Particule Si Semnificatii

BASIC URINALYSIS
Iris Diagnostics
A Division of International
Remote Imaging Systems, Inc.
3 Urine: What is it?
Urine The fluid secreted by the kidneys,

stored in
the bladder and discharged by the
urethra.
Urine, in health, has an amber color, a
slight acid reaction, a peculiar odor, and
a bitter, salty taste.

The Kidneys

The Kidneys
View from the back

The Kidneys
Cross Section
Medulla
Cortex
Papilla
Nephrons
Renal Pelvis
Ureter
The Kidneys:
Nephron = functional
unit
Consists of:
Glomerulus
Renal Tubules
Bowmans
Capsule
Proximal
Capsule
Distal Tubules

The Kidneys
(Nephron)
Urine formation begins at the capillary

bed known as the Glomerular
Membrane and empties into Bowmans
Capsule.
Membrane impermeable to Mol. Wt.
70,000
Filtrate plasma with very little protein
Plasma flow (both kidneys) 650 mL/min
Filtration rate (both kidneys) 125
mL/min ( 180 L/day)
> 99% of filtrate reabsorbed in the
tubules
Urine
Presentation
The Kidneys
(Nephron)
Filtrate passes through proximal tubule, loop of
Henle, distal
tubule, collecting tubule, and into the pelvis of
the kidney.
Along the path selective reabsorption and tubular
epithelium
Percent of filtrate water reabsorbed
occur.
secretions
Proximal
tubules 80%
Loop of Henle
6%
Distal tubules
9%
Collecting Ducts 4%
99%
Remaining 1% = Urine
Important nutriments such as glucose,
proteins, amino acids, and vitamins are
almost completely reabsorbed in the

The Ureters
The urine transport tube from the kidneys to the
bladder.
Virtually no reabsorption .
Urine passes directly from the kidney pelvis
directly into the bladder.

The Bladder
(The Holding Tank for the urine)
Urine passes directly from the ureters into - and

is temporarily stored in the bladder
Transitional epithelial cells stretch as the bladder
fills with urine.
Duration of stored urine can have negative
consequences (e.g., UTI).
The Urethra
Urine empties from the expanded bladder
into the urethra and out into a clean collection
cup.
4 - Why Is It Analyzed?
Urine as we have just seen through
the massive filtration and reabsorption of
the filtrate, significantly reflects many of
the metabolic/physiologic and pathologic
changes that occur in tissues and are
reflected the blood.
Analyzing the urine has a distinct
advantage for the patient:
its a non-invasive test
To help detect Disease of the Urinary Tract

System
Glomerulonephritis
Nephritis
Urinary Tract Infections
Calculi (Stones)
Metabolic Diseases
Diabetes Mellitus
Glomerulonephritis
One of the kidney disease that damage glomerulus
Many types of glomerulonephritis
Include immunologic, metabolic and hereditary
disorders
Syndroms: Hematuria, proteinuria, oliguria, azotemia,
edema and hypertension
People can lose 80 to 85% of the kidney function.
It can be a acute disease that can occur after a
streptococcal infection
Urinalysis results:
Chemistry: increased levels of blood and protein
Microscopic: increased RBCs, WBCs,
Renal epithelial cells, and Casts
Nephritis
Can occur as the result of various drugs and toxins
Response allergic in renal interstitium
Renal interstitium is infiltrate with leukocytes
(Lymphocytes, Macrophages, Eosinophils and
neutrophils)
Symptoms: Hematuria, mild proteinuria,
leukocyturia without bacteria
Urinalysis results:
Chemistry: increased levels of Protein, Blood and
Leukocyte esterase
Microscopic: Increase in WBCs, Rbcs, Casts of
leukocytes and eosinophils, Renal epithelial cells
and possibly Crystals
Urinary Tract Infections
Can involve the upper or lower urinary tract.
Lower tract can effect the urethra, bladder or
both
Upper tract can effect the renal pelvis,
interstitium or both
UTIs are 10 times more common in females
Urinalysis results:
Chemistry: increased levels of protein, blood,
leukocyte esterase and nitrite
Microscopic: increased WBCs, Bacteria, RBCs,
Transitional epithelial cells
Calculi (Stones)
Solid aggregates of chemicals, usually
mineral salts
Found in the renal calyces, pelvis, ureter or
bladder
75% of stones are composed of calcium and
oxalate or phosphate
Factor influencing formation:
Increase concentration of chemical salts
Changes in urinary pH
Urinary stasis
Diabetes Mellitus
Group of disorders that affects the
metabolism of carbohydrate, fat and protein
Increased levels of Glucose, Ketones and high
SG in urine.
Can cause retinopathy, meuropathy,
angiopathy and nephropathy
5 How Is It Analyzed?
Urine Specimen Collection
Random collected any time
Clean Catch patient cleans area before urinating
First AM generally best specimen for detection
because the urine has been in the bladder around 8
hours
Catheterized - urine is collected sterile invasive
procedure
Suprapubic Aspiration Urine collected using a
needle and syringe to go into the bladder through
the abdominal wall
24 Hour Collection not used for urinalysis but for
various special chemistry tests
Specimen Storage Issues
Urine should be tested as soon as possible after
collection
4 hours or less
Prolonged storage may cause the following:
Red blood cells undergo hemolysis
White blood cells degenerate
Protein could become positive due to changes in
higher pH values
Casts disappear
Bacteria multiply
pH fluctuates due to carbon dioxide loss and
reduction of urea to ammonia
Urine becomes cloudy due to solute precipitates
Specimen Storage Issues
Glucose level is reduced since glucose is
metabolized by bacteria and cells
Ketone level is reduced because of
bacterial effect
Bilirubin level is reduced due to light
sensitivity
Urobilinogen level is reduced since
urobilinogen is converted to urobilin
Nitrite appears as bacteria grow
Color darkens
Odor becomes foul
3 PARTS
Physical Characteristics:
- Color, Clarity, Specific Gravity
Chemical Characteristics:
- Glucose, Protein, Bilirubin,
Urobilinogen, pH, Blood, Ketones, Nitrite, and
Leukocytes
Microscopic Examination:
- Formed elements (particles), e.g.,
epithelial cells, blood cells, crystals, casts,
bacteria sperm, mucus
Maintenance
&
Quality control
Iris Diagnostics
Maintenance and Quality control

