Microscopic Findings Flashcards
Uromodulin
Another name for Tamm-Horsfall protein that creates casts, major constituent of mucus, it is a glycoprotein excreted by the RTE cells of the distal convoluted tubules and upper collecting ducts
Cast Formation
Protein gels more readily under conditions of urine flow stasis, acidity, in the presence of sodium and calcium.
Stepwise Cast Formation
- Uromodulin aggregates into individual protein fibrils attached to the RTE cells
- The fibrils interweave to form a loose fibrillar network
- The fibrils further interweave to form a solid structure
- Urinary constituents attach to the solid matrix
- Approaching fibrils detach from the epithelial cells
- The cast is excreted
Bacterial Casts
Bacterial casts (both within and bound to the protein matrix) are seen in pyelonephritis.
Epithelial Casts
Similar to RTE cells, they are associated with:
- heavy metal and chemical toxicity
- drug-induced toxicity
- viral infections
- allograft rejection
When tubular damage is present, the majority of cells will be attached to the cast surface.
Fatty Casts
Seen with oval fat bodies and free fat droplets in disorders causing lipiduria. Associated with nephrotic syndrome, toxic tubular necrosis, diabetes mellitus, and crush injuries. Confirmation of fatty casts is performed using polarized microscopy and Sudan III or Oil Red O fat stains.
- Cholesterol demonstrates characteristic Maltese cross formation under polarized light
- Triglycerides and neutral fats stain orange with fat stains.
Granular Casts
The origin of the granules in nonpathologic conditions is from the lysosomes excreted by RTE cells during normal metabolism
RBC Casts
Show bleeding in the nephron, primarily associated with damage to the glomerulus - allows passage of cells through the membrane, however any damage to the nephron capillary structure can cause their formation
Granular, dirty, brown casts representing hemoglobin degradation products such as methemoglobin may also be present, associated with the acute tubular necrosis often caused by the toxic effects of massive hemoglobinuria that can lead to renal failure
Waxy Casts
Show extreme urine stasis, indicating chronic renal failure. Brittle, highly refractive cast, caused by degeneration of the hyaline cast matrix and any cellular elements or granules contained in the matrix.
Last stage of degradation of granular casts.
Broad Casts
“Renal failure casts”, extreme urine stasis. As a mold of the distal convoluted tubules, the presence of broad casts indicates destruction (widening) of the tubular walls.
Sternheimer-Malbin Stain and 2% Acetic Acid
Consists of crystal violet and safranin O (WBCs)
2% acetic acid enhances nuclear detail in the sediment
Neutrophils in Urine
Neutrophils lyse rapidly in dilute alkaline urine and begin to lose nuclear detail
If they’re exposed to hypertonic urine they absorb water and swell, Brownian movement of the granules within these larger cells produces a sparkling appearance and they referred to as “glitter cells”
Lipid Stain
Oil red O and Sudan III and polarizing microscopy can be used to confirm the presence of free fat droplets and lipid containing cells
Hansel Stain
Preferred stain for urinary eosinophils consisting of methylene blue and eosin Y
What to do with a doubtful RBC ID
Adding acetic acid will lyse RBCs, leaving the yeast, oil droplets, and WBCs intact
Urinary Eosinophil Association
Primarily associated with drug induced interstitial nephritis
RTE cells
Are usually larger than WBCs with an eccentrically located nucleus
Pyuria
Increasing urinary WBCs indicating the presence of an infection or inflammation
Transitional Epithelial Cells, Types, Size, Numbers
- Smaller than squamous cells and appear in several forms, including spherical, polyhedral, and caudate, All forms have distinct centrally located nuclei
- Cells in direct contact with the urine absorb water, becoming spherical and forming cells much larger than the polyhedral and caudate cells.
- Increased numbers of transitional cell seen singly, in pairs, or in clumps are present following invasive urologic procedures such as catheterization
Renal Tubular Epithelial Cells
Cells from the proximal convoluted tubule are larger than other RTE cells and have coarsely granular cytoplasm
Cells from the distal convoluted tubule are smaller than those of the PCT and are round or oval
Collecting duct RTE cells are cuboidal and are never round along with the ecentrically placed nucleus the presence of at least one straight edge differentiates them
The presence of RTE cells are clinically significant in that increased amounts indicate necrosis of renal tubules, caused by exposure to heavy metals, drug-induced toxicity, hemoglobin and myoglobin toxicity, viral infections, pyelonephritis, allergic reactions, malignant infiltrations, salicylate poisoning, and acute allogenic transplant rejection
Lipiduria
Most frequently associated with damage to the glomerulus caused by the nephrotic syndrome, also seen with severe tubular necrosis, diabetes mellitus, and in trauma cases that cause release a bone marrow fat being released from the long bones
Yeast, Patients Found In
Most commonly seen in diabetic patients, immunocompromised patients, and women with vaginal moniliasis