Microscopic Examination of Urine

1
•To detect and identify insoluble materials
present in the urine which includes:
– RBC red blood cell; WBC white blood cell; CAST,
epithelial cells; bacteria, yeast, parasites, mucus,
spermatozoa, crystals and artifacts (11)
RWC EBY PMS CA
 1. Proper Specimen 2. Volume of urine evaluated
• Collection • Well-mixed urine
– Patient prep may or may not be done
– Random, clean catch, catheterized, etc • 12 milliliters (10-15 mL range) routine volume analyzed

• Rapid transport to lab

– Room temperature, refrigerated specimen
3. Centrifugation
Centrifugation is a technique used for the separation of particles from a solution according to
their size, shape, density, viscosity of the medium and rotor speed.
• RPM – 1200-1500
• Prompt examination • Time: 5 minutes
– Within 30 minutes of collection ideal • No brake: will resuspend pellet of sediment

4. Volume of urine resuspend 5. Volume of resuspended sediment to

Sediment examine
• 11:1 ratio desired:

– Centrifuge 12 mL of urine (when centrifuging, make sure that the

specimen has a balancer and a cover) •Glass slides with coverslip: 15 microliters using calibrated
pipette
– Decant urine using pipette, leaving 1 mL urine in
bottom of test tube

– Resuspend sediment in bottom of test tube with •No bubbles, do not overfill
the 1 mL urine volume retained

3
1. Proper Specimen
•Collection
–Patient preparation may or may not be done
–Random, clean catch, catheterized, etc

•Rapid transport to lab

–Room temperature, refrigerated specimen

•Prompt examination
–Within 30 minutes of collection ideal

4
2. Volume of urine evaluated
•Well-mixed urine

•12 milliliters ml (10-15 mL range) routine volume analyzed

3. Centrifugation
Centrifugation is a technique used for the separation of particles from
a solution according to their size, shape, density, viscosity of the
medium and rotor speed.
•RPM (revolutions per minute) – 1200-1500
•Time: 5 minutes
•No brake: will resuspend pellet of sediment 5
4. Volume of urine resuspend Sediment
•11:1 ratio desired:

–Centrifuge 12 mL of urine (when centrifuging, make sure

that the specimen has a balancer and a cover)

–Decant urine using pipette, leaving 1 mL urine in

bottom of test tube
(After decantation, remaining is 0.5 ml of liquid portion and
particles)

–Resuspend sediment in bottom of test tube with

the 1 mL urine volume retained (Resuspend by means
of agitation) 6
5. Volume of resuspended sediment to examine

•Glass slides with coverslip: 15 microliters (15 ul)

using calibrated pipette

•No bubbles, do not overfill

7
6. Consistent examination Field of View (FOV) Field of View (FOV)
FOV: what you see through the ocular lens
• Minimum ‘10-12 representative fields’

• Elements must be evenly distributed

throughout slide

• If not, prepare another wet prep

Low Power Objective

• 10x objective
• Examine perimeter of cover-slip
• Look for
–Squamous epithelial cells
–Casts
–Mucus

Field # 1
Field # 2

8
6. Consistent examination
•Minimum ‘10-12 representative fields’

•Elements must be evenly distributed throughout

slide

•If not, prepare another wet prep

Field # 1
Field # 2

9
Field of View (FOV)
FOV: what you see through the ocular lens

Field # 1
Field # 2

10
Field of View (FOV)

Field # 1
Field # 2

11
Field # 1
Field # 2

12
Low Power Objective
•10x objective
•Examine perimeter of cover-slip
•Look for
–Squamous epithelial cells
–Casts
–Mucus
• Manner of reporting (Non numerical)
Squamous, cast and mucous – rare, few, moderate,
Field # 1
Field # 2

many, too numerous to count (TNC)

13
High Power Objective
•40x objective
•Examine center area
•Look for
–RBC and WBC (red blood cell, white blood cells)
–Transitional and renal tubular cells
–Bacteria
–Yeast
–Sperm
–Trichomonads
–Crystals
• Manner of reporting (Numerical, range)
Cell or cast – numerical range
Field # 1
Field # 2

Ex. You have seen 0-4 in each field

Reporting: 0-4 RBC per HPO (0-4/hpo) 14
 8. Ensure Accuracy in Reporting
7. Report format and Microscopic results should be correlated to the physical and
terminology chemical results

• Number per low power field:

