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• Normal: Less than 2 RBC/HPF
• Can originate from any part of the urinary tract

• In females, consider menstrual contamination

Renal Tubular Epithelial Cells

• Slightly larger than WBC

• Flat, cuboidal or columnar

• One large round eccentrically placed nucleus

• Tubular damage, pyelonephritis, ATN, salicylate intoxication, transplant rejection

Squamous Epithelial Cells

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

Transitional Epithelial Cells

Appearance: smaller than squamous epithelial cells, spherical, polyhedral, caudate-shaped, centrally located nucleus, may have two nuclei.

"indicate disease in area of origin, lining of renal pelvis, calyces, ureters, bladder, and upper portion of the male urethra"?


• 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)

Hyaline Cast

Formed when protein accumulates in the kidney tubes and is deposited in the urine. May appear in normal urine. Can signal fever, stress, or high intensity exercise.

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

• 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

Significance same as for granular casts

Red Cell cast

• Renal hematuria, glomerular disease (ie, acute glomerulonephritis, lupus nephritis, renal trauma)

• brown to tan

Epithelial Cast

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

White Cell Cas

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

Oval Fat Body

• "Maltese-cross" pattern under polarized light.
• Fatty degeneration of the tubular epithelium in degenerative tubular disease.

Uric Acid Crystal (Acid)

• Very common
• Can be normal occurence
• Associated with increased purine metabolism

Calcium Oxalate (Acid)

Ingestion of oxalate-rich foods: spinach, rhubarb, tomatoes, garlic, oranges, asparagus

• High intake of ascorbic acid

• Ethylene glycol poisoning

Cystine (Acid)

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

Leucine (Acid)

• Clinically significant
• Maple syrup urine disease, Oasthouse urine disease, severe liver disease
• Seen with tyrosine in liver disease

Cholesterol (Acid)

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

Tyrosine (Acid)

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

Crystal Sulfate (Acid)

• Fan or sheaf of needles, eccentric binding

• Clear or brown

Ammonium Biurate (Alkaline)

Yellow-brown spherical bodies with long, irregular spicules

Calcium Phosphate (alkaline)

• Long thin, colorless needles

• One pointed end

• Arranged as rosettes or star

• Can be found in normal urines

Triple Phosphate

(Ammonium Magnesium Phosphate) (alkaline)

• Colorless prisms, 3-6 sides, oblique ends

• Coffin lids

• Can be found in normal urines

• Chronic urinary inflammation

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