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 Spherical with 0-5/hpf (M) Acute infection of
blood cells dull gray color. 0-8/hpf (F) kidney
Tend to be (pyelonephritis)
neutrophils. Cystitis (bladder)
10-12 um Urethritis (urethra)
Urinary tract
infections
Squamous Large, flat, irreg Few Occur in urethra and
epithelial shaped cells vagina
that contain Vaginal
small central contamination
nucleus
Abundant
cytoplasm
Cell size:23-40um
Renal Slightly larger Occasional Originate in
epithelia than WBC with convoluted and
round central collecting tubules
nucleus Increased numbers
Cell size: 20 um indicate tubular
injury and
damage to
epithelial BM
Transitional Can be round or Rare Line urinary tract
epithelial pear shaped from urinary
with tail like pelvis to upper
projections portion of urethra
Increased amounts
indicate disease
of bladder or
renal pelvis
Oval fat Renal epithelial Negative Result from tubular
bodies cells with lipid epithelial
that are highly degeneration of
refractive, nephron
coarse Are associated with
droplets in large amounts of
various sizes protein
Nephrotic syndrome

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 RBCs in hyaline Negative Intrinsic renal disease

cell cast matrix. Acute glomerulonephritis
Extremely fragile, Acute interstitial
degenerate to nephritis
granular casts Severe nephritis

White blood WBCs in hyaline Negative Renal Inflammation

cell cast matrix Renal infection
Usually neutrophils Pyelonephritis
Chronic renal disease
Acute glomerulonephritis

Renal Renal Tubular Negative Interstitial tubular

tubular epithelial cells in disease
epithelial hyaline matrix Vascular disease
cell Toxins
Glomerulonephritis
 Granular May be coarsely or Nonpathologic (seen with
Cast finely granular Hyalin casts) – after
Disintegration of strenuous exercise in
cellular casts or stress
from tubule Pathologic –
lysosomes or Glomerulonephritis
protein Pyelonephritis
aggregates
Waxy Homogenous with Negative Tubular obstruction with
well defined prolonged stasis
edges that are Called renal failure casts
sharp and have Severe chronic renal
blunt irregular failure
ends Malignant hypertension
Cracks on lateral Acute renal disease
edges Diabetes mellitus
Cylindroid Resemble casts but 0-2/hpf Found in conjunction
have one end with casts and have
that tapers to a same significance
tail

Fatty casts Associated with Negative Seen in disorders causing

oval fat bodies lipiduria (nephritic
and urinary lipids syndrome)
Highly refractile,
contain yellow-
brown fat
droplets
Mucous Long thin waxy Occasiona Can be found in small
threads threads, very l number in normal
transparent urine
Increased numbers
indicate inflammation
or irritation of the
urinary tract

3. Microorganisms and Parasites

Type Description Normal Significance
Values
Bacteria Color: colorless Free of Can be contamination from
Shape: Rods or cocci bacteria in external sources
may be found kidney and Rapidly multiply in
single or in chains bladder improper stored
specimen
With increased WBCs,
indicative of urinary
tract infection
Yeast Color: colorless cells Negative Found in urinary tract
Shape: ovoid smooth infections, especially
cells with doubly from diabetic parents
refractile walls Immunosuppressed patient
Often show budding Skin or vaginal infection
and pseudohyphae
Sometimes mistaken
for RBCs
Spermatozoa Oval heads with long Can be found Male: nocturnal emission,
thin tails in both male ejaculation and disease
and female of the genital organs
urine Female: after coitus

Trichomonas Turnip shaped Negative Transmitted sexually,

vaginalis flagellates with frequently infection of
three anterior vagina and vulva in
flagella and one females
anterior flagellum In males, the organisms
Confused with WBCs infects urethra
Needs to be mobile
for identification
Enterobius Ova have one flat and Negative Usually found in children
Vermicularis one round side and in fecal
with transparent contamination
shell. Developing Female worm lays her eggs
larvae can be seen in perirectal region, and
during collection they
can be carried into urine
specimen
 Schistosoma Ovium measures 50- Negative Inhibits veins in urinary
Hematobium 150 um bladder
Clear and colorless Endemic in Africa, Nile
with characteristic Valley and Middle East
terminal spine

