UNIVERSIDAD DE STA.

ISABEL
Naga City

BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY

CHAPTER 6

SEDIMENT
CONSTITUENT
Jan Ethan V. Lovendino, RMT, MSPH
Clinical Instructor
 Urine Sediment Constituents
 Small amounts of constituents can be
normal or pathogenic based on the
clinical picture
 Many urines have just a rare epithelial cell
 Some constituents are easily distorted
 Concentrations, pH, and presence of
metabolites
 Normals are not clearly defined
RBC
 RBC (Hematuria)
 RBC (Hematuria)- NV= 0-2 + 0-3/ HPF
 Smooth, non-nucleated, biconcave disks
 Hypertonic=_____________________________
 Hypotonic =_____________________________
 Glomerular membrane damage:
_________________________________
 Sources of error:Yeast, oil droplets, Air bubbles, Calcium
oxalate Crystals
 Remedy:
 RBC (Hematuria)
 Dysmorphic RBCs
 Glomerular bleeding
 Strenuous exercise
 Acanthocytic, blebs
 Fragmented, hypochromic
 Aid in diagnosis
RBC (Hematuria)
RBC (Hematuria)
 Air Bubbles
RBC (Hematuria)
 Oil Droplets
WBC
 WBCs (Pyuria, or Leukocyturia)
 Increased number indicates the presence
of an infection or inflammation

 Neutrophils (predominant)
 Granulated and multilobed
 In ____________________, granules swell and undergo
______________________, producing a sparkling
appearance (_____________________)- no pathologic
significance
 WBCs (Pyuria, or Leukocyturia)

Eosinophils
 Normal Value =________________
 Significant =________________-
Associated w/ drug-induced interstitial
nephritis
 WBCs (Pyuria, or Leukocyturia)

 Mononuclear
cells:
 Lymphocytes,
Monocytes,
Macrophages,
Histiocytes)- in small
numbers
 Urine Sediment Constituents
 Normal = <5 per hpf, more in females
 May enter through glomerulus or trauma
but also by amoeboid migration
 Increased WBCs = pyuria
 Infections: cystitis, pyelonephritis,
prostatitis, urethritis
 Glomerulonephritis, lupus erythematosus,
interstitial nephritis, tumors
 Report presence of bacteria
EPITHELIAL
CELLS
 Epithelial Cells
 Squamous epithelial cell
 ______________________ w/ abundant, irregular
cytoplasm & prominent nucleus
 From linings of vagina, female urethra & lower portion of
male urethra
 Variation: _________________
 Squamous epithelial cell covered with Gardnerella
vaginalis
 Associated with bacterial vaginosis
with Gardnerella vaginalis
 Transitional epithelial
(urothelial) cell
 Spherical, polyhedral, caudet with
____________________________
 Derived from the linings of renal pelvis, ureter,
urinary bladder &upper portion of male
urethra
 Increased numbers are seen following
catheterization
Transitional epithelial
(urothelial) cell
 Renal tubular epithelial
(RTE) cell
 Renal tubular epithelial (RTE) cell
 ______________________________________________________
 Origin: _____________________________
 Rectangular, polyhedral, cuboidal or columnar with an
_________________
 >2 RTE/hpf indicates ________________________________
 Renal tubular epithelial
(RTE) cell
 PCT CELLS
 Larger than other RTEs
 Columnar, convoluted, rectangular
 May resemble casts
 Coarsely granular cytoplasm
 Notice presence of nucleus
 Renal tubular epithelial
(RTE) cell
 DCT CELLS
 Round or oval shaped, smaller
 May resemble WBCs or spherical transitional cells
 Observe the eccentrically placed nucleus to differentiate from
spherical transitional
 Renal tubular epithelial
(RTE) cell
 COLLECTING DUCT RTEs
 Cuboidal, never round
 At least one straight edge
 Eccentric nucleus
 Three or more cells in clump is renal fragment; often
large sheets
 PCT and DCT not seen in clumps
 Renal tubular epithelial
(RTE) cell
RTE variations:
 I. ______________________________
 Lipid containing RTE cells
 Seen in lipiduria (ex: Nephrotic Syndrome)
 Identified by:
 -Lipid stains (TG & neutral fats)
 -Polarizing microscope (cholesterol- “Maltese cross”)
 Renal tubular epithelial
(RTE) cell
 II. _________________
 RTE cells w/ nonlipid-filled
vacuoles
 Seen in _____________
 REPORTING OF EPITHELIAL CELLS
Rare, few, moderate, many
 Squamous (LPF)
 Transitional (HPF)
Average number per HPF
 RTE cell
 Oval fat body
BACTERIA
 BACTERIA
Bacteria
 UTI=_____________________
 Enterobacteriaceae (ex. E. coli)= Most
common cause of UTI
 Staphylococcus, Enterococcus

