The Case of the Missing Casts
A 50 y/o woman presents with symptoms of fatigue and malaise for 1-2 weeks. Medications include ACE, HCTZ, and a multivitamin daily. She had a UTI 6 weeks ago that did not improve after a 5 day course…
Urine Sediment of the Month: To Stain or Not to Stain
To stain, or not to stain, that is the question. Different illumination techniques are available to visualize the formed elements in the urinary sediment. The two most commonly used are brightfield and phase contrast. Brightfield illumination provides high…
Urine Sediment of the Month: Mixed Cellular Casts
As we have covered before, RBC casts most often signify the presence of glomerulonephritis while WBC casts are indicative of an inflammatory process affecting the glomeruli or interstitium. Sometimes, casts can be seen which contain both red and…
Urine Sediment of the Month: Transmitted Light Microscopy Techniques
Although it remains a polarizing topic, looking at urine has come a long way since the dark ages before wide availability of renal biopsy. Not just a passing phase, modern urine microscopy allows the bright nephrologist to readily…
Urine Sediment of the Month: All About Those Oval Fat Bodies
Damage to the glomerular basement membrane allows plasma lipids to enter the urinary space. These lipids may appear in various forms, either as free lipid droplets, lipid casts, oval fat bodies, and/or as cholesterol crystals. In most cases,…
Urine Sediment of the Month: Drugs & Crystalluria
Several drugs, mainly antimicrobial or antiviral agents, can cause transient crystalluria, in isolation or in conjunction with other urinary abnormalities and a wide range of clinical implications. The factors favoring the formation of drug crystals are drug overdose,…
Urine Sediment of the Month: A Case of Recurrent “Sinus Infections,” Pyuria, & Hematuria
This is a fictional case, designed for educational purposes The Case The patient is a 66 year-old with a history of hypertension who presented with complaints of fatigue and recurrent “sinus infections” over the past few months. He…
Urine Sediment of the Month: How to Get a High Quality Image
In order to interpret your findings after collecting and preparing a urine specimen for microscopy you must obtain a high quality image. If you are not able to clearly see what you’re examining, it may be quite difficult…
Urine Sediment of the Month: White Blood Cells, “Glitter Cells”, and WBC Casts
White blood cells (WBC’s) in the urine may occur as a result of infection or inflammation anywhere in the urinary tract and the segmented polymorphonuclear neutrophil is the type most often encountered. These WBC’s are identified by the…
Urine Sediment of the Month: RBC Casts, Ghost Cells, & Heinz Bodies…Oh My!
Red Blood Cell (RBC) Casts:RBC casts (Fig. 1) are an important finding in the urinary sediment and most often signify the presence of a proliferative glomerulonephritis or vasculitic process. Although less common, RBC casts may also be seen…