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Symptoms and Signs – Differential Diagnosis of Urine microscopy
Bacteria
Urinary tract infection
Asymptomatic bacteriuria
Contamination
Casts Epithelial cell casts: acute glomerulonephritis, acute tubular necrosis
Fatty casts: moderate/heavy proteinuria
Granular casts, finely granulated: concentrated urine, diuretics (loop), exercise,
fever
Granular casts, densely granulated: glomerulonephritis, interstitial nephritis,
diabetic nephropathy, amyloidosis
Hyaline casts: same as finely granulated granular casts
Red cell casts: glomerulonephritis, vasculitis, malignant hypertension
Waxy casts: advanced renal failure
White cell casts: pyelonephritis, proliferative glomerulonephritis
Cells
White cells: UTI (pyelonephritis, cystitis, urethritis), pyuria without bacteriuria: culture inhibited by antibacterial agent or wrong growth condition for fastidious organisms, TB, renal/bladder calculi, glomerulonephritis, interstitial nephritis, analgesic nephropathy, chemical cystitis
Red cell
Tumour cells: Genitourinary malignancy e.g. bladder cancer, infiltration of renal
parenchyma e.g. lymphoma
Crystals
Calcium oxalate (dumbbell-shaped, envelope-shaped, needle-shaped) Calcium phosphate
Cystine (hexagonal shape)
Magnesium ammonium phosphate (coffin-lid-shaped)
Uric acid (rhombic plates, rosettes)
Bacteria
Urinary tract infection
Asymptomatic bacteriuria
Contamination
Casts Epithelial cell casts: acute glomerulonephritis, acute tubular necrosis
Fatty casts: moderate/heavy proteinuria
Granular casts, finely granulated: concentrated urine, diuretics (loop), exercise,
fever
Granular casts, densely granulated: glomerulonephritis, interstitial nephritis,
diabetic nephropathy, amyloidosis
Hyaline casts: same as finely granulated granular casts
Red cell casts: glomerulonephritis, vasculitis, malignant hypertension
Waxy casts: advanced renal failure
White cell casts: pyelonephritis, proliferative glomerulonephritis
Cells
White cells: UTI (pyelonephritis, cystitis, urethritis), pyuria without bacteriuria: culture inhibited by antibacterial agent or wrong growth condition for fastidious organisms, TB, renal/bladder calculi, glomerulonephritis, interstitial nephritis, analgesic nephropathy, chemical cystitis
Red cell
Tumour cells: Genitourinary malignancy e.g. bladder cancer, infiltration of renal
parenchyma e.g. lymphoma
Crystals
Calcium oxalate (dumbbell-shaped, envelope-shaped, needle-shaped) Calcium phosphate
Cystine (hexagonal shape)
Magnesium ammonium phosphate (coffin-lid-shaped)
Uric acid (rhombic plates, rosettes)
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