Particule Si Semnificatii

8/17/2019 Particule Si Semnificatii

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Iris Diagnostics

A Division of International

Remote Imaging Systems, Inc.

BASIC URINALYSISBASIC URINALYSIS


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3 – Urine: What is it?

Urine – The !i" secrete" #y the $i"neys,store" inthe #la""er an" "ischarge" #y the

!rethra.Urine, in health, has an am#er color, aslight aci" reaction, a %ec!liar o"or, an"&

&a #itter, salty taste.


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The Kidneys



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View from the back

The Kidneys



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The Kidneys Cross Section

'e%hrons

Renal (elvis

)e"!lla

*orte+

(a%illaUreter


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The Kidneys

Ne!hron " f#nctiona$

#nit Consists of

– %$omer#$#s

– Rena$ T#b#$es

Bowman&sCa!s#$e

'ro(ima$Ca!s#$e

)ista$ T#b#$es



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The Kidneys*Ne!hron+

• Urine formation #egins at the ca%illary#e" $no-n as the GlomerularMembrane an" em%ties into Bowman’sCapsule.

• )em#rane im%ermea#le to )ol. Wt./0,000

• 1iltrate 2 %lasma -ith very little %rotein

•(lasma o- #oth $i"neys4 2 560 m78min• 1iltration rate #oth $i"neys4 2 96m78min 2 9;0 78"ay4

• < ==> of ltrate rea#sor#e" in the

t!#!les



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Urine(resentation

The Kidneys*Ne!hron+

• 1iltrate %asses thro!gh proximal tubule, loop ofHenle, distal

tubule, collecting tubule, an" into the pelvis ofthe $i"ney.

•Along the %ath selective reabsorption an" tubularepithelium secretions occ!r.

(ercent of ltrate -ater rea#sor#e"

Proximal tubules ;0> Loop of Henle 5>

istal tubules => Collecting ucts @>

!!"

Remaining 9> #rine

Im%ortant n!triments s!ch as gl!cose,%roteins, amino aci"s, an" vitamins are

almost com%letely rea#sor#e" in the


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The Ureters

• The !rine trans%ort t!#e from the $i"neys to the#la""er.

• Birt!ally no rea#sor%tion .

•

Urine %asses "irectly from the $i"ney %elvis"irectly into the #la""er.



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The B$adder*The $Holding %an&' for the #rine+

Urine %asses "irectly from the !reters into C an"is tem%orarily store"E – in the #la""er

Transitional e%ithelial cells stretch as the #la""er

lls -ith !rine.

D!ration of store"E !rine can have negativeconseF!ences e.g., UTI4.

The Urethra

Urine em%ties from the e+%an"e" #la""erinto the !rethra an" o!t into a clean collectionc!%.



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Urine – as -e have G!st seen – thro!ghthe massive ltration an" rea#sor%tion ofthe ltrate, signicantly reects many ofthe meta#olic8%hysiologic an" %athologicchanges that occ!r in tiss!es an" arereecte" the #loo".

AnalyHing the !rine has a "istincta"vantage for the %atient:

itEs a non(invasive test

@ C Why Is It AnalyHe"?


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To hel% "etect Disease of the Urinary TractSystem

– lomer!lone%hritis

– 'e%hritis– Urinary Tract Infections

– *alc!li Stones4

– )eta#olic Diseases

Dia#etes )ellit!s



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lomer!lone%hritis Jne of the $i"ney "isease that "amage glomer!l!s

– )any ty%es of glomer!lone%hritis

– Incl!"e imm!nologic, meta#olic an" here"itary"isor"ers

– Syn"roms: Kemat!ria, %rotein!ria, olig!ria, aHotemia,

e"ema an" hy%ertension– (eo%le can lose ;0 to ;6> of the $i"ney f!nction.

It can #e a ac!te "isease that can occ!r after astre%tococcal infection

Urinalysis res!lts:Urinalysis res!lts:

– *hemistry: increase" levels of #loo" an" %rotein

– )icrosco%ic: increase" RL*Es, WL*Es,

Renal e ithelial cells, an" *asts



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'e%hritis

*an occ!r as the res!lt of vario!s "r!gs an" to+ins– Res%onse allergic in renal interstiti!m

– Renal interstiti!m is inltrate -ith le!$ocytes7ym%hocytes, )acro%hages, Mosino%hils an"ne!tro%hils4

– Sym%toms: Kemat!ria, mil" %rotein!ria,le!$ocyt!ria -itho!t #acteria


– *hemistry: increase" levels of (rotein, Lloo" an"7e!$ocyte esterase

– )icrosco%ic: Increase in WL*Es, R#cEs, *asts ofle!$ocytes an" eosino%hils, Renal e%ithelial cellsan" %ossi#ly *rystals



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Urinary Tract Infections

*an involve the !%%er or lo-er !rinary tract.

7o-er tract can eNect the !rethra, #la""er or#oth

U%%er tract can eNect the renal %elvis,interstiti!m or #oth

UTIEs are 90 times more common in females


– *hemistry: increase" levels of %rotein, #loo",le!$ocyte esterase an" nitrite

– )icrosco%ic: increase" WL*Es, Lacteria, RL*Es,

Transitional e%ithelial cells



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*alc!li Stones4

Soli" aggregates of chemicals, !s!allymineral salts

1o!n" in the renal calyces, %elvis, !reter or

#la""er /6> of stones are com%ose" of calci!m an"

o+alate or %hos%hate

1actor in!encing formation:

– Increase concentration of chemical salts

– *hanges in !rinary %K

– Urinary stasis



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Dia#etes )ellit!s

ro!% of "isor"ers that aNects themeta#olism of car#ohy"rate, fat an" %rotein

Increase" levels of l!cose, Oetones an" highS in !rine.

*an ca!se retino%athy, me!ro%athy,angio%athy an" ne%hro%athy



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Urine S%ecimen *ollection

Ran"om – collecte" any time

*lean *atch – %atient cleans area #efore !rinating

1irst A) – generally #est s%ecimen for "etection#eca!se the !rine has #een in the #la""er aro!n" ;ho!rs

*atheteriHe" C !rine is collecte" sterile – invasive%roce"!re

S!%ra%!#ic As%iration – Urine collecte" !sing a

nee"le an" syringe to go into the #la""er thro!ghthe a#"ominal -all

@ Ko!r *ollection – not !se" for !rinalysis #!t forvario!s s%ecial chemistry tests

6 – Ko- Is It AnalyHe"?



