Microscopic examination of urine
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Feb 18, 2021
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About This Presentation
An illustrative presentation on Microscopic examination of Urine for Medical, Dental, Pharmacology and Biotechnology students to facilitate easy- learning and self-study..
Slide Content
Dr. Rohini C Sane
Microscopic examination of urine
Urinary Tyrosine
crystals
Uric acid renal stones
Pseudomonas aeruginosa
Microscopic examination of urine
Urinary Tyrosine
crystals
Uric acid renal stones
Pseudomonas aeruginosa
Standard Routine urine analysis
❖TheStandard Routine urine analysis include :
1.Physical examination
2.Chemical examination
3.Microscopic examination of urine*
❖TheStandard Routine urine analysis include :
1.Physical examination
2.Chemical examination
3.Microscopic examination of urine*
Urine sample for the microscopic examination of urine
Freshly voided ,midstream ,morning urine sample
Freshly voided ,midstream ,morning urine sample
Precautions for the microscopic examination of the urine sample
1.Urine must be examined with the fresh sample . 24 hour specimen should be
preserved in a refrigerator or a preservative should be added.
2.A thin preparation are made under the coverslip and should be without any
air bubbles.
3.The condenser should be kept quite low and light cut down considerably
while examining with the low power in particular.( If not, certain structures
will be missed ,particularly hyaline casts).
4.Always examine using low power lens and then high power for finer details .
Observe at least 10-15 different fields.
5.Before centrifugation see that the urine in the container is well mixed or else
the cellular elements and other elements may have settled to the bottom
leaving the supernatant urine clear.
1.Urine must be examined with the fresh sample . 24 hour specimen should be
preserved in a refrigerator or a preservative should be added.
2.A thin preparation are made under the coverslip and should be without any
air bubbles.
3.The condenser should be kept quite low and light cut down considerably
while examining with the low power in particular.( If not, certain structures
will be missed ,particularly hyaline casts).
4.Always examine using low power lens and then high power for finer details .
Observe at least 10-15 different fields.
5.Before centrifugation see that the urine in the container is well mixed or else
the cellular elements and other elements may have settled to the bottom
leaving the supernatant urine clear.
Procedure for the microscopic examination of urine
Centrifuge ≈ 10ml urine in a centrifuge tube at moderate speed(1500 r.p.m*) for 5 minutes .
Decant the supernatant.
Tap the bottom of centrifuge tube to loosen the deposit.
Place one small drop on a clean glass slide.
Apply a coverslip ,avoiding formation of air bubbles .
Examine the field with the ⅔ in objective(low power) to obtain a general impression of the
deposit , then use the ¼ in objective (high power) to identify all the constituents.
Illumination of the field should not be too bright ,as casts and other structures
may not be seen.
*This speed is sufficient to bring to bottom of centrifuge tube ,tube cast , pus
cells ,RBC , and crystals . However sedimentation of bacteria require
centrifugation of urine at high speed (3000 R.P.M.)
↓
↓
↓
↓
↓
↓
Centrifuge ≈ 10ml urine in a centrifuge tube at moderate speed(1500 r.p.m*) for 5 minutes .
Decant the supernatant.
Tap the bottom of centrifuge tube to loosen the deposit.
Place one small drop on a clean glass slide.
Apply a coverslip ,avoiding formation of air bubbles .
Examine the field with the ⅔ in objective(low power) to obtain a general impression of the
deposit , then use the ¼ in objective (high power) to identify all the constituents.
Illumination of the field should not be too bright ,as casts and other structures
may not be seen.
*This speed is sufficient to bring to bottom of centrifuge tube ,tube cast , pus
cells ,RBC , and crystals . However sedimentation of bacteria require
centrifugation of urine at high speed (3000 R.P.M.)
↓
↓
↓
↓
↓
↓
Procedure for the microscopic examination of urine
Centrifuge ≈ 10ml urine in a centrifuge tube at moderate speed (1500 r.p.m*) for 5 minutes .
Decant the supernatant.
Tap the bottom of centrifuge tube to loosen the deposit.
Place one small drop on a clean slide.
Apply a coverslip ,avoiding formation of air bubbles .
Examine the field with the ⅔ in objective (low power) to obtain a general impression of the
deposit , then use the ¼ in objective (high power) to identify all the constituents.
Illumination of the field should not be too bright ,as casts and other structures may not be seen.
Centrifuge ≈ 10ml urine in a centrifuge tube at moderate speed (1500 r.p.m*) for 5 minutes .
Decant the supernatant.
Tap the bottom of centrifuge tube to loosen the deposit.
Place one small drop on a clean slide.
Apply a coverslip ,avoiding formation of air bubbles .
Examine the field with the ⅔ in objective (low power) to obtain a general impression of the
deposit , then use the ¼ in objective (high power) to identify all the constituents.
Illumination of the field should not be too bright ,as casts and other structures may not be seen.
Clinical importance of Microscopic examination of urine:1
•Microscopic examination of the centrifuged urinary sediments is done to
detect :
1.Cells : RBC , WBC/ Pus cells , bacteria, yeast cells ,parasites.
2.Crystals : e.g. Calcium oxalate ,Calcium phosphate, Uric acid , Amorphous
phosphate , Cystine.
3.Cast : e.g. hyaline casts, granular casts , waxy cast, and blood cast.
Examination of the urine for protein ,cells and casts give idea of an active
lesions in the kidney.
Presence of renal crystals /stones in urine are due to presence of specific type
of renal calculi and renal disease.
Microscopic examination of urinary sediment is completed by search for
bacteria.
•Microscopic examination of the centrifuged urinary sediments is done to
detect :
1.Cells : RBC , WBC/ Pus cells , bacteria, yeast cells ,parasites.
2.Crystals : e.g. Calcium oxalate ,Calcium phosphate, Uric acid , Amorphous
phosphate , Cystine.
3.Cast : e.g. hyaline casts, granular casts , waxy cast, and blood cast.
Examination of the urine for protein ,cells and casts give idea of an active
lesions in the kidney.
Presence of renal crystals /stones in urine are due to presence of specific type
of renal calculi and renal disease.
Microscopic examination of urinary sediment is completed by search for
bacteria.
Clinical Importance of microscopic examination of urine:2
❖microscopic examination of urineprovides information not given by chemical
tests viz:
1.Evidence of kidney damage →shown by casts.
2.Differentiate between Hematuria and Hemoglobinuria by the presence of
RBC.
3.Detection of bacteria, parasites and yeast.
4.Presence of crystals .
5.Detection of Pus cells →evidence of infection.
❖microscopic examination of urineprovides information not given by chemical
tests viz:
1.Evidence of kidney damage →shown by casts.
2.Differentiate between Hematuria and Hemoglobinuria by the presence of
RBC.
3.Detection of bacteria, parasites and yeast.
4.Presence of crystals .
5.Detection of Pus cells →evidence of infection.
Amorphous material present in normal urine
Amorphous material present in normal urine :
1.Amorphous urates of Sodium ,Potassium or Calcium
2.Amorphous phosphates of Calcium and Magnesium
Amorphous material present in normal urine :
1.Amorphous urates of Sodium ,Potassium or Calcium
2.Amorphous phosphates of Calcium and Magnesium
Broad classification of urinary sediments :1
Unorganized sediment Organized sediment
Crystals found in acid urine Crystals found in alkaline urineRenal Tube casts
Uric acid and urates Triple phosphates(Ammonium
Magnesium phosphate)
Hyaline casts
Calcium oxalate Disodium phosphate Granular casts
Cystine Calcium carbonate Epithelial casts
Leucine and Tyrosine Ammonium biurate Blood casts
Sulfa Pus cell casts
Cholesterol Fatty casts
Hippuric acid Waxy casts
Calcium sulphate Pus cells
Red blood cells
Bacteria , parasites and yeast
Unorganized sediment Organized sediment
Crystals found in acid urine Crystals found in alkaline urineRenal Tube casts
Uric acid and urates Triple phosphates(Ammonium
Magnesium phosphate)
Hyaline casts
Calcium oxalate Disodium phosphate Granular casts
Cystine Calcium carbonate Epithelial casts
Leucine and Tyrosine Ammonium biurate Blood casts
Sulfa Pus cell casts
Cholesterol Fatty casts
Hippuric acid Waxy casts
Calcium sulphate Pus cells
Red blood cells
Bacteria , parasites and yeast
Broad classification of urinary sediments :2
Renal calculi and renal conditions
•Renal stones are formed in urinary tract(kidney and bladder) due to an
imbalance between conservation of water and excretion of insoluble
substances by the kidneys. Crystal formation occurs when the urine is
supersaturated with substances of low solubility .
•They originate in renal papillae or in collecting tubules .
•They then pass into the pelvis of kidneys and may increase in size so that they
may not pass through ureters . Renal calculi may obstruct flow of urine(post -
renal condition).
•Other may pass to the bladder later may increase in size and obstruct the
urethra.
•Renal stones are formed in urinary tract(kidney and bladder) due to an
imbalance between conservation of water and excretion of insoluble
substances by the kidneys. Crystal formation occurs when the urine is
supersaturated with substances of low solubility .
•They originate in renal papillae or in collecting tubules .
•They then pass into the pelvis of kidneys and may increase in size so that they
may not pass through ureters . Renal calculi may obstruct flow of urine(post -
renal condition).
•Other may pass to the bladder later may increase in size and obstruct the
urethra.
Unorganized sediments
Unorganizeddeposits in urine
•A knowledge of the reaction of the urine sample is of great assistance in
identification of deposits.
•Commonest crystalline deposits in acidic urine sample : Calcium oxalate,
Sodium urates or Uric acid.
•Commonest crystalline deposits in alkaline urine sample : Phosphates ,Calcium
carbonate, Ammonium urate.
•A knowledge of the reaction of the urine sample is of great assistance in
identification of deposits.
•Commonest crystalline deposits in acidic urine sample : Calcium oxalate,
Sodium urates or Uric acid.
•Commonest crystalline deposits in alkaline urine sample : Phosphates ,Calcium
carbonate, Ammonium urate.
Clinical significance of Urinary Crystals
❖Many crystals are found in urine have little clinical
significance although they may be found in calculus
formation ,metabolic disorders and in the regulation of
medication .
❖Many crystals are found in urine have little clinical
significance although they may be found in calculus
formation ,metabolic disorders and in the regulation of
medication .
Characteristic of Urinary calculi
Criteria Characteristic of Urinary calculi
Composition of
substances
normally excreted in urine and found in part of the urinary tract .
Size may vary from a pin head size to the size of an egg .
Classification1.Simplecalculi: contain a single urinary constituent.
2.Mixedcalculi: contain two or more substances present in
urine.
3.Foreign body calculi : may be present due to introduction
of some substances from outside.
Substances
found in calculi
Uric acid, Urates, Triple phosphates ,Calcium carbonate, Cholesterol
(Cystine extremely rare).
