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Understanding urinalysis
MOHAMMAD NURIMAN BIN MOHD ZAINUDDIN (AA0890)
LABLINK, KPJ PUTERI SPECIALIST HOSPITAL
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Objectives

Upon completion of this unit, the participant will:

 • Describe routine UA microscopic exam
 • Correlate common microscopic findings with possible
clinical conditions
 • Identify conditions that enhance urine cast formation
 • Describe sources of error
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Urine Analysis

 Appearance or color
 Specific gravity
 pH
 Leukocyte esterase
 Nitrites
 Urobilinogen
 Bilirubin
 Glucose
 Ketones
 Protein
 Blood
 Microscopic examination
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Normal urinalysis
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Scanning the Microscope Slide
 Use 40X objective: scan the coverslip perimeter for:
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KOVA slide system

 Remember to scan a MINIMUM of 10 FIELDS

 Example: begin in the upper right hand corner, down the right
side then the bottom, up and over
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Microscopic & Chemical Correlation

Microscopic Physical Chemical (dipstick)

Elements appearance
WBC CLARITY + PROTEIN,
LEUKOCYTES,NITRATE
RBC CLARITY , COLOUR + ERYTROCYTES
EPITHELIAL CELLS CLARITY
CASTS CLARITY + PROTEIN
CRYSTALS CLARITY , COLOUR pH
BACTERIA CLARITY + NITRATE, pH
YEAST CLARITY
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RBC: Erytrocytes
 Intact RBC: hematuria
 Normal: 0-3 /hpf
 Abnormal: damage to basement membrane of glomerulus, kidney infection, kidney stones,
trauma
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WBC: Leukocytes

 WBC in urine: leukocyturia

 Indicates infection ( bacterial, non-bacterial)
 Normal: 0-3 WBC/hpf
 Neutrophil predominant type of WBC found in
urine
 Spherical
 Approximately 2x larger than RBC
 Cytoplasm contains granules
 Nucleus is segmented (lobed)
 Can be found singly or in clumps
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Epithelial Cells

Found in urine due to

 Normal sloughing of old cells
from lining of genitourinary
system
 Inflammation of the lining
 Renal disease
 Common contaminant in
female specimens
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Casts

 Abnormal: increased number and

type of cast significant
 • Certain types of casts are always
pathologic: RBC, WBC
 • Casts are only formed in the kidney
tubules: not the bladder, not urethra,
not ureters
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Hyaline cast WBC cast RBC cast

Granular cast Waxy cast

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Crystals

 Not normally found in fresh urine

 If found in fresh urine, pathologic
 Crystals
precipitate as urine cools to room temp or
when urine is refrigerated
 All clinically significant crystals are found in acid urine
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pH & Crystals

 Determine the existence of metabolic acid base disorder

 Precipitation of crystals to form stone requires specific pH for
each type.

 Crystalsfound in acidic urine: Amophous urate, Ca oxalate,

uric acid.

 Crystals
found in alkaline urine : Amophous phosphates, Ca
carbonate, Ca phosphate
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Amorphous Urates (U-pH <5.8)

 Thesecrystals have no distinct form

and appear as sand-like granules
microscopically
 Macroscopically appear as a pink
sediment after urine centrifugation
 Often seen after urine is
refrigerated
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Uric Acid Crystals (U-pH <5.8)

 Acid pH urine
 Appear in several forms
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Calcium Oxalate Crystals (U-pH 5.4 – 6.7)

 Most frequently observed crystal in

urine
 Mostcommon form is octahedryl
shape, often referred to as an
‘envelope’ shape
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Amorphous Phosphates (U-pH 6.2-7.0)

 Thesecrystals have no distinct form and

appear as sand-like granules
microscopically
 Macroscopically appear as a white
sediment after urine centrifugation
 Alkaline pH urine
 Often seen after urine is refrigerated
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Triple Phosphate Crystals (U-pH 6.2 - 7.0)

 Most frequently observed crystal in

alkaline urine
 Colorless, 4-6 sided prisms
 Referred to as ‘coffin lid crystals’
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Other Crystals

Bilirubin Cholestrol Cystine 2,8-DHA

Calcium
carbonate
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Bacteria

 Most often rod-shaped

 Vary in size
 Presence may indicate
– UTI
– Contamination
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Yeast and Mycelial Elements

 Budding forms or singly

 Ovoid and more refractile than RBC
 Will not lyse with acetic acid or KOH
 Note pseudohyphae (mycelial elements)
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Trichomonas vaginalis

 Round to lemon-pear shape

 Undulating membrane and flagella
provide movement
 Sexually transmitted
 Similar in size with WBC
 Can be confused with WBC Flagella
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Spermatozoa

 May be seen in male and

female urine
 Usually not clinically
significant unless
– Post vasectomy
– Rape
– Child urine
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Mucus

 Low refractive index makes it

difficult to see
 Wavy, delicate ribbon-like
strands or threads.
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Non Preserved Urine

 Transformation of urea to ammonia which increase pH.

urease
 Urea ─────── 2NH3 + Co2.
(Bacteria)

 Increase nitrite due to bacterial reduction of nitrate.

 Increase bacterial number.
 Increase turbidity caused by bacteria & amorphous.

 Decrease glucose due to glycolysis and bacterial utilization.

 Decrease bilirubin from exposure to light.
 Disintegration of RBCs casts.
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Quiz

1. True / False: Casts are formed in the bladder

2. True / False: Acid pH and urine stasis are conducive for cast formation

3. True / False: Crystals are identified by shape and urine pH

4. True / False: Uric acid crystals are found in acid urine and are shaped like a ‘coffin lid’

5. True / False: Neutrophil predominant type of WBC found in urine

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Quiz

6. True / False: Presence of ammonium biurate crystals indicate the urine is old

7. True / False: Presence of bilirubin crystals indicate severe liver disease

8. True / False : A positive chemistry strip result for blood should always be followed with
microscopic correlation of RBC and casts.

9. True / False: Casts are enumerated using the high power objective

10. True / False: Hyaline and RBC casts are not pathologic
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The End

 Thank you for your kind attention