Urinalysis
MJ del Barrio
Components of Urinalysis
Physical Examination
Chemical Examination
Microscopic Examination
Microscopic
Examination
Urine microscopy is important in detecting and
evaluating renal and urinary tract disorders
Microscopy was traditionally performed after physical
and chemical examination
Today, many laboratories perform urine microscopy if
the initial exams indicates the need for one.
Microscopy can be done either with bright field
microscopy or phase contrast
Casts
They are cylindrical bodies formed in DCT or CD
The cast matrix is composed of Tamm-Horsfall
Protein
Cast are usually indicative of Renal Disease
Normal individuals w/o Renal Disease may secrete
cast in some cases
Factors Promoting Casts Formation
Increased amounts of Plasma CHON
Decreased pH
Decreased Urinary Flow
Increased Urine Concentration
Hyaline Cast
The type most
commonly found in
normal urine
Strenous exercise, Fever
and Diurectic Therapy
CHF
Maybe seen together
with other casts in Renal
Disease
Cellular Casts
Consists of THP containing cellular elements in its
matrix
They originate from the DT
The presence of Cellular casts is ALWAYS
ABNORMAL.
White Blood Cell Casts
WBC casts/Leukocyte
Cast/Pus Cast
Found in Patients with
Inflammation/Infection
of the Nephron
Red Blood Cell Casts
Casts that contain RBCs
Indicates bleeding of the
nephrons
RBC within the casts are
rapidly lysed and then
cast become
Haemoglobin casts
Renal Tubular Epithelial Cell Casts
Epithelial cell casts
appear as clear cylinders
containing renal
epithelial cells
Tubular Damage
Difficult to distinguish
with WBC casts
Granular Casts
Cast with coarse or fine granules
Believed to be the product of cellular casts
degradation
Granular Cast
Coarse Granular Cast Fine Granular Casts
Waxy Casts
Waxy casts appear as
cylinders of smooth,
highly refractive material
yellow, homogeneous
and their ends may be
square or broken off
Final stage of cellular
cast degeneration
CRF, Transplant
Rejection
Broad Casts
“Renal Failure Casts”
Formed in the collecting
ducts as a result of renal
stasis
2x-6x bigger than other
casts
Fatty Casts
Clear cylinders with fat
droplets
Originate from the
breakdown of the
tubular epithelium
containing oval fat
bodies
Degenerative tubular
disease
Cylindroids
Formed in DCT
With tapered end
Same clinical
significance as casts
Frequently Hyaline
Cell Types in Urine
Epithelial Cells
White Blood Cells
Red Blood Cells
Yeast Cell
Bacteria
Epithelial Cells
Squamous Epithelial
Renal Tubular
Transitional Epithelial
Squamous Epithelial
Largest cells
Quadrangular/polygonal
shaped with small
central nucleus
Urethra and Vagina
Increase amounts
means urine not properly
collected
Renal Tubular Cells
Are round to oval cells
with eccentric nucleus
Tubular Damage , Viral
Infxns, Nephrotoxic
Drugs
Transitional Epithelial Cells
Shape and Nuclear
Location may vary
Urothelial Cells
Bladder/Ureter/Renal
Pelvis
Urolithiasis, Bladder CA,
Hydronephrosis, after
placements of bladder
catheters
Red Blood Cells
Round non-nucleated
cells with a central
pallor
Glomerular membrane
damage, Vascular injury
of the Urinary Tract,
Menstruation
Glomerular vs Non-Glomerular
Dysmorphic RBCs Non-Dysmorphic
Crenated RBC
Concentrated acid urine
Jagged cell wall which
are equally distributed
and blunt
Ghost Cell
Dilute alkaline urine
Dim or poorly defined
cell wall that appears
empty
Yeast Cells
Are unicellular organism
that reproduce by
budding
Candida albicans are the
most commonly found
species
Vaginitis, DM,
Catheters, Antibiotic Tx,
Immunosuppresion
Bacteria
Maybe rods or cocci
UTI, Prolonged standing
Nitrite
Crystals
ID of crystal needs knowledge of the Urine pH
Crystal can precipitate in the urinary system or after
voiding due changes in temperature or prolonged
standing
Phase Contrast is better than BF
Polarizing microscope can be used
Solubilty Properties of crystals are helpful in doubful
cases.
Crystals in Normal Acid Urine
Uric Acid
Amorphous Urate
Calcium Oxalate
Uric Acid
pH < 6
Amber coloured and comes in a wide variety of shapes
and sizes (rhombic, barrel, rosettes, needles, etc
Polychromatic under polarized light
Dissolve by heating or by adding alkali
Insoluble in Alcohol, HCl, Acetic Acid
Increased in Uric Acid Nephropathy, Chemotheraphy,
Leukemia
Uric Acid
Amorphous urates
Amorphous urates are
tiny granules than can
be found singly or in
aggregates
Morphologically
identical to Phosphates
They polarize
Solubility same with UA
Calcium Oxalate
Octahedral
Most common cause of
renal stones
Soluble in HNO3,
NaOH, HCl but
insoluble with Acetic
Acid
Crystals in Alkaline Urine
Triple Phosphate
Amorphous Phosphate
Calcium Carbonate
Ammonium Biurate
Triple Phosphate
Ammonium Magnesium
Phosphate
“ Coffin Lid” appearance
UTI Caused by urea
splitting organisms
Bladder stasis
Soluble with HCl, Acetic
Acid but insoluble with
NaOH and heat
Amorphous Phosphate
Granular ppt of of
calcium and phosphate
Can be mistaken
sometimes as bacteria
Soluble in HCl and
Acetic but not in NaOH
and heat
Vegetarians/ Diet rich in
Phosphates
Calcium Carbonate
Dumbell
shaped/spheres
Difficult to distinguish
with amorphous PO4
but same significance
Ammonium Biurate
Thorny apple
Old specimens
Solublein NaOH + NH3,
HCl, Acetic, Heat
Other Crystals
Cystine
Hexagonal crystal
Urine ph must be
lowered to 4.0 and
stored at 4 C
Cystinuria
Leucine
spheres with concentric
striations
Liver Failure
Tyrosine
They appear as thin
needles often aggregated
in bundles or rosettes
Liver failure
Other Stuff in Urines
Trichomonas Vaginalis Schistosoma haematobium
Entorobius Vermicularis Spermatozoa
Mucus Threads Air Bubbles
Starch Granules Fibers
Thank you!
Reference
http://www.comprehensive-kidney-facts.com/kidney-anatomy.html
Fogazzi, et al, The Urinary Sediment 2 nd Edition
Moore. Clinically Oriented Anatomy 3rd Ed
www.biologycorner.com
www.medialabinc.net
www.agora.crosemont.qc.ca
http://missinglink.ucsf.edu
www.irvingcrowley.com
www.wikipedia.com
