Red Blood Cells
●
Specific gravity
Characteristics
●
pH
Appearance:
●
smooth, non-nucleated, biconcave disk
Clinical significance
●
measuring around 7 mm in diameter
●
Ghost cell in hypotonic urine
●
Crenated in hypertonic urine
●
Dysmorphic with glomerular membrane
damage
An increase in urinary WBC is called Pyuria
and it indicates genitourinary system.
●
Bacterial infections, including
pyelonephritis, cystitis, prostatitis, and
urethritis, are frequent causes of pyuria.
●
However, pyuria is also present in
Reporting: Average number per 10 hpfs
nonbacterial disorders, such as
Source of error:
glomerulonephritis, lupus erythematosus,
●
Yeast
●
Oil droplets
●
Air bubbles
Complete urinalysis correlations:
●
Color
●
Reagent strip blood reaction
Clinical Significance
●
●
Squamous Epithelial Cells
Characteristics
Appearance:
●
Largest cell in the sediments
●
abundant , irregular cytoplasm, and
Associated with damage to the glomerular
prominent nuclei
membrane or vascular injury within the
Reporting: Rare, few, moderate, or many per lpf
genitourinary tract
Sources of error: rarely encountered, folded cells
Macroscopic hematuria is present, the
and may resemble casts
urine appears cloudy with a red to brown
Complete urinalysis correlations: Clarity
color. It is frequently associated with
Clinical Significance
advanced glomerular damage but also
●
interstitial nephritis, and tumors.
●
Squamous epithelial cells originate from
seen with damage integrity of the urinary
the linings of the vagina and female
tract, acute infection or inflammation, and
urethra and the lower portion of the male
coagulation disorders.
urethra. They represent normal cellular
Microscopic hematuria is critical to the
sloughing and have no pathologic
early diagnosis of glomerular disorder and
significance. Simply means that sample is
malignancy of the urinary tract and
contaminated.
confirmation of renal calculi.
●
A variation of the squamous epithelial cell
is the clue cell, which does have
White Blood Cells
pathologic significance. Clue cells are
Characteristics
indicative of vaginal infection by the
Appearance:
bacterium Gardnerella vaginalis. They
●
Larger than RBC
appear as squamous epithelial cells
●
Measures an average about 12 mm in
covered with the Gardnerella
diameter
coccobacillus
●
Granulated, multi bilobed neutrophils
●
Glitter cells in hypotonic urine
Transitional Epithelial Cells
●
Mononuclear cells with abundant
Other name: Urothelial
cytoplasm
Characteristics
Reporting: Average number per 10 hpfs
Source of Error : Renal Tubular Epithelial cells
Appearance:
●
Complete urinalysis correlations:
●
Leukocyte esterase
●
Nitrite
Spherical, polyhedral, or caudate with
centrally located nucleus
●
Smaller than squamous cells
Reporting: Rare, few, moderate, or many per hpf
Source of error: spherical forms resembles Renal
hemoglobin and myoglobin toxicity, viral
Tubular cells
infections (hepatitis B), pyelonephritis,
Complete urinalysis correlations:
allergic reactions, malignant infiltrations,
●
Blood, if malignancy associated
salicylate poisoning, and acute allogeneic
Clinical significance:
●
Transitional epithelial cells originate from
transplant rejection
●
the lining of the renal pelvis, calyces,
ureters, and bladder, and from the upper
RTE cells absorb bilirubin present in the
filtrate as the result of liver damage
●
Hemosiderin
portion of the male urethra.
●
●
Increased numbers of transitional cells
Oval Fat Bodies
seen singly, in pairs, or in clumps
Characteristics
(syncytia) are present following invasive
Appearance: Highly refractile Renal Tubular
urologic procedures such as
Epithelial cells
catheterization and are of no clinical
Reporting: Average number per 10 hpf
significance.
Sources of error: Confirm with fat stains and
An increase in abnormal morphology may
polarized microscopy (Sudan III or Oil Red O fat
be an indication of malignancy or viral
stain)
infection.
Complete urinalysis correlations:
●
Clarity
Renal Tubular Epithelial cells
●
Blood
Characteristics
●
Protein
Appearance
●
Free fat droplets/fatty casts
●
May vary in size and shape depending on
the area of renal tubules they originate
●
●
Rectangular, columnar, round, oval or
cuboidal with an eccentric nucleus
●
Other information:
Possibly bilirubin-stained or hemosiderin-
floating fat droplets
Clinical Significance
●
laden
Lipiduria is most frequently associated with
damage to the glomerulus caused by the
Reporting: Average number per 10 hpfs
Source of error:
Usually seen in conjunction with free-
nephrotic syndrome
●
Also seen with severe tubular necrosis,
●
Spherical transitional cells
diabetes mellitus, and in trauma cases
●
Granular casts
that cause release of bone marrow fat
Complete urinalysis correlations:
●
from the long bones.