Reporting of Bacteria
Few, moderate, or many per / HPF
YEAST
 YEAST
 True yeast infection= ______________
 Small, refractile oval structures that may or
may not bud
 ________= seen in DM & vaginal moniliasis

Reporting of Yeasts
Rare, few, moderate, or many per HPF
YEAST
PARASITES
 PARASITES
Trichomonas vaginalis
 _____________
 Pear-shaped flagellate with jerky motility
 Agent of _____________________
 Usually reported as Rare, few, moderate or many per HPF

Schistosoma haematobium ova

 Blood fluke with terminal spine
 Causes hematuria
 Specimen =________________________

 Enterobiusvermicularis ova
 ____________________
YEAST
SPERMATOZOA
 SPERMATOZOA
 Spermatozoa
After sexual intercourse

Reporting:
Present, Based
on laboratory
protocol
MUCUS
 MUCUS
 Mucus threads
 Major constituent= ___________

Reporting:
Rare, few, moderate, or many per LPF
CAST
 CAST
 Unique to the kidney
 Formed in the _______
 Major Constituent= __________
 Produced by RTE cells
 Performed along the edges of the
cover slip subdued light
 CAST
Formation of Casts
 Aggregation of Tamm-Horsfall protein into individual
protein fibrils attached to the RTE cells
 Interweaving of protein fibrils to form a loose
fibrillary network
 Further protein fibril interweaving to form a solid
structure
 Possible attachment of urinary constituents to the
solid matrix
 Detachment of protein fibrils from the epithelial cells
 Excretion of the cast
 CAST

HYALINE  CELLULAR 
COARSELY GRANULAR 
FINELY GRANULAR  WAXY
 CAST
CAST INFORMATION CLINICAL
SIGNIFICANCE
Hyaline Cast Prototype cast Physiologic:
Beginning of all types of casts  Stress
NV= 0-2/LPF  Strenuous exercise
Pathological
 Glomeulornephritis
 Pyelonephritis
 Congestive heart
failure
Hyaline cast
Hyaline cast
Hyaline cast
 CAST
CAST INFORMATION CLINICAL
SIGNIFICANCE
RBC Cast Bleeding within nephron  Glomerulonephritis
 Strenuous exercise
RBC cast
 CAST
CAST INFORMATION CLINICAL
SIGNIFICANCE
WBC Cast Inflammation within the  Pyelonephritis
nephron  Acute interstitial
May be confused with nephritis
epithelial cell casts. To
differentiate:
 Phase microscopy
 Supravital stain
WBC cast
 CAST
CAST INFORMATION CLINICAL
SIGNIFICANCE
Bacterial Cast Identified by performing Pyelonephritis
Gram stain
 CAST
CAST INFORMATION CLINICAL
SIGNIFICANCE
Epithelial (RTE) --  Advance tubular
cell cast destruction
 Renal tubular damage
EPITHELIAL cast
 CAST
CAST INFORMATION CLINICAL
SIGNIFICANCE
Fatty Cast Not stained with starnheimer-malbin  Nephrotic syndrome
stain
Identification:
 Neutral Fats:_______________
 Cholesterol:_________________
FATTY cast
 CAST
CAST INFORMATION CLINICAL
SIGNIFICANCE
Granular Cast Granules are derived from the  Glomerulonephritis
lysosomes of RTE cells during  Pyelonephritis
normal metabolism  Stress
(nonpathogenic)  Strenuous exercise
GRANULAR cast
 CAST
CAST INFORMATION CLINICAL
SIGNIFICANCE
Waxy Cast Final degenerative form of all  Stasis of urine flow
types of casts  Chronic renal failure
Brittle, highly refractile with
jagged ends
WAXY cast
 CAST
CAST INFORMATION CLINICAL
SIGNIFICANCE
Broad Cast A.k.a.____________  Extreme urine stasis
Indicates destruction  Renal failure
(widening ) of the tubular
walls.
Any type of cast can be broad
BROAD cast
URINARY CRYSTALS
 Crystal Formation
•Precipitation of urine solutes: salts, organic
compounds, and medications
•Formation based on temperature, solute
concentration, and pH
•Many crystals in refrigerated specimens
•High specific gravity needed in fresh specimens
Normal Urine Crystal

