ANALYSIS OF URINE AND BODY FLUIDS

URINALYSIS 4 - Microscopic Examination of Urine

LEC 5 BY OFELIA A. RACAZA, RMT
SEPTEMBER 19, 2022

LESSON OUTLINE 10.1. Yeast Cells

1. Rationale and General Considerations 10.2. Spermatozoa
1.1. Specimen Preparation 10.3. Parasites
1.2. Volume 10.4. Starch
1.3. Method and Equipment for Visualization 11. Quality Control
1.3.1. Brightfield Microscopy 11.1. Guidelines
1.3.2. Phase Contrast Microscopy 11.2. Automation of Urinalysis
1.3.3. Polarized Microscopy 11.3. KOVA System Sediment Exam
1.3.4. Interference Contrast LEARNING OBJECTIVES
1.3.5. Cytodiagnostic UA ● Explain the clinical significance of performing the microscopic
1.3.6. Fluorescence Microscopy examination of urine sediments.
1.3.7. Dark Field Microscopy ● Discuss the procedure in specimen preparation for microscopic
1.3.8. Commercial Systems exam.
2. Conversion of Average Numbers to Numbers per mL ● Explain the effects of stains used to enhance visualisation of
2.1. Factors that Influence Appearance of Urinary each type of urinary structures
Sediments ● Identify the different normal & pathological microscopic
2.2. Conventional Slide Method structures in the urine sediments and the manner of reporting
3. Sediment Constituents such findings.
3.1. White Blood Cells
3.1.1. Pyuria RATIONALE
3.1.2. Glitter Cells ● To detect if abnormal physical & chemical tests results are due
3.2. Red Blood Cells to renal disease or lower UTI
3.2.1. Hematuria ○ Microscopic examination is used to rule out if test results
3.2.2. Dysmorphic RBC’s is due to renal disease or lower UTI
3.3. Epithelial Cells ● To provide information to the type of renal disease
3.3.1. Squamous Epithelial Cells
3.3.2. Urothelial Cells GENERAL CONSIDERATIONS
3.3.3. RTE Cells A. Method of specimen preparation
3.3.3.1. Columnar/Convoluted Cells B. Volume of specimen actually examined
3.3.3.2. DCT distal convoluted tubule C. Methods & Equipment for visualization
3.3.3.3. Collecting Duct RTE D. Manner of reporting results
4. Renal Fragments
5. Conditions Producing Tubular Necrosis
I.A. SPECIMEN PREPARATION
6. Oval Fat Bodies
● Freshly voided or adequately preserved urine
6.1. Lipiduria
● Midstream clean catch
7. Bacteria
○ To avoid external contamination of the sediment
7.1. Bacteriuria
● Mix properly before centrifugation
8. Casts
● RBCs, WBCs, & casts particularly hyaline, disintegrate rapidly in
8.1. Hyaline Casts
dilute alkaline urine
8.2. RBC Casts
● If the test cannot be done immediately, preserve the sample but
8.3. Bacterial Casts
must have a proper/ adequate preservation. Usually done by
8.4. Epithelial Casts
refrigeration, but the effect of refrigeration can cause ppts
8.5. Granular Casts
amorphous urates & phosphates and non-pathologic crystals
8.6. Waxy Casts
● The normal pH or reaction of urine = acidic.
8.7. Broad Casts
● The diluted urine specimen can cause false negative readings
9. Crystals found in Urine and Factors Identifying Urinary
or result
Crystals
● Warming at 37°C dissolves some of the crystals
9.1. Normal Crystals in Acidic Urine
9.1.1. Amorphous Nitrates
9.1.1.1. Uric Acid I.B. VOLUME
9.1.1.2. Sodium urate ● 10-15 mL (12 mL average)
9.1.1.3. Calcium oxalate ● A representative of the elements in the urine
9.2. Normal Crystals in Alkaline Urine ● Insufficient volume should be noted so correction be made prior
9.2.1. Amorphous Phosphates to reporting
9.2.1.1. Triple Phosphate
9.2.1.2. Calcium Carbonate Centrifugation:
9.2.1.3. Ammonium biurate ● 5 min at 400 (RCF) relative centrifugal force or 1500-2000 rpm,
9.3. Abnormal Urine Crystals for optimum amount of sediment & least chance of damaging
9.3.1. Cystine the sediments.
9.3.2. Cholesterol ● 0.5 to 1.0mL sediment volume then gently agitate
9.4. Crystals Associated with Liver Disorders ● 20ul (.02 ml) sediments used in conventional slide method.
9.4.1. Tyrosine Crystals
9.4.2. Leucine Crystals Why is it the least chance of damaging the sediments? After
9.4.3. Bilirubin centrifugation, do not slow down the centrifuge machine.. Let it slow
9.5. Drug-related Crystals down, do not break it so that the sediments won’t be destroyed
9.5.1. Sulfamide Crystals therefore, preventing the disruption of sediments.
9.5.2. Ampicillin Crystals
10. Other Structures Seen in Urine ● 0.5-1.0ml sediment volume then gently agitate
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*Once sediment is collected, the ideal amount of sediment is —--------------------------------------------------------------------------------------------

0.5-1.0ml this is to maintain uniform sediment concentration
factor. Urine after centrifugation, it is not advisable to pour off the
supernate, it should be aspirated. In fact, some of the systems
provide a pipette.
● 20ul (0.2ml) sediments used in conventional glass slide method
*Conventional glass slide method, we use 20ul or 0.2ml
sediments but some commercial systems provide slides
with chambers that are capable of containing a
specified volume of sediment.
I.C. METHOD & EQUIPMENT FOR VISUALIZATION
C.1: BRIGHTFIELD MICROSCOPY
i. Using unstained sediment
*This is the usual microscope that we use in the laboratory.
The object appears dark against a light background. The light
source emits light in the visible wavelength range.
ii. Stained sediment by supravital stain examples:
● Sternheimer Malbin stain ● KOVA Stain
● SEDI Stain ● Prescott Brodie
● Sudan III
*These are the stains that were mentioned in the learning
objective.The different stains mentioned are used to demonstrate.
C.2: PHASE CONTRAST MICROSCOPY
● Permits more detailed visualization of elements with low
refractive index (e.g. hyaline casts & crystals) which is
accompanied by adaptation of the brightfield microscopy with
the phase contrast and a matching condenser (Reference book,
Figure 6-3 Strasinger)
C.3: POLARIZED MICROSCOPY
★ Confirms presence of fat, specifically cholesterol
● As the name implies, polarizing meaning the use of polarized
light. Polarized light aids in the identification of crystals and
lipids.
● Brightfield microscopy can be adapted for polarizing microscopy
● It refract light in two dimension at 90 degrees to each other
(birefringent) - polarizing
● The elements that can be seen are birefringent (refracting light
in two dimension 90 degrees to each other)
C.4: INTERFERENCE CONTRAST
★ Produces a 3-dimensional image & layer by layer imaging of
specimen
● Not routinely use in the laboratory
● 2 types of interference contrast provide layer by layer imaging
of the specimen and enhance detail of specimen with either
low or high refractive index.
1. Modulation contrast by Hoffman
2. Differential interference contrast by Nomarski
I.D2. CONVERSION OF AVERAGE NUMBERS TO NUMBERS PER
ML
1. Calculate the area of a lpf or hpf for the microscope used
Area of a circle = πr2
Example: Diameter of hpf = 0.35mm
A = 3.14 x 0.175 2 = 0.096mm2
where: π = 3.14 (constant); r = 0.175
2. Calculation of maximum number of lpf or hpf in viewing area:
Area (22mm x 22mm) coverslip = 484mm2
484
= 5040 ℎ𝑝𝑓𝑠
0.096
3. Calculate the number of hpfs per ml urine tested using the
concentration factor & volume of sediment examined.
5040 5040
0.02𝑚𝑙 × 12
= 0.24
= 21, 000 ℎ𝑝𝑓/𝑚𝑙
4. Calculate the number of formed elements per mL by urine by
multiplying the no. of hpfs/ml by the average no. of formed
elements per field.
Example: 4 wbc/hpf x 21,000 = 84,000 wbc/ml
Note: The number of hpf or lpf/ml of urine remains the same in the
same microscope and volume of the sediments used (constant)
I.D3. Factors that influence appearance of urinary sediments
1. Cells and cast in various stages of development or degradation
2. Distortion of cells and crystals by the chemical content of the
specimen
3. Presence of inclusions in cells and casts
4. Contaminants by artifacts
*Which is why freshly voided clean catch midstream.
I.D3. Conventional Slide Method
● Routinely done in the laboratory
● Uses 22x22 mm cover slip
● Overflowing may result in the loss of heavier elements
● Avoid overflowing because cast has a tendency to locate near
the edges of the coverslip [1 drop]
● Many sediments have a reflective index same as urine and it
is essential that examination must be done under reduced
light.
● Thomas Addis in 1926 introduced a standardized method of urine
sediment identification called the ADDIS count.
● It utilized a Hemocytometer to count rbc, wbc, casts and epithelia in
a 12 hr urine sample. ,
● Identification is sometimes difficult even for experienced lab
personnel so reading of sediments is enhanced by the use of
sediments stains:

C5. CYTODIAGNOSTIC UA STAIN ACTION FUNCTION

● Employs cytocentrifugation and subjected to Papanicolaou Sternheimer-Malbin Delineates structures & Identifies WBCs,
staining (crystal violet & contrasting colors of the epithelial cells and
safranin O) nucleus & cytoplasm casts
C6. FLUORESCENCE MICROSCOPY Differentiates WBCs &
● Allows visualization of naturally fluorescent microorganisms or Toluidine Blue Enhance nuclear details RTE Renal tubular
substance stained with fluorochrome, fluorophore, or epithelial cells
fluorescent dyes to provide an image Distinguishes RBCs
● Used to detect bacteria and viruses within the cells and tissues Lyses rbcs & enhances
2% acetic acid from WBCs, yeast, oil
– called immunofluorescent technique Nuclei of wbs
droplets & crystals
Identifies free fat
C7. DARKFIELD MICROSCOPY Lipid stains: Oil Stains triglycerides & droplets &
● For the identification of Treponema pallidum, a spirochete Red O, Sudan III Neutral fats –orange red lipid-containing cells &
● Used to enhance specimens that cannot be easily seen when casts
viewed with Brightfield microscope Differentiates Gm(+) & Identifies bacterial
Gram Stain
Gm(-) bacteria casts
C8. COMMERCIAL SYSTEMS (read for this one) Methylene blue & eosin Y Identifies urinary
● KOVA ● Quick-Prep UA System Hansel Stain
stains eosinophilic granules eosinophils
● Urisystem ● R/S Workstations Prussian Blue StainStains structures Identifies yellow
● Censlide 2000 ● Count 10
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(ROUS) containing iron granules of A. HEMATURIA

{ferric iron} hemosiderin in cells & ● Increased number of RBC in the urine
casts ● Presence of intact RBC in urine
● Take note of complete urinalysis correlation in RBC
Sternheimer-Malbin ○ Specific Gravity, Reagent Strip Method, PS
Most common stain used
(Components: crystal violet & safranin O) ● It is important to take note of the appearance of urine if RBCs
Metachromatic stain Toluidine Blue is suspected
Reading assignment: conditions associated with hematuria
II. SEDIMENT CONSTITUENTS renal disease/tumor hemorrhagic
renal disease/tumor
II.1 WHITE BLOOD CELLS (PUS CELLS) disease
pyelonephritis violent exercise
PYURIA trauma to kidneys Tb of the gut
● increase number of pus cells in urine traumatic catheterization prostatitis
○ Acute glomerulonephritis passage of stones/calculi cystitis
○ Urinary tract infection
contamination with menstrual blood
○ Leukocyte esterase