Elements Physical Chemical Exception
– 20-100 squamous epithelial cells/lpf
– 0-3 hyaline casts/lpf
RBC Turbidi +blood Numbe
– 5-10 granular casts/lpf ty RED r
color Hemoly
• Number per high power field:
– 10-25 RBC/hpf sis
– 5-10 renal tubular epithelial cells/hpf WBC Turbidity +Protein Number
+Nitrite Lysis
+leukocytes
Epithelial Turbidity Number
cells
CAST +Protein Number
Bacteria Turbidity pH Number
+nitrite and type
+Leukocytes
Crystals TUrbidity pH Number and
Color type

15
7. Report format and terminology
•Number per low power field:
–20-100 squamous epithelial cells/lpf
–0-3 hyaline casts/lpf
–5-10 granular casts/lpf (MALI)

•Number per high power field:

–10-25 RBC/hpf
–5-10 renal tubular epithelial cells/hpf

Manner of reporting
o Cell or cast – numerical range
o Squamous, cast and mucous – rare, few, moderate, many, too
numerous to count
 Elements Physical Chemical Exception
8. Ensure Accuracy in
Reporting RBC Turbidity +blood (positive) Number
(red blood RED color Hemolysis
Microscopic results cell)
should be correlated to WBC (white Turbidity +Protein Number
the physical and blood cell) +Nitrite Lysis
“Soldier” +leukocytes
chemical results Epithelial Turbidity Number
cells
Nitrite test – wbc or white CAST +Protein Number
blood cell/leukocytes in the Bacteria Turbidity pH Number
urine because of bacteria +nitrite and type
+Leukocytes
Crystals Turbidity pH Number and
Color type
17
 Microscopic Techniques

Acetic Acid, 2%
• Enhances nuclear structure of WBC
• Differentiates RBC from yeast (RBC will
hemolyze)

Brightfield vs Phase Contrast

Before Acetic Acid was added After Acetic Acid was added

18
TECHNIQUES USED TO ENHANCE VISUALIZATION

•Stains
•Microscopic techniques

Acetic Acid, 2%
•Enhances nuclear structure of WBC (white blood cells)
•Differentiates RBC from yeast (RBC will hemolyze) red blood
cells
19
Before Acetic Acid was added After Acetic Acid was added

20
 Microscopic Techniques

Brightfield vs Phase Contrast 21

 CLASSIFICATION (urine sediments) – (2)
• UNORGANIZED (2)
– Non pathologic (4)
• Acid urine – amorphous urates, uric acid, sodium urate, calcium sulfate
• Acid/Neutral/Sl alkaline (slightly alkaline) – calcium oxalate, hippuric acid
• Alkaline – amorphous phosphate, calcium carbonate, ammonium
burates, calcium phosphates
• Alkaline/neutral/sl acidic (slightly acidic) – triple phosphate, dicalcium
phosphate
– Pathologic
• Cystine
• Cholesterol
• Leucine
• Tyrosine
• Bilirubin & hematoids
 CLASSIFICATION
• ORGANIZED (“True cells”)
– RBC (red blood cell)
– WBC (white blood cells) – true/glitter cells
– Epithelial – squamous, caudal, renal
– Cylindroids
– Mucus threads
– Cast – hyaline, RBC, WBC, epithelial, granular, waxy, bacterial,
fibrous,
– Spermatozoa
– Bacteria and parasites
 RBC can resemble:
• Yeast
• Oil droplets, air bubbles
• Calcium oxalate crystals, oval form
• In concentrated urine, RBC will crenate and resemble WBC

RBCs showing rouleaux

24
 CELLS
Description Associated Conditions
Erythrocytes/RBC/red blood cells • Can originate from any part of the
• Size: 7-8 um in diameter urinary tract
• Pale or yellowish, smooth biconcave • In females, consider menstrual
disk
contamination
• No nucleus or cytoplasmic granules
• Normal: less than 2 RBC/HPF (High • Hematuria – blood in urine
power objective)

Leukocytes/WBC/White blood cells

• Can originate from any part of the
• Typically neutrophils (PMN)
urinary tract (glomerulus to urethra)
• Larger than RBC (red blood cell),
• Increased in inflammatory processes of
10-13 um in diameter
the urinary tract (pyuria)
• Brownian movement (“glitter
cells”)
• Normal: no more than 2
WBC/HPF (High power objective) 25
Leukocytes/WBC/
White blood cells
(“glitter cells”)
RBC (red blood cell) can resemble:
•Yeast
•Oil droplets, air bubbles
•Calcium oxalate crystals, oval form
•In concentrated urine, RBC will crenate and resemble WBC (white blood
cell)
RBCs showing rouleaux – stack of coins

