COMPONENTS OF THE URINALYSIS

Physical properties - color - clarity - specific gravity - pH - glucose - protein - blood - bilirubin - urobilinogen - ketones - nitrite - leukocyte esterase - crystals - microrganisms

Chemical composition

Microscopic examination - cells - casts - debris

Abnormalities

Casts
Indication Hardened cell fragments Formation Hyaline casts Red blood cell casts White blood cell casts Granular or waxy casts Broad waxy casts

Abnormalities

Casts
Red blood cell cast

Hyaline cast

Granular cast

White blood cell cast

Waxy cast

MICROSCOPIC ANALYSIS: URINE SEDIMENT

Cells (including tumor cells) Casts Lipids

Crystals Microorganisms Contaminants

40

Cells
WBC RBC Renal tubular cell Transitional cell Squamous cell

RED BLOOD CELLS

RBC in Urine :

Red Blood Cells

Monomorphic

Dysmorphic

Dysmorphic Red Blood Cells

Dysmorphic Red Blood Cells

WHITE BLOOD CELLS

WHITE BLOOD CELLS

WBC in Urine :

White Blood Cells

White bood cells are sometimes called glitter cells because of the Brownian motion of the neutrophilic particles

Urinary Sediment (3)

WBC Cells and WBC Casts
Acute interstitial nephritis Acute pyelonephritis

Squamous cells

WBC Squamous cell

RBC

Urine Microscopy :
Cells Casts Crystals. Casts are formed within nephron. Casts Suggest Kidney pathology. Casts can be made up of Protein, lipid, cells or mixed. Crystals suggest high concentration or altered solubility.

Formation of Casts:

PCT

DCT

Glomerulus

Collecting Duct CAST

Loop of Henle

Urinary casts are formed only in the DCT or the collecting duct (distal nephron).

CASTS
Cellular

Comment RBC glomerulonephritis pyelonephritis WBC Renal tubular tubular injury / disease
Protein Degenerated cells

Acellular

RED BLOOD CELL CAST

Red blood cells may stick together and form red blood cell casts. Such casts are indicative of glomerulonephritis, with leakage of RBC's from glomeruli, or severe tubular damage.

Red Blood Cell Cast

Two examples of red blood cell casts, typical of glomerular bleeding.

WHITE BLOOD CELL CAST

Acute pyelonephritis
White blood cell casts are most typical for acute pyelonephritis, but they may also be present with glomerulonephritis. Their presence indicates inflammation of the kidney, because such casts will not form except in the kidney.

WBC Cast Urine:

RENAL TUBULAR CELL CAST

Tubular injury

White Blood Cell Cast

Note the clear cell outlines and granular cytoplasm

Epithelial Casts in Urine:

Urinary Sediment
RTE cells, RTE cell casts, pigmented granular (muddy brown) casts
Acute tubular necrosis

If the urine demonstrates pigmented granular (muddy-brown) casts and/or renal tubular epithelial (RTE) cells in large numbers or in casts, acute tubular necrosis should be strongly considered.

Renal Tubular Epithelial Cell Cast

Pigmented Granular Casts

Pigmented granular (muddy brown) casts are characteristic of acute tubular necrosis. Although the exact pathogenesis of cast formation is not known, the major component is Tamm-Horsfall glycoprotein, a strongly anionic macromolecule secreted by the ascending thick limb of Henle. Hyaline and waxy casts are also prominent in this particular urinary sediment

Granular Cast:

Granular Casts in Urine:

AMORPHOUS URATE CRYSTALS*

* CAN FORM UPON COOLING & STANDING OF URINE

Can be found normally in acid urine

Amorphous phosphates is the name given to a granular

precipitate containing calcium and phosphate in an alkaline urine.

Urine Oxalate Crystals:

Bacteriuria

Mixed Cast Urine: