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Clinical Microscopy > Urinalysis > Flashcards

Urinalysis Flashcards

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1
Q

Urine Sx for routine screening, requires confirmatory testing based on diet and exercise

A

Random urine sx

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2
Q

Random urine Sx is affected by (2)

A

Diet

Exercise

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3
Q

Urine sx for ruling out orthostatic proteinuria

A

First morning urine

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4
Q

Urine Sx for pregnancy tests

A

First morning urine

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5
Q

Urine Sx for routine screening/confirmatory testing, collected immediately upon arising

A

First morning urine

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6
Q

Urine Sx which requires genital area to be washed, for bacterial cultures

A

Midstream clean catch

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7
Q

Urine sx: void in toilet-collect sx-finish voiding in toilet, for bacterial cultures

A

Midstream clean catch

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8
Q

For bacterial cultures, collected from catheter passed into bladder

A

Catheterized

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9
Q

T/F: if both urinalysis and culture required, perform culture first

A

True

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10
Q

Urine Sx: Px voids into toilet and begins timing, collects all urine during designated period, voids and collects urine at end of period

A

24-hour (timed) urine sx

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11
Q

Urine Sx which can provide quantitative results

A

24-hour (timed) urine sx

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12
Q

Changes in unpreserved urine

A 
Increased:
 pH
 Nitrite
 Bacteria
Decreased: 
 Bilirubin (oxidized to biliverdin)
 Urobiliogen (oxidized to urobilin)
 Glucose (glycolysis)
 Ketones (oxidized)
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13
Q

Normal urine volume

A

600-2000 mL/day

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14
Q

Decreased urine output

A

Oliguria

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15
Q

No urine output

A

Anuria

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16
Q

Increased urine output at night

A

Nocturia

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17
Q

Increased urine output >2.5 L/day

A

Polyuria

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18
Q

Oliguria urine output

A
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19
Q

Polyuria urine output

A

> 2.5 L/day

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20
Q

Increased urine output to excrete excess urine glucose

A

Diabetes mellitus

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21
Q

Increased urine output due to non-func insulin

A

Diabetes mellitus

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22
Q

Increased urine output caused by lack or dysfunctional anti-diuretic hormone

A

Diabetes insipidus

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23
Q

Results in polydipsia

A

Polyuria

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24
Q

Polyuria may be caused by (3)