GLITTER CELLS B. DYSMORPHIC RBCs

● Brownian movement of the granules
● W/n the neutrophil w/c absorbed water when exposed to
hypotonic urine.
Normal value: 0 - 5 wbc/hpf
( < 5 means increased pus cells in urine resulting to Pyuria )
● Conditions associated with the increased number of WBCs
○ Acute glomerulonephritis urinary tract infection
● Leukocyte esterase: Chemical correlation
○ What to correlate?
■ Chemical test
■ Correlate increased WBCs in the urine
● If WBCs are not exposed to hypotonic urine, it can exhibit
Brownian movement.
○ The granules will exhibit Brownian movement within the
neutrophil that absorbs water
○ Hypotonic + absorb water
■ Hypotonic urine absorbs water to exhibit Brownian
movement of the granules within the neutrophils.
Therefore, they are known as Glitter cells, more
sparkling appearance; glitters.
● Predominant WBC in the urine:
○ Neutrophils - Multilobed nucleus
● Variation of size, cellular protrusions & sometimes fragmented
● Associated with glomerular bleeding
II.3. Epithelial Cells
3A. Squamous Epithelial Cells
● Derives from the lower urinary tract, not present in the kidney,
lines the distal 1/3 of both male & female urethra entire vagina.
● Large flat cell with small central spherical nucleus
● Represents normal sloughing off of all cells
● Clue Cells:
- Gardnerella vaginalis infection (vaginal infection)
- coccobacilli covered most of the cell surface
3B. Transitional (Urothelial) Cells
● Originate from the lining of renal pelvis, cayces, ureters, bladder
& from the upper portion of the male urethra
● Smaller than squamous
● Appear in several forms: spherical, polyhedral, and caudate
● These differences are caused by its ability to absorb water
(hence the name: uroepithelial)
● Use HPO to examine transitional not LPO
● Reporting: semi-quantitative (rare/moderate)
● No clinical significance during increase in number during
catheterization
● If there is abnormal morphology such as presence of vacuoles
and irregular nucleoli, that indicates malignancy or viral infection
(this is referred to cytologic examination)

3C. Renal Tubular Epithelial Cells (RTE)

Figure 1. Microscopic Appearance
Refer also to the book to appreciate the microscopic appearance.
II.2. Red Blood Cells
Compared to WBC in appearance and microscopic:
● Smaller than WBCs
● Smooth, non-nucleated refractile, biconcave disc
● Refractile, approximately 7 mm in diameter
● Unfresh urine - colorless, ̏shadow cells ̋
● Hypersthenuric urine - concentrated urine, small & crenated
○ In hypersthenuric urine, osmolality; Therefore, that is
the effect if urine is hypersthenuric
○ Hypersthenuric: RBCs will shrink due to loss of
water
● Movement - from inside the cell, water will go out. Therefore, it
will appear crenated.
● Hyposthenuric urine - dilute urine, large swollen; termed as
“Ghost” cells.
Why is it ghost?
● Swollen and lyse, so releasing hemoglobin. Cells absorb
water, then swell, lyse and release hemoglobin.
● Most clinically significant of the three types of epithelial cells
● Shape of the cells depend on the area where they originate
● Presence of increased amount is indicative of necrosis of the
renal tubules
3C.1. Columnar/ convoluted cells
● Shape and Size: Large rectangular
● Originates from the proximal convoluted tubule
3C.2. DCT distal convoluted tubule
● Shape: Round or oval
● Size: Smaller than those from the PCT.
● Nucleus: Round and eccentrically-placed
3C.3. Collecting duct RTE
● Shape: cuboidal (never round)
● Eccentric and has at least one straight edge differentiating
from spherical or polyhedral transitional cells
● Originates from the collecting duct
RENAL FRAGMENTS
● Cells from the collecting duct that appear in groups of 3 or
more.
● Presence of more than 3 RTE cells for HPF indicates tubular
injury
↝ (Note: ma’am mentioned 3 RTE cells, but in the slide it
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indicated: “more than 2 RTE cells/ HPF indicates tubular 6A. Hyaline casts
injury) ● Unstained colorless sediments
● Presence of increased amounts is indicative of necrosis of the ● Phase contrast microscopy can be used to increase
renal tubules, with the possibility of affecting overall renal visualization
function. ● Normal value: 0-2 /Ipf
● Increased in the ff:
Conditions producing Tubular Necrosis:
○ Strenuous exercise ○ Heat exposure
○ Exposure to heavy metals ○ Pyelonephritis – allergic reactions ○ Dehydration ○ Emotional stress
○ Drug-induced toxicity ○ Acute allogenic transplant rejection
● Pathologic increase:
○ Hemoglobin & myoglobin toxicity ○ Malignant infiltrations
○ Viral infections (hep.B) ○ Salicylate poisoning ○ Acute glomerulonephritis ○ Pyelonephritis
○ Chronic renal disease ○ Congestive heart failure

