CLINICAL PATHOLOGY LABORATORY 6 – Urinalysis and Fecalysis
USTMED ’07 Sec C – AsM
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URINARY SEDIMENTS 1. Cells cells present in urinary sediment include WBCs, RBCs and epithelial cells. These cells can be anywhere in the urinary tract from the tubules to the urethra. Type Description Normal Clinical Values implications Red blood Uniform colorless 0-3/hpf Can originate from cells smooth any part of the biconcave disks urinary tract 7um Glomerulonephritis Trauma Systemic and renal diseases White blood cells
Spherical with dull gray color. Tend to be neutrophils. 10-12 um
0-5/hpf (M) 0-8/hpf (F)
Acute infection of kidney (pyelonephritis) Cystitis (bladder) Urethritis (urethra) Urinary tract infections
Squamous epithelial
Large, flat, irreg shaped cells that contain small central nucleus Abundant cytoplasm Cell size:23-40um Slightly larger than WBC with round central nucleus Cell size: 20 um
Few
Occur in urethra and vagina Vaginal contamination
Occasional
Transitional epithelial
Can be round or pear shaped with tail like projections
Rare
Oval fat bodies
Renal epithelial cells with lipid that are highly refractive, coarse droplets in various sizes
Negative
Originate in convoluted and collecting tubules Increased numbers indicate tubular injury and damage to epithelial BM Line urinary tract from urinary pelvis to upper portion of urethra Increased amounts indicate disease of bladder or renal pelvis Result from tubular epithelial degeneration of nephron Are associated with large amounts of protein Nephrotic syndrome
Renal epithelia
2. Casts Casts are cylindric structures formed primarily within the lumen of the distal convoluted tubule and collecting duct. The major constituent of casts is Tamm-Horsfall protein, a glycoprotein excreted by the renal tubular cells. Type Description N. Values Clinical Implications Hyaline Colorless, 0-2/lpf Can indicate mild to homogenous, severe renal disease semi-transparent when increased in numbers Can be found in healthy individuals after heavy exercise Red blood cell cast
RBCs in hyaline matrix. Extremely fragile, degenerate to granular casts
Negative
Intrinsic renal disease Acute glomerulonephritis Acute interstitial nephritis Severe nephritis
White blood cell cast
WBCs in hyaline matrix Usually neutrophils
Negative
Renal Inflammation Renal infection Pyelonephritis Chronic renal disease Acute glomerulonephritis
Renal tubular epithelial cell
Renal Tubular epithelial cells in hyaline matrix
Negative
Interstitial tubular disease Vascular disease Toxins Glomerulonephritis
Granular Cast
Waxy
Cylindroid
May be coarsely or finely granular Disintegration of cellular casts or from tubule lysosomes or protein aggregates Homogenous with well defined edges that are sharp and have blunt irregular ends Cracks on lateral edges Resemble casts but have one end that tapers to a tail
Nonpathologic (seen with Hyalin casts) – after strenuous exercise in stress Pathologic – Glomerulonephritis Pyelonephritis Negative
0-2/hpf
Tubular obstruction with prolonged stasis Called renal failure casts Severe chronic renal failure Malignant hypertension Acute renal disease Diabetes mellitus Found in conjunction with casts and have same significance
Fatty casts
Associated with oval fat bodies and urinary lipids Highly refractile, contain yellowbrown fat droplets
Negative
Seen in disorders causing lipiduria (nephritic syndrome)
Mucous threads
Long thin waxy threads, very transparent
Occasiona l
Can be found in small number in normal urine Increased numbers indicate inflammation or irritation of the urinary tract
3. Microorganisms and Parasites Type Description
Normal Values Free of bacteria in kidney and bladder
Significance
Bacteria
Color: colorless Shape: Rods or cocci may be found single or in chains
Yeast
Color: colorless cells Shape: ovoid smooth cells with doubly refractile walls Often show budding and pseudohyphae Sometimes mistaken for RBCs Oval heads with long thin tails
Negative
Can be found in both male and female urine
Male: nocturnal emission, ejaculation and disease of the genital organs Female: after coitus
Turnip shaped flagellates with three anterior flagella and one anterior flagellum Confused with WBCs Needs to be mobile for identification Ova have one flat and one round side with transparent shell. Developing larvae can be seen
Negative
Transmitted sexually, frequently infection of vagina and vulva in females In males, the organisms infects urethra
Negative
Usually found in children and in fecal contamination Female worm lays her eggs in perirectal region, and during collection they can be carried into urine specimen
Spermatozoa
Trichomonas vaginalis
Enterobius Vermicularis
Can be contamination from external sources Rapidly multiply in improper stored specimen With increased WBCs, indicative of urinary tract infection Found in urinary tract infections, especially from diabetic parents Immunosuppressed patient Skin or vaginal infection
