Microscopic exam of urine pt 1 Flashcards
(56 cards)
1
Q
RBCs normal value in urine
A
0-2 per hpf
2
Q
How do RBCs look in concentrated urine?
A
Small and crenated bc hypertonic
3
Q
How do RBCs look in dilute urine
A
- Ghost cells = Swollen, lysed, membrane intact
- Don’t count, just note
4
Q
RBCs confused with
A
- Yeast
- Oil droplets
- Air bubbles
5
Q
Hematuria
A
RBC in urine
6
Q
Explain how presence or absence of RBCs may not correlate with urine color or blood chemical result
A
- 1-4 RBC/hpf but chem strip negative
- Chem strip positive but no RBC seen microscopically due to RBC lysis, hemoglobin, or myoglobin
7
Q
Acetic acid lyses ___ but not ____
A
- RBCs
- Yeast, WBCs, or oil droplets
8
Q
Dysmorphic RBCs (cellular protrusions, vary in size, fragmented) big sign of ___
A
- Glomerular bleeding
- Rarely seen due to strenuous exercise
- 2nd tech review required bc rare and looks like yeast
9
Q
WBC normal value
A
0-5 per hpf
10
Q
WBC size and usual identity
A
- 12 microns
- PMN
11
Q
WBCS in hypertonic urine
How they look
Leukocyte esterase reaction
A
- Shrink
- Do not release granules, may be negative for leukocyte esterase strip test
12
Q
WBC hyptonic urine
A
Swell
13
Q
Glitter cells
A
- WBCs in hypotonic urine swell, thus granules undergo Brownian movement to cause glittering
- Not pathologically significant
14
Q
Pyuria
A
Increased WBCs in urine
15
Q
Causes of pyuria
A
- Bacterial infection
- Glomerulonephritis
- Lupus erythematosus
- Interstitial nephritis
- Tumors
- Parasites
- Fungi
16
Q
Mononuclear cells in urine
A
- Less common to see
- Lymphs (may resemble RBC), monocytes, macrophages, histocytes
17
Q
Lymphs seen in urine when
A
Early stages of renal transplant rejection
18
Q
What to do with urine that has a lot of mononuclear cells?
A
Refer to cytology
19
Q
Eosinophils associated with
A
- Drug-induced interstitial nephritis (primary reason)
- UTI
- Parasites
- Renal transplant rejection
20
Q
How to stain for eosinophils in UA
A
Hansel’s or Wright’s stain
21
Q
Clinically significant eosinophil value
A
Eos > 1%
22
Q
List 3 types of epithelial cells and their sources
A
- Squamous (urethra/genitalia)
- Transitional (upper urethra)
- Renal tubule (PCT, DCT, Henle, collecting duct aka nephron)
23
Q
ID this cell
A
RTE
24
Q
ID these cells
A
Squamous
25
ID this cell
Transitional cell
26
**What cell am I describing**
Largest cells in urinary sediment, nucleus about RBC size, easily seen under 10x, slough off, may look like casts, degenerate easily
Squamous cells
27
Clue cells
- Squamous cells with 75% bacteria
- Indicate bacterial vaginosis (Gardnerella vaginalis)
28
Are clue cells reported in hospitals?
Not usually, they are reported as normal squamous epithelial cells instead
29
**What cell am I describing**
Central nuclei, numerous forms, well defined edge
Transitional epithelial cell!
30
Transitional epithelial cell normal value
0-2 hpf
31
Increased amounts of transitional epithelial cells due to
Catheterization, but not pathologic in this case
32
Transitional epithelial cells with vacuoles or irregular nuclei may indicate
Viral infection, refer to cytology
33
**What cell am I describing**
Cuboidal, columnar, or round, flattened edge, eccentric nuclei
RTE cells
34
RTE normal value and clinically significant value
- 0-2/hpf normal
- RTE > 3/hpf indicates damage or necrosis to renal tubules (infection, drug toxicity, heavy metals, allergic reactions)
35
Since RTE cells reabsorb glomerular filtrate, what elements can they contain?
- Bilirubin = yellow color
- Hemosiderin = yellow-brown granules
36
Oval fat bodies
- RTE cells that absorbed **lipids** from glomerular filtrate
- Highly pathogenic and rare
37
When are oval fat bodies typically seen
Seen along with free fat droplets and or fatty casts
38
Lipiduria
Fat in urine
39
Lipiduria associated with
- Nephrotic syndrome (glomerular damage)
- Tubular necrosis
- Diabetes mellitus
- Trauma (BM fat)
- Oval fat bodies from histocytes instead of RTE, which are seen in lipid storage diseases
40
How do you detect oval fat bodies under the microscope?
- Stain with Oil Red O or Sudan III
- Polarizing microscopy to see if there's cholesterol
41
Oval fat bodies easily confused with
Starch or certain crystals
42
ID the following
Oval fat body
43
What does cholesterol look like under polarizing microscopy?
Maltese cross
44
If bacteria present, what reagent test strip results do you expect?
- Nitrite positive or negative
- Positive leukocyte esterase if WBC present
45
Collection method for urine samples suspected to contain bacteria
Clean catch or random specimen
46
Increased amounts of bacteria in urine suggest ___. What's the follow-up test?
- UTI
- Do quantitative urine culture
47
ID the element
Usually Candida albicans
48
Yeast appears in
- Diabetes mellitus (acid pH and more glucose)
- Immunocompromised pts
- Vaginal yeast infections
49
If yeast are present, what other element should be present?
WBCs
50
Major constituent of mucus
Tamm-Horsfall protein (uromodulin)
51
Mucus refractive index
- Low, making it hard to see
- More frequent in female urines
52
Mucus clinical significance
None for males or females
53
ID the element
Mucus
54
Increased amounts of semen may produce what positive result on chemical strip test?
Positive protein
55
ID the element
Sperm
56
What clinically insignificant causes of bacteria in urine are there?
- Normal sloughing off normal flora from genitalia
- Urine sat out more than 2 hrs
