FIGURE 8.1 Urine was obtained by free catch from a young dog. TNTC RBC with a few large squamous epithelial cells. It is not possible at this power to tell if other cells types are there or not (42X). FIGURE 8.2 Note numerous intact RBC in urine sediment from a cat with idiopathic cystitis. Some RBC stain dark red and others stain light orange. There are occasional struvite crystals (relatively flat sheet appearance) and rare WBC (168X SediStain). FIGURE 8.3 Urinary sediment image acquired by SediVue® automated microscopy. Most of the cells are RBC with a few WBC that are considerably larger than the RBC. Source: Courtesy of Dr. Ronald Lyman, Ft. Pierce, FL. FIGURE 8.4 Urinary sediment digital image of urine sediment acquired by SediVue®. Notice the small size of the RBC compared to the much larger struvite crystals. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.5 Urinary sediment image acquired by SediVue®. Numerous RBC are easily seen as the predominant cell type, some of which are crenated (arrow). A few easily identified neutrophils are also in this field. The WBC are at least 2.5 times the size of the RBC. The largest cells that are round to oblong are likely urothelial cells. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.6 Urinary sediment image acquired by SediVue®. Note numerous RBC with homogenous size and dark appearance; they are the smallest cells in this field. Look more closely to identify WBC that are much lighter in color (ghost‐like; arrow) and larger than RBC. Some of the WBC appear in small clumps. One very large epithelial cell assuming a tear drop shape is seen at the top left of this field; this is a squamous epithelial cell. Squamous cells often display sharp edges which are not seen in this particular cell. In a single area of this field is the appearance of what could be a few bacteria. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.7 Note numerous round clear droplets of varying size that do not take up stain. These are typical for lipid droplets from urine sediment in cats. These should not be confused with red blood cells. The very large sphere at the far right and bottom are artifacts from an air bubble under the cover slip during preparation for microscopy. FIGURE 8.8 Multiple lipid droplets captured with SediVue®. Lipid droplets accumulate in a similar plane above the other urinary elements, so they are not counted or confused with RBC or crystals. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.9 (a) Very cellular crowded field at low power. It is not possible to identify the cells without further magnification. (b) Upon higher magnification, nearly all the cells are neutrophils. A large number of bacteria are obvious between the WBC. FIGURE 8.10 Urine sediment from a dog with major neurological problems that include inability to fully empty the bladder. The dog had a long history of urinary infections. Note numerous RBC and WBC and some cells that cannot be readily identified. Particulate debris of unknown origin is seen in some areas of this field. Some of the particulates appear to be cocci, which is better confirmed with urine cytology. FIGURE 8.11 Urine sediment from a middle‐aged female Doberman with stranguria and masses within the bladder detected on ultrasonography. A large clump of WBC is seen staining mostly with red uptake into the nuclei, with some taking up blue. A few RBC are also seen. There are rare particulate elements that could be bacteria. There are no epithelial cells in this field. Polypoid cystitis was the diagnosis. FIGURE 8.12 Clump of three neutrophils with red staining nuclei, three free‐floating WBC, and clump of struvite crystals (bottom of picture). FIGURE 8.13 Numerous WBC (neutrophils) and many are in clumps. Nuclei of neutrophils stain mostly blue, but some are red. Notice fine linear structures between the neutrophils that are rods. Occasional nonsquamous epithelial cells are seen. A pure culture of Escherichia coli was isolated from this urine. Clumps of WBC, rather than individual cells, are more indicative of an infectious agent in the urine. There is loss of nuclear detail in some of the WBC. FIGURE 8.14 Note small clumps of WBC with numerous rod bacteria between the WBC. Some bacteria are free‐floating. Many of the neutrophils are not so easy to identify since the cytoplasm has shrunk tightly around the nuclei. The typical lobulated nucleus is seen in a few of the neutrophils. A few large free epithelial cells are seen at the top of this field. A large clump of epithelial cells with central nuclei are seen at the bottom right of this field. It is likely that the clump of transitional cells is “reactive” in the face of the other indicators of inflammation. Source: Reproduced by permission of Dr. Michael Horton, Fairborn, OH. FIGURE 8.15 Urine sediment from a dog with pyelonephritis. Note the large clump of RBC and mostly blue staining WBC on the far left of this field. Nuclear detail of the red staining