Lesson 1Crystals: common types (calcium oxalate, uric acid, struvite, cystine), pH dependence, and clinical implicationsDetails common urinary crystals, their morphology, and pH dependence in Eritrean diets. Reviews calcium oxalate, uric acid, struvite, cystine, and drug crystals, with emphasis on clinical relevance, stone risk, and differentiation from artifacts.
Calcium oxalate forms and stone riskUric acid crystals and metabolic causesStruvite crystals and infection stonesCystine crystals and inherited disordersDrug and iatrogenic crystal identificationEffect of urine pH and storage on crystalsLesson 2Use of stains (Gram stain, Sternheimer-Malbin, toluidine blue) for enhanced identification and when to performReviews stains used in urine sediment, including Gram, Sternheimer-Malbin, and toluidine blue, available in Eritrean labs. Discusses indications, preparation, staining steps, and how each enhances visualization of bacteria, cells, and casts for difficult cases.
Indications for performing special stainsSternheimer-Malbin stain principlesGram stain for bacteria and yeastsToluidine blue for nuclear detailSlide preparation and fixation choicesInterpreting stained vs unstained findingsLesson 3Recognition of bacteria, yeasts, parasites and differentiating contamination from significant bacteriuria (presence of WBCs, casts)Explores microscopic recognition of bacteria, yeasts, and parasites in urine sediment common in Eritrea. Emphasizes differentiating true infection from contamination using WBCs, casts, epithelial cells, and clinical context to guide interpretation.
Morphology of urinary bacteria on wet prepRecognition of budding yeasts and pseudohyphaeCommon urinary parasites and artifactsCriteria for significant bacteriuriaIndicators of contamination vs infectionCorrelation with WBCs, casts, and symptomsLesson 4Quantitative reporting: RBCs, WBCs, epithelial cells per high-power field and reporting conventionsExplains quantitative reporting of RBCs, WBCs, and epithelial cells per high-power field in standard formats. Reviews counting techniques, averaging fields, semi-quantitative ranges, and standardized wording to ensure reproducible, clinically useful reports.
Selecting representative microscopic fieldsCounting RBCs and WBCs per HPFEpithelial cell types and quantitationConverting counts to reportable rangesStandard report phrases and abbreviationsCommon pitfalls in cell quantitationLesson 5Identification and classification of casts: hyaline, granular, RBC, WBC, waxy, fatty (oval fat bodies) and pathologic significanceCovers formation, morphology, and classification of urinary casts, including hyaline, granular, cellular, waxy, and fatty forms. Highlights pathologic significance, disease associations, and reporting practices for accurate clinical correlation in Eritrean cases.
Pathophysiology of cast formation in tubulesHyaline and finely granular casts morphologyRBC and WBC casts and renal diseaseWaxy and broad casts in chronic damageFatty casts and oval fat bodiesStandardized cast reporting conventionsLesson 6Resuspension best practices and preparation of multiple slides (wet mount, fixed/stained) for comprehensive examCovers best practices for resuspending sediment and preparing multiple slides in basic Eritrean labs. Compares wet mounts with fixed and stained preparations, addressing when each is indicated to achieve a comprehensive microscopic examination.
Techniques for gentle sediment resuspensionPreparing high-quality wet mount slidesWhen to prepare fixed and stained slidesHandling limited-volume specimensLabeling and organizing multiple slidesStorage and reuse limitations of slidesLesson 7Microscope selection and setup: brightfield requirements, condenser settings, phase contrast use and when to apply itDiscusses microscope selection and setup for urine sediment using available equipment in Eritrea, including brightfield requirements, condenser and diaphragm settings, and when to use phase contrast. Emphasizes optimizing contrast and resolution for subtle findings.
Essential features of a urine microscopeKöhler illumination and brightfield setupCondenser and diaphragm adjustmentsAdvantages of phase contrast for sedimentWhen phase contrast is most beneficialRoutine maintenance and performance checksLesson 8Microscopy quality assurance: eyepiece calibration, inter-observer comparison, image capture and archivingFocuses on quality assurance in urine microscopy for Eritrean teams, including eyepiece calibration, field area standardization, and inter-observer comparison. Addresses image capture, archiving, competency assessment, and documentation of QC activities.
Eyepiece micrometer use and calibrationField size equivalence between microscopesInter-observer comparison and consensusImage capture and secure archivingOngoing competency and proficiency testingDocumentation of QC and corrective actionsLesson 9Systematic microscopic examination protocol: low-power scan (10x) for casts and crystals, high-power (40x) for cells and bacteria, oil immersion (100x) for confirmationDescribes a stepwise microscopic exam protocol for urine sediment in routine practice. Covers low-power scanning for casts and crystals, high-power evaluation of cells and bacteria, and selective oil immersion for confirmation of doubtful structures.
Slide placement and initial focusingLow-power scan for casts and crystalsHigh-power review of cells and bacteriaUse of fine focus to assess morphologyWhen to apply oil immersion objectivesRecording findings during the scanLesson 10Standard sediment preparation: recommended centrifugation speed and time (g and minutes), sample volume and decanting techniqueProvides procedures for standard urine sediment preparation using common centrifuges in Eritrea, including sample mixing, recommended centrifugation speed and time, volume selection, decanting technique, and minimizing cell loss or artifact formation during processing.
Specimen mixing and pre-centrifugation checksCentrifugation speed, time, and g-forceChoosing and measuring sample volumeSafe supernatant decanting techniquesResuspending the sediment uniformlyAvoiding artifacts during preparation