A

Diabetes mellitus
Diabetes insipidus
Polydipsia

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25
Normal color of urine
Yellow
26
Shades of yellow of urine are based on
Fluid consumption
27
T/F: Shades of yellow of urine are based on fluid consumption
True
28
Shades of yellow of urine vary from
Pale yellow (dilute) to dark yellow (concentrated)
29
Urine clarity terminology (5)
``` Clear Hazy Cloudy Turbid Milky ```
30
T/F: Freshly voided normal urine is clear
True
31
Appearance of freshly voided normal urine
Clear
32
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
33
T/F: white turbidity in urine may indicate presence of amorphous phosphates and carbonates
True
34
White turbidity in urine may indicate presence of
amorphous phosphates and carbonates
35
pH and color (of turbidity) of urine with amorphous phosphates and carbonates
Alkaline, white
36
T/F: pink turbidity in urine may indicate presence of amorphous urates
True
37
pink turbidity in urine may indicate presence of
amorphous urates
38
pH and color (of turbidity) of urine with amorphous urates
Acidic, pink
39
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 ```
40
Pathologic causes of turbidity in urine ((6)
``` RBCs Abnormal crystals Urothelial and renal tubular epithelial cells Lipids (milky) WBCs Yeasts ```
41
Causes tribe clarity to appear milky
Lipids
42
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
43
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
44
Cause black colored urine (2)
A. Oxidized RBCs, denature Hb -clear urine, + test for blood B. Melanin -darkens upon standing
45
Screening test for renal tubular reabsorption of essential elements filtered by glomerulus
Specific gravity
46
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
47
Glomerular filtrate specific gravity
1.010
48
T/F: Glomerular filtrate specific gravity is 1.010
True
49
It is the comparison of density of urine to that of d. H20
Specific gravity
50
Urine contains dissolved subs that produce density based on (2)
Size | Number
51
Used to measure specific gravity (3)
Reagent strip Refractometer Osmolarity (harmonic oscillation density)
52
Primary test for routine urinalysis
Reagent strip
53
T/F: Reagent strip is the primary test for routine urinalysis
True
54
Reagent strip is the __ test for ___ urinalysis
Primary, routine
55
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
56
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
57
T/F: increased urine conc = increased hydrogenated released = low pH (acidic)
True
58
increased urine conc = ____ hydrogenated released = ___ pH ( )
increased urine conc = increased hydrogenated released = low pH (acidic)
59
Indicator on reagent strip for specific gravity | -also color range
Bromothymol blue | -yellow-green (acidic) to green-blue (alkaline)
60
Uses a prism to direct wavelength of light thru urine; light angle read on scale calibrated with d H20
Refractometer
61
Principle of refractometer
The concentration of dissolved subs in soln directs the velocity and angle of light passing thru soln
62
Refractometer uses a ___ to direct ___ of light thru the urine
Prism, wavelength
63
Measurement of the number of particles into which 1g molec wt of subs dissociates
Osmolarity
64
Osmolarity measures only
of particles (size not relevant)
65
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
66
considered more representative of renal concentrating ability than sp grav because meas only # of particles and their size is not relevant
Osmolarity
67
Osmolarity is considered more representative of ___ than sp grav because meas only # of particles and their size is not relevant
Renal concentrating ability
68
Unit for reporting osmolarity
mOsm (milliosmoles)
69
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
70
T/F: in freezing point depression: 1 mole of NON-ionizing subs will LOWER freezing pt by 1.86。C
True
71
T/F: in freezing point depression: | volatile subs like alcohol can interfere
True
72
1 mole of NON-ionizing subs will LOWER freezing pt by __ 。C
1.86 。C
73
Temp at which vapor condenses to liq
Dew point
74
A Colligative property whose | actual measurement is dew point of urine
