Urine Sediment

Foreword
Preface
Acknowledgments
Contents
Abbreviations
About the Author
Part I
	1: The Microscope
		1.1	 Structure of the Microscope
		1.2	 Cleaning and Maintaining the Microscope
		1.3	 Servicing the Microscope
		1.4	 Light Bulb Replacement
	2: Setting-Up Köhler Illumination
		2.1	 Setting-Up Köhler Illumination or Aligning the Microscope
		2.2	 Quick Guide to Setting-Up Köhler Illumination
		Reference
	3: Phase-Contrast Microscopy
		3.1	 Application
		3.2	 What Is Required for Changeover?
		3.3	 The Light Pathway of Phase-Contrast Microscopy
		3.4	 Phase-Contrast Microscopy Equipment
			3.4.1	 PhaCo Objective
			3.4.2	 PhaCo Condensers
		3.5	 Centering the Phase Rings
	4: Macroscopic Urinalysis
		4.1	 Color
			4.1.1	 Some Examples
		4.2	 Odor
			4.2.1	 Some Examples
		4.3	 Cloudiness
			4.3.1	 Some Examples
	5: Microscopic Urinalysis
		5.1	 Urine Sediment Preparation
			5.1.1	 Performance
		5.2	 Error Checklist and Tips for Urine Sediment Preparation
		5.3	 Discussion: Types of Centrifuge (Fig. 5.2)
		5.4	 Centrifuge Nomogram
		5.5	 Preparing the Native Sample
			5.5.1	 Materials (Fig. 5.4)
			5.5.2	 Performance
		5.6	 Switching the Microscope Between Bright-Field and Phase-Contrast
			5.6.1	 Switching the Microscope from Bright-Field to Phase-Contrast Microscopy
			5.6.2	 Switching the Microscope from Phase-Contrast to Bright-Field Microscopy
		5.7	 Specimen-Specific Adjustment of the Microscope
		5.8	 Semi-quantitative Analysis/Units
		5.9	 Discussion: Field Number and Normal Values
	6: Anatomy of the Kidneys and Urinary Tract System
	7: Description of Urinary Sediment Constituents
		7.1	 Erythrocytes
			7.1.1	 Hematuria (Increased Excretion of Erythrocytes in Urine)
			7.1.2	 Eumorphic Erythrocytes—NR: 0–1/HPF
				7.1.2.1	 Biconcave, Disc-Shaped Erythrocytes (pH = 6)
				7.1.2.2	 Thorn Apple-Shaped Erythrocytes (pH < 6)
				7.1.2.3	 Erythrocyte Ghosts (pH > 6)
			7.1.3	 Dysmorphic Erythrocytes
			7.1.4	 Acanthocytes—NR: <5%
		7.2	 Leukocytes
			7.2.1	 Leukocytes—NR: 1–4/HPF
			7.2.2	 Special Forms of Leukocytes
				7.2.2.1	 Sternheimer-Malbin Cells or Bright Cells
			7.2.3	 Histiocytes (Macrophages)—NR: None
		7.3	 Epithelial Cells
			7.3.1	 Squamous Epithelial Cells—NR: 0–15/HPF
			7.3.2	 Transitional Epithelial Cells or Urothelial Cells—NR: 0–1/HPF
			7.3.3	 Deep Urothelial Cells—NR: None
			7.3.4	 Renal or Tubular Epithelial Cells—NR: None
			7.3.5	 Oval Fat Bodies—NR: None
			7.3.6	 Virus-Infected Cells
				7.3.6.1	 Example: Decoy Cells—NR: None
			7.3.7	 Discussion: Cell Description
				7.3.7.1	 Criteria
			7.3.8	 Discussion: Morphological Criteria of Old Cells and Epithelial Cells
		7.4	 Casts
			7.4.1	 Hyaline Casts—NR: Isolated
			7.4.2	 Granular Casts—NR: None
			7.4.3	 Waxy Casts—NR: None
			7.4.4	 Renal Epithelial Casts—NR: None
			7.4.5	 Erythrocyte Casts—NR: None
			7.4.6	 Leukocyte Casts—NR: None
			7.4.7	 Fatty or Lipid Casts and Oval Fat Bodies casts—NR: None
			7.4.8	 Hemoglobin Casts and Myoglobin Casts—NR: None