Daily iQ System Maintenance
1. Clean instrument exterior

surfaces
2. Clean sampler
3. Clean load/unload stations
4. Check iQ Series lamina supply
5. Empty waste
6. Run urine control racks
Chemistry
Microscopy
7. Run body fluids control rack

Monthly iQ System Maintenance
1.Microscopy calibration (see Quality

control)
2.Perform Backup

As Needed iQ System Maintenance
1. Clean rinse waste/baths

2. Replace lamina container
3. Replace lamina filter
4. Clean sample tube detector
5. Clean barcode reader window
6. Clean optical sensors
7. Clean sample filter
8. Inspect and clean racks

iQ Series Quality Control
Quality Control must be performed daily
Each iQ Control/Focus Set contains 2 bottles of
Focus, 1 bottle of Positive Control, 1 bottle of
Negative Control, and Lot Specific barcode labels
Note: the barcode labels contain the Lot ID,
unopened expiration date, and Pass/Fail
criteria
This information is tracked in QC Review for
the Positive and Negative Controls
Once the Set is opened, it is good for 30 days
This Set should be stored between 2 - 8C
The iQ Control rack is used to cleanse, focus,
and perform quality control on the iQ200 series

iQ Series Daily Quality Control
The iQ Control rack should be prepared as
follows:

iQ Series Monthly Quality Control
Calibration
Calibration must be performed monthly
Each iQ Calibrator Pack contains four bottles of
Calibrator and Lot Specific barcodes
The barcode labels contain the Lot ID, unopened
expiration date, and Pass/Fail criteria
Tracked in QC Review as REF values
Once opened, the bottle of calibrator expires in 24
hours
The Calibrator Packs should be stored between 2 8C.
To calibrate the instrument, the user labels tube 1 of
10 tubes with the appropriate calibrator label, mixes
one bottle of calibrator, pours 3 mL into each of the 10
tubes, inserts these tubes in to CAL labeled rack and

iQ Calibrator and iQ Control/Focus
Set
The iQ Calibrator, Focus and Positive

Control are made of fixed human RBCs
To assure proper cell suspension,

vigorously mix these solutions 5 times,
followed by 5 gentle inversions
Allow the bubbles to dissipate before
pouring
DO NOT mix the iQ Negative Control
before pouring. This reduces the potential
of bubbles and particulate debris from
entering the test aliquot
Throw unused barcode labels away when
the product is gone.

QC Review
Stores Chemistry QC, Microscopy QC, and
Microscopy Calibration results that can
be viewed at any time; removed on a
First In First Out basis
Results can be
sorted and
searched by Lot
ID, Date/Time,
Type, Status and
REF
Only a manager
can remove QC
data points.

