Urinalysis Flashcards
Urine Sx for routine screening, requires confirmatory testing based on diet and exercise
Random urine sx
Random urine Sx is affected by (2)
Diet
Exercise
Urine sx for ruling out orthostatic proteinuria
First morning urine
Urine Sx for pregnancy tests
First morning urine
Urine Sx for routine screening/confirmatory testing, collected immediately upon arising
First morning urine
Urine Sx which requires genital area to be washed, for bacterial cultures
Midstream clean catch
Urine sx: void in toilet-collect sx-finish voiding in toilet, for bacterial cultures
Midstream clean catch
For bacterial cultures, collected from catheter passed into bladder
Catheterized
T/F: if both urinalysis and culture required, perform culture first
True
Urine Sx: Px voids into toilet and begins timing, collects all urine during designated period, voids and collects urine at end of period
24-hour (timed) urine sx
Urine Sx which can provide quantitative results
24-hour (timed) urine sx
Changes in unpreserved urine
Increased: pH Nitrite Bacteria Decreased: Bilirubin (oxidized to biliverdin) Urobiliogen (oxidized to urobilin) Glucose (glycolysis) Ketones (oxidized)
Normal urine volume
600-2000 mL/day
Decreased urine output
Oliguria
No urine output
Anuria
Increased urine output at night
Nocturia
Increased urine output >2.5 L/day
Polyuria
Oliguria urine output
Polyuria urine output
> 2.5 L/day
Increased urine output to excrete excess urine glucose
Diabetes mellitus
Increased urine output due to non-func insulin
Diabetes mellitus
Increased urine output caused by lack or dysfunctional anti-diuretic hormone
Diabetes insipidus
Results in polydipsia
Polyuria
Polyuria may be caused by (3)
Diabetes mellitus
Diabetes insipidus
Polydipsia
Normal color of urine
Yellow
Shades of yellow of urine are based on
Fluid consumption
T/F: Shades of yellow of urine are based on fluid consumption
True
Shades of yellow of urine vary from
Pale yellow (dilute) to dark yellow (concentrated)
Urine clarity terminology (5)
Clear Hazy Cloudy Turbid Milky
T/F: Freshly voided normal urine is clear
True
Appearance of freshly voided normal urine
Clear
Appearance of refrigerated normal urine (2)
-also describe and explain each
A. White turbidity in urine
-w/ alkaline pH from amorphous phosphates and carbonates
B. Pink turbidity in urine
-w/ acidic pH from amorphous urates
T/F: white turbidity in urine may indicate presence of amorphous phosphates and carbonates
True
White turbidity in urine may indicate presence of
amorphous phosphates and carbonates
pH and color (of turbidity) of urine with amorphous phosphates and carbonates
Alkaline, white
T/F: pink turbidity in urine may indicate presence of amorphous urates
True
pink turbidity in urine may indicate presence of
amorphous urates
pH and color (of turbidity) of urine with amorphous urates
Acidic, pink
Non-pathologic causes of turbidity in urine (7)
Powder and creams Semen Feces Amorphous phosphates, carbonates, and urates Radiographic contrast media Mucus Squamous epithelial cells
Pathologic causes of turbidity in urine ((6)
RBCs Abnormal crystals Urothelial and renal tubular epithelial cells Lipids (milky) WBCs Yeasts
Causes tribe clarity to appear milky
Lipids
Cause orange colored urine (2)
-describe also
A. Bilirubin
-produces yellow foam when shaken; abnormal liver func
B. Pyridium
-produces thick orange pigment which may interfere with reagent strip tests
Cause red colored urine (4)
-describe also
A. RBCs
-cloudy urine, + test for blood, microscopic: rbcs
B. Hemoglobinuria
-clear urine, + test for blood
C. Myoglobinuria
-clear urine, + test for blood, needs further testing
D. Prophyrins
- (-) test for blood, needs further testing
Cause black colored urine (2)
A. Oxidized RBCs, denature Hb
-clear urine, + test for blood
B. Melanin
-darkens upon standing
Screening test for renal tubular reabsorption of essential elements filtered by glomerulus
Specific gravity
Specific gravity is a ___ test for renal tubular ___ of essential elements filtered by ____
Screening test for renal tubular reabsorption of essential elements filtered by glomerulus
Glomerular filtrate specific gravity
1.010
T/F: Glomerular filtrate specific gravity is 1.010
True
It is the comparison of density of urine to that of d. H20
Specific gravity
Urine contains dissolved subs that produce density based on (2)
Size
Number
Used to measure specific gravity (3)
Reagent strip
Refractometer
Osmolarity (harmonic oscillation density)
Primary test for routine urinalysis
Reagent strip
T/F: Reagent strip is the primary test for routine urinalysis
True
Reagent strip is the __ test for ___ urinalysis
Primary, routine
Principle of reagent strip for determination of specific gravity
The # of hydrogen ions in a polyelectrolyte (pKa) is proportional to the # of ions in urine
