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Diagnostics Exam 4 > Microscopic UA > Flashcards

Microscopic UA Flashcards

1
Q

When is microscopic examination typically performed?

A

On urine specimens that….

  1. Show some abnormalities on the physical and chemical analysis (UA w/ reflex to microscopic)
  2. Come from patients with known renal disease (e.g. chronic kidney disease)
  3. Microscopic specifically ordered by the clinician (complete UA)
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2
Q

What is microscopic examination used to identify?

A
  1. Cells
  2. Casts
  3. Crystals
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3
Q

What is normal sediment?

A
  1. Red Blood Cell (RBC) count: small amount is normal
  2. White Blood Cell (WBC) count : small amount is normal
  3. Epithelial cells: occasionally can be normal, can indicate contamination
  4. Bacteria: should NOT be present
  5. Casts: Should NOT be present
  6. Crystals: should NOT be present
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4
Q

Is CKD reversible?

A

NO. CKD is rarely reversible

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5
Q

CKD pathophysiology

A
  1. Rarely reversible
  2. Progressive decline in renal function, even after the cause has been removed
  3. Reduction in renal mass → hypertrophy of the remaining nephrons
  4. Hyperfiltration of remaining nephrons
  5. GFR in these nephrons is at a supranormal level…overall GFR still declines

*Once once nephron fails, the rest will fail over time due to increased stress on other nephrons which will result in a decreased GFR

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6
Q

What are associated conditions with RBCs found in the urine?

A
  1. Infection (pyelonephritis, cystitis)
  2. ureterolithiasis
  3. GU malignancy (bladder cancer)
  4. Renal cyst
  5. Acute kidney injury (AKI)
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7
Q

What are associated conditions with WBCs found on microscopy?

A
  1. Infection (pyelonephritis, cystits, urethritis)
  2. Renal inflammatory processes (interstitial nephritis)
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8
Q

What conditions are associated with Renal tubular epithelial cells found on microscopy?

A

***Always abnormal****

  1. AKI (acute tubular necrosis, interstitial nephritis)
  2. Nephrotic syndrome
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9
Q

What conditions are associated with squamous epithelial cells found on microscopy?

A

Contaminated catch

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10
Q

What conditions are associated with oval fat bodies found on microscopy?

A
  1. Nephrotic syndrome
  2. Autosomal dominant polycystic kidney disease
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11
Q

Graph of major causes of hematuria by age and duration

A
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12
Q

What do “dysmorphic RBCs” indicate on a urine microscopy report?

A

injury or pathology on the glomerular level

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13
Q

What are Urinary casts?

A
  1. Urinary proteins form fibrils that attach to the epithelial cells lining the tubule lumen as:
  • Urine in tubules becomes very concentrated (ex: dehydration)
  • Urine flow ceases (stasis)
  • Urinary pH is very low
  • Urinary salt concentration is high
  1. Fibrils may intertwine to form casts
  • Casts may in turn entrap chemicals or formed elements that are present in the urine
  • Casts are eventually washed out of their point of origin and appear in the urine

***Urinary casts are unique to the kidneys

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14
Q

How do urinary casts appear?

A

They appear as cylindrical, cigar-shaped bodies that represent molds or “casts” of the lumen of the renal tubule in which they were formed

  • Distal convoluted tubule
  • Collecting duct
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15
Q

What is the major protein constituent of normal urine and that often forms the commen matrix of casts?

A

Tamm-Hosfall glycoprotein is the major protein constituent

  • It is a major defense protein of urothelium against bacteria
  • Reagent chemical strips do not detect this protein (dipstick wont turn positive), because it is so heavily glycosylated
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16
Q

what is an element of the urine that is truly unique to the kidney?

A

Urinary casts!

Casts are the only formed element of urine that is truly unique to the kidney

ex: WBCs can be from many different things/organs but WBC casts are ONLY from the kidney

17
Q

What conditions are associated with hyaline casts seen on microscopy?