QC Statistics
Provides a Levy-Jennings Chart for all lots of iQ
Positive and Negative Control analyzed on the
instrument
Stores the last 31 days or 100 data points for
each lot
2 data
points
Requires
The Target,
Upper
and to make the LevyJennings
Chart
Lower Limits
are
obtained from the lot
specific barcodes
The Mean and 2 SD are
calculated from the data
points obtained from
each run of that lot.
Hands-on
iQ Daily maintenance
iQ monthly maintenance
iQ As needed maintenance
Specimen Preparation
Iris Diagnostics
Specimen Preparation
Specimen Requirements
Use only fresh urine specimens collected in
clean containers which are tightly capped.
If specimen isnt processed within 1 hour, store
at 2 8C. Bring to room temperature before
testing.
Mix specimen well before testing.
DO NOT add any disinfectant or detergent to the
specimen.
Keep specimens out of direct sunlight.
DO NOT centrifuge urine specimens.
Specimen volume is ~3mL for the iChem
VELOCITY and is ~3mL for the iQ.
Test tubes should be 16 x 100mm glass or
polystyrene round bottom tubes.
When to Dilute
iChem VELOCITY
DO NOT Dilute
iQ 200
Grossly bloody
Very dense
Heavy mucous
Short samples
Theory of operation
5. Quantitative Result Reporting
All particles are reported and displayed in

L
L results are converted automatically
when HPF and/or LPF are selected in settings
- HPF = L/5.5
- LPF = L * 2.9
The particle type and its number are
checked against user-defined auto-release
criteria
If criteria is met, result sent to LIS; if not,
Microscopic Examination
of urine sediment
Iris Diagnostics
Microscopic Examination of urine

sediment
iQ200 reports 12 auto-classified & quantified formed
elements:
RBCs
Crystals
WBCs
WBC Clumps
Hyaline Casts
Mucus
Pathological Casts
Sperm
Squamous Epithelial Cells

Non-squamous Epithelial Cells
Bacteria
Yeast
Plus Artifacts

sediment
Blood cells
Red Blood Cells (RBC)
White Blood Cells (WBC)

sediment
- Hematuria is normally associated with a urinary tract disease.
- Red blood cells (erythrocytes) may be a contaminate in the
urine from menstruating women.
Shape:
- Smooth, round biconcave discs
Size:
- 6 to 8 m in diameter and 3m in depth
iQ 200
Microscop
e

sediment
iQ 200
Pathologies: HEMATURIA
- Pyelonephritis,
- Nephrotoxins,
- Kidney trauma,
- Urinary tract infections,
- Cystitis,
- Acute tubular necrosis,
- Urinary tract stones : calculi,
- Glomerular damage
- Eroding urinary tract tumors.
Normal value: 3 to 12 /l
Microscop
e

sediment
Dysmorphic
Red Blood Cells (DRBC)
- The second type of hematuria is dysmorphic or renal
hematuria.
- This hematuria is characterized by: a great variation in
the size of the cells (anisocytosis), many ghost cells, and by
a high percentage of dysmorphocytosis (>20%).
- Dysmorphic or distored RBC can be found with normal
erythrocytes of healthy indivuduals.
Pathologies: - Glomerular damage
- Sickle cell disease.
Microscop
- The percentage of isomorphic and dysmorphic RBC will
e
be automatically calculated for the report
iQ 200

sediment
Red Blood Cells Clumps (RBCC)
- Could be found in urine with gross hematuria

- Do not confuse with RBC stick to mucous threads .

sediment
- White blood cells (leukocytes) from cervical or vaginal
infections or external urethral meatus may contaminate urine
samples.
- Manly WBCs in urine are Neutrophils

- Increased number of leucotytes = leukcyturia or piuria
= Turbid and cloudy urine specimens
Shape: - Rough with granular cytoplasm
- Spherical with caracteristic cytoplamic granules
- Lobed or segmented nuclei
Size: - 10 to 14 m in diameter
iQ 200
Microscop
e

sediment
Pathologies:
Bacterial causes:
- Pyelonephritis
- Cystitis
- Urethritid
- Prostatitis
Normal value: 10/l
Non bacterial causes:

- Nephritis
- Glomerulonephritis
- Chlamydia
- Mycoplasmosis
- Turbeculosis
- Trichomonas and mycoses
(= vaginal contaminants)

sediment

Eosinophils:
- 14 m in diameter
- bilobed nuclei
- Eosinophiluria = acute intestinal nephritis
chronic UTI
Lymphocytes: - 6 to 9m in diameter)
- oval nucleus and clear cytoplasm
- Lymphocyturia = inflammatory conditions
(pyelonephritis
renal transplant rejection
- They do not produce esterase (chemistry test neg)
Histiocytes:
- Macrophages (30 to 10m) / Monocytes (20 to 40 m)
- Cells which defend against microorganisms
- Renal tubulointerstitial diseases and immune reaction

sediment
White Blood Cells Clumps (WBCC)
- WBCC are typically found in urine samples containing large
quantities of WBC.
- Their presence generally represents an acute infectious
process.
iQ 200

sediment
Epithelial cells
Squamous Epithelial Cells (SQEP)
Non-squamous Epithelial Cells (NSE)
Renal Epithelial (REEP)
Transitional Epithelial TREP)

sediment
Squamous
Epithelial Cells (SQEP)
Shape:
- Very large, thin (40 60 m)
- Cells with small nuclei and clear sharp edges.
Clinical significance:
- Generally represents possible contamination of the
specimen.
- Their presence is generally not considered clinically
significant.
- It is necessary to be vigilant with elderly patient's
specimens.
Microscop
(squamous
metaplasia of the bladder)
e
iQ 200

sediment
Clue Cells (SQEP)
- Clue cells are squamous epithelial cells covered with

bacteria.
- Size: 40 60 m
- They appear shaggy, as seen above, and the nucleus
may not be visible due to the bacteria covering the cell.
- Clue cells are contaminants and are indicative of bacterial
vaginosis.
iQ 200

sediment
Non Squamous Epithelial Cells (NSE)
- Cells with abnormal shape, size, inclusions or nuclear

chromatin pattern
= needs futher cytologic studies
- Size: 14 to 60 m
- Neoplasia in genitourianry tract.
iQ 200
3 types of cells are found in urine sediment:

- Squamous (ever seen)
- Transitional (urothelial)
- Renal tubular epithelial cells

sediment
Transitional Epithelial Cells (TREP)
- Transitional epithelial cells occur in the renal pelvis,
ureter, calyces and bladder.
- These cells are smaller and more well defined than
squamous epithelial and have a larger nucleus.
Microscop
e
Size: 20 to 40 m
Shape: round or pear shape, dense oval to round
nucleus and abundant cytoplasm
Clinical significance (increased number):
Acute tubular disease
Glomerulonephritis
Acute infection
Renal toxicity
Viral infection
iQ 200

sediment
Renal Epithelial Cells (REEP)
- Renal epithelial cells are generally larger than

granulocytes and contain a large round or oval nucleus.
- Normally, these cells slough off into the urine in very
small numbers (except new born).
Microscop
e
Size: 12 to 20 m
Clinical significance (increased number):
- Nephrotic syndrome
- Conditions leading to tubular degeneration
iQ 200

sediment
Crystals
Calcium Oxalate (CAOX)
Uric Acid (URIC)
Calcium Phosphate (CAPH)
Triple Phosphate (TP04)

sediment
UnClassified Crystals
All crystals found by the APR are first named as UNCR.

It is up to the user to choose the category of the
crystals.
The majority of crystals found in the urinary sediment are
of limited clinical value.
value
It is tempting to associate crystals with a risk of
urolithiasis, but the majority of patients with a crystalluria
do not have and will not develop kidney stones.
In the majority of cases, the crystals found in urine are not
present in the freshly voided specimen.

sediment
Calcium Oxalate Crystals

Shape:
is
- The most common shape of calcium oxalate crystals

that of its octahedral form.
pH: - any pH of urines

- Severe chronic renal disease
- Ingestion of the oxalate precursor ethylene glycol
iQ 200
Microscop
e

sediment
Calcium Oxalate Monohydrate Crystals

Shape:
- Monoclinic leave shape, oval egg shape.