T/F: reagent strip test for sp grav: The # of hydrogen ions in a polyelectrolyte (pKa) is proportional to the # of ions in urine
True
T/F: increased urine conc = increased hydrogenated released = low pH (acidic)
True
increased urine conc = ____ hydrogenated released = ___ pH ( )
increased urine conc = increased hydrogenated released = low pH (acidic)
Indicator on reagent strip for specific gravity
-also color range
Bromothymol blue
-yellow-green (acidic) to green-blue (alkaline)
Uses a prism to direct wavelength of light thru urine; light angle read on scale calibrated with d H20
Refractometer
Principle of refractometer
The concentration of dissolved subs in soln directs the velocity and angle of light passing thru soln
Refractometer uses a ___ to direct ___ of light thru the urine
Prism, wavelength
Measurement of the number of particles into which 1g molec wt of subs dissociates
Osmolarity
Osmolarity measures only
of particles (size not relevant)
T/F: Osmolarity is considered more representative of renal concentrating ability than sp grav because meas only # of particles and their size is not relevant
True
considered more representative of renal concentrating ability than sp grav because meas only # of particles and their size is not relevant
Osmolarity
Osmolarity is considered more representative of ___ than sp grav because meas only # of particles and their size is not relevant
Renal concentrating ability
Unit for reporting osmolarity
mOsm (milliosmoles)
Colligative properties meas in clin lab (2)
-describe each also
A. Freezing point depression
- 1 mole of NON-ionizing subs will LOWER freezing pt by 1.86。C
-volatile subs like alcohol can interfere
B. Vapor pressure depression
- actual measurement is dew point of urine
-uses microsamples on filter paper discs
-NO interference from volatile subs
T/F: in freezing point depression: 1 mole of NON-ionizing subs will LOWER freezing pt by 1.86。C
True
T/F: in freezing point depression:
volatile subs like alcohol can interfere
True
1 mole of NON-ionizing subs will LOWER freezing pt by __ 。C
1.86 。C
Temp at which vapor condenses to liq
Dew point
A Colligative property whose
actual measurement is dew point of urine
Vapor pressure depression
T/F: Vapor pressure depression: NO interference from volatile subs
True
Colligative property which uses microsamples on filter paper discs
Vapor pressure depression
Normal serum osmolarity
275-300 mOsm
T/F: normal serum osmolarity is 275-300 mOsm
True
T/F: fluid intake influences urine osmolarity
True
Influences urine osmolarity
Fluid intake
random serum to urine ratio =
1:1
Serum to urine ratio for controlled fluid intake
3:1
Clin sig of osmolarity
To determine ADH production or tubular response to ADH for diabetes insipidus
Used to determine ADH production or tubular response to ADH for diabetes insipidus
Osmolarity
Harmonic oscillation density is for
Osmolarity
an automated instrumentation passes a sound wave thru urine and records change in freq of sound wave, which is proportional to urine density
Harmonic oscillation density
Harmonic oscillation density principle
Change in freq of sound wave is proportional to urine density
Low specific gravity = __ pH
Alkaline
High specific gravity = __ pH
Acidic
Specific gravity is ___ to pH
Inversely proportional
Reagent strips: care and quality control (7)
Don’t refrigerate (RT
Reagent strips: technique (6)
Thoroughly mix sx (detect rbcs and WBC’s)
Warm refrigerated sx (enzyme rxns)
Briefly dip strip (prevent leaching out of rgt from strip)
Blot strip (prevent runover)
Observe timing instructions (rxn color change)
Relate chemical with physical and microscopic results
T/F: urine pH doesn’t reach 9.0
True
A reading of pH 9.0 indicates a ___ and should be ___
Old sx, recollected
Normal value of urine pH
4.5-8.0
Reagent strip principle for pH
Double indicator (methyl red and bromothymol blue)
Clin sig of urine pH measurement (2)
Detect acid-base disorders
ID of urinary crystals
Used to detect acid-base disorders
Urine pH
Used to identify urinary crystals
Urine pH
Urine pH test sources of error
2) and test correlations (3
A. Old sx (+)
Runover from adjacent strips
B. Nitrite
Leukocyte esterase
MicroscopicUrine protein: reagent strips measure primarily __
Albumin
NV of urine protein
Urine protein with 30 mg/dL or greater is considered
Clinical proteinuria
Clinical protein urea is considered when urine protein reaches
30 mg/dL or greater
T/F: Clinical protein urea is considered when urine protein reaches 30 mg/dL or greater
True
Urine protein: reagent strip principle
Protein error of indicators
Clin sig of meas urine protein (2)
Clinically significant proteinuria is primarily caused by glomerular or tubular disorders