WBC in other parts of the field is more distinct. FIGURE 8.16 Oil immersion view of urine sediment from a dog with bacterial UTI. Most WBC are in clumps with obvious rod‐shaped bacteria in‐between the WBC. The multilobulated nature of the nucleus of the neutrophils is easy to see. FIGURE 8.17 Numerous RBC with stain uptake predominates in this field; some RBC do not take up the stain. Increased numbers of WBC are seen among the RBC. The pattern of nuclear segmentation of the neutrophils can still be seen but nuclear detail is poor due to degeneration. FIGURE 8.18 Mild increase in numbers of WBC with rare RBC in this stained sediment. Cytoplasm is swollen in several WBC. FIGURE 8.19 Image captured through the microscope eyepiece using a handheld iPhone. Note small cluster of three neutrophils in central field with pale blue staining nuclei. These neutrophils are swollen and the nuclei have undergone some degeneration. There are occasional RBC that do not take up stain. Also note free‐floating rod bacteria. Other WBC have red staining nuclei and scant cytoplasm. FIGURE 8.20 Urine sediment from a dog with a urinary tract infection. WBC that are blue staining are easier to identify than the WBC that are staining red. Many of the red staining WBC are smaller as the cytoplasm has contracted around the nucleus. A few RBC are available to compare the size of WBC as at least 2–2.5× larger than the RBC. Rod bacteria are seen in between the cells and sometimes can be seen protruding from the surface of the WBC. The lightly pink staining element at the lower right of the image could be confused for a cast, but its width varies too much and is likely mucus. FIGURE 8.21 (a) SediVue® acquired image of urinary sediment from a cat with CKD, USG of 1.017, and a pure culture of Escherichia coli. Note numerous WBC (neutrophils), some RBC, and quite a few bacteria recognized as rods. The results were officially reported as 47 WBC/HPF, eight RBC/HPF, absent cocci, and present rods. (b) Screenshot of how SediVue® recognized and labeled urinary sediment findings. Notice that most but not all cells are labeled. Bacteria in this field are not labeled. Source: Reproduced with permission of Dr. Carmen Colitz, Jupiter, FL. FIGURE 8.22 Many WBC, far fewer RBC, and multiple long rods. Image acquired by SediVue®. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.23 Numerous WBC and bacteria. The bacteria are cocci. Image acquired by Zoetis VETSCAN® UA Urine Analyzer. Reproduced with permission of Zoetis FIGURE 8.24 Large numbers of bacterial rods and moderate number of WBC. Some rods are elongated. FIGURE 8.25 This is an oil‐immersion view of a wet‐mount urinary sediment. Three WBC with red staining nuclei are in the upper left corner. There is a three epithelial cell clump on the right of image. Many very elongated bacterial organisms show how Escherichia coli can grow in urine. Source: Reproduced by permission of Dr. Richard A. Scott, Animal Medical Center, NY, NY. FIGURE 8.26 Stained urinary sediment from a dog with pyelonephritis. The most striking feature about this urinary sediment image is the abundance of long filamentous bacteria. Notice many WBC and RBC (pale stain) among the bacteria. Many of the WBC (most have blue nuclei) display degenerative changes likely the result of the toxic urinary environment from the urinary infection. At first glance, filamentous bacteria can be confused with fungal elements. Escherichia coli was isolated at >30 000 cfu/mL in pure culture from a cystocentesis sample. There is nothing pathognomonic about the findings in this urine sediment leading to the diagnosis of bacterial pyelonephritis, which requires the integration of findings from urinalysis, urine culture, clinical signs, and urinary tract imaging. FIGURE 8.27 Phase contrast microscopy urine sediment from a dog. This method of microscopy can be used to convincingly confirm the presence of bacteria. Note the rod bacteria grouped together in the center of the image. There is a large accumulation of mucus at the top of the image. Source: Reproduced by permission of Dr. Michael Horton, Fairborn OH. FIGURE 8.28 Dog with bacterial urinary tract infection. Note clump of WBC in the center of the image. Some bacteria are adherent to the WBC and some have been phagocytized inside the cell. FIGURE 8.29 Note large clump of nonsquamous epithelial cells of similar size with central nuclei. There are several clumps of WBC with red‐staining nuclei and numerous linear bacteria (rods) in between WBC; some bacteria are free‐floating. It is possible that the large clump of urothelial cells resulted from desquamation secondary to urinary infection and inflammation. Though the clump of epithelial cells could be “reactive,” this could occur in those with a urinary infection and urothelial neoplasia. Dry‐mount cytology is recommended to further evaluate this patient for neoplasia. Source: Reproduced by permission of Dr. Michael Horton, Fairborn, OH. FIGURE 8.30 Clumps of deeply staining dark red and blue nuclei of neutrophils. There is scant cytoplasm around the nuclei, but their segmented nature can still be seen. Bacterial rods are seen in between the WBC and also free. FIGURE 8.31 Several clumps of WBC with bacteria in between and around them. Nuclei stain red with little cytoplasm visible around some of the WBC. FIGURE 8.32 Clumps of WBC with bacterial rods within the clumps are obvious in this field (168×). Some of the neutrophils display swollen cytoplasm. FIGURE 8.33 Image acquired by SediVue®. WBC predominate in this field with one epithelial cell (far upper right) and many rod bacteria. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.34 Moderate numbers of WBC, rare RBC, and many bacteria (some rods and possibly some cocci) are seen. SediVue® image. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.35 Mature Capillaria spp. worms in urine sediment from a naturally infected Whippet. Eggs seen within the worms confirm that they are adults and not larvae. Source: Reproduced by permission of Dr. David Senior. FIGURE 8.36 Image captured by SediVue®. Pearsonema spp (Capillaria spp.) ova. Adult worms live in the bladder and can cause clinical signs or be nonclinical. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.37 Capillaria ova in urine from a cat. This cat did not have clinical signs related to the urinary tract. FIGURE 8.38 (a) Mature egg of Capillaria plica. (b) Immature egg of Capillaria plica. Source: From Basso et al. [1]. Used with permission. FIGURE 8.39 Adult Capillaria plica worms attached to the mucosa of the urinary bladder as seen during cystoscopy. Source: From Basso et al. [1]. Used with permission. FIGURE 8.40 Unstained sediment. Ova of Dioctophyma renale, and degenerating WBC and RBC. Source: Courtesy of Dr. Marcia Kogika, USP, Sao Paulo, Brazil. FIGURE 8.41 Dioctophyma renale adult worm shown during ultrasonography of the right kidney from a dog that presented for hematuria. Source: Courtesy of Dr. Marcia Kogika, USP, Sao Paulo, Brazil. FIGURE 8.42 (a, b, c, d, e) (a) Adult Dioctophyme renale being removed from a kidney. (b) An ultrasound demonstrating an end‐on view of segments of Dioctophyme renale. (c) Ultrasonogram of transverse view of kidney showing a ring‐like appearance of the parasite with a highly echogenic wall and anechoic central area. (d) Ultrasonogram in longitudinal view of the same kidney showing the parasite as bands. (e) CT of the right kidney of another dog. Note uptake of contrast in the atrophic renal cortex along with a ring like and band appearance of the parasite in the enlarged right kidney. Normal size and contrast uptake in the left kidney. Source: (c and d) Ferreira et al. [2]. (a, b and e) Rahal et al. [3]. FIGURE 8.43 Clump of budding yeast in central and far right field. WBC are rare. FIGURE 8.44 Cytoprep examination of urine confirming the presence of yeast. FIGURE 8.45 (a) Note the mild increase in WBC and abundant bacteria in the background of this image; most bacteria appear to be cocci. There is a small group of budding yeast (yellowish color) near the top of this image. (b) Urine sediment from same cat as in (a). Closer view of budding yeast. There are moderate numbers of neutrophils with contracted cytoplasm. Some WBC have bacteria protruding from their surface. (c) Same urine sediment as from (a) and (b). Note budding yeast that appears to be extending into a more filamentous form. A WBC with contracted cytoplasm is just above and below these organisms. Note the clump of WBC at the lower right of this image. Source: Reproduced with permission of Dr. Mary Ann Crawford, Oradell, NJ. FIGURE 8.46 Image acquired by SediVue®. Budding yeast (arrow) are the most important and unusual element to note in this field. There are moderate numbers of WBC, rare RBC, a few nonsquamous epithelial cells and one squamous epithelial cell. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.47 Urine from a 5 ½ year old male German Shepherd mix dog with disseminated Blastomycosis. (a) Highly cellular urinary sediment at lower power magnification. There are numerous WBC, occasional transitional epithelial cells and some highly round prominent elements near the top of this field that need further identification. (b) Higher power view of field showing wall structure of Blastomyces organisms. Many degenerate neutrophils are also in this field. Source: Reproduced with permission of Dr. James Brace, The Ohio State University. FIGURE 8.48 Cryptococcus in urine from a cat. FIGURE 8.49 Many degenerate neutrophils are seen throughout this field. Occasional transitional epithelial cells and many septate hyphae of Candida are also observed. FIGURE 8.50 In this field, the RBC and WBC are out of focus in the background. In a slightly different plane of focus, branching and septate hyphae of a fungal organism can be seen. Off to the right in this field is also a single ovum of Capillaria. The fungal