Urinalysis Flashcards Preview

RENAL Pathology > Urinalysis > Flashcards

Flashcards in Urinalysis Deck (55):
1

Red colored urine suggests the presence of?

hemoglobin, myoglobin, or red blood cells

2

Cloudy or turbid urine suggests the presence of?

crystals, cells or casts

3

hematuria from hemolysis

hemoglobinuria

4

hematuria from skeletal muscle injury or rhabdomyolysis

myoglobinuria

5

How do you determine whether red colored urine contains hemoglobin, myoglobin or RBCs?

Look for cloudiness. This would indicate the presence of red blood cells, which would only be present in hematuria. Alternatively, one can centrifuge the urine and see if the red color moves into the heavier pellet (red blood cells), or stays in the supernatant (hemoglobin or myoglobin).

6

higher specific gravity of urine indicates?

more concentrated urine

7

Urine protein by dipstick uses the free amino groups on proteins to bind to pH indicators on the strip. This is not really measuring protein directly and tends to better detect (1) more than (2)

1. charged proteins like albumin 2. globulins

8

Patients can have quite a bit of proteinuria from (3) like the (1) proteins found in (2) and have dipstick negative urine

3. globulins 1. Bence-Jones 2. multiple myeloma

9

Interpreting the dipstick for blood requires comparison with the microscopic exam and generally there should be (1) on microscopic exam when there is positive blood on dipstick

red cells (erythrocytes)

10

If the dipstick shows blood without red cells present, then this could be (1), indicating that hemolysis has occurred (for (2) or muscle injury (for (3).

1. hemoglobulinuria or myoglobinuria 2. hemoglobulinuria 3. myoglobin

11

If nitrite is present in urine by dipstick, it may be an indication that (1) are present

1. nitrite producing bacteria

12

Another dipstick test for urinary tract infection is the detection of (1) which is not normally found in urine unless the white cells which express (1) are present

1. leukocyte esterase

13

pyuria

white cells in urine; pus

14

Microscopic examination of urine is performed on centrifuged sediment which means it is a (1) sample

concentrated

15

The most important concept in urinalysis is that casts indicate (1) and cells indicate (2)

1. renal location of disease 2. disease anywhere else

16

form when cells or protein are trapped in tubules and form molds of their surroundings

casts

17

In stained samples or by light microscopy, red blood cells are (1), whereas by phase contrast, (2)

1. red 2. one notices a lack of nuclei without the aid of color

18

Red cells, either alone or within casts, lack nuclei so can generally be readily distinguished from (1) casts

white cell or epithelial cell

19

White cells are usually?

neutrophils

20

Red cells are found in conditions of bleeding (1) is always a concern) and white cells are found in (2)

1. cancer 2. infection

21

Red blood cell casts generally indicate (1) and white blood cell casts indicate (2)

1. glomerular inflammation/type of glomerulonephritis 2. infection within the kidney which is called pyelonephritis

22

Epithelioid cell casts are found in (1) but often degenerate into (2)

1. acute kidney injury (previously called acute tubular necrosis or ATN) 2. granular casts

23

Protein can form casts in the renal tubules in patients with (1) which is also useful for diagnosis

1. nephrotic syndrome

24

found frequently in urine even in asymptomatic patients and are often not very diagnostically useful other than as another measure of urine pH

crystals

25

(1) crystals tend to form in acidic urine while (2) crystals tend to form in alkaline urine

1. Uric acid and cystine 2. triple phosphate

26

one strategy to try and prevent crystal formation is?

making urine pH more or less alkaline in order to decrease crystal formation

27

There is one time when the microscopic exam can be wrong, and that is when the urine is so (1) it lyses the red cells, because red cells can’t survive in a (2) fluid

1. dilute 2. hypotonic

28

Urinalysis can be ___, ____, and ____

Macroscopic; chemical; or microscopic`

29

Gross examination of the urine to determine whether there is serious renal disease

macroscopic urinalysis

30

what is clarity of urine

Measure of transparency; NOT color;