Vapor pressure depression
75
T/F: Vapor pressure depression: NO interference from volatile subs
True
76
Colligative property which uses microsamples on filter paper discs
Vapor pressure depression
77
Normal serum osmolarity
275-300 mOsm
78
T/F: normal serum osmolarity is 275-300 mOsm
True
79
T/F: fluid intake influences urine osmolarity
True
80
Influences urine osmolarity
Fluid intake
81
random serum to urine ratio =
1:1
82
Serum to urine ratio for controlled fluid intake
3:1
83
Clin sig of osmolarity
To determine ADH production or tubular response to ADH for diabetes insipidus
84
Used to determine ADH production or tubular response to ADH for diabetes insipidus
Osmolarity
85
Harmonic oscillation density is for
Osmolarity
86
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
87
Harmonic oscillation density principle
Change in freq of sound wave is proportional to urine density
88
Low specific gravity = __ pH
Alkaline
89
High specific gravity = __ pH
Acidic
90
Specific gravity is ___ to pH
Inversely proportional
91
Reagent strips: care and quality control (7)
Don't refrigerate (RT
92
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
93
T/F: urine pH doesn't reach 9.0
True
94
A reading of pH 9.0 indicates a ___ and should be ___
Old sx, recollected
95
Normal value of urine pH
4.5-8.0
96
Reagent strip principle for pH
Double indicator (methyl red and bromothymol blue)
97
Clin sig of urine pH measurement (2)
Detect acid-base disorders | ID of urinary crystals
98
Used to detect acid-base disorders
Urine pH
99
Used to identify urinary crystals
Urine pH
100
Urine pH test sources of error | 2) and test correlations (3
``` A. Old sx (+) Runover from adjacent strips B. Nitrite Leukocyte esterase Microscopic ```
101
Urine protein: reagent strips measure primarily __
Albumin
102
NV of urine protein
103
Urine protein with 30 mg/dL or greater is considered
Clinical proteinuria
104
Clinical protein urea is considered when urine protein reaches
30 mg/dL or greater
105
T/F: Clinical protein urea is considered when urine protein reaches 30 mg/dL or greater
True
106
Urine protein: reagent strip principle
Protein error of indicators
107
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
108
Requires different reagent strip capable of testing for only albumin at levels below 10 mg/dL
Microalbuminuria
109
Provides early detection of renal disease, especially in patients with diabetes
Microalbuminuria
110
Reagent strip which tests for albumin and creatinine, along with other routine strip tests, EXCEPT urobilinogen
Multistix PRO 11
111
Multistix PRO 11 reagent strip tests for | ______, EXCEPT ___
Albumin and creatinine, along with other routine strip tests | Except urobilinogen
112
Multistix PRO 11 doesn't test for this
Urobilinogen
113
Corrects hydration in a random sample to provide an estimate of the 24-hr microalbumin level
Albumin-to-creatinine ratio
114
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
115
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 Nitrites ```
116
Glucose: reagent strip principle
Glucose oxidase test (specific for glucose)
117
T/F: glucose oxidase test is specific for glucose
True
118
Renal threshold for glucose
160-180 mg/dL
119
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
120
Glucose: clinitest principle
Reducing substances including glucose and other sugars can reduce copper sulfate (blue-green) to cuprous oxide (orange-red)
121
Color of copper sulfate in clinitest
Blue-green
122
Color of cuprous oxide in clinitest
Orange-red
123
May be used to test newborn urine for galactose
Clinitest
124
Clinitest may be used to test newborn urine for ___
Galactose
125
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 Ketones ```
126
Intermediate metabolites of fat, acetoacetic acid, acetone, and beta-hydroxybutyric acid
Ketones
127
Ketones are ___ metabolites of __, __, __, and __
``` Intermediate metabolites of Fats Acetoacetic acid Acetone Beta-hydroxybutyric acid ```
128
Ketones: reagent strip principle
Reaction of acetoacetic acid or acetone (with glycine) with sodium nitroprusside/ ferricyanide
129
clin sig of measuring ketones in urine (5)