infection was a consequence of long‐term antibiotic and steroid therapy in conjunction with an inability to fully empty the bladder. FIGURE 8.51 Unstained sediment showing a large clump of squamous epithelial cells. Voided specimen from a female dog. Notice flattened surfaces of these very large cells. Source: Reproduced with permission of Dr. Richard Scott, Animal Medical Center, New York, NY. FIGURE 8.52 Clump of squamous epithelial cells. One epithelial cell appears to have phagocytized several WBC. Source: Reproduced with permission Dr. Richard Scott, Animal Medical Center, New York, NY. FIGURE 8.53 One clump of squamous epithelial cells at left of field and one free squamous epithelial cell at top of field. Struvite crystals are also observed. Image captured by SediVue®. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.54 (a) Image captured through microscope eyepiece using a handheld digital phone camera showing an obviously cellular sediment. Higher power microscopy identified the cells as WBC, nonsquamous epithelial cells, and RBC (see b). (b) Higher power image from (a). Image captured through microscope eyepiece using a handheld digital phone camera. RBC are the smallest cells seen with pale stain; WBC are larger than the RBC and have blue staining nuclei. The largest cells are nonsquamous epithelial cells (transitional cells). Most of the epithelial cells stain red but some do not take up stain. This sediment is from a dog undergoing treatment for transitional cell carcinoma and was obtained by cystocentesis with ultrasound guidance. FIGURE 8.55 Image acquired by SediVue®. Large clump of nonsquamous epithelial cells to left of center. There are also a few squamous epithelial cells which are quite large; one is folded on itself (left central field). Moderate numbers of RBC and WBC accompany the epithelial cells. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.56 (a) SediVue® acquired image. There are many RBC, especially in the upper right corner of this image. Moderate WBC are seen, and some are in clumps (lower left field). The largest cells are nonsquamous epithelial cells; most are free but there is one clump at the center top field. One small epithelial cell is seen with a tail (arrow). No bacteria are observed. (b) Identification of elements in urine sediment as assigned by SediVue®. Note that not all cells are labeled. This happens with more frequency when urinary elements are crowded and when elements are clumped. It is always a good idea to check what an automated analyzer is reporting and compare that to your own visual inspection of the digital images collected by the machine. Source: Reproduced by permission of Dr. Carmen Colitz, Jupiter, FL. FIGURE 8.57 (a, b) Unlabeled digital image and screenshot of labels to identity elements in urine sediment as assigned by SediVue®. Many WBC, some RBC, and many nonsquamous epithelial cells are seen in this field. Not all elements are identified with a label. Source: Reproduced by permission of Dr. Carmen Colitz, Jupiter, FL. FIGURE 8.58 Image captured by SediVue® from an older cat with ketoacidotic diabetes mellitus and pancreatitis. Moderate RBC and WBC. There is a cluster of large round nonsquamous epithelial cells at top of this image. There are also occasional free nonsquamous epithelial cells. A WBC cluster of smaller round cells appears at the lower left. Though not identified by the analyzer, there are a few elements that are linear with parallel walls that are suspected to be granular casts. Source: Reproduced with permission of Dr. Ron Lyman, Ft Pierce, FL. FIGURE 8.59 (a, b) Three clumps of WBC – a large clump on the left and two smaller clumps on the right. The largest cells are nonsquamous epithelial cells. Some smaller nonsquamous epithelial cells are seen at the top center field. Source: Reproduced by permission of Dr. Carmen Colitz, Jupiter, FL. Image acquired by SediVue®. FIGURE 8.60 Image acquired by SediVue®. Small clump of nonsquamous epithelial cells. A single large squamous epithelial cell is to the right of the clump. Source: Courtesy of IDEXX Laboratories. Copyright © 2022, IDEXX Laboratories, Inc. All rights reserved. Used with permission. FIGURE 8.61 Clump of squamous epithelial cells. Image acquired by VETSCAN® SA Sediment Analyzer. Reproduced with permission of Zoetis. FIGURE 8.62 Epithelial cells distended with lipid accumulation. These are sometimes called “signet” cells and occur as part of cellular degeneration. Several WBC that have poorly defined cellular detail are in the background. Source: Reproduced with permission of Dr. Richard Scott, Animal Medical Center, New York, NY. FIGURE 8.63 Signet ring cells. Several of the epithelial cells in this field display lipid degeneration. Several WBC with poor detail are seen at the lower field. Source: Reproduced with permission of Dr. Richard Scott, Animal Medical Center, New York, NY. FIGURE 8.64 Sheets of renal epithelium as observed during phase