This document provides a detailed summary of microscopic elements that may be observed during examination of urinary sediments. It describes both organized elements like epithelial cells, red blood cells, white blood cells and casts, as well as unorganized elements like crystals that can be seen. Common normal and abnormal crystals are outlined, along with their appearances and clinical associations. The document also discusses artifacts that may be present during microscopic urinalysis.

1. MICROSCOPIC EXAMINATION OF
URINARY SEDIMENTS
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2. UNORGANIZED ELEMENTS
 Normal Acid Crystals
 1.Amorphous urates
 Pink to red dust or
aggregate or ppt. of
certain chemicals
 Cause turbidity

3. 2.Uric acid
 Highly birefringent in polarized
light
 Increase amount are
associated with inrease levels
of purine and nucleic acids
 In in patients with leukemia
receiving therapy, Lesch-
Nyhan syndrome and gout
 Exists in many forms
 Whetstone, Rhombic shaped
or lemon shaped

4.  3. Sodium urates
 Slender prism arranged in
“fan-like” manner
 Peacock-tail
 4. Calcium sulfates
 2 forms
 A. elongated prismatic tablet
 Cigarette-butt
 B. long thin needle arranged
in star-like manner
 Star like crystals

5.  5. Calcium oxalate
 Birefringent in polarized light
 Associated with foods high in
ascorbic acid, oxalic acid such
as tomatoes and asparagus
 2 forms
 A. small square with 2 diagonal
lines
 Enveloped shaped
 B. Dumbbell-shaped

6. Normal Alkaline Crystals
 1. Amorphous
Phosphates
 Colorless
aggregates or
precipitate of CHON
 2. Calcium
carbonates
 Tiny spheres or
dumbbells

7.  3.Triple phosphates
 A.3-6 sides (coffin lid
 B. fern –leaf appearance
 4. Ammonium biurates
 2 forms
 A. with spicules (thorny
apple appearance
 B.Without spicules

8. Abnormal Crystals
 Cystine
 Found in persons who inherit a
metabolic disorders that
prevents reabsorption or
cystine by the renal
tubules(cystinuria)
 Confirmation may be made by
using cyanide-nitroprusside
test
 Hexagonal plates (thick or
thin)

9.  2. Cholesterol crystals
 Rarely seen unless specimen
have been refrigerated
 Associated with disorders
producing lipiduria( nephrotic
syndrome)
 Seen in conjunction with fatty
acids and oval fat bodies
 Resembles a rectangular plate
with a notch in one or more
corners

10. Crystals associated with liver
disease
1. Tyrosine
May be seen in
conjunction with
leucine
Maybe encountered in in
inherited disorders of
amino-acid
metabolism
Appears as fine colorless
to yellowish needle
that forms clumps or
rosettes

11.  2. Leucine
 Appears as yellow-brown
spheres that demonstrate
concentric circles and radial
striations
 3. Bilirubin
 Present in persons with
hepatic disorders
 Appear as clumped needle
or granules with
characteristics yellow color
of bilirubin

12. Sulfonamide crystals
 Its appearance in fresh urine
can suggest the possibility of
tubular damage if crystals are
forming in the nephron.
 Common in persons treated
for UTI
 Varried shapes( rhombic,
whetstones, sheaves of wheat
and even rosettes

13. Ampicillin crystals
 Appears during massive
doses of penicillin crystals
without proper hydration
 colorless needles that tend
to form bundle following
refrigeration

14. Urinary sediment artifacts
 Strach
 Oil doplets
 Air bubbles
 Pollen grains
 Fibers
 fecal contamination

15. Organized elements
 1. epithelial cells
 A. Squamous epithelial cells
–
 with small centrally located
nucleus with thin edges
 From the superficial lining of
the urinary tract
 B.Transitional or caudate
 Tail-like projection
 Big nucleus(sometimes bi-
nucleated)

16.  C. RenalTubular or Renal
failure cells
 Polyhedral or cuboidal or
egg-shaped
 Big nucleus along the side
 2. Red blood cells
 Associated with glomerular
bleeding
 6-8 microns in dm
 Pale disc, with out nucleus
or granules
 “shaow cell “ or “ghost cell”
 0-2 NV

17.  3.White blood cell
 12-15 microns
predominantly
neutrophils
 Granulated spheres
(exhibits “brownian
movement”)
 Glitter cells
 Associated with pyuria
 0-5 NV

18.  4. Eosinophils
 Associated with drug-induced interstitial nephritis
Small numbers maybe associated with UTI and renal
transplant rejection
Preferred stain is “Hansels Stain”

19.  5. Mononuclear cells
 Lymphocytes resembles that of RBC
 Seen in increase numbers in the early stage of
renal transplant rejection
 RTE seen larger than WBC

20. Mucus
 A protein material produced by the glands
and epithelial cells of lower genitourinary
tract and the RTE
 Tamm-Horsfall CHON is the major
constituents of mucus

21. CASTS
 Formed within the lumen of the distal
convoluted tubules and collecting duct
provides a microscopic view of the conditions
of the nephron
 Formation
 Tamm-horsfallCHON is the major constituents
 2/3 albumin & globulin
 1/3 tamm-horsfall protein

22. 1. Hyaline casts
 Forms the basis of all types of
casts
 Type of casts wit refractive
index similar to that of urine
 Uses Sternheimer-Malbin
stain which produces pink
color
 Increase in
glomerulonephritis,
pyelonephiritis, chronic renal
disease and congestive heart
failure

23. 2. Waxy casts
 Final degenerative type of casts
 Representative of extreme urine stasis, indicating
chronic renal failure
 Uses KOVA stain

24. 3. Broad casts
 Type of cast which denotes bad prognosis
 Seen in distended tubules
 Often referred to as “renal Failure casts”
 Indicates destruction (widening) of tubular
walls.

25. 4. Granular casts
 Coarsely and finely granular casts are
frequently seen in the urinary sediments

26. 5. Red blood cell casts
 Shows bleeding within the nephron
 Associated with damage to the
glomerulus(glomerulonephritis)
 Also associated with proteinuria and
dysmorphic erythrocytes

27. 6. White blood cell casts
 Signifies infection or
inflammation within the
nephron
 Associated with
pyelonephritis
 Primary marker for
pyelonephritis(Upper UTI)
form lower UTI.
 Most frequently are
composed of neutrophils
thus appears granular

28. Epithelia casts
 Casts containing RTE cells represents
advance tubular destruction, producing
urinary stasis along with disruption of the
tubular lining.
 Bilirubin-staind RTE seen in cases of hepatitis

29. Fatty casts
 Seen in conjunction with oval fat bodies and
free fat droplets in disorders causing lipiduria.
 ConfirmII or Oil red O fat stains.

30. Mixed Cellular casts
 RBC and WBC casts seen in
glomerulonephritis whileWBC and RTE cell
casts , orWBC AND Bacterial casts in
pyelonephritis

31.  The end!!!