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Cells

Description Associated Conditions


Erythrocytes • Can originate from any part of the urina
• Size: 7-8 µm in diameter tract
• Pale or yellowish, smooth • In females, consider menstrual
biconcave disk contamination
• No nucleus or cytoplasmic granules
• Normal: Less than 2 RBC/HPF

Leukocytes • Can originate from any part of the urina


• Typically neutrophils (PMN) tract (glomerulus to urethra)
• Larger than RBC, 10-12 µm in • Increased In inflammatory processes of
diameter the urinary tract (pyuria)
• Contain nucleus and cytoplasmic
granules
• Brownian movement (“glitter
cells”)
• Normal: no more than 2 RBC/HPF

Renal Tubular Epithelial Cells • Tubular damage, pyelonephritis, ATN,


• Slightly larger than WBC salicylate intoxication, transplant rejectio
• Flat, cuboidal or columnar
• One large round nucleus

Transitional Epithelial Cells


• 2-4 times larger than leukocytes
• Round, pear-shaped, tail-like
projections
• Large round nucleus
Squamous Epithelial Cells • principally from the urethra and vagina
• Large, flat, irregular-shaped cells

Casts

Hyaline Casts • most frequently observed


• Tamm-Horsfall protein (very low • can be found in normal urine
refractive index) • physical exercise & dehydration
• Colorless, homogenous and
transparent
• Rounded ends

Waxy Cast • Severe chronic renal failure, malignant


• Very high refractive index hypertension, diabetic nephropathy
• Yellow, gray or colorless
• Smooth homogeneous appearance
• Short, broad with blunt or broken
ends
• Cracked or serrated edges

Granular Cast • Second-most common type of cast


• Large and coarse granules • Can result either from the breakdown of
cellular casts, or the inclusion of aggrega
of plasma proteins (eg, albumin) or
immunoglobulin light chains
• Significance: chronic renal disease; As
with hyaline casts, can also be seen for a
short time following strenuous exercise.
Fine Granular Cast • Significance same as for granular casts
• Fine granules, gray or pale yellow

Red Cell Cast • Renal hematuria, glomerular disease (ie


• brown to tan acute glomerulonephritis, lupus nephritis
renal trauma)

White Cell Cast • Infection and noninfectious renal


inflammation (ie, acute pyelonephritis,
interstitial nephritis & lupus nephritis)

Epithelial Cell Cast • Stasis and desquamation of renal tubula


epithelial cells following tubular damage
and necrosis.

Fatty Casts (Oval Fat Bodies) • Fatty degeneration of the tubular


• “Maltese-cross” pattern under epithelium in degenerative tubular diseas
polarized light.
Crystals in Acid Urine

Uric Acid • Very common


• Many different shapes, diamond, • Can be normal occurence
rhombic prism or rosette • Associated with increased purine
• Yellow or brown metabolism

Calcium Oxalate • Ingestion of oxalate-rich foods: spinach


• Colorless, octahedral or envelope rhubarb, tomatoes, garlic, oranges,
asparagus
• High intake of ascorbic acid
• Ethylene glycol poisoning

Cystine • Of diagnostic importance,


• Colorless, refractile, hexagonal • Congenital cystinosis or cystinuria
plates

Leucine • Clinically significant


• Oily, highly refractile, yellow or • Maple syrup urine disease, Oasthouse
brown spheroids and concentric urine disease, severe liver disease
striations • Seen with tyrosine in liver disease
Cholesterol • Excessive tissue breakdown
• Large, flat, transparent • Obstructed lymphatic flow
• Notched corners • Nephritis and nephrotic conditions

Tyrosine • Severe liver disease


• Very fine, highly refractile needles • Tyrosinosis
• Black, yellow
• In sheaves or clusters

Sulfonamide
• Fan or sheaf of needles, eccentric
binding
• Clear or brown

Crystals in Alkaline Urine


Triple Phosphate • Can be found in normal urines
(Ammonium Magnesium • Chronic urinary inflammation
Phosphate)
• Colorless prisms, 3-6 sides, oblique
ends
• Coffin lids
Ammonium Biurate
• Yellow-brown spherical bodies
with long, irregular spicules

Calcium Phosphate • Can be found in normal urines


• Long thin, colorless needles
• One pointed end
• Arranged as rosettes or star

Miscellaneous
Bacteria

Schistosoma haematobium
• Blood fluke egg
• 50 x 150 µm in diameter
• Leukocytes (eosinophils) in
background

Yeast Budding
• Smooth, colorless, oval, doubly
refractile walls
• Most common, Candida albicans
Yeast Branching

Trichomonas vaginalis •most frequently encountered parasite

Starch
• Round or oval
• Highly refractive, vary in size
• Hexagonal in shape
• Irregular indentation in the center
• "Maltese crosses" under
polarization

• A Handbook of Routine Urinalysis. Sister Laurine Graff. 1983