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S%ecimen Storage Iss!es

Urine sho!l" #e teste" as soon as %ossi#le aftercollection

@ ho!rs or less

(rolonge" storage may ca!se the follo-ing:

– Re" #loo" cells !n"ergo hemolysis

– White #loo" cells "egenerate

– (rotein co!l" #ecome %ositive "!e to changes inhigher %K val!es

– *asts "isa%%ear

– Lacteria m!lti%ly

– %K !ct!ates "!e to car#on "io+i"e loss an"re"!ction of !rea to ammonia

– Urine #ecomes clo!"y "!e to sol!te %reci%itates

6 Ko- Is It AnalyHe"?


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S%ecimen Storage Iss!es

– l!cose level is re"!ce" since gl!cose ismeta#oliHe" #y #acteria an" cells

– Oetone level is re"!ce" #eca!se of

#acterial eNect– Lilir!#in level is re"!ce" "!e to light

sensitivity

– Uro#ilinogen level is re"!ce" since

!ro#ilinogen is converte" to !ro#ilin– 'itrite a%%ears as #acteria gro-

– *olor "ar$ens

– J"or #ecomes fo!l



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/ 'ARTS/ 'ARTS

'hysica$ Characteristics'hysica$ Characteristics

C *olor, *larity, S%ecic ravity

Chemica$ CharacteristicsChemica$ CharacteristicsC l!cose, (rotein, Lilir!#in,

Uro#ilinogen, %K, Lloo", Oetones, 'itrite, an"7e!$ocytes

0icrosco!ic 1(amination0icrosco!ic 1(aminationC 1orme" elements %articles4, e.g.,

e%ithelial cells, #loo" cells, crystals, casts,#acteria s%erm, m!c!s



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Iris Diagnostics



0aintenance0aintenance

223#a$ity contro$3#a$ity contro$

)aintenance an" P!ality control


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9. *lean instr!ment e+teriors!rfaces

. *lean sam%ler

3. *lean loa"8!nloa" stations

@. *hec$ iP Series lamina s!%%ly

6. Mm%ty -aste

5. R!n !rine control rac$s

– *hemistry

– )icrosco%y

/. R!n #o"y !i"s control rac$

)aintenance an" P!ality controlDaily iP System )aintenance


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9.)icrosco%y cali#ration see P!ality

control4.(erform Lac$!%

)aintenance an" P!ality control )onthly iP System )aintenance



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9. *lean rinse -aste8#aths

. Re%lace lamina container

3. Re%lace lamina lter

@. *lean sam%le t!#e "etector

6. *lean #arco"e rea"er -in"o-

5. *lean o%tical sensors

/. *lean sam%le lter

;. Ins%ect an" clean rac$s

)aintenance an" P!ality control As 'ee"e" iP System )aintenance



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P!ality *ontrol m!st #e %erforme" "aily

Mach iP *ontrol81oc!s Set contains #ottles of1oc!s, 9 #ottle of (ositive *ontrol, 9 #ottle of'egative *ontrol, an" 7ot S%ecic #arco"e la#els

– 'ote: the #arco"e la#els contain the 7ot ID,!no%ene" e+%iration "ate, an" (ass81ailcriteria

– This information is trac$e" in P* Revie- forthe (ositive an" 'egative *ontrols

– Jnce the Set is o%ene", it is goo" for 30 "ays

– This Set sho!l" #e store" #et-een C ;°*

The iP *ontrol rac$ is !se" to cleanse, foc!s,

an" %erform F!ality control on the iP00 series

a e a ce a " P!a y co o

i3 Series 3#a$ity Contro$



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The iP *ontrol rac$ sho!l" #e %re%are" asfollo-s:

P y

i3 Series )ai$y 3#a$ity Contro$



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*ali#ration m!st #e %erforme" monthly

Mach iP *ali#rator (ac$ contains fo!r #ottles of*ali#rator an" 7ot S%ecic #arco"es

– The #arco"e la#els contain the 7ot ID, !no%ene"e+%iration "ate, an" (ass81ail criteria

– Trac$e" in P* Revie- as RM1 val!es

– Jnce o%ene", the #ottle of cali#rator e+%ires in @ho!rs

– The *ali#rator (ac$s sho!l" #e store" #et-een C

;°*.

To cali#rate the instr!ment, the !ser la#els t!#e 9 of90 t!#es -ith the a%%ro%riate cali#rator la#el, mi+esone #ottle of cali#rator, %o!rs 3 m7 into each of the 90

t!#es, inserts these t!#es in to *A7 la#ele" rac$ an"

P y i3 Series 0onth$y 3#a$ity Contro$

Ca$ibration



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i3 Ca$ibrator and i3 Contro$45oc#s

Set The iP *ali#rator, 1oc!s an" (ositive*ontrol are ma"e of +e" h!man RL*Es

– To ass!re %ro%er cell s!s%ension,vigoro!sly mi+ these sol!tions 6 times,follo-e" #y 6 gentle inversions

– Allo- the #!##les to "issi%ate #efore%o!ring

DJ 'JT mi+ the iP 'egative *ontrol#efore %o!ring. This re"!ces the %otentialof #!##les an" %artic!late "e#ris fromentering the test aliF!ot

Thro- !n!se" #arco"e la#els a-ay -henthe ro"!ct is one.

y



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3C Re6iew

Res!lts can #esorte" an"searche" #y 7otID, Date8Time,

Ty%e, Stat!s an"

RM1 Jnly a manager

can remove P*"ata %oints.

Stores *hemistry P*, )icrosco%y P*, an")icrosco%y *ali#ration res!lts that can#e vie-e" at any timeQ remove" on a1irst In 1irst J!t #asis

y



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3C Statistics

(rovi"es a 7evyCennings *hart for all lots of iP(ositive an" 'egative *ontrol analyHe" on theinstr!ment

Stores the last 39 "ays or 900 "ata %oints for

each lot ReF!ires "ata %oints to ma$e the 7evyC

ennings *hart The Target, U%%er an"

7o-er 7imits areo#taine" from the lot

s%ecic #arco"es The )ean an" SD are

calc!late" from the "ata%oints o#taine" from

each r!n of that lot.


