Deeper clinical insights with revolutionary urinalysis

Understand your SediVue Dx results

A guide to urine sediment images and information for interpreting in-house results

Results reporting  |  Understanding bacteria  |  Automated sample messages  |  Reviewing images

Results reporting

Blood cells

White blood cells (WBCs)
White blood cells on a slide

Image tag: WBC

Result
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
<1/HPF
(Some features were found in the sample; however, the quantity is below the clinical reporting threshold.)
Quantitative numerical result/HPF >50/HPF
Red blood cells (RBCs)
Red blood cells on a slide

Image tag: RBC

Result

None detected
(The element has not been detected, or there are not enough recognizable features to classify.)

<1/HPF
(Some features were found in the sample; however, the quantity is below the clinical reporting threshold.)
Quantitative numerical result/HPF >50/HPF

Bacteria

Rods
Bacteria rods on a slide

Image tag: N/A*

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
Suspect presence
(Some recognizable features of an element (cocci, rods, casts) are present; however, the quantity and detail is insufficient to report as “present.”)
Present
(There is high confidence that bacteria are present in the sample.)
Cocci
Bacteria cocci on a slide

Image tag: N/A*

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
Suspect presence
(Some recognizable features of an element (cocci, rods, casts) are present; however, the quantity and detail is insufficient to report as “present.”)
Present
(There is high confidence that bacteria are present in the sample.)

*To avoid blocking your visual interpretation, the analyzer classifies and counts all bacteria without tagging them.

NOTE: Bacteria results may be confounded by other debris and artifacts in the sample (e.g., sperm, crystalline debris).

Epithelial cells

Squamous
Squamous epithelial on a slide

Image tag: sqEPI

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
<1/HPF
(Some rare features have been found in the sample; however, the quantity is below the clinical reporting threshold.)
1–2/HPF 3–5/HPF 6–10 /HPF >10/HPF
Nonsquamous
Non-squamous epithelial on a slide

Image tag: nsEPI

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
<1/HPF
(Some rare features have been found in the sample; however, the quantity is below the clinical reporting threshold.)
1–2/HPF 3–5/HPF 6–10 /HPF >10/HPF

Casts

Hyaline
Hyaline casts on a slide

Image tag: HYA

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
Suspect presence
(Some features of casts are present; however, there may not be enough to provide a >1/LPF result. Image review is strongly recommended for confirmation.)
>1/LPF
Nonhyaline (e.g., granular, waxy)
Non-hyaline granular waxy casts on a slide

Image tag: nhCST

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
Suspect presence
(Some features of casts are present; however, there may not be enough to provide a >1/LPF result. Image review is strongly recommended for confirmation.)
>1/LPF

Crystals

Unclassified (all other crystals)
Unclassified crystals on a slide

Image tag: CRY

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
<1/HPF
(Some rare features have been found in the sample; however, the quantity is below the clinical reporting threshold.)
1–5/HPF 6–20 /HPF 21–50 /HPF >50/HPF
Calcium oxalate dihydrate
Calcium oxalate dihydrate crystals on a slide

Image tag: CaOxDi

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
<1/HPF
(Some rare features have been found in the sample; however, the quantity is below the clinical reporting threshold.)
1–5/HPF 6–20 /HPF 21–50 /HPF >50/HPF
Struvites
Struvites struvite crystals on a slide

Image tag: STR

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
<1/HPF
(Some rare features have been found in the sample; however, the quantity is below the clinical reporting threshold.)
1–5/HPF 6–20 /HPF 21–50 /HPF >50/HPF
Ammonium biurate
Ammonium biurate cell on a slide

Image tag: AmmBi

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
<1/HPF
(Some rare features have been found in the sample; however, the quantity is below the clinical reporting threshold.)
1–5/HPF 6–20 /HPF 21–50 /HPF >50/HPF
Bilirubin
Bilirubin cells on a slide

Image tag: BILI

Results
None detected
(The element has not been detected, or there are not enough recognizable features to classify.)
<1/HPF
(Some rare features have been found in the sample; however, the quantity is below the clinical reporting threshold.)
1–5/HPF 6–20 /HPF 21–50 /HPF >50/HPF

Understanding bacteria

Bacteria results

Bacteria result (rods/cocci) Definition Possible reason for validation Recommended next steps
None detected
The element has not been detected or there are not enough recognizable features to classify. Patient has clinical signs or a history of persistent UTIs. If visual review of images is negative and patient has no clinical signs or history, bacteriuria is unlikely. No further action is necessary.
Suspect presence
Some recognizable features of an element (cocci, rods, casts) are present; however, the quantity and detail is insufficient to report as “present.” Crystalline or amorphous debris is common in canine and feline samples (especially free catch).

