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8/17/2019 Particule Si Semnificatii
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Iris Diagnostics
A Division of International
Remote Imaging Systems, Inc.
BASIC URINALYSISBASIC URINALYSIS
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3 – Urine: What is it?
Urine – The !i" secrete" #y the $i"neys,store" inthe #la""er an" "ischarge" #y the
!rethra.Urine, in health, has an am#er color, aslight aci" reaction, a %ec!liar o"or, an"&
&a #itter, salty taste.
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The Kidneys
3 – Urine: What is it?
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View from the back
The Kidneys
3 – Urine: What is it?
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3 – Urine: What is it?
The Kidneys Cross Section
'e%hrons
Renal (elvis
)e"!lla
*orte+
(a%illaUreter
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The Kidneys
Ne!hron " f#nctiona$
#nit Consists of
– %$omer#$#s
– Rena$ T#b#$es
Bowman&sCa!s#$e
'ro(ima$Ca!s#$e
)ista$ T#b#$es
3 – Urine: What is it?
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The Kidneys*Ne!hron+
• Urine formation #egins at the ca%illary#e" $no-n as the GlomerularMembrane an" em%ties into Bowman’sCapsule.
• )em#rane im%ermea#le to )ol. Wt./0,000
• 1iltrate 2 %lasma -ith very little %rotein
•(lasma o- #oth $i"neys4 2 560 m78min• 1iltration rate #oth $i"neys4 2 96m78min 2 9;0 78"ay4
• < ==> of ltrate rea#sor#e" in the
t!#!les
3 – Urine: What is it?
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Urine(resentation
The Kidneys*Ne!hron+
• 1iltrate %asses thro!gh proximal tubule, loop ofHenle, distal
tubule, collecting tubule, an" into the pelvis ofthe $i"ney.
•Along the %ath selective reabsorption an" tubularepithelium secretions occ!r.
(ercent of ltrate -ater rea#sor#e"
Proximal tubules ;0> Loop of Henle 5>
istal tubules => Collecting ucts @>
!!"
Remaining 9> #rine
Im%ortant n!triments s!ch as gl!cose,%roteins, amino aci"s, an" vitamins are
almost com%letely rea#sor#e" in the
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The Ureters
• The !rine trans%ort t!#e from the $i"neys to the#la""er.
• Birt!ally no rea#sor%tion .
•
Urine %asses "irectly from the $i"ney %elvis"irectly into the #la""er.
3 – Urine: What is it?
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The B$adder*The $Holding %an&' for the #rine+
Urine %asses "irectly from the !reters into C an"is tem%orarily store"E – in the #la""er
Transitional e%ithelial cells stretch as the #la""er
lls -ith !rine.
D!ration of store"E !rine can have negativeconseF!ences e.g., UTI4.
The Urethra
Urine em%ties from the e+%an"e" #la""erinto the !rethra an" o!t into a clean collectionc!%.
3 – Urine: What is it?
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Urine – as -e have G!st seen – thro!ghthe massive ltration an" rea#sor%tion ofthe ltrate, signicantly reects many ofthe meta#olic8%hysiologic an" %athologicchanges that occ!r in tiss!es an" arereecte" the #loo".
AnalyHing the !rine has a "istincta"vantage for the %atient:
itEs a non(invasive test
@ C Why Is It AnalyHe"?
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To hel% "etect Disease of the Urinary TractSystem
– lomer!lone%hritis
– 'e%hritis– Urinary Tract Infections
– *alc!li Stones4
– )eta#olic Diseases
Dia#etes )ellit!s
@ C Why Is It AnalyHe"?
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lomer!lone%hritis Jne of the $i"ney "isease that "amage glomer!l!s
– )any ty%es of glomer!lone%hritis
– Incl!"e imm!nologic, meta#olic an" here"itary"isor"ers
– Syn"roms: Kemat!ria, %rotein!ria, olig!ria, aHotemia,
e"ema an" hy%ertension– (eo%le can lose ;0 to ;6> of the $i"ney f!nction.
It can #e a ac!te "isease that can occ!r after astre%tococcal infection
Urinalysis res!lts:Urinalysis res!lts:
– *hemistry: increase" levels of #loo" an" %rotein
– )icrosco%ic: increase" RL*Es, WL*Es,
Renal e ithelial cells, an" *asts
@ C Why Is It AnalyHe"?
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'e%hritis
*an occ!r as the res!lt of vario!s "r!gs an" to+ins– Res%onse allergic in renal interstiti!m
– Renal interstiti!m is inltrate -ith le!$ocytes7ym%hocytes, )acro%hages, Mosino%hils an"ne!tro%hils4
– Sym%toms: Kemat!ria, mil" %rotein!ria,le!$ocyt!ria -itho!t #acteria
Urinalysis res!lts:Urinalysis res!lts:
– *hemistry: increase" levels of (rotein, Lloo" an"7e!$ocyte esterase
– )icrosco%ic: Increase in WL*Es, R#cEs, *asts ofle!$ocytes an" eosino%hils, Renal e%ithelial cellsan" %ossi#ly *rystals
@ C Why Is It AnalyHe"?
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Urinary Tract Infections
*an involve the !%%er or lo-er !rinary tract.
7o-er tract can eNect the !rethra, #la""er or#oth
U%%er tract can eNect the renal %elvis,interstiti!m or #oth
UTIEs are 90 times more common in females
Urinalysis res!lts:Urinalysis res!lts:
– *hemistry: increase" levels of %rotein, #loo",le!$ocyte esterase an" nitrite
– )icrosco%ic: increase" WL*Es, Lacteria, RL*Es,
Transitional e%ithelial cells
@ C Why Is It AnalyHe"?
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*alc!li Stones4
Soli" aggregates of chemicals, !s!allymineral salts
1o!n" in the renal calyces, %elvis, !reter or
#la""er /6> of stones are com%ose" of calci!m an"
o+alate or %hos%hate
1actor in!encing formation:
– Increase concentration of chemical salts
– *hanges in !rinary %K
– Urinary stasis
@ C Why Is It AnalyHe"?
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Dia#etes )ellit!s
ro!% of "isor"ers that aNects themeta#olism of car#ohy"rate, fat an" %rotein
Increase" levels of l!cose, Oetones an" highS in !rine.
*an ca!se retino%athy, me!ro%athy,angio%athy an" ne%hro%athy
@ C Why Is It AnalyHe"?