``` Malabsorption Diabetes mellitus Insulin therapy monitoring Starvation CHO loss ```
130
Reagent strip: ketones: A. Sources of error (4) B. Test correlations (1)
``` A. Red urine (+) Old sx (-) Levodopa (+) Sulfhydryl medications (+) B. Glucose ```
131
Blood: reagent strip: (+) reactions seen with (3)
Hematuria Hemoglobinuria Myoblobinuria
132
Blood: reagent strip principle
Pseudoperoxidase activity of Hb
133
T/F: Hb has pseudoperoxidase activity
True
134
Clin sig of detecting blood in urine sx
Hemoglobinuria and myoglobinuria can cause acute renal failure
135
T/F: Hemoglobinuria and myoglobinuria can cause acute renal failure
True
136
Bleeding within genitourinary system, including pyelonephritis, renal calculi, anticoagulants, glomerulonephritis, trauma
Hematuria
137
Hematuria is bleeding within genitourinary system, including (5)
``` pyelonephritis renal calculi anticoagulants glomerulonephritis trauma ```
138
Intravascular hemolysis/ transfusion reactions, lysis of old RBCs by dilute alkaline urine
Hemoglobinuria
139
Rhabdomyolysis caused by prolonged coma, cholesterol statin drugs, muscle-wasting disorders, crush injuries
Myoglobinuria
140
Myoglobinuria is rhabdomyolysis caused by (4)
prolonged coma cholesterol statin drugs muscle-wasting disorders crush injuries
141
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 Microscopic ```
142
T/F: both bilirubin and urobilinogen are products of Hb degradation
True
143
Bilirubin: reagent strip principle
Disco reaction
144
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
145
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
146
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 Color ```
147
T/F: some of conj bilirubin is converted to urobilinogen in the intestine
True
148
Organ where some of conj bilirubin is converted to urobilinogen
Intestine
149
Amount of urobilinogen normally found in urine
1mg/dL
150
Urobilinogen: principle A. Multistix B. Chemstrip
A. Multistix: Ehrlich's reaction | B. Chemstrip: Diazo reaction
151
Clin sig of meas urobilinogen in urine (3)
Early detection of liver disease and hemolytic disorders, constipation
152
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 ```
153
Detects presence of reductase-producing bacteria that can convert urinary nitrate to nitrite
Nitrite test (reagent strip)
154
Nitrite test (reagent strip) principle
Diazo reaction
155
Clin sig of detecting nitrite in urine
Early detection of UTI
156
T/F: a + nitrite test should be accompanied by + leukocyte esterase test
True
157
T/F: nitrite may be used to screen Sx for microbiology terming
True
158
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 ```
159
Detects presence of granulocytuc WBCs, including used WBCs
Leukocyte esterase
160
T/F: leukocyte esterase detects presence of granulocytuc WBCs, including used WBCs
True
161
Leukocyte esterase: rgt strip principle
Diazo rxn
162
T/F: Leukocyte esterase rgt strip SHOULD be read 2 mins AFTER urine exposure
True
163
Clin sig of leukocyte esterase test (3)
UTI, including with non-reductase-containing bacteria, parasitic and fungal organisms which yield neg nitrite test
164
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 ```
165
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 ```
166
Types of common urine Sx (5)
``` Random First morning Midstream clean catch Catheterized 24-hour (timed) ```
167
Control ability of kidney to clear waste products and maintain body's water and electrolyte balance
Nephrons
168
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
169
Nephron found in cortex of kidney; remove waste products and reabsorption nutrients
Cortical nephron
170
Nephron which extend into the medulla; concentrate the urine
Juxtaglomerular nephron
171
Func of cortical nephron (2)
Remove waste | Reabsorption nutrients
172
Func of Juxtaglomerular nephron
Concentrate the urine
173
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
174
Normal renal blood flow
Approx 1200 mL/min
175
Normal plasma flow
Approx 600-700 mL/min
176
Non-selective filtration of plasma subs with MWs
Glomerular filtration
177
MW of albumin
67,000 Da
178
Controls filtration pressure
