MICROSCOPIC EXAMINATION Flashcards
(155 cards)
1
Q
The least standardized and most time- consuming part of the routine urinalysis
A
MICROSCOPIC EXAMINATION OF URINE
2
Q
WBCs, WBC casts, Bacteria
A
Leukocyte Esterase
3
Q
Casts, Cells
A
Protein
4
Q
Bacteria, WBCs
A
Nitrite
5
Q
Yeast (presence of glucose) + WBC = Fungal infection
A
Glucose
6
Q
Specimen volume must be?
Adult?
If pedriatic?
A
10-15 mL
12 mL
7
Q
In sediment preparation, Volumes of ____ and _____ mL are frequently used for microscopic exam.
A
0.5 and 1.0 mL
8
Q
When using the conventional glass-slide method, the recommended volume is _____ covered by a ______ mm glass cover slip.
A
20uL ( 0.02 mL) covered by 22x22 mm
9
Q
are reported as the average number per lowpower field (lpf) following examination of 10 fields
A
Casts
10
Q
as the average number per 10 highpower fields (hpf)
A
Rbcs and Wbcs
11
Q
are frequently reported in semi-quantitative terms:
- rare, few, moderate, many
- 1+, 2+, 3+, 4+
A
Epithelial cells, crystals and other elements
12
Q
Delineates structure and contrasting colors of the nucleus and cytoplasm.
Identifies WBCs, epithelial cells, and casts. Stains Neutrophil
A
SternheimerMalbin (Crystal Violet & Safranin
13
Q
Enhances nuclear detail
Differentiates WBCs and renal tubular epithelial cells
A
Toluidine Blue
14
Q
Lyses RBCs and enhances nuclei of WBCs
Distinguishes RBCs from WBCs, yeast, oil droplets, and crystals
A
2% Acetic Acid
15
Q
Stains triglycerides and neutral fats orange-red
A
Lipid Stains (Oil Red O, Sudan III)
16
Q
Differentiates gram-positive and gramnegative bacteria
Identifies bacterial casts
A
Gram stain
17
Q
Methylene blue and eosin Y stain eosinophilic granules
Identifies urinary eosinophils
A
Hansel Stain (Methylene blue & Eosin Y)
18
Q
Stains structures containing iron
Identifies yellowbrown granules of hemosiderin in cells and casts
A
Prussian Blue Stain
19
Q
releasing their hemoglobin and leaving only the cell membrane
A
GHOST CELLS
20
Q
urine, cells shrink due to loss of water and appear crenated or irregularly shaped
A
Concentrated/ hypersthenuric
21
Q
Urine cells absorb water swell and lyse rapidly, releasing their
A
In dilute (hyposthenuric)
22
Q
RBCs are the most difficult for students to recognize:
A
-RBCs’ lack of characteristic structures
- Variations in size
- Close resemblance to other sediment constituents
23
Q
dissolves RBC, not the Yeast cells
A
Add acetic acid
24
Q
RBC is red, Yeast is colorless
A
Stain with eosin
25
RBC with RBC cast (unique to the kidney) –
Renal disease
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RBC without cast and protein
Damaged distal to the kidney
27
Intact RBC found in?
Lower Tract
28
Crenated RBC
Upper tract
29
Dysmorphic RBC found in:
- Abnormal urine concentration
- Glomerular bleeding
- Non glomerular hematuria (in small amount)
- Strenuous exercise (in small amount
30
cloudy with a red to brown color. Microscopic analysis may be reported in terms of greater than 100/hpf. TNTC (too numerous to count)
Hematuria
31
Larger than RBCs, measuring an average of about 12 um in diameter
White blood cells
32
The predominant WBC in urine
• Exhibit Brownian movement (false motility) – because of the presence of granules with sparkling appearance
Neutrophils
33
Stain for for glitter cell
Sternheimer malbin
34
Associated with drug-induced interstitial nephritis
• Small amount urinary tract infection (UTI) and renal transplant rejection
Eosinophils
35
True or false more than 1% eosinophils is considered significant
True
36
Stain use for eosinophil
Hansel stain
37
Lymphocytes, Monocytes, Macrophage, Histiocytes
• Found in small amount
Mononuclear cells
38
mistaken as RBC because of its small size
Lymphocytes (agranulocyte)
39
Increased amount in early renal transplant rejection
Mononuclear cells
40
increased urinary WBC
Pyuria
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↑ WBC infection + cast • Cystitis + protein + bacteria • + turbidity + nitrite(gram negative) • - nitrite (gram positive)
Pyelonephritis
Cystitis
Prostatitis
Urethritis
42
↑WBC infection + cast + protein +turbidity - nitrite
Glomerulonephritis
Tumor
Interstitial nephritis
Lupus Erythematosus
43
Derived from the linings of the genitourinary system
Epithelial cells
44
Three types of epithelial cells are seen in urine:
Squamous
Rte cells
Transitional cells
45
•Largest cells found in the urine sediment
•Contain abundant, irregular cytoplasm and a
prominent nucleus about the size of an RBC
Squamous epithelial cells
46
Originate from the linings of the vagina and female urethra and the lower portion of the male urethra
Squamous epithelial cells
47
A variation of the squamous epithelial cell is called as?
