AUBF (urinary sediments) Flashcards
(208 cards)
1
Q
T/F
RBC can normally pass glomerulus
A
F
RBC normally cannot pass glomerulus
2
Q
has a smooth, non-nucleated biconcave disk (7 mm) “donut” appearance
A
RBCs
3
Q
RBCs in hypersthenuric (concentrated) urine
A
Crenated – shrinks due to water loss
4
Q
RBCs in hyposthenuric (diluted) urine
A
Ghost cells (large empty cells)
5
Q
result due to swelling from water absorption → lyse & Hgb released → cell membrane remains
A
Ghost cells (large empty cells)
6
Q
RBCs present in GLOMERULAR BLEEDING
A
Dysmorphic RBCs (cellular protrusions, fragmented, varied sizes)
7
Q
Its presence indicates damage to glomerular membrane or vascular injury within genitourinary tract
A
RBC
8
Q
Dysmorphic RBC presence indicates this condition
A
Glomerular bleeding
9
Q
T/F
No. of RBCs present is indicative of the extent of the damage/injury
A
T
10
Q
Conditions where RBCs are seen in urine
A
Glomerular bleeding (dysmorphic)
Glomerular membrane damage / vascular integrity damage within genitourinary tract
Macro & Micro Hematuria
11
Q
Type of hematuria wherein the urine appearance is cloudy, red-brown color and has intact RBCs microscopically
A
Macroscopic/Gross Hematuria
12
Q
Type of hematuria wherein the urine appearance is in normal color and has intact RBCs microscopically
A
Microscopic Hematuria
13
Q
Condition associated with ADVANCED GLOMERULAR DAMAGE
A
Macroscopic/Gross Hematuria
14
Q
Condition associated with damage to vascular integrity of urinary tract (trauma, acute kidney infection/inflammation, coagulation disorder)
A
Macroscopic/Gross Hematuria
15
Q
Presence of this condition is critical to:
- EARLY DX of glomerular disorders and urinary tract malignancy
- CONFIRM renal calculi (kidney stones)
A
Microscopic Hematuria
16
Q
Significance of Macroscopic/Gross Hematuria
A
- Advance glomerular damage
- Damage to vascular integrity of urinary tract (trauma, acute kidney infection/inflammation, coagulation disorder)
17
Q
Significance of Microscopic Hematuria
A
- Critical to early dx of glomerular disorders and urinary tract malignancy,
- Confirm renal calculi (kidney stones)
18
Q
↑ urinary WBC (presence of infection/inflammation of the genitourinary system)
A
Pyuria
19
Q
WBCs in urine
A
Neutrophil/PMN
Eosinophil
Mononuclear cells (monocyte/lympho)
20
Q
predominant WBC
A
Neutrophil/PMN
21
Q
contain granules; multilobed (2-5)
A
Neutrophil/PMN
22
Q
Exhibited by neutrophil/PMN granules in hypotonic (absorbs water and swell) urine
A
Brownian Movement (appear as GLITTER CELLS)
23
Q
appear as GLITTER CELLS due to Brownian movement
A
Neutrophil/PMN
24
Q
Clin. significance of EOSINOPHIL presence in urine
A
- Drug-induced interstitial nephritis
- UTI
- Renal transplant rejection
25
Urinary sediment increased during Drug-induced interstitial nephritis
Eosinophil
26
Urinary sediments increased during Renal transplant rejection
Eosinophil
Lymphocytes (early stages)
27
large mononuclear cell
Monocytes/macrophage
28
smallest WBC (close to RBC size, differs in pallor)
Lymphocytes
29
T/F
Primary concern in urinary WBC identification: Differentiation of mononuclear cells and disintegrating neutrophils from round renal tubular epithelial (RTE) cells (larger than WBCs with eccentric nucleus)
T
Mono: central nucleus
RTE: eccentric nucleus, LARGER
30
in urinary WBC identification, what is used to enhance nuclear detail of monocytes and RTE cells to differentiate resemblance?
