Urine Sediment Guide

Urine Sediment Guide Sediment Analyzer Reference bar = 20 microns Blood cells Figure 1. Red blood cells Figure 2. Crenated red blood cells Figure 3. White blood cells Figure 4. White blood cells Epithelial cells Figure 5. Squamous epithelial cells Figure 6. Squamous epithelial cells Figure 8. Numerous transitional (nonsquamous) Figure 7. Numerous transitional (nonsquamous) epithelial cells with RBCs and WBCs epithelial cells (Possible transitional cell carcinoma. Confirm with dry-slide cytology.) Bacteria Figure 9. Rods with white blood cells Figure 10. Rods with white and red blood cells Figure 11. Cocci with white blood cells Figure 12. Cocci in chains Casts Figure 13. Left and right, hyaline cast Figure 14. Cellular (nonhyaline) cast Figure 15. Numerous granular (nonhyaline) casts Figure 16. Waxy (nonhyaline) cast Figure 17. Large struvite crystals Figure 18. Numerous small struvite crystals Figure 19. Large calcium oxalate dihydrate crystals Figure 20. Numerous calcium oxalate dihydrate crystals Figure 21. Calcium oxalate monohydrate (picket fence) crystals Figure 22. Calcium oxalate monohydrate crystals; left, dumbbells; right, hemp seed Figure 23. Ammonium biurate (thorn apple) crystals Figure 24. Bilirubin crystal with WBCs Crystals Figure 25. Cholesterol crystals Figure 26. Cystine crystals with red blood cells Figure 27. Uric acid crystals Figure 30. Amorphous crystalline debris Figure 31. Hyphae Figure 28. Likely drug-related crystals Miscellaneous Figure 29. Lipids Figure 33. Left, Pearsonema spp. (Capillaria spp.) ova; right, macrocanidia Figure 34. Left, glove powder; right, pollen Figure 35. Fiber Figure 32. Sperm with white blood cells Figure 36. Dust mite Conventional microscopy All images, unless otherwise indicated, are representative of a high power (40x objective) field of view. Blood cells Figure 1. Erythrocytes and one squamous epithelial cell Figure 2. Erythrocytes and two leukocytes (black arrows) Figure 3. Numerous leukocytes and few rod-shaped bacteria Figure 4. Squamous epithelial cells Figure 5. Epithelial cells (black arrows), RBC (red arrows) and WBC (blue arrows) Figure 6. Transitional epithelial cells Figure 7. Left, Transitional cell carcinoma; right, NMB wet prep Figure 8. Transitional cell carcinoma (NMB wet prep on right) Figure 9. Transitional cell carcinoma, air-dried and Diff-Quik* stained Figure 11. Many leukocytes and large rod-shaped bacteria (black arrows) Figure 12. Numerous bacteria and leukocytes Figure 14 Left, granular cast; right, mixed waxy and granular cast Figure 15. Waxy cast Epithelial cells Bacteria Figure 10. Many rod-shaped bacteria,100× objective field of view Casts Figure 13. Hyaline cast (borders outlined) Crystals Figure 16. Struvite Figure 17. Amorphous (NMB wet prep on right) Figure 18. Bilirubin Figure 19. Ammonium biurate Figure 20. Left, calcium oxalate monohydrate; right, calcium oxalate dihydrate Figure 21. Drug (Tribrissen*) crystals, 10× objective field of view Figure 23. Pearsonema plica Figure 24. Contaminant fragmented fiber Miscellaneous Figure 22. Left, fat droplets (red arrows, RBC); right, sperm How to perform a dry prep/line smear Performing a dry prep or line smear is an extremely cost-effective means of confirming the presence or absence of bacteria, of differentiating between cocci and short rods, and for characterizing various cellular elements in the urine sample. 6 1. Label your slides appropriately. 2. Fill a centrifuge tube with well-mixed, fresh urine taken from the bottom of the sample tube. 3. Centrifuge the sample (and a balance tube) on the Urine setting (or 400 g). Note: If your centrifuge does not have a Urine setting, refer to its operator's manual for centrifugation settings and times. 4. After centrifugation, a concentrated pellet of formed elements should be visible at the bottom of the tube. Gently aspirate the supernatant down to the pellet, leaving an extremely small amount of urine to resuspend the pellet. Note: If the sample is extremely hypocellular, it may be very difficult to see the pellet. 5. Lightly flick the bottom of the tube multiple times with your finger to gently resuspend the formed elements. 6. Using a new pipette, dispense a drop of sample on a glass slide, similar to preparing a blood film. 7 8 9 7. Place a clean glass spreader slide on your labeled slide, at approximately 30°–40°, in front of the drop of urine. 8. Back the spreader slide into the drop allowing the material to spread along the edge of the spreader slide. 10 specimen slide, keeping the two in contact with each other. 10. In the middle of the slide, abruptly stop spreading the urine sample and lift the spreader slide straight up to form a line of material. 11. Air dry thoroughly and then stain the slide using your routine hematology/cytology stain (e.g., Diff-Quik*). 12. Review microscopically.