- Found in situations of massive calcium oxalate
precipitation.
pH: - any pH of urines
- Pathological massive precipitation
iQ 200
Microscop
e

sediment
Amorphous Phosphate or Biurate Crystals
- The amorphous phosphates seen in urine specimens and
are the result of refrigeration.
Shape: - white mass of small rounded particles.
pH:
>5,7
Clinical significance: None
iQ 200
Microscop
e

sediment
Amorphous Urate Crystals
The amorphous urates seen in urine specimens and are,
most of the time, the result of refrigeration.
Shape: - pink mass of small rounded particles.
pH: - 5,7 to 7,0
Microscop
e

sediment
Triple
Phosphate Crystals
Formation due to ammonia concentration.
Shape: - classic shape is the pyramid six-sided prisms,
that reminds a coffin lid
pH: > 6,5
- Associated with bacterial growth.
- With a first-morning fresh specimen, TPO4 can indicate
UTI
- They are often present in renal calculi
- Otherwise: little clinical value.
iQ 200
Microscop
e

sediment
Uric Acid Crystals

Shape:
- Uric acid crystals occur in several forms with the most

common being diamond shaped.
Microscop
e
pH: <5,5
- Can appear in healthy individuals
- Gout
- Increased purine metabolism (e.g. cytotoxic drugs)
iQ 200

sediment
Rare Crystals
Bilirubine crystals
Cystine crystals
Cholesterol crystals
Tyrosine crystals
Hemosiderin crystals
Leucine crystals
And other crystals

sediment
Ammonium Biurate Crystals
Shape:
- yellow-brown spheres with striation on their
surface
pH: - alkaline and neutral urine
Microscop
e
Clinical significance in fresh urine specimens:

- They can cause renal tubular damage
- Inadequate hydrataion of the patient
- If appears in prolonged storage urines (no clinical value)
iQ 200

sediment
Bilirubine Crystals
Shape:
- fine needles that regroup in a clump
- or as red brown spheres, plates
Microscop
e
pH: - acidic urine

- Bilirubinuria = metabolic disease process
- Hepatic disease: Hepatitis, Cirrhosis
- Obstructed bile duct
- Gall stones
- Tumors

sediment
Calcium Carbonate Crystals

Shape:
- small colorless granular crystals

- founds in paires dumbbell shape.
pH: - alkaline urine
Microscop
e

sediment
Calcium Phosphate Crystals

Shape:
- colorless,thin, wedgelike prism arranged in small

grouping or in a rosette patern
pH: - slightly alkalin or neutral urine
iQ 200

sediment
Cholesterol Crystals (CHOL)
Shape:
- clear flat rectangular plates with notched corners
pH: - acidic urine
iQ 200
- Accompagnied with fat in urine
- Nephrotic syndrome: lipiduria
- Chyluria: rupture of lymphatic vessels into renal
tubules (results of tumors)

sediment
Cystine Crystals
Microscop
e
Shape:
- colorless hexagonal plates
pH: - acidic pH
- Congenital cystinosis
- Cystinuria
- Tends to deposite in tubules as calculi = renal

damage
iQ 200

sediment
Hemosiderin Crystals
Shape:
- granules free floating in clumps, cells and casts
pH: - acidic and neutral urine
- Hemolytic events
Microscop
e

sediment
Leucine Crystals (LEU)
Shape:
- yellow to brown spheres with concentric or radial
striations on their surface.
Microscop
e
pH: - acidic pH
- Overflow aminoaciduria in plasma and so
increased
- Renal exrection
- Hereditary methabolic disorder like tyrosinosis
- Sever liver disease, often in a terminal stage

sediment
Radiographic Contrast Media Crystals

Shape:
- colorless long pointed needles singly or clustered in

sheaves
pH: - acidic urine
- Can significantly elevating the SG of urine
- Cause a false positive precipitation test for protein
iQ 200

sediment
Sulfonamides Crystals
Shape:
to
- yellow to brown bundles of needles that resemble

a fan formation
pH: - acidic urine

Clinical significance: Due to drugs

sediment
Tyrosine Crystals
(TRY)
Shape:
- brown neddles, isolated or forming a dense rosette
pH: - acidic pH
- Overflow aminoaciduria in plasma and so
increased
- Renal exrection
- Hereditary methabolic disorder like tyrosinosis
- Sever liver disease, often in a terminal stage
Microscop
e

sediment
Casts
Hyaline Casts
Non-Hyaline Casts
Granular (GRAN)
Cellular (CELL)

sediment What is a Casts?
Casts Formation & general characteristics
- cast is made of uromodulin or Tamm-Horsfall proteins.
- It is secreted by renal tubular cells and distal convuled
tubules
- when the tubular lumen contents become concentrated,
fibrils forms and are attached to the lumen cells.
- It is holding temporarly in place while it enmeshes any
substances present into its matrix.
-cast is detached from the tubular and flush into the urine.
Shape:
- cylindrical with parallel sides
- with ends that are rounded or straight

sediment What is a Casts?
- Casts reflected the status of renal tubules.
- the number of casts reflects the severity of the disease
Type of casts and its number = valuable information to
the clinician.
Exceptions: strenuous exercise & emotional stress
Normal value: 6 to 10 /l hyaline or granular casts
in a 24 hours urine collection.

