Quiz 3 Flashcards
(128 cards)
0
Q
Specimen Preparation
A
Fresh and adequately preserved
Well mixed
1
Q
What is the purpose of a microscopic examination?
A
To detect, identify, and semi-quantitate formed elements in the urine sediment
2
Q
Specimen Volume
A
10-15 ml in conical tube (usually 12 ml)
3
Q
Centrifugation
A
Do not use brake and cap all specimens usually 1500 rpm for 5 minutes
4
Q
Sediment Preparation
A
Leave volume of 1.0 ml or 12:1 concentration
Aspirate supernate with pipette
Gently resuspend the sediment
5
Q
Volume of Sediment Examined
A
Traditional – 1 drop with 22x22 glass cover slip; avoid overflow outside cover slip
6
Q
Examination of Sediment
A
Bright field most common microscopy used
Reduce light and use continuous fine adjustment focusing
Exam under power (100x) at least 10 field
Identify using high power (400x) for at least 10-15 fields
7
Q
Kova Stain
- Chemicals
- Identification
A
Most frequently used
- Crystal violet and Safranin O
- Identify WBCs, Epithelial, and Casts
8
Q
2% Acetic Acid
- Purpose
- Identification
A
- Lyses RBCs
2. Distinguish WBC, yeast, oil droplets, and crystals
9
Q
Lipid Stains
- Chemicals
- Identifies
A
- Oil Red O and Sudan III
2. Stains Triglycerides and neutral fats orange-red, but does not stain cholesterol
10
Q
Prussian Blue Stain
1. Stain
A
- Stain hemosiderin blue
11
Q
Cytodiagnostic Urine Testing
- What department?
- Type of stain?
- Clinical Significance
A
- Cytology Department
- Papanicolaou Stain
- Renal disease and malignancies of lower urinary tract
12
Q
What is the normal value for RBC in the urine sediment?
A
0-2 RBC / hpf
13
Q
What is the normal value for WBC in a urine sediment?
A
0-4 / hpf
14
Q
What is the normal value of epithelial cells in the urine sediment?
A
Few epithelial cells
15
Q
What is the normal value of hyaline casts in a urine sediment?
A
0-2 Hyaline casts / lpf
16
Q
What is the normal amount of mucus found in a urine sediment?
A
Trace amounts
17
Q
How do you calculate the amount of red blood cells in a microscopic?
A
Calculate average # in 10 hpf
18
Q
Crenated Red Blood Cells
A
Hypersthenuric –> high osmotic pressure in urine
19
Q
Ghost Cells
A
Lysed RBCs with only cell membrane left –> result of acetic acid
20
Q
Dysmorphic Red Blood Cells
A
Indicative of glomerular damage
Vary in size and cellular background
21
Q
Hematuria
A
Presence of RBC in urine
22
Q
What does hematuria indicate?
A
Renal disease; bleeding in urinary tract; infection; tumor; strenuous exercise; trauma; inflammation; stones; catheterization
23
Q
Pyuria
A
Presence of WBC in urine
24
How do you calculate white blood cells in a microscopic?
Calculate # / hpf (using at least 10 fields)
25
What white blood cell is most common in the urine?
Granulated, multilobed nucleated neutrophils
26
Glitter Cells
Neutrophils that have swelled due to a hypotonic urine
27
Eosinophils
Drug induced allergies
28
Mononuclear cells
Monocytes, lymphocytes, macrophages, histiocytes
29
What stain is used to enhance nuclear detail of white blood cells?
Supravital stains or acetic acid
30
What are white blood cells in the urine sediment indicative of?
Infection or inflammation of genitourinary system
31
What are epithelial cells in a urine sediment derived from?
Derived from normal sloughing of old cells from the linings of the genitourinary system
32
Origin of Squamous Epithelial Cells
From linings of vagina, female urethra, lower portion of male urethra
33
Characteristics of squamous epithelial cells
Largest cell in urine sediment with abundant, irregular cytoplasm and prominent nucleus
34
Clue Cell
Squamous variation with pathological significance: Gardnerella vaginalis covers cell surface
35
Transitional Epithelial Cell: Origin
From lining of renal pelvis, calyces, ureters, bladder, and upper portion of male urethra
36
Characteristics of Transitional Epithelial Cells
Absorb large amounts of water causing a variety of forms (caudate, polyhedral, spherical, flat, cube shaped, columnar)
37
What is an increase in transitional epithelial cells indicative of?
Viral infection or malignancy
38
Origin of Renal Tubular Epithelial Cells
Proximal Convoluted Tubule
Distal Convoluted Tubule
Collecting Duct
39
Characteristics of RTE (proximal convoluted tubule)
Larger, rectangular (column)
40
Characteristics of RTE from Distal Convoluted Tubule
Smaller, round, or oval
41
Characteristics of RTE from Collecting Duct
Cuboidal (never round) with one straight edge
42
What are RTE cells indicative of?