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Urine S%ecimen *ollection
Ran"om – collecte" any time
*lean *atch – %atient cleans area #efore !rinating
1irst A) – generally #est s%ecimen for "etection#eca!se the !rine has #een in the #la""er aro!n" ;ho!rs
*atheteriHe" C !rine is collecte" sterile – invasive%roce"!re
S!%ra%!#ic As%iration – Urine collecte" !sing a
nee"le an" syringe to go into the #la""er thro!ghthe a#"ominal -all
@ Ko!r *ollection – not !se" for !rinalysis #!t forvario!s s%ecial chemistry tests
6 – Ko- Is It AnalyHe"?
6 – Ko- Is It AnalyHe"?
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S%ecimen Storage Iss!es
Urine sho!l" #e teste" as soon as %ossi#le aftercollection
@ ho!rs or less
(rolonge" storage may ca!se the follo-ing:
– Re" #loo" cells !n"ergo hemolysis
– White #loo" cells "egenerate
– (rotein co!l" #ecome %ositive "!e to changes inhigher %K val!es
– *asts "isa%%ear
– Lacteria m!lti%ly
– %K !ct!ates "!e to car#on "io+i"e loss an"re"!ction of !rea to ammonia
– Urine #ecomes clo!"y "!e to sol!te %reci%itates
6 Ko- Is It AnalyHe"?
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S%ecimen Storage Iss!es
– l!cose level is re"!ce" since gl!cose ismeta#oliHe" #y #acteria an" cells
– Oetone level is re"!ce" #eca!se of
#acterial eNect– Lilir!#in level is re"!ce" "!e to light
sensitivity
– Uro#ilinogen level is re"!ce" since
!ro#ilinogen is converte" to !ro#ilin– 'itrite a%%ears as #acteria gro-
– *olor "ar$ens
– J"or #ecomes fo!l
6 – Ko- Is It AnalyHe"?
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/ 'ARTS/ 'ARTS
'hysica$ Characteristics'hysica$ Characteristics
C *olor, *larity, S%ecic ravity
Chemica$ CharacteristicsChemica$ CharacteristicsC l!cose, (rotein, Lilir!#in,
Uro#ilinogen, %K, Lloo", Oetones, 'itrite, an"7e!$ocytes
0icrosco!ic 1(amination0icrosco!ic 1(aminationC 1orme" elements %articles4, e.g.,
e%ithelial cells, #loo" cells, crystals, casts,#acteria s%erm, m!c!s
6 – Ko- Is It AnalyHe"?
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Iris Diagnostics
A Division of International
Remote Imaging Systems, Inc.
0aintenance0aintenance
223#a$ity contro$3#a$ity contro$
)aintenance an" P!ality control
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9. *lean instr!ment e+teriors!rfaces
. *lean sam%ler
3. *lean loa"8!nloa" stations
@. *hec$ iP Series lamina s!%%ly
6. Mm%ty -aste
5. R!n !rine control rac$s
– *hemistry
– )icrosco%y
/. R!n #o"y !i"s control rac$
)aintenance an" P!ality controlDaily iP System )aintenance
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9.)icrosco%y cali#ration see P!ality
control4.(erform Lac$!%
)aintenance an" P!ality control )onthly iP System )aintenance
)aintenance an" P!ality control
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9. *lean rinse -aste8#aths
. Re%lace lamina container
3. Re%lace lamina lter
@. *lean sam%le t!#e "etector
6. *lean #arco"e rea"er -in"o-
5. *lean o%tical sensors
/. *lean sam%le lter
;. Ins%ect an" clean rac$s
)aintenance an" P!ality control As 'ee"e" iP System )aintenance
)aintenance an" P!ality control
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P!ality *ontrol m!st #e %erforme" "aily
Mach iP *ontrol81oc!s Set contains #ottles of1oc!s, 9 #ottle of (ositive *ontrol, 9 #ottle of'egative *ontrol, an" 7ot S%ecic #arco"e la#els
– 'ote: the #arco"e la#els contain the 7ot ID,!no%ene" e+%iration "ate, an" (ass81ailcriteria
– This information is trac$e" in P* Revie- forthe (ositive an" 'egative *ontrols
– Jnce the Set is o%ene", it is goo" for 30 "ays
– This Set sho!l" #e store" #et-een C ;°*
The iP *ontrol rac$ is !se" to cleanse, foc!s,
an" %erform F!ality control on the iP00 series
a e a ce a " P!a y co o
i3 Series 3#a$ity Contro$
)aintenance an" P!ality control
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The iP *ontrol rac$ sho!l" #e %re%are" asfollo-s:
P y
i3 Series )ai$y 3#a$ity Contro$
)aintenance an" P!ality control
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*ali#ration m!st #e %erforme" monthly
Mach iP *ali#rator (ac$ contains fo!r #ottles of*ali#rator an" 7ot S%ecic #arco"es
– The #arco"e la#els contain the 7ot ID, !no%ene"e+%iration "ate, an" (ass81ail criteria
– Trac$e" in P* Revie- as RM1 val!es
– Jnce o%ene", the #ottle of cali#rator e+%ires in @ho!rs
– The *ali#rator (ac$s sho!l" #e store" #et-een C
;°*.
To cali#rate the instr!ment, the !ser la#els t!#e 9 of90 t!#es -ith the a%%ro%riate cali#rator la#el, mi+esone #ottle of cali#rator, %o!rs 3 m7 into each of the 90
t!#es, inserts these t!#es in to *A7 la#ele" rac$ an"
P y i3 Series 0onth$y 3#a$ity Contro$
Ca$ibration
)aintenance an" P!ality control
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i3 Ca$ibrator and i3 Contro$45oc#s
Set The iP *ali#rator, 1oc!s an" (ositive*ontrol are ma"e of +e" h!man RL*Es
– To ass!re %ro%er cell s!s%ension,vigoro!sly mi+ these sol!tions 6 times,follo-e" #y 6 gentle inversions
– Allo- the #!##les to "issi%ate #efore%o!ring
DJ 'JT mi+ the iP 'egative *ontrol#efore %o!ring. This re"!ces the %otentialof #!##les an" %artic!late "e#ris fromentering the test aliF!ot
Thro- !n!se" #arco"e la#els a-ay -henthe ro"!ct is one.
y
)aintenance an" P!ality control
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3C Re6iew
Res!lts can #esorte" an"searche" #y 7otID, Date8Time,
Ty%e, Stat!s an"
RM1 Jnly a manager
can remove P*"ata %oints.