			7.4.9	 Bacterial Casts—NR: None
			7.4.10	 Mucus Threads (Pseudocasts)
		7.5	 Microorganisms
			7.5.1	 Bacteria—NR: (+) - +/HPF
			7.5.2	 Trichomonads (Flagellates)—NR: None
			7.5.3	 Schistosoma haematobium Eggs—NR: None
			7.5.4	 Enterobius vermicularis (formerly Oxyuris vermicularis) Eggs—NR: None
			7.5.5	 Yeasts—NR: None
		7.6	 Crystals
			7.6.1	 Cystine—NR: None
			7.6.2	 Leucine—NR: None
			7.6.3	 Tyrosine—NR: None
			7.6.4	 Cholesterol—NR: None
			7.6.5	 Urates or Amorphous Uric Acid Salts
			7.6.6	 Uric Acid Crystals
			7.6.7	 Calcium Oxalates
			7.6.8	 Amorphous Phosphates (Tricalcium and Trimagnesium Phosphates)
			7.6.9	 Triple Phosphates or Ammonium Magnesium Phosphates
			7.6.10	 Calcium Phosphates
			7.6.11	 Ammonium Urate Crystals
			7.6.12	 Drug Crystals
		7.7	 Other Sediment Constituents
			7.7.1	 Spermatozoa
			7.7.2	 Lipid Particles
		7.8	 Artifacts
			7.8.1	 Fat Droplets
			7.8.2	 Air Bubbles
			7.8.3	 Glass Fragments
			7.8.4	 Fibers, Dust, and Hair
			7.8.5	 Feces
			7.8.6	 Pollen
	8: Staining of Urinary Sediment Constituents
		8.1	 Staining Techniques
			8.1.1	 From the KOVA® System: Staining Solution (Sternheimer-Malbin Solution) (Fig. 8.1)
			8.1.2	 Fat Staining (Fig. 8.2)
			8.1.3	 Papanicolaou Stain (Complex Stain) (Fig. 8.3)
	9: Cell Counting in the Fuchs-Rosenthal Counting Chamber
		9.1	 Discussion: Fuchs-Rosenthal Counting Chamber
			9.1.1	 Calculation
			9.1.2	 Microscope Set-Up
			9.1.3	 Normal Range
		9.2	 Discussion: Fuchs-Rosenthal Counting Chamber
			9.2.1	 Sliding on the Cover Glass
			9.2.2	 Filling the Counting Chamber
			9.2.3	 Counting Technique
			9.2.4	 Microscopic Detail of a Group Square/Least Square (Figs. 9.5 and 9.6)
		Reference
	10: Hematuria: Laboratory Investigations
		10.1	 Introduction
Part II
	11: Urinary Sediment Constituents in Bright-Field and Phase-Contrast Microscopy
		11.1	 Eumorphic Erythrocytes
		11.2	 Hematuria
			11.2.1	 Erythrocyte Accumulations
		11.3	 Dysmorphic Erythrocytes and Acanthocytes
		11.4	 Yeast Cells and Fungal Hyphae
			11.4.1	 Yeast Cells, Fungal Hyphae, and Erythrocytes: 1000× Magnification
			11.4.2	 Cluster Formation: Yeast Cells and Fungal Hyphae
			11.4.3	 Yeast Cells with Chlamydospores
			11.4.4	 Comparison: Yeast Cells (Mother–Daughter Asymmetry)–Acanthocytes
			11.4.5	 Bacteria, Fungal Hyphae, and Mucus Threads
		11.5	 Leukocytes (Granulocytes)
			11.5.1	 Old Leukocytes
			11.5.2	 Elongated Leukocytes
			11.5.3	 Leukocyte Accumulations: Pyuria, Casts, and Clusters
			11.5.4	 Comparison: Thorn Apple-Shaped Erythrocytes with Small-Cell Leukocytes
			11.5.5	 Comparison: Fresh Native Specimen and Old Native Specimen from the Same Urine Sample
			11.5.6	 Leukocytes with Phagocytized Yeast Cells
			11.5.7	 Discussion: Neutrophils and Eosinophilic Granulocytes, Lymphocytes
			11.5.8	 Histiocytes (Macrophages)
			11.5.9	 Old Histiocytes (Macrophages)
		11.6	 Parasites
			11.6.1 Trichomonads
			11.6.2	 Schistosoma haematobium Eggs