Criteria Characteristic of Urinary calculi
Composition of
substances
normally excreted in urine and found in part of the urinary tract .
Size may vary from a pin head size to the size of an egg .
Classification1.Simplecalculi: contain a single urinary constituent.
2.Mixedcalculi: contain two or more substances present in
urine.
3.Foreign body calculi : may be present due to introduction
of some substances from outside.
Substances
found in calculi
Uric acid, Urates, Triple phosphates ,Calcium carbonate, Cholesterol
(Cystine extremely rare).
Predisposing factors for renal stones formation
❖Predisposing factors for renal stones formation include :
1.High concentration of one of more normal constituents of the
glomerular filtrate .
2.Alteration in urinary pH due to bacterial infection.
3.Obstruction to urinary flow.
4.Hyperparathyroidism and hypervitaminosis D.
5.Absence of inhibitors of crystal growth.
❖Predisposing factors for renal stones formation include :
1.High concentration of one of more normal constituents of the
glomerular filtrate .
2.Alteration in urinary pH due to bacterial infection.
3.Obstruction to urinary flow.
4.Hyperparathyroidism and hypervitaminosis D.
5.Absence of inhibitors of crystal growth.
Bacterial infection as a predisposing factor for renal
calculi formation
❖Bacterial infection:
•Imparts alkalinity to infected urine due to urease producing organism.
•Formation of ammonium carbonate due to action of urease on urea.
•Facilitate the formation of Triple phosphate and Calcium carbonate.
calculi formation
❖Bacterial infection:
•Imparts alkalinity to infected urine due to urease producing organism.
•Formation of ammonium carbonate due to action of urease on urea.
•Facilitate the formation of Triple phosphate and Calcium carbonate.
Obstruction to urinary flow as a predisposing factor
for renal calculi formation
❖Obstruction to urinary flow(at bladder neck):
•May be due to prostatic hypertrophy.
•Leads to stasis of urine.
•Results in deposition of substances such as Calcium oxalate ,Uric
acid which may be present in the urine in supersaturated state.
for renal calculi formation
❖Obstruction to urinary flow(at bladder neck):
•May be due to prostatic hypertrophy.
•Leads to stasis of urine.
•Results in deposition of substances such as Calcium oxalate ,Uric
acid which may be present in the urine in supersaturated state.
Hyperthyroidism and hypervitaminosis D as a
predisposing factor for renal calculi formation
❖Hyperthyroidism and hypervitaminosis D:
▪leads to excessive mobilization and calcium excretion.
▪results in saturation of calcium ions and hence renal stone formation.
predisposing factor for renal calculi formation
❖Hyperthyroidism and hypervitaminosis D:
▪leads to excessive mobilization and calcium excretion.
▪results in saturation of calcium ions and hence renal stone formation.
Formation of urinary calculi
Formation of nucleus of stone can be obtained by presence of small lesion.
Deposition of Crystals on the stone nucleus.
Continuous growth of crystals of calculi.
Adherence of calculi to the renal papillae.
Formation of nucleus of stone can be obtained by presence of small lesion.
Deposition of Crystals on the stone nucleus.
Continuous growth of crystals of calculi.
Adherence of calculi to the renal papillae.
Consequences of renal calculi formation
The presence of stone in renal pelvis ,ureter or bladder often interferes with
normal flow of urine.
The presence of stone in renal pelvis ,ureter or bladder often interferes with
normal flow of urine.
Crystals found in acidic urine
Substances present in Renal stones
❖The substances present in renal stones urine include :
1.Uric acid (5 % of total)
2.Calcium oxalate
3.Calcium phosphate (80% of total)
4.Struvite / MgNH
4PO
4(15 % of total)
5.Amorphous urates
6.Sodium urates
7.Calcium sulphate
8.Cystine (1 % of total)
9.Tyrosine
10.Leucine
11.Cholesterol
12.Hippuric acid
❖The substances present in renal stones urine include :
1.Uric acid (5 % of total)
2.Calcium oxalate
3.Calcium phosphate (80% of total)
4.Struvite / MgNH
4PO
4(15 % of total)
5.Amorphous urates
6.Sodium urates
7.Calcium sulphate
8.Cystine (1 % of total)
9.Tyrosine
10.Leucine
11.Cholesterol
12.Hippuric acid
Urinary Uric acid ,Calcium oxalate , Hippuric acid and Ammonium
Biurate crystals
Biurate crystals
Cystine ,Calcium ,Uric acid and Struvite renal stones
Presence of renal crystals /stones in urine are due to presence of specific type of renal calculi.
Examination of urine for protein ,cells and casts give idea of an active lesions in the kidney.
Presence of renal crystals /stones in urine are due to presence of specific type of renal calculi.
Examination of urine for protein ,cells and casts give idea of an active lesions in the kidney.
Uric acid renal crystals
❖Uric acid renal crystals :
•are not found when urine is freshly passed but tend to develop when urine has been
standing for sometime. .
•occur in acidic urine (presence of uric acid can be a normal occurrence).
•vary in shape(characteristic diamond rhombic or rosette form) and stained with
urinary pigment as yellow or red brown.
•not dissolved by heat ,acetic acid or by HCl.
•soluble when heated with sodium hydroxide.
➢Excessive deposits of uric acid and urates in fresh urine are seen in concentrated
urine(e.g. Fever/acute febrile conditions, diarrhea) , disturbances of uric acid
metabolism(e.g. Gout), chronic nephritis, inflammatory bowel disease and
myeloproliferative disorders.
➢Amorphous urates are small ,yellowish-brown ,radio-translucent granules and more
common in men . They dissolve by heat and by sodium hydroxide not by acetic acid.
❖Uric acid renal crystals :
•are not found when urine is freshly passed but tend to develop when urine has been
standing for sometime. .
•occur in acidic urine (presence of uric acid can be a normal occurrence).
•vary in shape(characteristic diamond rhombic or rosette form) and stained with
urinary pigment as yellow or red brown.
•not dissolved by heat ,acetic acid or by HCl.
•soluble when heated with sodium hydroxide.
➢Excessive deposits of uric acid and urates in fresh urine are seen in concentrated
urine(e.g. Fever/acute febrile conditions, diarrhea) , disturbances of uric acid
metabolism(e.g. Gout), chronic nephritis, inflammatory bowel disease and
myeloproliferative disorders.
➢Amorphous urates are small ,yellowish-brown ,radio-translucent granules and more
common in men . They dissolve by heat and by sodium hydroxide not by acetic acid.
Management of Uric acid renal stones
❖Management of Uric acid renal stones include:
1.Increasing fluid intake
2.Alkalization of urine
3.Administration of Allopurinol
4.Restriction of dietary purine intake
5.Lithotripsy
Uric acid renal stones
❖Management of Uric acid renal stones include:
1.Increasing fluid intake
2.Alkalization of urine
3.Administration of Allopurinol
4.Restriction of dietary purine intake
5.Lithotripsy
Uric acid renal stones
Lithotripsy
Calcium oxalate renal crystals
❖Calcium oxalate renal crystals are:
1.very hard, colorless.
2.have the typical envelope shape and may also appear like biconcave disk which have
dump-bells shape(when viewed from outside) or octahedral or oval spheres . They have
tendency to clump together to form stones(fusiform) .
3.occur frequently in neutral or slightly alkaline urine(occasionally in in alkaline urine).
4.soluble in strong hydrochloric acid and insoluble in acetic acid .
5.commonly found when diet consists of food like tomatoes , spinach, garlic, oranges
asparagus and vitamin C.
6.found in the ureter.
7.Caused by pathological conditions( large number in freshly voided urine ) :
a)Hypercalciuria with or without hypercalcemia (possibility of oxalate calculi).
b)Hyperuricosuria due to stimulation of Calcium oxalate crystals by uric acid.
c)Hyperoxaluria , which favors formation of Calcium oxalate crystals even when calcium
excretion is normal.
d)Diabetes mellites
e)Liver diseases /chronic liver diseases
❖Calcium oxalate renal crystals are:
1.very hard, colorless.
2.have the typical envelope shape and may also appear like biconcave disk which have
dump-bells shape(when viewed from outside) or octahedral or oval spheres . They have
tendency to clump together to form stones(fusiform) .
3.occur frequently in neutral or slightly alkaline urine(occasionally in in alkaline urine).
4.soluble in strong hydrochloric acid and insoluble in acetic acid .
5.commonly found when diet consists of food like tomatoes , spinach, garlic, oranges
asparagus and vitamin C.
6.found in the ureter.
7.Caused by pathological conditions( large number in freshly voided urine ) :
a)Hypercalciuria with or without hypercalcemia (possibility of oxalate calculi).
b)Hyperuricosuria due to stimulation of Calcium oxalate crystals by uric acid.
c)Hyperoxaluria , which favors formation of Calcium oxalate crystals even when calcium
excretion is normal.
d)Diabetes mellites
e)Liver diseases /chronic liver diseases
Calcium oxalate renal crystals
Envelope shape Dump-bells shape
Envelope shape Dump-bells shape
Management of Calcium oxalate renal stones
❖Management of Calcium renal stones involves reducing urinary Calcium by:
1.Decreasing Calcium and oxalate intake.
2.Decreasing the intestinal absorption of calcium by administration of oral
phosphates.
3.Management of hypercalcemia or urinary tract infection.
4.administration of thiazide diuretics which reduce urinary calcium excretion.
❖Management of Calcium renal stones involves reducing urinary Calcium by:
1.Decreasing Calcium and oxalate intake.
2.Decreasing the intestinal absorption of calcium by administration of oral
phosphates.
3.Management of hypercalcemia or urinary tract infection.
4.administration of thiazide diuretics which reduce urinary calcium excretion.
Urinary Amorphousurates
❖Urinary Amorphousurates:
•are urates of Sodium ,Potassium, Magnesium and Calcium.
•occur as non-crystalline and amorphous.
•appear yellow-red granular.
•are soluble in alkali at 60ᴼC.
•have no clinical significance.
Thick sediment of amorphous urates
❖Urinary Amorphousurates:
•are urates of Sodium ,Potassium, Magnesium and Calcium.
•occur as non-crystalline and amorphous.
•appear yellow-red granular.
•are soluble in alkali at 60ᴼC.
•have no clinical significance.
Thick sediment of amorphous urates
Urinary Sodium urates
❖Urinary Sodium urates :
▪present as amorphous or as crystals(needles occurring in clusters).
▪are colorless or yellowish needles.
▪soluble in alkali at 60ᴼC.
▪have no clinical significance.
Urinary Sodium urates
❖Urinary Sodium urates :
▪present as amorphous or as crystals(needles occurring in clusters).
▪are colorless or yellowish needles.
▪soluble in alkali at 60ᴼC.
▪have no clinical significance.
Urinary Sodium urates
Urinary Calcium sulphate crystals
❖Urinary Calcium sulphate crystals :
▪are long ,thin and colorless needles or prism.
▪soluble in acetic acid.
▪occur rarely in the urine.
