De la página http://www.agora.crosemont.qc.ca/urinesediments/, me pareció muy buena la información. El autor es Richard Dion, canadiense:
Who I am ?
May I introduce myself. My name is Richard Dion MSc, a retired teacher at the department of Technologie de Laboratoire Médical at the Collège de Rosemont .The "Collège de Rosemont" is a pre-university and professional degree dispensing college, sited in Montreal.
It is with pleasure that I invite you to browse on this site dedicated to the microscopic examination of urine. You can leave, your messages at the following E-mail address:
Digo, cuando menos tiene una maestría en ciencias. Acerca de los leucocitos expone lo siguiente:
Leukocytes
Leukocytes or white blood cells designate all the hemoglobin free blood cells. These cells belong to the reticuloendothelial system. Based on their nuclear aspect, white blood cells can be divided into two categories: mononuclear cells and polynuclear cells. Lymphocytes and monocytes are the principal mononuclear cells and polynuclear are subdivided into neutrophilic, eosinophilic and basophilic cells. In the urinary sediment, the term leukocyte is usually interpreted as polynuclear, mostly neutrophils. The reason for this situation is that the neutrophils are, by far, the most abundant leukocytes in urine. In a normal specimen, up to 6 or 7 neutrophils / high-power field can be observed. High neutrophil counts are usually related to an inflammation process.Mononuclear leukocytes are occasionally seen. High mononuclear counts are usually related to a high blood count pathology, infiltrating the urinary space.
Under bright field microscopy and without staining, identification of the different types of white blood cells is almost impossible. The term leukocytes is indicated for the routine microscopy. The subclasses of leukocytes can be identified by staining with the Wright or PAP stain. Efficiency of these staining procedures is highly dependent of the conservation state of the cells. Staining with these represents a workload, not justified for the routine specimen.
Neutrophils
A polynuclear neutrophil (neutro) is a plurilobular nucleus bearing cell with a slightly granulated cytoplasm. Neutros have two types of granulations (lysozome) named azurophilic and specific. Neutros lysozomes havediverse enzyme activities, some being specific like the peroxydase. Neutrophils also possess a heterogenic group of hydrolase gathered under the term esterase. One of these esterases, the Naphtyl AS-D Chloroacetate esterase, seems to be specific for the polynuclear lineage. This activity is shared with the mastocytes and some macrophages (some think that this activity is due to phagocyted neutros). Since mastocytes are not seen in urine, and that the macrophage size and aspect is quite different from leukocytes, this activity is used in a specific staining procedure for leukocytes.Because of a pycnotic nucleus or of an unfavorable refractive index of the urine, the plurilobulated nucleus are not always obvious. Acidification of the sediment, with one drop of 2% acetic acid enhances the contrast of the preparation.
El hace una diferenciación entre leucocitos neutrófilos refiriéndose a ellos como "células viejas" y "células nuevas":
In the urinary sediment, there are two types of neutrophils. The first type is the usual named "Old" by Stamey. When numerous, these cells are related to inflammation.
The second type, named "Fresh" by Stamey, and "Pale cells" by Sternheimer, is bigger in size and resistant to some stains. If the urine density is lower than 1,019 this cell will demonstrate a brownian movement of its granules wich will give a glittering cytoplasm. These cells are then called glitter cells. For a time, these cells were thought to be specific to pyelonephritis. Since these were found in other conditions the accepted interpretation is relating them to an active inflammation process of the urinary tract.
O sea que él llama "glitter cells" o células destellantes a aquellos leucocitos agrandados y resistentes a algunos colorantes, cuyo destello se debe al movimiento browniano de sus gránulos. Y a continuación indica lo que yo leí en otras bibliografías: durante un tiempo estas células se consideraron específicas (patognomónicas) de pielonefritis, pero desde que se encontraron estas células en otras condiciones (como en orinas hipotónicas) se acepta que pueden encontrarse en cualquier proceso inflamatorio del tracto urinario.
Escribe también acerca de los piocitos:
One characteristic of the activated neutrophil is it's adherent capacity. This characteristic is essential for the migration of the cell. Because of this, neutrophils can easily aggregate. In some cases, it is important not to confuse cell aggregation and pus. Pus is formed of degenerated neutrophils (pyocytes) and cellular debris compacted into a mass where cell identity is lost. This discrimination is not commonly used with the urinary sediment, so that many aggregates are reported as pus. The term pus should be restrained to real pus.
Dice que por las mismas características de los neutrófilos tienden a agregarse, y que no hay que confundir agregación celular con pus. Literalmente: "La pus está formada de neutrófilos degenerados (piocitos) y restos celulares compactados en una masa en donde se ha perdido la identidad celular". Finaliza diciendo que esta diferenciación entre leucocitos agregados y pus no se hace comunmente en el sedimento urinario, porque muchos agregados son reportados (mal reportados) como pus. Termina diciendo que el termino pus debe aplicarse sólo cuando existe realmente pus.
Resumiendo: piocitos son leucocitos degenerados que forman parte, junto con restos celulares, de pus. Y células destellantes son leucocitos que presentan un movimiento browniano en su interior, y no son patognomónicos de pielonefritis porque se pueden encontrar en otros diferentes procesos o condiciones urinarias.
PD: Encontré que también se llaman células de Schilling, o de Sternheimer-Malbin.
Excelente 😍
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