Urinary Sediment Flashcards
Smooth, Non-nucleated biconcave disc
Red Blood Cell
Normal Value of RBC in urine
0-2 cells/10 HPF
size of RBC
7mm
(Concentrated): Shrink → Crenated
Hypersthenuric
(Diluted): Swell and lyse → leaving cell membrane only → Ghost cell
Hyposthenuric
(cellular protrusions, fragmented): Glomerular Bleeding
Dysmorphic
Urine appears cloudy with a red to brown color
Macroscopic (Gross) hematuria
Associated with advanced glomerular damage, can also be seen with damage to the vascular integrity of the urinary tract caused by trauma, acute infection or inflammation and coagulation disorders
Macroscopic (Gross) hematuria
Presence of RBC can be seen only under the microscope, normal color
Microscopic hematuria
Can be critical to the early diagnosis of glomerular disorder and malignancy of the urinary tract and to confirm the presence of renal calculi (kidney stones)
Microscopic hematuria
Associated with damage to the glomerular membrane or vascular injury within genitourinary tract
RBC
The number of cells present is indicative of the extent of damage and injury
RBC
Increased in urinary WBC
Pyuria
Predominant, has granules and multilobed
Neutrophil
(absorbs water and swell)
Hypotonic
granules exhibit Brownian movement → sparkling appearance or appear as
“Glitter cells”
Drug-induced interstitial nephritis, small numbers can be seen in UTI and renal transplant rejection
Eosinophil
Ex. of Mononuclear cells
Lymphocytes, Monocytes, Macrophage, Histiocytes
resembles RBC because they are both small
Lymphocytes
large cells with vacuoles, may or may not contain inclusions
Monocytes, Macrophage, Histiocytes
increase in urinary WBCs which indicates the presence of an infection or inflammation in the genitourinary system
Pyuria
seen in increased number in the early stages of renal transplant rejection
Lymphocytes
(usually larger than WBCs with an eccentrically located nucleus)
renal tubular epithelia cells
Primary concern in identification of WBC in urine:
differentiation of mononuclear cells and disintegrating neutrophils from round renal tubular epithelia cells
used to enhance nuclear detail
Supravital staining / Addition of acetic acid
Normal, Sloughing off
Squamous EC
largest cells found in urine sediment, derived from the genitourinary tract
Squamous EC
They represent normal cellular sloughing and have no pathologic significance
Squamous EC
Urothelial
Transitional EC
Smaller than squamous cells and appear in several forms, including spherical, polyhedral and caudate
Transitional EC
These differences are caused by the ability of transitional epithelial cells to absorb large amounts of water
Transitional EC
Originate from the lining of the renal pelvis, calyces, ureters, and bladders, and from the upper portion of the male urethra
Transitional EC
(they are flexible and can change shape)
Transitional EC
Increase in transitional cells → invasive urologic procedure → catheterization (no pathologic significance)
Transitional EC
Clumps of transitional cell is called
synctia
increase in abnormal morphology (has vacuoles or irregular nuclei)
malignancy or viral infection
Ex. of RTE Cell
PCT, DCT, CD
(if they appear in groups of 3)
Renal Fragments
Has pathologic significance, indication of tissue destruction necrosis
RTE Cell
size and shape depending on the area of the renal tubules from which they originate
RTE Cell
larger than any RTE cells, rectangular in shape referred to as columnar or convoluted cells
PCT
resembles casts
PCT
can be mistaken as WBC or spherical transitional cell
DCT
smaller, round or oval
DCT
cuboidal and are never round
RTE cell from Collecting duct
Lipid-containing RTE cells
Oval Fat bodies
contains non-lipid filled vacuoles
Bubble cells
associated with Acute Tubular Necrosis
Bubble cells
Squamous EC covered with Gardnerella coccobacillus
Clue Cells
clue cells is indication or microscopic sediment used to diagnosed ___ ___
Bacterial Vaginosis
Not normally present since urinary bladder is sterile
Bacteria
Spherical-shaped
Cocci
Rod shaped
Bacilli
(gram negative) – most frequently associated with UTI
Enterobacteriaceae
Bacteria should be accompanied by WBC
UTI
Small refractile oval structures (may or may not contain bud)
Yeast
yeast that primarily seen in urine of the patient with DM, Vaginal moniliasis, Immunocompromised individual
Candida albicans
most frequent parasite encountered in the urine, sexually transmitted, associated with vaginal inflammation
Trichomonas vaginalis
Resembles WBC if left standing for hours
Trichomonas vaginalis
bladder parasite (ova); bladder cancer
Schistosoma haematobium
Men are often asymptomatic
Trichomonas vaginalis
most common fecal contaminant, D-shape
Enterobius vermicularis
Spermatozoa seen in the urine of male and female
Normal. Do not report in routine urinalysis
Significant Spermatozoa
Male infertility, Retrograde ejaculation
(sperm is expelled into bladder instead of urethra)
Male infertility, Retrograde ejaculation
toxic for sperm
Urine
major constituent of mucus
Uromodulin
Thread-like structures (Low refractive index)
Mucus
usually missed out in microscopic
Mucus
Frequently seen in females (if she didn’t wash prior to collection)
Mucus
Only elements found in urine
Casts
unique to the kidney
Casts
presence of urinary cast
Cylinduria
True geometrically structure or
amorphous materials
Crystals
highly refractile sphere with dimpled center
Starch
appear as spheres with a cell wall and occasional concentric circles
Pollen grains
may resemble casts however fibers polarized while casts do not
Fibers/Hairs
appear as plant and meat fibers or as brown amorphous material
Fecal Contamination
Ex. of Artifacts
- Starch
- Oil droplets
- Air bubbles
- Pollen grains
- Fibers/Hairs
- Fecal Contamination