Supravital staining or
Addition of Acetic Acid
31
Epithelial cells in urine
Squamous EC
Transitional / Urothelial EC
RTE Cell
Oval Fat Bodies
Bubble Cells
32
epithelial cells indicating normal sloughing off (NONPATHOLOGIC)
Squamous EC
33
Derived from genitourinary system linings – old cells of urethra
Squamous EC
34
Largest cells in urine sediment
* POINT OF REFERENCE
Squamous EC
35
Smaller than squamous EC (NONPATHOLOGIC)
Transitional / Urothelial EC
36
Dome/umbrella-like shaped; spherical eccentric nucleus
Transitional / Urothelial EC
37
FORMS of TRANSITIONAL/UROTHELIAL EC
spherical
polyhedral
caudate
(differences is caused by the ability to absorb large amount of water)
38
ORIGIN of TRANSITIONAL/UROTHELIAL EC
lining of renal pelvis, calyces, ureters, bladder; upper urethra (male)
39
clumps of transitional EC, appears following an invasive procedure (catheterization)
SYNCITIA
40
Abnormal morphology of transitional EC
Vacuolation/irregular nuclei
41
Indication of vacuolation/irregular nuclei of transitional EC
Malignancy
Viral infection
42
cells present in tissue destruction (necrosis)
RTE cells
43
Has hemosiderin granules in cytoplasm (+ Prussian Blue) → hemoglobinuria
RTE cells
44
Size and shape vary depending on the area of renal tubules they originate
RTE cells
45
ORIGINS of RTE cells
PCT
DCT
CD
46
RTE cells originating on this area are larger than any RTE cells origin
PCT
47
RTE cells originating on this area are rectangular (columnar/convoluted cells)
PCT
48
RTE cells originating on this area resembles CAST
PCT
49
RTE cells originating on this area are smaller, round, oval
DCT
50
RTE cells originating on this area are mistaken for WBC or spherical transitional EC
DCT
51
RTE cells originating on this area are Cuboidal, NEVER round
Collecting duct
52
RTE cells originating on this area forms groups of 3 or more → forming RENAL FRAGMENTS
Collecting duct
53
RTE cells + Lipids
Oval Fat Bodies
54
RTE cells + Non-lipid vacuoles
Bubble Cells
55
indication of bubble cells in urine
Acute tubular necrosis
56
present in urine during ACUTE TUBULAR NECROSIS
Bubble Cells (RTE cells + Non-lipid vacuoles)
57
Squamous EC covered with Gardnerella coccobacillus
Clue cells
58
Indication of clue cells presence
Bacterial vaginosis
59
Normally not present in urine (bladder is sterile) – may be a contamination or infection
Bacteria
60
Spherical-shaped bacteria
cocci
61
Rod-shaped bacteria
bacilli
62
Gram (-) rods
Most frequently associated with UTI
Enterobacteriaceae
63
Bacteria + WBCs indicates?
SIGNIFICANT UTI
64
what must be present to confirm a "SIGNIFICANT" UTI?
Bacteria + WBCs
65
Small refractile oval structures
Yeast
(may or may not contain bud → mycelial: severe)
66
Common specie of yeast in urine that causes human infections
Candida albicans
67
Indication of Candida albicans presence
* DM (yeasts are sugar-loving)
* Vaginal Moniliasis
* Immunocompromised Individual
68
Common parasites in urine
Trichomonas vaginalis
Schistosoma haematobium
Enterobius vermicularis (pinworm)
69
Most frequent parasite encountered in urine – has jerking motility
Trichomonas vaginalis
70
Infection caused by this parasite is sexually transmitted
Trichomonas vaginalis
71
presence of this parasite causes vaginal inflammation; Asymptomatic in male urethra and prostate
Trichomonas vaginalis
72
Bladder parasite (ova) – has terminal spine
Schistosoma haematobium
73
parasite causing BLADDER CANCER
Schistosoma haematobium
74
Most common fecal contaminant
Enterobius vermicularis (pinworm)
75
T/F
Spermatozoa in Routine UA is reported
F
NOT REPORTED (unless MALE)
76
Spermatozoa is only significant in cases of?
