AUBF LEC

Macroscopic Screening

❑ Specimen Preparation
❑ Specimen Volume
❑ Centrifugation
o RCF = 1.118 x 10-5 x radius in cm x
rpm
o Calibration
❑ Sediment Preparation
Urine Sediment Constituents
o 0.5 mL to 1.0 mL (after decantation)
o Resuspension by gentle agitation ▪︎ Cellular Elements
▪︎ Crystals
❑ Volume of Sediment Examined ▪︎ Cast
▪ 20 uL or 0.02mL
❑ Examining the Sediment Cellular Elements
▪ 10 fields both LPO (10x) and HPO Red Blood Cells (RBCs)
(40x)
➢ smooth, non-nucleated,
▪ Sediments examined under reduced
biconcave disks
light
➢ 7 mm in diameter
❑ Reporting the microscopic
examination ➢ Identified in HPO
▪ Cast – average # /lpf ➢ Average # in 10 hpf
▪ RBCs, WBCs – average # /hpf ➢ NV: 0-2/hpf
▪ Other elements – rare, few,
moderate, many
1+, 2+, 3+, 4+

Sediment Examination

❑ Sediment Stains
▪ Sternheimer-Malbin stain (crystal violet,
safranin O)
▪ WBCs,
▪ Epithelial cells
▪ cast
▪ 0.5% solution of toluidine blue
▪ WBC and RTE/RTC differentiation
▪ Cells from other body fluids
❑ Microscopy
▪ Bright-field microscopy (common)
Clinical Significance:
➢ Dysmorphic RBCs : glomerular
bleeding
➢ Damage of glomerular membrane
➢ Vascular injury within Genitourinary
tract
➢ Macroscopic Hematuria
▪ Advance Glomerular damage Mononuclear Cell
▪ Trauma ➢ Smaller numbers
➢ Lymphocytes : early sign of renal
▪ Acute infection/inflammation
rejection
▪ Coagulation disorder
➢ Monocytes, macrophages, and
histiocytes - large cells
White Blood Cells (WBCs) vacuolated or contain
➢ 12mm in diameter inclusions
➢ predominant: neutrophil – contains
granules and multilobed nuclei
➢ Identified in HPO
➢ Average # in 10 hpf
➢ NV: 0-5/hpf

Eosinophil
➢ Drug induced interstitial nephritis
➢ Not normally seen, 1% considered
significant
White Blood Cells (WBCs): Pyuria
➢ Hansel stain
➢ Predominantly seen
➢ contains granules and
multilobe nuclei
➢ Neutrophils: “glitter
cells” sparkling
appearance
Neutrophils
Epithelial Cells ➢ moderate cytoplasm
➢ normal sloughing of old cells ➢ Nucleus: 8-14 um, centrally located
➢ derived from the linings of ➢ Nucleus round or oval, off center in
genitourinary system elongated cells
➢ Viewed in LPO
➢ Semiquantitative in 10 lpf
➢ Squamous, Transitional, Renal

Squamous Epithelial cells:

➢ 40-60 um
➢ Shape : thin, irregular agled
(flagstone shape)
➢ Distinct boarder
➢ Abundant cytoplasm
➢ Nucleus: 8-14 um, centrally located
➢ Nucleus can be anucleated or
multinucleated Renal Tubular Epithelial cells
➢ Site: Small Collecting duct cells
➢ Shapes :
• 12-20um
• Polygonal or cuboidal
• Nucleus : larger covers 60-70%
of the cell
➢ Site: Large Collecting duct cells
• 6-10 um
• Shape: columnar
• Nucleus – 6-8 um off center

Transitional Epithelial cells

➢ 15-40 um
➢ Shapes : ➢ Site: DCT
• Round or pear shape ➢ Shapes :
• Clublike, caudate (with tail), • 14-25 um
elongated • Oval to round
• Small rectangular or columnar • Cytoplasm: grainy
like
 • Nucleus: small, round central or
off center

➢ Site: PCT
➢ Shapes : Yeast
• 20-60um ➢ Refractile oval
• Oblong or cigar shape with ➢ Budding or no budding
indistinct cell ➢ Mycelial forms : branched
• Cytoplasm: grainy ➢ Viewed in HPO
• Nucleus: off center and ➢ Reported as rare, few, moderate, many
multinucleated ➢ Candida albicans : primary yeast
• Diabetic patients
• Immunocompromised patients
• Vaginal moniliasis (women)

Bacteria
➢ Cocci (spherical)
➢ Bacilli (rods)
• Viewed in HPO
• Reported as few. , moderate, many
• Motile bacteria suggestive of (+) culture
• Presence of bacteria can indicate LUTI or
UUTI

Parasites
➢ Trichomonas vaginalis (trophozoite)
• Pear shape flagellate Hyaline Cast
➢ Rapid fliting motion ➢ colorless
➢ Mycelial forms : branched ➢ Refractive index similar to urine
➢ Viewed in HPO (reduce light)
➢ Reported as rare, few, ➢ Shape:
moderate , many • normal parallel sides and
rounded ends
• cylindroid forms
• wrinkled or convoluted

Mucus
➢ Protein material
➢ Thread-like structures
➢ Viewed in LPO
RBC Cast
➢ Reported as rare, few,
➢ Indicates bleeding within the
moderate, many
nephron: glomerulonephritis
➢ orange-red color
➢ Reported:
• Average # 10 lpf