Benign orthostatic proteinuria testing requires a first morning sx and a sx after Px has been active for 2 hrs. First sx should be neg while 2nd is positive
Requires different reagent strip capable of testing for only albumin at levels below 10 mg/dL
Microalbuminuria
Provides early detection of renal disease, especially in patients with diabetes
Microalbuminuria
Reagent strip which tests for albumin and creatinine, along with other routine strip tests, EXCEPT urobilinogen
Multistix PRO 11
Multistix PRO 11 reagent strip tests for
______, EXCEPT ___
Albumin and creatinine, along with other routine strip tests
Except urobilinogen
Multistix PRO 11 doesn’t test for this
Urobilinogen
Corrects hydration in a random sample to provide an estimate of the 24-hr microalbumin level
Albumin-to-creatinine ratio
Albumin-to-___ ratio corrects for ___ in a ___ urine sample to provide an estimate of the ____
Albumin-to-creatinine ratio corrects hydration in a random sample to provide an estimate of the 24-hr microalbumin level
Reagent strip: protein:
A. Sources of error (6)
B. Test correlations (4)
A. Pyridium (+)
High sp grav (+)
Detergents (+)
Chlorhexidine (+)
Highly buffered alkaline urine (+)
Microalbuminuria (-)
B. Blood
Leukocyte esterase
Microscopic
NitritesGlucose: reagent strip principle
Glucose oxidase test (specific for glucose)
T/F: glucose oxidase test is specific for glucose
True
Renal threshold for glucose
160-180 mg/dL
Clin sig of measuring urine glucose (3)
Diabetes mellitus, gestational diabetes (placental hormones blocking insulin)
Hormonal disorders and stress block insulin production and action
Renal tubular disorders prevent tubular reabsorption of glucose
Glucose: clinitest principle
Reducing substances including glucose and other sugars can reduce copper sulfate (blue-green) to cuprous oxide (orange-red)
Color of copper sulfate in clinitest
Blue-green
Color of cuprous oxide in clinitest
Orange-red
May be used to test newborn urine for galactose
Clinitest
Clinitest may be used to test newborn urine for ___
Galactose
Reagent strip: glucose:
A. Sources of error (5)
B. Tests correlation (2)
A. Oxidizing agent (+)
Low temp (-)
Increased ascorbic acid (+)
Detergents (+)
Old sx (-)
B. Protein
KetonesIntermediate metabolites of fat, acetoacetic acid, acetone, and beta-hydroxybutyric acid
Ketones
Ketones are ___ metabolites of __, __, __, and __
Intermediate metabolites of Fats Acetoacetic acid Acetone Beta-hydroxybutyric acid
Ketones: reagent strip principle
Reaction of acetoacetic acid or acetone (with glycine) with sodium nitroprusside/ ferricyanide
clin sig of measuring ketones in urine (5)
Malabsorption Diabetes mellitus Insulin therapy monitoring Starvation CHO loss
Reagent strip: ketones:
A. Sources of error (4)
B. Test correlations (1)
A. Red urine (+)
Old sx (-)
Levodopa (+)
Sulfhydryl medications (+)
B. GlucoseBlood: reagent strip: (+) reactions seen with (3)
Hematuria
Hemoglobinuria
Myoblobinuria
Blood: reagent strip principle
Pseudoperoxidase activity of Hb
T/F: Hb has pseudoperoxidase activity
True
Clin sig of detecting blood in urine sx
Hemoglobinuria and myoglobinuria can cause acute renal failure
T/F: Hemoglobinuria and myoglobinuria can cause acute renal failure
True
Bleeding within genitourinary system, including pyelonephritis, renal calculi, anticoagulants, glomerulonephritis, trauma
Hematuria
Hematuria is bleeding within genitourinary system, including (5)
pyelonephritis renal calculi anticoagulants glomerulonephritis trauma
Intravascular hemolysis/ transfusion reactions, lysis of old RBCs by dilute alkaline urine
Hemoglobinuria
Rhabdomyolysis caused by prolonged coma, cholesterol statin drugs, muscle-wasting disorders, crush injuries
Myoglobinuria
Myoglobinuria is rhabdomyolysis caused by (4)
prolonged coma
cholesterol statin drugs
muscle-wasting disorders
crush injuries
Reagent strip: blood:
A. Sources of error (7)
B. Test correlations (2)
A. Unmixed Sx (-)
Crenated RBCs (-)
Oxidizing agents (+)
Menstrual contamination (+)
Bacterial peroxidases (+)
Increased ascorbic acid (-)
Increased nitrite (-)
B. Color
MicroscopicT/F: both bilirubin and urobilinogen are products of Hb degradation
True
Bilirubin: reagent strip principle
Disco reaction
Clin sig of detecting bilirubin in urine
Conj bilirubin enters the urine due to leakage of damaged liver or blocked bile duct
- kidneys can’t filter unconj bilirubin
- Px appears jaundiced
Trace the pathway of processing bilirubin and urobilinogen
RBCs- Hb- protoporphyrin- unconj bili- blood- liver- conj bilirubin- bile duct- intestine- stercobilinigen- urobilin- feces
Intestine may produce urobilinogen
Intestine- urobilinogen- blood- liver- bile duct- intestine- feces
Urobilinogen from intes may also travel from blood to kidney
Intestine- urobilinogen- blood- kidney
Bilirubin: reagent strip
A. Sources of error (6)
B. Test correlations
A.