Necrosis of renal tubules due to drugs, hemoglobin, and metal toxicity
43
Function of RTE cells
Reabsorption of glomerular filtrate and can contain filtrate substances such as bilirubin, hemosiderin, and oval fat bodies
44
Oval Fat Bodies
Lipids, highly refractile
Fat stains stain triglycerides and neutral fats
Cholesterol -- polarized -- Maltese cross formed
45
Bacteria
| 1. Types
Rod or cocci
46
What does bacteria indicate?
Upper or lower urinary tract infection especially if seen with WBCs, positive nitrite, and positive leukocyte esterase and should be cultured for identification
47
Characteristics of Yeast
Small, oval, refractile cells with or without buds or mycelia
48
What is the most common yeast infection?
Candida albicans
49
What increases your chances of a yeast infection?
Diabetes, pregnancy, immunocompromised patients, vaginitis
50
What is the most common parasite encountered?
Trichomonas vaginalis
51
Characteristics of spermatozoa
Tapered, oval head with long flagella-like tail
52
What does urine do to sperm?
Toxic to sperm so rarely moving
53
When is sperm found in urine in females and males?
Sexual intercourse, masturbation, nocturnal emissions
54
Mucus
Protein produced by glands, epithelial cells of lower genitourinary tract, and RTE cells
55
What is the main constituent of mucus?
Tamm-Horsfall Protein
56
What are the characteristics of mucus under the microscope?
Single or clumped, long thread-like structures with low refractive index
57
Cylindruria
Presence of urinary casts
58
Where are casts formed?
Within the lumen of the distal convoluted tubules and collecting duct
59
What are the overall characteristics of casts?
Parallel sides with rounded ends and may contain filtrate elements
(column like)
60
What view (purpose) do casts show?
Microscopic conditions of the kidney
61
What are casts a result of (how are they formed)?
Result of solidification of protein within the lumen of kidney tubule and may trap filtrate elements within its matrix
62
What is the protein matrix of casts made out of?
Mainly Tamm-Horsfall protein
63
What are the conditions for cast formation?
Protein gels more readily with urine flow stasis, acidity, and presence of Na and Cl
64
What conditions cause casts secretions?
Stress and exercise
65
What type of urine usually inhibits cast formation?
Dilute alkaline urine
66
How are casts classified?
Based on their inclusions
67
What cast is most frequently seen in the urine?
Hyaline casts
68
What are the characteristics of a hyaline cast?
Colorless, homogenous, semitransparent with low refractive index with varied morphology
69
What do hyaline casts consist of?
Tamm-Horsfall Protein
70
What causes an increase of hyaline casts in the urine?
Exercise, dehydration, heat exposure, emotional stress
71
What do a large number of hyaline casts indicate?
Glomerulonephritis, pyelonephritis, chronic renal disease, and congestive heart failure
72
What are the characteristics of red blood cell casts?
Orange-red color with casts matrix containing RBCs
73
What are red blood cell casts associated with pathologically?
Bleeding within the nephron and glomerulus damage as well as strenuous exercise and contact sports
74
What are WBC casts associated with pathologically?
Associated with infection (pyelonephritis) or inflammation (acute interstitial nephritis) in nephron
75
What stain do you use to ID white blood cell casts?
Kova
76
Bacterial Casts (definition)
Bacilli in and bound to protein matrix
77
What are bacterial casts indicative of?
Pyelonephritis
78
Epithelial Casts (definition)
RTE cells are attached to protein matrix
79
What are Epithelial casts indicative of?
Advanced renal tubular damage
80
Fatty Casts Definition
Fat droplets and oval fat bodies attached to protein matrix (lipiduria)
81
What are the characteristics of fatty casts?
Highly refractile
| Contain yellow-brown fat droplets
82
What are fatty casts associated with pathologically?
Nephrotic Syndrome
83
Granular Casts Definition
Coarse and fine granules in cast matrix
84
What are nonpathological granular casts?
Lysosomal granules excreted from RTE cells during normal metabolism and also seen with strenuous exercise and stress
85
What are pathological granular casts?
Granules from disintegration of cellular casts and tubular cells or protein aggregates filtered by glomerulus as seen with glomerulonephritis and pyelonephritis
86
Waxy Casts Characteristics
Brittle, highly refractile with jagged ends and notches, may have cracks
87
What do waxy casts indicate?
Chronic renal failure and extreme stasis of urine flow
88
What is the cause of waxy casts?
Caused by disintegration of hyaline or granular casts during stasis
89
Broad casts characteristics
Wider than normal cast matrix
90
What are broad casts indicative of?
Extreme urine stasis and renal failure
91
What is the cause of broad casts?
Broad destruction or widening of tubular walls
92
How are crystals formed?
Result of precipitation of urine solutes
93
What affects precipitation of crystals in the urine?
Temperature, solute concentration, and pH
94
What level of specific gravity is associated with crystals?
