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MICROSCOPIC EXAMINATION OF Urinary Sediments are classified into:

URINE 1. Organized sediments - include
● Specimen Preparation - should be epithelial cells, leukocytes,
examined while fresh or adequately erythrocytes, casts, parasites,
preserved bacteria, semen.
● Specimen Volume - 10-15 ml 2. Unorganized sediments - fat
● Centrifugation - 5 minutes at a droplets, mucus thread, crystals,
relative centrifugal force of 1,200 artifacts.
● Sediment Preparation - decant (0.5 -
1 ml) ➢ RBCs - Red Blood Cells
● Volume of Sediment examined - 20 ● Hypotonic solutions = swell (ghost
uL cells)
● Examination of sediment - 10 fields ● Hypertonic solutions = shrink
both in low and high power (crenated cells)
- Reported as to number of cells seen
SEDIMENT STAIN per HPF

STAIN ACTION FUNCTION ➢ WBCs - White Blood Cells

Delineate Identifies - Larger than RBCs, size of 12 um
structure and WBCs, ● Neutrophils - predominant WBC in
Sternheimer- contrasting epithelial urine
Malbin colors of the cells and
- When exposed to hypotonic
nucleus and casts
cytoplasm urine, they swell.
- Brownian movement of
Enhances Differentiates granules, produces a
Toluidine nuclear detail WBCs from
Blue Renal tubular
sparkling appearance,
epithelial referred to as glitter cells.
cells ● Eosinophils - associated with drug
induced interstitial nephritis
Lyses RBCs Distinguish
2% Acetic and RBCs from - Preferred stain is Hansel’s
acid enhances WBCs, yeast, stain
nuclei of oil droplets - Wright stain can be used
WBCs mononuclear cells
Differentiates Identify - lymphocytes, monocytes,
Gram Stain gram (+) from bacterial macrophages and histiocytes
gram (-) casts
bacteria WBC - fewer than 5/HPF found in normal
Stain Identify urine
Hansel Stain eosinophilic urinary Pyuria - increase in urinary WBC, indicates
granules eosinophils presence of infection

➢ Epithelial cells
- represent normal sloughing of old
cells.
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- An epithelial cells in a urine test 3. Renal Tubular Epithelial Cells

looks at urine under a microscope to - Vary depending on the area of the
see if the number of your epithelial renal tubules from which they
cells is in the normal range. It’s originate.
normal to have a small amount of - Cells from PCT have coarsely
epithelial cells in your urine. A large granulated cytoplasm.
amount may indicate an infection, - Cells from collecting ducts are finely
kidney disease, or other serious granulated.
medical condition. - Absorb lipids present in glomerular
- To be reported as rare, few, filtrate.
moderate, and many
➢ Bacteria
TYPES OF EPITHELIAL CELLS - not normally present in urine
1. Squamous - May produce positive nitrite, pH
- Largest cells found in urine above 8.0
sediment. - In the form of cocci or bacilli
- Contain abundant, irregular - High Power Objective (HPO)
cytoplasm and a prominent nucleus - Reported as few, moderate, and
about the size of a RBC. many
- Reported in terms of rare, few,
moderate, and many. ➢ Mucus
- Originate from the linings of vagina - protein material produced by glands
and female urethra and lower portion and epithelial cells
of male urethra. - Appear as thread-like structures
- Midstream clean catch technique will - No clinical significance
contain less contamination. - Reported as few, moderate and
- Variation of squamous Epithelial cell many
is CLUE CELLS (Gardnerella - Tamm-horsfall protein is its major
vaginalis) constituent

2. Transitional Epithelial (Urothelial ➢ Yeast

Cells) - Appear as small, refractile oval
- Smaller than squamous cells and structures with buds or mycelia
appear in several forms (spherical, - Reported as few, moderate and
polyhedral and caudate) many
- Has the ability to absorb large - Primarily Candida albicans
amount of water - Maybe seen in urine of diabetic,
- Originates from the lining of the immunocompromised patients
renal pelvis, ureters, bladder and
upper portion of male urethra. ➢ Parasites
- Transitional cells with abnormal - T. vaginalis (a pear- shaped
morphology may be indicative of flagellate)
malignancy or viral infection. - Sexually transmitted
- S. hematobium, E. vermicularis
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➢ Spermatozoa 2. RED BLOOD CELLS CASTS