Leukocyte esterase and nitrite
●
Large fat-laden histiocytes
(pyelonephritis)
●
In acute tubular necrosis, “bubble cells”
●
Color
appear to represent injured cells in which
●
Clarity
the endoplasmic reticulum has dilated
●
Protein
prior to cell death.
●
Bilirubin (hepatitis)
●
Blood
Clinical Significance
●
Most clinically significant of the epithelial
cells
●
●
Bacteria
Characteristics
Appearance:
●
Small spherical and rod-shaped structures
Increase amounts of is indicative of
Reporting: Few, moderate, or many per hpf, the
necrosis, possibly affect overall renal
presence of WBCs may be required
function
Sources of error:
Tubular necrosis include exposure to
●
Amorphous,
heavy metals, drug-induced toxicity,
●
Phosphate
●
Urates
●
Complete urinalysis correlations
The presence of WBCs is an indication of a
true yeast infection.
●
pH
●
Nitirte
Trichomonas vaginalis
●
Leukocyte esterase
Characteristics
●
WBCs
Appearance:Pear-shaped, motile, flagellated with
Other information:
●
●
Not normally present in urine, unless
Reporting: Rare, few, moderate, or many per hpf
specimen are collected under sterile
Source of error: WBCs, Renal Tubular Epithelial
conditions
cells
Few bacteria are usually present as a
Complete urinalysis:
result of vaginal, urethral, external
●
Leukocyte esterase
genitalia, or collection-container
●
WBCs
contamination. No clinical significance
Clinical Significance
●
undulating membrane
Clinical Significance
●
Pingp-pong disease
Presence of bacteria can be indicative of
●
Most common parasite found in urine
either lower or upper Urinary Tract
●
A sexually transmitted pathogen
Infection.
●
The bacteria most frequently associated
associated with vaginal inflammation.
●
Males are often asymptomatic carriers
with UTI are the Enterobacteriaceae
(referred to as gramnegative rods);
Schistosoma haematobium
however, the cocci-shaped
Characteristics:
Staphylococcus and Enterococcus are
Appearance:
also capable of causing UTI.
slightly transparent and possess a delicate
terminal spine
Yeast
ova are elongated and are 60 X 160
Characteristics
microns.
Appearance:
●
Small, oval, refractile structures that may
Clinical Significance
●
or may not contain buds
●
In severe infections, they appear as
rarely be seen in urine sediment.
●
branched, mycelial forms
This parasite is considered an important
factor in the etiology of carcinoma of the
Reporting: Rare, few, moderate, or many per hpf,
the presence of WBCs may be required
Schistosoma haematobium ova may
bladder.
●
Sources of error: Red Blood Cells
Associated with Haematuria (cloudy, red
urine
Complete urinalysis correlations:
●
Glucose
Enterobius vermicularis
●
Leukocyte esterase
Characteristics:
●
WBCs
Appearance:
Clinical Significance
●
-
Yeast cell, primarily Candida albicans , are
seen in the urine of diabetic patients,
one side flattened.
-
immunocompromised patients, and
women with vaginal moniliasis.
●
ova are ovoid in shape and smooth with
Embryos (larvae) may be visible within the
ova.
-
E. vermicularis egg (400X magnification)
The acidic, glucose-containing urine of
with an embryo (larva) visible within the
patients with diabetes provides an ideal
thick hyaline shell.
medium for the growth of yeast.
Other information:
-
Enterobius vermicularis (pinworm) is not a
●
primary urine parasite.
-
rounded ends
E. vermicularis ova (eggs) are usually
●
Cylindroid forms
present in the urine sediment as a fecal
●
Wrinkled or convoluted shapes (indicates
contaminant.