Figure 2. Squamous epithelial cells
Figure 3. Transitional (in clumps) Figure 6. Hyaline Casts
6B. RBC casts
● Associated with glomerular damage with proteinuria &
dysmorphic erythrocytes.
● Positive (+) reagent strip for blood - Orange red
○ Reagent strip method is one of the parameters for test
area

Figure 4. RTE Cell

(Please refer to your reference book. – Ma’am Racaza)

II.4. Oval Fat Bodies

● Lipid-containing RTE cells, highly refractile, usually seen in
conjunction with free-floating fat droplets
● Confirmed by staining: Sudan III or Oil Red O fat stain
Figure 7. RBC Casts.
● Using polarized microscopy, it will show maltase
cross-formation 6C: WBC casts
LIPIDURIA ● Signifies inflammation within the nephron associated with
pyelonephritis from lower UTI.
● Most frequently associated with damage of the glomerulus
● Supravital staining helps differentiate WBC cast from your RTE
caused by nephrotic syndrome
cast
● Also seen in:
○ Severe Tubular Necrosis
○ Diabetes mellitus
○ Trauma that releases bone marrow fat from long bones

II.5. Bacteria
● Not normally seen in urine, unless specimen is collected in
sterile container
● To be considered significant, it should be accompanied by WBC Figure 8. WBC Casts
● Reported as few, moderate or many /hpf (semi-quantitative) 6D: Bacterial casts
BACTERIURIA ● Containing bacilli both within and bound to the protein matrix
● Increase in bacteria = UTI seen in pyelonephritis
● Findings to suspect UTI:
○ Increased pus cells (Pyuria)
○ Nitrate & Leukocyte esterase (+)

Figure 9. Bacterial Casts

6E: Epithelial casts

● Cast containing RTE cells represent the presence of advance
Figure 5.
tubular destruction
II.6. Casts
● Formed within the lumens of the distal convoluted tubules &
collecting ducts;
● Major component: Tamm-Horsfall Protein
○ Glycoprotein excreted by the renal tubule epithelial cells of
the distal convoluted tubule and the upper collecting ducts.
○ Mucus - major constituent
● Cylindruria - presence of urinary casts Figure 10. Epithelial Casts
● Shape: parallel or cylindrical shape

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6F: Granular casts II.7. Crystals found in the Urine

● In disease granules may represent disintegration of cellular ● Formed by the precipitation of urinary solutes
casts & tubule cells or protein aggregates filtered by the ○ Precipitation of urinary solutes such as inorganic salts,
glomerulus. organic compounds, medications, and iatrogenic
● 2 types: compounds
○ coarsely granular ● Subject to changes in temperature, solute concentration, and
○ finely granular pH
● Frequently seen in pathologic or nonpathologic [specimens] ○ Sample should be refrigerated in order for crystals to
● Normal origin is from the lysosomes of the RTE cells appear
● Presence in freshly voided urine is associated with concentrated
specimens (high specific gravity)
Factors in Identifying Urinary Crystals
● Characteristic shape & color ● Polarized microscopy
● Urine pH ● Solubility

Figure 11. Granular Casts

7.1. Normal Crystals in Acidic Urine:
↣ Amorphous Nitrates
6G: Waxy casts
● Representative of extreme urine stasis, indicating renal failure ↣ Brick red granules/pink sediment
● Appearance under the microscope: fragmented with jagged
ends with notched sides 7.1A. Uric Acid
↣ Yellow brown
↣ Variety in shape: rhombic, four-sided flat plates
(whetstones), wedges, and rosettes
↣ Increased levels of purines & nucleic acids
↣ Birefringent under polarized microscopy
↣ Seen in leukemia under chemotherapy, gout, and in
Leysch-Nylan syndrome
Figure 12. Waxy Casts
6H: Broad casts
● Indicates destruction of the tubular wall
● Other name for broad cast is renal failure cast