▪no clinical significance.
❖Urinary Calcium sulphate crystals :
▪are long ,thin and colorless needles or prism.
▪soluble in acetic acid.
▪occur rarely in the urine.
▪no clinical significance.
Urinary Hippuric acid crystals
❖Urinary Hippuric acid crystals :
•occur in the form of elongated prisms or plates.
•are yellow or brown or colorless.
•soluble in water.
•rarely seen in urine.
•have no clinical significance.
Urinary Hippuric acid crystals
❖Urinary Hippuric acid crystals :
•occur in the form of elongated prisms or plates.
•are yellow or brown or colorless.
•soluble in water.
•rarely seen in urine.
•have no clinical significance.
Urinary Hippuric acid crystals
Urinary Cystine crystals
❖Urinary Cystine crystals:
1.are very rarely seen in urine .
2.highly refractile hexagonal plates with equal or unequal sides.
3.soluble in hydrochloric acid and ammonia but insoluble in acetic
acid.
4.more soluble in alkaline urine.
5.can form calculi.
6.occur in patients with either congenital cystinosis or congenital
cystinuria.
7.may form stones which are found in homocystinuria.
❖Urinary Cystine crystals:
1.are very rarely seen in urine .
2.highly refractile hexagonal plates with equal or unequal sides.
3.soluble in hydrochloric acid and ammonia but insoluble in acetic
acid.
4.more soluble in alkaline urine.
5.can form calculi.
6.occur in patients with either congenital cystinosis or congenital
cystinuria.
7.may form stones which are found in homocystinuria.
Management of Cystine renal stones
❖Management of Cystine renal stones involves :
1.increasing fluid intake.
2.increasing urine volume.
3.alkalization of urine.
4.administration of penicillamine that binds cystine.
❖Management of Cystine renal stones involves :
1.increasing fluid intake.
2.increasing urine volume.
3.alkalization of urine.
4.administration of penicillamine that binds cystine.
Urinary TyrosineandLeucinecrystals
1.occur together.
2.are found in those conditions associated with severe liver damage.
Consequently one would hesitate to identify crystals as Tyrosine or Leucine
in absence of bile pigments.
Urinary Tyrosine crystals Urinary Leucine crystals
Fine needles arranged as sheaves or clusters
with a marked constriction at the middle.
may be merged together as cluster.
Appear black or refractile.Slightly yellow or brown , oily looking spheres .Many of
them with radial and constriction at the middle.
Soluble in ammonia( ammonium hydroxide) ,
alcohol and hydrochloric acid. Insoluble in acetic
acid.
Soluble in alcohol. Insoluble in hydrochloric acid or ether.
Seen in severe liver disease , Tyrosinosis.Severe hepatitis , Maple syrup urine ,acute yellow atrophy
1.occur together.
2.are found in those conditions associated with severe liver damage.
Consequently one would hesitate to identify crystals as Tyrosine or Leucine
in absence of bile pigments.
Urinary Tyrosine crystals Urinary Leucine crystals
Fine needles arranged as sheaves or clusters
with a marked constriction at the middle.
may be merged together as cluster.
Appear black or refractile.Slightly yellow or brown , oily looking spheres .Many of
them with radial and constriction at the middle.
Soluble in ammonia( ammonium hydroxide) ,
alcohol and hydrochloric acid. Insoluble in acetic
acid.
Soluble in alcohol. Insoluble in hydrochloric acid or ether.
Seen in severe liver disease , Tyrosinosis.Severe hepatitis , Maple syrup urine ,acute yellow atrophy
Urinary TyrosineandLeucinecrystals
Urinary Tyrosinecrystals Urinary Leucinecrystals
Urinary Tyrosinecrystals Urinary Leucinecrystals
Morner’s test for detection of Urinary Tyrosine crystals
Morner’s reagent:
Formalin : 1 ml
Distilled water : 45 ml
Concentrated H
2 SO
4 : 55ml
Morner’s test for detection of tyrosine
crystals:
A Small quantity of crystals in a test
tube + 1ml of Morner’s reagent →boil
→green colour indicatespresenceof
Tyrosine.
Urinary tyrosine
crystals
Morner’s reagent:
Formalin : 1 ml
Distilled water : 45 ml
Concentrated H
2 SO
4 : 55ml
Morner’s test for detection of tyrosine
crystals:
A Small quantity of crystals in a test
tube + 1ml of Morner’s reagent →boil
→green colour indicatespresenceof
Tyrosine.
Urinary tyrosine
crystals
Urinary Cholesterol crystals
❖Urinary Cholesterol crystals :
✓Appearance: large , flat and in the form of transparent
plates with notched corners.
✓Solubility: soluble in ether, chloroform and hot alcohol.
✓Pathologicalconditions: Nephritis , Nephrotic syndrome,
Chyluria and excessive tissue breakdown.
❖Urinary Cholesterol crystals :
✓Appearance: large , flat and in the form of transparent
plates with notched corners.
✓Solubility: soluble in ether, chloroform and hot alcohol.
✓Pathologicalconditions: Nephritis , Nephrotic syndrome,
Chyluria and excessive tissue breakdown.
Urinary Cholesterol crystals
Urinary Uric acid ,Tyrosine, Leucine and cholesterol crystals
Tyrosinecrystals: soluble in acid /alcohol ,needle shaped. Seen in severe liver disease and
Tyrosinosis. Leucinecrystals: yellow spherical ,insoluble in acids ,soluble in alcohol. Seen in
Severe hepatitis , Maple syrup urine and Acute yellow atrophy.
Tyrosinecrystals: soluble in acid /alcohol ,needle shaped. Seen in severe liver disease and
Tyrosinosis. Leucinecrystals: yellow spherical ,insoluble in acids ,soluble in alcohol. Seen in
Severe hepatitis , Maple syrup urine and Acute yellow atrophy.
Urinary Sulpha crystal
1.found in urine when the patient is
undergoing treatment with one of
the sulphonamides group of drugs.
2.vary in shape.
3.Whenever unfamiliar crystals are
seen ,particularly in acid urine.
Sulpha crystals should be thought
of.
4.Urine tested chemically for
sulphonamides compounds/the
patient questioned as to whether
he/she has taken these drugs.
➢Reference : Grathwohl's book of
clinical laboratory methods and
diagnosis.
Urinary Sulpha crystal
1.found in urine when the patient is
undergoing treatment with one of
the sulphonamides group of drugs.
2.vary in shape.
3.Whenever unfamiliar crystals are
seen ,particularly in acid urine.
Sulpha crystals should be thought
of.
4.Urine tested chemically for
sulphonamides compounds/the
patient questioned as to whether
he/she has taken these drugs.
➢Reference : Grathwohl's book of
clinical laboratory methods and
diagnosis.
Urinary Sulpha crystal
Biochemical Tests for detection of urinary Sulpha drugs
BiochemicalTest with Ehrlich’s reagentObservation Inference
Dilute urine until it appears colorless +few
drops of Ehrlich’s reagent.
Picric acid yellow
color
Sulphonamides drug
present.
LigninTest Observation Inference
Wet the news paper
/Whatman's paper with the
urine + few drops of 5%
diluted hydrochloric acid.
Yellow color produced Sulpha drugs present.
The arylamine group of
sulphonamides drug reacts
with crude cellulose(in the
presence of acid).
BiochemicalTest with Ehrlich’s reagentObservation Inference
Dilute urine until it appears colorless +few
drops of Ehrlich’s reagent.
Picric acid yellow
color
Sulphonamides drug
present.
LigninTest Observation Inference
Wet the news paper
/Whatman's paper with the
urine + few drops of 5%
diluted hydrochloric acid.
Yellow color produced Sulpha drugs present.
The arylamine group of
sulphonamides drug reacts
with crude cellulose(in the
presence of acid).
Interpretativemicroscopicurinalysis(crystals found in acidic urine ):1
Urinary microscopic
Findings
Findings in Normal
urine
Findings in Abnormal
urine
Pathology /etiology
Cystine Absent Present Congenital cystinosis
Congenital cystinuria
Cholesterol Absent Present Lipoid nephrosis
Nephritic conditions
Leucine Absent Present Acute yellow atrophy
Tyrosine Absent Present Destructive disease of
liver
Bilirubin Absent Present Bilirubinuria
Sulphonamides Absent Present May cause kidney
damage by blocking the
tubules.
Crystals found in acidic urine are suggestive of abnormal metabolism. (There are no non-
pathogenic causes for these urinary crystals).
Urinary microscopic
Findings
Findings in Normal
urine
Findings in Abnormal
urine
Pathology /etiology
Cystine Absent Present Congenital cystinosis
Congenital cystinuria
Cholesterol Absent Present Lipoid nephrosis
Nephritic conditions
Leucine Absent Present Acute yellow atrophy
Tyrosine Absent Present Destructive disease of
liver
Bilirubin Absent Present Bilirubinuria
Sulphonamides Absent Present May cause kidney
damage by blocking the
tubules.
Crystals found in acidic urine are suggestive of abnormal metabolism. (There are no non-
pathogenic causes for these urinary crystals).
Interpretativemicroscopicurinalysis(acidic crystals found in urine):2
Urinary
microscopic
Findings
Findings in
Normal urine
Findings in
Abnormal urine
Pathology /etiologyNon-pathologic
Acidic
crystals
Uric acid
Calcium
sulphate
(When)
present in
fresh urine in
high
proportion
Presence of
renal calculi
-
Urinary
microscopic
Findings
Findings in
Normal urine
Findings in
Abnormal urine
Pathology /etiologyNon-pathologic
Acidic
crystals
Uric acid
Calcium
sulphate
(When)
present in
fresh urine in
high
proportion
Presence of
renal calculi
-
Types of renal stones
Crystals found in alkaline urine
Triple phosphates/ Struvite / Ammonium Magnesium phosphate
(NH
4MgPO
4 ) renal crystals
1.Colorless.
2.appear prisms with three to six sidesor coffin-lidcrystals or as feathery or
leaf like forms frequently with opaque ends.
3.dissolve /soluble in acetic acid.
4.Phosphates may occur as an amorphous deposit in alkaline urine.
5.frequently found in normal urine but can form crystals.
6.may indicate stones in kidney or bladder when they appear in freshly voided
urine in large number.
7.are common in women and result from renal infection with a Proteus vulgaris
(urease producing organism) .
8.enlarge ,assume a ‘staghorn’ appearance, fill the renal pelvis thereby causing
obstruction.
9.can be managed by antibiotics that suppress infection and prevent
recurrence .
(NH
4MgPO
4 ) renal crystals
1.Colorless.
2.appear prisms with three to six sidesor coffin-lidcrystals or as feathery or
leaf like forms frequently with opaque ends.
3.dissolve /soluble in acetic acid.
4.Phosphates may occur as an amorphous deposit in alkaline urine.
5.frequently found in normal urine but can form crystals.
6.may indicate stones in kidney or bladder when they appear in freshly voided
urine in large number.
