URINARY SEDIMENTS

Organized Sediments Unorganized Sediments

Epithelial Cells Squamous cells Normal Crystals Uric acid
Transitional cells Amorphous urates
Renal tubular cells Calcium sulfate
Oval fat bodies Sodium urates
Miscellaneous Structures Bacteria Acid urates
Yeast Calcium oxalates
Parasites Amorphous phosphates
Mucus threads Triple phosphates
Spermatozoa Ammonium biurate
Calcium carbonate
Formed Elements Pus Abnormal crystals Cystine
Glitter cells Cholesterol
Leukocytes Leucine
RBCs Tyrosine
Urinary Casts Cellular Casts Bilirubin
Acellular Casts

I. ORGANIZED SEDIMENTS  number exhibiting abnormal morphology such as vacuoles

A. EPITHELIAL CELLS and irregular nuclei may be indicative of malignancy or viral
a. SQUAMOUS EPITHELIAL CELLS infection
 Largest cells in the sediment  Correlation: Clarity; Blood if malignancy associated
 Thin, flat cells, w/ angular border, anuclear or small central
nucleus, present as single cells c. RENAL TUBULAR EPITHELIAL CELLS
 Correlation: represent contamination  Most clinically significant
 Clue cells:  Originate from the nephrons
o Indicative of vaginal infection: Gardnerella vaginalis  >2RTE cells/hpf indicates tubular injury
o SEC studded with lots of bacteria
d. OVAL FAT BODIES
b. TRANSITIONAL EPITHELIAL CELLS  Thought to be RTE cells laden with highly refractile fat droplets
 “Urothelial cells”  Many of the fat droplets are birefringent and anisotrophic and
 From renal pelvis, ureters, urinary bladder, and urethra with polarized light will give the distinctive “Maltese Cross
 Variable size and shape: round or polygonal, pear-shaped, pattern”
caudate, tailed, spindle, may develop refractile, fatty inclusions  Correlation: Extensive tubular degeneration and nephrotic
with storage syndrome
 Present following invasive urologic procedures(catheterization)
and are of no clinical significance
B. MISCELLANEOUS STRUCTURES  Anucleated granular cytoplasm
a. BACTERIA  Clin. Significance: UTI, Kidney stones
 Can be identified in unstained urine sediments when present in
sufficient numbers by their characteristic rod shapes b. GLITTER CELLS
 Mistaken as amorphous urates/phosphates  Urine SG <1.019: demonstrate Brownian movement of its
 Correlation: infection or contamination granules w/c will give a glittering cytoplasm
 WBCs in hypotonic urine
b. YEAST
 Small, oval, refractile with buds and mycelia, colorless c. LEUKOCYTE
 In singles, chains, or budding  Normal value: 5WBC/hpf
 Often found in patients with DM  Spherical, nucleated, granular cytoplasm
 Should be distinguished from RBCs  Clin. Significance: Pyelonephritis, bladder infections, UTI
 Primary yeast: Candida albicans o Neutrophil: most predominant type
 A true yeast infection should be accompanied: WBCs o Eosinophils: assoc. w/ drug-induced interstitial nephritis
c. PARASITES o Lymphocytes:  in early stages of transplant rejection
 Most common: Trichomonas vaginalis  WBCs vs. RTE cells
o Pear-shaped, motile and flagellated o RTE cells are usually larger than WBCs and more
o Come from genital secretions contaminating the polyhedral in shape, w/ an eccentrically located nucleus
specimen
o Clinical significance: Trichomoniasis d. RED BLOOD CELLS
 Schistosoma haematobium: large terminal spine  Normal value: 0-2/hpf
 Enterobius vermicularis eggs: fecal contaminants  May appear normally shaped, swollen by diluted urine or
crenated by concentrated urine
d. MUCUS THREADS  Both swollen, partly hemolyzed RBCs and crenated RBCs are
 Single or clumped threads with low refractive index sometimes difficult to distinguish from WBCs
 May be confused with hyaline casts or cylindroids  Ghost cells – RBCs in hypotonic urine
 Clinical significance: Urinary tract infection or irritation of the  Dysmorphic forms of RBCs: patients w/glomerular bleeding
urinary tract :large amounts of mucus in urine  Clin.Significance: Kidney trauma, UT stones, glomerulonephritis

e. SPERMATOZOA D. URINARY CASTS

 Not reported in routine UA  The only sediment that is unique to the kidneys
 Found in urine: sexual intercourse or emission  Made up of Tamm-Horsfall protein produced by RTE cells
 Rarely considered as clin. Significant except in cases of
infertility or retrograde ejaculation a. CELLULAR CASTS
a.1. RBC CASTS
C. FORMED ELEMENTS  Yellowish brown color
a. PUS CELLS  Generally cylindrical w/ sometimes ragged edges
 Formed of degenerated neutrophils (pyocytes) and cellular  Presence of RBCs w/in the cast is always pathological
debris compacted into a mass where cell identity is lost  Clin. Significance: glomerular damage, renal infarction and
 Spherical, slightly smaller than leukocyte subacute bacterial endocarditis
 a.2. WBC CASTS  Clin. Significance: Chronic renal disease,
 WBCs w/in a cast glomerulonephritis, stress and exercise
 WBCs sometimes can be difficult to discern from epithelial
cells b.3. WAXY CASTS
 Clin. Significance: indicative of inflammation or infection,  Highly refractile w/ jagged ends and notches
the presence of WBCs w/in or upon cast strongly suggest  Represent the end product of cast evolution
pyelonephritis  Clin. Significance: urine stasis and chronic renal failure

