Practicum Flashcards
(113 cards)
1
Q
Under what magnification are urine cells enumerated?
A
400x
2
Q
How may TNTC (too numerous to count) RBCs be dispersed so other sediment may be evaluated?
A
2% acetic acid will lyse the RBCs
3
Q
Casts and ____ go hand-in-hand in a urine sediment
A
protein
4
Q
Identify possible causes of a false negative dipstick test for blood.
A
ascorbic acid
high specific gravity
high nitrite
5
Q
Which crystals appear in acid urine?
A
ampicillin amorphous urate aspirin bilirubin calcium phosphate calcium oxalate cholesterol cysteine hemosiderin hippuric acid leucine sulfonamide tyrosine uric acid x-ray media
6
Q
Which crystals appear in alkaline urine?
A
- ammonium biurate
- amorphous phosphate
- calcium carbonate
- calcium phosphate
- calcium oxalate
- triple phosphate
7
Q
Cystine
A
1) Can indicate congenital cystinosis or cystinuria, tend to deposit in tubules as calculi resulting in renal damage. 2) Can be caused by pyelonephritis, diet high in animal fat and protein.
8
Q
Bilirubin
A
1) Indicates liver disease. 2) Formed when large amount of bilirubin is present in urine.
9
Q
Leucine
A
1) Indicates aminoaciduria or severe liver disease. 2) Very water soluble so rarely seen.
10
Q
Tyrosine
A
1) Indicates aminoaciduria or severe liver disease. 2) Water soluble so rarely seen but found more often than leucine.
11
Q
Cholesterol
A
1) Rare; always accompanied by large amount of protein & other fats. 2) Seen in nephrotic syndrome & conditions resulting in chyluria (rupture of lymphatic vessels into renal tubules).
12
Q
Uric Acid
A
1) Can be non-pathologic but large numbers seen in gout & conditions of increased purine metabolism (cytotoxic drugs used in leukemia). 2) Crystals form as body tries to rid itself of excessive uric acid in the blood possibly caused by overweight, rich diet, exposure to lead or genetic predisposition.
13
Q
Calcium Oxalate
A
1) Non-pathologic with ingestion of high oxalate foods but also seen in ingestion of antifreeze and severe chronic renal disease. 2) Oxalic acid (metabolite of ascorbic acid) will combine with Ca2+ in urine to form calcium oxalate.
14
Q
Ampicillin
A
1) Rare. 2) Indicates large doses of ampicillin (antibiotic).
15
Q
Calcium Phosphate
A
1) Not clinically significant 2) Calcium and phosphate combine in urine to form an insoluble complex.
16
Q
Hippuric acid
A
1) No clinical significance. 2) Might be seen in ethylene glycol (antifreeze) intoxication or exposure to toluene in atmosphere.
17
Q
Aspirin
A
1) Extremely rare; if seen indicates overdose of aspirin (salicylic acid poisoning). 2) Excess aspirin in body excreted in urine where it may crystalize in acid urine.
18
Q
Sulfonamide
A
1) Rare; renal damage uncommon 2) Original drug was insoluble & formed crystals in renal tubules causing damage. Current drugs do not have solubility problems.
19
Q
x-ray media
A
1) Not clinically significant but may be mistaken for cholesterol. 2) Crystals can form in acid urine as body excretes the dye.
20
Q
Triple Phosphate
A
1) No clinical significance but can be associated with UTI in alkaline pH. 2) Ammonium combines with magnesium and phosphate in alkaline urine to form “coffin lid” crystals.
21
Q
Ammonium biurate
A
1) Not clinically significant unless found in fresh urine (extremely rare). Can be mistaken for sulfonamide. 2) Forms as urine ages. If seen, must check collection time of specimen.
22
Q
Calcium carbonate
A
1) No clinical significance. Can be mistaken for bacteria. 2) Can be seen after large consumption of vegetables.
23
Q
Amorphous urate & Amorphous phosphate
A
1) Not clinically significant but can make microscopy difficult. Enhanced when urine is refrigerated. 2) Can only be distinguished by acetic acid or heating to 60C (urate will dissolve when heated, phosphate will not).