Stores *hemistry P*, )icrosco%y P*, an")icrosco%y *ali#ration res!lts that can#e vie-e" at any timeQ remove" on a1irst In 1irst J!t #asis
y
)aintenance an" P!ality control
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3C Statistics
(rovi"es a 7evyCennings *hart for all lots of iP(ositive an" 'egative *ontrol analyHe" on theinstr!ment
Stores the last 39 "ays or 900 "ata %oints for
each lot ReF!ires "ata %oints to ma$e the 7evyC
ennings *hart The Target, U%%er an"
7o-er 7imits areo#taine" from the lot
s%ecic #arco"es The )ean an" SD are
calc!late" from the "ata%oints o#taine" from
each r!n of that lot.
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Kan"sCon
iP Daily maintenance
iP monthly maintenanceiP As nee"e" maintenance
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Iris Diagnostics
A Division of International
Remote Imaging Systems, Inc.
S!ecimen 're!arationS!ecimen 're!aration
Specimen Preparation
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p p
S%ecimen ReF!irements
– Use only fresh !rine s%ecimens collecte" in
clean containers -hich are tightly ca%%e".– If s%ecimen isnEt %rocesse" -ithin 9 ho!r, store
at – ;*. Lring to room tem%erat!re #eforetesting.
– )i+ s%ecimen -ell #efore testing.
– DJ 'JT a"" any "isinfectant or "etergent to thes%ecimen.
– Oee% s%ecimens o!t of "irect s!nlight.
– DJ 'JT centrif!ge !rine s%ecimens.
– S%ecimen vol!me is 3m7 for the i*hemBM7J*IT an" is 3m7 for the iP.
– Test t!#es sho!l" #e 95 + 900mm glass or%olystyrene ro!n" #ottom t!#es.
“When to Dilute”
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When to Dilute
i*hem BM7J*ITDJ 'JT Dil!teDJ 'JT Dil!te
iP 00rossly #loo"y
Bery "ense
Keavy m!co!sShort sam%les
Theory of o%eration
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Theory of o%eration7878 3#antitati6e Res#$t Re!ortin93#antitati6e Res#$t Re!ortin9
All %articles are re%orte" an" "is%laye" in
V7V7 res!lts are converte" a!tomatically-hen K(1 an"8or 7(1 are selecte" in settings
C K(1 V786.6
C 7(1 V7 .=
The %article ty%e an" its n!m#er arechec$e" against !serC"ene" a!toCreleasecriteria
If criteria is met, res!lt sent to 7ISQ if not,
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Iris Diagnostics
A Division of International
Remote Imaging Systems, Inc.
0icrosco!ic 1(amination0icrosco!ic 1(amination
of #rine sedimentof #rine sediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
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i3:;; re!orts -: a#to#anti=ed formedi3:;; re!orts -: a#to#anti=ed formede$ementse$ements
RL*s
WL*s
Kyaline *asts
(athological *asts
SF!amo!s M%ithelial *ells
'onCsF!amo!s M%ithelial *ells Lacteria
east
*rystals
WL* *l!m%s
)!c!s
S%erm
(l!s Artifacts
0icrosco!ic 1(amination of #rinec osco! c a a o o # e
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
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White Lloo" *ells WL*4
Re" Lloo" *ells RL*4
B$ood ce$$sB$ood ce$$s
c osco! c a a o o # e!
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
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Red B$ood Ce$$s *RBC+Red B$ood Ce$$s *RBC+
C Kemat!ria is normally associate" -ith a !rinary tract "isease.
C Re" #loo" cells erythrocytes4 may #e a contaminate in the!rine from menstr!ating -omen.
Sha!e
C Smooth, ro!n" #iconcave "iscs
Si?e
C 5 to ; Xm in "iameter an" 3Xm in "e%th
i3 :;;i3 :;;0icrosco!0icrosco!
ee
!!
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
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Red B$ood Ce$$s *RBC+Red B$ood Ce$$s *RBC+
'atho$o9ies KM)ATURIAC (yelone%hritis,C 'e%hroto+ins,C Oi"ney tra!ma,C Urinary tract infections,
C *ystitis,C Ac!te t!#!lar necrosis,C Urinary tract stones : calc!li,C lomer!lar "amageC Mro"ing !rinary tract t!mors.
Norma$ 6a$#e 3 to 9 8Xl
i3 :;;i3 :;;
0icrosco!0icrosco!ee
!!
sedimentsediment
) hi R d B$ d C $$ *)RBC+)ysmor!hic Red B$ood Ce$$s *)RBC+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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)ysmor!hic Red B$ood Ce$$s *)RBC+)ysmor!hic Red B$ood Ce$$s *)RBC+
C The secon" ty%e of hemat!ria is "ysmor%hic or renal
hemat!ria.
C This hemat#ria is characteri?ed by a great variation inthe siHe of the cells anisocytosis4, many ghost cells, an" #ya high %ercentage of "ysmor%hocytosis *@:;.+8
C Dysmor%hic or "istore" RL* can #e fo!n" -ith normal
erythrocytes of healthy in"iv!"!als.
'atho$o9ies C lomer!lar "amage
C Sic$le cell "isease.
C The %ercentage of isomor%hic an" "ysmor%hic RL* -ill#e a!tomatically calc!late" for the re%ort
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
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Red B$ood Ce$$s C$#m!s *RBCC+Red B$ood Ce$$s C$#m!s *RBCC+
C *o!l" #e fo!n" in !rine -ith gross hemat!ria
C Do not conf!se -ith RL* stic$ to m!co!s threa"s .
!sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
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hite B$ood Ce$$s *BC+hite B$ood Ce$$s *BC+
C White #loo" cells le!$ocytes4 from cervical or vaginalinfections or e+ternal !rethral meat!s may contaminate !rinesam%les.