7.are common in women and result from renal infection with a Proteus vulgaris
(urease producing organism) .
8.enlarge ,assume a ‘staghorn’ appearance, fill the renal pelvis thereby causing
obstruction.
9.can be managed by antibiotics that suppress infection and prevent
recurrence .
Triple phosphates/ Struvite / Ammonium
Magnesium phosphate (NH
4MgPO
4 ) renal crystals
Triple phosphates
Magnesium phosphate (NH
4MgPO
4 ) renal crystals
Triple phosphates
Urinary Amorphousphosphates
❖Urinary Amorphousphosphates:
•are present in amorphous granular form.
•spherical , dumb-bell shaped or granular type.
•are soluble in acetic acid . Amorphous urates which appear
similar to these phosphates are insoluble in acetic acid.
•have no clinical significance.
❖Urinary Amorphousphosphates:
•are present in amorphous granular form.
•spherical , dumb-bell shaped or granular type.
•are soluble in acetic acid . Amorphous urates which appear
similar to these phosphates are insoluble in acetic acid.
•have no clinical significance.
Urinary Amorphous Phosphates
Disodiumphosphate renal crystals
1.may appear in slightly alkaline or neutral urine.
2.colorless prisms arranged in stars and rosettes. Because of the
shape of the crystals ,these are sometimes called “stellar
phosphates ”.
3.The individual prisms are slender ,with are usually slender(thin)
with one levelled wedge-like end , sometimes needle-like
irregular or usually granular colorless plates.
4.soluble in acetic acid.
5.soft ,white ‘staghorn’ calculi in the renal pelvis that precipitate
under alkaline conditions.
6.seen during chronic renal infection with a Proteus vulgaris(urease
producing organism).
1.may appear in slightly alkaline or neutral urine.
2.colorless prisms arranged in stars and rosettes. Because of the
shape of the crystals ,these are sometimes called “stellar
phosphates ”.
3.The individual prisms are slender ,with are usually slender(thin)
with one levelled wedge-like end , sometimes needle-like
irregular or usually granular colorless plates.
4.soluble in acetic acid.
5.soft ,white ‘staghorn’ calculi in the renal pelvis that precipitate
under alkaline conditions.
6.seen during chronic renal infection with a Proteus vulgaris(urease
producing organism).
Calciumcarbonate renal crystal
❖Calciumcarbonate renal crystal:
▪aresometimes mixed with the phosphate deposits.
▪occur usually as amorphous granules or more rarely as
colorless spheres and dumb-bells.
▪are soluble in acetic acid with gas formation.
▪have no clinical significance.
❖Calciumcarbonate renal crystal:
▪aresometimes mixed with the phosphate deposits.
▪occur usually as amorphous granules or more rarely as
colorless spheres and dumb-bells.
▪are soluble in acetic acid with gas formation.
▪have no clinical significance.
Calciumcarbonate renal crystal
Calcium phosphate renal crystals
❖Calcium phosphate renal crystals :
•are long, thinandcolourless.
•appear like prism with pointed end arranged as rosettes or stars or
appearing as needles.
•may also appear as irregular ,granular plates .
•soluble in dilute acetic acid .
•may be present in normal urine.
•may also form renal calculi.
❖Calcium phosphate renal crystals :
•are long, thinandcolourless.
•appear like prism with pointed end arranged as rosettes or stars or
appearing as needles.
•may also appear as irregular ,granular plates .
•soluble in dilute acetic acid .
•may be present in normal urine.
•may also form renal calculi.
Calcium phosphate renal crystals
Urinary AmmoniumBiurate
❖Urinary AmmoniumBiurate:
•are generally found along with phosphates in decomposing urine
when free ammonia is present.
•form opaque ,yellow crystals usually in the form of spheres which
are covered with or without long, fine or coarse(irregular) spicules.
•soluble in acetic acid and rhombic plates of uric acid appear.
•presence suggestive of pathological conditions, if found in a fresh
urine.
❖Urinary AmmoniumBiurate:
•are generally found along with phosphates in decomposing urine
when free ammonia is present.
•form opaque ,yellow crystals usually in the form of spheres which
are covered with or without long, fine or coarse(irregular) spicules.
•soluble in acetic acid and rhombic plates of uric acid appear.
•presence suggestive of pathological conditions, if found in a fresh
urine.
Urinary AmmoniumBiurate
Interpretativemicroscopicurinalysis(acidic ,neutral or slightly alkaline
crystals found in urine )
Urinary
microscopic
Findings
Findings in
Normal urine
Findings in
Abnormal urine
Pathology
/etiology
Non-pathologic
Acidic,
neutral or
slightly
alkaline
crystals
Calcium
oxalate
Hippuric acid
(When)
present in
fresh urine in
high
proportion
Not
significant
May indicate
presence of
renal calculi.
They are derived
from various
drugs a food
items (spinach ,
vitamin C,
berries,
tomatoes).
crystals found in urine )
Urinary
microscopic
Findings
Findings in
Normal urine
Findings in
Abnormal urine
Pathology
/etiology
Non-pathologic
Acidic,
neutral or
slightly
alkaline
crystals
Calcium
oxalate
Hippuric acid
(When)
present in
fresh urine in
high
proportion
Not
significant
May indicate
presence of
renal calculi.
They are derived
from various
drugs a food
items (spinach ,
vitamin C,
berries,
tomatoes).
Interpretativemicroscopicurinalysis(alkaline, neutral or slightly acidic
crystals found in urine)
Urinary
microscopic
Findings
Findings in
Normal urine
Findings in
Abnormal urine
Pathology
/etiology
Non-pathologic
Alkaline,
neutral or
slightly acidic
crystals
Triple
phosphates
(Ammonium
magnesium
phosphate )
Present in
high
concentration
May indicate
presence of
renal calculi.
-
crystals found in urine)
Urinary
microscopic
Findings
Findings in
Normal urine
Findings in
Abnormal urine
Pathology
/etiology
Non-pathologic
Alkaline,
neutral or
slightly acidic
crystals
Triple
phosphates
(Ammonium
magnesium
phosphate )
Present in
high
concentration
May indicate
presence of
renal calculi.
-
Interpretativemicroscopicurinalysis(alkaline crystals found in urine)
Urinary
microscopic
Findings
Findings in Normal urineFindings in
Abnormal
urine
Pathology
/etiology
Non-pathologic
Alkaline
crystals
Calcium carbonate,
Ammonium biurate,
Calcium phosphate
Not
significant
- -
Urinary
microscopic
Findings
Findings in Normal urineFindings in
Abnormal
urine
Pathology
/etiology
Non-pathologic
Alkaline
crystals
Calcium carbonate,
Ammonium biurate,
Calcium phosphate
Not
significant
- -
Chemical examination of urinary calculi for diagnostic purpose:1
Type Procedure Results
Uric acid and Urates Make the powder of the stone by
using mortar and pestle.
Pinch of the powder in test tube .
Add 1 drop of 20g/dL Na
2CO
3.
Add 2 drops of phosphotungstic
acid reagent .
Formation of deep blue
color.
Type Procedure Results
Uric acid and Urates Make the powder of the stone by
using mortar and pestle.
Pinch of the powder in test tube .
Add 1 drop of 20g/dL Na
2CO
3.
Add 2 drops of phosphotungstic
acid reagent .
Formation of deep blue
color.
Chemical examination of urinary calculi for diagnostic purpose:2
Type Procedure Results
PhosphatesMake the powder of the stone by
using mortar and pestle.
Add 0.5 ml of Ammonium
Molybdate reagent. Warm over a
gas flame.
Formation of yellow
precipitate.
OxalatesMake the powder of the stone by using
mortar and pestle.
Add 2-3 drops of 10% HCl.
Cool and add pinch of MnO
2. Do not mix.
Formation of gas bubbles
from bottom.
Type Procedure Results
PhosphatesMake the powder of the stone by
using mortar and pestle.
Add 0.5 ml of Ammonium
Molybdate reagent. Warm over a
gas flame.
Formation of yellow
precipitate.
OxalatesMake the powder of the stone by using
mortar and pestle.
Add 2-3 drops of 10% HCl.
Cool and add pinch of MnO
2. Do not mix.
Formation of gas bubbles
from bottom.
Chemical examination of urinary calculi for diagnostic purpose:3
Type Procedure Results
SulphonamidesMake the powder of the stone by using
mortar and pestle.
Add 2 drops of 10% HCl.
After one minute ,add 2 drops of NaNO
2.
Wait for a minute.
Add 2 drops of 0.5g/dl Ammonium sulfamate.
Add 2 drops of reagent ‘S’(100mg/dl N(1-
naphthylethylenediamine dihydrochloride in
Distilled Water).
Formation of
Brownish pink to
magenta color.
Type Procedure Results
SulphonamidesMake the powder of the stone by using
mortar and pestle.
Add 2 drops of 10% HCl.
After one minute ,add 2 drops of NaNO
2.
Wait for a minute.
Add 2 drops of 0.5g/dl Ammonium sulfamate.
Add 2 drops of reagent ‘S’(100mg/dl N(1-
naphthylethylenediamine dihydrochloride in
Distilled Water).
Formation of
Brownish pink to
magenta color.
Chemical examination of urinary calculi for diagnostic purpose:4
Type Procedure Results
Cystine Make the powder of the
stone by using mortar
and pestle.
Add 1 drop of
Ammonium hydride
reagent + one drop of
NaCNreagent, wait for 5
minutes.
Add 2drops of Sodium
nitroprusside solution.
Beet red color changes to
orange on standing.
Type Procedure Results
Cystine Make the powder of the
stone by using mortar
and pestle.
Add 1 drop of
Ammonium hydride
reagent + one drop of
NaCNreagent, wait for 5
minutes.
Add 2drops of Sodium
nitroprusside solution.
Beet red color changes to
orange on standing.
Chemical examination of urinary calculi for diagnostic purpose:5
Type Procedure Results
Carbonates Make the powder of the
stone by using mortar
and pestle.
Take 0.5g in a test tube.
Add 1ml of 10% HCl.
Centrifuge and separate acid
extract. Use this acidextract
for following tests.
Formation of foaming
effervescence.
Calcium 0.2ml of acidextract+
2-3drops of 20g/dl NaOH.
Fine white precipitate of
Calcium oxalate .Dense
white precipitate of Calcium
phosphate.
Type Procedure Results
Carbonates Make the powder of the
stone by using mortar
and pestle.
Take 0.5g in a test tube.
Add 1ml of 10% HCl.
Centrifuge and separate acid
extract. Use this acidextract
for following tests.
Formation of foaming
effervescence.
Calcium 0.2ml of acidextract+
2-3drops of 20g/dl NaOH.
Fine white precipitate of
Calcium oxalate .Dense
white precipitate of Calcium
phosphate.
Chemical examination of urinary calculi for diagnostic purpose:6
Type Procedure Results
Magnesium 0.2ml of acidextract.
Add 2 drops of 20 g/dl NaOH.
