Manual of basic techniques for a health laboratory - libdoc.who.int

7. Examination of urine 243Table 7.4 Reporting the results of microscopic examination of urinefor leukocytesNumber of leukocytes per microscope fieldResult0–10 few leukocytes (normal)10–20 moderate number of leukocytes20–30 many leukocytes20–30 (degenerated) in clumps many leukocytes seen in clumps> 30 (degenerated) in clumps full fieldFig. 7.12 Renal cellsFig. 7.13 Hyaline castsRenal cells (Fig. 7.12)Renal cells are smaller than renal pelvic cells (the size of 1–2 leukocytes) and arevery granular. The nucleus is shiny and clearly visible.Renal cells are almost always present with protein in the urine.CastsCasts are cylindrical in shape and long, crossing almost the whole field when examinedunder the ¥ 40 objective.Hyaline casts are transparent and slightly shiny; the ends are rounded or tapered(Fig. 7.13). They may be found in healthy persons after strenuous muscular effortand have no diagnostic significance.Granular casts are rather short casts filled with large granules, paleyellow in colour, with rounded ends (Fig. 7.14). The granules comefrom degenerated epithelial cells from the tubules of the kidneyand have no diagnostic significance.Fine granular casts (Fig. 7.15) have smaller granules that do not fillthe cast (a). Do not confuse with hyaline casts, partly covered byamorphous phosphate crystals (b).Blood casts are filled with more or less degenerated erythrocytes,brownish in colour (Fig. 7.16). They are found in acute kidneyFig. 7.14 Granular castsdisease.Pus casts (Fig. 7.17) are completely filled with leukocytes (a). Do not confuse withhyaline casts, which may contain a few leukocytes (b). Pus casts are found in patientssuffering from kidney infection.Epithelial casts are filled with pale yellow epithelial cells (Fig. 7.18). (To make thecells more distinct, add a drop of 10% acetic acid (reagent no. 2) to the deposit.)Epithelial casts have no diagnostic significance.Fatty casts are very shiny yellowish casts; the edges are indented and distinct andthe ends are rounded (Fig. 7.19). They are soluble in ether but not in acetic acid.Fatty casts are found in patients with severe kidney disease.