( Manl) *BCs in urine are( Manl) *BCs in urine are +eutrophils+eutr ophils
C Increase" n!m#er of le!cotytes le!$cyt!ria or %i!ria
T!r#i" an" clo!"y !rine s%ecimens
Sha!e C Ro!gh -ith gran!lar cyto%lasm
C S%herical -ith caracteristic cyto%lamic gran!les
C 7o#e" or segmente" n!clei
Si?e C 90 to 9@ Xm in "iameter
i3 :;;i3 :;;
0icrosco!0icrosco!ee
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
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hite B$ood Ce$$s *BC+hite B$ood Ce$$s *BC+
'atho$o9ies'atho$o9ies
Bacteria$ ca#ses
C (yelone%hritis
C *ystitisC Urethriti"
C (rostatitis
Norma$ 6a$#e 908Xl
sedimentsediment
Non bacteria$ ca#sesC 'e%hritisC lomer!lone%hritis
C *hlamy"iaC )yco%lasmosisC T!r#ec!losisC Trichomonas and mycoses
(= vaginal contaminants)
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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hite B$ood Ce$$s *BC+hite B$ood Ce$$s *BC+
1osino!hi$s1osino!hi$s C 9@ Xm in "iameter
C #ilo#e" n!clei
CC Mosino%hil!ria ac!te intestinal ne%hritis
chronic UTI
Lym!hocytesLym!hocytes C 5 to =Xm in "iameter4
C oval n!cle!s an" clear cyto%lasm
C 7ym%hocyt!ria inammatory con"itions%yelone%hritis
renal trans%lant reGection
C They "o not %ro"!ce esterase chemistry test neg4
istiocytesistiocytes
C )acro%hages 30 to 90Xm4 8 )onocytes 0 to @0 Xm4
C *ells -hich "efen" against microorganisms
C Renal t!#!lointerstitial "iseases an" imm!ne reaction
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinedi
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hite B$ood Ce$$s C$#m!s *BCC+hite B$ood Ce$$s C$#m!s *BCC+
C WL** are ty%ically fo!n" in !rine sam%les containing largeF!antities of WL*.
C Their %resence generally re%resents an ac!te infectio!s%rocess.
i3 :;;i3 :;;
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
didi t
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SF!amo!s M%ithelial *ells SPM(4
'onCsF!amo!s M%ithelial *ells 'SM4
Renal M%ithelial RMM(4 Transitional M%ithelial TRM(4
1!ithe$ia$ ce$$s1!ithe$ia$ ce$$s
sedimentsediment
S>#amo#s 1!ithe$ia$ Ce$$s *S31'+S>#amo#s 1!ithe$ia$ Ce$$s *S31'+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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S>#amo#s 1!ithe$ia$ Ce$$s *S31'+S>#amo#s 1!ithe$ia$ Ce$$s *S31'+
Sha!eSha!e
C Bery large, thin @0 – 50 Xm4
C *ells -ith small n!clei an" clear shar% e"ges.
C$inica$ si9ni=canceC$inica$ si9ni=cance
C enerally re%resents %ossi#le contamination of thes%ecimen.
C Their %resence is generally not consi"ere" clinicallysignicant.
C It is necessary to #e vigilant -ith el"erly %atientYs
s%ecimens.sF!amo!s meta%lasia of the #la""er4
i3 :;;i3 :;;
0icrosco!0icrosco!ee
sedimentsed e
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di tdi t
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C$#e Ce$$s *S31'+C$#e Ce$$s *S31'+
C *l!e cells are s>#amo#s e!ithe$ia$s>#amo#s e!ithe$ia$ ce$$s co6ered withce$$s co6ered with
bacteria8bacteria8
C SiHe: @0 – 50 Xm
C They a%%ear shaggyE, as seen a#ove, an" the n!cle!s
may not #e visi#le "!e to the #acteria covering the cell.
C *l!e cells are contaminants an" are in"icative of #acterialvaginosis.
i3 :;;i3 :;;
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
di tsediment
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Non S>#amo#s 1!ithe$ia$ Ce$$s *NS1+Non S>#amo#s 1!ithe$ia$ Ce$$s *NS1+
C *ells -ith a#normal sha%e, siHe, incl!sions or n!clearchromatin %attern
nee"s f!ther cytologic st!"ies
C SiHe: 9@ to 50 Xm
C$inica$ si9ni=canceC 'eo%lasia in genito!rianry tract.
/ ty!es of ce$$s are fo#nd in #rine sediment/ ty!es of ce$$s are fo#nd in #rine sediment
C SF!amo!s ever seen4
C Transitional !rothelial4
C Renal t!#!lar e%ithelial cells
i3 :;;i3 :;;
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Transitiona$ 1!ithe$ia$ Ce$$s *TR1'+Transitiona$ 1!ithe$ia$ Ce$$s *TR1'+
CC Transitional e%ithelial cells occ!r in the renal %elvis,!reter, calyces an" #la""er.
C These cells are smaller an" more -ell "ene" thansF!amo!s e%ithelial an" have a larger n!cle!s.
Si?e 0 to @0 Xm
Sha!e ro!n" or %ear sha%e, "ense oval to ro!n"n!cle!s an" a#!n"ant cyto%lasm
C$inica$ si9ni=cance *increased n#mber+
Ac!te t!#!lar "isease
lomer!lone%hritis
Ac!te infection
Renal to+icity
Biral infectioni3 :;;i3 :;;
0icrosco!0icrosco!
ee
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Rena$ 1!ithe$ia$ Ce$$s *R11'+Rena$ 1!ithe$ia$ Ce$$s *R11'+
- Renal epithelial cells are generally larger thangran!locytes an" contain a large ro!n" or oval n!cle!s.
C 'ormally, these cells slo!gh oN into the !rine in verysmall n!m#ers e+ce%t ne- #orn4.
Si?e 9 to 0 Xm
C$inica$ si9ni=cance *increased n#mber+
C 'ephrotic syndrome
- Con"itions lea"ing to tubular degeneration
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
sedimentsediment
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sedimentsediment
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*alci!m J+alate *AJZ4
Uric Aci" URI*4
Crysta$sCrysta$s
*alci!m (hos%hate *A(K4
Tri%le (hos%hate T(0@4
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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UnC$assi=ed Crysta$sUnC$assi=ed Crysta$s
All crystals fo!n" #y the A(R are rst name" as U'*R.,t is up to the user to choose the categor) of thecr)stals.
C$inica$ si9ni=cance
The maGority of crystals fo!n" in the !rinary se"iment areof limited clinical valuelimited clinical value.
It is tem%ting to associate crystals -ith a ris$ of!rolithiasis, #!t the maGority of %atients -ith a crystall!ria"o not have an" -ill not "evelo% $i"ney stones.