Renin-angiotensin-aldosterone system (RAAS)
179
Trace RAAS
Find in book p 166 elsevier
180
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 ```
181
Renal tubular concentration occurs in (2)
Ascending and descending loops of Henle
182
Occurs in ascending and descending loops of Henle
Renal tubular concentration
183
Removes non-filtered waste products from blood to the filtrate and maintains acid-base balance in body
Renal tubular secretion
184
Renal tubular secretion is for (2)
Removing non-filtered waste products from blood to the filtrate and maintaining acid-base balance in body
185
T/F: subs like medications are bound to plasma carrier proteins and are too large to be filtered
True
186
T/F: medications bound to carrier proteins dissociate from them in the tubules and are then secreted into the filtrate
True
187
T/F: small hydrogen molecules are easily filtered and must be returned to the blood
True
188
Small hydrogen molecules combo with __ or __ secreted by ___ and are secreted back to the blood
phosphate ions or ammonia secreted by renal tubular cells
189
T/F: Small hydrogen molecules combo with phosphate ions or ammonia secreted by renal tubular cells and are secreted back to the blood
True
190
T/F: Small bicarbonate ions (HCO3-) are needed for the acid-base buffering system
True
191
Small bicarbonate ions (HCO3-) are needed in this system
acid-base buffering system
192
T/F: small bicarbonate ions (HCO3-) are easily filtered
True
193
small bicarbonate ions (HCO3-) combo with __, producing __ that can be secreted back to blood
Hydrogen molecules | Bicarbonate (H2CO3)
194
GFR normal value
120 mL/min
195
Classic test for GFR
Creatinine clearance test
196
Creatinine clearance test requires this kind of urine
Timed (24-hr) urine
197
T/F: calculated GFR estimates (eGFR) doesn't require a timed urine Sx
True
198
Small molec produced at constant rate by ALL nucleated cells
Cystatin C
199
T/F: Cystatin C is produced at CONSTANT rate by ALL nucleated cells
True
200
T/F: Cystatin C is COMPLETELY filtered, reabsorbed, and broken down by renal tubular cells
True
201
Cystatin C is COMPLETELY filtered, reabsorbed, and broken down by
Renal tubular cells
202
Primary tests for renal tubular reabsorption
Serum and urine osmolarity
203
Serum and urine osmolarity are primary tests for
Renal tubular reabsorption
204
Meas ability of kidneys to respond to body's hydration
Free water clearance test
205
Creatinine clearance formula
C= (UxV)/P
206
Free water clearance test formula
Cosm= [(Uosm)x(V)]/Posm
207
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
208
Tubular secretion test which detects inability of proximal convoluted tubules to secrete hydrogen molecules
Titratable acidity
209
Tubular secretion test which detects inability of proximal and distal convoluted tubules to produce ammonia
Urinary ammonia
210
Enumerate rxn pads on rgt strip (in order) (10)
1. Glucose 2. Bilirubin 3. Ketone 4. Sp grav 5. Blood 6. pH 7. Protein 8. Urobilinogen 9. Nitrite 10. Leukocyte esterase
211
Glomerular disorders due to post-streptococcal infection
Acute glomerulonephritis
212
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 ```
213
Tubular disorders enumerate (3)
K. Acute tubular necrosis L. Fanconi's syndrome M. Renal glycosuria
214
Enumerate tubulointerstitial disorders (5)
``` N. Cystitis O. Acute pyelonephritis P. Chronic pyelonephritis Q. Acute interstitial nephritis R. Renal lithiasis (calculi) ```
215
Glomerular disorder which exhibits anti-glomerular basement membrane antibodies
Goodpasture's syndrome
216
Glomerular disorder which exhibits antineutrophil cytoplasmic antibody
Wegner's granulomatosis
217
Glomerular disorder primarily seen in children after respiratory infection
Henoch-Schönlein purpura
218
Glomerular disorder which caused by autoimmune disorders
Membranous glomerulonephritis
219
Glomerular disorder due to progression from previous disorders
Chronic glomerulonephritis
220
Immune IgA complexes deposited in glomerular membrane
IgA nephropathy
221
Circulatory disruption decreasing blood flow to kidney, increased serum lipids
Nephrotic syndrome
222
Glomerular disorder seen in children after allergic reactions, heavy edema, good prognosis