Male infertility
Retrograde ejaculation (sperm in bladder, instead of urethra)
77
sperm in BLADDER, instead of urethra
Retrograde ejaculation
78
major constituent of mucus
Uromodulin
79
Thread-like structures (low refractive index) – must be viewed with low brightness
Mucus
80
T/F
Mucus is frequent in MALES
F
Mucus is frequent in FEMALES
81
Only element FOUND ONLY IN URINE: unique to the kidney
Casts
82
condition indicating urinary cast presence
CYLINDURIA
83
T/F
Cast width depends on the size of the tubule in which it is formed
T
84
Origin of CASTS
DCT
CT
85
core matrix of cast consists of?
Uromodulin/Tamm Horsfall protein
86
True geometrically structure or amorphous materials
Crystals
87
Result of precipitation of urine solutes
Crystals
88
NOT normally present in freshly voided urine
Crystals
(RT --> ref, forms amorphous urates, crystals)
89
Enumerate artifacts in urine
Starch
Oil droplets
Air bubbles
Pollen grains
Fibers/hair
Fecal contamination
90
Artifacts that is defined as highly refractile sphere with dimpled center (resembles RBCs)
Starch
91
Artifact that resembles fat globules
Oil droplets
92
Spherical artifact with a cell wall and occasional concentric circles
Pollen grains
93
Artifact that resembles casts
What is the point of difference?
Fibers/hair
Difference: POLARIZATION
Fibers (+)
Casts (-)
94
artifact appearing as plant and meat fibers or as brown amorphous material
Fecal contamination
95
URINARY CASTS
Hyaline cast
RBC cast
WBC cast
Bacterial cast
EC cast
Fatty cast
Mixed cellular cast
Granular cast
Waxy cast
Broad cast (renal failure cast)
96
Most frequently seen urinary cast
Hyaline cast
97
NORMAL hyaline cast
0-2 / LPF
98
Unstained hyaline cast color
colorless
99
Hyaline cast stained with Sternheimer Malbin stain
pink (parallel/rounded ends)
100
↑ hyaline cast in cylindroid form
CYLINDURIA
101
Wrinkled appearance or convoluted shapes (disintegration) of hyaline cast signifies?
aging of cast matrix
102
Hyaline cast is NORMALLY increased in:
"SHED"
* Strenuous exercise
* Heat exposure
* Emotional stress
* Dehydration
103
Hyaline cast is PATHOLOGICALLY increased in:
* Acute glomerulonephritis
* Pyelonephritis
* Chronic Renal disease
* CHF
104
RBC cast is aka
Blood cast / Muddy Brown cast
105
Hyaline cast + RBC
RBC cast / Blood cast / Muddy Brown cast
106
color of Blood cast / Muddy Brown cast in LPF
Orange-red
107
RBC casts degenerate into pigment + GRANULAR cast indicates?
Greater stasis of urine
(severe damage to glomerulus)
108
RBC cast is NORMALLY increased in:
Strenuous exercise
109
RBC cast is PATHOLOGICALLY increased in:
* Bleeding within the nephron
* Glomerular damage (glomerulonephritis) – associated with proteinuria and dysmorphic RBCs
110
cast present in urine during nephron bleeding
RBC cast
111
cast presence during glomerular damage (glomerulonephritis)
RBC cast
112
Associated with glomerular damage (glomerulonephritis)
RBC cast
proteinuria
dysmorphic RBCs
113
Hyaline cast + WBCs
WBC cast
114
Signifies infection or inflammation within the nephron
WBC cast
115
WBC cast, no bacteria
Example?
Non-bacterial inflammation
Acute interstitial nephritis
116
WBC cast + Bacteria
Example?