Figure 15. Microscopic appearance of amorphous urates (left) and uric acid crystals
(right)
7.1B. Sodium urate
↣ Needle-shaped
Figure 13. Broad Casts

Figure 16. Needle-shaped sodium urate crystals (left and right)

7.1C. Calcium oxalate
↣ May be related to formation of renal calculi
○ Formation of calcium oxalate crystals in fresh urine
↣ Most common form is the dihydrate, which appears as an
octahedral envelope
↣ Monohydrate - oval or dumbbell shaped crystals, not
considered normal

Figure 17. Dihydrate calcium oxalate octahedral envelope (left), monohydrate calcium
oxalate crystals (right)

7.2. Normal Crystals in Alkaline Urine:

7.2A. Amorphous phosphates

↣ Granular as a. Urates, does not dissolve in warming

↣ Opposite to urease. Urease is acidic, while phosphates is
Alkaline

Figure 14. Urinalysis & Body Fluids, 6th ed. (Strasinger & Di Lorenzo) pp. 129-130
Figure 18.
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7.2B. Triple phosphate , 7.4B. Leucine Crystals

↣ Prism shape, coffin-lid crystals ↣ Yellow brown spheroids / spheres, concentric circles, and
↣ Other name: Ammonium magnesium phosphate radial striations
↣ Birefringent under polarized microscopy

Figure 19. Figure 25.

↣ Less frequently seen w/ tyrosine but is accompanied with
7.2C. Calcium Carbonate tyrosine
↣ Colorless, dumbbell shape 7.4C. Bilirubin
↣ Reddish brown cubes in color.
↣ Seen in hepatic disorders in clumped needles in granules

Figure 20.
7.2D. Ammonium biurate Figure 26.
↣ Thorn apple crystal
7.5. Drug Related Crystals:
7.5A. Sulfamide Crystals

↣ Appear yellow to brown as bundles of needles or sheaves of

Figure 21.
wheat
↣ Inadequate patient hydration
↣ Seen in patient treated with UTI
7.3. Abnormal Urine Crystals: ↣ Vary in shape, needles rhombix(?), lipstones?, -inaudible
● Found in acid urine or rarely in neutral urine unclear word-, colorless yellow brown.
7.3A. Cystine
↣ Colorless hexagonal plates
↣ Thick or thin
↣ Positive confirmation is Cyanide nitroprusside Test.
↣ Sometimes it is mistaken as a uric acid crystal

Figure 27.
7.5B. Ampicillin Crystals
Figure 22. ↣ Long colorless, thin prism or needles tend to form bundles.
7.3B. Cholesterol ↣ Figure 6-96 refer to the book -Ofelia
↣ Broken window panes or stair-step appearance ↣ Patient history will aid in the identification
↣ Resembling rectangular plates with a knots (? not sure) in one
or more corners
↣ Associated with nephrotic syndrome, lipiduria seen in
conjunction with hepatic cast and oval fat bodies
↣ Birefringent with polarised microscopy

Figure 23.
7.4. Crystals Associated with Liver Disorders:
7.4A. Tyrosine crystals
↣ Fine colorless to yellow needles that frequently form clumps or
rosettes
↣ Associated with Disorder of Amino acid metabolism
↣ Read the description and compare it to the picture. Refer to
Figure 6-19 of the reference book
Figure 28.
7.6. Other structure seen in urine:
7.6A. Yeast cells
↣ Smaller than RBCS, budding
↣ Often confused with RBCs
↣ Mycelial form
↣ Often confused with red blood cells
↣ Seen in immunocompromised and diabetic patients with
vaginal moniliasis
↣ Refractile oval structures that will form buds
↣ Severe infection appears branched
↣ Reporting: rare, few

Figure 24.