Pyridium (+)
Indican (+)
Lodine (+)
Increased ascorbic acid (-)
Increased nitrite (-)
Sx exposed to light (-)
B. Urobilinogen
ColorT/F: some of conj bilirubin is converted to urobilinogen in the intestine
True
Organ where some of conj bilirubin is converted to urobilinogen
Intestine
Amount of urobilinogen normally found in urine
1mg/dL
Urobilinogen: principle
A. Multistix
B. Chemstrip
A. Multistix: Ehrlich’s reaction
B. Chemstrip: Diazo reaction
Clin sig of meas urobilinogen in urine (3)
Early detection of liver disease and hemolytic disorders, constipation
Urobilinogen: reagent strip
A. sources of error (10)
B. Test correlations (1)
A. Highly pigmented urine (+) Increased nitrates (-) Multistix Ehrlich's reactive compounds (+) Chemstrip Highly pigmented urine (+) Old Sx (-) Porphobilinogen (+) Preservation in formalin (-) Preservation in formalin (-) B. Bilirubin
Detects presence of reductase-producing bacteria that can convert urinary nitrate to nitrite
Nitrite test (reagent strip)
Nitrite test (reagent strip) principle
Diazo reaction
Clin sig of detecting nitrite in urine
Early detection of UTI
T/F: a + nitrite test should be accompanied by + leukocyte esterase test
True
T/F: nitrite may be used to screen Sx for microbiology terming
True
Nitrite: rgt strip
A. sources of error (8)
B. Test correlations (3)
A. Non-reductase-containing bacteria (-) Increased bacteria converting nitrite to nitrogen (-) No urinary nitrate (-) Early infection (-) Old Sx (+) High sp grav (no indication if + or -) Antibiotics Increased ascorbic acid (-) Highly pigmented urine (+) B. Leukocytes Microscopic Protein
Detects presence of granulocytuc WBCs, including used WBCs
Leukocyte esterase
T/F: leukocyte esterase detects presence of granulocytuc WBCs, including used WBCs
True
Leukocyte esterase: rgt strip principle
Diazo rxn
T/F: Leukocyte esterase rgt strip SHOULD be read 2 mins AFTER urine exposure
True
Clin sig of leukocyte esterase test (3)
UTI, including with non-reductase-containing bacteria, parasitic and fungal organisms which yield neg nitrite test
Leukocyte esterase: rgt strip:
A. sources of error (8)
B. Test correlation (3)
A. Oxidizing agents (+) Formalin (+) High protein and glucose (-) Increased ascorbic acid (-) Nitrofuration (+) Antibiotics (-) Highly pigmented urine (+) Inaccurate timing (-) ** B. Nitrite Microscopic Protein
Specific gravity: rgt strip:
A. sources of error
B. Test correlations
A. Increased protein (+) Highly alkaline urine (-) Add 0.005 to any urine with pH 6.5 or higher B. None
Types of common urine Sx (5)
Random First morning Midstream clean catch Catheterized 24-hour (timed)
Control ability of kidney to clear waste products and maintain body’s water and electrolyte balance
Nephrons
2 types of nephrons
-describe each
Cortical nephron
- in cortex of kidney; remove waste products and reabsorption nutrients
Juxtaglomerular nephron
- extend into the medulla; concentrate the urine
Nephron found in cortex of kidney; remove waste products and reabsorption nutrients
Cortical nephron
Nephron which extend into the medulla; concentrate the urine
Juxtaglomerular nephron
Func of cortical nephron (2)
Remove waste
Reabsorption nutrients
Func of Juxtaglomerular nephron
Concentrate the urine
Trace the renal blood flow
Renal artery- afferent arteriole- efferent arteriole- proximal convoluted tubule capillaries- vasa recta/ loop of Henle- distal convoluted tubule capillaries- renal vein
Normal renal blood flow
Approx 1200 mL/min
Normal plasma flow
Approx 600-700 mL/min
Non-selective filtration of plasma subs with MWs
Glomerular filtration
MW of albumin
67,000 Da
Controls filtration pressure
Renin-angiotensin-aldosterone system (RAAS)
Trace RAAS
Find in book p 166 elsevier
Renal tubular reabsorption:
Passive transport reabsorbs (2)
Active transport reabsorbs (4)
Passive transport reabsorbs (2) Urea, water Active transport reabsorbs (4) Glucose Amino acids Chloride Sodium
