MICROSCOPIC EXAMINATION

URINE SEDIMENT CONSTITUENTS

- RED BLOOD CELLS
- WHITE BLOOD CELLS
- BACTERIA

Jazyl Bless Faunillan

The normal urine sediment may contain a
variety of formed elements.

Cellular elements are easily distorted by

the widely varying concentrations, pH, and
presence of metabolites in urine, making
identification more difficult.

URINARY SEDIMENT CONSTTITUENTS

RED BLOOD CELLS
Smooth, non-nucleated, biconcave, disks
measuring approximately 7 mm in
diameter
RED BLOOD CELLS
 Routinely reported as the average number
seen in 10 hpfs.
 Concentrated (hypersthenuric) urine - the cells
shrink due to loss of water and may appear
crenated.
 Dilute (hyposthenuric) urine - the cells absorb
water, swell, and lyse rapidly, releasing their
hemoglobin and leaving only the cell
membrane.
Microcytic and crenated RBCs (× 100)
RED BLOOD CELLS
 RBCs are frequently confused with yeast cells, oil
droplets, and air bubbles.
 The rough appearance of crenated RBCs may
resemble the granules seen in WBCs.
Remember:
 Yeast cells usually exhibit budding.

 Oil droplets and air bubbles are highly refractile

when the fine adjustment is focused up and down.

 RBCs are much smaller than WBCs.
Oil droplet
(400x)

Adding acetic acid to

a portion of the
sediment will lyse the
RBCs, leaving the
yeast, oil droplets, and Air bubble (100x)
WBCs intact.
RED BLOOD CELLS
 RBCs that vary in size, have cellular protrusions, or
are fragmented are termed dysmorphic and have
been associated primarily with glomerular bleeding.
 Abnormal urine concentration affects RBC
appearance.
 Small number of dysmorphic cells are found with
nonglomerular hematuria.
Dysmorphic RBCs (×400)
CLINICAL SIGNIFICANCE

 The presence of RBCs in the urine is associated

with damage to the glomerular membrane or
vascular injury within the genitourinary tract.
Macroscopic analysis
- cloudy with a red to brown color
Microscopic analysis
- may be reported in terms of
greater than 100 per hpf or as specified by
laboratory protocol.
CLINICAL SIGNIFICANCE
 The observation of microscopic hematuria can
be critical to the early diagnosis of glomerular
disorders and malignancy of the urinary tract
and to confirm the presence of renal calculi.

 The presence of not only RBCs but also hyaline,

granular, and RBC casts may be seen following
strenuous exercise.
CLINICAL SIGNIFICANCE
 The presence of hemoglobin that has been
filtered by the glomerulus produces a red urine
with a positive chemical test result for blood in
the absence of microscopic hematuria.

 Specimen appearing macroscopically

normal may contain a small but
pathologically significant number of RBCs when
examined microscopically.
TAKE NOTE ! 
WHITE BLOOD CELLS
WBCs are larger than RBCs, measuring an
average of about 12 mm in diameter.
 WHITE BLOOD CELLS
 Neutrophils contain granules and multilobed nuclei.
They lyse rapidly in dilute alkaline urine and
begin to lose nuclear detail.
Neutrophils exposed to hypotonic urine absorb
water and swell. Glitter cells sparkling appearance,
produce from the Brownian movement of the granules
within these larger cells.
Sternheimer-Malbin stain - large cells stain light
blue as opposed to the violet color usually seen with
neutrophils.
Glitter cells
WHITE BLOOD CELLS
 Eosinophils - primarily associated with drug-
induced interstitial nephritis.
 Small numbers of eosinophils may be seen with
urinary tract infection (UTI) and renal transplant
rejection.
 Urine sediment may be concentrated by routine
centrifugation alone or with cytocentrifugation.
 Hansel preferred eosinophil stain.

 Eosinophils are not normally seen in the urine.

Hansel-stained eosinophils (×400)
WHITE BLOOD CELLS
 Mononuclear cells
 Lymphocytes are the smallest WBCs, they may
resemble RBCs. They may be seen in increased
numbers in the early stages of renal transplant
rejection.
 Monocytes, macrophages, and histiocytes are large
cells and may appear vacuolated or contain
inclusions inclusions.
WHITE BLOOD CELLS
 An increase in urinary WBCs is called pyuria and
indicates the presence of an infection or
inflammation in the genitourinary system.
 Pyelonephritis, cystitis, prostatitis, and urethritis, are
frequent causes of pyuria – bacterial disorders
 Glomerulonephritis, lupus erythematosus, interstitial
nephritis, and tumors - nonbacterial disorders
WBCs with acetic acid nuclear
enhancement.
TAKE NOTE ! 
BACTERIA
BACTERIA
 Bacteria may be present in the form of cocci
(spherical) or bacilli (rods).
 They are reported as few, moderate, or many per
high-power field.
 To be considered significant for UTI, bacteria should
be accompanied by WBCs.
 Observing bacteria for motility also is useful in
differentiating them from similarly appearing
amorphous phosphates and urates.
BACTERIA
 The presence of bacteria can be indicative of either
lower or upper UTI.
 Specimens containing increased bacteria and
leukocytes are routinely followed up with a
specimen for quantitative urine culture.
 The bacteria most frequently associated with UTI
are the Enterobacteriaceae (referred to as
gram negative rods)
BACTERIA
 The cocci-shaped Staphylococcus and Enterococcus
are also capable of causing UTI.

 The actual bacteria producing an UTI cannot be

identified with the microscopic examination.
 A. Rod-shaped
bacteria often seen
in urinary tract
infections

B. KOVA-stained
bacteria and WBC
(×400)
TAKE NOTE ! 
Source: Urinalysis and Body Fluids SIXTH EDITION
Susan King Strasinger, DA, MLS(ASCP)