24
Q
RBCs
A
1) Increased # indicates renal bleed, either glomerular or tubular. Assoc. with casts and proteinuria. 2) Indicates glomerulonephritis, pyelonephritis, cystitis, calculi, tumors or trauma. If no casts or proteinuria, bleed is below the kidney or may be contamination.
25
WBCs
1) Increased # indicates inflammation of urinary tract. 2) Indicates bacterial/parasitic infections or renal diseases (glomerulonephritis, chlamydia, mycoplasmosis, TB, trichomonas, mycoses).
26
Eosinophils
1) Discrimination of eos from WBCs often impossible. 2) Indicates acute interstitial nephritis (AIN) or chronic UTIs.
27
Lymphocytes
1) Normally present in urine in small #. Not normally distinguished from WBCs but large # is significant. 2) Present in inflammatory conditions such as acute pyelonephritis or in renal rejection transplant.
28
Monocytes & Macrophages
1) Increased in viral conditions 2) Drawn to site of inflammation resulting from renal infection or immune reactions.
29
Transitional Epithelial
1) Indicates inflammation or renal damage if large #. 2) Can be UTI. Clusters/sheets seen after catheritization but if no instrumentation used, indicates a pathologic process.
30
Squamous Epithelial
1) Not clinically significant. 2) Indicates specimen contamination.
31
Convoluted Renal Tubular Epithelial
1) Increased in acute ischemic or toxic renal tubular disease. 2) Indicates heavy metal or drug toxicity.
32
Collecting Duct Renal Epithelial
1) Very significant 2) All types of renal disease (nephritis, acute tubular necrosis, kidney transplant rejection, salicylic poisoning).
33
Oval fat bodies
1) Indicates glomerular dysfunction with renal tubular cell death & leakage of plasma into urine. Assoc. with proteinuria & casts. 2) Renal tubular cells become engorged with fats from tubular lumen or own degenerating intracellular lipids.
34
Cytomegalic Inclusion Bodies
1) Indicates viral infection affecting newborns with liver, spleen & blood disorders and adults with Hodgkins, leukemia & aplastic anemia. 2) Viral inclusions found in nucleus of renal tubular epithelial cells.
35
Hyaline
1) Normal in low numbers. High numbers can indicate strenuous exercise, dehydration, fever, stress, renal disease or congestive heart failure (CHF). 2) Composed of homogenous Tamm-Horsfall (T-H) protein matrix and formed within tubules.
36
Waxy
1) Indicates urinary stasis 2) Formed when granular cast degenerates as it sits in the renal tubule.
37
Granular
1) Finely granular in low numbers can be normal. Coarse granular and broad granular indicates poor prognosis. Assoc. with renal tubular epithelial cell casts and proteinuria. 2) Coarse granular results from degeneration of renal cells and other casts. Broad granular indicates renal damage.
38
Broad
1) Renal Failure, increase # is poor prognosis. 2) Cast forms in dilated convoluted tubules or collecting ducts indicating severe urinary stasis.
39
Renal Tubular Epithelial Cast
1) Indicates renal tubular disease. Assoc with proteinuria and granular casts. 2) Renal epithelial cells become incorporated into the T-H matrix as it sits in the tubule (urinary stasis).
40
Red Blood Cell Cast
1) Diagnostic of intrinsic renal disease. Assoc with proteinuria. Occasionally found in healthy people 24-48 hrs after contact sports. 2) RBCs from glomerulus or tubular damage.
41
Leukocyte (WBC) Cast
1) Indicates renal inflammation or infection. 2) Glomerulonephritis will also have RBC casts; Pyelonephritis will also have proteinuria and hematuria.
42
Bacterial Cast
1) Not often IDed because difficult to see, diagnostic of pyelonephritis. 2) Usually contains WBCs so often reported as WBC cast.
43
Fatty Cast
1) Significant renal pathology: nephrotic syndrome or severe crush injury. 2) Usually contained with hyaline or granular matrix and assoc. with proteinuria.
44
Hemosiderin & crystals
1) Sulfonamide & Ca oxalate most common. Assoc with hematuria. 2) Any substance present in tubular lumen can be in casts.
45
Pigmented casts
Hb & Myoglobin: yellow to brown with hematuria Bilirubin: all urine sediment will be yellow-golden brown Urobili: yellow-golden but will not color sediment Phenazopyridine (urinary pain killer): brown to reddish brown
46
What is the principle of the reaction for pH with dipstick method (Multistix)?