Renal tubular concentration occurs in (2)
Ascending and descending loops of Henle
Occurs in ascending and descending loops of Henle
Renal tubular concentration
Removes non-filtered waste products from blood to the filtrate and maintains acid-base balance in body
Renal tubular secretion
Renal tubular secretion is for (2)
Removing non-filtered waste products from blood to the filtrate and maintaining acid-base balance in body
T/F: subs like medications are bound to plasma carrier proteins and are too large to be filtered
True
T/F: medications bound to carrier proteins dissociate from them in the tubules and are then secreted into the filtrate
True
T/F: small hydrogen molecules are easily filtered and must be returned to the blood
True
Small hydrogen molecules combo with __ or __ secreted by ___ and are secreted back to the blood
phosphate ions or ammonia secreted by renal tubular cells
T/F: Small hydrogen molecules combo with phosphate ions or ammonia secreted by renal tubular cells and are secreted back to the blood
True
T/F: Small bicarbonate ions (HCO3-) are needed for the acid-base buffering system
True
Small bicarbonate ions (HCO3-) are needed in this system
acid-base buffering system
T/F: small bicarbonate ions (HCO3-) are easily filtered
True
small bicarbonate ions (HCO3-) combo with __, producing __ that can be secreted back to blood
Hydrogen molecules
Bicarbonate (H2CO3)
GFR normal value
120 mL/min
Classic test for GFR
Creatinine clearance test
Creatinine clearance test requires this kind of urine
Timed (24-hr) urine
T/F: calculated GFR estimates (eGFR) doesn’t require a timed urine Sx
True
Small molec produced at constant rate by ALL nucleated cells
Cystatin C
T/F: Cystatin C is produced at CONSTANT rate by ALL nucleated cells
True
T/F: Cystatin C is COMPLETELY filtered, reabsorbed, and broken down by renal tubular cells
True
Cystatin C is COMPLETELY filtered, reabsorbed, and broken down by
Renal tubular cells
Primary tests for renal tubular reabsorption
Serum and urine osmolarity
Serum and urine osmolarity are primary tests for
Renal tubular reabsorption
Meas ability of kidneys to respond to body’s hydration
Free water clearance test
Creatinine clearance formula
C= (UxV)/P
Free water clearance test formula
Cosm= [(Uosm)x(V)]/Posm
Tubular secretion tests (2)
-describe each
Titratable acidity
-detects inability of proximal convoluted tubules to secrete hydrogen molecules
Urinary ammonia
-detects inability of proximal and distal convoluted tubules to produce ammonia
Tubular secretion test which detects inability of proximal convoluted tubules to secrete hydrogen molecules
Titratable acidity
Tubular secretion test which detects inability of proximal and distal convoluted tubules to produce ammonia
Urinary ammonia
Enumerate rxn pads on rgt strip (in order) (10)
- Glucose
- Bilirubin
- Ketone
- Sp grav
- Blood
- pH
- Protein
- Urobilinogen
- Nitrite
- Leukocyte esterase
Glomerular disorders due to post-streptococcal infection
Acute glomerulonephritis
Enumerate glomerular disorders (10)
A. Acute glomerulonephritis B. Goodpasture's syndrome C. Wegner's granulomatosis D. Henoch-Schönlein purpura E. Membranous glomerulonephritis F. Chronic glomerulonephritis G. IgA nephropathy H. Nephrotic syndrome I. Minimal change disease J. Focal segmental glomerulosclerosis
Tubular disorders enumerate (3)
K. Acute tubular necrosis
L. Fanconi’s syndrome
M. Renal glycosuria
Enumerate tubulointerstitial disorders (5)
N. Cystitis O. Acute pyelonephritis P. Chronic pyelonephritis Q. Acute interstitial nephritis R. Renal lithiasis (calculi)
Glomerular disorder which exhibits anti-glomerular basement membrane antibodies
Goodpasture’s syndrome
Glomerular disorder which exhibits antineutrophil cytoplasmic antibody
Wegner’s granulomatosis
Glomerular disorder primarily seen in children after respiratory infection
Henoch-Schönlein purpura
Glomerular disorder which caused by autoimmune disorders
