Urinalysis Flashcards
(166 cards)
1
Q
Urine is an _ of plasma
A
Ultrafiltrate
2
Q
Average daily filtered plasma
A
170,000mL
3
Q
Average daily urine output
A
1,200 mL
4
Q
Urine path
A
Kidney - ureter - bladder - urethra
5
Q
kidney
A
formation
6
Q
kidney
A
formation
7
Q
ureter
A
transport
8
Q
bladder
A
storage
9
Q
urethra
A
excretion
10
Q
functional unit of kidney
A
Nephron
11
Q
how many nephrons in each kidney
A
1-1.5million in each kidney
12
Q
Nephron function
A
- renal blood flow
- glomerular filtration
- tubular reabsorption
- tubular secretion
13
Q
Renal Blood flow
A
Afferent ateriole - Globerulus - efferent ateriole - pertibular capilaries and vasa recta - renal vein
14
Q
Glomerular filtration
A
Capillary Tuft within Bowman’s capsule (leads to renal tubules)
- Performs non selective filtration
1. plasma substances <70,0000 molecular weight are filtered
2. filters approx 120mL/minute - Plasma filatrate passes through 3 layers:
1. capillary wall membrane
2. basement membrane ‘basal lamina’
3. Visceral epithelium of Bowmans’ capsule
15
Q
Nephron structure
A
- Bowman’s capsule
- Proximal Convoluted Tubule
- Decsending Loop of Henle
- Ascending Loop of Hnle
- Distal Convuluted Tubule
- Collecting Duct
16
Q
Two forms of reabsorption
A
Active Transport
- substances must combine with a carrier protein in renal tubular cell membrane
Passive Transport
- Substance moves along gradient without a carrier protein
17
Q
Nephron location: Proximal Convoluted tubule
A
Active transport
- sodium, glucose, amino acids, salts
Passive transport
- water, urea
18
Q
Nephron location: Descending loop of henle
A
Passive transport: water
19
Q
Nephron Location: ascending loop of henle
A
Active transport: chloride
Passive transport: urea, sodium
20
Q
Distal convoluted tubule
A
Active transport: sodium
21
Q
Nephron location: Collecting Duct
A
Passive transport: water
22
Q
Nephron location: Collecting Duct
A
Passive transport: water
23
Q
Tubular secretion
A
Elimination of waste products not filtered by the glomerulus
- ex: Medication bi-products
Regulation of acid- base balancein the body
- Secretion of H+ ions
- Hydrogen ions in filtrate bind:
1. Bicarbonate -> reabsorbed as CO2 and H2O
2. Phosphate - excreted as H2PO4
3. Ammonia - excreted as NH4+
24
Q
Urine Specimen collections
A
Random
Midstream clean catch
Catherizied (most sterile)
24 hour (or timed)
25
Urine collection
Requires a clean, dry, leak-proof container
Must be labeled (NOT on the lid)
- patient name, MR#, Date/Time of collection, Preservative Used
Must be refrigereted until transported to lab
Preservative may be used
- depends on test methodology, time delay, and transport conditions
Protect the sample from light
26
Normal Urine Output
600 - 2000 mL/day
27
Oliguria
Decrease in urine output
- <400 mL/day for adults
- Indicates dehydration
28
Anuria
Cessation of urine flow
- Kidney damage or decreased blood flow to the kidneys
29
Nocturia
Increase in nocturnal excretion of urine (at night)
30
Polyuria
increased in daily urine volume
- > 2.5 L/day for adults
- Cause: Diabetes Mellitus and Diabetes Insipidus
31
Normal color of urine
Pale yellow, yellow, dark yellow
32
Color: Dark yellow color
Cause?
Concentrated specimen (ex: 1st pee in the morning)
33
Color: Amber
Cause:
Dehydration
34
Color: Orange
Cause?
Bilirubin, medications
35
Color: Yellow-green/yellow-brown
Cause?