Add 2 drops of reagent “M” (1 mg/dl
p-nitrobenzene azo-resorcinol in 1N
Sodium hydroxide).
Formation of blue
precipitate.
Ammonium group 0.2ml of acidextract.
Add 2 drops of 20 g/dl NaOH.
Add 2-3 drops of Nessler’s reagent.
Yellow –orange
precipitate.
Type Procedure Results
Magnesium 0.2ml of acidextract.
Add 2 drops of 20 g/dl NaOH.
Add 2 drops of reagent “M” (1 mg/dl
p-nitrobenzene azo-resorcinol in 1N
Sodium hydroxide).
Formation of blue
precipitate.
Ammonium group 0.2ml of acidextract.
Add 2 drops of 20 g/dl NaOH.
Add 2-3 drops of Nessler’s reagent.
Yellow –orange
precipitate.
Mucusin urine
•Mucusin urine:
•is derived from mucous glands the urinary tract.
•appears as long translucent shreds .
•presence of small amounts Mucous is considered normal .
•Mucusin urine:
•is derived from mucous glands the urinary tract.
•appears as long translucent shreds .
•presence of small amounts Mucous is considered normal .
Organized sediments
Broad classification of the urinary sediments
Urinary Organized sediments
•Organized sediments are more important sediments.
•The principal organized structure in urinary sediments are :
1.Tube casts
2.Epithelial cells
3.White blood cells (pus cells)
4.Red cell cells
5.Spermatozoa
6.Bacteria
7.Yeast cells
8.Animal parasites
•Organized sediments are more important sediments.
•The principal organized structure in urinary sediments are :
1.Tube casts
2.Epithelial cells
3.White blood cells (pus cells)
4.Red cell cells
5.Spermatozoa
6.Bacteria
7.Yeast cells
8.Animal parasites
Formation of Urinary casts
▪Site of formation of urinary casts: in the lumen of distal and
collecting tubules of the kidney. This because the formation of casts
require acidic conditions and high solute concentration.
▪Tamm-Horsfall protein :(a mucoprotein) secreted by renal tubular
cells forms basic matrix of all casts.
▪Urinary casts can form as the result of :
a.Precipitation of gelatin of Tamm-Horsfall mucoprotein.
b.Clumping of cells on other material within protein matrix.
c.The adherence of cells or cellular material to the matrix.
d.Coagulation of material within the lumen.
▪Site of formation of urinary casts: in the lumen of distal and
collecting tubules of the kidney. This because the formation of casts
require acidic conditions and high solute concentration.
▪Tamm-Horsfall protein :(a mucoprotein) secreted by renal tubular
cells forms basic matrix of all casts.
▪Urinary casts can form as the result of :
a.Precipitation of gelatin of Tamm-Horsfall mucoprotein.
b.Clumping of cells on other material within protein matrix.
c.The adherence of cells or cellular material to the matrix.
d.Coagulation of material within the lumen.
Properties of Casts of Renal tubules
•Casts of Renal tubules : absent in a normal urine.
•Renal dysfunction : casts present in urine(associated with
albuminuria).
•Appearance of casts :
a.Sides: Parallel
b.End : may be rounded or blunted
c.May be convoluted ,straight or curved or broken off.
•Solubility of renal casts: dissolve in alkaline urine.
•Casts of Renal tubules : absent in a normal urine.
•Renal dysfunction : casts present in urine(associated with
albuminuria).
•Appearance of casts :
a.Sides: Parallel
b.End : may be rounded or blunted
c.May be convoluted ,straight or curved or broken off.
•Solubility of renal casts: dissolve in alkaline urine.
Renal Tubecasts
❖Renal Tube casts :
•Formation: are formed in renal tubules by the coagulation of
albuminous material and are washed out by glomerular secretion
into collecting tubules and finally in the bladder .
•Shape: cylindrical with round or broken ends.
•Length: varying
•Diameter: not varying (as formed in tubules of kidney).
•Diagnostic tests: to be performed in cases of renalalbuminuria.
•Clinical significance :associated with some pathological change in
kidney (slight or transitory), temporary irritation and congestions
(e.g. heart failure).
❖Renal Tube casts :
•Formation: are formed in renal tubules by the coagulation of
albuminous material and are washed out by glomerular secretion
into collecting tubules and finally in the bladder .
•Shape: cylindrical with round or broken ends.
•Length: varying
•Diameter: not varying (as formed in tubules of kidney).
•Diagnostic tests: to be performed in cases of renalalbuminuria.
•Clinical significance :associated with some pathological change in
kidney (slight or transitory), temporary irritation and congestions
(e.g. heart failure).
Types of renal casts
Hyaline Renal casts Cellular Renal casts Granular Renal casts
▪Colorless/semi-transparent.
▪Homogenous →consists of
coagulated protein material
▪Soluble in acetic acid.
▪Few found in a normal urine.
▪Occur in urine in large
numbers in some diseases of
kidneys(suggestive of mildest
type of renal disease).
▪Quantitative measurements
by Addis count.
▪To be examined by lowering
the condenser and cutting
light.
▪Composed of epithelial or red
blood cells or pus cells partially
or wholly.
▪Epithelialcasts: coagulated
protein in which are
embedded epithelial cells
from renal tubules and
indicate kidney disease.
▪Red Bloodcasts: red blood
cells embedded in coagulated
protein in tubule and indicate
acute glomerular nephritis.
▪Puscellcasts: pus cell
embedded in coagulated
protein & indicate renal
infection.
▪Contain large Granules and are
merely coagulated proteins in
which numerous granules are
embedded or due to
aggregation or direct
aggregation of serum protein in
Tamm-Horsefallmucoprotein .
▪Granules are due to
disintegration/degeneration of
white blood cells or epithelial
cells of the renal tubules
(Degenerated cellular casts).
▪Not found in a normal urine.
Indicate severe kidney disease .
Hyaline Renal casts Cellular Renal casts Granular Renal casts
▪Colorless/semi-transparent.
▪Homogenous →consists of
coagulated protein material
▪Soluble in acetic acid.
▪Few found in a normal urine.
▪Occur in urine in large
numbers in some diseases of
kidneys(suggestive of mildest
type of renal disease).
▪Quantitative measurements
by Addis count.
▪To be examined by lowering
the condenser and cutting
light.
▪Composed of epithelial or red
blood cells or pus cells partially
or wholly.
▪Epithelialcasts: coagulated
protein in which are
embedded epithelial cells
from renal tubules and
indicate kidney disease.
▪Red Bloodcasts: red blood
cells embedded in coagulated
protein in tubule and indicate
acute glomerular nephritis.
▪Puscellcasts: pus cell
embedded in coagulated
protein & indicate renal
infection.
▪Contain large Granules and are
merely coagulated proteins in
which numerous granules are
embedded or due to
aggregation or direct
aggregation of serum protein in
Tamm-Horsefallmucoprotein .
▪Granules are due to
disintegration/degeneration of
white blood cells or epithelial
cells of the renal tubules
(Degenerated cellular casts).
▪Not found in a normal urine.
Indicate severe kidney disease .
Types of renal casts
Hyaline Renal casts Cellular Renal casts Granular Renal casts
▪Transparent , colorless
▪Homogenous
▪Composed of pus,
epithelial or red blood cells
partially or wholly.
▪Granular in appearance.
▪Degenerated cellular casts.
Red blood cell renal cast
White blood cell renal cast
Granular Renal cast
Hyaline renal cast
Hyaline Renal casts Cellular Renal casts Granular Renal casts
▪Transparent , colorless
▪Homogenous
▪Composed of pus,
epithelial or red blood cells
partially or wholly.
▪Granular in appearance.
▪Degenerated cellular casts.
Red blood cell renal cast
White blood cell renal cast
Granular Renal cast
Hyaline renal cast
Cellular Renal casts
Interpretativemicroscopicurinalysis(urinary casts ):1
Urinary microscopic
finding
Findings
in Normal
urine
Findings in
Abnormal urine
Pathology /etiology Non-
pathologic
Hyaline casts Absent Present Glomerular damage , renal
inflammation, renal
infection , suggestive of
mildest kind of renal
disease
Occasional –
hyaline casts may
be present due
to physical
exercise and or
physiologic
dehydration
Red cell casts
( contain only a few
RBC in protein
matrix or many RBC
packed together with no
visible matrix)
Absent Present Glomerular damage,
Acute glomerulonephritis,
Subacute bacterial
endocarditis,renal
infarction , severe
pyelonephritis
-
Urinary microscopic
finding
Findings
in Normal
urine
Findings in
Abnormal urine
Pathology /etiology Non-
pathologic
Hyaline casts Absent Present Glomerular damage , renal
inflammation, renal
infection , suggestive of
mildest kind of renal
disease
Occasional –
hyaline casts may
be present due
to physical
exercise and or
physiologic
dehydration
Red cell casts
( contain only a few
RBC in protein
matrix or many RBC
packed together with no
visible matrix)
Absent Present Glomerular damage,
Acute glomerulonephritis,
Subacute bacterial
endocarditis,renal
infarction , severe
pyelonephritis
-
Interpretativemicroscopicurinalysis(urinary casts ):2
Urinary
microscopic finding
Findings in
Normal
urine
Findings in
Abnormal urine
Pathology /etiology Non-
pathologic
White cell casts
(WBC in cast are
polymorphonucl
ear neutrophils,
packed
together)
Absent Present Renal infection and non-
infectious inflammation,
acute pyelonephritis,
intestinal nephritis ,
glomerular disease
Granular
casts may
be present
after
strenuous
exercise.
Granular castsAbsent Present Significant renal disease-
Epithelial cell
casts
Absent Present Tubular degeneration,
necrosis, nephrotoxic agents
or viruses, chronic renal
disease
-
Urinary
microscopic finding
Findings in
Normal
urine
Findings in
Abnormal urine
Pathology /etiology Non-
pathologic
White cell casts
(WBC in cast are
polymorphonucl
ear neutrophils,
packed
together)
Absent Present Renal infection and non-
infectious inflammation,
acute pyelonephritis,
intestinal nephritis ,
glomerular disease
Granular
casts may
be present
after
strenuous
exercise.
Granular castsAbsent Present Significant renal disease-
Epithelial cell
casts
Absent Present Tubular degeneration,
necrosis, nephrotoxic agents
or viruses, chronic renal
disease
-
Interpretativemicroscopicurinalysis(urinary casts ):2
Urinary
microscopic
finding
Findings
in
Normal
urine
Findings in
Abnormal
urine
Pathology /etiologyNon-
pathologic
Waxy castsAbsentPresent Degenerated waxy casts,
severe chronic renal failure,
malignant hypertension,
tubular inflammation
-
Fatty castsAbsentPresent Fatty degeneration of the
tubular epithelium ,nephrotic
syndrome ,chronic
glomerulonephritis ,toxic renal
poisoning
-
Urinary
microscopic
finding
Findings
in
Normal
urine
Findings in
Abnormal
urine
Pathology /etiologyNon-
pathologic
Waxy castsAbsentPresent Degenerated waxy casts,
severe chronic renal failure,
malignant hypertension,
tubular inflammation
-
Fatty castsAbsentPresent Fatty degeneration of the
tubular epithelium ,nephrotic
syndrome ,chronic
glomerulonephritis ,toxic renal
poisoning
-
Urinary Fatty and waxy casts
Fatty casts Waxy casts
▪are formed by incorporated free oil
droplets or oval fat bodies.