sediment
Hyaline
Casts (HYAL)
Shape/ texture:
casts without inclusion, are seen in numerous conditions.
iQ 200
Normal urine
Strenuous exercise
Acute glomerulonephritis
Acute pyelonephritis
Malignant hypertension
Chronic renal disease
Microscop
e

sediment
Waxy
Casts (WAXY)
Shape/ texture:
- Opaque waxlike matrix with square, sharpe, blunt ends
- Cracks or fissures in their margins = caracteristic of waxy casts
- Indicate tubular obstruction with prolonged stasis
= advance stage of other casts transformed during stasis
- Chronic renal failure
- Acute renal diseases : glomerulonephritis or nephrotic
syndrome
- Malignant hypertension
- Renal allograft rejection
Normal value: Not seen
iQ 200
Microscop
e

sediment
Granular
Casts (GRAN)
Shape/ texture:
- Small thin to large coarse granules dispersed throughout the cast
matrix.
- Colorless to yellow
Microscop
e
- All shapes and sizes

Intrinsic renal disease, Granular casts are accompanied by

cellular casts.
Heavy proteinuria (nephrotic syndrome)
Orthostatic proteinuria
iQ 200
Congestive heart failure with proteinuria

Acute or chronic renal disease

sediment
Cellular Casts:
RBCs casts
Shape/ texture:
- Hyaline casts containing ghost red blood cells, or hyaline
casts filled with numerous orange red erythrocytes.
- The unpigmented form of red blood cells casts is more
frequent.
Microscop
- Color: yellow to red-brown or colorless
e
- Always linked with proteinuria
- Intrinsic renal disease: glomerular or tubular damages
iQ 200

sediment
Cellular Casts:
WBCs casts
Shape/ texture:
- Hyaline matrix cast bearing neutrophil inclusions
- Infection: pyelonephritis (UTI)
* WBC casts with bacteriuria, proteinuria and hematuria
- Glomerulonephritis: RBC casts are also present with WBC
casts
- Renal inflammation without bacteriuria
iQ 200
Microscop
e

sediment
Cellular Casts:
Renal tubular cells casts
Shape/ texture:
- Alignement of RTC or randomly arranged within a cast
- Hyaline cast with characteristic large central nuclei
- Intrinsic renal tubular diseases:
Microscop
e
* Acute interstitial nephritis

* Acute transplant rejection
* Tubular necrosis
- Granular casts and proteinuria accompany RTCC

sediment
Fatty casts (FATC)
Shape/ texture:
- Haline or granular matrix with free fat globules or/and oval fat
bodies
- Renal tubular cell death
- Accompanied by significant proteinuria = nephrotic syndrome
Microscop
e

sediment
BROAD Casts
Shape/ texture:
- Hayline or granular matrix
- Formed in extremely dilated tubes or the whilde collecting
ducts
- Indicates pronounced urinary statis
renal disease
- Always seen with convoluted casts
iQ 200

sediment
Crystal casts
CaOx
Shape/ texture:
- Hayline matrix with inclusion of crystals
- indicates an intratubular crystallization.
- Provoked renal damages: due to an inflammation process or
by obstruction.
- Most seen: Calcium Oxalte (hyperoxaliuria) and Uric acid
(nephropathy)
Uric Acid

sediment
Other casts
Microorganisms Inclusion Casts : Yeast, Bacteria
Fibrin thread casts
Myeloma casts
Pigmented casts: Hemoglobin, Myoglobin, Bilirubin

sediment
Yeast
Budding Yeast (BYST)

Yeast
Hyphae Yeast (HYST)

sediment
Budding Yeast (BYST)

Shape/ texture:
- Size: 5 to 7 m
- Ovoid and colorless (looks like RBC)