Bilirubin oxidized to biliverdin
36
Color: green
Cause?
Pseudomonas infection
37
Color: blue-green
Cause?
Amtriptyline, robaxin, clorets, indcican, methylene blue, phenol
38
Color: pink/red
Cause?
RBCs, hemoglobin, myeglobin, prophyrins, beets, rifampin, menstrual contamination
39
Color: Brown/black
cause?
RBCs oxidized, methemoglobin, homogenistic acid, melanin, phenol derivatives, argyrol, methyldopa, levodopa, flagyl
40
Clarity: Clear Urine
no visible particles, transparent
41
Clarity: hazy urine
few particles, print easily seen through urine
42
Clarity: cloudy urine
many particles, print blurred through urine
43
clarity: turbid
Print cannot be seen through urine
44
Clarity: milky
may precpitate or be clotted
45
Chemical examimation
- Dip reagent strip completely, but briefly into the well mixed specimen
Remove excess urine from the strip by running the edge on the container when withdrawing or blotting side on paper towel
Wait the specified amount of time for each reaction to take place
Compare the colored reactions against the manufactruerer's chart
46
Leukocyte 120s
inflammation in urinary track
47
Nitrite 60s
UTI - Bacteria that reduce nitrate
48
Urobilonogen 60s
Prehepatic or hepatic conditions
49
Protein 60s
defective glomerular filtration barrier
50
pH 60s
renal tibular absorption/secretion problem
51
blood 60s
Hematuria
Hemoglobinuria
Myeoglobinuria
52
Specific gravity 45s
Low = Diabetes Insipidus
High = Adrenal Insufficiency, hepatic disease, congestive heart failure, dehydration
53
ketone 40s
Diabetes mellitus; inadequate intake/loss of carbohydrates
54
biliubin 30s
hepatic or posthepatic conditions
55
glucose 30s
diabetes mellitus, hormone disorders, end-stage renal disease
56
Hematuria (blood in urine)
- renal calculi
- gloerulonephritis
- pyelonephritis
- tumors
- trauma
- exposure to toxic chemicals
- anticoagulants
- strenuous excercise
57
Hemoglobinuria (blood in urine)
- Transfusion reactions
- hemolytic anemias
- severe burns
- infections/malaria
- strenous excercise
- brown recluse spider bite
58
Bilirubin
1.Prehaptic conditions
2.Hepatic conditions
3.Posthepatic conditions
1.Normal
2.Increased
3.Increased
59
Urobilinogen
1.Prehaptic conditions
2.Hepatic conditions
3.Posthepatic conditions
1. Increased
2. Increased
3. Normal/absent
60
Prehepatic conditions examples
- hemolysis
- drugs and toxins
- thalassemia
- hemoglobinopathies
61
Hepatic conditions
- Cirrhosis
- Viral Hepatitis
- Toxic Hepatitis
- Intrahepatic Cholestasis
62
Post Hepatic conditions
- Biliary obstructions
- Gallstones
- Tumors of the bile duct
- Pancreatic carcinoma
63
Conirmatory test for Protein
Sulfosalicylyc acid precepitaiton test
64
Confirmatory test for specific gravity
refractometer
65
confirmatory test for ketone
Acetest
66
Confirmatory test for bilirubin
Icotest
67
Confirmatory test for glucose
Copper reduction test (clinitest)
68
pH in urine - normal range
4.5 - 8.0
- First morning specimen usually slightly acidic (5.0-6.)
69
pH clinical significance in urine
Kidneys help maintaining acid/base balance. when this is disrupted, it helps us to identify problems with renal tubular reabsorption and secretion
70
pH Interference in urine
- No known substances interfere with this measurement
- Runover from protein pad which has an acidic reagent --> false acidic reading
71
Normal protein range in urine
<10 mg/dL
72
Protein principle in urine
- Protein error of indicators
- pH held constant by buffer, certain indicatory dyes realease hydrogen ions as a result of the presence of proteins and cause a color change from yellow.to blue-green
73
Clinical significance of protein in urine
- proteinuria (>30 mg/dL)
indicates defective glomerular filtration barrier
74
Protein interference urine
- Extreme alkaline or highly buffered urine -> false positive
- overwhelms buggering capacity of reagent strip
75
SSA - Sulfosalycylic Acid Preciptation test
(PROTEIN)
- Cold precipitation test that reacts equally with all forms of protein
- Sulfosalicylic acid is added to clear aupernatant (after centrifiguation)
- Precipitation is graded to determoine protein concentration
- interferences
1. highly alkaline urine -> false negeative
2. non-protein compound precipitation -> false positive
76
Glucose in urine principle - 2 steps
1. Glucose oxidase catalyzes a reaction between glucose and room air to produce gluconic acid peroxidase
2. Peroxidase catalyzes the reaction between peroxide and chromogen to form an oxidized colored compound that represetns the presence of glucose
77
Glucose in urine - Clinical signfiicance
Glucosuria - can be found in diabetees mellitus, hormone function disorders, and end-stage renal disease
78
Gluocose interferences in urine (false positive)
strong oxidizing agents or contaminating peroxidases
79
Glucose interfernces in urine
80
Glucose interfernces in urine (false negative)
asorbic acid contamination or high specific gravity
81
Copper reduction test (clinitest) - GLUCOSE confirmatory test (reducing sugar test )
Adantage - more sensitive than reagant strip and detects all reducing sugars
Process
- urine and water are added to clinitest tablet made with curpric sulfide
- redcuing substances will react forming cuprous oxide with a color reaction
- The color is read after 15 seconds
82
Commonly found reducing sugars (clinitest)
- galactose
- fructose
- pentose
- lactose
- glucose
Galactose in newborns (<2 years), represetns an "inborn error of metabolism", that is life threatening
83
Ketones in urine
Detects acetoacetate and less effectively acetone
- intermediate products of fat metabolism
Does not detect beta-hydroxybutyrate (often found in DKA)
Principle
- nitroferricynide reacts with acetoacetate in an alkaline medium to produce a color change from beige to purple
Clinical signfiicance
- evidence of fat metabolism - inability to metabolize carbohydrate for energy (diabetes mellitus), increased loss or inadequate intake of carbohydrates
Confirmatory test - Acetest
84
Blood in urine
Principle
- pseudoperoxidase activity of hemoglobin catalizes a reacion between hydrogen peroxide and chromogen tetramethylbenzidine to produce an oxidized chromogen, which is a green- blue color
1. Hematuria
2. Hemoglobunuria
3. Myeloginuria
85
Interferences in blood urine
(FALSE positive)
Menstrual contamination or microbial peroxidases, soaps, detergents -> false positive
86
Interferences in blood urine
(FALSE positive)
Menstrual contamination or microbial peroxidases, soaps, detergents -> false positive
87
Interferences in blood urine (FALSE negative)
Ascorbic acid, or high specific gravity, or unmixed specimen or concentration of nitrite
88
hematuria
presence of intact RBCs
89
Hemoglobinuria
presence of free hemoglobin indicates RBC lysis
90
myoglobinuria
Presence of myoglobin indicates muscle destruction
91
Bilirubin in urine
Principle
- Diazo reaction of coupling between bilirubin and diaazonium salt
- Resulting Azodye causing a color change from light tan-beige to pink
Clinical significance
- bile duct obstructions - ex. gallstones and pancreatic cancer
- liver damage - ex: hepatitis and cirrhosis
92
bilirubin interferences in urine (false positive)
pigemneted materials or drugs