▪Fatty casts can be stained by adding
a few drops of Sudan III solution
(take red stain).
▪Notfound in a normal urine.
▪derived from degenerating tubular
epithelial cells .
▪suggestive ofNephrotic syndrome,
Chronic glomerulonephritis and
Toxic renal poisoning.
•resemble hyaline casts but opaque
with a fully waxy homogenous
appearance.
•have very high refractive index.
•yellow or colorless.
•result from the degeneration of
granular cast.
•found in terminalstagesof
Nephritis.
Fatty casts Waxy casts
▪are formed by incorporated free oil
droplets or oval fat bodies.
▪Fatty casts can be stained by adding
a few drops of Sudan III solution
(take red stain).
▪Notfound in a normal urine.
▪derived from degenerating tubular
epithelial cells .
▪suggestive ofNephrotic syndrome,
Chronic glomerulonephritis and
Toxic renal poisoning.
•resemble hyaline casts but opaque
with a fully waxy homogenous
appearance.
•have very high refractive index.
•yellow or colorless.
•result from the degeneration of
granular cast.
•found in terminalstagesof
Nephritis.
Urinary Fatty and waxy casts
Fatty casts Waxy casts
Suggestive of nephrotic syndrome
Found in terminal stages of nephritis
Fatty casts Waxy casts
Suggestive of nephrotic syndrome
Found in terminal stages of nephritis
Types of renal casts
Urinary Mucousthreads
❖Mucousthreads:
•are long ,thin waxy threads of ribbon like structures.
•may be present in the normal urine.
•Found in high proportion in the presence of inflammation or irritation
of urinary tract.
❖Mucousthreads:
•are long ,thin waxy threads of ribbon like structures.
•may be present in the normal urine.
•Found in high proportion in the presence of inflammation or irritation
of urinary tract.
Renal Cylindroids
❖Renal Cylindroids:
▪resemblecasts.
▪have one end which tapers out like a strand of mucous.
▪frequently hyaline.
➢Exact site and mechanism of their formation are under
further study.
❖Renal Cylindroids:
▪resemblecasts.
▪have one end which tapers out like a strand of mucous.
▪frequently hyaline.
➢Exact site and mechanism of their formation are under
further study.
Hyaline and granular Cylindroids
Renal Cylindroids
Microscopic examination of urinary cells:1
Microscopic examination of urinary cells:2
Urinary Epithelial cells Urinary Red blood
cells(RBC)
Leucocytes(white blood
cells/pus cells)
▪Originate from any site in
genito-urinary tract from
proximal convoluted tubule
to urethra or from vagina.
▪Normally (3-5 per h.p.f.)
due to sloughing off old
cells.
▪Squamous are present in many
normal urine specimens ,
especially in non-catheter
samples from female patients.
▪Not present in the urine
of normal males.
▪In samples from female
patients ,they may be of
menstrual origin.
▪Red cells may be normal,
crenated or swollen ,
depending on whether
the urine is isotonic,
hypertonic or hypotonic.
▪Enter urine anywhere
from the glomerulus to
urethra.
▪Are found occasionally,
generally not more than
2-3 per h.p.f./field using
4mm objective.
▪Depending on the toxicity
of the urine , they may
normal, swollen or
shrunken in size.
▪when degenerate,they are
sometimes called puscells.
Urinary Epithelial cells Urinary Red blood
cells(RBC)
Leucocytes(white blood
cells/pus cells)
▪Originate from any site in
genito-urinary tract from
proximal convoluted tubule
to urethra or from vagina.
▪Normally (3-5 per h.p.f.)
due to sloughing off old
cells.
▪Squamous are present in many
normal urine specimens ,
especially in non-catheter
samples from female patients.
▪Not present in the urine
of normal males.
▪In samples from female
patients ,they may be of
menstrual origin.
▪Red cells may be normal,
crenated or swollen ,
depending on whether
the urine is isotonic,
hypertonic or hypotonic.
▪Enter urine anywhere
from the glomerulus to
urethra.
▪Are found occasionally,
generally not more than
2-3 per h.p.f./field using
4mm objective.
▪Depending on the toxicity
of the urine , they may
normal, swollen or
shrunken in size.
▪when degenerate,they are
sometimes called puscells.
Microscopic examination of urinary cells:3
Urinary Epithelial cells Urinary Red blood cells(RBC) Urinary Leucocytes(WBC)
.
↗
↑
←
↗
Urinary Epithelial cells Urinary Red blood cells(RBC) Urinary Leucocytes(WBC)
.
↗
↑
←
↗
Microscopic examination of urinary cells:4
Interpretativemicroscopicurinalysis(urinary epithelial cells)
Urinary microscopic
finding
Findings in
Normal urine
Findings in
Abnormal urine
Pathology /etiologyNon-pathologic
Epithelial cells Male :
2 to 3 per HPF
Female :
3 to 5 per HPF
> 5 epithelial cells
per HPF
3 Types of epithelial cells :
a)Tubularb) transitional
c) squamous
Increased number oftubular
epithelial cellssuggest tubular
damage. It can occur in
pyelonephritis, Acute tubular
necrosis, Salicylates intoxication and
kidney transplant rejection .
Transitional epithelial cells : line the
urinary tract from pelvis of the kidney
to upper portion of the urethra.
Squamous epithelial cells : occur
principally in urethra and vagina may
be present in as urinary contaminant
from vulva or vagina in female .
Few epithelial
cells from these
sites can be found
in urine as a result
of the normal
sloughing off of
old cells.
Urinary Epithelial
cells originate from
any site in
genitourinary tract
from proximal
convoluted tubule
to urethra or from
vagina.
Urinary microscopic
finding
Findings in
Normal urine
Findings in
Abnormal urine
Pathology /etiologyNon-pathologic
Epithelial cells Male :
2 to 3 per HPF
Female :
3 to 5 per HPF
> 5 epithelial cells
per HPF
3 Types of epithelial cells :
a)Tubularb) transitional
c) squamous
Increased number oftubular
epithelial cellssuggest tubular
damage. It can occur in
pyelonephritis, Acute tubular
necrosis, Salicylates intoxication and
kidney transplant rejection .
Transitional epithelial cells : line the
urinary tract from pelvis of the kidney
to upper portion of the urethra.
Squamous epithelial cells : occur
principally in urethra and vagina may
be present in as urinary contaminant
from vulva or vagina in female .
Few epithelial
cells from these
sites can be found
in urine as a result
of the normal
sloughing off of
old cells.
Urinary Epithelial
cells originate from
any site in
genitourinary tract
from proximal
convoluted tubule
to urethra or from
vagina.
Types of urinary epithelial cells
Renal Tubular epithelial
cells
Transitional epithelial cellsSquamous epithelial cells
▪Slightly larger than
leucocytes.
▪Cuboidal ,flat or
columnar.
▪contain large round
nucleus.
▪Slightly larger than
leucocytes.
▪Pear or round shaped .
▪contain large nucleus .
Occasionally contain
two nuclei.
▪Large ,flat and
irregularly shaped.
▪contain small central
nucleus and abundant
cytoplasm .
Squamous epithelial cellRenal Tubular epithelial cells
Renal Tubular epithelial
cells
Transitional epithelial cellsSquamous epithelial cells
▪Slightly larger than
leucocytes.
▪Cuboidal ,flat or
columnar.
▪contain large round
nucleus.
▪Slightly larger than
leucocytes.
▪Pear or round shaped .
▪contain large nucleus .
Occasionally contain
two nuclei.
▪Large ,flat and
irregularly shaped.
▪contain small central
nucleus and abundant
cytoplasm .
Squamous epithelial cellRenal Tubular epithelial cells
Morphology of urinary epithelial cells
Origin of Epithelial cells as the organized renal sediments
▪Normal urine : fewepithelialcells.
▪Abnormal/pathological urine: a large number which indicate
destruction of tissue in urinary tract.
▪Sources of urinary epithelial cells :
Renal Tubular
epithelial cells
Transitional epithelial
cells
Squamous epithelial
cells
Kidney tubulesKidney pelvis ,urethra
or bladder
Urethra or vagina
▪Normal urine : fewepithelialcells.
▪Abnormal/pathological urine: a large number which indicate
destruction of tissue in urinary tract.
▪Sources of urinary epithelial cells :
Renal Tubular
epithelial cells
Transitional epithelial
cells
Squamous epithelial
cells
Kidney tubulesKidney pelvis ,urethra
or bladder
Urethra or vagina
Interpretativemicroscopicurinalysis(urinary pus cells)
Urinary
microscopic
finding
Findings in
Normal
urine
Findings in
Abnormal urine
Pathology /etiology Non-
pathologic
Pus cells
(leucocytes)
2 to 3 per
HPF
> 5 pus cells per
HPF
Pyuria (pus in urine): urinary
tract infection , inflammatory
process in or adjacent in
urinary tract.
Non-infectious conditions:
acute glomerulonephritis, renal
tubular acidosis , dehydration,
stress ,fever, non-infectious
irritation to the ureter ,bladder
or urethra.
Few leucocytes
can normally
be found in
secretions from
male or female
genital tracts .
There is
possibility of
contamination
and should be
considered.
Urinary
microscopic
finding
Findings in
Normal
urine
Findings in
Abnormal urine
Pathology /etiology Non-
pathologic
Pus cells
(leucocytes)
2 to 3 per
HPF
> 5 pus cells per
HPF
Pyuria (pus in urine): urinary
tract infection , inflammatory
process in or adjacent in
urinary tract.
Non-infectious conditions:
acute glomerulonephritis, renal
tubular acidosis , dehydration,
stress ,fever, non-infectious
irritation to the ureter ,bladder
or urethra.
Few leucocytes
can normally
be found in
secretions from
male or female
genital tracts .
There is
possibility of
contamination
and should be
considered.
Pus cells as the organized renal sediments
▪Normal urine : few pus cells (2 to 3 WBC per high power field)
➢When pus cells are degenerating they tend to occur in clumps.
➢When pus cells present in large number ,the urine will most
certainly contain albumin .
➢Abnormal/pathological urine:
•Pyuria (pus in urine): urinary tract infection , inflammatory process in or
adjacent in urinary tract andin female, contamination with vaginal
secretions.
•Non-infectious conditions: Acute glomerulonephritis, Renal tubular acidosis ,
Dehydration, stress ,fever, non-infectious irritation to the ureter ,bladder or
urethra .
