Microscopic examination of urine

Possible interpretation of the results

The result of laboratory tests is not a sufficient basis for diagnostics. Interpretation of results and further diagnostics should be performed only by a physician-specialist.

Erythrocytes. Red blood cells in the urine can be found in any part of the urinary tract. In women it can also be the result of menstrual pollution.

It is very important to note the presence of microscopically dysmorphic (deformed) erythrocytes (> 30% indicate glomerular origin of hematuria.

Leukocytes. A small number of them are also found in normal urine. An increased number of leukocytes indicates an inflammatory process in the urinary tract or surrounding areas. When their numbers are very high and have a degraded appearance or appear in groups, acute urinary tract infection is suspected. Occasionally, pyuria (pus in the urine) is also found for acute non-renal causes such as appendicitis or pancreatitis. It can also develop in non-infectious conditions such as glomerulonephritis (e.g. SLE), renal tubular acidosis, dehydration, stress, and damage to the urethra, bladder, or urethra; Increased lymphocyte and plasma cell counts indicate acute renal transplant rejection, while increased eosinophil counts are associated with tubular-interstitial nephritis and hypersensitivity to penicillin.

Epithelial cells. Can occur in any part of the urogenital tract. They are usually found as a result of physiological shedding of aging cells in the urine. A significant increase indicates inflammation in the area of ​​the urinary tract from which these cells originate. There are 3 types of epithelial cells:

• Renal tubular epithelial cells are associated with tubular lesions associated with pyelonephritis, acute tubular necrosis, salicylate poisoning, and renal transplant rejection.
• Transitional epithelial cells enter the urine from the pelvis to the beginning of the urethra.
• Squamous epithelial cells enter the urine from the urethra and vagina.

Salts. Most of them, which can be found in urine, have low clinical significance, except in cases of metabolic imbalance, stone formation, or drug regulation.

Cylinders. Arises in the lumen of the renal tubules. The origin of the cylinders is always renal and is an indicator of kidney disease. Cylinders are classified according to their composition, appearance, and cellular components. The width of the cylinders indicates the size of the renal tubules in which they form; Large cylinders are formed in the collecting tubes of the kidney; Their presence usually indicates a marked decrease in the functional capacity of the nephron and the late stage of kidney disease.

• Hyaline cylinders - can be detected in mild kidney disease; In small quantities they may be present in normal urine and in increased quantities during intense physical exertion or dehydration.
• Leukocyte cylinders - Less common and their presence indicates acute pyelonephritis, interstitial nephritis, glomerular nephritis, glomerulonephritis.
• Erythrocyte cylinders - Their presence means renal hematuria and is always abnormal. It is usually found in the following diseases: glomerulonephritis (acute and chronic), glomerular nephritis, Goodpasture syndrome, subacute bacterial endocarditis, renal trauma, renal infarction, severe pyelonephritis, perineal tuberculosis, congestive heart failure.
• Grain cylinders - Found during severe pathological processes in the kidneys, but reversible can be found after intense physical activity.
• Epithelial cylinders - Rarely found. They may appear in the urine after exposure to nephrotoxins or viruses (cytomegalovirus, hepatitis viruses) that cause tubular necrosis.
• Wax cylinders - Occurs in severe chronic renal failure, malignant hypertension, renal amyloidosis, diabetic nephropathy, acute renal disease, renal transplant rejection, inflammation and tubular degeneration.
• Fat cylinders - Found in nephrotic syndrome, diabetic glomerulosclerosis, chronic glomerulonephritis, lupus erythematosus and other cases.

Bacteria. Found in fresh urine and is accompanied by a large number of leukocytes. Usually indicates a urinary tract infection.

Fungi. May be found in urine during urinary tract infections, especially in diabetic patients, as well as as a result of skin or vaginal contamination. Candida Albicans is the most common fungus.