93
bilirubin interferences in urine (false negative)
Ascorbic acid or elevated nitrites or old specimens
94
Ictotest (bilirubin confirmatory test)
- more senesitive than reagent pad
- less interferences
- process
1. urine is dropped on special pad
2. icto tables is placed on pad
3. water is added
4. color reaction occurs and read at 30 seconds
95
Positive Ictotest (bilirubin)
blue to purple color
96
Negative Ictotest(Bilirubin)
Pink to red
97
urobilinogen in urine
Principle
- Diazo reaction of coupling between urobilinogen and diazonium salt
- resulting azodye causing a color change from light pink to dark pink
Clinical significance
- Increased Pre-hepatic or hepatic conditions
- decreased in post-hepatic conditions
98
urobilinogen interferences in urine (false positive)
1. Porphobilinogen, sulfamides, and p-aminosalicylyic acid
2. highly pigmented urine
99
Interferences - Uribilinogen in urine (false negative)
formalin or high levels of nitrites
100
Nitrite in urine
Certain bacteria can reduce nitrate to nitrite
Principle
**- Greiss reaction ** nitrite at an acidic pH reacts with an aromatic amine to form diazonium compound that reacts with tetrahydrobenzoquinolin compounds to prouduce a pink-colored azodye
Clinical significance
- Urinary Tract Infection - UTI (E. coli, Proteus, enterobacter, klebsiella)
101
Interferences Nitritie in urine
(false negative)
Urine not held in bladder at least four hours or bactera that do not have nitrate reducing enzyme. Absent diatery nitrates, absorbic aicd, high specific gravity, or antibiotics)
102
Interferences nitrite in urine
(false positive)
highly pigmented or old urine
103
Leukocyte esterase in urine
Leukocyte is present in granulocytes, monocytes, macrophages but NOT lymphocytes
Principle
- Leukocyte esterase catalyzes hydrolysis of embedded ester (pad) forming an aromatic compound
- aromatic compound combines with diazonium salt present in pad to produce purple azodye
Clinical signfiicance
- indicative of inflammation anywhere from kidneys to uthethra
104
Leukocyte esterase interferences (false positive)
vaginal contamination or highly pigmented urine. Or strong oxidizing agent
105
Leukocyte esterase interferences in urine (false negative)
high specific gravity or high glucose/protein levels. Absorbic acid or certain antibiotic drugs
105
Leukocyte esterase interferences in urine (false negative)
high specific gravity or high glucose/protein levels. Absorbic acid or certain antibiotic drugs
106
normal range for specific gravity of urine
1.002-1.035
107
principle of SG in urine
Polyelectolytes ionizes, releasing hydrogen ions in proportion to the number of ions in the solution. Bromthymol blue measures change in pH
108
Clinical signficance of SG in urine
Low SG - diabetes insipidus, and loss of tubular concentrating ability
High SG - adrenal insufficiency, hepatic disease, congestive heart failure, and excess water loss (vomitting, diarrhea, sweating)
109
Interferences of SG in urine (false low SG)
high glucose, urea or pH
110
Interferences of SG in urine (false high SG )
elevated proteins or ketones
111
Specific gravity confirmatory testing
Refractometer
- determines the concentration of dissolved particles in a specimen
- Uses refractive index of light
112
Specimen preperation
- Urine is placed in a test tube
- sample is centrifuged
- supernatant is discarded leabing 1ml of sediment left
- resuspend sedi ment
- dispense drop onto center of slide (put on coverslip)
- a kova slide can also be used (slide with premade cover slips and loading area)
- scan slide on 10X or 40X
113
all cells are reported with _ except for _ they are reported with _
40X
Squamous epithelial Cell
10X
114
RBC
appearance
correlations
Appearance
- non nucleated biconcave disc (normal)
- crenated in hypertonic (concentrated) urine
- ghOst cells in hypOtonic (diluted urine)
- Dysmorphic (irregular) with glomerular membrane damage
Correlations
- color, clarity, strip - blood reaction
115
RBC clinical significance
- damage to the glomerular membrane
- vascular injury within the genitourinary tract
- malignancy of the urinary tract
- renal calculi
- menstrual contamination
116
common misinterpretation RBC