It indicates:
- Infection
- Multiple myeloma
- Inflammation
- Connective tissue
disorder

27
WBC (white blood cell) can resemble:
•Renal tubular epithelial cells
•Crenated RBC (red blood cell)
•Transitional epithelial cells

WBC (white blood cell)

Leukocytes

• Cytoplasm contains granules

• Nucleus is segmented (lobed)
• Can be found singly or in clumps

 5 WBC/leukocytes: Neutrophil, eosinophil, basophils,

lymphocytes, monocytes
 NEUTROPHILS – mostly seen in urine
28
 Epithelial Cells
Epithelial Cells
•Found in urine due to •Three types:
–Normal sloughing of –Squamous epithelial cells
old cells from lining of –Transitional epithelial cells
genitourinary system –Renal tubular epithelial cells

–Inflammation of the
lining

–Renal disease
29
 Renal Tubular Epithelial Cells
• Slightly larger than WBC (white
blood cells)
• Flat, cuboidal or columnar
• One large round nucleus
Transitional Epithelial Cells
• 2-4 times larger than leukocytes
• Round, pear-shaped, tail-like
projections
• Large round nucleus
Squamous Epithelial Cells
• Large, flat, irregular-shaped
cells
• Tubular damage, pyelonephritis, ATN
Acute tubular necrosis, salicylate
intoxication, transplant rejection
For example, patient has undergone a
kidney transplant and seen RTE (Renal
tubular epithelial cells, meaning the body
doesn’t accept the kidney has been
transplanted
• Principally from the urethra and vagina
• (Lack of washing the vagina, non
pathologic)
Squamous Epithelial Cells Transitional Epithelial Cells

RTE Cells

32
 Transitional Epithelial Cells
Squamous Epithelial Cells

33
34
RTE Cells (Renal Tubular Cells)

35
Casts Cast Formation Enhanced By:
• Acidity of urine

• Presence of casts reflect health status

of renal tubules • Increased solute concentration

• Normal: few hyaline or few granular casts • Decreased urine flow rate (urine stasis)

• Abnormal: increased number and type • Presence of plasma proteins (albumin,

of cast significant globulins, hemoglobin, myoglobin)

36
Casts
- It has different types
•Presence of casts reflect health status of renal
tubules

•Normal: few hyaline or few granular casts

•Abnormal: increased number and type of cast

significant
37
Cast Formation Enhanced By:
•Acidity of urine

•Increased solute concentration

•Decreased urine flow rate (urine stasis)

•Presence of plasma proteins (albumin, globulins,

hemoglobin, myoglobin)
38
39
 Cast
Identification/Classification
•Youngest cast is the
hyaline, oldest is
waxy

•Cast becomes waxy

as the cast ages and
substances inside
the cast degenerate

40
 Cast
Identification/Classification
•Youngest cast is the
hyaline, oldest is
waxy

•Cast becomes waxy

as the cast ages and
substances inside
the cast degenerate

41
 Cast Identification/Classification
•Youngest cast is the hyaline, oldest is
waxy
•Hyaline, Granular, Epithelial Cell, Fatty Cast
(Oval Fat bodies), Waxy
•Cast becomes waxy as the cast ages and
substances inside the cast degenerate

42
 Cast
Hyaline Cast
• Most frequently observed
• Tamm-Horsfall protein (very low
refractive index) • Can be found in normal urine
• Colorless, homogenous and • Physical exercise and dehydration
transparent • Non pathologic
• Rounded ends

Waxy
WaxyCast
Cast • Severe chronic renal failure, malignant
• • Very hypertension, diabetic nephropathy
Veryhigh
highrefractive
refractiveindex
index
•• Yellow,
Yellow,gray
grayororcolorless
colorless
•• Smooth
Smoothhomogenous
homogenousappearance
appearance
•• Short,
Short,broad
broadwith
withblunt
bluntororbroken
brokenends
ends
•• Cracked
Crackedororserrated
serratededges
edges • Second most common type of cast
Granular Cast
• Can result either from the breakdown of cellular casts,
• Large and coarse granules or the inclusion of aggregates of plasma proteins (ex.
Albumin) or immunoglobulin light chains
• Significance: chronic failure, as with hyaline casts, can
also be seen for a short time following strenuous
exercise 43
Epithelial Cell Cast • Stasis and desquamation of renal
tubular epithelial cells following
tubular damage and necrosis

