Urine Sediment Examination in the Diagnosis and Management of Kidney Disease: Core Curriculum 2019  Corey Cavanaugh, Mark A. Perazella  American Journal of Kidney Diseases  DOI: 10.1053/j.ajkd.2018.07.012 Copyright © 2018 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Urine sediment shows (A) white blood cell cast and (B) uric acid crystals (lower panel: polychromatic appearance under polarization). (A) Reproduced with permission from Perazella MA. The urine sediment as a biomarker of kidney disease. Am J Kidney Dis. 2015;66(5):748-755. American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.07.012) Copyright © 2018 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Urine sediment shows (A) renal tubular epithelial cells (RTECs) with a single nucleus and (B) RTEC cast, with multiple RTECs within the cast matrix. American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.07.012) Copyright © 2018 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Granular or muddy brown casts of various widths and lengths are seen in a patient with acute kidney injury due to septic shock. American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.07.012) Copyright © 2018 National Kidney Foundation, Inc. Terms and Conditions

Figure 4 A hyaline cast is noted in a patient with acute kidney injury in the setting of decompensated heart failure. American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.07.012) Copyright © 2018 National Kidney Foundation, Inc. Terms and Conditions

Figure 5 Urine sediment of a patient with infection-related glomerulonephritis reveals (A) dysmorphic red blood cells (RBCs), including acanthocytes and isomorphic RBCs, and (B) RBC cast. American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.07.012) Copyright © 2018 National Kidney Foundation, Inc. Terms and Conditions

Figure 6 Crystals of: (A) calcium oxalate monohydrate and (B) calcium oxalate bihydrate. The former are biconvex rods or sticks but may also appear as dumbbells (inset), while the latter are bipyramidal and look like “envelopes” (particularly visible in the inset). American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.07.012) Copyright © 2018 National Kidney Foundation, Inc. Terms and Conditions

Figure 7 Urine sediment examination of a patient receiving intravenous sulfadiazine who developed acute kidney injury on day 4 of therapy reveals (A) sulfadiazine crystals that are (B) strongly birefringent with polarization. American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.07.012) Copyright © 2018 National Kidney Foundation, Inc. Terms and Conditions

Figure 8 Methotrexate crystals are seen in urine sediment of a patient who developed acute kidney injury following therapy with high-dose intravenous methotrexate. American Journal of Kidney Diseases DOI: (10.1053/j.ajkd.2018.07.012) Copyright © 2018 National Kidney Foundation, Inc. Terms and Conditions