QAIWAN

IN TERNATI ONAL UNIVER SIT Y

Urinalysis and Body Fluids

Week 6: Microscopic Examination of Urine Part 1
By: Ramyar M. Sleman
6. 6.0 Microscopic Examination of Urine
• 6.1) 6.1 Urine Specimen Preparation
• 6.2) 6.2 Sediment Constituents
• 6.3) 6.3 Quality Assurance in Urinalysis
6.1 Urine Sediment Preparation
• The type of urine specimen used for microscopy is the Wet
preparation, which is either Neat Urine or Centrifuged
urine.

• Important structures to include: casts, erythrocytes,

leukocytes, epithelial cells, budding yeasts, protozoa,
and bacteria.

QAIWAN
6.2 Sediment Constituents
• A variety of normal and abnormal cellular elements may be seen in urine
when looked at under a microscope, including:
• Organized Elements (biological part)
• RBC
• WBC
• Casts
• Epithelial cells
• Bacteria, parasites, yeast and fungi

• Unorganized Elements
• Crystals:
• Acidic and Alkaline urine crystals

QAIWAN
6.2 Sediment Constituents :Organized Elements
1. Red Blood Cells:
• Indicates hematuria, indicative of:
1. Renal diseases — glomerulonephritis
2. Physiological changes.
3. Schistosoma haematobium infecti on (urinary blood flukes causing Schistosoma)

• Hematuria is the presence of abnormal numbers of red blood cells in urine, due to:
• Glomerular damage

• tumors
• Urinary tract stones
• Upper and lower urinary tract infections

QAIWAN
 6.2 Sediment Constituents :Organized Elements
Two Types of Hematuria
• Gross haematuria means that the blood can be seen by the
naked eye. The urine may look pinkish, brownish, or bright
red.

• Microscopic haematuria means that the urine is clear,

but blood cells can be seen under the microscope.

QAIWAN
QAIWAN
QAIWAN
Urine Microscopic Examination: Organized Elements
White blood cells:
Indicates i n fl a m m a ti o n of UT, referred to as pyuria.
i. Infection-cystitis, urethritis etc.
ii. Acute or chronic bacterial pyelonephritis
iii. Calculi (kidney stones)

• Pyuria refers to the presence of abnormal

numbers of leukocytes that may appear with
infection in either the upper or lower urinary
tract or with acute glomerulonephritis

• WBCs ≤ 2-5 cell/hpf (cells per high power field)

QAIWAN
Urine Microscopic Examination: Organized Elements
White blood cells:

QAIWAN
QAIWAN
 Urine Microscopic Examination: Organized Elements
Epithelial cells
• Renal tubular epithelial cells contain a large round or oval nucleus
and normally slough into the urine in small numbers.

• However, with nephrotic

syndrome and in conditions leading
to tubular degeneration, the
number sloughed is increased.
• Normal ≤15—20 squamous epithelial cells/hpf

QAIWAN
Urine Microscopic Examination: Organized Elements
Epithelial cells
Large numbers of epithelial
cells usually indicate
inflammation of the UT or vaginal
contamination of the specimen.

Epithelial cells presence

normally due to sloughing
the lining layer of urinary tubules,
bladder and
urethra or because of some renal
diseases.
QAIWAN
Urine Microscopic Examination: Organized Elements
Epithelial cells

Other cells that can be

seen in urine:

QAIWAN
Urine Microscopic Examination: Organized Elements
Urinary casts :
• Casts are linear tubular structures that form in the renal
tubules, usually in the loop of Henle, distal tubules or collecting
ducts
• Presence of casts in urine is called as Cylinduria.
• The cells and proteins which leak into the urine get
incorporated into the casts. The number of casts may
predict the severity of injury
• Casts cylindrical bodies performed in distal collecting
tubules from RBCs or WBCs or fatty compounds or
waxes.

QAIWAN
Urine Microscopic Examination: Organized Elements
Urinary casts :
• Diagnosis of cast type will aid in diagnosis of the disease.

• Casts could be made up of cells (such as WBCs, RBCs,

kidney cells) or substances (such as protein).

QAIWAN
Urine Microscopic Examination: Organized Elements
Urinary casts :
There are several types of casts:
Hyaline casts, density granulated casts, finely granulated
casts, red cell casts (hematouria), and white cell casts
(inflammation), wax casts, fat casts, and epithelial casts.

Hyaline casts are composed primarily of a mucoprotein

(Tamm-Horsfall proteins) secreted by tubule cells.

Erythrocytes Casts and leukocytes Casts present in

urine in case of UT infection, diseases, inflammation.
Urine Microscopic Examination: Organized Elements
Urinary casts :
• Bence Jones proteins are small proteins found in the urine. Testing for these proteins is
done to diagnose and monitor multiple myeloma and other similar diseases.

• Bence Jones proteins are considered the first tumor marker.

• A tumor marker is a substance, made by the body that is linked
to a certain cancer, or malignancy.
• Bence Jones proteins (myeloma casts) are made by plasma
cells, a type of white blood cells. .’ "
• The presence of these proteins in a person’s urine is associated ’
with malignancy of plasma cells. ”

QAIWAN
Urine Microscopic Examination: Organized Elements

QAIWAN
Urine Microscopic Examination: Organized Elements
Urinary casts :

QAIWAN
Urine Microscopic Examination: Organized Elements
Urinary casts :

QAIWAN
Urine Microscopic Examination: Organized Elements
Urinaw casts :

QAIWAN
Urine Microscopic Examination: Organized Elements
Urinary casts : other types of casts:

• Myoglobin casts: Pigmented cylinders with myoglobin providing

color. Similar to hemoglobin
casts.

• Bilirubin casts: Cylinders pigmented with bilirubin, which can stain

any particle contained in the cast. Observed in
patients with jaundice associated with
increased direct conjugated bilirubin.

• Mixed casts: Contain components of different nature, such as granules,

cells, and lipids. QAIWAN
Urine Microscopic Examination: Organized Elements
Bacteria, Parasites, Yeast, Fungi, and Protozoa:
Refers to the presence of microorganisms (mostly pathogenic) in urine sample.

• Bacteria are a common finding in urine; secondary to either non-sterile

collection techniques or delayed examination.

• Suspect urine infection only if bacteria seen in non contaminated freshly

voided midstream urine sample.

• Genital contaminants include; Candida, Enterobius, Trichomonas

QAIWAN
Urine Microscopic Examination: Organized Elements
Bacteria, Parasites, Yeast, Fungi, and Protozoa:
• Yeast cells: can be differentiated from red cells by their oval shape and
some of the yeasts usually show single budding.
• Budding yeasts: Candida albicans, found in diabetes patients' urine because of
the low PH and the presence of sugar necessary for the growth.
• Protozoa: like Trichomonas vaginalis that infect the vagina in women and urethra
in men and cause trichomoniasis.

• Indicates fecal contamination, vaginal candidiasis, or diabetes due to high

content of glycogen.
QAIWAN
QAIWAN
IN TERNATI ONAL UNIVER SIT Y

Urinalysis and Body Fluids

Week 6 Pre-Lab: Specimen Preparation
By: Ramyar M. Sleman