The influence of urine concentration on the cells we observe during urine microscopy is well known.
Concentrated urine specimens with a high urine specific gravity (SG) preserve nucleated cellular morphology the best, however, some cellular structures (e.g.: erythrocytes) can become shrunken and appear crenated.
On the other hand, dilute specimens with a low SG will result in poor preservation of cellular structures. This is because water enters the cells making it swollen with eventual lysis of the cell. Usually both erythrocytes and leukocytes can be destroyed in dilute urine with low SG.
The video shows how exactly the leukocytes are destroyed (the ones that became dark in the video) in a urine with a low SG (less than 1.010).
The photos (Figure 1) shows the same microscopic field immediately after sample preparation, with the leukocytes perfectly viewed with their usual morphology and how these cells became totally different within 2-3 minutes.
The use of phase contrast increases the ability to view this. Using Only bright field, the dead leukocytes are basically ghosts, almost impossible to be seen.
Sample conditions like SG (and pH) impacts in the quality of the information that can be observed during microscopic examination of the urine sediment. Leukocytes, erythrocytes and urinary casts are the most affected, being specially destroyed in dilute urines with low SG and alkaline pH.
Keep in mind to always check urine SG and pH When performing urine sediment analysis.
Post by José Antonio Tesser Poloni
Reviewed by Matthew A. Sparks