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Kan"sCon

iP Daily maintenance

iP monthly maintenanceiP As nee"e" maintenance


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Iris Diagnostics



S!ecimen 're!arationS!ecimen 're!aration

Specimen Preparation


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p p

S%ecimen ReF!irements

– Use only fresh !rine s%ecimens collecte" in

clean containers -hich are tightly ca%%e".– If s%ecimen isnEt %rocesse" -ithin 9 ho!r, store

at – ;*. Lring to room tem%erat!re #eforetesting.

– )i+ s%ecimen -ell #efore testing.

– DJ 'JT a"" any "isinfectant or "etergent to thes%ecimen.

– Oee% s%ecimens o!t of "irect s!nlight.

– DJ 'JT centrif!ge !rine s%ecimens.

– S%ecimen vol!me is 3m7 for the i*hemBM7J*IT an" is 3m7 for the iP.

– Test t!#es sho!l" #e 95 + 900mm glass or%olystyrene ro!n" #ottom t!#es.

“When to Dilute”


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When to Dilute

i*hem BM7J*ITDJ 'JT Dil!teDJ 'JT Dil!te

iP 00rossly #loo"y

Bery "ense

Keavy m!co!sShort sam%les

Theory of o%eration


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Theory of o%eration7878 3#antitati6e Res#$t Re!ortin93#antitati6e Res#$t Re!ortin9

All %articles are re%orte" an" "is%laye" in

V7V7 res!lts are converte" a!tomatically-hen K(1 an"8or 7(1 are selecte" in settings

C K(1 V786.6

C 7(1 V7 .=

The %article ty%e an" its n!m#er arechec$e" against !serC"ene" a!toCreleasecriteria

If criteria is met, res!lt sent to 7ISQ if not,


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Iris Diagnostics



0icrosco!ic 1(amination0icrosco!ic 1(amination

of #rine sedimentof #rine sediment

0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine


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i3:;; re!orts -: a#to#anti=ed formedi3:;; re!orts -: a#to#anti=ed formede$ementse$ements

RL*s

WL*s

Kyaline *asts

(athological *asts

SF!amo!s M%ithelial *ells

'onCsF!amo!s M%ithelial *ells Lacteria

east

*rystals

WL* *l!m%s

)!c!s

S%erm

(l!s Artifacts

0icrosco!ic 1(amination of #rinec osco! c a a o o # e

sedimentsediment



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White Lloo" *ells WL*4

Re" Lloo" *ells RL*4

B$ood ce$$sB$ood ce$$s

c osco! c a a o o # e!

sedimentsediment



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Red B$ood Ce$$s *RBC+Red B$ood Ce$$s *RBC+

C Kemat!ria is normally associate" -ith a !rinary tract "isease.

C Re" #loo" cells erythrocytes4 may #e a contaminate in the!rine from menstr!ating -omen.

Sha!e

C Smooth, ro!n" #iconcave "iscs

Si?e

C 5 to ; Xm in "iameter an" 3Xm in "e%th

i3 :;;i3 :;;0icrosco!0icrosco!

ee

!!

sedimentsediment



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Red B$ood Ce$$s *RBC+Red B$ood Ce$$s *RBC+

'atho$o9ies KM)ATURIAC (yelone%hritis,C 'e%hroto+ins,C Oi"ney tra!ma,C Urinary tract infections,

C *ystitis,C Ac!te t!#!lar necrosis,C Urinary tract stones : calc!li,C lomer!lar "amageC Mro"ing !rinary tract t!mors.

Norma$ 6a$#e 3 to 9 8Xl

i3 :;;i3 :;;

0icrosco!0icrosco!ee

!!

sedimentsediment

) hi R d B$ d C $$ *)RBC+)ysmor!hic Red B$ood Ce$$s *)RBC+

0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment


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)ysmor!hic Red B$ood Ce$$s *)RBC+)ysmor!hic Red B$ood Ce$$s *)RBC+

C The secon" ty%e of hemat!ria is "ysmor%hic or renal

hemat!ria.

C This hemat#ria is characteri?ed by a great variation inthe siHe of the cells anisocytosis4, many ghost cells, an" #ya high %ercentage of "ysmor%hocytosis *@:;.+8

C Dysmor%hic or "istore" RL* can #e fo!n" -ith normal

erythrocytes of healthy in"iv!"!als.

'atho$o9ies C lomer!lar "amage

C Sic$le cell "isease.

C The %ercentage of isomor%hic an" "ysmor%hic RL* -ill#e a!tomatically calc!late" for the re%ort

i3 :;;i3 :;;

0icrosco!0icrosco!

ee

sedimentsediment



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Red B$ood Ce$$s C$#m!s *RBCC+Red B$ood Ce$$s C$#m!s *RBCC+

C *o!l" #e fo!n" in !rine -ith gross hemat!ria

C Do not conf!se -ith RL* stic$ to m!co!s threa"s .

!sedimentsediment



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hite B$ood Ce$$s *BC+hite B$ood Ce$$s *BC+

C White #loo" cells le!$ocytes4 from cervical or vaginalinfections or e+ternal !rethral meat!s may contaminate !rinesam%les.

