BCC CLT 202 ` Urinalysis & Body Fluid Lab

Name: Lisa Lovell Date: 11/4/2010

Title of Lab: Microscopic Examination of Urine Lab
The sample will be selected for a microscopic exam only if it meets certain criteria. It is different for each lab but
but the most common parameters are color, clarity, blood, protein, nitrite, leukocyte esterase. The Clinical and Laboratory
Standards Institute recommends the microscopic examination be performed when requested by a physician, when a
laboratory specified population is being tested or when any abnormal physical or chemical result is obtained.
The specimen should be examined while fresh or after being properly preserved. If the specimen was refrigerated then
warming the specimen to 37 degrees C before centrifuging will dissolve any amorphous urates or phosphates that may
have precipitated during refrigeration. The midstream clean catch method should be use to collect the specimen to
minimize external contamination of the sediment. The sample should be between 10 and 15 ml (12 ml is ideal) and
centrifuged in a conical tube at 400 RCF for 5 minutes. After centrifuging decant all but 1 ml of the specimen, the
remaining sample should be gently re-suspended. We then use the pipette supplied and the sample applied the the multi
sample viewing slide. You have to make sure that the chamber is completely filled then use bright field microscopy to
examine the specimen.
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Data:
Specimen ID 0392 Date 11/5

WBC 0 /HPF
RBC 5 /HPF
Epithelial cells 1 /HPF
Squamous 2/HPF
Transitional 0/HPF
RTE

Casts 1 /LPF Hyaline

Crystals Few, moderate, many Amorphous

phosphates

Yeast Few, moderate, many 0

Bacteria Few, moderate, many 0

Mucus None seen, present

Also the sample was yellow and hazy, pH 7.0, KET 15 mg/dl, BLO large, PRO 30 mg/dl

Discussion: No WBC's were found, if they were there, it could signify an infection or inflammation in the genitourinary
tract, if the cells present were neutrophils, WBC's can also enter the urine through glomerular or capillary damage. Could
also be caused by glomerulonephritis, lupus erythematosus, interstitial nephritis and tumors.

I found an average of 5 RBC's per high power field. Clinically this can mean damage to the glomerular membrane
or vascular innjury within the genitourinary tract. The number of cell indicates how severe the damage is. It can be caused
by trauma, acute infection, inflammation or coagulation disorders. RBC's and RBC casts can be seen after strenuous
exercise. Lastly the possibility of menstrual contamination must be considered in a female specimen.
 Epithelial cells are only significant if they are not squamous, however, clue cells, which are squamous cells
covered with Gardnerella coccobacillus are indicative of vaginal infection. I found 2 squamous epithelial cells per high
power field

Renal Tubular Epithelial cells are the most clinically significant and their presence in increased amounts means
there is necrosis of the renal tubules, affecting overall renal function. This could occur from heavy metal exposure, viral
infections, pyelonephritis, allergic reactions, malignant infiltrations, or acute allogenic transplant rejection.

Transitional cells may also be observed after an invasive urological procedure or in increased numbers due to
malignancy or viral infection and the sample should be sent for cytological examination.

I did observe one type of cast in this specimen of the hyaline variety. These can be present following stress,
strenuous exercise, dehydration, heat exposure and emotional stress. They are increased in pyelonephritis, chronic renal
disease and congestive heart failure.

Other types that I did not observe in this sample are:

RBC cast, which can be found if there is damage to the nephron, glomerulous or capillary structure, from
glomerulonephritis primarily. They can also be found in relation to participation in strenuous contact sports.

WBC casts, can be due to a UTI, means inflammation within the nephron associated with pyelonephritis or can be from
acute interstitial nephritis and may accompany RBC casts in glomerulonephritis.

Granular cast, can be one of two two types, non pathogenic are from lysosomes secreted by the RTE cells durring normal
metabolism. In the pathogenic type the granule represent disintegration of cellular casts, tubule cells, or protein
aggregates filtered by the glomerulous , stasis causes the cellualr cast to be formed and then they breakdown into
granular casts.

Waxy casts, mean extreme urine stasis indicating chronic renal failure, they are usually seen with other cast types
associated with thecondition that lead to the chronic renal failure.