In the maGority of cases, the crystals fo!n" in !rine are not%resent in the freshly voi"e" s%ecimen.
sedimentsediment
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sedimentsediment
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Ca$ci#m (a$ate Crysta$sCa$ci#m (a$ate Crysta$s
Sha!eC The most common sha%e of calci!m o+alate crystals
is that of its octahe"ral form.
! C any %K of !rines
C$inica$ si9ni=cance
C Severe chronic renal "isease
C Ingestion of the o+alate %rec!rsor ethylene glycol
i3 :;;i3 :;;0icrosco!0icrosco!
ee
sedimentsediment
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sedimentsediment
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i3 :;;i3 :;; 0icrosco!0icrosco!ee
Ca$ci#m (a$ate 0onohydrate Crysta$sCa$ci#m (a$ate 0onohydrate Crysta$s
Sha!eC )onoclinic leave sha%e, oval egg sha%e.
C 1o!n" in sit!ations of massive calci!m o+alate%reci%itation.
! C any %K of !rines
C$inica$ si9ni=cance
C (athological massive %reci%itation
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Amor!ho#s 'hos!hate or Bi#rate Crysta$sAmor!ho#s 'hos!hate or Bi#rate Crysta$s
C The amor%ho!s %hos%hates seen in !rine s%ecimens an"are the res!lt of refrigeration.
Sha!e C -hite mass of small ro!n"e" %articles.
!
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Amor!ho#s Urate Crysta$sAmor!ho#s Urate Crysta$s
The amor%ho!s !rates seen in !rine s%ecimens an" are,most of the time, the res!lt of refrigeration.
Sha!e C %in$ mass of small ro!n"e" %articles.
! C 6,/ to /,0
C$inica$ si9ni=cance 'one
0icrosco!0icrosco!
ee
sedimentsediment
Tri!$e 'hos!hate Crysta$sTri!$e 'hos!hate Crysta$s
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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1ormation "!e to ammonia concentration.
Sha!e C classic sha%e is the %yrami" si+Csi"e" %risms,
that remin"s a co[n li"
! < 5,6
C$inica$ si9ni=cance
C Associate" -ith #acterial gro-th.
C With a rstCmorning fresh s%ecimen, %P- can indicate#%,
C They are often %resent in renal calc!li
C Jther-ise: little clinical val!e.
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Uric Acid Crysta$sUric Acid Crysta$s
Sha!e
C Uric aci" crystals occ!r in several forms -ith the mostcommon #eing "iamon" sha%e".
! \6,6
C$inica$ si9ni=cance
C *an a%%ear in healthy in"ivi"!als
C o!t
C Increase" %!rine meta#olism e.g. cytoto+ic "r!gs4
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
sedimentsediment
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Rare Crysta$sRare Crysta$s
sedimentsediment
*ystine crystals
Tyrosine crystals
7e!cine crystals
Lilir!#ine crystals
*holesterol crystals
Kemosi"erin crystals
And other crysta$sDAnd other crysta$sD
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Ammoni#m Bi#rate Crysta$sAmmoni#m Bi#rate Crysta$s
Sha!eC yello-C#ro-n s%heres -ith striation on their
s!rface
! C al$aline an" ne!tral !rine
C$inica$ si9ni=cance in fresh #rine s!ecimens
C They can ca!se renal t!#!lar "amage
C Ina"eF!ate hy"rataion of the %atient
C If a%%ears in %rolonge" storage !rines no clinical val!e4
sediment
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Bi$ir#bine Crysta$sBi$ir#bine Crysta$s
Sha!eC ne nee"les that regro!% in a cl!m%
C or as re" #ro-n s%heres, %lates&
! C aci"ic !rine
C$inica$ si9ni=cance
C Lilir!#in!ria meta#olic "isease %rocess
C Ke%atic "isease: Ke%atitis, *irrhosis
C J#str!cte" #ile "!ct
C all stones
C T!mors
0icrosco!0icrosco!
ee
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Ca$ci#m Carbonate Crysta$sCa$ci#m Carbonate Crysta$s
Sha!eC small colorless gran!lar crystals
C fo!n"s in %aires "!m##ell sha%e.
! C al$aline !rine
C$inica$ si9ni=cance 'one
0icrosco!0icrosco!
ee
$ i h h $C $ i 'h h t C t $
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Ca$ci#m 'hos!hate Crysta$sCa$ci#m 'hos!hate Crysta$s
Sha!e
C colorless,thin, -e"geli$e %rism arrange" in smallgro!%ing or in a rosette %atern
! C slightly al$alin or ne!tral !rine
C$inica$ si9ni=cance 'one
i3 :;;i3 :;;
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sedimentsediment
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Cho$estero$ Crysta$s *CL+Cho$estero$ Crysta$s *CL+
Sha!e
C clear at rectang!lar %lates -ith notche" corners
! C aci"ic !rine
C$inica$ si9ni=cance
C Accom%agnie" -ith fat in !rine
C 'e%hrotic syn"rome: li%i"!ria
C *hyl!ria: r!%t!re of lym%hatic vessels into renalt!#!les results of tumors4
i3 :;;i3 :;;
C ti C t $C ti C t $
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Cystine Crysta$sCystine Crysta$s
Sha!eC colorless he+agonal %lates
! C aci"ic %K
C$inica$ si9ni=cance
C *ongenital cystinosis
C *ystin!ria
C Ten"s to "e%osite in t!#!les as calc!li renal
"amage
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
emosiderin Crysta$semosiderin Crysta$s
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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0icrosco!0icrosco!
ee
emosiderin Crysta$semosiderin Crysta$s
Sha!e
C gran!les free oating in cl!m%s, cells an" casts
! C aci"ic an" ne!tral !rine
C$inica$ si9ni=cance
C Kemolytic events
Le#cine Crysta$s *L1U+Le#cine Crysta$s *L1U+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Le#cine Crysta$s *L1U+Le#cine Crysta$s *L1U+
Sha!e
C yello- to #ro-n s%heres -ith concentric or ra"ialstriations on their s!rface.