Fatty Cast (Oval fat bodies) • Fatty degeneration of the tubular

epithelium in degenerative
• Maltese-cross pattern under tubular disease
polarized light
• Chronic Kidney Disease (CKD)
Maltese cross – looks like “V”
 Crystal Identification

• Microscopic appearance

Crystals • Urine pH
Crystal Formation
• Not normally found in fresh urine Enhanced By
Crystals
• Increased concentration
• If found in fresh urine, pathologic
of solute in urine • Normal acid pH crystals

• Crystals precipitate as urine

• Urine pH • Normal alkaline pH
cools to room temp or when
crystals
urine is refrigerated
• Urine stasis
• Pathologic crystals
• All clinically significant crystals
• Temperature found in acid or neutral
are found in acid urine
urine

• Drug induced crystals

45
Crystals Crystal Formation Crystal Identification

•Not normally found in fresh urine Enhanced By •Microscopic appearance

•Increased •Urine pH
•If found in fresh urine, pathologic concentration of
Crystals
solute in urine
•Crystals precipitate as urine •Normal acid pH crystals

cools to room temperature or •Urine pH

•Normal alkaline pH crystals
when urine is refrigerated

•Urine stasis •Pathologic crystals found in acid

•All clinically significant crystals Decreased urine flow or neutral urine
are found in acid urine rate
•Drug induced crystals

•Temperature
NORMAL CRYSTALS
• Uric acid
• Calcium Oxalate
• Hippuric
• Calcium phosphate
• Triple phosphate
• Calcium Carbonate
• Ammonium biurate

ABNORMAL CRYSTALS
• Bilirubin
• Cholesterol
• Cystine
• Leucine
• Tyrosine
• Sulfa
• Acyclovir
• Indinavir
 Amorphous Urates
Normal Acid pH • These crystals have no distinct form
and appear as sand-like granules
microscopically

Crystals • Macroscopicall
y appear as a
• Amorphous urates pink sediment
• Uric acid after urine
centrifugation
• Calcium oxalate
• Acid pH urine

Uric Acid Crystals

• Acid pH urine
• Appear in several forms
• Multicolored when polarized
• Diamond shape most common form

Calcium Oxalate Crystals

• Acid pH urine

• Most frequently observed crystal in

urine

• Most common form is octahedryl

shape, often referred to as an
‘envelope’ shape

• Multicolored when polarized

48
 Amorphous Urates
Normal Acid pH • These crystals have no distinct form
and appear as sand-like granules
microscopically

Crystals • Macroscopicall
y appear as a
• Amorphous urates pink sediment
• Uric acid after urine
centrifugation
• Calcium oxalate
• Acid pH urine

Uric Acid Crystals

• Acid pH urine
• Appear in several forms
• Multicolored when polarized
• Diamond shape most common form

Calcium Oxalate Crystals

• Acid pH urine

• Most frequently observed crystal in

urine

• Most common form is octahedryl

shape, often referred to as an
‘envelope’ shape

• Multicolored when polarized

49
Amorphous Urates
•These crystals have no distinct form and
appear as sand-like granules microscopically

•Macroscopically appear as a pink

sediment after urine centrifugation

•Acid pH urine
•Normal acid crystals
•Non pathologic
•No significance in fresh urine
•To make sure it is amorphous urates use two
or they dissolves into two ways (soluble):
1. Heat
2. Sodium Hydroxide (NaOH)

50
Uric Acid Crystals
•Acid pH urine
•Appear in several forms such as:
1. Rosette formation
2. Barrel formation Diamond shape

3. Rhombic formation Rosette formation

4. Whetstone formation
5. Diamond – most common
•Multicolored when polarized
Rhombic formation
•Diamond shape most common form
•It may indicate kidney stone
•Soluble (dissolves) in two:
1. Heat
2. Sodium Hydroxide (NaOH)
51
Calcium Oxalate Crystals (CaOx)
•Acid pH urine

•Most frequently observed crystal in

urine

•Most common form is octahedryl

shape, often referred to as an
‘envelope’ shape

•Multicolored when polarized

•Sometimes indicate kidney stones
•Soluble (dissolves) in: Hydrochloric
acid (HCl) Hydrogen Chloride
•Insoluble in: Hydrogen Acetate
(C4H8O4) 52
 Amorphous Phosphates
Normal Alkaline pH • These crystals have no distinct form and appear as sand-like
granules microscopically
Crystals
• Macroscopically appear as a white
• Amorphous phosphates sediment after urine centrifugation
• Triple phosphate
• Ammonium biurate • Alkaline pH urine
• Calcium carbonate