Membranous glomerulonephritis
Glomerular disorder due to progression from previous disorders
Chronic glomerulonephritis
Immune IgA complexes deposited in glomerular membrane
IgA nephropathy
Circulatory disruption decreasing blood flow to kidney, increased serum lipids
Nephrotic syndrome
Glomerular disorder seen in children after allergic reactions, heavy edema, good prognosis
Minimal change disease
Glomerular disorder due to drugs of abuse and HIV
Focal segmental glomerulosclerosis
Tubular disorders which may be due to hemoglobinuria, myoglobinuria, antibiotics
Acute tubular necrosis
General failure of tubular reabsorption
Fanconi’s syndrome
Failure of active transport of only glucose
Renal glycosuria
Bladder infection; a tubulointerstitial disorder
Cystitis
Tubular infection indicated by WBC casts
Acute pyelonephritis
Structural abnormalities that affect normal tubular emptying, often in children
Acute interstitial nephritis
Tubulointerstitial disorder which exhibits urine eosinophils, no bacteria, reaction to toxic medications
Acute interstitial nephritis
Patient with severe back pain; pH varies with type of calculi
Renal lithiasis (calculi)
Casts are composed of ____ aka ____ excreted by ____
Tamm-Horsefall protein, uromodulin
Renal tubular epithelial cells
Composed of Tamm-Horsfall (uromodulin) protein
Casts
Tamm-Horsfall protein aka
Uromodulin
Uromodulin aka
Tamm-Horsfall protein
Casts: when other urinary constituents are present, they are found in ___ or
___
Enmeshed in cast matrix or attached to cast matrix
Where are casts formed
Distal convoluted tubules and collecting ducts (wider casts)
Wider casts are formed in
Collecting ducts
Casts are reported as
/LPF
Colorless cast
Hyaline cast
Hyaline casts:
A. sources of error (3)
B. Clin sig (5)
A. Mucus Increased light Fibers B. Congestive heart failure Pyelonephritis Exercise Glomerulonephritis Stress
RBC casts:
A. Appearance
B. Clin sig
A. Orange/red-containing RBCs
B. Glomerulonephritis, strenuous exercise
WBC casts: clin sig
Pyelonephritis, acute interstitial nephritis
RTE cells attached to cast matrix
Epithelial cell cast
Epithelial cell cast:
A. Source of error
B. Clin sig
A. WBC casts
B. Renal tubular damage
Bacterial casts:
A. Source of error
B. Clin sig
A. Granular casts
B. Pyelonephritis
Granular casts:
A. Sources of error (2)
B. Clin sig (4)
A. Clumps of small crystals, columnar RTE cells
B. Glomerulonephritis, pyelonephritis, stress, exercise
Highly refractive casts with jagged edges and notches
Waxy casts
Waxy casts:
A. Sources of error (2)
B. Clin sig (2)
A. Fibers, fecal material
B. Stasis of urine flow, chronic renal failure
Casts with fat droplets and oval fat bodies attached to cast matrix
Fatty casts
Fatty casts:
A. Source of error
B. Clin sig
A. Fecal material
B. Nephrotic syndrome, DM, crush injuries
Wider than normal casts
Broad casts
Broad casts:
A. Sources of error (2)
B. Clin sig (2)
A. Fiber, fecal material
B. Extreme urine stasis, renal failure
Small non-nucleated discs
RBCs
RBC appearance on concentrated urine
Crenated
RBC appearance on dilute urine
Larger empty cells (ghost cells)
RBCs: regular (dysmorphic) shapes indicate
Glomerular bleeding
RBC shape which indicate glomerular bleeding
Regular (dysmorphic) shapes
RBC:
A. Sources of error (3)
B. Clin sig (4)
A. Oil droplets Air bubbles Yeast cells B. Renal calculi Bleeding in urinary tract Glomerulonephritis Malignancy
RBC: urinalysis correlations:
A clear red urine w/ + rgt strip for blood and no RBCs seen in microscope indicates (2)
Hemoglobinuria
Myoglobinuria
Larger than RBCs and contain nucleus
WBCs
WBC with multilevel nuclei and granules
Neutrophils
WBC stained with Wright or Hansel stain
Eosinophil
Eosinophil granules stained with Wright or Handel stain
Red
Stains for Eosinophil
Wright
Hansel
Neutrophils that have swollen in dilute urine, resulting in Brownian movement of granules in cytoplasm
Glitter cells