▪Normal urine : few pus cells (2 to 3 WBC per high power field)
➢When pus cells are degenerating they tend to occur in clumps.
➢When pus cells present in large number ,the urine will most
certainly contain albumin .
➢Abnormal/pathological urine:
•Pyuria (pus in urine): urinary tract infection , inflammatory process in or
adjacent in urinary tract andin female, contamination with vaginal
secretions.
•Non-infectious conditions: Acute glomerulonephritis, Renal tubular acidosis ,
Dehydration, stress ,fever, non-infectious irritation to the ureter ,bladder or
urethra .
Red blood cells as the organized renal sediments
•Red blood cells in the fresh urine :
✓occasional presence(of erythrocytes).
✓have a normal pale or yellow appearance.
✓appear smooth ,biconcave disks about 7 μm diameter and 2μm thick.
✓Do not contain nuclei.
✓Solubility of RBC : in acetic acid
•Hypotonicurine: red blood cells swell up and lyse.
•Hypertonicurine:red blood cells crenate.
•Abnormal/pathological urine: a large number erythrocytes which may appear normal
or crenated .
•When red blood cells present in large number, the urine will most certainly contain
albumin .
➢Reporting of RBC in urine : number of RBC per high power field .
•Red blood cells in the fresh urine :
✓occasional presence(of erythrocytes).
✓have a normal pale or yellow appearance.
✓appear smooth ,biconcave disks about 7 μm diameter and 2μm thick.
✓Do not contain nuclei.
✓Solubility of RBC : in acetic acid
•Hypotonicurine: red blood cells swell up and lyse.
•Hypertonicurine:red blood cells crenate.
•Abnormal/pathological urine: a large number erythrocytes which may appear normal
or crenated .
•When red blood cells present in large number, the urine will most certainly contain
albumin .
➢Reporting of RBC in urine : number of RBC per high power field .
Microscopic features of urinary RBC
Crenated RBC Abnormal/pathological urine:
a large number erythrocyte(RBC)
Crenated RBC Abnormal/pathological urine:
a large number erythrocyte(RBC)
Yeast cells can be mistaken for RBCs .Yeast cells are ovoid and frequently
contain buds.
Microscopic view of Budding yeast cells in urine
Budding yeast cells in urine
contain buds.
Microscopic view of Budding yeast cells in urine
Budding yeast cells in urine
Addis count for urinary casts /cells
❖Addis Count: quantitative measure of the urine sediment.
•Specimen: 12 hours urine (mix thoroughly before centrifugation).
•Preservative: formalin
•Centrifugation: 10 ml urine in a graduated centrifuge tube at 1800 RPM for 5 minutes.
•Procedure: remove 9ml of supernatant fluid and thoroughly mixed sediment.
•Count of cast : using blood counting chamber and count same as a total WBC count
under low power in all 9 large squares (0.0009 ml of urine).
•V = accurate volume of 12hr urine in ml
•S= volume of urine centrifuged
•v= volume of in ml in which count is made
•n= number of casts / cells counted
•N= number of cell/casts in 12hours
•Calculation: N= VX SX n
vx 10
Normalrange:
Casts : 0-5000
RBC : 0-500000
WBC : 1,000,000
Spermatozoamay be sometimes found in urine from males.
❖Addis Count: quantitative measure of the urine sediment.
•Specimen: 12 hours urine (mix thoroughly before centrifugation).
•Preservative: formalin
•Centrifugation: 10 ml urine in a graduated centrifuge tube at 1800 RPM for 5 minutes.
•Procedure: remove 9ml of supernatant fluid and thoroughly mixed sediment.
•Count of cast : using blood counting chamber and count same as a total WBC count
under low power in all 9 large squares (0.0009 ml of urine).
•V = accurate volume of 12hr urine in ml
•S= volume of urine centrifuged
•v= volume of in ml in which count is made
•n= number of casts / cells counted
•N= number of cell/casts in 12hours
•Calculation: N= VX SX n
vx 10
Normalrange:
Casts : 0-5000
RBC : 0-500000
WBC : 1,000,000
Spermatozoamay be sometimes found in urine from males.
Quantitative evaluation of the urine sediments
Addis count for urinary casts /cells
Interpretativemicroscopicurinalysis of organisms or abnormal cells
Urinary microscopic
finding
Findings in
Normal urine
Findings in
Abnormal urine
Pathology
/etiology
Non-pathologic
Bacteria Absent Absent Renal infectionAfter storage at
room temperature
bacterial growth
may take place in
urine.
Yeast cells Absent Present May be present
in acidic urine
containing sugar.
-
Parasites Absent Present Trichomonas
vaginalis from
vagina and
Trichomonas
hominis from
rectum.
-
Urinary microscopic
finding
Findings in
Normal urine
Findings in
Abnormal urine
Pathology
/etiology
Non-pathologic
Bacteria Absent Absent Renal infectionAfter storage at
room temperature
bacterial growth
may take place in
urine.
Yeast cells Absent Present May be present
in acidic urine
containing sugar.
-
Parasites Absent Present Trichomonas
vaginalis from
vagina and
Trichomonas
hominis from
rectum.
-
Urinary Organisms
•Organisms are of no significance when they are found in urine samples that
have been standing overnight.
•Presence of bacteria and pus cells in freshly voided urine : indicative of renal
infection(finding should be reported).
•Organisms are of no significance when they are found in urine samples that
have been standing overnight.
•Presence of bacteria and pus cells in freshly voided urine : indicative of renal
infection(finding should be reported).
Urinary Bacteria
•Normalurine: when fresh does not show any bacteria , when allowed to stand for
some times may show bacteria.
•Presence of large number of bacteria with many pus cells in the fresh urine :
suggestive of bacterial infection of kidney(abnormal urine). Contamination may
occur from bacteria present in urethra, vagina or external sources.
•Precaution: collect urine aseptically(cleaned-up mid-stream specimens of urine in
the sterile container). Catheter specimens should be avoided because of high
incidence of bladder infections after catheterization.
•Examination of bacteria : direct smear
•Recommended stains for smears :
a.Acid /alcohol fast stain : tubercule bacillus
b.Gram’s stain : gonococcus
➢Culture of urine sample : e.g. Typhoid
➢Animal inoculation: diagnosis Weil’s syndrome
•Normalurine: when fresh does not show any bacteria , when allowed to stand for
some times may show bacteria.
•Presence of large number of bacteria with many pus cells in the fresh urine :
suggestive of bacterial infection of kidney(abnormal urine). Contamination may
occur from bacteria present in urethra, vagina or external sources.
•Precaution: collect urine aseptically(cleaned-up mid-stream specimens of urine in
the sterile container). Catheter specimens should be avoided because of high
incidence of bladder infections after catheterization.
•Examination of bacteria : direct smear
•Recommended stains for smears :
a.Acid /alcohol fast stain : tubercule bacillus
b.Gram’s stain : gonococcus
➢Culture of urine sample : e.g. Typhoid
➢Animal inoculation: diagnosis Weil’s syndrome
Staining of bacteria
Ziehl–Nielsen's staining of acid-fast bacteria
e.g. Mycobacterium Tuberculosis
Gram’s staining of Neisseria gonococcus
Ziehl–Nielsen's staining of acid-fast bacteria
e.g. Mycobacterium Tuberculosis
Gram’s staining of Neisseria gonococcus
Weil’s syndrome (Leptospirosis)
Causative organism : Leptospira interorgan /
Leptospira enterohemorrhagic
Causative organism : Leptospira interorgan /
Leptospira enterohemorrhagic
Salmonella Typhi cause Typhoid fever
Salmonella Typhi
Salmonella Typhi
Common urinary pathogens
Organisms Observation in wet preparationGram smear
E. Coli Motile or non-motile rods Gram negative
Staphylococcus
saprophyticus
Cocci(after attached to epithelial
cells)
Gram positive
staphylococci
Proteus species Motile rods Gram negative rods
Pseudomonas aeruginosa Motile rods Gram negative rods
Streptococcus faecalis
(group D streptococci )
Cocci in chains
Klebsiella strainsNonmotile rods or coco bacilliGram negative
capsulated rods
Enterococci cocci in short chains or pairs Gram positive
streptococci
Organisms Observation in wet preparationGram smear
E. Coli Motile or non-motile rods Gram negative
Staphylococcus
saprophyticus
Cocci(after attached to epithelial
cells)
Gram positive
staphylococci
Proteus species Motile rods Gram negative rods
Pseudomonas aeruginosa Motile rods Gram negative rods
Streptococcus faecalis
(group D streptococci )
Cocci in chains
Klebsiella strainsNonmotile rods or coco bacilliGram negative
capsulated rods
Enterococci cocci in short chains or pairs Gram positive
streptococci
Microscopic features of Common urinary pathogens
Staphylococcus saprophyticus:
▪Gram positive Cocci in groups.
▪causative agent for urinary tract infection.
Escherichia coli:
▪Motile or non-motile
gram negative rods.
▪causative agent for
urinary tract infection.
Staphylococcus saprophyticus:
▪Gram positive Cocci in groups.
▪causative agent for urinary tract infection.
Escherichia coli:
▪Motile or non-motile
gram negative rods.
▪causative agent for
urinary tract infection.
Microscopic features of urinary Proteus species and Pseudomonas aeruginosa
Pseudomonasaeruginosa: Motile rods &
causative agent for urinary tract infection.
Proteus species: Motile rods & cause
urinary tract infection.
Pseudomonasaeruginosa: Motile rods &
causative agent for urinary tract infection.
Proteus species: Motile rods & cause
urinary tract infection.
Microscopic features of Streptococcus faecalis and Klebsiella
pneumoniae
Enterococcusfaecalis: Gram positive cocci in chains
and causative agent for urinary tract infection .
Klebsiella pneumoniae : non-motile capsulated gram
negative rods & causative agent of urinary tract infection.
pneumoniae
Enterococcusfaecalis: Gram positive cocci in chains
and causative agent for urinary tract infection .
Klebsiella pneumoniae : non-motile capsulated gram
negative rods & causative agent of urinary tract infection.
Concentration method for Acid fast bacteria
▪Specimen : 24hr. Specimen is collected in sterile “ Winchester bottle ”.
▪Preservative : to be added if culture is not to be carried out .
▪Refrigeration of urine sample needed. No preservative ,ifculture is to be
carried out.
▪Procedure :
a.siphon off supernatant fluid.
b.Acid treatment : treat deposit with equal volume of 6% sulphuric acid for 20
minutes.
c.centrifugation : 3000 RPM for 30 minutes.
d.Washing of deposit : 3 times in distilled water.
e.Prepare a smears and examine after acid fast staining.
▪Specimen : 24hr. Specimen is collected in sterile “ Winchester bottle ”.
▪Preservative : to be added if culture is not to be carried out .
▪Refrigeration of urine sample needed. No preservative ,ifculture is to be
carried out.
