Urine Microscopical Examination

MICROSCOPICAL EXAMINATION OF URINE

Preperation of slide

Morning midstream urine or fresh random urine 3-4 hours after the patient has last voided is satisfactory 

After 2 hour cells & cast begin to lysis. 
Refrigeration (2-8) prevent from lysis

Preparation of slide - 
Take 10-15 ml urineà centrifuge at 2000 rpm x 5min à discard the supernatants --> take a drop of deposit on slide -> cover with 18mm squire cover slip.

Then see under microscope in high power, condrnser down , iris small setting.

Urine should be examined within one hour after collection. otherwise preservative should be used (Formalin/ thymol)

Comment  on:

Squamous/ transitional epithelial cell present if large number or as fragments.

No. Of cell in / HPF

Bacteria/ yeast/ microorganism as (2+ like)

Crystals. Abnormal crystal should be confirmed chemically.

On large amount of mucus. 

MICROSCOPICAL FINDINGS TO NOTE:

Organised  sediments

Cell

RBC

WBC

Epithelial cell

Squamous

Transitional

Renal tubular

Casts

Matrix casts

Hyaline cast- formed almost with tamm-Horsfall protein. / upto 2 /HPF is normal. / found normally in – exercise/ old/ HTN/ CCF/ dehydration/ Fever

Waxy cast : common in CRF. If broad- called Renal failure cast

Inclusion cast

Granular cast – protein[ fibrinogen/ Immune complex/ globulin] , cell debris [cell damage & degeneration]

Fatty cast : in heavy proteinuria, in normal saline.

Hemosiderin granules-

Melanin granules

Pigments cast :

Hemoglobin- typically yellow/ red. Found with RBC cast in glomerular disease. & in tubular bleeding/ hemoglobinuria.

Myoglobin : red brown. Found in myoglobinuria following muscle damage.

Bilirubin : deep yellow brown cast. Found in obs. Jaundice.

Drug 

Cellular cast:

RBC cast- condition when RBC appear in urine, like- AGN/ SABE/ IgA nephropathy/ Tubulo-interstitial disease.

Leucocytic cast:- mostly in Tubulo-interstitial disease., inflammation/ glomerular disease.

Renal tubular epithelial cell cast : ATN/ viral disease/ drug toxicity/ heavy metal toxicity.

Mixed cell

Broad cast : 

Dismater 2-6 times than normal cast, due to tubular dilation and/or stasis in collecting duct. Typically seen in CRF, has poor prognosis. (Renal failure cast)

Telescoped sediment : simultaneous finding of elements of GN + NS. Include – RBC, RBC cast, Cellular Cast, Broad Waxy cast, oval fat bodies, fatty cast, lipid droplet. Found in – SABE/ collagen vascular disease (Lupus nephritis). 

Abnormal cell & other formed elements

Tumor cell

Viral inclusion cell

Platelets

Bacteria

Fungi

Spermatozoa

Parasie 

Trichomonas vaginalis- motile found if female, contaminated/ urethral, bladder infection. Schistosomia and E.Histolytica ova also may be found.

Urine examination findings

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Un-organised crystal

Formed by ppt. Of urinary salts when PH, Temperature & concentration of urine changes. These appear either amorphous or crystalline form. Crystal forms on standing/ refrigeration, in vivo, main cause is increase of solute concentration.]

Crystal found in normal acid urine : 

Amorphous urates:

(Calcium, Magnesium, Sodium, Potassium) : dissolve by heat & NaOH, not by acetic acid.

Crystalline urates

( Sodium, potassium, Ammonium): on addition of acetic acid- turn to crystal f uric acis, can be seen microscopically .

Crystalline uric acid

 4 sided, flat, yellow/ reddish brown, rhombic plates or prism

Calcium oxalates

occurs in Ph-6, nutral, slight alkaline urine], often associated with spinach,Tomato.

Crystal found in normal alkaline urine

Amorphous  phosphates 

(Calcium, Magnesium). [ found in alkaline/ slightly acidic ph] – dissolve in acetic acid.

Crystalline phosphates.

( triple phosphate :  ammonium- magnesium-calcium) : presence of fresh urine indicate stone in kidney/ bladder.

6 sided prism

Leaf like

Calcium carbonate

[rare in man.] small colourless sphere/ granules. Soluable in acetic acid with gas formation.

Ammonium biurate

[ in alkaline/ nutral/ slightly acidic urine]

Usually found with phosphate crystal.

Yellow/ brown sphere showing concentric striation.

Dissolve in acetic acid + heat.

Crystal found in abnormal urine

Leucine 

Oil drop like with radial & concentric striation.

Tyrosine

fine needle like, called Tyrosine needle.

Cystine

hexagonal, colorless, plate like.

 Found in acidic urine- resemble uric acid crystal

Found in cystinuria- congenital renal tubular defect.

Drug crystal

sulphonamide, ampicillin, radiographic material, others.

Artifacts

Air bubble 

Fibre

 Oil  

 Hair