Triple Phosphate vs Calcium

Oxalate

Triple Phosphate Crystals

• Most frequently observed crystal
in alkaline urine

• Colorless, 4-6 sided prisms

• Referred to as ‘coffin lid crystals’

Ammonium Biurate Crystals

• Alkaline pH urine

• Yellow spheres with spicules on surface

• Referred to as ‘thorny apple crystals’

• Significant when found in fresh urine

• Presence indicates urine is old

53
 Amorphous Phosphates
Normal Alkaline pH • These crystals have no distinct form and appear as sand-like
granules microscopically
Crystals
• Macroscopically appear as a white
• Amorphous phosphates sediment after urine centrifugation
• Triple phosphate
• Ammonium biurate • Alkaline pH urine
• Calcium carbonate

Triple Phosphate vs Calcium

Oxalate

Triple Phosphate Crystals

• Most frequently observed crystal
in alkaline urine

• Colorless, 4-6 sided prisms

• Referred to as ‘coffin lid crystals’

Ammonium Biurate Crystals

• Alkaline pH urine

• Yellow spheres with spicules on surface

• Referred to as ‘thorny apple crystals’

• Significant when found in fresh urine

• Presence indicates urine is old

54
Normal Alkaline pH Crystals

1. Amorphous phosphates
2. Triple phosphate
3. Ammonium biurate
4. Calcium carbonate

55
Amorphous Phosphates
•These crystals have no distinct form and
appear as sand-like granules
microscopically

•Macroscopically appear as a
white sediment after urine
centrifugation

•Alkaline pH urine
•It is the same as amorphous urates but
the difference is the pH because this is
alkaline
•Amorphous phosphate - white
•Amorphous urates - pink 56
Triple Phosphate Crystals
•Most frequently observed crystal in alkaline urine
•Colorless, 4-6 sided prisms
•Referred to as ‘coffin lid crystals’

Triple Phosphate vs Calcium Oxalate

57
Ammonium Biurate Crystals
•Alkaline pH urine

•Yellow spheres with spicules on surface

•Referred to as ‘thorny apple crystals’

•Significant when found in fresh urine

•Presence indicates urine is old

58
Pathologic Crystals (acid, Cystine Crystals
neutral pH) • Colorless hexagonal plates

• Cystine
• Tyrosine • Do not polarize
• Leucine
• Cholesterol
• Bilirubin • Can be confused with uric acid crystals

Cystine vs Uric Acid Crystals

Cholesterol Crystals
• Clear, large, flat, rectangular plates with notched corners

• Multicolored when polarized

Cystine Crystal Uric Acid Crystal

Acid pH urine Acid pH urine
• Can be confused with radiographic dye crystals
Do not polarize light Multicolored when polarized

Cholesterol Crystals
Leucine Crystals
•Yellow-brown spheres with concentric
circles on surface
•Can resemble free fat globules
Bright field Light vs Polarized Light

59
Pathologic Crystals (acid, Cystine Crystals
neutral pH) • Colorless hexagonal plates

• Cystine
• Tyrosine • Do not polarize
• Leucine
• Cholesterol
• Bilirubin • Can be confused with uric acid crystals

Cystine vs Uric Acid Crystals

Cholesterol Crystals
• Clear, large, flat, rectangular plates with notched corners

• Multicolored when polarized

Cystine Crystal Uric Acid Crystal

Acid pH urine Acid pH urine
• Can be confused with radiographic dye crystals
Do not polarize light Multicolored when polarized

Cholesterol Crystals
Leucine Crystals
•Yellow-brown spheres with concentric
circles on surface
•Can resemble free fat globules
Bright field Light vs Polarized Light

60
Pathologic Crystals (acid, neutral pH)

•Cystine
•Tyrosine
•Leucine
•Cholesterol
•Bilirubin
 Cystine Crystals
•Colorless hexagonal plates
•Do not polarize
•Can be confused with uric
acid crystals
•It may indicate CKD (Chronic
Kidney Disease)
Do not polarize light
- Not multicolored

62
 Cystine vs Uric Acid Crystals

Cystine Crystal Acid pH urine Uric Acid Crystal Acid pH urine

Do not polarize light Multicolored when polarized
- Not multicolored
Cholesterol Crystals
•Clear, large, flat, rectangular plates
with notched corners

