Chapter 6 Microscopic Examination
Chapter 6 Microscopic Examination
- sexually transmitted assoc. primarily w/ vaginal protein gels more readily under conditions of:
inflammation. Inf.of the male urethra and prostate
is asymptomatic urine-flow stasis
- resembles WBCs, renal tubular epithelial cells differentiated acidity
with presence of undulating membrane presence of Na &Ca
- use phase microscopy
↑urinary protein = presence of casts caused byunderlying renal
Reporting: rare, few, moderate, or many perhpf conditions
Schistosomahaematobium (ova)- bladder parasite assoc. w/ bladder Scanning electron microscope studies, provided a step-by-step
cancer analysis of the formation of the uromodulin protein matrix:
Enterobiusvermicuralis (ova)- most common fecal contaminant 1. Aggregation of uromodulin protein into individual protein fibrils
attached to the RTE cells
Complete urinalysis correlations: LE, WBCs
2. Interweaving of protein fibrils to form a loose fibrillar network
SPERMATOZOA (urinary constituents may become enmeshed in the network at this
- oval, slightly tapered heads and long,thin, flagella-like tails time)
- occasionally found in the urine of men & women ff.
sexual intercourse, masturbation, or nocturnal emission 3. Further protein fibril interweaving to form a solid structure
male infertility or retrograde ejaculation- sperm is expelled into the 4. Possible attachment of urinary constituents to the solid matrix
bladder instead of the urethra
5. Detachment of protein fibrils from the epithelial cells
+ reagent strip test for protein = ↑ amt. of semen
6. Excretion of the cast
*Urine is toxic to spermatozoa
*Cast forms= ↓urinary flow w/n tubule = lumen is blocked
Most frequently include RBC and WBC cast in Primary diagnostic marker: presence of one homogenous
glomerulonephritis and WBC and RTE cell casts, or WBC cast of at least one of the cell types Predominant Cast in
and bacterial cast in pyelonephritis glomerulonephritis :
RBC Predominant Cast in pyelonephritis: WBC CRYSTAL FORMATION
GRANULAR CAST Crystals are formed by precipitation of urine solutes
including organic, inorganic and medications
coarsely and finely granular casts are frequently seen in ( iatrogenic compounds)
the urinary sediment may be pathologic or non pathologic
significance Precipitation is subject to changes in temperature,solute
concentration,and pH which affect solubility
The origin of the granules in non pathologic conditions
appears to be from the lysosomes excreted by the RTE solutes precipitates at low temperatures
cells during normal metabolism
Crystals are abundant in refrigerated specimen
Increases cellular metabolism accounts for the Increase
of granular cast that accompany Increased hyaline As the concentration of urinary solutes increases, their ability
cast.....
to remain in solution decreases resulting in crystal formation
WAXY CASTS
Presence of crystals in freshly voided urine is associated
with concentrated ( high specific gravity) specimens
representative of extreme urine stasis,indicating chronic
renal failure.
a valuable aid in identification of crystals is the pH of the
specimen, this determines the type of chemicals
the brittle, highly refractive cast matrix is believed to be
precipitated
cause by degeneration of hyaline cast matrix.
Organic and iatrogenic compounds crystalize more in acidic
more easily visualized than hyaline casts because of their
higher refractive index often appear fragmented with jagged ph
ends and have notches on their sides
Inorganic salts are less soluble in neutral and alkaline
with supravital stain, waxy cast stain a homogenous, dark solutions an
pink
Exemption is Calcium Oxalate , which precipitates in both
BROAD CASTS acidic and neutral urine.
broad cast like waxy cast represent extreme urine stasis all abnormal crystals are found in acidic urine
All type of cast may occur in broad form -the most commonly amorphous phosphate requires acetic acid to dissolve
seen broad cast are granular and waxy
when solubility characteristics are needed for identification,
bile-stained broad, waxy cast are seen as the result the sediment should be aliquoted to prevent destruction of
other elements .
of tubular necrosis caused by viral hepatitis ( fig 6-73)
URINARY CRYSTALS (table 6.6 characteristic for the most commonly encountered
crystals)
Crystals found in urine are rarely of clinical significance
NORMAL CRYSTAL SEEN IN URINE
may appear as true geometrically formed structures or as
most common crystal seen in urine are Urates consisting of
amorphous materials
amorphous urates, uric acid, and acid and sodium urates
urinary crystals is to detect the presence of the relatively
Microscopically most urate crystals appears yellow to
abnormal types that may represents such disorders ( liver
reddish brown and are the only normal crystals found in
disease, inborn errors of metabolism, or renal damage
acidic urine the appear colored
caused by crystallization medication compounds within
the tubules) Amorphous urates appear microscopically as yellow
brown granules, occurs in clumps resembling granular
Crystals are reported as rare,few,moderate, many per hpf.
casts and attached to sediment structures, produce a very
characteristic pink sediments because of accumulation of
Abnormal crystal maybe average and reported as lpf.
pigment uroerythrin on the surface of the granules