Week 9: Urinary Sediments

Formed elements: epithelia, red cells, white

cells
Crystals
Mucus
Renal casts
Microorganisms
Sternheimer-Malbin stain

Microscopic UA
Correlate with cloudiness and other findings
Quality control

Consistent volume
Centrifugation
Well mixed fresh specimen
Microscopy (wet mount, use low light)
Sternheimer-Malbin stain

Epithelia
Squamous epithelia
Large flat cell with central oval nucleus
Transitional (bladder) epithelia
Spindle shaped with large oval nucleus
Maybe in sheet
Renal tubular epithelia
Small cell with large oval nucleus
Most clinically significant

SquamousEpithelia

TransitionalEpithelia

RenalTubularEpithelia

Leukocytes
Pus, or pyuria
May indicate urinary tract infection UTI if
more than 10/HPF
Glitter cells in dilute alkaline urine

Pyuria

Bacteriuria

Erythrocytes
Hematuria may indicate renal damage
Menstrual contamination
May be crenated or ghost cells

Hematuria

Renal Casts
Cylindruria

Renal stasis
Acidic pH
Proteinuria
Concentrated urine

Tamm-Horsfall mucoprotein matrix

Renal Casts
Hyaline
Least significant
Not refractile

Coarse and fine granular

Cellular
Classified by cells in the cast

Waxy
End stage renal disease

HyalineCast

Howmanycastsdoyousee?

FineGranularCasts

CoarseGranularCast

RBCCasts

WBCCasts

EpithelialCasts

FattyCast

BroadCast

WaxyCasts

Mucus
Usually of no clinical significance

Common Crystals in Acid pH

Amorphous urate
Orange powder
May clear with warming or saline
Uric acid
Brown lemon shaped or star shaped
Birefringent with polarized light
Calcium oxalate
Envelope

AmorphousUrate

UricAcid

UricAcid
Polarized

CalciumOxalate

Common Crystals in Alkaline pH

Amorphous phosphate
White powder
May clear with saline

Triple phosphate
Coffin lid

Ammonium biurate
Thorn apple

Calcium carbonate
Effervesce with SSA

AmorphousPhosphate

TriplePhosphate

AmmoniumBiurate

CalciumCarbonate

QualityControlandQualityAssurance