( Manl) *BCs in urine are( Manl) *BCs in urine are +eutrophils+eutr ophils

C Increase" n!m#er of le!cotytes le!$cyt!ria or %i!ria

T!r#i" an" clo!"y !rine s%ecimens

Sha!e C Ro!gh -ith gran!lar cyto%lasm

C S%herical -ith caracteristic cyto%lamic gran!les

C 7o#e" or segmente" n!clei

Si?e C 90 to 9@ Xm in "iameter

i3 :;;i3 :;;


sedimentsediment



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'atho$o9ies'atho$o9ies

Bacteria$ ca#ses

C (yelone%hritis

C *ystitisC Urethriti"

C (rostatitis

Norma$ 6a$#e 908Xl

sedimentsediment

Non bacteria$ ca#sesC 'e%hritisC lomer!lone%hritis

C *hlamy"iaC )yco%lasmosisC T!r#ec!losisC Trichomonas and mycoses

(= vaginal contaminants)


sedimentsediment


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1osino!hi$s1osino!hi$s C 9@ Xm in "iameter

C #ilo#e" n!clei

CC Mosino%hil!ria ac!te intestinal ne%hritis

chronic UTI

Lym!hocytesLym!hocytes C 5 to =Xm in "iameter4

C oval n!cle!s an" clear cyto%lasm

C 7ym%hocyt!ria inammatory con"itions%yelone%hritis

renal trans%lant reGection

C They "o not %ro"!ce esterase chemistry test neg4

istiocytesistiocytes

C )acro%hages 30 to 90Xm4 8 )onocytes 0 to @0 Xm4

C *ells -hich "efen" against microorganisms

C Renal t!#!lointerstitial "iseases an" imm!ne reaction

sedimentsediment

0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinedi


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hite B$ood Ce$$s C$#m!s *BCC+hite B$ood Ce$$s C$#m!s *BCC+

C WL** are ty%ically fo!n" in !rine sam%les containing largeF!antities of WL*.

C Their %resence generally re%resents an ac!te infectio!s%rocess.

i3 :;;i3 :;;

sedimentsediment


didi t


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SF!amo!s M%ithelial *ells SPM(4

'onCsF!amo!s M%ithelial *ells 'SM4

Renal M%ithelial RMM(4 Transitional M%ithelial TRM(4

1!ithe$ia$ ce$$s1!ithe$ia$ ce$$s

sedimentsediment

S>#amo#s 1!ithe$ia$ Ce$$s *S31'+S>#amo#s 1!ithe$ia$ Ce$$s *S31'+



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S>#amo#s 1!ithe$ia$ Ce$$s *S31'+S>#amo#s 1!ithe$ia$ Ce$$s *S31'+

Sha!eSha!e

C Bery large, thin @0 – 50 Xm4

C *ells -ith small n!clei an" clear shar% e"ges.

C$inica$ si9ni=canceC$inica$ si9ni=cance

C enerally re%resents %ossi#le contamination of thes%ecimen.

C Their %resence is generally not consi"ere" clinicallysignicant.

C It is necessary to #e vigilant -ith el"erly %atientYs

s%ecimens.sF!amo!s meta%lasia of the #la""er4

i3 :;;i3 :;;


sedimentsed e


di tdi t


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C$#e Ce$$s *S31'+C$#e Ce$$s *S31'+

C *l!e cells are s>#amo#s e!ithe$ia$s>#amo#s e!ithe$ia$ ce$$s co6ered withce$$s co6ered with

bacteria8bacteria8

C SiHe: @0 – 50 Xm

C They a%%ear shaggyE, as seen a#ove, an" the n!cle!s

may not #e visi#le "!e to the #acteria covering the cell.

C *l!e cells are contaminants an" are in"icative of #acterialvaginosis.

i3 :;;i3 :;;

sedimentsediment


di tsediment


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Non S>#amo#s 1!ithe$ia$ Ce$$s *NS1+Non S>#amo#s 1!ithe$ia$ Ce$$s *NS1+

C *ells -ith a#normal sha%e, siHe, incl!sions or n!clearchromatin %attern

nee"s f!ther cytologic st!"ies

C SiHe: 9@ to 50 Xm

C$inica$ si9ni=canceC 'eo%lasia in genito!rianry tract.

/ ty!es of ce$$s are fo#nd in #rine sediment/ ty!es of ce$$s are fo#nd in #rine sediment

C SF!amo!s ever seen4

C Transitional !rothelial4

C Renal t!#!lar e%ithelial cells

i3 :;;i3 :;;

sedimentsediment


sedimentsediment


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Transitiona$ 1!ithe$ia$ Ce$$s *TR1'+Transitiona$ 1!ithe$ia$ Ce$$s *TR1'+

CC Transitional e%ithelial cells occ!r in the renal %elvis,!reter, calyces an" #la""er.

C These cells are smaller an" more -ell "ene" thansF!amo!s e%ithelial an" have a larger n!cle!s.

Si?e 0 to @0 Xm

Sha!e ro!n" or %ear sha%e, "ense oval to ro!n"n!cle!s an" a#!n"ant cyto%lasm

C$inica$ si9ni=cance *increased n#mber+

Ac!te t!#!lar "isease

lomer!lone%hritis

Ac!te infection

Renal to+icity

Biral infectioni3 :;;i3 :;;

0icrosco!0icrosco!

ee

sedimentsediment


sedimentsediment


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Rena$ 1!ithe$ia$ Ce$$s *R11'+Rena$ 1!ithe$ia$ Ce$$s *R11'+

- Renal epithelial cells are generally larger thangran!locytes an" contain a large ro!n" or oval n!cle!s.

C 'ormally, these cells slo!gh oN into the !rine in verysmall n!m#ers e+ce%t ne- #orn4.

Si?e 9 to 0 Xm

C$inica$ si9ni=cance *increased n#mber+

C 'ephrotic syndrome

- Con"itions lea"ing to tubular degeneration

i3 :;;i3 :;;

0icrosco!0icrosco!

ee

sedimentsediment


sedimentsediment


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*alci!m J+alate *AJZ4

Uric Aci" URI*4

Crysta$sCrysta$s

*alci!m (hos%hate *A(K4

Tri%le (hos%hate T(0@4

sedimentsediment


sedimentsediment


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UnC$assi=ed Crysta$sUnC$assi=ed Crysta$s

All crystals fo!n" #y the A(R are rst name" as U'*R.,t is up to the user to choose the categor) of thecr)stals.

C$inica$ si9ni=cance

The maGority of crystals fo!n" in the !rinary se"iment areof limited clinical valuelimited clinical value.

It is tem%ting to associate crystals -ith a ris$ of!rolithiasis, #!t the maGority of %atients -ith a crystall!ria"o not have an" -ill not "evelo% $i"ney stones.

In the maGority of cases, the crystals fo!n" in !rine are not%resent in the freshly voi"e" s%ecimen.

sedimentsediment


sedimentsediment


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Ca$ci#m (a$ate Crysta$sCa$ci#m (a$ate Crysta$s

Sha!eC The most common sha%e of calci!m o+alate crystals

is that of its octahe"ral form.