Clue cells
48
indicative of vaginal infection by gardenella vaginalis
Clue cells
49
Smaller than squamous and appear in several forms:
- Spherical
- Polyhedral
- Caudate/ Cuboidal
Transitional epithelial cells
50
Originate from the lining of the renal pelvis (UT), calyces, ureters, bladder, and upper portion of male urethra
Transitional cells
51
•Most significant epithelial cell.
Vary in size and shape depending on the area of the renal tubules from which they originate – cuboidal, columnar with eccentrically located nucleus
RTE CELLS
52
More than 2 RTE cells/hpf caused what injury
Tubular injury
53
Lipid containing RTE CELLS
Seen in lipiduria
Oval fat bodies
54
Stain use to oval fat bodies
Sudan III / oil red o
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- larger than other RTE cells
- Rectangular shape
- referred as columnar or convoluted cells
RTE IN PCT
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smaller than those from the PCT
- round or oval/ spherical
RTE IN DCT
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• Only elements found in urinary sediment that are unique to the kidney
• Formed within the lumens of the DCT and collecting ducts, providing a microscopic view of conditions within the nephron
• Condition associated with upper urinary tract
Casts
58
main component of casts matrix
Uromodulin
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Matrix (boundary/ cell membrane) –
Tamm Horsfall Protein
60
(glycoprotein secreted by RTE cells in DCT and collecting ducts
Tamm Horsfall Protein
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final degenerative form of all types of casts)
Waxy cast
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presence of cast in urine
Cylinduria
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Most frequently seen cast
• Least clinical significance
• Consists almost entirely of Tamm-Horsfall protein
• Presence of 0-2 hyaline casts /lpf is considered normal
Hyaline casts
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strenuous exercise, dehydration, heat exposure, and emotional stress
Non-pathological causes of increase
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acute glomerulonephritis, pyelonephritis, chronic renal disease, and congestive heart failure.
Pathological causes of increase
66
Rbc casts is Easily detected under LPO by their ______ color
Orange red
67
Indicates bleeding from an area within the GUT
• If the RBC observed microscopically is crenated, morphic which have damage in cell membrane that is associated with upper bleeding
Rbc casts
68
RBC casts associated with glomerular damage are usually associated with
increase proteinuria and dysmorphic erythrocytes
69
Primarily associated with damage to the glomerulus (glomerulonephritis) that allows passage of the cells through the glomerular membrane
Rbc casts
70
Signifies infection/inflammation within the nephron
•Infection depends on other structures that can be observe
Wbc casts
71
Most frequently associated with ________and an ________marker for distinguishing
pyelonephritis and upper uti from lower uti
72
(+) bacteria
(+) wbc cells
(+) wbc cast
Upper uti
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(+) bacteria
(+) wbc
(-) wbc casts
Lower uti
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with matrix as compared to WBC in clumps
Wbc casts
75
is bacterial infection,
Pyelonephritis
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is nonbacterial infection
glomerulonephritis
77
Contain bacilli both within and bound to the protein matrix – seen in pyelonephritis
Bacterial casts
78
Confirmation of bacterial casts is best made by performing a?