Oxidized dye (yellow) reacts with hydrogen ions to produce hydrogen and reduced dye (green to blue).
47
What is the principle of the reaction for protein with dipstick method (Multistix)?
An indicator dye added to protein in presence of pH3.0 will produce a blue-green color as hydrogen ions are released from the indicator dye.
48
What is the principle of the reaction for nitrite with dipstick method (Multistix)?
With an acid pH, nitrite in urine reacts with para-arsanilic acid to form a diazonium compound, which in turn couples with 1,2,3,4-tetrahydrobenzo(h)quinolin-3-ol to produce a pink color.
49
What is the principle of the reaction for glucose with dipstick method (Multistix)?
Glucose oxidase catalyzes the oxidation of glucose in urine to form a hydrogen peroxide and gluconic acid. The hydrogen peroxide then oxidizes the chromogen on the pad in the presence of the peroxidase.
50
What is the reason for a negative dipstick for glucose and a positive Clinitest?
A reducing substance is present (e.g. sucrose)
51
What is the principle of the reaction for ketones with dipstick method (Multistix)?
Acetoacetic acid in an alkaline medium reacts with sodium nitroprusside (nitroferricycanide) to produce a color change from beige to purple.
52
What is the principle of the reaction for bilirubin with dipstick method (Multistix)?
Bilirubin reacts with a diazonium salt (diazotized 2,4-dichloroaniline) in acid medium to form an azodye (color changes from light tan to beige).
53
What is the principle of the reaction for leukocyte esterase with dipstick method (Multistix)?
Leukocyte esterases cleave ester to form an aromatic compound which then combines with diazonium salt in acid pH to produce an azodye (color changes from beige to violet).
54
What is the principle of the reaction for specific gravity with dipstick method (Multistix)?
Ionic solutes in urine cause protons to release from a polyelectrolyte. As protons are released, the pH decreases and produces a color change of the bromthymol blue indicator from blue-green to yellow-green.
55
How may amorphous be dispersed so other sediment may be evaluated?
2% acetic acid gets rid of amorph phosphate. Heat to 60\*C gets rid of amorph urates.
56
What organism may be found in the urine of diabetics?
Yeast
57
What type of urine specimen provides an overall picture of the patient's health?
Random specimen
58
List various types of preservatives and their uses.
1) Refrigeration: routine analysis up to 24 hours. 2) Commercial transport tubes (boric acid): preserves urine for longer time at RT; routine analysis. 3) Thymol: preserves sediments, inhibits bacteria & yeast. 4) KNOW Formalin: cellular preservation, will cause false-negative in blood & urobili reagent tests; used in cytology. 5) Saccomanno's fixative: cellular preservation; used in cytology. 6) Acids (HCl, glacial acetic acid): UNACCEPTABLE for urinalysis! 7) Sodium carbonate: UNACCEPTABLE for urinalysis!
59
What is the clinical significance of bilirubin &/or urobilinogen in a urine specimen?
Any bilirubin in urine is not normal; can indicate hepatitis, cirrhosis or biliary obstruction. But negative in chronic liver disease. Small amount of urobilinogen is normal in urine. Increased amount can indicate hepatitis, cirrhosis or hemolytic states (pernicious anemia). Decreased in chronic liver disease (remember, cannot report negative Uro).
60
What is the SG of normal urine?
1.002 to 1.030
61
What is the significance of ketones in the urine?
Indicates fat metabolism resulting from starvation or deficiency in carbohydrate metabolism.
62
How is urine osmolality determined?
Measured by freezing point depression or vapor pressure osmometer. Unaffected by heavy molecules, all solutes contribute equally. Normal value is 275-900 mOsm/kg of water.
63
What are the findings on the dipstick with a UTI?
Protein: small (
64
What are the findings on the dipstick with a HTR?
Elevated urobilinogen but not bile.
65
Define Addis count
Count of # of WBCs, RBCs & casts in a 12 hr overnight period when patient is not eating or drinking; used to follow progress of renal disease, not commonly done.
66
Define Sensitivity
Ability of a test to pick up the lowest level of pathological concentrations, but not normal urine levels.
