Urine Microscopic Exam

Aka: Urine Microscopic Exam, Microscopic Urinalysis, Urine Red Blood Cell, Urine RBC, Urine White Blood Cell, Urine WBC, Urine Squamous Epthelial Cell

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II. Preparation: Sample

  1. Obtain fresh urine sample
  2. Centrifuge 10-15 ml at 1500 to 3000 rpm for 5 minutes
  3. Decant supernatant (pour out) and resuspend remainder of urine in small amount of urine
  4. Place 1 drop of urine on slide and apply cover slip and observe under low power and high power field (hpf)

III. Exam

  1. Urine Cells
    1. Urine White Blood Cells
      1. Normal <2/hpf in men and <5/hpf in women
      2. Neutrophils are the most common WBC identified
    2. Urine Red Blood Cells
      1. Normal <3/hpf in adults (<5/hpf in children)
      2. RBCs appear as small, round and colorless cells ("ghost cells")
      3. Dysmorphic RBCs (blebs, protrusions, spiked cells) suggest glomerular disease
    3. Squamous Epithelial cells
      1. Transitional epithelial cells are normally present
      2. Squamous epithelial cells >5/hpf suggest contamination
      3. Renal tubule epithelial cells suggest renal disease
  2. Bacteria
    1. Five Bacteria per hpf predicts positive Urine Culture with >100,000 CFU/ml
    2. Diagnostic for Urinary Tract Infection
      1. Men: Any Bacteria
      2. Women: 5 or more Bacteria per hpf
  3. Urine Crystals
    1. See Urine Crystals
  4. Urine Casts
    1. See Urinary Cast

IV. References

  1. Hitzeman (2022) Am Fam Physician 106(1): 27-35 [PubMed]
  2. Simerville (2005) Am Fam Physician 71(6): 1153-62 [PubMed]

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