Urine Sediment Identification
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Transcript Urine Sediment Identification
Urine Sediment Identification
Penny S. Stevens, MBS, MT(ASCP), CLS(NCA)
Sr. International QA/QC Medical Technologist
SMILE, Johns Hopkins University
Course Objectives
Review the kidney structure
Review rapid chemical tests
Identify normal and abnormal urine sediment
Review steps for accurate sediment ID
Case studies
2
Kidney Structure - Overview
Approximately 1 million
nephrons in each
kidney
Waste products and
water pass along the
tubule
Water, salts, sugar, &
other large molecules
reabsorbed within limits.
Excess products &
Urine are excreted.
3
Rapid Chemical Test
Bilirubin
Blood
Glucose
Ketones
pH
Protein
Urobilinogen
Nitrite
Leukocytes
Specific Gravity
4
Normal & Abnormal
Microscopy Review
Cells
Casts
Uric Acid Crystals
Crystals
RBC’s & WBC’s
Epithelial Cast
5
Microscopy - Cells
Red Blood Cell
What rapid chemistry
result do you expect to
be positive?
Blood
Leukocyte Esterase
Possibly Nitrite
6
Microscopy - Cells
White Blood Cell
What rapid chemistry
result do you expect to
be positive?
Leukocyte Esterase
7
Microscopy - Cells
Squamous Epithelial
What rapid chemistry
result do you expect to
be positive?
Possibly Nitrite
8
Microscopy - Cells
Renal Epithelial
What rapid chemistry
result do you expect to
be positive?
Possibly Protein
9
Kidney Structure – Cast
Formation
Protein – Tamm-Horsfall
T-H Protein, albumin &
immunoglobulin
Secreted by tubule cells
Distal convoluted tubule
(DCT).
Combine to form cast
Include tubule contents
Illustration:
Protein secretion (green
dots)
Hyaline cast (formed in the
collecting duct.
10
Cast Formation
DST protein secretion
Tubule contents
wrapped into protein
matrix
None = Hyaline
Cells = Cellular Cast
Progression
Cellular
Coarse Granular
Fine Granular
Waxy – (Theory)
11
Microscopy – Cast ID
Hyaline Cast
Key Features
Transparent
Cylindrical
Rounded Ends
Colorless
Homogenous
Nearly Parallel sides
No Dark Edges
12
Microscopy – Cast ID
Hyaline Cast
What rapid chemistry
result do you expect to
be positive?
Protein:
Negative – 1+
13
Microscopy – Cast ID
Cellular Cast – (Renal)
Key Features
Cellular: Few – Numerous
Cylindrical
Rounded Ends
Color – depends on the
contents
Nearly Parallel sides
No Dark Edges
14
Microscopy – Cast ID
Fatty Cast – Polarized
Light
Starch - Polarized
Maltese cross
Similar to starch
What rapid chemistry result
do you expect to be
positive?
Protein
Other rapid chemistriesDepends on the contents15
Fat - Polarized
Microscopy – Cast ID
Granular Cast
Coarse Granular Cast
Key Features
Fine Granular Cast
Coarse - black
Fine – grey/pale yellow
Cellularity Indeterminate
Cylindrical
Rounded Ends
Nearly Parallel sides
No Dark Edges
16
Microscopy – Cast ID
Granular Cast
(Hemoglobin)
What rapid chemistry
result do you expect to
be positive?
Protein
Other - Depends on
the origin:
Blood/Hemoglobin
17
Microscopy – Cast ID
Waxy Cast
Key Features
Opaque (Refractive)
Homogeneous (non-cellular)
At Least One Flat/Blunt End
Short
Possibly Cracked, Serrated or
Convoluted
Nearly Parallel Sides
18
Microscopy – Cast ID
Waxy Cast
What rapid chemistry
result do you expect to
be positive?
Protein
>3+
19
Microscopy – Artifact
Fibers
Key Features
Refractile
Flat
Parallel Sides
Dark Edges
20
Cast Comparison
Hyaline Cast
Transparent
Cylindrical
Rounded Ends
Waxy Cast
Opaque
Cylindrical
Blunt Ends
Fiber
Refractile
Flat
Dark Edges21
Urine Sediment Training
Questions??
22