Minimal change disease
223
Glomerular disorder due to drugs of abuse and HIV
Focal segmental glomerulosclerosis
224
Tubular disorders which may be due to hemoglobinuria, myoglobinuria, antibiotics
Acute tubular necrosis
225
General failure of tubular reabsorption
Fanconi's syndrome
226
Failure of active transport of only glucose
Renal glycosuria
227
Bladder infection; a tubulointerstitial disorder
Cystitis
228
Tubular infection indicated by WBC casts
Acute pyelonephritis
229
Structural abnormalities that affect normal tubular emptying, often in children
Acute interstitial nephritis
230
Tubulointerstitial disorder which exhibits urine eosinophils, no bacteria, reaction to toxic medications
Acute interstitial nephritis
231
Patient with severe back pain; pH varies with type of calculi
Renal lithiasis (calculi)
232
Casts are composed of ____ aka ____ excreted by ____
Tamm-Horsefall protein, uromodulin | Renal tubular epithelial cells
233
Composed of Tamm-Horsfall (uromodulin) protein
Casts
234
Tamm-Horsfall protein aka
Uromodulin
235
Uromodulin aka
Tamm-Horsfall protein
236
Casts: when other urinary constituents are present, they are found in ___ or ___
Enmeshed in cast matrix or attached to cast matrix
237
Where are casts formed
Distal convoluted tubules and collecting ducts (wider casts)
238
Wider casts are formed in
Collecting ducts
239
Casts are reported as
#/LPF
240
Colorless cast
Hyaline cast
241
Hyaline casts: A. sources of error (3) B. Clin sig (5)
``` A. Mucus Increased light Fibers B. Congestive heart failure Pyelonephritis Exercise Glomerulonephritis Stress ```
242
RBC casts: A. Appearance B. Clin sig
A. Orange/red-containing RBCs | B. Glomerulonephritis, strenuous exercise
243
WBC casts: clin sig
Pyelonephritis, acute interstitial nephritis
244
RTE cells attached to cast matrix
Epithelial cell cast
245
Epithelial cell cast: A. Source of error B. Clin sig
A. WBC casts | B. Renal tubular damage
246
Bacterial casts: A. Source of error B. Clin sig
A. Granular casts | B. Pyelonephritis
247
Granular casts: A. Sources of error (2) B. Clin sig (4)
A. Clumps of small crystals, columnar RTE cells | B. Glomerulonephritis, pyelonephritis, stress, exercise
248
Highly refractive casts with jagged edges and notches
Waxy casts
249
Waxy casts: A. Sources of error (2) B. Clin sig (2)
A. Fibers, fecal material | B. Stasis of urine flow, chronic renal failure
250
Casts with fat droplets and oval fat bodies attached to cast matrix
Fatty casts
251
Fatty casts: A. Source of error B. Clin sig
A. Fecal material | B. Nephrotic syndrome, DM, crush injuries
252
Wider than normal casts
Broad casts
253
Broad casts: A. Sources of error (2) B. Clin sig (2)
A. Fiber, fecal material | B. Extreme urine stasis, renal failure
254
Small non-nucleated discs
RBCs
255
RBC appearance on concentrated urine
Crenated
256
RBC appearance on dilute urine
Larger empty cells (ghost cells)
257
RBCs: regular (dysmorphic) shapes indicate
Glomerular bleeding
258
RBC shape which indicate glomerular bleeding
Regular (dysmorphic) shapes
259
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 ```
260
RBC: urinalysis correlations: | A clear red urine w/ + rgt strip for blood and no RBCs seen in microscope indicates (2)
Hemoglobinuria | Myoglobinuria
261
Larger than RBCs and contain nucleus
WBCs
262
WBC with multilevel nuclei and granules
Neutrophils
263
WBC stained with Wright or Hansel stain
Eosinophil
264
Eosinophil granules stained with Wright or Handel stain
Red
265
Stains for Eosinophil
Wright | Hansel
266
Neutrophils that have swollen in dilute urine, resulting in Brownian movement of granules in cytoplasm
Glitter cells
267
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
268
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) ```
269
WBC seen in UTIs
Neutrophil
270
WBC seen in drug-induced interstitial nephritis
Eosinophil
271
WBC seen in malignancy
Mononuclear cells
272
3 types of epithelial cells
Squamous epithelial cells Transitional (urothelial) cells RTE cells
273
Largest cells in urine sediment
Squamous epithelial cells
274
Represent normal sloughing of old lower genitourinary tract cells