31

Red urine: centrifuge it to differentiate RBCs from Hbemia/myoglobinemia

centrifuge the urine to see if the red color moves into the heavier pellet (indicates RBCs, i.e. hematuria) or stays in the supernatant (Hbemia or myoglobinemia)

32

Note: these are SCREENING tests

Chemical urinalysis

33

______ detects esterase enzyme present in certain WBCs (neutrophils and monocytes) --> indicates urinary tract infection, since seeing host response

Leukocyte esterase

34

If there is bacteria present w/o a host rxn (WBCs) then it is likely a _____ (since bacterial diseases usually produce neutrophilic response)

contaminan

35

Microscopic exam: ___ urine to get concentrated sediment (for better determination). Examination can be viewed either 1) 2)

Centrifuged; 1. with a stain or unstained by phase contrast 2. light microscopy.

36

____ can be present anyplace between kidney and the collection system—i.e. indicates disease anywhere

Cells

37

RBCs--> indicates ____, thus worry about ___

bleeding, cancer

38

•Result of bleeding at any point in the urinary system.

•No nuclei

 

) RBCs

39

•(b) WBCs --> Indicates ___

•Usually ____ (type of cell)

•Presence of a few is normal

•High numbers indicate inflammation or infection.

See nuclei and cytoplasm—so more internal structure

infection;

neutrophils (poly-lobed nuclei)

40

RBCs vs. WBCs on histo

RBCs have NO nuclei; WBCs have nuclei and are multi-lobed

41

____ are much smaller than the cells; 

small numbers--> ____; high numbers--> more likely to be contamination

bacteria;

infection;

42

____ --> indicate glomerulonephritis (both acute and chronic; this is a more severe disorder than pyelonephritis)

RBC Casts;

43

__->indicate pyelonephritis; suggests acute inflammation (if ____) or chronic (if ___); can be treated w/ antibiotics and less severe than _____

WBC Casts; neutrophils; lymphocytes; glomerulonephritis

44

•Cells are large and flat.

•Normal cells that line the urinary and genital tract or renal tubules + transitional cells (bladder)

Epithelial cells

45

epithelial cells vs. epithelioid casts

Normal cells that line the urinary and genital tract or renal tubules + transitional cells (bladder 

Epithelioid Casts --> indicate Acute Renal Injury (AKI)

46

•) ____ --> indicate Acute Renal Injury (AKI) (pts will have low urine output/oligouria).

•Often degenerate into granular casts  go from coarse granular cast -> fine granular cast -> waxy cast (not much internal structure) as gets older.

Form in the loops of Henle, distal tubules, and collecting ducts

 

 

Epithelioid Casts

47

indicate nephrotic syndrome, can be normally present, or in those w/ dehydration

Hyaline Casts

48

Hyaline casts

•___ and fatter than mucus.

•A few are normal; a lot indicates ___.

•May be increased after ____.

From when ___ solidifies in the nephron

Colorless; nephrotic syndrome; strenuous exercise;protein

49

Found frequently in urine, even in asymptomatic pts; more distraction than useful—clinical correlation required

Crystals

50

•colorless; octahedron; found in acidic urine

Calcium oxalate crystals

51

•in cystinuria in small children; hexagon (6 sides); acidic urine

Cystine Crystals

52

•in MSUD  (important to diagnoses, especially in children); round shape w/ clear border and a darker center.

 Leucine Crystals

53

•colorless; coffin-lid prism; common finding and not usually significant (pH info).; alkaline urine

Triple Phosphate Crystals

54

Acidic urine

(1) ___: colorless; octahedron.

(2) ___: sharper borders

•(3) Other urates: sodium urate, amorphous urates (all sharp borders)

•(4) Cystine Crystals: in cystinuria in small children; hexagon (6 sides)

•(5) Leucine Crystals: in MSUD  (important to diagnoses, especially in children); round shape w/ clear border and a darker center.

Calcium Oxalate Crystals; Uric Acid Crystals;

55

(1) Triple Phosphate Crystals: colorless; coffin-lid prism; common finding and not usually significant (pH info).

(2) Calcium phosphate (spear-head) and amorphous phosphates

Found in  ___

alkaline urine