High Specific gravity
95
What are abnormal crystals associated with pathologically?
Liver disease, inborn metabolic errors renal damage
96
What characteristics of crystals help to identify them?
pH
Shapes and colors
Polarized microscopy
Solubility characteristics
97
What type of urine are all abnormal crystals found in?
Acid
98
What are the normal crystals found in acidic urine?
Amorphous urates
Uric acid crystals
Acid Urates and Sodium Urates
Calcium Oxalate
99
Amorphous Urates
1. pH?
2. Characteristics
3. How to get rid of?
1. Acid
2. Yellow to brown granules; refrigerated specimens pink sediment
3. Warm specimen
100
Uric Acid Crystals
1. pH?
2. Characteristics?
3. Associated with what chemicals?
4. Seen in patients with...
1. Acid
2. Variety of shapes (rhombic, wedges, 4-sided flat, rosettes, needles); yellow-brown; highly birefringent
3. Increase in purines and nucleic acids
4. Gout and leukemic patients undergoing chemotherapy
101
Acid Urates
1. pH?
2. Characteristics?
1. Acid
| 2. Large granules and may have spicules
102
Sodium Urates
1. pH?
2. Characteristics?
1. Acid
| 2. Needle-like and found in synovial fluid with gout
103
Calcium Oxalate Crystals
1. pH?
2. Characteristics?
3. Types?
4. Associated with...
1. Acid
2. Colorless, Birefringent
3. Dihydrate and monohydrate
4. Renal calculi formation associated with foods and high in oxalic acid such as asparagus
104
Normal Crystals in Alkaline Urines
1. Amorphous Phosphates
2. Triple Phosphates
3. Calcium Phosphates
4. Calcium Carbonate
5. Ammonium Biurate
105
Amorphous Phosphates
1. pH?
2. Characteristics?
1. Alkaline
| 2. Granular, white to colorless under microscope; white precipitation in refrigerator
106
Triple Phosphate Crystals
1. pH?
2. Characteristics?
3. Associated with?
1. Alkaline
2. Colorless with prism or "coffin-lid" shape; birefringent
3. Urea-splitting bacteria
107
Calcium Phosphate
Colorless, flat rectangular plates or thin prisms in rosettes
108
Calcium Carbonate
Birefingent; colorless with dumbbell or spherical shape; formed from gas with acetic acid
109
Ammonium Biurate
Yellow-brown "thorny apples"
| Seen in old specimens
110
Abnormal Urine Crystals are found in what type of urine?
Acidic
111
What are the abnormal urine crystals?
1. Cystine
2. Cholesterol
3. Radiographic Dye
4. Tyrosine
5. Leucine
6. Bilirubin
7. Sulfonamide
8. Ampicillin
112
Cystine Crystals
1. Characteristics
2. Associated with what pathological issue
1. Colorless, hexagonal plates, do not polarize
| 2. Renal calculi formation
113
Cystinuria
Inherited metabolic disorder that prevents reabsorption of cystine in renal tubules
114
Cholesterol Crystals
1. Characteristics
2. Associated with?
1. Highly birefringent; rectangular plate with one or more notches in corners
2. Lipiduria (nephrotic syndrome)
115
Radiographic Dye Crystals
| 1. Characteristics
1. Highly Birefringent and specific gravity is elevated
116
Tyrosine Crystals
1. Characteristics
2. Seen with..
3. Pathological issue
1. Fine colorless to yellow needles and frequently arranged as clumps or rosettes
2. Leucine crystals and (+) bilirubin
3. Severe liver damage and an inherited amino acid metabolism disorder
117
Leucine Crystals
1. Characteristics
2. Pathological issue
1. Yellow-brown spheres with concentric circles or radial striations
2. Severe liver disorder
118
Bilirubin
| 1. Associated with pathologically??
1. Severe liver damage, renal tubular damage, viral hepatitis
119
Sulfonamide Crystals
1. What is the drug sulfonamide used for?
2. What is indicative of sulfonamide crystals?
1. Treatment for UTI and patients with dehydration
| 2. Suggest renal tubular damage
120
Ampicillin Crystals
| 1. Pathologically
1. Seen with patients with dehydration
121
Artifacts
1. Characteristics
2. Types
1. Highly refractile; different microscope planes
| 2. Starch granules; oil droplets; air bubbles; pollen grains; hair and fibers; fecal artifacts
122
Starch Granules
| 1. Characteristics
1. Highly refractile with dimple in the middle
123
Oil Droplets
| 1. Cause?
Immersion oil, lotions, creams
124
Air Bubbles (cause)
Cover slip placement
125
Pollen grains (cause and appearance)
Seasonal, large size sphere with cell wall
126
Hair and Fibers
1. Cause
2. Characteristics
1. Clothing and diapers
| 2. Polarize
127
Fecal Artifacts
| 1. Cause
1. Plant, meat fibers, brown amorphous material in a variety of sizes and shapes