! C aci"ic %K
C$inica$ si9ni=cance
C Jvero- aminoaci"!ria in %lasma an" soincrease" C Renal e+rection
C Kere"itary metha#olic "isor"er li$e tyrosinosis C /ever liver disease, often in a terminal stage
0icrosco!0icrosco!
ee
Radio9ra!hic Contrast 0edia Crysta$sRadio9ra!hic Contrast 0edia Crysta$s
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Radio9ra!hic Contrast 0edia Crysta$sRadio9ra!hic Contrast 0edia Crysta$s
Sha!e
C colorless long %ointe" nee"les singly or cl!stere" insheaves
! C aci"ic !rine
C$inica$ si9ni=cance
C *an signicantly elevating the S of !rine
C *a!se a false %ositive %reci%itation test for %rotein
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0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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S#$fonamides Crysta$sS#$fonamides Crysta$s
Sha!e
C yello- to #ro-n #!n"les of nee"les that resem#leto a fan formation
! C aci"ic !rine
C$inica$ si9ni=cance D!e to "r!gs
T i C t $ *TRY+Tyrosine Crysta$s *TRY+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Tyrosine Crysta$s *TRY+Tyrosine Crysta$s *TRY+
Sha!e
C #ro-n ne""les, isolate" or forming a "ense rosette
! C aci"ic %K
C$inica$ si9ni=cance
C Jvero- aminoaci"!ria in %lasma an" soincrease" C Renal e+rection
C Kere"itary metha#olic "isor"er li$e tyrosinosis C /ever liver disease, often in a terminal stage
0icrosco!0icrosco!
ee
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Kyaline *asts
'onCKyaline *asts
ran!lar RA'4 *ell!lar *M774
CastsCasts
hat is a CastsEhat is a CastsE
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Casts 5ormation 2 9enera$ characteristicsCasts 5ormation 2 9enera$ characteristicsC cast is ma"e of !romo"!lin or TammCKorsfall %roteins.
C It is secrete" #y renal t!#!lar cells an" "istal conv!le"t!#!les
C -hen the t!#!lar l!men contents #ecome concentrate",
#rils forms an" are attache" to the l!men cells.C It is hol"ing tem%orarly in %lace -hile it enmeshes anys!#stances %resent into its matri+.
Ccast is "etache" from the t!#!lar an" !sh into the !rine.
Sha!e
C cylin"rical -ith %arallel si"es
C -ith en"s that are ro!n"e" or straight
hat is a CastsEhat is a CastsE
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sedimentsediment
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C$inica$ si9ni=canceC$inica$ si9ni=cance
C *asts reecte" the stat!s of renal t!#!les.
C the n!m#er of casts reects the severity of the "isease
Ty%e of casts an" its n!m#er val!a#le information tothe clinician.
1(ce!tions stren!o!s e+ercise ] emotional stress
Norma$ 6a$#e 5 to 90 8Xl hyaline or gran!lar casts
in a @ ho!rs !rine collection.
ya$ine Casts *YAL+ya$ine Casts *YAL+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Sha!e4 te(t#re
casts -itho!t incl!sion, are seen in n!mero!s con"itions.
C$inica$ si9ni=cance
– 'ormal !rine
– Stren!o!s e+ercise– Ac!te glomer!lone%hritis
– Ac!te %yelone%hritis
– )alignant hy%ertension
–*hronic renal "isease
Norma$ 6a$#e 5 to 90 8Xl
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsedimenta(y Casts *AFY+a(y Casts *AFY+
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Sha!e4 te(t#re
C J%aF!e -a+li$e matri+ -ith sF!are, shar%e, #l!nt en"sC *rac$s or ss!res in their margins caracteristic of -a+y casts
C$inica$ si9ni=cance
C In"icate t!#!lar o#str!ction -ith %rolonge" stasis
a"vance stage of other casts transforme" "!ring stasis
C *hronic renal fail!re
C Ac!te renal "iseases : glomer!lone%hritis or ne%hroticsyn"rome
C )alignant hy%ertensionC Renal allograft reGection
Norma$ 6a$#e 'ot seen
0icrosco!0icrosco!
eei3 :;;i3 :;;
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment%ran#$ar Casts *%RAN+%ran#$ar Casts *%RAN+
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Sha!e4 te(t#re
C Small thin to large coarse gran!les "is%erse" thro!gho!t the castmatri+.
C *olorless to yello-
C All sha%es an" siHes
C$inica$ si9ni=cance
– Intrinsic renal "isease, ran!lar casts are accom%anie" #ycell!lar casts.
– Keavy %rotein!ria ne%hrotic syn"rome4
– Jrthostatic %rotein!ria– *ongestive heart fail!re -ith %rotein!ria
– Ac!te or chronic renal "isease
Norma$ 6a$#e 5 to 90 8Xl
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
Ce$$#$ar CastsCe$$#$ar Casts RBCs castsRBCs casts
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Sha!e4 te(t#reC Kyaline casts containing ghost re" #loo" cells, or hyalinecasts lle" -ith n!mero!s orange re" erythrocytes.
C The !n%igmente" form of re" #loo" cells casts is morefreF!ent.
C *olor: yello- to re"C#ro-n or colorless
C$inica$ si9ni=cance
C Al-ays lin$e" -ith %rotein!ria
C Intrinsic renal "isease: glomer!lar or t!#!lar "amages
Norma$ 6a$#e 'ot seen
0icrosco!0icrosco!
ee
i3 :;;i3 :;;
Ce$$#$ar CastsCe$$#$ar Casts BCs castsBCs casts
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Sha!e4 te(t#reC Kyaline matri+ cast #earing ne!tro%hil incl!sions
C$inica$ si9ni=cance
C Infection: %yelone%hritis UTI4
WL* casts -ith #acteri!ria, %rotein!ria an" hemat!ria
C lomer!lone%hritis: RL* casts are also %resent -ith WL*casts
C Renal inammation -itho!t #acteri!ria
Norma$ 6a$#e 'ot seen
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsedimentCe$$#$ar CastsCe$$#$ar Casts Rena$ t#b#$ar ce$$s castsRena$ t#b#$ar ce$$s casts
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Sha!e4 te(t#re
C Alignement of RT* or ran"omly arrange" -ithin a cast
C Kyaline cast -ith characteristic large central n!clei
C$inica$ si9ni=cance
C Intrinsic renal t!#!lar "iseases:
Ac!te interstitial ne%hritis
Ac!te trans%lant reGection
T!#!lar necrosis
C ran!lar casts an" %rotein!ria accom%any RT**
Norma$ 6a$#e 'ot seen
0icrosco!0icrosco!