Glitter cells are __ that have ___ in dilute urine, resulting in ___ movement of ___ in cytoplasm
Glitter cells are neutrophils that have swollen in dilute urine, resulting in Brownian movement of granules in cytoplasm
WBC:
A. sources of error (3)
B. Urinalysis correlations (4)
C. Clin sig (3)
A. Monocytes RTE cells mononuclear lymphocytes B. Sp grav pH nitrite leukocyte esterase C. Malignancy (mononuclear cells) UTI (neutrophils) Drug-induced interstitial nephritis (eosinophils)
WBC seen in UTIs
Neutrophil
WBC seen in drug-induced interstitial nephritis
Eosinophil
WBC seen in malignancy
Mononuclear cells
3 types of epithelial cells
Squamous epithelial cells
Transitional (urothelial) cells
RTE cells
Largest cells in urine sediment
Squamous epithelial cells
Represent normal sloughing of old lower genitourinary tract cells
Squamous epithelial cells
T/F: squamous ep cells represent normal sloughing of old lower genitourinary tract cells
True
Squamous ep cells represent normal __ of old __ genitourinary tract cells
Sloughing
Lower
T/F: Folded squamous cells may resemble urinary casts
True
Differentiates folded sq ep cells from urinary casts
With centrally-located nucleus
Squamous cells covered with Gardnerella vaginalis, indicating a vaginal infection
Clue cells
Clue cells are squamous cells covered with this bacteria, indicating a vaginal infection
Gardnerella vaginalis
Transitional (urothelial) cells are found in (4)
Renal pelvis
Ureters
Bladder
Male urethra
Epithelial cells normally seen after catheterization procedures
Transitional (urothelial) cells
T/F: Transitional (urothelial) cells are normally seen after catheterization procedures
True
3 dif forms of transitional (urothelial) cells
Spherical
Caudate
Polyhedral
Transitional (urothelial) cell form which resembles renal tubular cells, except has centrally-located nucleus
Spherical
Increased transitional cells may indicate
Malignancy
RTE cells are found in (2)
Renal tubules
Collecting ducts
T/F: RTE cell shape varies with location
True
Rectangular with coarse granules and may resemble a cast (look for a nucleus)
Convoluted tubule cells
Convoluted tubule cells: Shape- Kind of granules- Resemble this urinary sediment- Differentiated from this urinary sediment-
Shape- rectangular
Kind of granules- coarse
Resemble this urinary sediment- cast
Differentiated from this urinary sediment- presence of nucleus
Small and round, may resemble spherical transitional cells but have eccentric nucleus
Distal convoluted tubule cells
Based on nucleus: Distal convoluted tubule cells vs. spherical transitional (urothelial) cells
Distal convoluted tubule cells
-eccentric nucleus
Spherical transitional (urothelial) cells
-centrally-located nucleus
Cuboidal RTE cells with at least 1 straight edge and freq in clumps
Cells from collecting duct
Cells from collecting duct are __ in shape RTE cells with at least __(#) __ edges and freq in clumps
Cuboidal
At least 1 straight edge
T/F: more than 2 RTE cells per HPF is considered significant
True
of RTE cells in HPF to be considered significant
> 2
Clin sig of RTE cells (1)
Tubular necrosis, often from poisoning or viral infections
Func of RTE cells
Absorb filtrate
Bilirubin-stained RTE cells may indicate
Liver damage
T/F: RTE cells may be bilirubin-stained (liver damage), contain hemosiderin granules (Hb) or lipids
True
RTE cells that have absorbed lipids
Oval fat bodies
T/F: oval fat bodies are highly refractile
True
Oval fat bodies are seen in conjunction with
Free-floating lipids
Oval fat bodies are RTE cells that have absorbed
Lipids
Oval fat bodies confirmed by (3)
Staining with oil red O, Sudan III, or polarized microscope
Clin sig of detecting oval fat bodies (3)
Nephrotic syndrome
DM
crush injuries
Small spheres (cocci) and rod-shaped organisms
Bacteria
Bacteria in urine should be accompanied by
WBCs
Bacteria:
A. source of errors (3)
B. Clin sig
A. Amorphous phosphates, urates, old sx with high pH
B.