Differentiate bacteria from debris.

Review visually; if confirmed, diagnose and manage based on your interpretation.

  • If, however, visual review is inconclusive and white blood cells, red blood cells, clinical signs, and/or history of urinary tract infection are present, confirm presence of bacteria with a dry prep.
  • If, however, visual review is inconclusive and there are no supporting clues present (e.g., active urine sediment, history), the presence of bacteria is unlikely.
Present
There is a high confidence that bacteria are present in the sample. Bacteria results may be confounded by other debris and artifacts in the sample (e.g., sperm, crystalline debris). If visual review of images is confirmatory and/or the patient has clinical signs or history, bacteriuria is likely. No further action is necessary.

Top 4 questions about bacteria results

A result that reads "suspect presence" means that the SediVue Dx analyzer has detected enough uniformly sized, small structures in the sample to deem the result positive. However, there is not enough evidence to differentiate bacteria from crystalline or amorphous debris, which are both common in canine and feline samples, especially those obtained via free catch. 

Here’s what we recommend doing:

First, review the images to determine if bacteria can be visually identified. If so, trust your visual interpretation of the sample and move on to a diagnosis, treatment, or follow-up appointment. Make a note of your findings in the patient record, and unless you feel the need for culture or sensitivity testing, no further action is necessary.

If, after reviewing the images, you are still not sure, ask these questions: 
  • Are white blood cells (WBCs) or red blood cells (RBCs) present?
  • Does your patient have clinical signs?
  • Is there a recurring history of lower urinary tract issues? 
     

If the answer to any of the questions is "yes," perform a dry prep (air-dried, stained cytological slide) to confirm the presence of bacteria. Watch our short video to learn how to do a dry prep in 3–5 minutes.

If bacteria cannot be visually confirmed in the images and there are no other supporting clues (active urine sediment, patient history, etc.), then the presence of bacteria is unlikely. Once you’ve documented your findings in the patient record, no further action is required. 

Key takeaways
  • "Suspect presence" = sample contains uniform, small structures
  • Results could be bacteria, crystalline debris, or amorphous debris
  • Review images for additional evidence
    • Presence of clinical signs and/or recurring history of lower urinary tract issues warrant a dry prep

If the SediVue Dx analyzer reports that a specimen is positive for bacteria and the culture result from the laboratory says negative, it is possible that both are correct. Even when best practices are followed, discordance between microscopic evaluation and culture results may occur. 

Results of "no growth" on culture when bacteria are seen in the urine sediment may occur for the following reasons:
  • Bacteria may have been visualized microscopically but may be dead (nonviable), especially if the animal is currently on antibiotics or had previously or recently been treated with antibiotics at the time of sample collection. Other factors that may inhibit or prevent bacteria growth in culture include exposure of the sample to temperature extremes, extremes of urine pH (≤4 or ≥9), or inhibition by white blood cells (in urine with "too numerous to count" white blood cells). 
  • The "organisms" identified with microscopy could have been crystalline or amorphous debris in the urine that was misidentified as bacteria, called pseudobacteria (particularly with unstained urine sediment examination). 
  • Random motion of small colloidal particles, known as Brownian motion, can falsely appear to be cocci bacteria (particularly with unstained urine sediment examination). 
  • Rarely, anaerobic bacteria may be visualized on urinalysis but not grown in aerobic cultures. 
  • If the urine sample was stained in-clinic prior to manual microscopic examination, the stain may have been contaminated with bacteria. Stains should be changed regularly. 
     