Cast
➢ Only element found in urinary sediment
of kidney WBC Cast
➢ Formed in lumens of DCT and collecting ➢ Infection within the nephron
ducts ➢ Pyelonephritis
➢ Viewed in LPO (HPO: further ➢ Composed of neutrophils
identification) ➢ Granular, multilobed nuclei
➢ Reported: average # 10 lpf ➢ Reported:
➢ Observation: subdued light, cast matrix • Average # 10 lpf
has low
refractive index
➢ Major Constituent of cast is Uromodulin
Epithelial cell Cast
➢ RTE cells
➢ Cells in the matrix Waxy Cast
• Smaller round ➢ Appearance
• Oval cells • Ground glass (brittle)
➢ Reported: • High refractive
• Average # 10 lpf • Homogeneous matrix
➢ Indicates chronic renal failure

Granular Cast
Fatty Cast
➢ Fine Granular Cast
➢ Appearance
• Small granules dispensed
• Fat droplets/oval fat bodies
throughout the matrix
• High refractile
• Sand Paper appearance
• Yellowish to green sheen
➢ Coarse Granular Cast
➢ Associated with nephrotic
• Larger coarse granules
syndrome
• Granules primarily from
degenerating cells
CRYSTALS
➢ Used to help diagnose kidney stones
➢ Problem in metabolism
➢ Formed:
• Precipitation of urinary solutes happen
due to
• Temperature
• Solute concentration
• pH
➢ Viewed on LPO
➢ Reported: rare, few, moderate, or
many

Normal Urine Crystals

Abnormal Urine Crystals
 Bilirubin
▪ Yellow clumped needles or granules
▪ hepatic disorders
▪ Positive Chemical test result for bilirubin

Crystals Associated with Liver Disorder

▪︎ Tyrosine
▪︎ Leucine
▪︎ Bilirubin

Tyrosine
▪ fine colorless to yellow needles
▪ Seen together with leucine
▪ Positive chemical test for bilirubin
▪ Amino Acid metabolism disorder

Leucine
▪ yellow-brown spheres
▪ Seen together with tyrosine
▪ concentric circles and radial striations
Tubular Disorder Renal Glycosuria
▪︎ Tubules are disrupted ▪︎ Affects the reabsorption of glucose
▪︎ Caused by:
Acute Tubular Necrosis (ATN) -​ Decrease in the number of glucose
▪︎ Primary disorder transporters in tubules
-​ Decrease in the affinity of
▪︎ Categorized: Ischemic ATN, Toxic ATN transporters for gluvose
▪︎ Disorders leading to ATN include; shock, ▪︎ Inherited as an autosomal recessive trait
trauma, surgical procedure ▪︎ Correlation
▪︎ Correlation: mild proteinuria, microscopic
hematuria, RTE Renal Tubular Acidosis
▪︎ Characterized by the inability of the
Hereditary and Metabolic Tubular tubules
Disorder

Fanconi Syndrome INTERSTITIAL DISORDER

▪︎ Most frequently associated with tubular ▪︎ Most common renal disease - UTI
dysfunction -​ Lower UTI (urethra and bladder)
▪︎ Caused by generalized failure of tubular ▪︎ Urethritis: infection in the urethra
▪︎ may be inherited in association with ▪︎
cystinosis and Harrnup disease
▪︎ Correlation:
Alport Syndrome -​ Presence of numerous WBC
▪︎ Inherited disorder of collagen production
affecting basement membrane
-​ Can be Acute Pyelonephritis
▪︎ glomerular basement membrane exhibits ▪︎ Infection of the upper UT
lamellated -​ Ascending movement of bacteria
from lower UTI
Uromodulin-Associated Kidney Disease -​ Enhanced in the following
▪︎ inherited disorder caused by an autosomal conditions:
mutation in the gene ▪︎
▪︎ Tubules become necrotic
▪︎ correlation; increase in serum acid, ▪︎ Abcess formation from bacteria and
leukocytic enzymes
Diabetic Nephropathy ▪︎ Correlation:
▪︎ Most common cause of wnd stage renal -​ Numerous leukocytes
disease
▪︎Glomerular membrane is damaged by:
-​ Glomerular membrane thickening Chronic Pyelonephritis
▪︎ Develops when persistent inflammation or
Nephrogenic Diabetes insipidus renal
▪︎ Action ADH is disrupted by inability of the ▪︎ Results to permanent renal tubule damage
renal tubules to respond to ADH that leads to chronic renal failure
▪︎ Correlation:
-​ Increased leukocytes but bacteria
may or may not be present
-​ A

Acute Interstitial Nephritis

▪︎ Marked by inflammation
▪︎ commonly caused by acute allograft
rejection of transplant kidney
▪︎ Any immune response in the interstitium of
the kidney can cause AIN

▪︎ Correlation:
-​ Macroscopic hematuria
-​ Mild to moderate proteinuria
-​ Numerous WBCs
-​ WBC casts without bacteria

Renal Failure
▪︎ Acute Renal Failure
-​ Frequently reversible once patient is
treated correctly
-​ Correlation:

▪︎ Chronic Renal Failure

-​ Progressive

Renal Lithiasis
▪︎ Layman's term: kidney stones
▪︎ Can also be term as renal calculi
-​ Aggregates of solid chemical
▪︎ rarely composed of a single components
are mixture of
-​ A
▪︎ Factors influence calculi formation
-​ Supersaturation of chemical salts in
urine
-​ Optimal Urinary pH
-​ Urinary stasis
-​ Nucleation or initial crystal formation