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    1. #1
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      اطلس تصویری - میکروسکوپی ادرار



      Granular starch (Biosorb) is used as powder on surgical and exam gloves. These granules are commonly encountered as contaminants not only in urine sediments, but also in cytology smears of various types. They are variable in size, round to polygonal in shape, colorless, and usually have a circular or Y-shaped "dot" in the center









      Mold spores and pollens come in a wide variety of shapes and sizes. Shown here is an Alternaria spore surrounded by amorphous crystals and a few lipid droplets. Pollen grains are generally round to oval and some have a yellow to brown tint. They are most likely to be confused for parasitic ova. A good knowledge of the actual appearance of the few true parasite eggs that can occur in urine is easier to achieve than specific recognition of all types of pollen and mold spores. Again, optimizing specimen collection and handling will reduce the chances of seeing potentially confusing structures











      White blood cells (WBC) in unstained urine sediments typically appear as round, granular cells which are1.5-2.0 times the diameter of RBC. The details of nuclear shape often are difficult to discern, especially if the specimen is not fresh. WBC in urine are most commonly neutrophils. Staining of air-dried sediment smears with a hematologic stain sometimes is useful for more specific identification. Like erythrocytes, WBC may lyse in very dilute or highly alkaline urine. WBC up to 5/HPF are commonly accepted as normal. Greater numbers (pyuria) generally indicate the presence of an inflammatory process somewhere along the course of the urinary tract (or urogenital tract in voided specimens). Pyuria often is caused by urinary tract infection, and many times bacteria can be seen on sediment preps. Depending on clinical signs, pyuria may be an indication for culture of urine even if no bacteria are seen. Non-septic causes of inflammation, such as uroliths and tumors, also must be consid











      Fatty casts are identified by the presence of refractile lipid droplets. The background matrix of the cast may be hyaline or granular in nature. Often, they are seen in urines in which free lipid droplets are present as well. Fatty casts are the most common type seen in cat urines. Interpretation of the significance of "fatty" casts should be based on the character of the cast matrix, rather than on the lipid content per se. Pictured here is a fatty cast with a hyaline matrix. Also notice the free lipid droplets in the background. Such droplets are most commonly seen in feline urine. As an isolated finding, lipiduria is seldom of clinical significance











      Calcium oxalate monohydrate crystals vary in size and may have a spindle, oval, or dumbbell shape. Most commonly, they appear as flat, elongated, six-sided crystals ("fence pickets") such as shown to the right. The arrow in the photo indicates a "daughter" crystal forming on the face of a larger underlying crystal. We have not observed this form of calcium oxalate crystals in urine of normal dogs and cats, and believe their presence is virtually always associated with ethylene glycol intoxication











      Cotton, plant, and paper fibers may be confused for parasite larvae or urinary casts. Care in sample collection and handling will minimize the presence of such material








      Neoplastic cells may be seen in urine sediments of patients with tumors of the urinary tract. Transitional cell carcinomas arising in the urinary bladder or urethra are most likely to spontaneously exfoliate, but cannot be ruled out based on a failure to identify malignant cells in urine. Rarely, lymphomas and renal carcinomas also can be diagnosed from urine sediment. The pictures shown are from a case of transitional cell carcinoma in the bladder of a dog. Though the presence of neoplastic cells may be suspected on examination of unstained wet-mounts (upper panel), evaluation of air-dried sediment smears or cytocentrifuge preps stained with hematologic stains (lower panel) is necessary for confirmation. In the case shown here, the cytologic criteria of malignancy are clearly fulfilled; in other cases a distinction from hyperplastic cells cannot be made with certainty without a tissue biopsy











      The appearance of red blood cells (RBC) in urine depends largely on the concentration of the specimen and the length of time the red cells have been exposed. Fresh red cells tend to have a red or yellow color (lower panel). Prolonged exposure results in a pale or colorless appearance as hemoglobin may be lost from the cells (upper panel). In fresh samples with S.G. of 1.010-1.020, RBC may retain the normal disc shape (upper panel). In more concentrated urines (>1.025), red cells tend to shrink and appear as small, crenated cells (lower panel). In more dilute samples, they tend to swell. At urine S.G. <1.008 and/or highly alkaline pH, red cell lysis is likely. Lysed red cells appear as very faint "ghosts", or may be virtually invisible. Red blood cells up to 5/HPF are commonly accepted as normal. Increased red cells in urine is termed hematuria, which can be due to hemorrhage, inflammation, necrosis, trauma, or neoplasia somewhere along the urinary tract (or urogenital tract in vo











