Cells in Urine Sediment

by Carlo Raj, MD

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    00:01 The cells in your sediment of urine include the following: bacteria, sign of urinary tract infection what kind do we talk about over and over again? E.coli What are we going to find? Nitrites Right? Nitrites.

    00:15 And sensitivity- quite low. specificity - quite high RBCs, examples: renal stone, cancer- bladder or renal Stop here for one second..

    00:27 If there was a RBC of a particular shape known as a dysmorphic RBC Well that RBC would be probably more specific for what kind of damage? Glomerular damage What if there was a renal stone? Maybe there was transitional cell cancer, squamous cell cancer adenocarcinoma of the urinary bladder, could you result in RBCs being found in the urine? Of course, you could.

    00:53 Renal hematuria, RCC - renal cell carcinoma, yes you could.

    00:58 glomerulonephritis, more so with what type of glomerulonephritis, nephritic, or nephrotic? Good, nephritic.

    01:08 And I told you earlier, with nephritic you probably want to focus upon the letter "H" give yourself one little clue in which you start the cascade of symptoms.

    01:19 hypertension, hematuria, RBC cast - that's nephritic.

    01:23 and nephrotic? Oh you pay attention to letter "O", why? "O", representing vast or large amount of protein being lost.

    01:33 We talked about dysmorphic, we already did.

    01:35 If you have an RBC that's passing through the glomerulus, it might get disfigured, well mal-shape and then morphic would be your actual morphology So misshapen RBC - glomerular. Continue.

    01:50 Neutrophils - urinary tract infection, sterile pyuria, both.

    01:55 make sure that you differentiate between the two.

    01:57 Do not just read through this.

    01:59 Urinary tract infection, you'd find there to be pyuria and you'd also find there to be esterase and you'd find there to be positive culture Sterile pyuria, give me two big examples: chlamydia and what's the other one? something like drug-induced nephritis.

    02:16 Pyuria refers to what? greater than or equal to 10 WBCs by high field type of microscopy in a centrifuged specimen or greater than or equal to (5) WBCs in an uncentrifuged specimen So centrifugation becomes important to you in terms of laboratory settings with neutrophils Oval fat bodies.

    02:41 Here, right off the bat you should be thinking about nephrotic syndrome Now let me give you a concept here okay, as I love to do.

    02:48 It's a fact that if you have for whatever reason, If you don't have enough protein in your body, you have an inverse relationship with lipid accumulating in the body Once again, for whatever reason, if you are not having enough protein in your body, you'll have an increase in lipid in your patient.

    03:09 For example, nephrotic syndrome.

    03:12 You're losing greater than 2.5 grams of protein per day thus your patient has hyperlipidemia, because this is occuring in the kidney, you'd expect to find oval fat body another name perhaps you've known nephrotic at times is lipoid nephrosis Let me give you another one.

    03:32 Say that your patient has cirrhosis, you can't make protein.

    03:36 Oftentimes, your patient will have hyperlipidemia, that you already know.

    03:39 And then of course say that you damaged your rough endoplasmic reticulum Rough endoplasmic reticulum, dying organelle in your cell.

    03:48 We can't produce what? Protein.

    03:51 may result in? hyperlipidemia.

    03:53 Do you see the parallel that I have just given you? When dealing with nanoprotein, increase lipid.

    04:00 This is specifically in the kidney and I will show you a picture of oval fat body Let's continue, important section of cells vs cast.

    About the Lecture

    The lecture Cells in Urine Sediment by Carlo Raj, MD is from the course Urinalysis.

    Included Quiz Questions

    1. 2-3 RBCs per high powered field
    2. > 5 RBCs per high powered field in a uncentrifuged specimen
    3. None of these are correct
    4. At least 1 RBC per high powered field
    5. > 10 RBCs per high powered field in a centrifuged specimen
    1. IgA nephropathy
    2. Diabetic nephropathy
    3. Minimal change disease
    4. Cirrhosis
    5. Kwashiorkor
    1. More than 2-3 RBCs per HPF indicates nephrotic syndrome.
    2. Dysmorphic red blood cells imply a glomerular origin of hematuria.
    3. Oval fat bodies are renal tubular cells filled with lipid.
    4. More than 5 WBCs per HPF in an uncentrifuged specimen is considered pyuria.
    5. More than 10 WBCs per HPF in a centrifuged specimen is considered pyuria.

    Author of lecture Cells in Urine Sediment

     Carlo Raj, MD

    Carlo Raj, MD

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