Urine Microscopy

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Urine Microscopy

• Dr. Mohammed Iqbal Musani, MD

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.
White blood cell cast
WBC in Urine
Seen in interstitial disease most commonly Also
seen in glomerulonephritis
Mixed Cast Urine
WBC Cast Urine
Waxy cast
Non-renal epithelial cells
Uro-epithelium is columnar If there are a lot of
these it means there is sloughing of the
system Skin is squamous If there are a lot of
squamous it is a contaminated specimen
Thought to result from the degeneration of
cellular casts
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Urine Oxalate Crystals
                                                                                        
This is a photograph of urinary sediment under brightfield microscopy (250X magnification). The sediment contains two red blood cells (right) and one white blood cell (left). The white blood cell appears to have a lobulated nucleus.
White blood cells/red blood cells in urine
                                                                                  
These are white blood cells and bacteria found in urinary sediment using interference-contrast microscopy. The cell in the center has a pseudopod extending from its cytoplasm indicating amoeboid motion.
White blood cells and bacteria
Red blood cells in urine
                                                                            
These are red blood cells found in urinary sediment under bright field microscopy (160x magnification).
Squamous epithelial cell in urine
                                                                                       
This is a squamous epithelial cell under brightfield microscopy (250X magnification).Squamous epithelial cells are characterized by a small, round, central nucleus with a large amount of granular or wrinkled cytoplasm (a "fried egg" appearance).
Squamous epithelial cells
                                                                                
Shown here is a group of squamous epithelial cells in urine sediment. Interference-contrast microscopy was used to enhance surface characteristics of the cells (200X magnification). A few white blood cells and bacteria are visible in the periphery.
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Bacteria and white blood cells
Renal Epithelial Cells
                                                                                   
This is a low power view (100X magnification) of urine with bacteria and several leukocytes in the field. Bacteria are bacillary and diffusely scattered throughout. The urine is stained with Sternheimer-Malbin stain.
                                                                               
A group of attached renal tubular epithelial cells are seen in the center of this slide. The background contains white blood cells and red blood cells (bright field microscopy, 250X magnification)
                                                                                           
Budding yeast are visible on the left side of this slide with a squamous epithelial cell on the right. There are no segmented neutrophils seen. This suggests the yeast are a contaminant and not causing a urinary tract infection (bright field microscopy, 200X).
Budding yeast cells
Mucus
                                                                                          
This slide shows mucus in urine with two entrapped white cells. There are also two red cells present, one within the mucus and one above it. Mucus fibers are fibrillar and delicate. They have a very low refractive index. (Bright field microscopy, 160X magnification.)
                                                                               
This slide shows a red blood cell cast with red blood cells concentrated at one end.(Bright field microscopy, 160X magnification)
Red blood cell cast
Hyaline cast
                                                                               
Hyaline casts are difficult to see due to their low refractive index. This one is granular, which makes it easier to visualize. (Bright field microscopy, 200X magnification.)
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White blood cell cast
Coarsely granular cast
                                                                               
This coarsely granular cast is easily seen with interference-contrast microscopy at 160X magnification.
                                                                             
This is a white blood cell cast with intact leukocytes. The leukocytes have multilobed nuclei. (Bright field microscopy)
                                                                           
Amorphous urates appear as fine pink or brownish-tan granules (brightfield microscopy, 200X magnification). They are salts of uric acid and are normally found in acid or neutral urine.
Amorphous urates in urine
Waxy cast
                                                                               
This is a waxy cast seen in urine with interference-contrast microscopy at 160X magnification. The cast is surrounded by red blood cells and segmented neutrophils.
Calcium oxalate crystals in urine
Uric acid crystals in urine
                                                                           
Calcium oxalate crystals are usually found in acid urine. They commonly appear octahedral.(Brightfield microscopy, 100X magnification.)
                                                                           
Uric acid crystals exhibit extreme pleomorphism in size and in shape. They appear readily in acid urine allowed to stand at room temperature. (Bright field microscopy, 160X magnification)
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Amorphous phosphates in urine
Triple phosphate crystals in urine
                                                                           
Ammonium urate crystals are easily distinguished by their golden brown color and "thorn apple" shape. They are seen here under bright field microscopy (160X magnification). They are the only urate crystals that appear in alkaline urine.
                                                                           
Amorphous phosphates appear in neutral to alkaline urine as fine, colorless or slightly brown granules. White precipitate is observed on centrifugation. (Brightfield microscopy, 160X magnification.)
                                                                          