UTI
Oval struc with buds or mycelia
Yeast
Yeasts in urine should be accompanied by
WBCs
Associated with acidic urine from Px w/ diabetes mellitus
Yeast
Yeast is associated with __ urine from Px with __
Acidic
diabetes mellitus
Yeast:
A. Source of error
B. Clin sig (3)
A. RBCs B. Diabetes mellitus Immunocompromised Px Vaginal infections
Most common parasite in urine, exhibits flagellar movement in wet prep
Trichomonas vaginalis
Common parasites in urine (3)
Trichomonas vaginalis Enterobium vermicularis (fecal contamination) Schistosoma haematobium (urine parasite)
Trichomonas vaginalis exhibits __ movement in wet prep
Flagellar movement
Parasites:
A. Sources of error (2)
B. Clin sig
A. WBC, RTE cells
B. Sexually transmitted disease which is asymptomatic in males and causes vaginal infection in females
Strands of protein secreted by glands and RTE cells
Mucus
Mucus are strands of protein secreted by (2)
Glands
RTE cells
Major protein in mucus
Tamm-Horsfall (uromodulin) protein
Mucus: sources of error (2)
Clumps may resemble hyaline casts (look for the consistent shape of cast to differentiate)
How to differentiate mucus from hyaline cast
look for the consistent shape of cast to differentiate
T/F: mucus is of no clin importance
True
Produced by the precipitation of urine solute affected by temp, solute conc, and pH
Crystals
Crystal formation in urine is affected by (3)
Temp
Solute conc
pH
T/F: crystals are more abundant in refrigerated urine sx
True
Kind of microscopy which aids in crystal ID
Polarized microscopy
Abnormal crystals are found only in (2)
Acidic and normal urine
T/F: Abnormal crystals are found only in acidic and normal urine
True
Normal crystals seen in acidic urine (3)
Amorphous urates
Calcium oxalate crystals
Utica acid crystals
Uric acid crystals: appearance
Yellow-brown, flat-sided rhombic plates, wedges, or rosettes
Uric acid crystals: sources of error
Cystine crystals
How to differentiate uric acid crystals from cystine crystals
Uric acid crystals polarize while cystine crystals don’t
Uric acid crystals: clin sig (2)
Lesch-Nyhan disease
Px receiving chemotherapy
Crystals in acidic urine which appear yellow-brown flat-sided rhombic plates, wedges, or rosettes
Uric acid crystals
Small spheres producing brick-dust (uroerythrin) or yellow-brown sediment
Amorphous urates
Brick-dust
Uroerythrin
Uroerythrin
Brick-dust
Amorphous urates: appearance
Small spheres producing brick-dust (uroerythrin) or yellow-brown sediment
Normal crystals seen in acidic urine and may also be in alkaline urine
Calcium oxalate crystals
2 forms of calcium oxalate crystals
Dihydrate form
-envelope-shaped; clumps in urine may indicate renal calculi
Monohydrate form
-oval or dumbbell-shaped; presence may indicate ethylene glycol (anti-freeze) ingestion
envelope-shaped calcium oxalate crystal; clumps in urine may indicate renal calculi
Dihydrate form of calcium oxalate crystal
Oval or dumbbell-shaped calcium oxalate crystal; presence may indicate ethylene glycol (anti-freeze) ingestion
Monohydrate form of calcium oxalate crystal
Disease associated with dihydrate form of calcium oxalate crystals
If in clumps: renal calculi
Disease associated with presence of monohydrate form of calcium oxalate crystals
Ethylene glycol (anti-freeze) ingestion
Normal crystals seen in alkaline urine (4)
Amorphous phosphate crystals
Calcium carbonate crystals
Ammonium biurate crystals
Triple phosphate crystals
Coffin-lid shaped, associated with very high pH and bacteria found in old Sx
Triple phosphate
Produce white ppt after refrigeration
Amorphous phosphate crystals
With dumbbell and spherical shapes, produce gas with acetic acid
Calcium carbonate crystals
2 shapes of calcium carbonate crystals
Dumbbell
Spherical
Yellow-brown thorny apple-shaped, assoc with old Sx with bacteria
Ammonium biurate
Artifacts in urine (5)
Starch granules Oil droplets Air bubbles Pollen grains Fibers
Abnormal crystals in urine (7)
Cystine crystals Ampicillin crystals Tyrosine crystals Cholesterol crystals Sulfonamide crystals Leucine crystals Bilirubin crystals
Hexagonal flat plates
Cystine crystals
Inherited disorder that inhibits reabsorption of cystine by renal tubules
Cystinuria
Rectangular plates with notches edges, highly birefringent under polarized light
Cholesterol crystals
Cholesterol crystals are seen in refrigerated tribe and accompanied by (2)
Fatty casts and oval fat bodies
Cholesterol crystals: clin sig
Nephrotic syndrome
Yellow needle-shaped forms in clusters or rosettes
Tyrosine crystals
Tyrosine crystals: clin sig
Severe liver disease
Yellow-brown spheres with concentric circles
Leucine crystals
Leucine crystals are seen in conjunction with
Tyrosine crystals
Leucine crystals: clin sig
Severe liver disease
Bright yellow clumped needles and granules
Bilirubin crystals
Bilirubin crystals: clin sig
Liver damage often from viral infections that damage the renal tubules, preventing reabsorption of bilirubin
T/F: bilirubin crystals clin sig:
Liver damage often from viral infections that damage the renal tubules, preventing reabsorption of bilirubin
True
With needle, rosette, and rhombic shapes, in adequately hydrated Px
Sulfonamide crystals
Tribe crystals which appear as colorless needles that form clumps after refrigeration, in inadeq hydrated Px
Ampicillin crystals