! C any %K of !rines


C Severe chronic renal "isease

C Ingestion of the o+alate %rec!rsor ethylene glycol

i3 :;;i3 :;;0icrosco!0icrosco!

ee

sedimentsediment


sedimentsediment


57/112

i3 :;;i3 :;; 0icrosco!0icrosco!ee

Ca$ci#m (a$ate 0onohydrate Crysta$sCa$ci#m (a$ate 0onohydrate Crysta$s

Sha!eC )onoclinic leave sha%e, oval egg sha%e.

C 1o!n" in sit!ations of massive calci!m o+alate%reci%itation.

! C any %K of !rines


C (athological massive %reci%itation

sedimentsediment


sedimentsediment


58/112

Amor!ho#s 'hos!hate or Bi#rate Crysta$sAmor!ho#s 'hos!hate or Bi#rate Crysta$s

C The amor%ho!s %hos%hates seen in !rine s%ecimens an"are the res!lt of refrigeration.

Sha!e C -hite mass of small ro!n"e" %articles.

!


59/112

Amor!ho#s Urate Crysta$sAmor!ho#s Urate Crysta$s

The amor%ho!s !rates seen in !rine s%ecimens an" are,most of the time, the res!lt of refrigeration.

Sha!e C %in$ mass of small ro!n"e" %articles.

! C 6,/ to /,0

C$inica$ si9ni=cance 'one

0icrosco!0icrosco!

ee

sedimentsediment

Tri!$e 'hos!hate Crysta$sTri!$e 'hos!hate Crysta$s



60/112

1ormation "!e to ammonia concentration.

Sha!e C classic sha%e is the %yrami" si+Csi"e" %risms,

that remin"s a co[n li"

! < 5,6


C Associate" -ith #acterial gro-th.

C With a rstCmorning fresh s%ecimen, %P- can indicate#%,

C They are often %resent in renal calc!li

C Jther-ise: little clinical val!e.

i3 :;;i3 :;;

0icrosco!0icrosco!

ee


sedimentsediment


61/112

Uric Acid Crysta$sUric Acid Crysta$s

Sha!e

C Uric aci" crystals occ!r in several forms -ith the mostcommon #eing "iamon" sha%e".

! \6,6


C *an a%%ear in healthy in"ivi"!als

C o!t

C Increase" %!rine meta#olism e.g. cytoto+ic "r!gs4

i3 :;;i3 :;;

0icrosco!0icrosco!

ee

sedimentsediment


sedimentsediment


62/112

Rare Crysta$sRare Crysta$s

sedimentsediment

*ystine crystals

Tyrosine crystals

7e!cine crystals

Lilir!#ine crystals

*holesterol crystals

Kemosi"erin crystals

And other crysta$sDAnd other crysta$sD


sedimentsediment


63/112

Ammoni#m Bi#rate Crysta$sAmmoni#m Bi#rate Crysta$s

Sha!eC yello-C#ro-n s%heres -ith striation on their

s!rface

! C al$aline an" ne!tral !rine

C$inica$ si9ni=cance in fresh #rine s!ecimens

C They can ca!se renal t!#!lar "amage

C Ina"eF!ate hy"rataion of the %atient

C If a%%ears in %rolonge" storage !rines no clinical val!e4

sediment

i3 :;;i3 :;;

0icrosco!0icrosco!

ee


sedimentsediment


64/112

Bi$ir#bine Crysta$sBi$ir#bine Crysta$s

Sha!eC ne nee"les that regro!% in a cl!m%

C or as re" #ro-n s%heres, %lates&

! C aci"ic !rine


C Lilir!#in!ria meta#olic "isease %rocess

C Ke%atic "isease: Ke%atitis, *irrhosis

C J#str!cte" #ile "!ct

C all stones

C T!mors

0icrosco!0icrosco!

ee


sedimentsediment


65/112

Ca$ci#m Carbonate Crysta$sCa$ci#m Carbonate Crysta$s

Sha!eC small colorless gran!lar crystals

C fo!n"s in %aires "!m##ell sha%e.

! C al$aline !rine


0icrosco!0icrosco!

ee

$ i h h $C $ i 'h h t C t $


sedimentsediment


66/112

Ca$ci#m 'hos!hate Crysta$sCa$ci#m 'hos!hate Crysta$s

Sha!e

C colorless,thin, -e"geli$e %rism arrange" in smallgro!%ing or in a rosette %atern

! C slightly al$alin or ne!tral !rine


i3 :;;i3 :;;


sedimentsediment


67/112

Cho$estero$ Crysta$s *CL+Cho$estero$ Crysta$s *CL+

Sha!e

C clear at rectang!lar %lates -ith notche" corners

! C aci"ic !rine


C Accom%agnie" -ith fat in !rine

C 'e%hrotic syn"rome: li%i"!ria

C *hyl!ria: r!%t!re of lym%hatic vessels into renalt!#!les results of tumors4

i3 :;;i3 :;;

C ti C t $C ti C t $


sedimentsediment


68/112

Cystine Crysta$sCystine Crysta$s

Sha!eC colorless he+agonal %lates

! C aci"ic %K


C *ongenital cystinosis

C *ystin!ria

C Ten"s to "e%osite in t!#!les as calc!li renal

"amage

i3 :;;i3 :;;

0icrosco!0icrosco!

ee

emosiderin Crysta$semosiderin Crysta$s



69/112

0icrosco!0icrosco!

ee

emosiderin Crysta$semosiderin Crysta$s

Sha!e

C gran!les free oating in cl!m%s, cells an" casts

! C aci"ic an" ne!tral !rine


C Kemolytic events

Le#cine Crysta$s *L1U+Le#cine Crysta$s *L1U+


sedimentsediment


70/112

Le#cine Crysta$s *L1U+Le#cine Crysta$s *L1U+

Sha!e

C yello- to #ro-n s%heres -ith concentric or ra"ialstriations on their s!rface.

