MICROSCOPIC

EXAMINATION OF
URINE (PART 2)
MYRA O. CORNEJA, RMT
Instructor
• HYALINE CAST
o Uromodulin – main constituents
o 0-2/lpf – normal
o Refractive index similar to urine
o Subdued light

• RBC CAST
o Indicated bleeding
o Specific bleeding in nephrons
o Associated to glomerulonephritis
o Orange red color under lpf
o Must accompanied with freestanding RBC’s
• WBC CAST
 Infection or inflammation
 Pyelonephritis
 Cystitis
 Compose of neutrophils
 Eosinophils – acute interstitial nephritis (no bacteria)
• BACTERIAL CAST
 Bacilli
 Pyelonephritis
 Gram stain
• Epithelial Cell Cast
o Cast with RTE cells- advance tubular destruction
o Disruption of tubular linings

• Fatty Cast
o Conjunction with oval fat bodies
o Lipiduria
o Nephrotic syndrome
o Highly refractile
o Polarized microscopy- confirmation
o Fat stain ( Oil Red O, Sudan III)
o Maltese cross formation
o Orange – TAG and neutral fats
• MIXED CELLULAR CAST
o Glomerulonephritis – RBC, WBC or RTE Casts
o Pyelonephritis – Bacterial cast and WBC cast

• Granular Cast
o Lysosomes excreted by RTE cells- non-pathologic
o Cellular disintegration – pathologic

• Waxy Cast
o Extreme urine stasis
o Chronic renal failure

• Broad Casts
o Renal failure casts
o Destruction (widening ) of the tubular walls
o Bile stained broad, waxy cast- seen in viral hepatitis
URINARY CRYSTALS
•Acidic (normal crystals)
Urates
 (amorphous urates, uric acid, sodium urates)
Amorphous urates- Pink sediments (pH > 5.5)

Uric acid- most varied in shape

Acid urates- may have spicules similar to ammonium biurate

Sodium urates –needle shape

Calcium oxalate

oTwo forms
oOctahedral envelope or as two pyramid joined together
- tomatoes, asparagus and ascorbic acid
oOval
- ethylene glycol ( antifreeze)
oDihydrate – weddelite (Octahedral envelope or as two pyramid joined together )
oMonohydrate- whewellite (oval)
• ALKALINE ( Normal Crystals)
o Triple phosphate ( ammonium, magnesium, phosphate) – coffin lid

o Calcium phosphate- dissolve in dilute acetic acid

o Calcium carbonate- Formation of gas after addition of acetic acid.
o Ammonium biurate – ‘’thorny apple’’ dissolved at 60 degree Celsius
and convert to uric acid when glacial acetic acid is added.
• ACIDIC URINE ( PATHOLOGIC CRYSTALS)
Cystine Crystal
o inherited metabolic disorder
o Tendency to form renal calculi
o Cyanide – nitroprusside test- Confirmatory test
Cholesterol Crystal
o Notch in one or more corners
o Cannot be stained
o Conjunction with fatty cast and oval fat bodies
o Highly birefringent
• Radiographic Dye Crystals
o Similar to cholesterol
o Patient history
o SG is markedly elevated using refractometer
• Crystals Associated with Liver Disease
o TBL
o Tyrosine
o Leucine
o Bilirubin
• Sulfonamide Crystals
o Inadequate hydration
o UTI
o Needles, rhombic, whetstone, sheaves of wheat and rosettes
• Ampicillin Crystals
o Colorless needles tend to form bundle after refrigeration
Urinary Sediments Artifacts

• Starch granules- Dimple

• Oil droplets and air bubbles
• Pollen grains
• Hair and fibers from clothing and diapers
 Thank You! 

• Reference: Urinalysis and Body Fluids 6th edition

• Authors : Susan King Strasinger , Marjorie
Schaub Di Lorenzo