microscopy. Source: Reproduced with permission Dr. Michael Horton, Fairborn, OH. FIGURE 8.65 Urine from a dog. Note the clump of small epithelial cells with tails. Nuclear degeneration precludes definitive assessment of the position of the nucleus within these cells, but some appear to be basal. Renal origin epithelial cells. Nuclear positing and detail would be better analyzed with dry mount cytology. FIGURE 8.66 Large sheet of small epithelial cells, some of which have tails. The cells with more basal positioning of nuclei suggest renal origin. Dry mount cytology would provide greater cellular detail. FIGURE 8.67 Small epithelial cells, some in clusters. A few of the epithelial cells have “tails” (caudate cells). Cytology is needed to provide more detail for these cells. Based on the history and the absence of other cell types, it was concluded that these cells arose from the kidney. This dog had a diagnosis of AKI. Source: Reproduced with permission Dr. Richard Scott, Animal Medical Center, New York, NY. FIGURE 8.68 (a) Urine tube post centrifugation. Pedicel at the bottom was quite cellular with renal epithelial cells. (b) Urine from a cat. WBC and RBC are easy to identify. The epithelial cells are round to ovoid to cuboidal. Nuclei of the epithelia cells are noted to be basal in many of the cells supporting renal tubular origin for these epithelial cells. FIGURE 8.69 Large clump of nonsquamous epithelial cells left lower field. These cells stain both blue and red but cellular detail is lacking. Occasional free transitional epithelial cells and WBC are seen. It is not possible from examination of this urine sediment to tell if this is a “reactive” clump of epithelial cells or those that are neoplastic. FIGURE 8.70 Stained urine microscopy. Note clump of four transitional epithelial cells. Clumps are usually more clinically significant than single epithelial cells. The nuclei look normal. There is one poorly stained WBC toward the upper right; note that transitional epithelial cells are usually 2–2.5 times the size of WBC. This clump does not have definitive character for neoplasia. It could still be a neoplastic condition, or it could represent desquamation in the face of urinary tract infection, trauma, or abrasion from urinary stones. Source: Reproduced with permission of Dr. Michael Horton, Fairborn, OH. FIGURE 8.71 Large cluster of transitional epithelial cells. The cells are so tightly packed that it is not possible to describe the cellular details further. Submission of urine sediment for cytology will reveal more cellular detail. Diagnosis was transitional cell carcinoma in a dog. FIGURE 8.72 (a) Voided urine sample from a female dog with TCC of the urethra. This image shows several neutrophils and some bacteria, but not atypical epithelial cells. Many of the neutrophils show swollen cytoplasm.(b) Voided urine sample from a female dog with TCC of the urethra. This image shows a single raft of epithelium with some malignant character. Cells around this clump are out of focus and cannot be identified. FIGURE 8.73 Clumps and free transitional epithelium. TCC of urinary bladder in a Shetland Sheepdog. Note the large blue staining clump in the right of this field. Several of the cells in this clump are lipid distended. Moderate RBC are in the background. FIGURE 8.74 Large clump of epithelial cells. Voided specimen from a dog. There are several lipid droplets in this field. Transitional cell carcinoma (urothelial carcinoma) was the diagnosis. FIGURE 8.75 (a) Highly cellular sediment with numerous RBC, some WBC, and clumps of round blue‐ and red‐staining epithelial cells. The dog was evaluated for one day of macroscopic hematuria. (b) Higher magnification of the same urine sediment as in (a). Clump of blue‐ and red‐staining epithelial cells. The nuclei are particularly large compared to the cytoplasm. Orange staining RBC are in background as are a few WBC. These epithelial cells should be further evaluated with cytology. The diagnosis in this dog was transitional cell carcinoma of the bladder. FIGURE 8.76 Note large clump of epithelial cells of widely varying size. Some take up the blue stain and others take up the red stain. Cell shape is round to ovoid to cuboidal. Some of the epithelial cells have tails. RBC are in the background. The diagnosis was TCC of the urinary bladder in a Shetland Sheepdog. FIGURE 8.77 Hyaline cast is visible in lower left field. Note many linear bacteria in the background as well as a mild increase in WBC. Particle debris appears to adhere to the outside of the hyaline cast. Urine culture was positive for large growth of bacteria, but it is not possible to tell from this image alone if the urinary infection is confined to the lower urinary tract, or if it extends to the kidneys.
CHAPTER 8
Atlas
CELLULAR ELEMENTS
RED BLOOD CELLS
WHITE BLOOD CELLS
ORGANISMS (INCLUDING PARASITES)
EPITHELIAL CELLS
CASTS
HYALINE
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