- Contamination from vaginal infection, air or skin
- Can be primary UTI (no freequent)
- Most common specie: C. glabrata (Torulopsis glabrata)
iQ 200
Microscop
e

sediment
Hyphae Yeast (HYST)
Shape/ texture:
- Colorless
- Contamination from vaginal infection, air or skin
- Can be primary UTI (no freequent)
- Most common specie: Candida albicans
iQ 200

sediment
Miscellaneous
Oval Fat Body

(OVFB) & FAT
Bacteria (BACT)
Mucus (MUCS)
Sperm (SPRM)

sediment
Bacteria
(BACT)
Shape/ texture:
- Various size and shapes: long, thin rods to short, plump
rods
- Appears single or in chains (depending to the species)
- Most seen: rodshaped (bacilli) & cocoid froms
- UTI
- Can be contamination form vagina and gastrointestinal
Microscop
tract
e
iQ 200

sediment
Mucus
(MUCS)
Shape/ texture:
- Fibrillar protein, delicate, ribbonlike strands
- None
- Can comes from the genitourinary tract
Do not misidentified with casts (no rounded ends)
iQ 200

sediment
Spermatozoa (SPRM)
Shape/ texture:
- Oval head: 2,5m to 3,5m width: 4m to 5um length
Tail <45um
- None
iQ 200
Microscop
e

sediment
FAT
Origin of fat in urine:
Fat or lipidare found in urine in 3 forms:
free as the birefringent fat droplets
intracellular in the oval fat bodies
imbedded within a cast matrix in the fatty cast.
- Lipuduria always accompagnied with proteinuria
(if lipids can cross into Bowmans space, so can plasma
proteins and albumin)
- Glomerular dysfonction with lipiduria and proteinuria
- Nephrotic syndrome (nephrosis)

sediment
Oval Fat Body
(OVFB)
Definition:
- oval fat bodies are macrophages also known as foam cells
- renal tubular cell engorged with absorbed fat
Glomerular dysfonction with lipiduria and proteinuria
Nephrotic syndrome (nephrosis)
it can occure with other kidney disease and/ or methabolic
diseases such as diabete mellitus
Normal value: None

sediment
Trichomonas (TRICH) Trichomonas vaginalis
Shape/ texture:
- Avrage size: 15 m (can be 5 to 30 m)
- 2 anterior flagella and a posterior axostyle
- Parasitic gynecological infection
- Same size, shape and contrast as WBC, found in WBC
!!
iQ 200

sediment
Schistosoma Haematobium Ova

Shape/ texture:
- Oval and large size ova
- May be found most commonly in SQEP, HYAL, UNCC or

UNCL
-> 40m
- Enter into the urine from the blader wall mucosa.
- Means a prarsitic infection and need treatment
UNCL
DEFINITION
Iris Diagnostics
300-4953 Rev. D
UNCL Classification
Represents the entire specimen sorted by

size
Used to identify particles not auto-classified
by APR
Used by the technologist to account for all
NSEs and Casts
UNCL Unclassified
- Includes Particles not categorized by APR (less than the
90% confidence level of all auto-classified categories)
-The UNCL category is a representation of the entire
sample with the particles sorted by size except for casts
and NSE.
-UNCL is used to look for particles that havent been autoclassified and to account for all NSEs and casts.
-If the lab has a specific particle that they dont report and
have used auto-classify to prevent the reporting of that
particle will find that particle images in UNCL if they are in
the specimen.
-Any particles that have been already classified dont need
to be moved.
Do you have
questions?
iQ200 REVIEW
STRATEGY
Iris Diagnostics
300-4953 Rev. D
PROPOSED REVIEW STRATEGY
All specimens on the Work List need

review
Bacteria
Auto-classification
APR will identify bacilli > 3 microns
in size as isolated images
Bacteria < 3 microns in size are
too small to be automatically
identified by APR and require a
tech to identify and grade
Verification of Results
The user is responsible for verifying that the classified

particles displayed match their appropriate autoclassification
The presence/absence of clinically significant bacteria
changes the verification process
Presence
Absence
How to review a specimen ?

Look at the bacteriuria check list for microscopy
and chemistry:
Bacteria? WBC? Small particles Count?
Begin at the first category (RBC)

To change a category use the button at top right
Reclassify pictures
Do not review the images of any classification that is
negative
Review the images of any classification that is
borderline abnormal
Reclassify or sub classify particles only when it
makes a clinical difference (more than 50%)
Review and sub classify all images found in NonSquamous Epithelial (NSE), Unclassified Casts
(UNCC), and Unclassified Crystals (UNCX)
How to review a specimen ?
Review UNCL and answer to those 3

questions:
Is there any additional Casts?
Is there any additional Renals, Transitionals
cells?
Is there anything new (new category
particle)?
When finished, review the final results
and accept when satisfied
Verification of Results: Absence of Bacteria