Bacterial inflammation
Pyelonephritis
117
primary marker for distinguishing pyelonephritis from cystitis
WBC cast
118
upper UTI
Pyelonephritis
119
lower UTI
Cystitis
120
T/F
Bacterial casts may be PURE or mixed with WBCs
T
121
Indication of bacterial cast
Bacterial inflammation: Pyelonephritis (DIAGNOSTIC)
122
Consists of bacterial casts containing bacilli both within and bound to the protein matrix
Pyelonephritis
123
Diagnostic for pyelonephritis
Bacterial cast
124
Bacterial cast may resemble this cast
GRANULAR CAST
125
Performed to differentiate BACTERIAL cast from GRANULAR cast
Gram staining
126
Considered as significant EC cast
cast containing RTE cells
127
Indication of EC cast containing RTE cells
* Advance tubular obstruction
* Heavy metal, chemical, or drug toxicity
* Viral infection
* Allograft rejection (EC cast + WBC cast)
128
EC cast + WBC cast in urine
Allograft rejection
129
Fatty casts + Oval fat bodies + Free fat droplets
LIPIDURIA
130
Fatty cast is frequently associated with:
* Nephrotic Syndrome
* Tubular necrosis
* DM
* Crash injuries
131
Casts containing multiple cell types
Mixed cellular cast
132
RBC + WBC casts &/or WBC + RTE cell casts
GLOMERULONEPHRITIS
133
WBC + Bacterial cell casts
PYELONEPHRITIS
134
What must be found in urine to diagnose GLOMERULONEPHRITIS?
RBC + WBC casts &/or
WBC + RTE cell casts
135
What must be found in urine to diagnose PYELONEPHRITIS?
WBC + Bacterial cell casts
136
Result of cellular disintegration
Granular cast
137
T/F
Increased cellular metabolism during strenuous exercise accounts for the transient increase of granular casts that accompany the increased hyaline cast
T
138
Grainy appearance, broken cast matrix
Granular cast
139
Fragmented with jagged ends; notches on sides
Waxy cast
140
Color of waxy cast in Supravital staining:
Homogenous dark pink
141
Indication of WAXY cast
Extreme urine stasis (Chronic renal failure)
142
Represent as ADVANCED STAGE of other casts that are transformed during urinary stasis
Waxy cast
143
aka broad cast
Renal failure cast
144
INDICATION of BROAD CAST
Destruction or widening of tubular walls
Extreme urine stasis
145
indication of BILE-STAINED BROAD & WAXY CAST
Tubular necrosis due to viral hepatitis
146
pH of uric acid
acid
147
Appearance:
Rhombic, Wedges, Rosettes, 4-sided flat plates (whetstones), 6-sided plates (resembles cystine)
Yellow-brown color to colorless
Uric acid
148
Resembles CYSTINE crystals
Uric acid
149
distinguishing feature of uric acid from Cystine crystals
HIGHLY BIREFRINGENT
150
URIC ACID is significantly increased in:
Gout
Lesch-Nyhan Syndrome
151
pH of amorphous urates
acid
152
Colorless to yellow-brown granules
Amorphous urates
153
Macroscopic (sediment): orange-pink precipitate (“brick-dust”)
Amorphous urates
154
Resembles Amorphous phosphates and FECAL contaminants
Amorphous urates
155
Composition of Amorphous urates
Ca, Mg, Na, K
156
What will happen to amorphous urates when refrigerated?
forms a PINK sediment (uroerythrin + urates)
157
added to convert amorphous urates to URIC acid
conc. HCl
158
pH of amorphous phosphates
Alk
159
Macroscopic (sediment): White to
beige precipitate
Amorphous phosphates
160
What will happen to amorphous phosphates when refrigerated?