cytocentrifuged sediment or Gram stain
79
Represent the presence of advanced tubular destruction, producing urinary stasis along with disruption of the tubular linings
Epithelial casts
80
epithelial cells that can be observed in urinary sediment:
Squamous
Rte
Transitional
81
never seen in epithelial cells casts; nonpathological; lower urinary tract)
Epithelial cell
82
stained RTE cells (Spherical) are seen in cases of hepatitis
Bilirubin
83
Fats do not stain with
Sternheimer-Malbin stains
84
Combination of Cellular Cast components in one matrix
MIXED CELLULAR CASTS
85
Most frequently encountered include:
- RBC and WBC casts in glomerulonephritis
- WBC and RTE cell casts, or WBC and bacterial casts in pyelonephritis
Mixed cellular casts
86
• Coarsely and finely granular casts are frequently seen in the urinary sediment
• May be of pathologic or non-pathologic significance
Granular casts
87
Representative of extreme urine stasis, indicating chronic renal failure
Usually seen in conjunction with other types of casts associated with the condition that caused the renal failure (granular casts
brittle, highly refractive cast matrix f
Waxy casts
88
They often appear fragmented with jagged ends and have notches in their sides
Waxy casts
89
Represent extreme urine stasis
•
Indicates destruction (widening) of the tubular walls.
Broad / renal failure casts
90
Most commonly – granular and waxy casts
• Associated with renal failure
Broad casts
91
Not normally present in urine (because the bladder is sterile where the urine stored)
Bacteria
92
To be considered significant for UTI, bacteria should be accompanied by
Wbc
93
UTI caused by
SES
Enterobacteriaceae, Staphylococcus and Enterococcus
94
• Small, refractile oval structures that may or may not contain a bud
• They may appear as branched, mycelial forms
Yeast
95
A true yeast infection should be accompanied by the presence of ____
and correlate to what analyte
WBC
Glucose
96
Yeast cells, primarily _______ (fungi), seen in diabetic, immunocompromised patients and women with
Candida albicans with vaginal moniliasis
97
The most frequent parasite encountered in the urine is ____________ easily identified in wet preparations of the urine sediment by its rapid darting movement in the microscopic field
Trichomonas vaginalis,
98
When not moving, Trichomonas is more difficult to identify and may resemble a
WBC,rte cells and transitional cells
99
Bacteria, parasite, fungi same manner of reporting which is
Semi quantitative
100
Oval, slightly tapered heads and long, flagella - like tails
Spermatozoa
101
instead going out to the urethra, it will going up to urinary bladder (sperm cell) and combine with urine which having a traces of sperm cell in sediment.
Retrograde ejaculation
102
Protein material produced by the glands and epithelial cells of the lower GUT and the RTE cells
Mucus
103
is a major constituent of mucus
Tamm-Horsfall protein
104
• Appears microscopically as thread-like structures with a low refractive index
Mucus
105
• Appears microscopically as thread-like structures with a low refractive index
Rte cells
106
Appear as true geometrically formed structures or as amorphous material
Urinary crystals
107
Formed by the precipitation of urine solutes, including inorganic salts, organic compounds, and medications
Crystal formation
108
appear yellow to reddish brown and are the only normal crystals found in acidic urine that appear colored
Urates crystals
109
not found in urine (Synovial fluid)
Sodium urates
110
Example of urates crystals
- Amorphous urates
- Uric acid
- Acid urates
- Sodium urates
111
• Appear as yellow- brown granules
• May occur in clumps resembling granular casts
• Common in refrigerated specimen
AMORPHOUS URATES
112
on the surface of the granules is the cause of the pink color
Uroerythrin
113
Seen in a variety of shapes -- rhombic, four-sided flat plates (whetstones), wedges, and rosettes
• Usually appear yellow-brown, but may be colorless and have a six-sided shape, similar to cystine crystals
• Highly birefringent under polarized light, which aids in distinguishing from cystine crystals
Uric acid crystals
114
Increased amounts of uric acid crystals are associated with increased levels of purines and nucleic acids seen in patients with
Leukemia undergo to chemotherapy, and , Lesch-Nyhan syndrome and gout
115
appear as larger granules and may have spicules similar to the ammonium biurate crystals seen in alkaline urine
Acid urates
116
crystals are needle-shaped and are seen in synovial fluid during episodes of gout, but do appear in the urine
Sodium urates
117
• Rarely encountered