Triple phosphate crystals, viewed here with interference-contrast microscopy (160X magnification), resemble prisms or "coffin lids". They are found normally in alkaline or neutral urine. They are colorless.
Calcium phosphate crystals in urine
Ammonium biurate crystals in urine
                                                                           
Calcium phosphate crystals assume various forms including the rosette and pointed finger forms shown here with bright field microscopy (160X magnification). They appear most often in alkaline urine.
                                                                           
Calcium carbonate crystals are small and colorless and appear in alkaline urine as granules or as small dumbbells. Bacteria are also present in this field (brightfield microscopy, 250X magnification).
                                                                           
Cystine, an amino acid, is an abnormal finding in urine. Rarely seen, these crystals are found in acid urine and are seen as thin, colorless, hexagonal plates. (Brightfield microscopy, 160X magnification.)
Cystine crystals in urine
Calcium carbonate crystals in urine
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Tyrosine crystals in urine
Leucine crystals in urine
                                                                           
Leucine crystals are not normally found in urine They appear in urine in association with tyrosine and are manifestations of the same clinical conditions. When found, leucine crystals are in acid urine in the form of spheroids with concentric striations. They are dense, highly refractive and appear as yellowish brown bodies. (Brightfield, 160X magnification)
                                                                           
Tyrosine crystals are not normally found in urine. They are products of protein metabolism and appear in urine of people with tissue degeneration or necrosis (acute liver disease, severe leukemia, typhoid fever, and smallpox). They are present only when urine is acid. They are colorless to yellowish brown, needle shaped crystals and have a fine silky appearance. The needles may be single or arranged in sheaves or rosettes. Tyrosine crystals usually appear in urinary sediment together with leucine crystals
Sulfa crystals in urine
Cholesterol crystals in urine
                                                                           
Sulfonamide crystals form primarily in acid urine. The shape and color of these crystals are extremely variable, depending on the particular sulfonamide being administered to the patient. The most common forms encountered include rosettes, fan shapes and those resembling shocks of wheat. Sulfa crystals have pathologic significance, since they tend to form renal calculi that may damage renal tubules. (Brightfield microscopy, 160X magnification.)
                                                                           
Cholesterol crystals are seen in the center of this field with squamous epithelial cells on either side. Cholesterol crystals are found in acid or neutral urine. They appear as regular or irregular transparent plates. They may occur singly or in large numbers. Usually one or more corners are cut off or notched, justifying their description as "stair step crystals". They are not commonly seen and are always considered pathological. They can be found in various renal diseases. (Brightfield microscopy, 160X magnification.)
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Fecal material in urine
Talc in urine
                                                                          
Talcum powder, commonly used as a dusting powder to prevent chafing or heat rash, appears as a contaminant in urine as crystals. (Brightfield microscopy, 128X magnification.)
                                                                           
Fecal material can usually be identified by its brown coloration, and the assortment of bizarre shapes and sizes of component elements. Fecal contamination of urine most often occurs in incontinent babies or elderly persons. (Brightfield microscopy, 40X magnification)
                                                                          
A cotton fiber is easily identified by its size. A cotton fiber is seen here with squamous epithelial cells and white blood cells.(Brightfield microscopy, 51X magnification.)
Cotton fiber in urine
                                                                           
A derivative of cornstarch is used as a dusting powder for surgical gloves. It can enter the urine during catheterization. The starch granules are usually identifiable by their size, shape and high refractive index. (Brightfield microscopy, 100X magnification.)
Starch in urine
Fiber in urine
                                                                           
This slide depicts a fiber artifact found in urine under brightfield microscopy at 200X magnification.
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Sowhat is a cast???

• Protein based cylindrical molds of the renal
  tubule
• Form in distal tubules and collecting ducts
• Result of damage to the renal tubule
• Can contain cells and other material
• Dehydration and acidic urine especially
  predisposes to cast formation

Red cell cast
Formation of Casts
Almost always associated with glomerulonephritis
or vasculitis Virtually exclude extra-renal
causes of bleeding
Red cell Casts in Urine
Epithelial Casts in Urine
Granular Casts in Urine
Granular cast
Non-specific but usually pathologic Usually the
granules are from the degeneration of cellular
casts
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White blood cell cast
WBC Cast Urine

• Seen in interstitial disease most commonly
• Also seen in glomerulonephritis

Waxy cast
Mixed Cast Urine
Thought to result from the degeneration of
cellular casts
Non-renal epithelial cells
Uro-epithelium is columnar If there are a lot of
these it means there is sloughing of the
system Skin is squamous If there are a lot of
squamous it is a contaminated specimen