Schistosoma Hematobium
Ovium measures 50150 um Clear and colorless with characteristic terminal spine
Negative
Inhibits veins in urinary bladder Endemic in Africa, Nile Valley and Middle East
4. Crystals Crystals are frequently found in the urine. They are formed by the precipitation of urine salts subjected o changes in pH, temperature or concentration, which affect their solubility. Crystals are identified by their appearance, solubility and pH. Type Description pH Solubility Significance Uric acid Color: yellow-brown Acid AlkaliAssociated with renal Shape: different soluble, stones, gout, high shapes, most sodium purine metabolism, common are hydroxide acute febrile diamond, rhombic conditions, chronic plates in clusters, nephritis lemon shape Calcium oxalate
Colorless Envelope with intersecting diagonal lines Birefringent
Acid/ Neutral
HClsoluble Acetic acid insoluble
Hippuric acid
Color: yellow-brown to colorless Shape: elongated prisms/plates with pyramidal ends
Acid/ Neutral
Soluble in water, alkali Insoluble in acetic acid
Sodium urate
Color: yellow to colorless Shape: needle or slender prisms in sheaves or clusters
Acid
Soluble at 60oC
Report as urate crystals No clinical significance
Color: brick-dust, yellow brown Shape: small granular pink precipitation at refrigeration Salts of Na,Ca,K,Mg Triple Colorless Phosphate Shape: three to six (ammoniumsided prisms magnesium described as phosphate) coffin-lid shaped
Acid/ Neutral
Soluble at 60oC and alkali Acetic acidinsoluble
No clinical significance
Alkaline
Soluble in dilute acetic acid
Associated with renal calculi, chronic pyelitis, enlarged prostate, urinary tract infection Found in normal urine
Amorphous phosphates
Colorless Shape: granular patches with no definite shape
Alkaline
Soluble in acetic acid Insoluble at 60oC
No clinical significance
Calcium carbonate
Colorless Shape: small dumbbells or spherical forms; can be found in granular masses or in pairs
Alkaline
Soluble in acetic acid
No clinical significance
Calcium Phosphate
Colorless Shape: long, thin prisms with one pointed and arranged as rosettes or clusters of needles Thin irregular plates that float on surface of urine
Alkaline
Soluble in acetic acid
Associated with renal calculi Can be found in normal urine
Amorphous urates
Neutral
Can be found in normal individuals after ingestion of oxalate rich food and large doses of vitamin C Associated with renal stones, diabetes mellitus, liver disease and chronic renal disease Associated with diets high in fruits and vegetables containing large quantities of benzoic acid
Ammonium Biurate
Color: yellow to brown Shape: Spherical bodies with long irregular spicules
Abnormal Crystals Cystine Colorless and refractile Shape: hexagonal with equal and unequal sides Appear single or in clusters Leucine Color: yellow to brown Shape: spheroids with radial concentric striations Highly refractile with oil-like appearance Tyrosine Color: black or yellow with presence of bilirubin Shape: highly refractile needles occurring in sheaves or clusters Cholesterol Color: transparent Shape: regular to irregular flat plates with one corner notched out, may be single or in larger #s Most often found after refrigeration Bilirubin Color: yellow to brown to reddish Shape: Granules or clusters
Sulfa
Ampicillin
Color: brown to yellow Shape: needle-like shapes seen in bundles or sheaves Stacks of wheat Colorless Shape: elongated long thin needles
Alkaline/ Neutral
Soluble in acetic acid and warming
Usually indicates old urine
Acid
Soluble in HCl, alkali, and ammonia
Amino acid crystal, inherited as a metabolic defect that prevents reabsorption of cystine
Acid
Soluble in hot acetic acid, hot alcohol and alkali
Maple syrup disease Severe liver disease
Acid
Soluble in HCl, NH4OH, dilute mineral oil
Severe liver disease and tyrosinosis
Acid/ Neutral
Soluble in chlorofor m, ether, hot alcohol Insoluble in alcohol
Excessive tissue breakdown Seen in nephritis and nephritic syndrome Lipiduria, lipidemia and lymphatic obstruction due to neoplasms
acid
Soluble in chlorofor m, acetone, acid and alkali
Obstructive jaundice Bilirubin must be present in urine
acid
Soluble in acetone
Most sulfonamide drugs are more soluble than older types
acid
Administration of large parenteral doses
Radiographic Color: hypaque media (opaque?), appear dark and thick Shape: pleomorphic needles, single or sheaves
acid
Soluble in 10% NaOH
Intravenous injection for radiography Can appear up to 3 days after injection
Hemosiderin Color: yellow to brown to red Shape: heavy large granules Prussian blue stain for iron
Acid/ alkaline
Insoluble granules
Associated with anemia and destruction of RBC
Demo Slides Pus Cells
Granular Cast
Hylaline Cast
RBCs
Squamous Cells
Uric Acid crystal
Yeast Cells
