Week 9: Urinary Sediments

choppedspleenΜηχανική

22 Φεβ 2014 (πριν από 3 χρόνια και 6 μήνες)

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Week 9: Urinary Sediments


Formed elements: epithelia, red cells, white
cells


Crystals


Mucus


Renal casts


Microorganisms


Sternheimer
-
Malbin stain

Microscopic UA


Correlate with cloudiness and other findings


Quality control


Consistent volume


Centrifugation


Well mixed fresh specimen


Microscopy (wet mount, use low light)


Sternheimer
-
Malbin stain

Epithelia


Squamous epithelia


Large flat cell with central oval nucleus


Transitional (bladder) epithelia


Spindle shaped with large oval nucleus


Maybe in sheet


Renal tubular epithelia


Small cell with large oval nucleus


Most clinically significant

Squamous Epithelia

Transitional Epithelia

Renal Tubular Epithelia

Leukocytes


Pus, or pyuria


May indicate urinary tract infection UTI if
more than 10/HPF


Glitter cells in dilute alkaline urine

Pyuria

Bacteriuria

Erythrocytes


Hematuria may indicate renal damage


Menstrual contamination


May be crenated or ghost cells

Hematuria

Renal Casts


Cylindruria


Renal stasis


Acidic pH


Proteinuria


Concentrated urine


Tamm
-
Horsfall mucoprotein matrix

Renal Casts


Hyaline


Least significant


Not refractile


Coarse and fine granular


Cellular


Classified by cells in the cast


Waxy


End stage renal disease


Hyaline Cast

How many casts do you see?

Fine Granular Casts

Coarse Granular Cast

RBC Casts

WBC Casts

Epithelial Casts

Fatty Cast

Broad Cast

Waxy Casts

Mucus


Usually of no clinical significance

Common Crystals in Acid pH


Amorphous urate


Orange powder


May clear with warming or saline


Uric acid


Brown lemon shaped or star shaped


Birefringent with polarized light


Calcium oxalate


Envelope

Amorphous Urate

Uric Acid

Uric Acid

Polarized

Calcium Oxalate

Common Crystals in Alkaline pH


Amorphous phosphate


White powder


May clear with saline


Triple phosphate


Coffin lid


Ammonium biurate


Thorn apple


Calcium carbonate


Effervesce with SSA

Amorphous Phosphate

Triple Phosphate

Ammonium Biurate

Calcium Carbonate

Quality Control and Quality Assurance