Positive results on culture when bacteria are not identified during the urine sediment analysis may occur for the following reasons: 

Bacterial colony counts are too low to be visualized on sediment analysis, for example in very dilute urine, following incomplete or unsuccessful antibiotic therapy or in the case of localized pyelonephritis. In situations where the clinical history is suggestive of urinary tract infection or an active urine sediment is present, urine culture should be considered even in the absence of bacteriuria on urinalysis.

Key takeaways
  • Possible reasons for discordant results include the following:
    • Dead (nonviable) bacteria
    • Conditions that inhibit growth (temperature, pH, WBCs)
    • Misidentified crystalline or amorphous debris
    • Sample contaminated during staining
    • Motion of small colloidal particles (Brownian motion)
    • Very dilute urine
    • Suggest urine culture in patients with a history of urinary tract infection or active urine sediment 

A dry prep (air-dried, stained cytological slide) should only be considered if you cannot visually confirm the absence or presence of bacteria in the images but suspect bacteria presence based on other supporting clues (active urine sediment, patient with clinical signs, or a recurring history of lower urinary tract issues) that could lead you to a diagnosis. A dry prep is a quick, easy way to validate the absence or presence of bacteria and distinguish it from amorphous or crystalline debris, and it can be done in 3–5 minutes!

NOTE: On rare occasions, bacteria can be found in the sample when there are no other supporting clues or clinical signs.

Key takeaways
  • Perform a dry prep when you cannot visually confirm the presence of bacteria AND any of the following are present:
    • Active urine sediment
    • Clinical signs
    • Recurring history of lower urinary tract issues
  • Watch a short video to learn how to perform a dry prep in 3–5 minutes.

Bacteria tags on the images could be overwhelming and block your visual interpretation. Rest assured that even though bacteria are not tagged, the SediVue Dx analyzer is still counting and classifying them.

Key takeaways
  • Absence of tags improves visual review
  • SediVue Dx analyzer quantifies and classifies bacteria

Urinalysis versus culture

Understanding possible discordant results

Bacteria result (rods/cocci) Culture result Causes for discordant results
Present
No growth
  • Bacterial growth was inhibited or prevented by:
    • Antibiotic treatment at time of sample collection.
    • Exposure of sample to extreme temperatures.
    • Extremes of urine pH (≤4 or ≥9).
    • High quantity of white blood cells in urine.
  • Microscopy results misidentified amorphous or crystalline debris as bacteria.*
  • False identification of cocci was due to random motion of small colloidal particles (Brownian motion).*
  • Stain used on urine sample prior to in-house microscopy was contaminated by bacteria.
  • Anaerobic bacteria were identified by the analyzer but cannot be grown in aerobic cultures (rare).
     

*Particularly with unstained urine sediment examinations.

None detected
Positive
  • Bacteria colony counts are too low to be visualized on urine sediment analysis because of:
    • Very dilute urine.
    • Incomplete or unsuccessful antibiotic therapy.
    • Localized pyelonephritis.
  • In cases where clinical history is suggestive or urinary tract infection or an active urine sediment is present, urine culture should be considered even in the absence of bacteriuria on urinalysis.

Automated sample messages

Automated sample messages

Your SediVue Dx Urine Sediment Analyzer may include sample messages in the patient report. These messages are generated based on numerical results and are intended to provide you with further insight and guide you with recommended next steps.

Analyzer message

Confirm with one of the following: image review; air-dried, stained cytological preparation ("dry prep"); or urine culture.

Definition

Some recognizable features of an element (cocci, rods, casts) are present; however, the quantity or details are insufficient to report as “present.” Debris commonly found in canine and feline urine can be confused with bacteria.

Guidance

If images do not provide visual confirmation of bacteria, but patient has clinical signs or there are other clues present (white blood cells, etc.), it is recommended to perform a dry prep to confirm.

If bacteria are obvious in the images or the result is “present,” a dry prep is not necessary, but you can follow up with a culture and sensitivity (MIC) test if you want to further classify the bacteria as well as test for sensitivity to certain antibiotics.

Analyzer message

Images crowded. Review images and follow the guidance below to determine next steps.

Definition

When a urine sample is crowded and the edges of the elements overlap, the SediVue Dx convolutional neural network may have difficulty discerning the elements from one another.