a.3. BACTERIAL CASTS b.4. FATTY CASTS

 Bacilli bound to protein matrix  Fat droplets and oval fat bodies inside matrix
 Due to infection-fighting efficiency of neutrophils  Formed by the breakdown of lipid-rich epithelial cells
 Mistaken as fine granular cast  Hyaline casts w/ fat globule inclusions
 Clinical significance: pyelonephritis  Yellowish-tan in color
 Clin. Significance: Nephrotic syndrome, toxic tubular
a.4 EPITHELIAL CASTS necrosis and DM
 Formed by inclusion or adhesion of desquamated EC of the
tubule lining b.5. BROAD CASTS
 Cells can adhere in random order or in sheets and are  “renal failure cast”
distinguished by large, round nuclei, and a lower amount  Formed in the collecting ducts as the result of urinary stasis
of cytoplasm  2 to 6 times the size of other type of casts
 Clin. Significance: renal tubular damage, acute tubular  Clin. Significance: Extreme urine stasis and renal failure
necrosis, and toxin ingestion.
II. UNORGANIZED SEDIMENTS
b. ACELLULAR CASTS
b.1. HYALINE CASTS  CRYSTALS:
 Normal value: 0-2/lpf o Formed by the precipitation of urine solutes including inorganic
 Most common type salts, organic compounds, and medications
 Colorless, homogenous matrix, nonrefractive o pH of the specimen: valuable aid in the identification of crystals
 Formed in the absence of cells in the tubular lumen,
hyaline casts are solidified Tamm-Horsfall mucoprotein A. NORMAL CRYSTALS
secreted from the RTE cells of individual nephrons
 Clin. Significance: may be seen in normal individuals in a. URIC ACID
dehydrated state or vigorous exercise  pH lower than 5.5
 yellow brown, may be colorless, highly birefringent under
b.2. GRANULAR CASTS polarized light
 Coarse and fine granules inside matrix  Clin. Significance:  in fresh specimen assoc. w/ leukemic
 2nd most common type of cast patients and  levels of purine and nucleic acid
 Can result either from:
o Breakdown of cellular casts
o Inclusion of aggregates of plasma proteins
b. AMORPHOUS URATES g. AMORPHOUS PHOSPHATES
 Brick dust or yellow brown granules  White or colorless granule
 Has pink color due to uroerythrin attaching on the surface of  If refrigerated: produces white precipitates
granules  Granular precipitate containing calcium and phosphate in an
 Found in acidic urine (pH 5.5) alkaline urine

c. CALCIUM SULFATE h. TRIPLE PHOSPHATE

 “cigarette butt” colorless long prism w/ beveled ends  Colorless “coffin lid” w/c when disintegrated forms feathery
 Rarely seen appearance
 Identical in appearance to an alkaline crystal – calcium  Birefringent under polarized light
phosphate in its prism form  Assoc. w/ urea-splitting bacteria and chronic urinary
 No significance inflammation

d. SODIUM URATE i. AMMONIUM BIURATE

 Rarely encountered  “thorny apple” appearance
 Blunt ended needle-like or slender prisms occurring in sheaves  Large, amber, rounded crystals w/ pointed protuberances
or clusters (peacock tail) along their surface
 Colorless or yellowish  Assoc. w/ urea splitting bacteria
 No significance
j. CALCIUM CARBONATE
e. ACID URATES  Birefringent colorless dumbbells or spherical
 Brown larger granules, may have spicules similar to amorphous  Usually found in alkaline urine
biurates
 No significance B. ABNORMAL CRYSTALS
a. CYSTINE
f. CALCIUM OXALATES  Colorless, refractile, hexagonal plates, may be thick or thin
 Major component of renal calculi/renal stones  Disintegrating forms: presence of NH3
 Clin. Significance: calculi formation and ethylene glycol  Clin. Significance: congenital cystinosis or cystinuria and renal
poisoning calculi
 2 forms:
o Calcium oxalate dihydrate b. CHOLESTEROL
- Found in acidic or neutral urine  Large, flat, transparent
- Colorless envelope or two-pyramid shaped  Notched corners
- Most common  Highly birefrigent
- Soluble in dilute HCl  Clin. Significance: lipiduria and nephrotic syndrome
o Calcium oxalate monohydrate
- Found in acidic or neutral urine
- Oval or dumbbell-shaped
- Found in patients w/ ethylene glycol poisoning
c. LEUCINE  In sheaves/clusters (rosette formation)
 Oily, highly refractile, yellow or brown spheroids and  Clin. Significance: severe liver disease and tyrosinosis
concentric striations
 Clin. Significance: maple syrup urine disease and severe liver e. BILIRUBIN
disease  Yellowish brown in the shape of small needle-like crystals
 Often are phagocytized by WBCs
d. TYROSINE  Clin. Significance: hepatic d/o
 Very fine, highly refractile needles
 Black, yellow