air bubbles
yeast
if, acetic acid is added, RBC will lyse
117
WBC appearance (larger than RBC)
- Granulated, multilobed neutrophils
- Glitter cells in hypotonic urine (brownian motion)
- mononuclear cells with abundant cytoplasm
118
WBC correlations
clarity, strip - leukocyte esterase, nitrite
119
WBC clinical significnace
pyuria - increase in urinary WBC
Indicative of infection or inflammation in genitourinary system
120
predominant WBC in urine - Neutrophil
indicativeof bacterial infections
121
predominant WBC in urine - Eosinophil
indicative of drug-undice interstital nephritis or renal transplant rejection
122
predominant WBC in urine - Mononuclear (non-granulocytic cells)
indicative of early stage renal transplant rejection
123
WBC common misinterpreations
renal tubular epithelial cell
124
Epithelial cell - squamous
- appearance
- reporting
- correlations
- clinical signficance
- misinterpreations
- appearance
Largest cell in sediment with abundant, irregular cytoplasm and prominent nuclei
- reporting
Graded on low power field **(lpf) ( 10X)**
- correlations
Clarity
- clinical signficance
normal cellular sloughing
- misinterpreations
casts
125
Epithelial Cells - Transitional
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance
Spherical, polyhedral, caudate with centrally located nucleus
- correlations
clarity strip - blood
- clinical signficance
normal ceullar sloughing (bladder and up urinary system), catherization, malignancy, viral infection
- misinterpreations
Renal tubular Epi Cells (RTE)
126
Renal Tubular Epithelial Cell (RTE)
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance
Rectangular; columnar; round; oval or cuboidal with an eccentric nucleus.
Possibly bilirubin - stained
Hemosiderin - laden
- correlations
-color, clarity, strip - protein, bilirubin (hepatitis), blood
- clinical signficance
Cells from the renal tubules of nephron; indicative of tubular injury or tubular necrosis
- misinterpreations
Transitional Epi cell or granular casts
127
Oval fat bodies
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance
Highly refractile RTE cells; mau observe maltese cross in cholesteral oval fat bodies
- correlations
clarity, strip - blood, protein
microscopic - free fat droplets
- clinical signficance
RTE has aborbed lipids; indicative of nephrotic syndrome, severe tubular necrosis, diabetes mellitus, and traume causing bone marrow fat release
- misinterpreations
Usually confrimed with polarized microscopy or fat stains
128
Cast formation
**Uromodulin (Tamm-Horsfall protein) ** is excreted by RTE cells of the distal convoluted tubule and upper collecting duct
other proteins in the ultrafiltrate join the matrix
protein matrix "gels" more readily in cases of urine-flow stasls, acidity and the presence of sodium and calcium
129
Hyaline cast
- appearance
- correlations
- clinical signficance
- misinterpreations
appearance - colorless homogenous matrix
correlations - strip (protein and blood)
clinical significance - glomerulonephritis, pyelonephritis, chronic renal disease, congestive heart failure, and stress and excercise
misinterpretations - mucus, fiber, hair, bright ligting
130
RBC cast
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance - orange/red color; cast matrix containing RBCs
- correlations - microcopic RBC / Strip- blood, protein
- clinical signficance -glomerulonphritis, strenous excercise
- misinterpreations - RBC clumps
131
WBC cast
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance - cast matrix containing WBCs
- correlations - Microscopic: WBC, Strip: protein, leukocyte esterase
- clinical signficance - pyelonephritis, actute interstial nephritis
- misinterpreations - WBC clumps
132
Bacterial Cast
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance - Bacilli bound to protein matrix
- correlations - Microscopic: bacteria, WBC casts, WBCs. Strip - Leukocyte esterase, nitrite, protein
- clinical signficance - pyelonephritis
- misinterpreations - granular casts
133
Epithelial cell cast
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance - RTE cells attached to protein matrix
- correlations - Microscopic - RTE cells. Strip - protein
- clinical signficance - renal tubular damage