      Granular casts, as the name implies, have a textured appearance which ranges from fine to coarse in character. Since they usually form as a stage in the degeneration of cellular casts, the interpretation is the same as that described previously











      Tyrosine crystals are usually seen as fine brownish needles. These can be associated with severe liver disease in humans, but they are very rarely seen in domestic animals
      [hr]







      Fecal material, including eggs of intestinal parasites, sometimes contaminates voided urine samples. For example, the structure at the right was found in the urine of a cat. In the upper panel is a low magnification view showing a packet of eggs. In the lower panel, higher magnification reveals the internal structure of the hexacanth embryos of Dipylidium caninum










      Transitional epithelial cells originate from the renal pelvis, ureters, urinary bladder and/or urethra. Their size and shape depends on the depth of origin in the mucosa. Most often they are round or polygonal; less commonly pear-shaped, tailed, or spindle-shaped. They are generally somewhat smaller and smoother in outline than squamous cells, but larger than WBC. They may develop refractile, fatty inclusions as they degenerate in older specimens (arrow, upper panel). In cleanly-collected normal samples, transitional cells are few, and present as single cells or small clusters (arrow, lower panel, Sedi-Stain). Specimens collected by catheter sometimes contain large sheets of cells scraped off during passage of the catheter. In inflammatory conditions causing hyperplasia of the urinary mucosa, larger numbers/clusters may exfoliate. In such cases, differentiation from neoplastic transitional cells may be difficult











      Cellular casts most commonly result when disease processes such as ischemia, infarction, or nephrotoxicity cause degeneration and necrosis of tubular epithelial cells. The presence of these casts indicates acute tubular injury but does not indicate the extent or reversibility of the injury. A common scenario is the patient with decreased renal perfusion and oliguria secondary to severe dehydration. Ischemic injury results in degeneration and sloughing of the epithelial cells. The resulting casts often are prominent in urine produced following rehydration with fluid therapy. The restoration of urine flow "flushes" numerous casts out of the tubules. Leukocytes can also be incorporated into casts in cases of tubulo-interstitial inflammation (eg, pyelonephritis). It is rarely possible to distinguish between epithelial casts and leukocyte casts in routine sediment preparations, however, since nuclear detail is obscured by the degenerated state of the cells











      Many drugs excreted in the urine have the potential to form crystals. Hence, a review of the patients drug history is prudent when faced with unidentified urine crystals. Most common among these are the sulfa drugs. Both panels on the right are from patients receiving trimethoprim-sulfadiazine. The differing appearance may relate to variation in drug concentration, urine pH, and other factors. The upper panel is from a feline case, the lower from a horse. The inset in the lower panel shows the crystals as they appeared when polarized. Other examples include radiopaque contrast agents (Hypaque, Renografin) and ampicillin which may precipitate in acid urine as fine needle-like crystals -not shown








      Specimens mailed to laboratories without refrigeration or preservatives are subject to overgrowth of microbes, whether contaminants or pathogens. Shown here is a dense mat of fungal hyphae which was seen in a sediment prep of a canine urine specimen which had been several days in transit. Since fungal infection of the urinary tract in dogs is quite uncommon, the odds are that this represents overgrowth of contaminants. Bacteria, whether pathogens or contaminants, also can multiply when analysis is delayed. This often clouds the interpretation of both sediment examination and culture results. Refrigeration is perhaps the best all-around method for preserving a specimen. Some laboratories also suggest specific transport media or swabs when sending a specimen for culture








      Squamous epithelial cells are the largest cells which can be present in normal urine samples. They are thin, flat cells, usually with an angular or irregular outline and a small round nucleus. They may be present as single cells or in variably-sized clusters. Those shown in the upper panel are unstained; that in the lower panel was prepared using Sedi-Stain. Squamous cells are common in low numbers in voided specimens and generally represent contamination from the genital tract. Their main significance is as an indicator of such contamination. Many dogs with squamous metaplasia of the prostate, due either to exogenous estrogen or Sertoli cell tumor, have extremely large numbers of squamous cells in urine











