Urinalysis and Body Fluids CRg Unit 2; Session 7Miscellaneous Structures found in Urine SedimentMiscellaneous Urinary Structures• Topics Included in this session are • Cylindroids • Hemosiderin• Mucous threads• Oval Fat Bodies and Free Fat• Bacteria, Yeast, and other Parasites that can be observed in the urine sample• Spermatozoa• ArtifactsCylindroidsCylindroids, same as casts.Hemosiderin• Free granules of hemosiderin & inclusions in a cast• Patient had hemolytic event, ie. Incompatible transfusion, DIC, acute hemolytic anemia – such as sickle-cell anemia, etc. • Picture shows free granules of hemosiderin. X400.• Unstained & Prussian blue stainMucous Threads•Mucous threads have low refractive index: to locate them, use same microscopic techniques as for casts.•Small amount is normalOval Fat Bodies (OFBs)•RTE cells that are undergoing fatty degeneration or have absorbed lipid in the filtrate.•Can also be lipophagesOval Fat Bodies (OFBs)•Maltese cross formation with polarized light•Cholesterol esters polarize•Triglycerides and neutral fats do not •If negative check with Sudan III or oil red O stainLipiduriaOval fat bodies and WBCsLipiduria•Fat is not detected by chemical tests•Fatty degeneration of tubules•Chronic glomerulomephritis•Diabetes mellitus•Eclampsia•Lipid nephrosis•Nephrotic syndrome•Toxic renal poisoning•Fat embolism•Extensive injuries (crushing of subcutaneous fat)•Fractures of the long bonesLipiduria•Polarized anisotropic fat dropletsLipiduriaSudan III-stained fat dropletsBacteria• Normally none present in urine• May be contamination from urethra, vagina, or external sources• Fresh, properly collected specimen that contains many bacteria usually indicates UTI• Especially if ↑# WBCs presentBacteria• Reported using semi-quantitative terms• Such as trace, 1+. 2+, etc.• Nitrite may be positive, but not always• WBCs may be present and more accurately reflect infection than does nitriteYeast• Smooth, colorless• May be budding • May be mistaken for RBCs•Candida albicans most commonYeast cells Yeast• Reported using semi-quantitative terms• Such as trace, 1+. 2+, etc.• Budding yeast or mycelial forms may be present• Common in • Diabetics & Immunocompromised,Yeast (cont.)Budding yeast SM-stained yeast with pseudohyphaeUrinary Sediment: Parasites• Indigenous to urinary tract• Vaginal or fecal contamination• No chemical analysis available• WBCs may be presentParasites -Trichomonas vaginalisParasites -Enterobius vermicularis Parasites -Enterobius vermicularis Head of the Enterobius vermicularis Parasites - Schistosoma haematobium Schistosoma haematobium ovumUrinary Sediment: Spermatozoa• Oval shaped heads with long tails• May be seen in urine of men and women• ?? Report them?Confusing Artefacts-FibersFibersDebris from a diaperUrinary Casts: Confusing Artefacts-HairHair and a coarsely granular castArtifact Interference• Large pollen grain• No usual sediment elements in view• Grain is in a different liquid plane than the urine constituents due to its larger sizeFecal contaminationAir bubblesAir bubble and amouphous uratesAir bubbles, phosphate plate, and amorphous phosphates. Air bubbles can assume a variety of shapes, especially if the coverslip is moved or depressedOil dropletsSummary• Urine sediment may contain– Blood cells (RBCs and WBCs)– Epithelial cells (renal and transitional)– Oval fat bodies (cellular degeneration, anisotropic)– Infectious agents (bacteria, yeast, parasites)– Contaminants (squamous epithelial, bacteria, sperm, parasites and fecal matter)– Artifacts (air bubbles, oil droplets) Lillian Mundt & Kristy Shanahan, Graff’s Textbook of Urinalysis and Body Fluids, 2ndEd. Susan Strassinger & Marjorie Di Lorenzo, Urinalysis and Body Fluids, 5thEd.  Mery Haber, MD, A Primer of Microscopic Urinalysis, 2ndEd. Zenggang Pan, MD, PhD., Dept of Pathology, U of Alabama at Birmingham http://www.enjoypath.com/cp/Chem/Urine-Morphology/Urine-morphology.htm Department of the Army, Landstuhl Regional Medical Center http://www.dcss.cs.amedd.army.mil/field/FLIP%20Disk%204.2/FLIP42.html Nobuko IMAI, Central Laboratory for Clinical Investigation, Osaka University Hospital http://square.umin.ac.jp/uri_sedi/Eindex.htmlReference