			11.6.3	 Enterobius vermicularis Eggs
		11.7	 Epithelial Cells: An Overview
			11.7.1	 Squamous Epithelial Cells
			11.7.2	 Squamous Epithelial Cells: Cell Groups
			11.7.3	 Transitional Epithelial Cells (Urothelium)
			11.7.4	 Deep Urothelial Cells
			11.7.5	 Comparison: Transitional Epithelial Cells–Old Leukocytes
			11.7.6	 Comparison: Squamous Epithelium–Transitional Epithelium
			11.7.7	 Renal Epithelial Cells (Renal Tubular Epithelial Cells)
			11.7.8	 Old Epithelial Cells
			11.7.9	 Oval Fat Bodies–Intracellular Lipid Droplets
			11.7.10 Discussion: Extracellular Lipid Droplets
			11.7.11 Comparison: Oval Fat Bodies–Histiocytes
			11.7.12 Comparison of Oval Fat Bodies–Histiocyte–Leukocyte with Phagocytized Yeast Cells–Old Epithelial Cells
			11.7.13 Decoy Cells
			11.7.14 Tumor Cells
		11.8	 Casts: Overview
			11.8.1	 Pseudocasts = Mucus Threads
			11.8.2	 Hyaline Casts
			11.8.3	 Old Casts
			11.8.4	 Waxy Casts
			11.8.5	 Granular Casts
			11.8.6	 Erythrocyte Casts
			11.8.7	 Hemoglobin Casts
			11.8.8	 Leukocyte Casts
			11.8.9	 Renal Epithelial Casts
			11.8.10 Mixed Cell Casts
			11.8.11 Microscopy Technique: E.g., Casts
			11.8.12 Oval Fat Body Casts
			11.8.13 Lipid Casts
			11.8.14 Bacterial Casts
			11.8.15 Long Casts: Erythrocyte Cast, Mixed Cell Cast and Oval Fat Body Cast
		11.9	 Bacteria
			11.9.1	 Semi-quantitative Bacterial Analysis
			11.9.2	 Discussion: Vaginal Swab
			11.9.3	 Discussion: Bacteriuria and Fecal Material
		11.10	 Spermatozoa
		11.11	 Crystals: Overview
			11.11.1 Cystine
			11.11.2 Cholesterol
			11.11.3 Tyrosine Crystals
			11.11.4 Comparison: Leucine–Ammonium Urates
			11.11.5 Ammonium Urates
			11.11.6 Calcium Oxalates
			11.11.7 Uric Acid Crystals
			11.11.8 Urates: Semi-quantitative Analysis
			11.11.9 Amorphous Phosphates (Tricalcium and Trimagnesium Phosphates)
			11.11.10 Comparison: Urates–Amorphous Phosphates
			11.11.11 Triple Phosphates
			11.11.12 Calcium Phosphates
			11.11.13 Drug Crystals
		11.12	 Artifacts
			11.12.1 Glass Fragments
			11.12.2 Pollen
			11.12.3 Starch Grains
			11.12.4 Cylindrical Artifacts
			11.12.5 Air Bubbles and Fat Droplets
			11.12.6 Other Artifacts
Part III
	12: Microscopic Urine Sediment: Analysis and Findings
		12.1	 Introduction to the Analysis and Diagnosis of the Microscopic Urinary Sediment Image
		12.2	 Illustrated Diagnostic Examples
			12.2.1 Normal Findings
			12.2.2 Eumorphic Hematuria I
			12.2.3 Eumorphic Hematuria II
			12.2.4 Dysmorphic Hematuria
			12.2.5 Dysmorphic Hematuria with Erythrocyte Casts
			12.2.6 Bacterial Urinary Tract Infection
			12.2.7 Bacterial Urinary Tract Infections with Renal Involvement
			12.2.8 Yeast Infections
			12.2.9 Yeast Contamination
			12.2.10 Pseudo-urinary Tract Infection
			12.2.11 Bacteriuria
		12.3	 Analysis
			12.3.1 Exercises in the microscopic analysis of urinary sediment images
			12.3.2 Eumorphic Hematuria
			12.3.3 Eumorphic Hematuria and Yeast Cells
			12.3.4 Eumorphic Hematuria and Yeast Cells with Fungal Hyphae