Clinical Significance:
-
consisting of normal parallel sides and
Most common fecal contamination
cast aging)
Reporting: Average number per 10 lpf
Sources of error: Mucus, fibers, hair, increased
lighting
Spermatozoa
Complete urinalysis correlations:
Characteristics
●
Protein
Appearance: Tapered oval head with long,
●
Blood (exercise)
●
Color (exercise)
flagella-like tails
Reporting: Present, based on laboratory protocol
Clinical significance:
Source of error: None
●
Acute Glomerulonephritis
Complete urinalysis correlations: Protein
●
Pyelonephritis
Other informations:
●
Chronic renal disease
●
Easily identified in the urine sediment
●
Congestive heart failure
●
Occasionally found in urine of both men
●
Stress and exercise
and women following sexual intercourse,
masturbation or nuctornal emission
Clinical significance
●
Rarely of clinical significance except in
RBC Cast
Characteristics
Appearance:
cases of male infertility or retrograde
●
Orange-red color
ejaculation in which sperm is expelled into
●
More fragile than under cast
the bladder instead of the urethra
●
May exist as fragments or have more
irregular shape as the result of tightly
Mucus
packed red cells adhering to the protein
Characteristics
matrix
Appearance: Single or clumped threads with a low
Reporting: Average number per 10 lpf
refractive index
Source of error: RBC Clumps
Reporting: Rare, few, moderate, or many per lpf
Complete urinalysis correlations:
Source of error: Hyaline casts
●
RBCs
Complete urinalysis correlations: None
●
Blood
Other informations:
●
Protein
●
Protein material produced by glands and
Clinical Significance
epithelial cells of the lower genitourinary
●
Glomerulonephritis
tract and the RTE cells.
●
Glomerular damage usually associated
Clinical significance
●
with proteinuria and dysmorphic
No clinical significance when present in
either female or male urine.
erythrocytes
●
Strenuous exercise
Hyaline Cast
WBC Cast
Characteristics
Characteristics
Appearance:
Appearance:Cast matrix containing WBCs
●
Colorless, homogeneous matrix
Morphology:
●
Varied
Reporting:Average number per 10 lpf
Source of error: WBC Clumps
Complete urinalysis correlations:
●
WBCs
●
Protein
●
Leukocyte esterase
Clinical Significance
●
●
Highly refractile under bright-field
microscopy
Reporting: Average number per 10 lpf
Appearance of WBC cast in the urine
Source of error: Fecal debris
signifies infection or inflammation within
Complete urinalysis correlations:
the nephron
●
Protein
●
Pyelonephritis
●
Free fat droplets
●
Present in non-bacterial inflammation like
●
Oval fat bodies
Acute interstitial nephritis
●
Primary marker to distinguish
Other information:
●
pyelonephritis (upper UTI) from cystitis
microscopy and Sudal III or Oil Red O fat
(lower UTI)
●
May accompany RBC cast in
glomerulonephritis
Confirmation is performed using polarized
stains
Clinical Significance
●
Nephrotic syndrome
●
Toxic tubular necrosis
Bacterial Cast
●
Diabetes mellitus
Characteristics
●
Crush injuries
Appearance:Bacilli bound to protein matrix
Reporting: Average number per 10 lpf
Granular cast
Source of error: Granular cast
Characteristics
Complete urinalysis correlations:
Appearance: Coarse and fine granules in a cast
●
WBC casts (pyelonephritis)
matrix
●
WBCs
Reporting:Average number per 10 lpf
●
Leukocyte esterase
Source of error:
●
Nitrite
●
Clumps of small crystals
●
Protein
●
Columnar RTE cells
●
Bacteria
Other information:
●
Complete urinalysis correlations:
●
Protein
Bacterial cast is best made by performing
●
Cellular casts
Gram stain on the dried or cytocentrifuge
●
RBCs
sediment
●
WBCs
Clinical Significance: Pyelonephritis
Clinical Significance
●
Glomerulonephritis
Epithelial cell cast
●
Pyelonephritis
Characteristics
●
Stress and exercise
Appearance: RTE cells attached to protein matrix
Reporting:Average number per lpf
Waxy cast
Source of error: WBC cast
Characteristics
Complete urinalysis correlations:
Appearance:
●
Protein
●
RTE cells
Clinical Significance: Renal Tubular damage
●
Highly refractile cast with jagged ends and
notches
●
More easily visualized than hyaline cast
●
With supravital stains, waxy casts stain a
Fatty Cast
homogeneous, dark pink
Characteristics
Reporting: Average number per 10 lpf
Appearance:
Source of error: Fibers and fecal material
●
Fat droplets and oval fat bodies attached
to protein matrix
Complete urinalysis correlations:
●
Protein
●
Cellular casts
●
Granular casts
●
WBCs
●
RBCs
Clinical Significance
●
Stasis of urine flow
●
Chronic renal failure
Broad Cast
Often referred to RENAL FAILURE CAST
Characteristics
Appearance:Wider than normal cast matrix
Reporting: Average number per 10 lpf
Source of error: Fecal materials, fibers
Complete urinalysis correlations:
●
Protein
●
WBCs
●
RBCs
●
Granular casts
●
Waxy casts
Clinical Significance
●
Extreme urine stasis
●
Renal failure