Guidance

  • When images provide clinical insight: No dilution needed, add comments to patient record.
  • Moderate amount of cells or crystalline material: Dilute 1:5 with 0.9% normal saline and rerun.
  • Marked amount of cells or crystalline material: Dilute 1:10 with 0.9% normal saline and rerun.


Note: You will only be charged for the first run from the same patient ID within a 24-hour period.

Analyzer message

Review images to confirm results.

Definition

The convolutional neural network cannot verify the quality of focus in the images.

Guidance

  • The sample may have very little sediment (e.g., “normal”) or contain air bubbles, or the analyzer is dirty.
  • If the expected results do not align with the image review, rerun the sample.
  • If the message appears with several consecutive samples, the analyzer may require cleaning.


Note: You will only be charged for the first run from the same patient ID within a 24-hour period.

Crystals can come in a variety of different shapes, sizes, and presentations. Urine pH, specific gravity, sample preparation and handling, and drugs can all play a part in crystal formation. Crystals in small numbers (e.g., struvites) may be normal for some dogs, but others (e.g., cystine) may signify disease processes. The following Smart Flags are designed to provide further clinical insight into the presence of crystalluria.


Analyzer message

Crystalline debris detected.

Definition

Crystalline debris can be abundant and variable in size and presentation in some samples. Due to background density, the presence of large amounts of crystalline debris can affect the identification of other formed elements in the sample. This flag is displayed when crystalline debris has been detected by the algorithm. The neural network algorithm has been trained to exclude crystalline debris from the unclassified crystal (CRY) category.

Guidance

When this flag is present, users will be notified so they can be more discerning about the bacteria result, as very small particles of debris can resemble bacteria.

Analyzer message

Consider evaluation of urine protein:creatinine ratio.

Definition

When this message appears, the urine chemical results indicate the presence of protein. A UPC ratio can be used to quantify protein loss in the urine as it is unaffected by urine volume or concentration. It has been incorporated into the International Renal Interest Society (IRIS) Guidelines on Staging and Treatment of Chronic Kidney Disease (CKD) as an important monitoring tool at all stages.

Guidance

A UPC ratio should be performed after urinalysis with urine sediment examination. It is not recommended for use if there is an active urine sediment, as inflammatory conditions in the urinary tract will increase protein and negate the usefulness of the ratio.

Analyzer message

Recommend reevaluating proteinuria after resolution of active sediment.

Definition

When this message appears, the urine chemical results indicate the presence of protein in addition to an active urine sediment (red blood cells [RBCs] and/or white blood cells [WBCs] and possibly bacteria).

Guidance

First, resolve the infection. Once the urine sediment becomes inactive, consider running a UPC ratio to quantify protein loss.

For a complete list of automated sample messages, consult the SediVue Dx Urine Sediment Analyzer Operator's Guide.

Reviewing images

Guidance for reviewing images

Reviewing images will validate the numerical data provided and supplement the SediVue Dx analysis.

  • Tap on an image to make it full screen.
  • Reverse the contrast to see details such as cell nuclei.
  • Zoom in up to 200% to see smaller elements.
  • Turn image tags on or off.
  • Select an image to add to the patient record or print an area of interest.
  • Use the large arrows to scroll through images.
  • Seventy high-resolution images are taken for every sample run.
  • Images have been prioritized based on the absence or presence of formed elements and the clinical significance of each element found.
  • Highest scoring images are displayed first.
  • Select View all images to easily scroll through all 70 images.
  • Classified elements may be tagged (labeled).
  • Depending on the type of element, its concentration, and sample, you may not see tags.
  • Whether a tag is present or not, all formed elements are classified by the analyzer and reflected in the result.
  • For Cornerstone Software users, three prioritized images are automatically saved to the patient record and transmitted to VetConnect PLUS. You may select up to three additional images to save to the patient record and VetConnect PLUS.
  • For all other practice management software, the first image will be included with the results PDF.
  • Include comments about findings you consider noteworthy.
  • From the patient results screen, tap Add comments. Your comments will be automatically uploaded to VetConnect PLUS and, if applicable, your practice management software.

Image tags are not available for “none to rare” for all elements as well as “suspect presence” for casts and all bacteria categories. However, all elements that are found are identified, classified, and counted. Tagging bacteria could be overwhelming and block your visual interpretation. The SediVue Dx Urine Sediment Analyzer classifies and counts all bacteria without tagging it.

