CLLS 3231

URINALYSIS AND BODY

FLUIDS

MICROSCOPIC EXAMINATION
Formed Elements: Cellular, Casts,
Bacteria and Yeast
 Standardization of Specimen
Preparation
• Commercial Systems
• Specimen volume

• Centrifugation

• Sediment Concentration

• Volume of Sediment Viewed

 Comparison of Standardized UA Systems
Count 10
KOVA System URISYSTEM
Features System
(ICL Scientific) (Fisher Scientific)
(V-Tech Inc.)
Initial Volume 12 ml 12 ml 12 ml
Final vol. w/ sediment 0.8 ml 1.0 ml 0.4 ml
Sediment concentration 15:1 12:1 30:1
Volume sediment used 6 l 6 l 16 l
Viewing area 36 mm2 32 mm2 90 mm2
# LPF’s (10x) 11 10 28
# HPF’s (40x) 183 163 459
Coverslip type Acrylic Acrylic Glass
#Specimens/slide 10 4, 10 4
 Methods to Increase Contrast
• Staining Techniques
– Supravital Stains

– Fat or Lipid Stains

– Acetic Acid
– Gram Stain
– Hansel’s Stain
 Microsocpic Techniques

• Examine within 2 hours of collection

• Correlation with physical and chemical results
• FIRST
– Scan using low (10X) power and report LPF for
certain elements
• SECOND
– Scan high (40X) power and report as indicated
 Formed Elements: RBCs

• Appearance
– hypertonic
– hypotonic
• Differentiate from yeast, oil, etc..

• Correlate with physical examination

 Formed Elements: RBCs

• Correlate with chemical examination

– False Positive Chemical

– False Negative Chemical

• Clinical Significance - Handout

RBC’s Cont...
RBC’s
 Formed Elements: WBC’s

• Appearance

• Correlation with Physical Examination

• Correlation with Chemical Examination

 Formed Elements: WBC’s

• Look-alikes:

• Eosinophiluria

• Lymphocytes
• Monocytes and Macrophages
WBC’s
WBC’s Cont...
Macrophage
 Formed Elements: Epithelial
Cells
• Presence:

• Squamous Epithelial Cells

– Most Common
– Largest
 Squamous Epithelial Cells

• Specimen Contamination

• Low Power magnification

Squamous Epithelal Cells
 Transitional (urothelial)
Epithelial Cells
• Location:

• Description

• UTI
Transitional Epis.
 Renal Tubular Epithelial Cells

• Each renal tubule is lined with a single

layer of a characteristically different
epithelium
– Convoluted Renal Tubule
• Proximal convoluted tubular cells
• Distal convoluted tubular cells
– Collecting Duct Cells
Renal with Squamous Epis
 Convoluted Renal Tubular Cells
• Description

• Differentiation

• Clinical Significance

• Oval Fat Bodies

Renals Continued...
 Collecting Duct Epithelial Cells

• Description

• Clinical Significance

• Fragments
 Comparison of Epithelial Cells from the Urinary Tract

EPITHELIAL CELL SIZE

SHAPE NUCLEUS
TYPE (DIAMETER)

Thin, flagstone shape, with distinct edges. Small (approx. 8 m), centrally located,
Squamous 40 - 60m Large amount of cytoplasm with fine can be anucleated.
granulation that increases with age.

Variable, depending on cell layer. Small (8 - 14m), centrally located,

Transitional (urothelial)
Superficial layer: large, round or pear oval to round with variable density in
shape; Intermediate layer: smaller and the chromatin pattern
20 - 40m
rounder; Deep basal layer: small and can
be elongated or columnar-like. Cell edges
are distinct and appear “firm”.

Renal Tubular Epithelial Cells

Variable. Polygonal or cuboidal from small Large, moderately dense, round

ducts; columnar from larger ducts. nucleus that takes up approx. 2/3’s
Collecting duct cells 12 - 20m Relatively smooth cytoplasm cytoplasm. Columnar cells the nucleus
is usually slightly eccentric.

Distal Convoluted Oval to round with grainy cytoplasm. Small, round, dense nucleus; centered
14 - 25m or slightly eccentric.
tubular cells

Oblong or cigar-shaped. These cells have a Small, round, dense nucleus; eccentric;
Proximal convoluted large amount of grainy cytoplasm. Cell can be multinucleated.
20 - 60m edges are not sharply defined. They can
tubular cells
resemble casts.
 CASTS

• Formation and General Characteristics

– Formed in distal and collecting tubules
– Accounts for shape:
– Tamm-Horsfall protein:

• Enhanced Cast Formation

Renal Cast Formation
 Classification of Casts
• Classified microscopically based on
composition of matrix and the type of
substances or cells enmeshed in them.
– Homogenous: hyaline, waxy
– Cellular Inclusion: RBC, WBC, RTE, Mixed
cells, Bacteria
– Other inclusions: granular, fat globules
(cholesterol or triglycerides), hemosiderin
granules, crystals
– Pigmented: bilirubin, hemoglobin, myoglobin
– Size: broad
 C a s t F o r m a tio n

H y a lin e
C aused by
L o w p H , H ig h S G
a n d S lo w U r in e F lo w

R BC W BC R e n a l E p i. M is c .
G lo m e r u lo n e p h r it is P y e lo n e p h r it is T u b u la r D a m a g e C r y s t a ls e t c .

C o u r s e a n d F in e G r a n u la r
C h r o n ic D is e a s e s

W a x y C a s ts
R e n a l F a ilu r e
 Homogenous Casts

• Hyaline Cast

• Waxy Cast
Hyaline Cont...
Hyaline
Waxy Casts Cont...
Waxy Casts
 Cellular Casts

• RBC Cast

• WBC Cast
RBC Cast
RBC Cast Cont...
WBC Cast
WBC Cast Cont...
 Cellular Casts Continued

• RTE Cast

• Mixed Cell Cast

• Bacterial Cast
Renal Cast
 Other inclusions

• Granular Cast

• Fatty Cast

• Hemosiderin and Crystal Casts

Granular Casts
Granular Casts Cont...
Fatty Cast
 Pigmented and Broad Casts

• Hyaline matrix with pigment incorporated

– hemoglobin
– myoglobin
– bilirubin

• Broad Cast - dilated convoluted tubule or in

collecting ducts
Bacteria
Yeast
Yeast Cont...
Oval Fat Bodies
 Oval Fat
Bodies Cont...
Artifacts
More Artifacts
Artifacts Cont...
Artifacts Cont....