Acidic Urine
 NORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Amorphous urates -Brick dust/ yellow -- Alkali & heat
brown granules
-pink sediment
(uroerythrin)
 NORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Uric acid -product of purine Lesch-Nyhan Alkali
metabolism syndrome
-Rhombic, wedge, Chemotherapy
hexagonal, four-sided flat (increased
plate (whetstone), metabolism of cell
Lemon-shaped- Henrys nuclie) Gout
 NORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Calcium oxalate Forms: High food high in Dilute HCl
1. Dihydrate ascorbic
(Wheddelite) (Tomato/asparagus)
______________ Ethylene glycol
1. Monohydrate poisoning
(Whewellite) (anti-freeze agent)
_______________ High
_______________
 NORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Calcium sulfate “Cigarette-butt” in -- Acetic
appearance acid
 NORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Hippuric acid Yellow-brown or -- H2O,
colorless elongated ether
prisms
Normal Urine Crystal

Alkaline Urine
 NORMAL URINARY
CRYSTALS
ALKALINE URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY

Amorphous Granular in -- Dilute

phosphates appearance acetic acid
White precipitate
 NORMAL URINARY
CRYSTALS
ALKALINE URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Calcium Colorless, flat plates, -- Dilute acetic
phosphate/ Apetite thin prisms in rosette acid
form
Rosettes may resemble
sulfonamide crystals
Other forms:
a. Hydroxyapatite
(basic calcium
phosphate)
b. Brushite (calcium
hydrogen
phosphate)
 NORMAL URINARY
CRYSTALS
ALKALINE URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY

Calcium Small, colorless, -- Gas from

carbonate dumbbell or acetic acid
spherical-shaped
Formation of gas
(effervescence
after adding acetic
acid)
 NORMAL URINARY
CRYSTALS
ALKALINE URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY

Ammonium Yellow-brown Presence of Acetic

biurate “thorny apples” urea-splitting acid with
Seen in old bacteria (urea heat
specimens ammonia)
 NORMAL URINARY
CRYSTALS
ALKALINE URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY

Triple Colorless, prism- Presence of Dilute

phosphate/ shape or “coffin- urea-splitting acetic acid
Magnesium lid” bacteria (urea
ammonium Feathery ammonia)
phosphate/ appearance when
Struvite they disintegrate
Fern-leaf
Abnormal Urine Crystal

Acidic Urine
 ABNORMAL URINARY
CRYSTALS
ACIDIC URINE

CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY

Cystine Colorless Cystinuria Ammoni

hexagonal plates Cystinosis um,
Mistaken as uric dilute
acid crystals HCl
 URIC ACID CYSTINE
Color
Solubility in
ammonia
Solubility in dilute
HCl
Birefringence (ability
to refract light in 2
direction)
Cyanide-
nitroprusside reaction
 ABNORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Cholesterol Rectangular plates Nephrotic Chloroform
w/ a notch in one or syndrome
more corners (Lipiduria)
(staircase pattern)
Responsible crystals
of radiographic
 ABNORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Radiographic dye Similar to cholesterol -- 10% NaOH
crystals
To differentiate the 2
crystal:
 Patient history
 Correlation w/ other
UA results
 Radiographic dye=
SG >1.040
(refractometer)
 ABNORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY

Tyrosine Colorless to Liver disease Alkali or

yellow needles (most heat
in clumps or common)
rosettes
 ABNORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Leucine Yellow-brown Liver disease Hot alkali
spheres with or alcohol
concentric circles
& radial striations
Precipitated with
tyrosine after
adding alcohol
 ABNORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Bilirubin Clumped needles or Liver disease Acetic acid,
granules with bright HCl, NaOH,
yellow color ether,
chloroform
 ABNORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Sulfonamide Colorless to yellow- Possible tubular Acetone
brown needles, damage
sheaves of wheat, (may deposit in
rosettes, arrowhead, nephrons)
petals, & round forms
May be mistaken as
calcium phosphate
crystals. To
differentiate:
 Calcium phosphate:
soluble in acetic
acid
 Sulfonamide= (+)
Lignin test, Diazo
reaction
ABNORMAL URINARY
CRYSTALS
ACIDIC URINE
 ABNORMAL URINARY
CRYSTALS
ACIDIC URINE
CRYSTAL INFORMATION SIGNIFICANCE SOLUBILITY
Ampicillin Colorless needles Massive doses Refrigerati
that tend to form of penicillin on forms
bundles following bundles
refrigeration
 ABNORMAL URINARY
CRYSTALS
ACIDIC URINE
URINARY SEDIMENT ARTIFACTS
1. Starch granules 1. Oil droplets
 Spheres with dimples centers 2. Air bubbles
 “Maltese cross” formation on 3. Pollen grains = spheres w/ a cell
polarizing microscope: wall & concentric circles
 ________________________ 4. Hair & fibers = mistaken for casts
 ________________________ 5. Fecal contamination
 ________________________
 ________________________