Broad casts, also represent extreme urine stasis. They are a mold of the DCT, Their presence indicates widening of the
tubular walls. When the flow of urine to the larger collecting ducts becomes severely compromised casts will form in that
area and appear broad. Bile stained broad casts can be seen with viral hepatitis as a result of tubular necrosis.

Other elements that may be observed in a microscopic examination are crystals. There are only a few types that are
clinically significant and all of those are found in acid urine.

Cystine crystals can be observed in a specimen from someone who inherited a metabolic disorder that prevents the
reabsorbtion of cystine by the renal tubules. These people form renal calculi at an early age. These crystals appear as
colorless hexagonal plates and may be thick or thin, they may disintegrate in the presence of ammonia and you can
confirm cystine crystals using the cyanide-nitroprusside test.

Cholesterol crystals are also seen in acid urine, and are rarely seen unless the specimen has been refrigerated, otherwise
the lipids remain in droplet form. They resemble a rectangular plate with one or more notched corners. They are
associated with disorders producing lipiduria, like nephrotic syndrome and are seen with oval fat bodies and fatty casts.

Leucine crystals are seen in acid and neutral urine. They are yellow-brown and shaped like concentric circles and usually
are present with tyrosine crystals. They are associated with inherited disorders of amino acid metabolism.

Tyrosine crystals would be found in acid or neutral urine and appear as colorless or yellow needles that clump and look
like rosettes. They are associated with inherited disorders of amino acid metabolism as well.

Bilirubin crystals are found in acid urine and appear as yellow, clumped needles or granules. They are usually seen when
you have a hepatic disorder producing large amounts of bilirubin.

Sulfonamides are found in acid or neutral urine and appear in many different colors and shapes. The are seen when
people on sulfa drugs prescribed for a UTI are not keeping properly hydrated and that leads to these crystals forming.
They suggest the possibility of tubular damage if the crystals are forming in the nephron.
Radiographic dye is found in acid urine and appears colorless and looks kind of like cholesterol. It should only be found in
the urine of patients that are undergoing specific diagnostic procedures.

There are also crystals that are not clinically significant including:

Amorphous phosphates are found in alkaline urine and look like grains of sand. I found these crystals in my sample, but
they are not clinically significant and are most likely due to refrigeration of the specimen.

Triple phosphate are found in alkaline urine and appear as colorless coffin lids..

Ammonium biurate is found in alkaline urine as well and look like yellow-brown thorny apples.

Calcium phosphate is found in alkaline urine and are not usually seen, they look like colorless flat rectangles or thin
prisms often found in rosette formation.

Calcium carbonate is found in alkaline urine and looks like colorless dumbbells.

Amorphous urates are found in acid urine and appear brick dust or yellow brown.

Uric acid crystals are found in acid urine and are yellow brown and come in a variety of shapes, including rhombic, four
sided flat plates, wedges, and rosettes.

Calcium oxalate crystals can be found in acid or neutral urine as bumbbells or envelopes.

Sodium urate crystals can be found in alkaline or neutral urine and are needle shaped.

Hippuric acid crystals are found in acid urine and looks like colorless thin needles elongated prisms or plates.

Yeast may be present as small retractile oval structures that may or may not have a bud, in severe infections they may
appear as branched, mycelial forms. They are seen in the urine of diabetic, immunocompromised patients and women
with vaginal moniliasis. A true yeast infection would be accompanied by the presence of WBC's.

Bacteria are not normally present in urine, but unless the specimen was collected under sterile conditions then you might
see a few bacteria present as a result of contamination. Some labs only report bacteria when WBC's are also present,
which would be indicative of either an upper or lower UTI. The specimens positive for bacteria will be sent for a urine
culture.

Artifacts may also be found in a sample and they include starch, oil droplets, air bubbles, pollen grains, fibers, fecal
matter. They often resemble pathologic elements. To distinguish between other sediment constituents artifacts are highly
refractile or occur in another microscopic plane than the true sediment constituents. Starch can be confused with fat
droplets or RBC's. Oil droplets and air bubbles can be confused with RBC's . Hair and fibers may be mistaken for casts.
Fecal contamination may look like brown amorphous matter or animal or plant fibers.

My specimen also had flagged dipstick results for Ketones (15 mg/dl), a large amount of blood a pH of 7.0 and protein
(30 mg/dl).