Figure 29. Yeast cells

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II.4. Spermatozoa TYPE APPEARANCE CLINICAL SIGNIFICANCE

● Oval, slightly tapered head Hyaline ● Colorless ● Strenuous exercise
● With long flagella-like tails cast ● Homogenous protein matrix ● Stress
● for males: early ejaculation w/ rounded ends, various ● Inflammation of urogenital
● for females: postcoital sizes & shapes tract
RBC ● Protein matrix filled w/ RBCS ● Glomerulonephritis
cast ● Often many free RBCs ● Acute interstitial nephritis
● strenuous exercise
WBC Protein matrix filled w/ ● Pyelonephritis
cast WBCS ● Kidney infection (w/ bacteria,
protein, RBC)
● Glomerulonephritis w/ RBC
Figure 30. Spermatozoa casts
Epithelia Matrix filled w/ renal Epithelial renal tubular damage
II.5. Parasites l cast cells
● Trichomonas vaginalis - trophozoite Fine / Matrix filled w/ degenerating ● Urine flow stasis
● Schistosoma haematobium - ovum coarsely cells, amorphous crystals or ● UTI
NOTE: presence of parasites granular bacteria, colorless-yellowish ● Strenuous exercise
suggest fecal contamination = ● Stress
reject specimen Waxy / ● Homogenous w/ waxy, ● Tubular obstruction/dss
broad ● Thick appearance extreme urine flow stasis
● Often w/blunt uneven, ● Severe nephron damage
brittle-looking edges ● Nephrotic syndrome
Fatty Protein matrix w/ oval fat bodies ● Nephrotic syndrome
Figure 31. Parasites ● RTE cell death
● Severe crush injury w/
II.6. Starch
disruption of body fat
● With dimpled center accompanied w/ proteinuria
● Can be seen on infants whose parents are fond of putting
Pigment Hyaline matrix w/ coloration due ● Incorporated Bilirubin
powder in the inguinal area
ed to pigment incorporation (golden brown)
casts ● Hgb or myoglobin (yellow to
red brown)
Mixed ● 2 or more cell types 2 cell types in filtrate during cast
enmeshed in a protein formation initial cast formation in
matrix one tubule, followed by stasis in
● Part granular & part waxy, another wider lumen & further
any combination possible cast formation
Figure 32. Starch

III. QUALITY CONTROL IN URINALYSIS

III.1. Guidelines
● Specimen evaluation
● Physical evaluation
↝ Sp. gravity (refractometer) baselines:
w/ distilled water 1.000
Figure 33. Oil droplets & air bubbles Figure 34. Pollen grains w/ 9% sucrose 1.034
w/ 3% NaCl 1.015
w/ 5% NaCl 1.022
● Chemical examination → reagent strip
● Confirmatory test controls
● Proficiency testing

III.2. Automation of Urinalysis

Figure 35. Hair and fibers Advantages:
● Improves productivity ● Minimize variability
● Improve on TAT
(turn-around-time)
CRYSTALS pH COLOR SOLUBILITY
Examples of Automated Urine Analysers:
Cystine acid colorless ammonia. dilute HCI
● Clinitek and Atlas ● Rapimat II
Cholesterol acid colorless chloroform
● Xhemstrip Urine Analyser
Leucine acid/N yellow hot alkali or alcohol
Tyrosine acid/N colorless/yellow alkali and heat
Aspects of Automation in Urinalysis:
Bilirubin acid yellow HAc, HCI, NaOH, ether,
chloroform Chemical Tests
Sulfonamides acid/N varied acetone ↣ Use of test strip readers like Clinitek (Ames)
Radiographic dye acid colorless 10% NaOH
Ampicillin acid/N colorless refrigeration forms bundles Complete Urinalysis (chemistry/sediment/sp. gravity)
↣ YELLOW IRIS (International Remote Imaging System)
↣ Chemistry – test strip reader using reflectance photometry
↣ Sp. Gravity – sound wave frequency
↣ Sediment examination – uses planar hydrodynamic
positioning
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III.3. KOVA SYSTEM SEDIMENT EXAM

● Provides a standardized urine sediment examination using a
standard volume of 12 ml and aspiration of a fixed amount of
sediment placed in a chamber of a constant volume for
microscopic evaluation.

Miss: The speed and time of centrifugation must be consistent.

REFERENCES:
● Strasinger & Di Lorenzo, 6th ed. Urinalysis & Body Fluids, pp.
86-140, Chapter 6
● Mundt & Shanahan, 2nd ed. Graff’s Textbook of Routine Urinalysis
& Body Fluids, pp. 55-170, Chapter 5
● Brunzel, Urine & Body Fluid Analysis 2013, pp. 157-210, Chapter 8

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