A

nonspecific

may be “normal”- due to dehydration, concentrated urine

*If this is due to dehydration/concentrated urine then you would also see a high specific gravity and the color of the urine would be amber or dark yellow

18
Q

What conditions are associated with white blood cell casts seen on microscopy?

A
  1. infection (pyelonephritis)
  2. AKI/renal inflammatory processes (interstitial nephritis)
19
Q

What conditions are associated with red blood cell casts seen on microscopy?

A
  1. AKI (glomerulonephritis)
  2. Nephritic syndrome
20
Q

What conditions are associated with granular casts seen on microscopy?

A

AKI (acute tubular necrosis

21
Q

What conditions are associated with renal tubular epithelial cell casts seen on microscopy?

A
  1. AKI (acute tubular necrosis, interstitial nephritis)
  2. Nephritic syndrome
22
Q

What conditions are associated with waxy casts seen on microscopy?

A

nonspecific

CKD

23
Q

What conditions are associated with broad casts seen on microscopy?

A

CKD

24
Q
A
25
Q

Which urinary cast is ALWAYS an abnormal finding?

A

renal tubular epithelial cell cast

26
Q

What urine crystals are normal for acidic pH?

A
  1. Uric acid crystal
  2. Amorphous urates
  3. Calcium oxalate
27
Q

What types of urine crystals are normal for neutral pH?

A
  1. Triple phosphate
  2. Ammonium biurate
  3. Calcium carbonate
  4. Calcium oxalate
28
Q

What types of urine crystals are normal for alkaline pH?

A
  1. Triple phosphate
  2. Ammonium biurate
  3. Calcium carbonate
  4. Calcium phosphate
  5. Amophous phosphates
29
Q

Where are abnormal urinary crystals usually found?

A

in acidic urinary pH

30
Q

Abnormal urinary crystals

A
  • Typically found in acidic urinary pH
  • Always require confirmation, meaning they need chemical testing to identify the nature of the crystal

-Correlation to patients drug history because some medications can cause abnormal urianry crystals

**For testing purposes- any crystal that is not on the normal urinary crystal list that he gave we do not need to know. Won’t be asked “which of the following is an abnormal urinary crystal”- dont need to know names

31
Q

What different things can cause abnormal urinary crystals?

A
  1. Antibiotics – Ampicillin, Sulfonamides
  2. Amino Acids – Cystine, Leucine, Tyrosine
  3. Altered metabolism – Bilirubin, Cholesterol
  4. Radiographic Contrast Media
32
Q

When would a urine culture and sensitivity be performed?

A
  1. UA w/ reflex to microscopic and/or culture
  2. Symptomatic complaints that raise concern for infection (dysuria, increased frequency, fever, flank pain, etc). Ways to treat:
  • Empiric treatment
  • Urinalysis with treatment
  • Urinalysis with culture and pretreatment
33
Q

What are urine culture indications?

A
  1. Evidence based medicine- important to consider patient’s expectations, individual clinical expertise and best available clinical evidence
  2. Suspicion of complicated infection
  3. Presentation suggestive of pyelonephritis
  4. Failure to respond to initial therapy, raising the possibility of a resistant organism
  5. Recurrent symptoms (less than 1 month) after treatment of a previous UTI for which no culture was performed
34
Q

When are urine culture results typically available and how long until they are considered negative?

A
  • Urine collected and send for culture
  • This usually includes a preliminary gram stain
  • Sensitivity of any organisms is usually helpful as well
  • Typically results available 24-48 hours but test considered negative after 5 days
35
Q
A
36
Q

Urine culture and sensitivity result patterns

A
  • No Growth
  • 100 cfu (colony forming units)
  • 1000 cfu
  • 10,000 cfu
  • 50,000 cfu- intermediate result—> This is an “on the fence” culture result
  • >100,000 cfu (typically the cutoff for what is considered infection)

Diagnostics Exam 4 (3 decks)

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