•Multicolored when polarized

•Can be confused with radiographic

dye crystals

•It may indicate high in protein and

nephrotic conditions
Cholesterol Crystals

Bright field Light vs Polarized Light

65
Leucine Crystals
•Yellow-brown spheres with
concentric circles on
surface
•Can resemble free fat
globules
•“scallop-lily” crystals

66
• Tyrosine crystals
– Colorless fine needles grouped in clusters or sheaves
crossing at various angles
– Clusters may appear black in the center soluble in ammonium
hydroxide and HCl hydrogen chloride/Hydrochloric acid but not
in HAC (hydrogen acetate)
• BILIRUBIN & HEMATOIDIN
– Yellow/ rhomic/ ruby red crystals
– May appear as plates, needles or granules
Other Microscopic Bacteria
Elements • Most often rod-shaped
• Bacteria • Vary in size
• Yeast, mycelial elements • Must use high power
(pseudohyphae) objective
• Fat • Presence may indicate
• Trichomonas vaginalis –UTI
• Sperm – Contamination
• Mucus • Correlate with
–Nitrite reagent strip
• Starch, talc
• Fibers
• Glass, plastic

Fat
• Highly refractile
Yeast and Mycelial • Found in 3 forms:
Elements – Within fatty cast Free fat droplet,
– Within oval fat body bright field
• Budding – Free fat droplet
forms or Ova
singly l fat
• Ovoid and bodi
more es
refractile than
RBC
• Will not lyse Free fat droplet,
with acetic polarized
Fatty cast
acid
• Note pseudohyphae

69
Other Microscopic Bacteria
Elements • Most often rod-shaped
• Bacteria • Vary in size
• Yeast, mycelial elements • Must use high power
(pseudohyphae) objective
• Fat • Presence may indicate
• Trichomonas vaginalis –UTI
• Sperm – Contamination
• Mucus • Correlate with
–Nitrite reagent strip
• Starch, talc
• Fibers
• Glass, plastic

Fat
• Highly refractile
Yeast and Mycelial • Found in 3 forms:
Elements – Within fatty cast Free fat droplet,
– Within oval fat body bright field
• Budding – Free fat droplet
forms or Ova
singly l fat
• Ovoid and bodi
more es
refractile than
RBC
• Will not lyse Free fat droplet,
with acetic polarized
Fatty cast
acid
• Note pseudohyphae

70
Other Microscopic Bacteria
Elements
•Most often rod-shaped
•Bacteria
•Yeast, mycelial elements •Vary in size
(pseudohyphae) •Must use high power
•Fat objective
•Trichomonas vaginalis •Presence may indicate
•Sperm –UTI (Urinary tract infection)
•Mucus –Contamination
•Starch, talc Correlate with
•Fibers
–Nitrite reagent strip
•Glass, plastic 71
Yeast and Mycelial
Elements
•Budding forms
or singly
•Ovoid and more
refractile than
RBC (red blood
cell)
•Will not lyse with
acetic acid
•Note pseudohyphae 72
Fat
•Highly refractile
•Found in 3 forms:
–Within fatty cast
–Within oval fat body/Fatty Cast
–Free fat droplet Free fat droplet, bright field

Oval fat bodies

Free fat droplet, polarized

73
Fatty cast
 Trichomonas vaginalis
• Round to lemon-pear
shape
• Undulating membrane
and flagella provide
movement
• Sexually transmitted
• Similar in size with
WBC and RTE
• Can be confused with

Spermatozoa Mucus
• May be seen in • Low refractive
index makes
male and it difficult to
female urine see

• Usually not • Wavy, delicate

clinically ribbon-like
significant strands or
unless threads
– Post vasectomy
– Rape
• Can be
– Child urine mistaken for
hyaline cast

Fibers
• Contaminant
• Large, with distinct edges
• Misidentified as casts

74
Trichomonas vaginalis

•Round to lemon-pear
shape
•Undulating membrane and
flagella provide movement
•Sexually transmitted
•Similar in size with WBC
(white blood cells) and
RTE (renal tubular
epithelial cells)
•Can be confused with
75
Spermatozoa
•May be seen in male
and female urine

•Usually not clinically

significant unless
–Post vasectomy
–Rape
–Child urine
76
Mucus
•Low refractive index
makes it difficult to
see

•Wavy, delicate ribbon-

like strands or threads

•Can be mistaken for

hyaline cast
77
Fibers
•Contaminant
•Large, with
distinct
edges
•Misidentified as
casts

78