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 Alkali- Associated 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 Colorless Acid/ HCl- Can be found in
oxalate Envelope with Neutral soluble normal individuals
intersecting Acetic after ingestion of
diagonal lines acid oxalate rich food
Birefringent insoluble and large doses of
vitamin C
Associated with renal
stones, diabetes
mellitus, liver
disease and
chronic renal
disease
Hippuric Color: yellow-brown Acid/ Soluble in Associated with diets
acid to colorless Neutral water, high in fruits and
Shape: elongated alkali vegetables
prisms/plates Insoluble containing large
with pyramidal in acetic quantities of
ends acid benzoic acid

Sodium Color: yellow to Acid Soluble at Report as urate

urate colorless 60oC crystals
Shape: needle or No clinical
slender prisms in significance
sheaves or
clusters

Amorphous Color: brick-dust, Acid/ Soluble at No clinical

urates yellow brown Neutral 60oC and significance
Shape: small alkali
granular pink Acetic
precipitation at acid-
refrigeration insoluble
Salts of Na,Ca,K,Mg
Triple Colorless Alkaline Soluble in Associated with renal
Phosphate Shape: three to six dilute calculi, chronic
(ammonium- sided prisms Neutral acetic pyelitis, enlarged
magnesium described as acid prostate, urinary
phosphate) coffin-lid shaped tract infection
Found in normal urine

Amorphous Colorless Alkaline Soluble in No clinical

phosphates Shape: granular acetic significance
patches with no acid
definite shape Insoluble
at 60oC

Calcium Colorless Alkaline Soluble in No clinical

carbonate Shape: small acetic significance
dumbbells or acid
spherical forms;
can be found in
granular masses
or in pairs

Calcium Colorless Alkaline Soluble in Associated with renal

Phosphate Shape: long, thin acetic calculi
prisms with one acid Can be found in
pointed and normal urine
arranged as
rosettes or
clusters of
needles
Thin irregular plates
that float on
surface of urine
Ammonium Color: yellow to Alkaline/ Soluble in Usually indicates old
Biurate brown Neutral acetic urine
Shape: Spherical acid and
bodies with long warming
irregular spicules

Abnormal Crystals
Cystine Colorless and Acid Soluble in Amino acid crystal,
refractile HCl, inherited as a
Shape: hexagonal alkali, metabolic defect
with equal and and that prevents
unequal sides ammonia reabsorption of
Appear single or in cystine
clusters
Leucine Color: yellow to Acid Soluble in Maple syrup disease
brown hot acetic Severe liver disease
Shape: spheroids acid, hot
with radial alcohol
concentric and alkali
striations
Highly refractile
with oil-like
appearance
Tyrosine Color: black or Acid Soluble in Severe liver disease
yellow with HCl, and tyrosinosis
presence of NH4OH,
bilirubin dilute
Shape: highly mineral
refractile needles oil
occurring in
sheaves or
clusters
Cholesterol Color: transparent Acid/ Soluble in Excessive tissue
Shape: regular to Neutral chlorofor breakdown
irregular flat m, ether, Seen in nephritis and
plates with one hot nephritic syndrome
corner notched alcohol Lipiduria, lipidemia
out, may be single Insoluble and lymphatic
or in larger #s in alcohol obstruction due to
Most often found neoplasms
after refrigeration
Bilirubin Color: yellow to acid Soluble in Obstructive jaundice
brown to reddish chlorofor Bilirubin must be
Shape: Granules or m, present in urine
clusters acetone,
acid and
alkali

Sulfa Color: brown to acid Soluble in Most sulfonamide

yellow acetone drugs are more
Shape: needle-like soluble than older
shapes seen in types
bundles or
sheaves
Stacks of wheat
Ampicillin Colorless acid Administration of
Shape: elongated large parenteral
long thin needles doses

Radiographic Color: hypaque acid Soluble in Intravenous injection

media (opaque?), appear 10% NaOH for radiography
dark and thick Can appear up to 3
Shape: pleomorphic days after
needles, single or injection
sheaves
Hemosiderin Color: yellow to Acid/ Insoluble Associated with
brown to red alkaline granules anemia and
Shape: heavy large destruction of RBC
granules
Prussian blue stain
for iron

Demo Slides
Pus Cells Granular Cast Hylaline Cast RBCs
Squamous Cells Uric Acid crystal Yeast Cells