Microscopic Examination of Urine Sediment

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The page below is a sample from the LabCE course The Urine Microscopic: Microscopic Analysis of Urine Sediment. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Microscopic Examination of Urine Sediment

The sediment is usually examined using brightfield microscopy and subdued light (some structures will be missed if there is too much light in the field). The fine focus throughout the examination is used to identify structures in different focal planes.

Scan the slide on low power (100X total magnification) for quantification of casts and elements that are present in only a few fields. Use high power (400X total magnification) to identify casts, crystals, parasites, bacteria, yeast, and sperm and to count red blood cells (RBCs), white blood cells (WBCs), and epithelial cells.
Staining may be helpful in the identification of some cells and casts. Supravital stains that may be used include Sternheimer-Malbin and 0.5% toluidine blue.
If available, phase-contrast microscopy enhances the identification of some sediment elements, particularly those with a very low refractive index and may be missed using brightfield microscopy (e.g., some casts).
Polarized light enhances the identification of lipids and some crystals.