- Urine is toxic to sperm - Shows bleeding within the nephron
- Tapered oval head with long, thin tail - Associated with glomerulonephritis
- Can be easily detected by their
➢ Casts orange - red color
- Formed within the lumens of the - More fragile than other casts
distal convoluted tubules and
collecting ducts 3. WHITE BLOOD CELLS CASTS
- Their shape is representative of the - Signifies infection and inflammation
tubular lumen within the nephron
- Parallel sides and somewhat - Associated with pyelonephritis
rounded ends and may contain - Present in non bacteria inflammation
additional elements present in the such as interstitial nephritis
filtrate. - Primary marker to distinguish upper
- Reported as the average number UTI (pyelonephritis) from lower UTI
per 10 LPF - Composed of neutrophils, appear
- Major constituent is Tamm-Horsfall granular, multilobed nuclei
protein
4. BACTERIAL CASTS
Glycoprotein excreted by RTE cells of the - Containing bacilli
distal convoluted tubules and upper - Seen in pyelonephritis
collecting ducts - Difficult to identify
- Cylindruria (presence of urinary - Confirmation of bacterial cast
casts) - Perform gram stain on centrifuge
sediment
TYPES OF CASTS
1. HYALINE CASTS 5. EPITHELIAL CELL CASTS
- Frequently seen casts - Indicates advanced tubular
- Consist almost entirely of Tamm- destruction
Horsfall protein - Associated with drug induced
- Presence of 0-2/LPF is considered toxicity, viral infections and allograft
normal rejections
- Strenuous exercise, dehydration, - Cells visible are smaller, cuboidal
heat exposure and emotional stress and columnar shaped cells
- Pathologically, in acute
glomerulonephritis, chronic renal 6. MIXED CELLULAR CASTS
disease, pyelonephritis, congestive - Frequently encountered are RBC
heart failure and WBC casts in
- Appears colorless glomerulonephritis
- Sternheimer-Malbin stain produces - WBC and bacterial casts in
pink color pyelonephritis
- When mixed casts are present, there
should be a homogenous cast of at
least one cell type
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- Example: ~ Inorganic in neutral or alkaline

~ WBC cast in pyelonephritis
~ RBC cast in glomerulonephritis NORMAL CRYSTALS IN ACIDIC
URINE
7. GRANULAR CASTS ● Amorphous urates - yellow brown
- Coarsely and finely granular cast granules
- Seen after strenuous exercises - Refrigerated specimen,
- In disease state, granules may produce pink sediment
represent disintegration of cellular (accumulation of uroerythrin)
casts and protein aggregates filtered
by the glomerulus ● Uric acid crystals - variety of
- Easily visualized under LPO, final ID shapes
at HPO - Rhombic, four sided flat
plates, wedges and rosettes
8. WAXY CASTS - Yellow brown, colorless
- Granular casts remain in the tubules - Highly birefringent under
for an extended period polarized light
- Granules disintegrate, cast matrix - Associated with increased
develops a waxy appearance levels of purines and nucleic
- Structures becomes more rigid, end acid
of the casts may appear jagged or - Seen in patients with
broken leukemia undergoing
- Diameter becomes broader chemotherapy

➢ URINARY CRYSTALS ● Sodium urates - needle shape

- Of rare clinical significance - Seen in synovial fluid in
- To detect the presence of relatively episodes of gout
few abnormal types
- May represent disorders such as ● Calcium oxalate - octahedral
liver disease, inborn errors of envelop
metabolism - Birefringent under polarized
- Reported as few, moderate and light
many - Associated with food in high
- Precipitation of urine solutes oxalic acid such as tomatoes,
- Crystal formation takes place at low asparagus and ascorbic acid
temperature - Primary pathologic
- Presence of crystals in freshly significance in cases of
voided urine is associated with ethylene glycol poisoning
concentrated high specific gravity
specimen NORMAL CRYSTALS SEEN IN
~ pH - valuable aid in ID of ALKALINE URINE
crystals ● Phosphate
~ Organic compounds crystallize - majority of the crystals found in
more easily in acid pH alkaline urine
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- Difficult to differentiate from

● Amorphous Phosphate uric acid cystals
- granular in appearance - Positive (+) confirmation with
- Does not dissolve in warming cyanide nitroprusside tests

● Triple Phosphate ● Cholesterol Crystals

- colorless, prism shape that - Rarely seen unless specimen have
resembles a coffin lid been refrigerated
- As they disintegrate, crystals may - Rectangular plate with a notch in
develop a feathery appearance one or more corners
- Birefringent under polarized - Birefringent with polarized light
microscope - Associated with disorders producing
- Associated with urea-splitting lipiduria such as nephrotic syndrome
bacteria
CRYSTALS ASSOCIATED WITH
● Calcium Phosphate Crystals LIVER DISORDERS
- colorless, flat rectangular plates, thin 1. Tyrosine
prisms in rosette formation - Appear a fine colorless to
- dissolve in dilute acetic acid yellow needles that
frequently form clumps or
● Calcium Carbonate Crystal rosettes.
- Small, colorless, dumbbell or - Seen with leucine crystals in
spherical shapes specimens with positive
- May occur in clumps chemical tests for bilirubin.
- Distinguish by the formation of gas - Seen in patients with
after the addition of acetic acid disorders of amino acid
- Have no clinical significance metabolism.

● Ammonium Biurate 2. Leucine

- Thorny apple - Yellow brown spheres
- Spicule covered spheres - Demonstrate concentric
- Dissolve at 60°C circles and radial striations
- Upon addition of glacial acetic acid, - It is with tyrosine crystals
it will be converted to uric acid
crystals 3. Bilirubin
- Present in hepatic disorders
Abnormal Urinary Crystals - Appear as clumped needles
- Found in acidic urine or granules
● Cystine Crystals - found in patients - Yellow in color
with metabolic disorder that prevents - A positive chemical test with
reabsorption of cystine by renal bilirubin
tubules
- Colorless, hexagonal plates 4. Sulfonamide Crystals
- Inadequate patient hydration
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- With variety of shapes and

colors which include needles,
rhombics, sheaves, rosettes,
colors ranging from colorless
to yellow brown
- Diazo reaction for
confirmation

● Ampicillin Crystals
- Colorless needles that tend
to form bundles following
refrigeration appear.

URINARY SEDIMENT ARTIFACTS

Starch granules
Oil droplets
Air bubbles
Hair
Diaper fibers