67
Define Specificity
Ability of test to react specifically to the substance being tested and no other.
68
Define Glitter Cells
Neutrophils in hypertonic solution swell causing Brownian movement in cytoplasmic granules.
69
What urinary crystal appears in more forms than any other crystal?
Uric acid crystals (?)
70
How may RBCs and yeast plus WBCs and renal epithelial cells be differentiated?
Acetic acid lyses RBCs but not yeast, WBC or RE and it will accentuate nuclei of WBC. Toluidine blue will also accentuate WBC nuclei. RE have large, dense nuclei and polygonal shape where WBCs and RBCs are spherical. Yeast vary in size, are not biconcave and usually are budding.
71
What sugar is a non-reducing sugar?
Sucrose (any sugar that has an aldehyde group or can form one)
72
How may myoglobin and hemoglobin be differentiated?
80% Ammonium sulfate precipitation: Hb precipitates out of solution but myoglobin remains soluble.
73
What is the best way to find urinary casts in a microscopic field?
Low power, dim light
74
What is the most common constituent of renal calculi?
Calcium oxalate
75
1) Can indicate congenital cystinosis or cystinuria, tend to deposit in tubules as calculi resulting in renal damage. 2) Can be caused by pyelonephritis, diet high in animal fat and protein.
Cystine
76
1) Indicates liver disease. 2) Formed when large amount of bilirubin is present in urine.
Bilirubin
77
1) Indicates aminoaciduria or severe liver disease. 2) Very water soluble so rarely seen.
Leucine
78
1) Indicates aminoaciduria or severe liver disease. 2) Water soluble so rarely seen but found more often than leucine.
Tyrosine
79
1) Rare; always accompanied by large amount of protein & other fats. 2) Seen in nephrotic syndrome & conditions resulting in chyluria (rupture of lymphatic vessels into renal tubules).
Cholesterol
80
1) Can be non-pathologic but large numbers seen in gout & conditions of increased purine metabolism (cytotoxic drugs used in leukemia). 2) Crystals form as body tries to rid itself of excessive uric acid in the blood possibly caused by overweight, rich diet, exposure to lead or genetic predisposition.
Uric Acid
81
1) Non-pathologic with ingestion of high oxalate foods but also seen in ingestion of antifreeze and severe chronic renal disease. 2) Oxalic acid (metabolite of ascorbic acid) will combine with Ca2+ in urine to form calcium oxalate.
Calcium Oxalate
82
1) Rare. 2) Indicates large doses of ampicillin (antibiotic).
Ampicillin
83
1) Not clinically significant 2) Calcium and phosphate combine in urine to form an insoluble complex.
Calcium Phosphate
84
1) No clinical significance. 2) Might be seen in ethylene glycol (antifreeze) intoxication or exposure to toluene in atmosphere.
Hippuric acid
85
1) Extremely rare; if seen indicates overdose of aspirin (salicylic acid poisoning). 2) Excess aspirin in body excreted in urine where it may crystalize in acid urine.
Aspirin
86
1) Rare; renal damage uncommon 2) Original drug was insoluble & formed crystals in renal tubules causing damage. Current drugs do not have solubility problems.
Sulfonamide
87
1) Not clinically significant but may be mistaken for cholesterol. 2) Crystals can form in acid urine as body excretes the dye.
x-ray media
88
1) No clinical significance but can be associated with UTI in alkaline pH. 2) Ammonium combines with magnesium and phosphate in alkaline urine to form "coffin lid" crystals.
Triple Phosphate
89
1) Not clinically significant unless found in fresh urine (extremely rare). Can be mistaken for sulfonamide. 2) Forms as urine ages. If seen, must check collection time of specimen.
Ammonium biurate
90
1) No clinical significance. Can be mistaken for bacteria. 2) Can be seen after large consumption of vegetables.
Calcium carbonate
91
1) Not clinically significant but can make microscopy difficult. Enhanced when urine is refrigerated. 2) Can only be distinguished by acetic acid or heating to 60C (urate will dissolve when heated, phosphate will not).
Amorphous urate & Amorphous phosphate
92
1) Increased # indicates renal bleed, either glomerular or tubular. Assoc. with casts and proteinuria. 2) Indicates glomerulonephritis, pyelonephritis, cystitis, calculi, tumors or trauma. If no casts or proteinuria, bleed is below the kidney or may be contamination.