▪Procedure :
a.siphon off supernatant fluid.
b.Acid treatment : treat deposit with equal volume of 6% sulphuric acid for 20
minutes.
c.centrifugation : 3000 RPM for 30 minutes.
d.Washing of deposit : 3 times in distilled water.
e.Prepare a smears and examine after acid fast staining.
Urinary yeast cells
•smooth , colorless and usually avoid cells.
•vary in size and have refractile walls.
•often show budding.
•insoluble in acid and alkali(unlike red blood cells).
•willnotstain with eosin.
•may be found in urinary tract infections (mainly in diabetic
patients).
•may be present in urine as a result of skin or vaginal
contamination.
•smooth , colorless and usually avoid cells.
•vary in size and have refractile walls.
•often show budding.
•insoluble in acid and alkali(unlike red blood cells).
•willnotstain with eosin.
•may be found in urinary tract infections (mainly in diabetic
patients).
•may be present in urine as a result of skin or vaginal
contamination.
Microscopic examination of yeast cells(Candida Albicans and
Clostridium perfringens)
Candida Albicans
Clostridium perfringens)
Candida Albicans
Normal flora of Urethra and Vagina
Body site of
urinary tract
Normal flora
Urethra ▪Candida species
▪Mycobacterium smegmatis
▪Mycoplasma species
▪Acinetobacter species
Vagina
(between
puberty and
menopause)
acid pH
▪Lactobacillus species
▪Streptococcus species
▪Clostridium species
▪Corynebacterium species
▪Gardnerella vaginalis
Body site of
urinary tract
Normal flora
Urethra ▪Candida species
▪Mycobacterium smegmatis
▪Mycoplasma species
▪Acinetobacter species
Vagina
(between
puberty and
menopause)
acid pH
▪Lactobacillus species
▪Streptococcus species
▪Clostridium species
▪Corynebacterium species
▪Gardnerella vaginalis
Parasites observed in microscopic examination of urine
Trichomonas vaginalis
Enterobius vermicularis ova
Schistosoma haematobium ovum
Trichomonas vaginalis
Enterobius vermicularis ova
Schistosoma haematobium ovum
Trichomonas vaginalis in microscopic examination of urine
Trichomonas vaginalis causes Trichomoniasis
Enterobius vermicularis ova in microscopic examination of urine
Enterobius vermicularis
Enterobius vermicularis
Schistosoma haematobium ovum microscopic examination of
urine
Schistosoma haematobium ovum
urine
Schistosoma haematobium ovum
Oval fat bodies and fat droplets
❖Oval fat bodies:
•are renal tubular cells containing highly refractile fat droplets.
•may be macrophages or polynuclear leucocytes which have
ingested lipids or have undergone fatty degeneration.
❖Free fat droplets:
▪Present in urine in lipuria /chyluria(presence of lipids in urine).
▪Present in Nephrotic syndrome, Diabetes mellitus , Lipoid nephrosis
in chronic glomerulonephritis and fat embolism.
❖Oval fat bodies:
•are renal tubular cells containing highly refractile fat droplets.
•may be macrophages or polynuclear leucocytes which have
ingested lipids or have undergone fatty degeneration.
❖Free fat droplets:
▪Present in urine in lipuria /chyluria(presence of lipids in urine).
▪Present in Nephrotic syndrome, Diabetes mellitus , Lipoid nephrosis
in chronic glomerulonephritis and fat embolism.
Chyluria
❖Chyluria: milky appearance of urine.
•Etiology: rupture of wall of the bladder or kidney pelvis leading to escape of
fat droplets in the urine.
•Diagnosis of chyluria :
a.Staining with Sudan III.
b.Adding of little ether which dissolves the fat clearing the urine.
c.Microscopic examinations : presence of Microfilaria.
•Clinical condition associated with chyluria : LymphaticFilariasis.
❖Chyluria: milky appearance of urine.
•Etiology: rupture of wall of the bladder or kidney pelvis leading to escape of
fat droplets in the urine.
•Diagnosis of chyluria :
a.Staining with Sudan III.
b.Adding of little ether which dissolves the fat clearing the urine.
c.Microscopic examinations : presence of Microfilaria.
•Clinical condition associated with chyluria : LymphaticFilariasis.
Causes of Chyluria
Microfilaria
Filariasis
Microfilaria
Filariasis
Specimen collection for urogenital specimens
•Wear rubber gloves.
•Use sterile cotton swab moistened with normal saline to cleans around ulcer .
•Collect serous exudate on a coverslip and invert it on a slide.
•Examine immediately on dark-field microscopy.
•Examine saline preparation for suspected Trichomoniasis.
•Wear rubber gloves.
•Use sterile cotton swab moistened with normal saline to cleans around ulcer .
•Collect serous exudate on a coverslip and invert it on a slide.
•Examine immediately on dark-field microscopy.
•Examine saline preparation for suspected Trichomoniasis.
Examination of Urogenital specimens
Perform gram’s staining and observe the following organisms :
Suspected gonorrhea Pus cells containing Gram negative diplococci
Suspected vaginitis Large gram positive yeastcells
(Candida albicans or candida species)
Suspected peripheral
sepsis or septic abortion
Large gram positive rod cells(Clostridiumperfringens)
Gram positive streptococci
Gram negative rods (Bacteroides species)
Perform gram’s staining and observe the following organisms :
Suspected gonorrhea Pus cells containing Gram negative diplococci
Suspected vaginitis Large gram positive yeastcells
(Candida albicans or candida species)
Suspected peripheral
sepsis or septic abortion
Large gram positive rod cells(Clostridiumperfringens)
Gram positive streptococci
Gram negative rods (Bacteroides species)
Gonorrhea
•Gonorrhea: a sexually transmitted blood -borne infection.
•Causative Organism: Neisseriagonorrhea
•Diagnosis: in men , Gram stain of urethral discharge using swabs. In women,
urethral ,cervical and or anal swabs.
•Microscopic examination of urethral discharge : Gram Negative diplococci.
•Biochemical test: purple color after pouring weak solution of tetra-methyl para
phenylenediamine over the culture plate.
•Clinical manifestation : inflammation of the urethra ,cervix , fallopian tubes,
rectum, prostrate and /or pharynx spread to joints and skin. Congenitally
transmitted infection in eye of newborn(neonatal conjunctivitis). Infection
around the liver may result from peritoneal spread of the disease.
•Management: Cephalosporins or fluoroquinolones (Tetracyclines used to treat
coinfection with Chlamydia).
•Gonorrhea: a sexually transmitted blood -borne infection.
•Causative Organism: Neisseriagonorrhea
•Diagnosis: in men , Gram stain of urethral discharge using swabs. In women,
urethral ,cervical and or anal swabs.
•Microscopic examination of urethral discharge : Gram Negative diplococci.
•Biochemical test: purple color after pouring weak solution of tetra-methyl para
phenylenediamine over the culture plate.
•Clinical manifestation : inflammation of the urethra ,cervix , fallopian tubes,
rectum, prostrate and /or pharynx spread to joints and skin. Congenitally
transmitted infection in eye of newborn(neonatal conjunctivitis). Infection
around the liver may result from peritoneal spread of the disease.
•Management: Cephalosporins or fluoroquinolones (Tetracyclines used to treat
coinfection with Chlamydia).
Neisseriagonorrhea
Intracellular
in
polymorphonuclear
cells in the exudate
from the gonorrheal
sore.
Oxidase-positive ,confirmed by typical sugar
reactions.
Intracellular
in
polymorphonuclear
cells in the exudate
from the gonorrheal
sore.
Oxidase-positive ,confirmed by typical sugar
reactions.
Spermatozoa in urine
▪Spermatozoa: have oval bodies and thin, long and delicate
tails.
▪Presence of Spermatozoa in urine of man: after nocturnal
emission, epileptic convulsions and diseases of genital organ.
▪After coitus, they may be present in the urine of both the
sexes.
▪Spermatozoa: have oval bodies and thin, long and delicate
tails.
▪Presence of Spermatozoa in urine of man: after nocturnal
emission, epileptic convulsions and diseases of genital organ.
▪After coitus, they may be present in the urine of both the
sexes.
Spermatozoa in urine
Presence of when present in large number , they should be reported as it may
suggest a lesion in the Genito-urinary tract.
Presence of when present in large number , they should be reported as it may
suggest a lesion in the Genito-urinary tract.
Artifacts in microscopic examination of urine
Starch crystals : found occasionally in urine as round or oval highly refractile
crystals.
Fibers: come from clothing ,toilet paper or may be piece of lint from the air.
Hair
Air bubbles
Talcum powder particles
Starch crystals : found occasionally in urine as round or oval highly refractile
crystals.
Fibers: come from clothing ,toilet paper or may be piece of lint from the air.
Hair
Air bubbles
Talcum powder particles
Artifacts in microscopic examination of the urine
Alterations in urine test results
Test False positive False negative
Specific gravity Contamination ding collection and storage None
pH Increased while standing due to urease producing
microorganisms
Blood Hypochlorite bacterial peroxidase Ascorbic acid ,nitrites
Protein Fever , cells, bacteria, concentrated urine Dilution of urine
Glucose Oxidizing agents Ascorbic acid
Ketone bodies Captopril ,M-dopa Prolonged standing
Bilirubin Rifampicin , chlorpromazine Sunlight, Ascorbic acid
Urobilinogen Alkaline urine, Sulphonamide Broad spectrum antibiotics, sunlight
Leukocyte
esterase
Oxidizing agents ,Trichomonas Ascorbic acid , Tetracyclines,
cephalosporin
Nitrites Ascorbic acid , Mycobacterium
Test False positive False negative
Specific gravity Contamination ding collection and storage None
pH Increased while standing due to urease producing
microorganisms
Blood Hypochlorite bacterial peroxidase Ascorbic acid ,nitrites
Protein Fever , cells, bacteria, concentrated urine Dilution of urine
Glucose Oxidizing agents Ascorbic acid
Ketone bodies Captopril ,M-dopa Prolonged standing
Bilirubin Rifampicin , chlorpromazine Sunlight, Ascorbic acid
Urobilinogen Alkaline urine, Sulphonamide Broad spectrum antibiotics, sunlight
Leukocyte
esterase
Oxidizing agents ,Trichomonas Ascorbic acid , Tetracyclines,
cephalosporin
Nitrites Ascorbic acid , Mycobacterium
Thank You Google Images
Tags
microscopic examination of urine
precautions for the microscopic examination of the
procedure for the microscopic examination of urine
clinical importance of microscopic examination of
broad classification of urinary sediments
renal calculi and renal conditions
unorganized deposits in urine
clinical significance of urinary crystals
characteristic of urinary calculi
predisposing factors for renal stones formation
formation of urinary calculi
substances present in renal stones
management of uric acid renal stones
calcium oxalate renal crystals
urinary cystine crystals
urinary tyrosine and leucine crystals
morner’s test for detection of urinary tyrosine cr
urinary cholesterol crystals
biochemical tests for detection of urinary sulpha
interpretative microscopic urinalysis
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