ee
* C+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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5atty casts *5ATC+5atty casts *5ATC+
Sha!e4 te(t#re
C Kaline or gran!lar matri+ -ith free fat glo#!les or8an" oval fat#o"ies
C$inica$ si9ni=cance
C Renal t!#!lar cell "eath
C Accom%anie" #y signicant %rotein!ria ne%hrotic syn"rome
Norma$ 6a$#e 'ot seen
0icrosco!0icrosco!
ee
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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BRA) CastsBRA) Casts
Sha!e4 te(t#re
C Kayline or gran!lar matri+
C$inica$ si9ni=cance
C 1orme" in e+tremely "ilate" t!#es or the -hil"e collecting"!cts
C In"icates %rono!nce" !rinary statis
renal "isease
C Al-ays seen -ith convol!te" casts
Norma$ 6a$#e 'ot seen i3 :;;i3 :;;
Crysta$ castsCrysta$ casts
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
C C
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Crysta$ castsCrysta$ casts
Sha!e4 te(t#re
C Kayline matri+ -ith incl!sion of crystals
C$inica$ si9ni=cance
C in"icates an intrat!#!lar crystalliHation.
C (rovo$e" renal "amages: "!e to an inammation %rocess or#y o#str!ction.
C )ost seen: *alci!m J+alte hy%ero+ali!ria4 an" Uric aci"ne%hro%athy4
Norma$ 6a$#e 'ot seenUric AcidUric Acid
Ca(Ca(
ther caststher casts
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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ther caststher casts&
)icroorganisms Incl!sion *asts : east, Lacteria
1i#rin threa" casts
)yeloma casts
(igmente" casts: Kemoglo#in, )yoglo#in, Lilir!#in&
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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L!""ing east LST4
Ky%hae east KST4
Yeast Yeast
east
B#ddin9 Yeast *BYST+B#ddin9 Yeast *BYST+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Sha!e4 te(t#reC SiHe: 6 to / Xm
C Jvoi" an" colorless loo$s li$e RL*4
C$inica$ si9ni=cance
C *ontamination from vaginal infection, air or s$in
C *an #e %rimary UTI no freeF!ent4
C )ost common s%ecie: *. gla#rata (Torulopsis glabrata)
Norma$ 6a$#e 'ot seen
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
y!hae Yeast *YST+y!hae Yeast *YST+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Sha!e4 te(t#reC *olorless
C$inica$ si9ni=cance
C *ontamination from vaginal infection, air or s$in
C *an #e %rimary UTI no freeF!ent4
C )ost common s%ecie: *an"i"a al#icans
Norma$ 6a$#e 'ot seen
i3 :;;i3 :;;
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Lacteria LA*T4
)!c!s )U*S4
0isce$$aneo#s0isce$$aneo#s
S%erm S(R)4
Jval 1at Lo"yJB1L4 ] 1AT
Bacteria *BACT+Bacteria *BACT+
0ic
rosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine
sedimentsediment
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Bacteria *BACT+Bacteria *BACT+
Sha!e4 te(t#re
C Bario!s siHe an" sha%es: long, thin ro"s to short, %l!m%ro"s
C A%%ears single or in chains "e%en"ing to the s%ecies4
C )ost seen: ro"sha%e" #acilli4 ] cocoi" froms
C$inica$ si9ni=cance
C UTI
C *an #e contamination form vagina an" gastrointestinaltract
Norma$ 6a$#e 'ot seen&i3 :;;i3 :;;
0icrosco!0icrosco!ee
0#c#s *0UCS+0#c#s *0UCS+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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0#c#s *0UCS+0#c#s *0UCS+
Sha!e4 te(t#re
C 1i#rillar %rotein, "elicate, ri##onli$e stran"s
C$inica$ si9ni=cance
C 'one
C *an comes from the genito!rinary tract
o not misidenti0ed with casts 1no rounded ends2o not misidenti0ed with casts 1no rounded ends2
i3 :;;i3 :;;
S!ermato?oa *S'R0+S!ermato?oa *S'R0+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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Sha!e4 te(t#re
C Jval hea": ,6Xm to 3,6Xm -i"th: @Xm to 6!m length
Tail \@6!m
C$inica$ si9ni=cance
C 'one
i3 :;;i3 :;;
0icrosco!0icrosco!
ee
5AT5AT
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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ri9in of fat in #rine
1at or li%i"are fo!n" in !rine in 3 forms:
free as the #irefringent fat "ro%lets
intracell!lar in the oval fat #o"ies
im#e""e" -ithin a cast matri+ in the fatty cast.
C$inica$ si9ni=cance
C 7i%!"!ria al-ays accom%agnie" -ith %rotein!ria
if li%i"s can cross into Lo-manEs s%ace, so can %lasma%roteins an" al#!min4
C lomer!lar "ysfonction -ith li%i"!ria an" %rotein!ria
C 'e%hrotic syn"rome ne%hrosis4
6a$ 5at Body *V5B+6a$ 5at Body *V5B+
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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)e=nitionC oval fat #o"ies are macro%hages also $no-n as foam cells
C renal t!#!lar cell engorge" -ith a#sor#e" fat
C$inica$ si9ni=cance
lomer!lar "ysfonction -ith li%i"!ria an" %rotein!ria
'e%hrotic syn"rome ne%hrosis4
it can occ!re -ith other $i"ney "isease an"8 or metha#olic"iseases s!ch as "ia#ete mellit!s
Norma$ 6a$#e 'one
Trichomonas *TRIC+Trichomonas *TRIC+ %richomonas vaginalis%richomonas vaginalis
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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Sha!e4 te(t#re
C Avrage siHe: 96 Xm can #e 6 to 30 Xm4
C anterior agella an" a %osterior a+ostyle
C$inica$ si9ni=cance
C (arasitic gynecological infection
Norma$ 6a$#e 'ot seen
C Same siHe, sha%e an" contrast as WL*, fo!n" in WL*^^
i3 :;;i3 :;;
Schistosoma aematobi#m 6aSchistosoma aematobi#m 6a
0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment
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Sha!e4 te(t#reC Jval an" large siHe ova
C )ay #e fo!n" most commonly in SPM(, KA7, U'** orU'*7
C< @0Xm
C$inica$ si9ni=cance
C Mnter into the !rine from the #la"er -all m!cosa.