Squamous epithelial cells
275
T/F: squamous ep cells represent normal sloughing of old lower genitourinary tract cells
True
276
Squamous ep cells represent normal __ of old __ genitourinary tract cells
Sloughing | Lower
277
T/F: Folded squamous cells may resemble urinary casts
True
278
Differentiates folded sq ep cells from urinary casts
With centrally-located nucleus
279
Squamous cells covered with Gardnerella vaginalis, indicating a vaginal infection
Clue cells
280
Clue cells are squamous cells covered with this bacteria, indicating a vaginal infection
Gardnerella vaginalis
281
Transitional (urothelial) cells are found in (4)
Renal pelvis Ureters Bladder Male urethra
282
Epithelial cells normally seen after catheterization procedures
Transitional (urothelial) cells
283
T/F: Transitional (urothelial) cells are normally seen after catheterization procedures
True
284
3 dif forms of transitional (urothelial) cells
Spherical Caudate Polyhedral
285
Transitional (urothelial) cell form which resembles renal tubular cells, except has centrally-located nucleus
Spherical
286
Increased transitional cells may indicate
Malignancy
287
RTE cells are found in (2)
Renal tubules | Collecting ducts
288
T/F: RTE cell shape varies with location
True
289
Rectangular with coarse granules and may resemble a cast (look for a nucleus)
Convoluted tubule cells
290
``` 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
291
Small and round, may resemble spherical transitional cells but have eccentric nucleus
Distal convoluted tubule cells
292
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
293
Cuboidal RTE cells with at least 1 straight edge and freq in clumps
Cells from collecting duct
294
Cells from collecting duct are __ in shape RTE cells with at least __(#) __ edges and freq in clumps
Cuboidal | At least 1 straight edge
295
T/F: more than 2 RTE cells per HPF is considered significant
True
296
of RTE cells in HPF to be considered significant
>2
297
Clin sig of RTE cells (1)
Tubular necrosis, often from poisoning or viral infections
298
Func of RTE cells
Absorb filtrate
299
Bilirubin-stained RTE cells may indicate
Liver damage
300
T/F: RTE cells may be bilirubin-stained (liver damage), contain hemosiderin granules (Hb) or lipids
True
301
RTE cells that have absorbed lipids
Oval fat bodies
302
T/F: oval fat bodies are highly refractile
True
303
Oval fat bodies are seen in conjunction with
Free-floating lipids
304
Oval fat bodies are RTE cells that have absorbed
Lipids
305
Oval fat bodies confirmed by (3)
Staining with oil red O, Sudan III, or polarized microscope
306
Clin sig of detecting oval fat bodies (3)
Nephrotic syndrome DM crush injuries
307
Small spheres (cocci) and rod-shaped organisms
Bacteria
308
Bacteria in urine should be accompanied by
WBCs
309
Bacteria: A. source of errors (3) B. Clin sig
A. Amorphous phosphates, urates, old sx with high pH B. UTI
310
Oval struc with buds or mycelia
Yeast
311
Yeasts in urine should be accompanied by
WBCs
312
Associated with acidic urine from Px w/ diabetes mellitus
Yeast
313
Yeast is associated with __ urine from Px with __
Acidic | diabetes mellitus
314
Yeast: A. Source of error B. Clin sig (3)
``` A. RBCs B. Diabetes mellitus Immunocompromised Px Vaginal infections ```
315
Most common parasite in urine, exhibits flagellar movement in wet prep
Trichomonas vaginalis
316
Common parasites in urine (3)
``` Trichomonas vaginalis Enterobium vermicularis (fecal contamination) Schistosoma haematobium (urine parasite) ```
317
Trichomonas vaginalis exhibits __ movement in wet prep
Flagellar movement
318
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
319
Strands of protein secreted by glands and RTE cells
Mucus
320
Mucus are strands of protein secreted by (2)
Glands | RTE cells
321
Major protein in mucus
Tamm-Horsfall (uromodulin) protein
322
Mucus: sources of error (2)
Clumps may resemble hyaline casts (look for the consistent shape of cast to differentiate)
323
How to differentiate mucus from hyaline cast
look for the consistent shape of cast to differentiate
324
T/F: mucus is of no clin importance
True
325