			12.3.5 Eumorphic Hematuria with Crystalluria
			12.3.6 Dysmorphic Hematuria
			12.3.7 Dysmorphic Hematuria: Stained
			12.3.8 Dysmorphic Hematuria and Erythrocyte Casts
			12.3.9 Dysmorphic Hematuria and Lipid Casts
			12.3.10 Dysmorphic Hematuria with Yeast Cells
			12.3.11 Leukocyturia
			12.3.12 Leukocyturia and Bacteriuria
			12.3.13 Leukocyturia, Bacteriuria, and Triple Phosphates
			12.3.14 Leukocyturia with Leukocyte Casts
			12.3.15 Leukocyturia and Yeasts
			12.3.16 Leukocyturia and Spermatozoa
			12.3.17 Bacteriuria and Crystalluria
			12.3.18 Bacteriuria and Lipiduria
			12.3.19 Lipid Cylinduria
			12.3.20 Atypical Cells: Suspected Decoy Cells
			12.3.21 Crystalluria and Lipid Casts: Stained
			12.3.22 Crystalluria
			12.3.23 Schistosoma haematobium Egg and Eumorphic Hematuria
		12.4	 Diagnosis
			12.4.1 Exercises in the diagnosis of microscopic urinary
			12.4.2 Findings Sheet: Urine Status
			12.4.3 Eumorphic Hematuria (Thorn-Apple) with Fine Granular Cast
			12.4.4 Eumorphic Hematuria with Histiocytes
			12.4.5 Eumorphic Hematuria
			12.4.6 Eumorphic Hematuria and Crystalluria
			12.4.7 Eumorphic Hematuria and Yeast Cells
			12.4.8 Dysmorphic Hematuria
			12.4.9 Dysmorphic Hematuria with Erythrocyte Cast
			12.4.10 Erythrocyte Casts
			12.4.11 Yeast Cells with Chlamydospores
			12.4.12 Yeast Cells and Fungal Hyphae
			12.4.13 Leukocyturia with Bacteriuria and Eumorphic Hematuria
			12.4.14 Leukocyturia and Yeast Cells
			12.4.15 Leukocyturia with Yeast Cells and Eumorphic Hematuria
			12.4.16 Leukocyturia with Fungal Hyphae and Yeast Cells
			12.4.17 Leukocyturia with Bacterial Casts
			12.4.18 Leukocyturia and Bacteriuria with Deep Urothelial Cells
			12.4.19 Leukocyturia and Bacteriuria: Old Urine Sample
			12.4.20 Suspected Pseudo-urinary Tract Infection
			12.4.21 Bacteriuria
			12.4.22 Bacteriuria and Feces
			12.4.23 Crystalluria (Uric Acid Crystals and Calcium Oxalates)
			12.4.24 Crystalluria (Uric Acid Crystals and Urates)
			12.4.25 Crystalluria (Square/Envelope-Shaped and Round/Oval Calcium Oxalates)
			12.4.26 Crystalluria (Amorphous Phosphates)
			12.4.27 Granular Casts
			12.4.28 Lipiduria with Oval Fat Body Casts
			12.4.29 Epithelial Casts
			12.4.30 Cylindruria (Hyaline Casts)
			12.4.31 Waxy Cast, Leukocyturia, and Yeast Cells
			12.4.32 Cystinuria and Eumorphic Hematuria
Part IV
	13: Urine Sediment Quiz
		13.1	 Quiz on Urinary Sediment Constituents
		13.2	 Quiz on Urinary Sediment Constituents: Answers
		13.3	 Exercise Sheet to Fill Out
		13.4	 What Is What? Bacteriuria and/or Crystalluria?
			13.4.1	 Answers
		13.5	 What Is What? Hematuria?
			13.5.1	 Answers
		13.6	 What Is What?
			13.6.1	 Answers
		13.7	 What Is What?
			13.7.1	 Answers
		13.8	 What Is What?
			13.8.1	 Answers
		13.9	 Is the Microscope Plane Correct?
			13.9.1	 Answer
		13.10	 Schematic Images of Urine Sediment: Quiz
			13.10.1 Cellular Constituents, etc.
			13.10.2 Epithelial Cells
			13.10.3 Casts
			13.10.4 Crystals
Index