! C aci"ic %K


C Jvero- aminoaci"!ria in %lasma an" soincrease" C Renal e+rection

C Kere"itary metha#olic "isor"er li$e tyrosinosis C /ever liver disease, often in a terminal stage

0icrosco!0icrosco!

ee

Radio9ra!hic Contrast 0edia Crysta$sRadio9ra!hic Contrast 0edia Crysta$s


sedimentsediment


71/112

Radio9ra!hic Contrast 0edia Crysta$sRadio9ra!hic Contrast 0edia Crysta$s

Sha!e

C colorless long %ointe" nee"les singly or cl!stere" insheaves

! C aci"ic !rine


C *an signicantly elevating the S of !rine

C *a!se a false %ositive %reci%itation test for %rotein

i3 :;;i3 :;;


sedimentsediment


72/112

S#$fonamides Crysta$sS#$fonamides Crysta$s

Sha!e

C yello- to #ro-n #!n"les of nee"les that resem#leto a fan formation

! C aci"ic !rine

C$inica$ si9ni=cance D!e to "r!gs

T i C t $ *TRY+Tyrosine Crysta$s *TRY+


sedimentsediment


73/112

Tyrosine Crysta$s *TRY+Tyrosine Crysta$s *TRY+

Sha!e

C #ro-n ne""les, isolate" or forming a "ense rosette

! C aci"ic %K


C Jvero- aminoaci"!ria in %lasma an" soincrease" C Renal e+rection

C Kere"itary metha#olic "isor"er li$e tyrosinosis C /ever liver disease, often in a terminal stage

0icrosco!0icrosco!

ee


sedimentsediment


74/112

Kyaline *asts

'onCKyaline *asts

ran!lar RA'4 *ell!lar *M774

CastsCasts

hat is a CastsEhat is a CastsE


sedimentsediment


75/112

Casts 5ormation 2 9enera$ characteristicsCasts 5ormation 2 9enera$ characteristicsC cast is ma"e of !romo"!lin or TammCKorsfall %roteins.

C It is secrete" #y renal t!#!lar cells an" "istal conv!le"t!#!les

C -hen the t!#!lar l!men contents #ecome concentrate",

#rils forms an" are attache" to the l!men cells.C It is hol"ing tem%orarly in %lace -hile it enmeshes anys!#stances %resent into its matri+.

Ccast is "etache" from the t!#!lar an" !sh into the !rine.

Sha!e

C cylin"rical -ith %arallel si"es

C -ith en"s that are ro!n"e" or straight

hat is a CastsEhat is a CastsE


sedimentsediment


76/112

C$inica$ si9ni=canceC$inica$ si9ni=cance

C *asts reecte" the stat!s of renal t!#!les.

C the n!m#er of casts reects the severity of the "isease

Ty%e of casts an" its n!m#er val!a#le information tothe clinician.

1(ce!tions stren!o!s e+ercise ] emotional stress

Norma$ 6a$#e 5 to 90 8Xl hyaline or gran!lar casts

in a @ ho!rs !rine collection.

ya$ine Casts *YAL+ya$ine Casts *YAL+


sedimentsediment


77/112

Sha!e4 te(t#re

casts -itho!t incl!sion, are seen in n!mero!s con"itions.


– 'ormal !rine

– Stren!o!s e+ercise– Ac!te glomer!lone%hritis

– Ac!te %yelone%hritis

– )alignant hy%ertension

–*hronic renal "isease


i3 :;;i3 :;;

0icrosco!0icrosco!

ee

0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsedimenta(y Casts *AFY+a(y Casts *AFY+


78/112

Sha!e4 te(t#re

C J%aF!e -a+li$e matri+ -ith sF!are, shar%e, #l!nt en"sC *rac$s or ss!res in their margins caracteristic of -a+y casts


C In"icate t!#!lar o#str!ction -ith %rolonge" stasis

a"vance stage of other casts transforme" "!ring stasis

C *hronic renal fail!re

C Ac!te renal "iseases : glomer!lone%hritis or ne%hroticsyn"rome

C )alignant hy%ertensionC Renal allograft reGection

Norma$ 6a$#e 'ot seen

0icrosco!0icrosco!

eei3 :;;i3 :;;

0icrosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rinesedimentsediment%ran#$ar Casts *%RAN+%ran#$ar Casts *%RAN+


79/112

Sha!e4 te(t#re

C Small thin to large coarse gran!les "is%erse" thro!gho!t the castmatri+.

C *olorless to yello-

C All sha%es an" siHes


– Intrinsic renal "isease, ran!lar casts are accom%anie" #ycell!lar casts.

– Keavy %rotein!ria ne%hrotic syn"rome4

– Jrthostatic %rotein!ria– *ongestive heart fail!re -ith %rotein!ria

– Ac!te or chronic renal "isease


i3 :;;i3 :;;

0icrosco!0icrosco!

ee

Ce$$#$ar CastsCe$$#$ar Casts RBCs castsRBCs casts


sedimentsediment


80/112

Sha!e4 te(t#reC Kyaline casts containing ghost re" #loo" cells, or hyalinecasts lle" -ith n!mero!s orange re" erythrocytes.

C The !n%igmente" form of re" #loo" cells casts is morefreF!ent.

C *olor: yello- to re"C#ro-n or colorless


C Al-ays lin$e" -ith %rotein!ria

C Intrinsic renal "isease: glomer!lar or t!#!lar "amages


0icrosco!0icrosco!

ee

i3 :;;i3 :;;

Ce$$#$ar CastsCe$$#$ar Casts BCs castsBCs casts


sedimentsediment


81/112

Sha!e4 te(t#reC Kyaline matri+ cast #earing ne!tro%hil incl!sions


C Infection: %yelone%hritis UTI4

WL* casts -ith #acteri!ria, %rotein!ria an" hemat!ria

C lomer!lone%hritis: RL* casts are also %resent -ith WL*casts

C Renal inammation -itho!t #acteri!ria


i3 :;;i3 :;;

0icrosco!0icrosco!

ee


sedimentsedimentCe$$#$ar CastsCe$$#$ar Casts Rena$ t#b#$ar ce$$s castsRena$ t#b#$ar ce$$s casts


82/112

Sha!e4 te(t#re

C Alignement of RT* or ran"omly arrange" -ithin a cast

C Kyaline cast -ith characteristic large central n!clei


C Intrinsic renal t!#!lar "iseases:

Ac!te interstitial ne%hritis

Ac!te trans%lant reGection

T!#!lar necrosis

C ran!lar casts an" %rotein!ria accom%any RT**


0icrosco!0icrosco!