A guide to all urine sediment images from the SediVue Dx analyzer

Reference bar = 20 microns

Blood cells
Urine sediment red blood cells on a slide

Figure 1. Red blood cells

Urine sediment crenated red blood cells on a slide

Figure 2. Crenated red blood cells

Urine sediment white blood cells on a slide

Figure 3. White blood cells

Urine sediment white blood cells on a slide

Figure 4. White blood cells

Epithelial cells
Urine sediment squamous epithelial cells on a slide

Figure 5. Squamous epithelial cells

Urine sediment squamous epithelial cells on a slide

Figure 6. Squamous epithelial cells

Urine sediment transitional nonsquamous epithelial cells with red and white blood cells on a slide

Figure 7. Numerous transitional (nonsquamous) epithelial cells with red and white blood cells

Urine sediment transitional nonsquamous epithelial cells on a slide

Figure 8. Numerous transitional (nonsquamous) epithelial cells (possible transitional cell carcinoma; confirm with dry prep)

Bacteria
Urine sediment bacteria rods with white blood cells on a slide

Figure 9. Rods with white blood cells

Urine sediment bacteria rods with white and red blood cells on a slide

Figure 10. Rods with white and red blood cells

Urine sediment bacteria cocci with white blood cells on a slide

Figure 11. Cocci with white blood cells

Urine sediment bacteria cocci chains on a slide

Figure 12. Cocci in chain

Casts
Urine sediment hyaline casts on a slide

Figure 13. Left and right, hyaline cast

Urine sediment cellular nonhyaline casts on a slide

Figure 14. Cellular (nonhyaline) cast

Urine sediment granular nonhyaline casts on a slide

Figure 15. Numerous granular (nonhyaline) casts

Urine sediment waxy nonhyaline casts on a slide

Figure 16. Waxy (nonhyaline) cast

Crystals
Urine sediment large struvite crystals on a slide

Figure 17. Large struvite crystals

Urine sediment small struvite crystals on a slide

Figure 18. Numerous small struvite crystals

Urine sediment large calcium oxalate dihydrate crystals on a slide

Figure 19. Large calcium oxalate dihydrate crystals

Urine sediment calcium oxalate dihydrate crystals on a slide

Figure 20. Numerous calcium oxalate dihydrate crystals

Urine sediment calcium oxalate monohydrate picket fence crystals on a slide

Figure 21. Calcium oxalate monohydrate (picket fence) crystals

Urine sediment calcium oxalate monohydrate crystals dumbbells and hemp seed on a slide

Figure 22. Calcium oxalate monohydrate crystals; left, dumbbells; right, hemp seed

Urine sediment ammonium biurate thorn apple crystals on a slide

Figure 23. Ammonium biurate (thorn apple) crystals

Urine sediment bilirubin crystals with white blood cells on a slide

Figure 24. Bilirubin crystal with white blood cells

Urine sediment cholesterol crystals on a slide

Figure 25. Cholesterol crystals

Urine sediment cystine crystals with red blood cells on a slide

Figure 26. Cystine crystals with red blood cells

Urine sediment uric acid crystals on a slide

Figure 27. Uric acid crystals

Urine sediment likely drug-related crystals on a slide

Figure 28. Likely drug-related crystals

Miscellaneous
Urine sediment lipids on a slide

Figure 29. Lipids

Urine sediment amorphous crystalline debris on a slide

Figure 30. Amorphous crystalline debris

Urine sediment hyphae on a slide

Figure 31. Hyphae

Urine sediment sperm with white blood cells on a slide

Figure 32. Sperm with white blood cells

Urine sediment pearsonema spp capillaria spp ova and macrocanidia on a slide

Figure 33. Left, Pearsonema spp. (Capillaria spp.) ova; right, macroconidia

Urine sediment glove powder and pollen on a slide

Figure 34. Left, glove powder; right, pollen

Urine sediment fiber on a slide

Figure 35. Fiber

Urine sediment dust mite on a slide

Figure 36. Dust mite

Get answers to common questions about results and images: FAQs

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