C )eans a %rarsitic infection an" nee" treatment
Norma$ 6a$#e 'ot seen
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Iris Diagnostics
A Division of International
Remote Imaging Systems, Inc.
UNCLUNCL)15INITIN)15INITIN
300-4953 Rev. D
UNCL Classification
Re%resents the entire s%ecimen sorte" #y
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Re%resents the entire s%ecimen sorte" #y
siHe Use" to i"entify %articles not a!toCclassie"
#y A(R
Use" #y the technologist to acco!nt for all
'SMs an" *asts
C Incl!"es 'artic$es not cate9ori?ed #y A(R less than the=0> con"ence level of all a!toCclassie" categories4
UNCL – “Unclassified”
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CThe U'*7 category is a re!resentation of the entiresam!$e -ith the %articles sorte" #y siHe e(ce!t for castsand NS1.
CU'*7 is !se" to $ook for %articles that havenEt #een a!toCclassie" an" to acco!nt for all NS1&s and casts.
CIf the la# has a s%ecic %article that they "onEt re%ort an"have !se" a#to
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Do yo! have
F!estions?
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Iris Diagnostics
A Division of International
Remote Imaging Systems, Inc.
i3i3GG:;; R1VI1:;; R1VI1
STRAT1%Y STRAT1%Y
300-4953 Rev. D
PROPOSED REVIEW STRATEGY
A$$ s!ecimens on the ork List need
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A$$ s!ecimens on the ork List need
re6iew Bacteria
− A#to
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p " #
particles $ispla"e$ match their appropriate auto%classiication
The presence&absence o clinicall" si#niicant bacteria
chan#es the !eriication process
!resence "#sence
7oo$ at the #acteri!ria chec$ list for microsco%yan" chemistry:
Lacteria? WL*? Small %articles *o!nt?
'o( to re!ie( a specimen )
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Lacteria? WL*? Small %articles *o!nt?
Legin at the rst category RL*4
To change a category !se the #!tton at to% right
Reclassify %ict!res
– Do not revie- the images of any classication that isne9ati6e
– Revie- the images of any classication that isborder$ine abnorma$
– Reclassify or s!# classify %articles on$y when iton$y when it
makes a c$inica$ diHerencemakes a c$inica$ diHerence more than 60>4
– Revie- an" s!# classify all images fo!n" in 'onCSF!amo!s M%ithelial +/34, Unclassie" *asts#+CC4, an" Unclassie" *rystals #+C4 4
Re6iew UNCL and answer to those /Re6iew UNCL and answer to those /
>#estions>#estions
'o( to re!ie( a specimen )
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>#estions>#estions
Is there any a""itional *asts?Is there any a""itional Renals, Transitionalscells?
Is there anything ne- ne- category%article4?
When nishe", revie- the nal res!ltsan" acce%t -hen satise"
Verification of Reslts$ "#sence of %acteria
Veri" that the auto%classiie$ particle ima#es match the
cate#ories the" are $ispla"e$ (ithin
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Reclassi" particles (hen it (ill ma*e a clinical $ierence
Sub%classi" particles classiie$ in the N&'+ UNCC+ an$&or
UNC( cate#ories
Account or all ne( particles+ casts+ renals+ an$
transitionals $ispla"e$ in UNCL
N)*'$ (hen usin# auto%classi" to pre!ent reportin# o a
particular particle remember that the ima#es o that
particle (ill still appear in ,-./0
Verification of Reslts$ !resence of %acteria
Veri" that the auto%classiie$ particle ima#es match the
cate#ories the" are $ispla"e$ (ithin
1anuall" #ra$e bacteria base$ on (hat is obser!e$
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" #
(ithin the bac*#roun$s o the +%C+ +%CC+ &,'!+ an$UC& classiications
Reclassi" particles (hen it (ill ma*e a clinical $ierence
Sub%classi" particles classiie$ in the N&'+ UNCC+
an$&orUNC(
cate#ories Account or all ne( particles+ casts+ renals+ an$
transitionals $ispla"e$ in UNCL
N)*'$ (hen usin# auto%classi" to pre!ent reportin# o a
particular particle remember that the ima#es o that
particle (ill still appear in ,-./
Gra$in# an$ 2uanti"in# All .asts an$ -SE Unli$e other cell ty%es, the 'ormaliHation 1actor
for 'SMs an" *asts "oes not e+ist
All 'SMs an" *asts m!st #e acco!nte" for #y the
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All 'SMs an" *asts m!st #e acco!nte" for #y the
!ser
If gra"ing, only one image of a 'SM an"8or *astnee"s to #e move" to the a%%ro%riateclassication.
55 Note: This applies to normal samples only. !the sample is "agged #ith $igh Concentration or%ossible &morphous, all N' and Casts must beclassied in order to obtain an accurate result.
If en!merating, all 'SM an"8or *asts nee" to #emove" to the a%%ro%riate classication to #eacco!nte" for correctly.
When to return to the manual microscope)
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There are @ times reg!lators reF!ire !sers to goto a man!al microsco%e
9. Jval 1at Lo"iesC conrm !sing %olariHe" lightmicrosco%y
. 1atC conrm !sing %olariHe" light microsco%y
3. TrichomonasC conrm %resence of agella #ymotility
@. Any *ell!lar *astC to ID cell ty%e
i2Series Deinitions
A#normal Threshol"
– The !ser "ene" concentration at -hich a
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res!lt is consi"ere" a#normal– Kighlights the res!lt in red an" re%orts an
ne+t to the corres%on"ing res!lt
– A%%lies to #oth forme" %articles an"
chemistries *hemistry *onrmation Threshol"
– The !ser "ene" concentration at -hich ares!lt -ill #e agging for conrmatory testing
– talici*es the res!lt that is agge"
– A%%lies to chemistry res!lts only
i2Series Deinitions A!toCclassify
– The minim!m concentration of a %articleto #e i"entie" #efore creating the%article classication
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– Use" to increase the s%ecicity of thesoft-are for a %artic!lar %atient"emogra%hic
– (articles %resent that are less than the
threshol" -ill a%%ear in U'*7
A!toCrelease
– Dene" #y the !ser to allo- theinstr!ment to a!tomatically re%ort forme"
%articles to a %rinter an"8or 7IS -itho!t atechnologistEs revie-
– 1lagge" sam%les cannot #e a!toCrelease". These sam%le -ill a!toCrelease