Produced by the precipitation of urine solute affected by temp, solute conc, and pH
Crystals
326
Crystal formation in urine is affected by (3)
Temp Solute conc pH
327
T/F: crystals are more abundant in refrigerated urine sx
True
328
Kind of microscopy which aids in crystal ID
Polarized microscopy
329
Abnormal crystals are found only in (2)
Acidic and normal urine
330
T/F: Abnormal crystals are found only in acidic and normal urine
True
331
Normal crystals seen in acidic urine (3)
Amorphous urates Calcium oxalate crystals Utica acid crystals
332
Uric acid crystals: appearance
Yellow-brown, flat-sided rhombic plates, wedges, or rosettes
333
Uric acid crystals: sources of error
Cystine crystals
334
How to differentiate uric acid crystals from cystine crystals
Uric acid crystals polarize while cystine crystals don't
335
Uric acid crystals: clin sig (2)
Lesch-Nyhan disease | Px receiving chemotherapy
336
Crystals in acidic urine which appear yellow-brown flat-sided rhombic plates, wedges, or rosettes
Uric acid crystals
337
Small spheres producing brick-dust (uroerythrin) or yellow-brown sediment
Amorphous urates
338
Brick-dust
Uroerythrin
339
Uroerythrin
Brick-dust
340
Amorphous urates: appearance
Small spheres producing brick-dust (uroerythrin) or yellow-brown sediment
341
Normal crystals seen in acidic urine and may also be in alkaline urine
Calcium oxalate crystals
342
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
343
envelope-shaped calcium oxalate crystal; clumps in urine may indicate renal calculi
Dihydrate form of calcium oxalate crystal
344
Oval or dumbbell-shaped calcium oxalate crystal; presence may indicate ethylene glycol (anti-freeze) ingestion
Monohydrate form of calcium oxalate crystal
345
Disease associated with dihydrate form of calcium oxalate crystals
If in clumps: renal calculi
346
Disease associated with presence of monohydrate form of calcium oxalate crystals
Ethylene glycol (anti-freeze) ingestion
347
Normal crystals seen in alkaline urine (4)
Amorphous phosphate crystals Calcium carbonate crystals Ammonium biurate crystals Triple phosphate crystals
348
Coffin-lid shaped, associated with very high pH and bacteria found in old Sx
Triple phosphate
349
Produce white ppt after refrigeration
Amorphous phosphate crystals
350
With dumbbell and spherical shapes, produce gas with acetic acid
Calcium carbonate crystals
351
2 shapes of calcium carbonate crystals
Dumbbell | Spherical
352
Yellow-brown thorny apple-shaped, assoc with old Sx with bacteria
Ammonium biurate
353
Artifacts in urine (5)
``` Starch granules Oil droplets Air bubbles Pollen grains Fibers ```
354
Abnormal crystals in urine (7)
``` Cystine crystals Ampicillin crystals Tyrosine crystals Cholesterol crystals Sulfonamide crystals Leucine crystals Bilirubin crystals ```
355
Hexagonal flat plates
Cystine crystals
356
Inherited disorder that inhibits reabsorption of cystine by renal tubules
Cystinuria
357
Rectangular plates with notches edges, highly birefringent under polarized light
Cholesterol crystals
358
Cholesterol crystals are seen in refrigerated tribe and accompanied by (2)
Fatty casts and oval fat bodies
359
Cholesterol crystals: clin sig
Nephrotic syndrome
360
Yellow needle-shaped forms in clusters or rosettes
Tyrosine crystals
361
Tyrosine crystals: clin sig
Severe liver disease
362
Yellow-brown spheres with concentric circles
Leucine crystals
363
Leucine crystals are seen in conjunction with
Tyrosine crystals
364
Leucine crystals: clin sig
Severe liver disease
365
Bright yellow clumped needles and granules
Bilirubin crystals
366
Bilirubin crystals: clin sig
Liver damage often from viral infections that damage the renal tubules, preventing reabsorption of bilirubin
367
T/F: bilirubin crystals clin sig: | Liver damage often from viral infections that damage the renal tubules, preventing reabsorption of bilirubin
True
368
With needle, rosette, and rhombic shapes, in adequately hydrated Px
Sulfonamide crystals
369
Tribe crystals which appear as colorless needles that form clumps after refrigeration, in inadeq hydrated Px
Ampicillin crystals

Clinical Microscopy (1 decks)

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