      Waxy casts have a smooth consistency but are more refractile and therefore easier to see compared to hyaline casts. They commonly have squared off ends, as if brittle and easily broken. Waxy casts indicate tubular injury of a more chronic nature than granular or cellular casts and are always of pathologic significance











      Hyaline casts are formed in the absence of cells in the tubular lumen. They have a smooth texture and a refractive index very close to that of the surrounding fluid. Reduced lighting is essential to see hyaline casts. Lower the substage condenser. When present in low numbers (0-1/LPF) in concentrated urine of otherwise normal patients, hyaline casts are not always indicative of clinically significant renal disease. Greater numbers of hyaline casts may be seen in association with proteinuria of renal (e.g., glomerular disease) or extra-renal (e.g., overflow proteinuria as in myeloma) origin. In such cases it has been proposed that the presence of excessive serum protein in the tubular lumen promotes precipitation of the Tamm-Horsefall mucoprotein











      Ammonium urate (or biurate) crystals generally appear as brown or yellow-brown spherical bodies with irregular protrusions ("thorn-apples"). Though possible in urine of any pH, their formation is favored in neutral to alkaline urine. These crystals are fairly common in dogs and cats with congenital or acquired portal vascular anomalies, with or without concomitant ammonium urate uroliths. They can be seen in urine from normal Dalmatian dogs. Both Dalmations and Bulldogs are predisposed to urate urolithiasis. They are rarely, if ever, seen in urine from normal cats or dogs of other breeds











      Cystine crystals are flat colorless plates and have a characteristic hexagonal shape with equal or unequal sides. They often aggregate in layers. Their formation is favored in acidic urine. Cystine crystalluria or urolithiasis is an indication of cystinuria, which is an inborn error of metabolism involving defective renal tubular reabsorption of certain amino acids including cystine. Sex-linked inheritance is suspected since male dogs are almost exclusively affected. Many breeds, as well as mongrels, have been reported affected . Renal function otherwise appears to be normal and, aside from a tendency to form uroliths, the defect is without serious consequence

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    4. #2
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      Bacteria can be identified in unstained urine sediments when present in sufficient numbers. Rod-shaped bacteria and chains of cocci are often readily identifiable. The images at right show E.coli bacilli from a case of cystitis in a dog. However, small amorphous crystals, cellular debris, and small fat droplets can either mask or mimic cocci. If there is any doubt about the presence of bacteria, a Gram-stained smear of urine sediment (middle panel) should be examined. Urine in the bladder of normal animals is sterile. Though bacteria from the distal urethra and/or genital tract may contaminate voided specimens, they are usually too few to see if a good mid-stream collection was obtained. Although phagocytized bacteria cannot be seen in unstained wet mounts of urine sediment, they may found in stained smears of sediment. The lower panel at the right shows a neutrophil containing phagocytized bacteria. Notice that the nucleus in this cell is round; nuclei tend to become round as neut











      Calcium carbonate crystals usually appear as large yellow-brown or colorless spheroids with radial striations. They can also be seen as smaller crystals with round, ovoid, or dumbbell shapes. These crystals are common in the urine of normal horses, rabbits, guinea pigs and goats. They have not been observed in canine or feline urines











      Dissolving Crystals











      Triple Phosphate Crystals











      Capillaria plica is a helminth parasite of the canine urinary bladder. C. felis-cati is the feline counterpart. The ova are similar to those of Trichuris spp. in that they are oval in shape and have bipolar plugs (see picture). Since fecal contamination of the urine could result in the presence of whipworm eggs, the two must be differentiated. If the ova were seen in a well- handled urine collected by cystocentesis, fecal contamination could be ruled out. Additionally, the ova of C. plica are colorless and rougher in texture compared to the smooth, yellowish eggs of T. vulpis. Dioctophyma renale, the giant kidney worm, has large, yellow-brown, thick-walled ova with a characteristic wavy surface (not pictured). Eggs may be seen in urine if a gravid female worm is present. Though endemic in areas of Canada, the infection is very rare in the United States











      Yeasts in unstained urine sediments are round to oval in shape, colorless, and may have obvious budding (upper panel). They often represent contaminants, and are especially suspect if the sample is voided and/or old. In other circumstances, however, their significance should not be discounted. The pictures shown here, for example, are of fresh urine collected by cystocentesis from a dog that had been on long-term antibiotic and immunosuppressive therapy. The lower photo shows pseudohyphae formation by the yeasts, which were identified on culture as Candida albicans











