Microscopic Examination

Question 1

Polarized Light

2 things

Answer 1

Maltese cross pattern: cholesterol, starch, 4 glowing orbs in a clover pattern
Birefringent: glowing, most crystals, fibers, radiographic dye

Question 2

Cells: Red Cells

causes, where, test result

Answer 2

Damage to vascular system, renal disease

RBC cast and proteinuria: kidney/upper UT
No RBC cast or proteinuria: lower UT

Test: positive blood pad

Question 3

Cells: White Blood Cells

3 types, appearance and test result

Answer 3

Leukocyturia: inflammation, disease, infection

Casts and proteins: upper/kidney

Trace protein, no casts: lower/bladder

Appearance and test result: cloudy, smelly, positive leukocyte esterase

Question 4

Cells: SEC

Answer 4

Poor collection, normal

Question 5

Cells: TEC

Increased in what

Answer 5

Normal: 0-2
Increased: UTI, urinary inflammation

Question 6

Cells: RTE

significance

Answer 6

Tubular cells, collecting duct cells
Always significant: upper kidney infection, renal disease, sheets = tubular injury/death

Question 7

Cells: Oval Fat Bodies

Answer 7

RTE with absorbed fats, glomerular dysfunction with renal cell death
- Refractive
- Polarized microscope
- Fat stain

Question 8

Casts: Basics and Formation

increased in what, disintegration?, significance

Answer 8

Formed in tubules, formation of Tamm-Horsfall protein

Increased: acidic, more solutes, stasis, more proteins
Disintegration: alkaline, dilute
Significance: more in number type and size

Question 9

Casts: Homogenous - Hyaline

increased

Answer 9

Low refractile
Pretty normal
Increased: dehydration, exercise

Question 10

Casts: Homogenous - Waxy

significance

Answer 10

NOT NORMAL
Highly refractile

Significance: chronic renal disease, renail failure, advanced stage cast

Question 11

Casts: Inclusion - Granular

significance

Answer 11

Protein/cell degradation products, very refractile

NOT NORMAL (or heavy exercise)

Significance: renal disease

Question 12

Casts: Inclusion - Fatty

signif.

Answer 12

Free fat or OFB, maltese cross pattern
NOT NORMAL

Significance: some renal diseases

Question 13

Casts: Inclusion - Other

Answer 13

Elements: hemosiderin, crystals

Pigmented: hyaline with colo from myoglobin, hemoglobin, etc.

Question 14

Casts: Cellular - RBC

Answer 14

NOT NORMAL
Significance: glomerular disease

Question 15

Casts: Cellular - WBC

Answer 15

NOT NORMAL
Significance: glomerular disease, infection/inflammation

Question 16

Casts: Cellular - Other

Answer 16

Mixed cells, bacterials

Broad casts: poor prognosis, urinary stasis, can be any type

Question 17

Casts: Cellular - Renal Tubular

Answer 17

Severe cell death
ALWAYS PATHOGENIC, rare
Significance: tubular necrosis

Question 18

Crystals: Formation

Answer 18

Depends on concentration, pH, temp/time, flow through tubules

Form outside of body

Question 19

Crystals: Acidic - Amorphous Urates

Answer 19

No significance
Increased: fridge
Dissolve: alkaline, heated

Question 20

Crystals: Acidic - Uric Acid

Answer 20

Diamond, rhombus, rosette
- Very acidic
- Colorful birefringence
Increased: gout, cytotoxic drugs

Question 21

Crystals: Acidic - Calcium Oxalate

Answer 21

Pretty normal
- Dissolves in HCl, large pH range
- Birefringent

Increased: food, kidney stone

Question 22

Crystals: Acidic - Hippuric Acid

Answer 22

No significance
- Ethylene glycol poisoning

Question 23

Crystals: Acidic - Sodium Urate

Answer 23

Nor important, amorph

Question 24

Crystals: Acidic - Bilirubin

Answer 24

Amber, large granules, fine needles

• Fridge
• Always abnormal, check chemical exam

Question 25

Crystals: Acidic - Tyrosine

Answer 25

Sheaves, yellow, needles - Rare **Abnormal:** congenital overflow, causes damage from needles

Question 26

Crystals: Acidic - Leucine

Answer 26

Tree trunk - Dissolves in alkaline **Abnormal:** congenital overflow, liver issues

Question 27

Crystals: Acidic - Cholesterol

Answer 27

Clear, flat, corner notch - Colorful birefringence **Abnormal:** tissue breakdown, renal disease, lymphatic rupture

Question 28

Crystals: Acidic - Cystine

Answer 28

pH less than 8 Hexagon plates, clear, refractile **Abnormal:** tubule damage, congenital overflow

Question 29

Crystals: Acidic - Radiographic Dye

Answer 29

Large needles or plates - Birefringent **- Specific gravity of over 1.040**

Question 30

Crystals: Alkaline - Amorphous Phosphates

Answer 30

pH 7.0, colorless grains **Increased:** fridge - Soluble in acetic acid - Does not dissolve when heated NO BIGGIE

Question 31

Crystals: Alkaline - Triple Phosphate

Answer 31

Coffin lid - Normal urine - Sometimes kidney stones

Question 32

Crystals: Alkaline - Calcium Phosphate

Answer 32

Short prisms - Normal urine - Kidney stones

Question 33

Crystals: Alkaline - Calcium Carbonate

Answer 33

No biggie, large amorph

Question 34

Crystals: Alkaline - Ammonium Biurate

Answer 34

Very alkaline, yellow/brown spheres, spicules, old urine Normal in vitro NOT normal in body (vivo)