ee

* C+


sedimentsediment


83/112

5atty casts *5ATC+5atty casts *5ATC+

Sha!e4 te(t#re

C Kaline or gran!lar matri+ -ith free fat glo#!les or8an" oval fat#o"ies


C Renal t!#!lar cell "eath

C Accom%anie" #y signicant %rotein!ria ne%hrotic syn"rome


0icrosco!0icrosco!

ee


sedimentsediment


84/112

BRA) CastsBRA) Casts

Sha!e4 te(t#re

C Kayline or gran!lar matri+


C 1orme" in e+tremely "ilate" t!#es or the -hil"e collecting"!cts

C In"icates %rono!nce" !rinary statis

renal "isease

C Al-ays seen -ith convol!te" casts

Norma$ 6a$#e 'ot seen i3 :;;i3 :;;

Crysta$ castsCrysta$ casts


sedimentsediment

C C


85/112

Crysta$ castsCrysta$ casts

Sha!e4 te(t#re

C Kayline matri+ -ith incl!sion of crystals


C in"icates an intrat!#!lar crystalliHation.

C (rovo$e" renal "amages: "!e to an inammation %rocess or#y o#str!ction.

C )ost seen: *alci!m J+alte hy%ero+ali!ria4 an" Uric aci"ne%hro%athy4

Norma$ 6a$#e 'ot seenUric AcidUric Acid

Ca(Ca(

ther caststher casts


sedimentsediment


86/112

ther caststher casts&

)icroorganisms Incl!sion *asts : east, Lacteria

1i#rin threa" casts

)yeloma casts

(igmente" casts: Kemoglo#in, )yoglo#in, Lilir!#in&


sedimentsediment


87/112

L!""ing east LST4

Ky%hae east KST4

Yeast Yeast

east

B#ddin9 Yeast *BYST+B#ddin9 Yeast *BYST+


sedimentsediment


88/112

Sha!e4 te(t#reC SiHe: 6 to / Xm

C Jvoi" an" colorless loo$s li$e RL*4


C *ontamination from vaginal infection, air or s$in

C *an #e %rimary UTI no freeF!ent4

C )ost common s%ecie: *. gla#rata (Torulopsis glabrata)


i3 :;;i3 :;;

0icrosco!0icrosco!

ee

y!hae Yeast *YST+y!hae Yeast *YST+


sedimentsediment


89/112

Sha!e4 te(t#reC *olorless


C *ontamination from vaginal infection, air or s$in

C *an #e %rimary UTI no freeF!ent4

C )ost common s%ecie: *an"i"a al#icans


i3 :;;i3 :;;


sedimentsediment


90/112

Lacteria LA*T4

)!c!s )U*S4

0isce$$aneo#s0isce$$aneo#s

S%erm S(R)4

Jval 1at Lo"yJB1L4 ] 1AT

Bacteria *BACT+Bacteria *BACT+

0ic

rosco!ic 1(amination of #rine0icrosco!ic 1(amination of #rine

sedimentsediment


91/112

Bacteria *BACT+Bacteria *BACT+

Sha!e4 te(t#re

C Bario!s siHe an" sha%es: long, thin ro"s to short, %l!m%ro"s

C A%%ears single or in chains "e%en"ing to the s%ecies4

C )ost seen: ro"sha%e" #acilli4 ] cocoi" froms


C UTI

C *an #e contamination form vagina an" gastrointestinaltract

Norma$ 6a$#e 'ot seen&i3 :;;i3 :;;


0#c#s *0UCS+0#c#s *0UCS+



92/112

0#c#s *0UCS+0#c#s *0UCS+

Sha!e4 te(t#re

C 1i#rillar %rotein, "elicate, ri##onli$e stran"s


C 'one

C *an comes from the genito!rinary tract

o not misidenti0ed with casts 1no rounded ends2o not misidenti0ed with casts 1no rounded ends2

i3 :;;i3 :;;

S!ermato?oa *S'R0+S!ermato?oa *S'R0+



93/112

Sha!e4 te(t#re

C Jval hea": ,6Xm to 3,6Xm -i"th: @Xm to 6!m length

Tail \@6!m


C 'one

i3 :;;i3 :;;

0icrosco!0icrosco!

ee

5AT5AT



94/112

ri9in of fat in #rine

1at or li%i"are fo!n" in !rine in 3 forms:

free as the #irefringent fat "ro%lets

intracell!lar in the oval fat #o"ies

im#e""e" -ithin a cast matri+ in the fatty cast.


C 7i%!"!ria al-ays accom%agnie" -ith %rotein!ria

if li%i"s can cross into Lo-manEs s%ace, so can %lasma%roteins an" al#!min4

C lomer!lar "ysfonction -ith li%i"!ria an" %rotein!ria

C 'e%hrotic syn"rome ne%hrosis4

6a$ 5at Body *V5B+6a$ 5at Body *V5B+



95/112

)e=nitionC oval fat #o"ies are macro%hages also $no-n as foam cells

C renal t!#!lar cell engorge" -ith a#sor#e" fat


lomer!lar "ysfonction -ith li%i"!ria an" %rotein!ria

'e%hrotic syn"rome ne%hrosis4

it can occ!re -ith other $i"ney "isease an"8 or metha#olic"iseases s!ch as "ia#ete mellit!s

Norma$ 6a$#e 'one

Trichomonas *TRIC+Trichomonas *TRIC+ %richomonas vaginalis%richomonas vaginalis



96/112

Sha!e4 te(t#re

C Avrage siHe: 96 Xm can #e 6 to 30 Xm4

C anterior agella an" a %osterior a+ostyle


C (arasitic gynecological infection


C Same siHe, sha%e an" contrast as WL*, fo!n" in WL*^^

i3 :;;i3 :;;

Schistosoma aematobi#m 6aSchistosoma aematobi#m 6a



97/112

Sha!e4 te(t#reC Jval an" large siHe ova

C )ay #e fo!n" most commonly in SPM(, KA7, U'** orU'*7

C< @0Xm


C Mnter into the !rine from the #la"er -all m!cosa.