      Bilirubin crystals tend to precipitate onto other formed elements in the urine. In the top picture, fine needle-like crystals have formed on an underlying cell. This is the most common appearance of bilirubin crystals. In the lower two pictures, cylindrical bilirubin crystals have formed in association with droplets of fat, resulting in a "flashlight" appearance. This form is less commonly seen. Bilirubin crystals are seen most commonly in canine urine, especially in highly concentrated specimens. They are less common in urine of other species. In dogs, they often are of no significance (healthy dogs can have low, but detectable, bilirubin levels in urine). Bilirubin crystals (or a positive chemical reaction on the urine dipstick) in feline, equine, or bovine urine should be investigated since an underlying cholestatic process is likely











      Polarized Triple Phosphate Crystals











      Triple Phosphate Crystals











      Microfilariae of Dirofilaria immitis may be seen in the urine sediment in cases of hematuria in microfilaremic dogs. The finding is without significance, other than as an indication of heartworm disease


      [hr]







      Yeasts in unstained urine sediments are round to oval in shape, colorless, and may have obvious budding (upper panel). They often represent contaminants, and are especially suspect if the sample is voided and/or old. In other circumstances, however, their significance should not be discounted. The pictures shown here, for example, are of fresh urine collected by cystocentesis from a dog that had been on long-term antibiotic and immunosuppressive therapy. The lower photo shows pseudohyphae formation by the yeasts, which were identified on culture as Candida albicans











      Struvite crystals (magnesium ammonium phosphate, triple phosphate) usually appear as colorless, 3-dimensional, prism-like crystals ("coffin lids"). Occasionally, they instead resemble (vaguely) an old-fashioned double-edged razor blade (lower frame). Struvite crystals are the most common type in urine from dogs and cats. They are often seen in urine from clinically normal individuals. Though they can be found in urine of any pH, their formation is favored in neutral to alkaline urine. Urinary tract infection with urease-positive bacteria can promote struvite crystalluria (and urolithiasis) by raising urine pH and increasing free ammonia








      Triple Phosphate Crystals








      Polarized Cystine Crystals











      Fungal hyphae in urine sediment preps most commonly represent overgrowth of contaminants in samples where analysis was delayed. If seen in a fresh sample, especially one collected by cystocentesis, fungal infection of the kidneys and/or bladder should be suspected. Aspergillus terreus (shown at right) has been documented to cause systemic infection including colonization of the renal pelvis











      Amorphous" crystals appear as aggregates of finely granular material without any defining shape at the light microscopic level. Amorphous urates (Na, K, Mg, or Ca salts) tend to form in acidic urine, and may have a yellow or yellow-brown color. Amorphous phosphates are similar in general appearance, but tend to form in alkaline urine and lack color. Calcium oxalate dihydrate crystals sometimes also can present as "amorphous" when the individual crystals are very small. Examination at higher magnification will reveal the typical "envelope" appearance. Xanthine crystals are usually in the form of "amorphous" crystals. These crystals occur in Dalmations on allopurinol therapy for urate urolithiasis. Generally, no specific clinical interpretation can be made based on the finding of amorphous crystals. Small amorphous crystals can be confused with bacterial cocci in some cases, but can be distinguished by Gram-staining








      Calcium Oxalate and Cystine Crystals











      Triple Phosphate Crystals











      sided of varying dimension Sharp edges











      sided Does not have to be equal Edges are sharp

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    6. #3
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      RE: اطلس تصویری - میکروسکوپی ادرار





      Intact tubular epithelial cells laden with numerous refractile fat droplets






      Mixed Cell Cast






      Cystine Crystals






      Oval Fat Body











      Microscopic analysis reveals a protein cast containing white blood cells. Compared to RBC casts, the WBC's are larger, have nuclei and contain cytoplasmic granules. The cast takes the shape of the renal tubule











      Three urine samples are shown. The one at the left shows a red, cloudy appearance. The one in the center is red but clear. The one on the right is yellow, but cloudy








      Rhomboid forms of uric acid dyhydrate






      Oval Fat Body






      These cystine crystals are shaped like stop signs. Cystine crystals are quite rare






      Polarized Double Refractile Lipid Droplets





      Mixed Cell Cast






      These "triple phosphate" crystals look like rectangles, or coffin lids if you are feeling depressed

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