RBCs
93
1) Increased # indicates inflammation of urinary tract. 2) Indicates bacterial/parasitic infections or renal diseases (glomerulonephritis, chlamydia, mycoplasmosis, TB, trichomonas, mycoses).
WBCs
94
1) Discrimination of eos from WBCs often impossible. 2) Indicates acute interstitial nephritis (AIN) or chronic UTIs.
Eosinophils
95
1) Normally present in urine in small #. Not normally distinguished from WBCs but large # is significant. 2) Present in inflammatory conditions such as acute pyelonephritis or in renal rejection transplant.
Lymphocytes
96
1) Increased in viral conditions 2) Drawn to site of inflammation resulting from renal infection or immune reactions.
Monocytes & Macrophages
97
1) Indicates inflammation or renal damage if large #. 2) Can be UTI. Clusters/sheets seen after catheritization but if no instrumentation used, indicates a pathologic process.
Transitional Epithelial
98
1) Not clinically significant. 2) Indicates specimen contamination.
Squamous Epithelial
99
1) Increased in acute ischemic or toxic renal tubular disease. 2) Indicates heavy metal or drug toxicity.
Convoluted Renal Tubular Epithelial
100
1) Very significant 2) All types of renal disease (nephritis, acute tubular necrosis, kidney transplant rejection, salicylic poisoning).
Collecting Duct Renal Epithelial
101
1) Indicates glomerular dysfunction with renal tubular cell death & leakage of plasma into urine. Assoc. with proteinuria & casts. 2) Renal tubular cells become engorged with fats from tubular lumen or own degenerating intracellular lipids.
Oval fat bodies
102
1) Indicates viral infection affecting newborns with liver, spleen & blood disorders and adults with Hodgkins, leukemia & aplastic anemia. 2) Viral inclusions found in nucleus of renal tubular epithelial cells.
Cytomegalic Inclusion Bodies
103
1) Normal in low numbers. High numbers can indicate strenuous exercise, dehydration, fever, stress, renal disease or congestive heart failure (CHF). 2) Composed of homogenous Tamm-Horsfall (T-H) protein matrix and formed within tubules.
Hyaline
104
1) Indicates urinary stasis 2) Formed when granular cast degenerates as it sits in the renal tubule.
Waxy
105
1) Finely granular in low numbers can be normal. Coarse granular and broad granular indicates poor prognosis. Assoc. with renal tubular epithelial cell casts and proteinuria. 2) Coarse granular results from degeneration of renal cells and other casts. Broad granular indicates renal damage.
Granular
106
1) Renal Failure, increase # is poor prognosis. 2) Cast forms in dilated convoluted tubules or collecting ducts indicating severe urinary stasis.
Broad
107
1) Indicates renal tubular disease. Assoc with proteinuria and granular casts. 2) Renal epithelial cells become incorporated into the T-H matrix as it sits in the tubule (urinary stasis).
Renal Tubular Epithelial Cast
108
1) Diagnostic of intrinsic renal disease. Assoc with proteinuria. Occasionally found in healthy people 24-48 hrs after contact sports. 2) RBCs from glomerulus or tubular damage.
Red Blood Cell Cast
109
1) Indicates renal inflammation or infection. 2) Glomerulonephritis will also have RBC casts; Pyelonephritis will also have proteinuria and hematuria.
Leukocyte (WBC) Cast
110
1) Not often IDed because difficult to see, diagnostic of pyelonephritis. 2) Usually contains WBCs so often reported as WBC cast.
Bacterial Cast
111
1) Significant renal pathology: nephrotic syndrome or severe crush injury. 2) Usually contained with hyaline or granular matrix and assoc. with proteinuria.
Fatty Cast
112
1) Sulfonamide & Ca oxalate most common. Assoc with hematuria. 2) Any substance present in tubular lumen can be in casts.
Hemosiderin & crystals
113
Hb & Myoglobin: yellow to brown with hematuria Bilirubin: all urine sediment will be yellow-golden brown Urobili: yellow-golden but will not color sediment Phenazopyridine (urinary pain killer): brown to reddish brown
Pigmented casts
