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Cells
	Description	Associated Conditions
	Erythrocytes • Size: 7-8 µm in diameter • Pale or yellowish, smooth biconcave disk • No nucleus or cytoplasmic granules • Normal: Less than 2 RBC/HPF	• Can originate from any part of the urinary tract • In females, consider menstrual contamination

	Leukocytes • Typically neutrophils (PMN) • Larger than RBC, 10-12 µm in diameter • Contain nucleus and cytoplasmic granules • Brownian movement (“glitter cells”) • Normal: no more than 2 RBC/HPF	• Can originate from any part of the urinary tract (glomerulus to urethra) • Increased In inflammatory processes of the urinary tract (pyuria)

	Renal Tubular Epithelial Cells • Slightly larger than WBC • Flat, cuboidal or columnar • One large round nucleus	• Tubular damage, pyelonephritis, ATN, salicylate intoxication, transplant rejection

	Transitional Epithelial Cells • 2-4 times larger than leukocytes • Round, pear-shaped, tail-like projections • Large round nucleus

	Squamous Epithelial Cells • Large, flat, irregular-shaped cells	• principally from the urethra and vagina

Casts

	Hyaline Casts • Tamm-Horsfall protein (very low refractive index) • Colorless, homogenous and transparent • Rounded ends	• most frequently observed • can be found in normal urine • physical exercise & dehydration

	Waxy Cast • Very high refractive index • Yellow, gray or colorless • Smooth homogeneous appearance • Short, broad with blunt or broken ends • Cracked or serrated edges	• Severe chronic renal failure, malignant hypertension, diabetic nephropathy

	Granular Cast • Large and coarse granules	• Second-most common type of cast • Can result either from the breakdown of cellular casts, or the inclusion of aggregates of plasma proteins (eg, albumin) or immunoglobulin light chains • Significance: chronic renal disease; As with hyaline casts, can also be seen for a short time following strenuous exercise.

	Fine Granular Cast • Fine granules, gray or pale yellow	• Significance same as for granular casts

	Red Cell Cast • brown to tan	• Renal hematuria, glomerular disease (ie, acute glomerulonephritis, lupus nephritis, renal trauma)

	White Cell Cast	• Infection and noninfectious renal inflammation (ie, acute pyelonephritis, interstitial nephritis & lupus nephritis)

	Epithelial Cell Cast	• Stasis and desquamation of renal tubular epithelial cells following tubular damage and necrosis.

	Fatty Casts (Oval Fat Bodies) • “Maltese-cross” pattern under polarized light.	• Fatty degeneration of the tubular epithelium in degenerative tubular disease.

Crystals in Acid Urine

	Uric Acid • Many different shapes, diamond, rhombic prism or rosette • Yellow or brown	• Very common • Can be normal occurence • Associated with increased purine metabolism

	Calcium Oxalate • Colorless, octahedral or envelope	• Ingestion of oxalate-rich foods: spinach, rhubarb, tomatoes, garlic, oranges, asparagus • High intake of ascorbic acid • Ethylene glycol poisoning

	Cystine • Colorless, refractile, hexagonal plates	• Of diagnostic importance, • Congenital cystinosis or cystinuria

	Leucine • Oily, highly refractile, yellow or brown spheroids and concentric striations	• Clinically significant • Maple syrup urine disease, Oasthouse urine disease, severe liver disease • Seen with tyrosine in liver disease

	Cholesterol • Large, flat, transparent • Notched corners	• Excessive tissue breakdown • Obstructed lymphatic flow • Nephritis and nephrotic conditions

	Tyrosine • Very fine, highly refractile needles • Black, yellow • In sheaves or clusters	• Severe liver disease • Tyrosinosis

	Sulfonamide • Fan or sheaf of needles, eccentric binding • Clear or brown

Crystals in Alkaline Urine
	Triple Phosphate (Ammonium Magnesium Phosphate) • Colorless prisms, 3-6 sides, oblique ends • Coffin lids	• Can be found in normal urines • Chronic urinary inflammation

	Ammonium Biurate • Yellow-brown spherical bodies with long, irregular spicules

	Calcium Phosphate • Long thin, colorless needles • One pointed end • Arranged as rosettes or star	• Can be found in normal urines
Miscellaneous
	Bacteria

`	Schistosoma haematobium • Blood fluke egg • 50 x 150 µm in diameter • Leukocytes (eosinophils) in background

	Yeast Budding • Smooth, colorless, oval, doubly refractile walls • Most common, Candida albicans

	Yeast Branching

	Trichomonas vaginalis	•most frequently encountered parasite

	Starch • Round or oval • Highly refractive, vary in size • Hexagonal in shape • Irregular indentation in the center • "Maltese crosses" under polarization

REFERENCES
Dr. Allen's lecture "Urinalysis". Oct. 13, 2008. A Handbook of Routine Urinalysis. Sister Laurine Graff. 1983

Urine Sediments
		Uploaded: 2008-02-08, Updated: 2008-02-08