C )eans a %rarsitic infection an" nee" treatment



98/112

Iris Diagnostics



UNCLUNCL)15INITIN)15INITIN

300-4953 Rev. D

UNCL Classification

Re%resents the entire s%ecimen sorte" #y


99/112

Re%resents the entire s%ecimen sorte" #y

siHe Use" to i"entify %articles not a!toCclassie"

#y A(R

Use" #y the technologist to acco!nt for all

'SMs an" *asts

C Incl!"es 'artic$es not cate9ori?ed #y A(R less than the=0> con"ence level of all a!toCclassie" categories4

UNCL – “Unclassified”


100/112

CThe U'*7 category is a re!resentation of the entiresam!$e -ith the %articles sorte" #y siHe e(ce!t for castsand NS1.

CU'*7 is !se" to $ook for %articles that havenEt #een a!toCclassie" an" to acco!nt for all NS1&s and casts.

CIf the la# has a s%ecic %article that they "onEt re%ort an"have !se" a#to


101/112

Do yo! have

F!estions?


102/112

Iris Diagnostics



i3i3GG:;; R1VI1:;; R1VI1

STRAT1%Y STRAT1%Y

300-4953 Rev. D

PROPOSED REVIEW STRATEGY

A$$ s!ecimens on the ork List need


103/112

A$$ s!ecimens on the ork List need

re6iew Bacteria

− A#to


104/112

p " #

particles $ispla"e$ match their appropriate auto%classiication

The presence&absence o clinicall" si#niicant bacteria

chan#es the !eriication process

!resence "#sence

7oo$ at the #acteri!ria chec$ list for microsco%yan" chemistry:

Lacteria? WL*? Small %articles *o!nt?

'o( to re!ie( a specimen )


105/112

Lacteria? WL*? Small %articles *o!nt?

Legin at the rst category RL*4

To change a category !se the #!tton at to% right

Reclassify %ict!res

– Do not revie- the images of any classication that isne9ati6e

– Revie- the images of any classication that isborder$ine abnorma$

– Reclassify or s!# classify %articles on$y when iton$y when it

makes a c$inica$ diHerencemakes a c$inica$ diHerence more than 60>4

– Revie- an" s!# classify all images fo!n" in 'onCSF!amo!s M%ithelial +/34, Unclassie" *asts#+CC4, an" Unclassie" *rystals #+C4 4

Re6iew UNCL and answer to those /Re6iew UNCL and answer to those /

>#estions>#estions

'o( to re!ie( a specimen )


106/112

>#estions>#estions

Is there any a""itional *asts?Is there any a""itional Renals, Transitionalscells?

Is there anything ne- ne- category%article4?

When nishe", revie- the nal res!ltsan" acce%t -hen satise"

Verification of Reslts$ "#sence of %acteria

Veri" that the auto%classiie$ particle ima#es match the

cate#ories the" are $ispla"e$ (ithin


107/112

Reclassi" particles (hen it (ill ma*e a clinical $ierence

Sub%classi" particles classiie$ in the N&'+ UNCC+ an$&or

UNC( cate#ories

Account or all ne( particles+ casts+ renals+ an$

transitionals $ispla"e$ in UNCL

N)*'$ (hen usin# auto%classi" to pre!ent reportin# o a

particular particle remember that the ima#es o that

particle (ill still appear in ,-./0

Verification of Reslts$ !resence of %acteria

Veri" that the auto%classiie$ particle ima#es match the

cate#ories the" are $ispla"e$ (ithin

1anuall" #ra$e bacteria base$ on (hat is obser!e$


108/112

" #

(ithin the bac*#roun$s o the +%C+ +%CC+ &,'!+ an$UC& classiications

Reclassi" particles (hen it (ill ma*e a clinical $ierence

Sub%classi" particles classiie$ in the N&'+ UNCC+

an$&orUNC(

cate#ories Account or all ne( particles+ casts+ renals+ an$

transitionals $ispla"e$ in UNCL

N)*'$ (hen usin# auto%classi" to pre!ent reportin# o a

particular particle remember that the ima#es o that

particle (ill still appear in ,-./

Gra$in# an$ 2uanti"in# All .asts an$ -SE Unli$e other cell ty%es, the 'ormaliHation 1actor

for 'SMs an" *asts "oes not e+ist

All 'SMs an" *asts m!st #e acco!nte" for #y the


109/112

All 'SMs an" *asts m!st #e acco!nte" for #y the

!ser

If gra"ing, only one image of a 'SM an"8or *astnee"s to #e move" to the a%%ro%riateclassication.

55 Note: This applies to normal samples only. !the sample is "agged #ith $igh Concentration or%ossible &morphous, all N' and Casts must beclassied in order to obtain an accurate result.

If en!merating, all 'SM an"8or *asts nee" to #emove" to the a%%ro%riate classication to #eacco!nte" for correctly.

When to return to the manual microscope)


110/112

There are @ times reg!lators reF!ire !sers to goto a man!al microsco%e

9. Jval 1at Lo"iesC conrm !sing %olariHe" lightmicrosco%y

. 1atC conrm !sing %olariHe" light microsco%y

3. TrichomonasC conrm %resence of agella #ymotility

@. Any *ell!lar *astC to ID cell ty%e

i2Series Deinitions

A#normal Threshol"

– The !ser "ene" concentration at -hich a


111/112

res!lt is consi"ere" a#normal– Kighlights the res!lt in red an" re%orts an

ne+t to the corres%on"ing res!lt

– A%%lies to #oth forme" %articles an"

chemistries *hemistry *onrmation Threshol"

– The !ser "ene" concentration at -hich ares!lt -ill #e agging for conrmatory testing

– talici*es the res!lt that is agge"

– A%%lies to chemistry res!lts only

i2Series Deinitions A!toCclassify

– The minim!m concentration of a %articleto #e i"entie" #efore creating the%article classication


112/112

– Use" to increase the s%ecicity of thesoft-are for a %artic!lar %atient"emogra%hic

– (articles %resent that are less than the

threshol" -ill a%%ear in U'*7

A!toCrelease

– Dene" #y the !ser to allo- theinstr!ment to a!tomatically re%ort forme"

%articles to a %rinter an"8or 7IS -itho!t atechnologistEs revie-

– 1lagge" sam%les cannot #e a!toCrelease". These sam%le -ill a!toCrelease

Particule Si Semnificatii

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