forms WHITE sediment
161
pH of Calcium Oxalate
Acid, Alk, Neutral
162
Forms of CaOx
Dihydrate (MOST COMMON)
Monohydrate
163
colorless, octahedral envelope or 2 pyramids joined at their base
Dihydrate CaOx
164
Oval or Dumbbell shaped CaOx
Monohydrate CaOx
165
formed due to Ethylene Glycol “Anti-freeze” Poisoning
Monohydrate CaOx
166
Seen in majority of renal calculi (kidney stones)
Calcium oxalate
167
pH of Calcium phosphate
Alk
168
Appearance: Colorless, flat rectangular plates/prisms in rosette forms
Calcium phosphate
169
Resembles Sulfonamide crystals if in NEUTRAL pH
Calcium phosphate
170
Used to distinguish Calcium phosphate from sulfonamide crystals
addition of DILUTE ACETIC ACID:
Calcium phosphate - (dissolved)
Sulfonamide crystals - (remain)
171
pH of Triple phosphate
Alk
172
Appearance: Prism, resembles “COFFIN-LID”, “FERN-LIKE” form can be induced by addition of AMMONIA
Triple phosphate
173
aka Triple phosphate
Ammonium magnesium phosphate
174
appearance of triple phosphate induced after addition of ammonia
FERN-LIKE
175
pH of ammonium biurate
Alk
176
Appearance: THORNY APPLES – spicule-covered spheres
Ammonium biurate
177
Most often encountered in OLD SPX (ammonia produced by urea-splitting bacteria)
Ammonium biurate
178
Crystal that dissolves at 60ºC
Ammonium biurate
179
Added to convert Ammonium biurate to URIC ACID
Glacial acetic acid
Conc. HCl
180
pH of Calcium carbonate
Alk
181
Appearance: Small, colorless dumbbell of spherical shapes
Calcium carbonate
182
Resembles Monohydate CaOx and amorphous materials
Calcium carbonate
183
Added to distinguish monohydrate caox and amorphous materials from Calcium carbonate
ACETIC ACID
(GAS FORMATION – observe for effervescence or bubbles)
184
NORMAL URINARY CRYSTALS
Uric acid
Amorphous urates
Amorphous phosphates
Calcium oxalate
Calcium carbonate
Calcium phosphate
Triple phosphate
Ammonium biurate
185
ABNORMAL URINARY CRYSTALS
Cystine
Cholesterol
Radiographic Dye/RCM
Sulfonamides
Ampicillin
Leucine
Tyrosine
Bilirubin
186
Abnormal urinary crystals are most often found in this pH
ACIDIC urine
187
Abnormal urinary crystals are rarely found in this pH
NEUTRAL urine
188
Colorless, Hexagonal plates (thick or thin) crystals
Cystine
189
Test for confirmation of Cystine in urine
Cyanide-Nitroprusside Test
190
Metabolic disorder that prevents reabsorption of cysteine by renal tubules
Cystinuria
191
Rectangular plates with notch on one or more corners
Cholesterol
192
Can be seen in: NEPHROTIC SYNDROME in conjunction with FATTY CASTS and OVAL FAT BODIES
Cholesterol
193
What must be present to diagnose NEPHROTIC SYNDROME?
Cholesterol
Fatty cast
Oval fat bodies
194
Colorless, flat plates
Similar to CHOLE crystals
Radiographic Dye/RCM
195
Used to distinguish RCM from CHOLE crystals
RCM: Markedly ELEVATED SG
196
Colorless to yellow-brown, needles, rhombic, whetstones, “SHEAVES OF WHEAT” and rosettes
Sulfonamides
197
T/F
Sulfonamides dissolves in dilute acetic acid
F
Sulfonamides does not dissolve upon addition of DILUTE ACETIC ACID
198
Primary cause of sulfonamide presence
patient hydration (damage nephrons)
199
this crystal appearance must be correlated with medical history
sulfonamides
200
Colorless needles (tend to form bundles following refrigeration)
Ampicillin
201
Precipitation of antibiotics following massive
dosage of penicillin compound without adequate hydration
Ampicillin
202
Yellow-brown spheres (concentric circles with radial striations)
Leucine
203
Should be accompanied by: TYROSINE CRYSTALS
Leucine
204
Fine, colorless to yellow needles (in clumps or rosettes)
Tyrosine
205
Seen in conjunction with:
LEUCINE CRYSTALS & (+)
BILIRUBIN (chem test)
Tyrosine
206
Yellow, clump needles or granules
Bilirubin
207
must be accompanied by (+) Bilirubin in urine strip
Bilirubin
208
Abnormal crystals signifying LIVER disorder
Leucine
Tyrosine
Bilirubin
