasis (candidiasis)
• A true yeasts infection should be accompanied
by the presence of WBCs.
 Parasites (Trichomonas vaginalis)
Appearance:
pear-shaped, motile, flagellated
Sources of Error:
WBCs, RTE cells, transitional cells
Reporting:
rare, few, moderate, or many per hpf
Complete urinalysis correlations:
LE, WBCs
 Mucus
Appearance:
single or clumped threads with a low
refractive index
Sources of Error:
hyaline casts
Reporting:
rare, few, moderate, or many per lpf
Complete urinalysis correlations:
none
 3

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 Source:
Strasinger, S.K, & Di Lorenzo,
M. S. (2014). Urinalysis and
Other Body Fluids (6th Edition).

END