Rouleaux in urine sediment - Urine Microscopy Rouleaux in urine sediment. As the finding in the blood smears, it is caused by paraproteins (usually observed on patients with multiple myeloma). But, it is a very rare finding. Dr. José A. T. Poloni @JoseTesser #Rouleaux #urine #sediment #Microscopy #clinical #nephrology