Verify that the auto-classified particle images match the
categories they are displayed within
Reclassify particles when it will make a clinical difference
Sub-classify particles classified in the NSE, UNCC, and/or
UNCX categories
Account for all new particles, casts, renals, and
transitionals displayed in UNCL
NOTE: when using auto-classify to prevent reporting of a
particular particle remember that the images of that
particle will still appear in UNCL.
Verification of Results: Presence of Bacteria

Verify that the auto-classified particle images match the
categories they are displayed within
Manually grade bacteria based on what is observed
within the backgrounds of the WBC, WBCC, SQEP, and
MUCS classifications
Reclassify particles when it will make a clinical difference
Sub-classify particles classified in the NSE, UNCC,
and/or UNCX categories
Account for all new particles, casts, renals, and
transitionals displayed in UNCL
NOTE: when using auto-classify to prevent reporting of a
particular particle remember that the images of that
particle will still appear in UNCL
Grading and Quantifying All Casts and NSE

Unlike other cell types, the Normalization Factor
for NSEs and Casts does not exist
All NSEs and Casts must be accounted for by the
user
If grading, only one image of a NSE and/or Cast
needs to be moved to the appropriate
classification.
** Note: This applies to normal samples only. If
the sample is flagged with High Concentration or
Possible Amorphous, all NSE and Casts must be
classified in order to obtain an accurate result.
If enumerating, all NSE and/or Casts need to be
moved to the appropriate classification to be
accounted for correctly.
When to return to the manual microscope?
There are 4 times regulators require users to go

to a manual microscope
1. Oval Fat Bodies- confirm using polarized light
microscopy
2. Fat- confirm using polarized light microscopy
3. Trichomonas- confirm presence of flagella by
motility
4. Any Cellular Cast- to ID cell type
iQ Series Definitions
Abnormal Threshold
The user defined concentration at which a
result is considered abnormal
Highlights the result in red and reports an H
next to the corresponding result
Applies to both formed particles and
chemistries
Chemistry Confirmation Threshold
The user defined concentration at which a
result will be flagging for confirmatory testing
Italicizes the result that is flagged
Applies to chemistry results only
iQ Series Definitions
Auto-classify
The minimum concentration of a particle

to be identified before creating the
particle classification
Used to increase the specificity of the
software for a particular patient
demographic
Particles present that are less than the
threshold will appear in UNCL
Auto-release
Defined by the user to allow the
instrument to automatically report formed
particles to a printer and/or LIS without a
technologists review
Flagged samples cannot be autoreleased. These sample will auto-release

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BASIC URINALYSIS

3 Urine: What is it?

Urine The fluid secreted by the kidneys,

3 Urine: What is it?

3 Urine: What is it?

3 Urine: What is it?

3 Urine: What is it?

3 Urine: What is it?

Urine formation begins at the capillary

Filtrate passes through proximal tubule, loop of

3 Urine: What is it?

3 Urine: What is it?

Urine passes directly from the ureters into - and

its a non-invasive test

To help detect Disease of the Urinary Tract

Renal epithelial cells, and Casts

Maintenance and Quality control

1. Clean instrument exterior

Maintenance and Quality control

1.Microscopy calibration (see Quality

Maintenance and Quality control

1. Clean rinse waste/baths

Maintenance and Quality control

and perform quality control on the iQ200 series

Maintenance and Quality control

Maintenance and Quality control

Maintenance and Quality control

The iQ Calibrator, Focus and Positive

To assure proper cell suspension,

Maintenance and Quality control

Maintenance and Quality control

All particles are reported and displayed in

Microscopic Examination of urine

Squamous Epithelial Cells

Microscopic Examination of urine

Microscopic Examination of urine

Microscopic Examination of urine

Microscopic Examination of urine

Microscopic Examination of urine

- Could be found in urine with gross hematuria

Microscopic Examination of urine

- Manly WBCs in urine are Neutrophils

Microscopic Examination of urine

Non bacterial causes:

Microscopic Examination of urine

White Blood Cells (WBC)

Microscopic Examination of urine

Microscopic Examination of urine

Non-squamous Epithelial Cells (NSE)

Renal Epithelial (REEP)

Transitional Epithelial TREP)

Microscopic Examination of urine

Microscopic Examination of urine

Clue Cells (SQEP)

- Clue cells are squamous epithelial cells covered with

Microscopic Examination of urine

- Cells with abnormal shape, size, inclusions or nuclear

3 types of cells are found in urine sediment:

Microscopic Examination of urine

Microscopic Examination of urine

Renal Epithelial Cells (REEP)

- Renal epithelial cells are generally larger than

Microscopic Examination of urine

Uric Acid (URIC)