• Frequently seen in conjunction with amorphous urates
• have little clinical significance
Acid urates and sodium urates
118
Frequently seen in acidic urine, but can be found in neutral urine and rarely in alkaline urine
Calcium oxalate
119
Most common form of calcium oxalate
Dihydrate
120
Most common easily recognized as colorless, octahedral envelope or two pyramids joined at their bases
Dihydrate
121
Less common in calcium oxalate
Monohydrate
122
which are oval or dumbbell shaped
Monohydrate
123
Clumps of calcium oxalate crystals may be related to
Renal calculi
124
Common constituents of kidney stone
Calcium oxalate
125
__________ is form in cases of ethylene glycol poisoning
Monohydrate
126
• Common
• pH acid or neutral
• Envelope or dumb bell shaped
• Oval – may be mistaken for RBC
• Soluble in HCl; Insoluble in acetic acid
Calcium oxalate
127
represent the majority of crystals seen in alkaline urine
Phosphates crystals
128
Types of phosphates crystals
- Amorphous phosphates
- Triple phosphates
- Calcium phosphates
129
What are the NORMAL CRYSTALS SEEN IN ALKALINE URINE
• Calcium carbonate
• Ammonium biurate • Phosphates crystals
130
• Granular in appearance, similar to amorphous urates
• When present in large quantities following specimen refrigeration, they cause a white precipitate that does not dissolve on warming
AMORPHOUS PHOSPHATES
131
• Ammonium Magnesium phosphate crystals
• Commonly seen in alkaline urine
TRIPLE PHOSPHATE
132
Easily identified by their prism shape that frequently resembles a “coffin lid”
TRIPLE PHOSPHATE
133
Dissolve in dilute acetic acid and sulfonamides do not Resembles sulfonamide crystals (needle shape
CALCIUM PHOSPHATE
134
• “Sheets of Ice”
• Rosettes
• Associated with Cystitis and Urine retention
CALCIUM PHOSPHATE
135
Small and colorless, with dumbbell or spherical shapes
CALCIUM CARBONATE
136
• May occur in clumps that resemble amorphous material, but they can be distinguished by the formation of gas after the addition of acetic acid
• They are also birefringent, which differentiates them from bacteria
• No clinical significance
CALCIUM CARBONATE
137
Acidic normal crystals are?
1. URATES CRYSTALS
- Amorphous urates
- Uric acid
- Acid urates
2. CALCIUM OXALATE
138
Alkaline normal crystals are?
1. Phosphates crystals
- Amorphous phosphates
- Triple phosphates
- Calcium phosphates
2. Calcium carbonate
3. Ammonium biurat
139
ABNORMAL CRYSTALS are
Cystine
• Cholesterol
• Crystals Associated with Liver Disorders – in s
- Tyrosine
- Leucine
- Bilirubin
• Sulfonamides
• Ampicillin
140
severe liver disorders, three rarely seen crystals may be found in the urine sediment:
- Tyrosine
- Leucine
- Bilirubin
141
Found in the urine of persons who inherit a metabolic disorder that prevents reabsorption of cystine by the renal tubules (cystinuria)
CYSTINE
142
Disintegrating forms may be seen in the presence of ammonia
• They may be difficult to diff
Cystine
143
Appear as colorless, hexagonal plates and may be thick or thin; not birefringent
Cystine
144
• Rarely seen unless specimens have been refrigerated, because lipids remain in droplet form
• Resembling a rectangular plate with a notch in one or more corners
Cholesterol
145
Associated with disorders producing lipiduria, such as the nephrotic syndrome, and are seen in conjunction with fatty casts and oval fat bodies
Cholesterol crystals
146
• appear as fine colorless to yellow needles that frequently form clumps or rosettes
• usually seen in conjunction with leucine crystals in specimens with positive chemical test results for bilirubin
Tyrosine
147
Encountered in inherited disorders of amino-acid metabolism
Tyrosine
148
Yellow-brown to golden yellow spheres that demonstrate concentric circles and radial striations
• They are seen less frequently than tyrosine
Leucine
149
• Present in hepatic disorders producing large amounts of bilirubin in the urine
• Appear as clumped needles or granules with the characteristic yellow color of bilirubin
Bilirubin
150
bilirubin crystals may be found incorporated into the
Matrix of casts
151
In disorders that produce renal tubular damage, such as viral hepatitis
Bilirubin
152
• Common among patients treated with UTI
• Inadequate patient hydration was and still is the primary cause of sulfonamide crystallization
Sulfonamides
153
• Shapes most frequently encountered include needles, rhombics, whetstones, sheaves of wheat, and rosettes with colors ranging from colorless to yellow-brown
Sulfonamides
154
Appear as colorless needles that tend to form bundles following refrigeration
Ampicilin
155
Precipitation of antibiotics is not frequently encountered
Ampicilin