- misinterpreations - WBC cast
134
Granular cast
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance - course and fine granules in a cast matrix
- correlations - microscopic: cellular cast, RBCs, WBCs. Strip: protein
- clinical signficance - Glomerulonpehritis, Pyelonephritis, Stress and excercise
- Misinterpreations - Clumps of small crystals, columnar RTE cells
135
Waxy cast
- appearance
- correlations
- clinical signficance
- misinterpreations
Appearance - hihgly refractile cast with jagged ends and notches
correlations - cellular casts, granular casts, WBCs, RBCs. Strip - protein
Clinical significnce - stasis of urine flow, chronic renal failure
misinterpretations - fibers and fecal material
136
Fatty cast
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance - fat droplets and oval fat bodies attached to protein matrix
- correlations - Microscopic: free fat droplets, oval fat bodies. Strip- protein
- clinical signficance - Nephrotic syndrome, toxic tubular necrosis , diabetes mellitus, crush injuries
- misinterpreations - fecal debris
137
Broad cast
- appearance
- correlations
- clinical signficance
- misinterpreations
- appearance - wider than normal matrix cast
- correlations - microscopic: WBCs, RBCd, grnular casts, waxy casts. Strip: protein
- clinical signficance - extreme urine stasis, renal failure
- misinterpreations - fecal material, fibers
138
Normal urinary crystals
Types
- uric acid
- amorphous urates
- calcium oxalate
- amorphours phosphates
- calcium phosphate
- triple phosphate
- ammonium biurate
- calcium carbonate
139
Reporting of normal urinary crystals
High power field (hpf) (40x)
140
Uric acid crystal (NORMAL)
Urine pH
Color/shape
Clinical significance
Urine pH - acidic
Color/shape
- yellow-brown / variable shapes (rhombic, four sided flat plates, wedges, and rosettes)
Clinical significance
- increased levels of purines and nucleic acids; chemotherapy patients; Lesch-Nyhan syndrome patients; gout
141
Amorphous urates
Urine pH
Color/shape
Clinical significance
Urine pH - acidic
Color/shape
- brick dust or yellow brown/fine particles
Clinical significance
- refrigeration
142
Calcium oxalate crystal
Urine pH
Color/shape
Clinical significance
Urine pH
- acidic / neutral / sometimes alkaline
Color/shape
- colorless / envelope, oval, dumbbell
Clinical significance
- Renal calculi; antifreeze poisoning; diet high in oxalic acid (tomatoes, aspargus, ascorbic acid)
143
Amorphous phosphates
Urine pH
Color/shape
Clinical significance
Urine pH - alkaline/neutral
Color/shape - white-colorless/fine dust particles
Clinical significance - refrigeration
144
Calcium phosphate crystal
Urine pH
Color/shape
Clinical significance
Urine pH - alkaline/neutral
Color/shape - colorless/variable: rectangles, thin prisms, rosette formation
Clinical significance - no clinical significance, but are common constituent in renal calculi
145
Triple phosphate crystal
Urine pH
Color/shape
Clinical significance
Urine pH - alkaline
Color/shape - colorless/ coffin lids
Clinical significance - no clinical significance, but often found with urea-splitting bacteria
146
Ammonium Biurate Crystal
Urine pH
Color/shape
Clinical significance
Urine pH - alkaline
Color/shape - yellow-brown / thorny apples
Clinical significance - found in old specimens and often present with ammonia
147
Calcium carbonate crystal
Urine pH
Color/shape
Clinical significance
Urine pH - alkaline
Color/shape - colorless/dumbbells
Clinical significance - no clinical significance
148
Abnormal urinary crystals
- Cystine
- Cholesterol
- Leucine
- Tyrosine
- Bilirubin
- Sulfonamides
- Radiographic dye
- Ampicillin
149
reporting of abnormal urinary crystals
High power field (hpf) 40X
150
Cystine Crystal
Urine pH
Color/shape
Clinical significance
Urine pH - acidic
Color/shape - colorless/hexagonal plates
Clinical significance - cystinuria patients (increased tendency to form renal calculi)
151
Cholesterol Crystal
Urine pH
Color/shape
Clinical significance
Urine pH - acidic
Color/shape - colorless/ "notched" plates "utah"
Clinical significance - refrogerated specimen (otherwise lipids would stay droplet form); Nephrotic syndrome, often seen with fatty casts and oval fat bodies.
152
Leucine Crystal
Urine pH
Color/shape
Clinical significance
Urine pH - Acidic / neutral
Color/shape - Yellow/Concentric circles "Tree rings"
Clinical significance - Liver disorders
153
Tyrosine Crystal
Urine pH
Color/shape
Clinical significance
Urine pH - Acidic /neutral
Color/shape - Colorless-yellow / needles
Clinical significance - liver disorders, amino-acid metabolism disorders
154
Bilirubin crystal
Urine pH
Color/shape
Clinical significance
Urine pH - Acidic
Color/shape - Yellow/ "uneven sweet gum pod"
Clinical significance - liver disorders
155
Sulfonamide Crystal
Urine pH
Color/shape
Clinical significance
Urine pH - Acidic/Neutral
Color/shape - varied colors/ "glassy needles"
Clinical significance - dehydration; UTI medication administration
156
Radiographic dye
Urine pH
Color/shape
Clinical significance
Urine pH - Acidic
Color/shape - colorless/ rectangles or thicker needles
Clinical significance - recent procedure, check medical history
157
Ampicillin
Urine pH
Color/shape
Clinical significance
Urine pH - Acidic /neutral
Color/shape - colorless/needles "pick up sticks". Refrigeration forms bundles
Clinical significance - antibiotic prescription
158
Microorganisms ar reported on
40X
- bacteria
- yeast
- trichomonas vaginalis
159
Bacteria
Appearance
Correlations
Clinical Significance
Misinterpretations
Appearance
- small spherical and rod-shaped structures
Correlations
- Microscopic: WBCs
- Strip: pH, Nitrite, Leukocyte Esterase
Clinical Significance
- Contamination or indicative of upper/lower UTI
Misinterpretations
- Amorphous phosphates
- Urates
160
Yeast
Appearance
Correlations
Clinical Significance
Misinterpretations
Appearance
- small, oval, refractile structures with buds and/or mycelia (branching hyphae)
Correlations
- microscopic -WBCs
- strip - glucose, leukocyte esterase
Clinical Significance
- yeast infection (commonly found in diabetic pateints)
- glucose present in ruine
Misinterpretations
- RBCs
161
Trichomonas Vaginalis
Appearance
Correlations
Clinical Significance
Misinterpretations
Appearance
- pear shapes
- motile
- flagellated
Correlations
- microscpic: WBCs
- Strip : Leukocyte esterase
Clinical Significance
- trichomonas infection
Misinterpretations
- WBC, RTE
162
Miscellaneous urine sediment
- mucus
- spermatozoa
- artifacts
163
mucus
- Appearance
- reporting
- correlations
- clinical significance
- misinterpretations
Appearance
- single or clumped threads with a low refractive index
reporting - graded per lpf (10x)
correlations - none
clinical significance - none, but more often in female patients
misinterpretations - hyaline casts
164
Spermatozoa
Appearance
Reporting
Correlations
Clinical significance
Misinterpretations
Appearance
- tapered oval head with long, thin tail
Reporting
- present or absent
Correlations
- strip: protein
Clinical significance
- in male, can be found in cases of male infertility due to retrograde ejaculation
- often found with recent sexual intercourse (both), masturbation (male), or nocturnal emission male)
Misinterpretations
- none
165
Urine Artifacts
considered contaminants and are not pathologic
- starch granules (from powdered gloves or talc)
- oil (immersion oil)
- air bubbles
- pollen grains
- fibers
- fecal debris
