Urinalysis- Microscopic

Question 1

Preservation
– Cells and casts begin to disintegrate in ___________
– Refrigeration for up to 48 hours (little loss of cells).

Answer 1

1 - 3 hrs . at room temp.

Question 2

Abnormal Findings Per High Power Field (HPF) (400x)

Answer 2

– > 3 erythrocytes
– > 5 leukocytes
– > 2 renal tubular cells
– > 10 bacteria

Question 3

Per Low Power Field (LPF) (200x)

Answer 3

– > 3 hyaline casts or > 1 granular cast
– > 10 squamous cells (indicative of contaminated specimen)
– Any other cast (RBCs, WBCs)

Question 4

Abnormal finding AbPresence of:
– Fungal hyphae or yeast, parasite, viral inclusions
– Pathological crystals (leucine, tyrosine, cystine)
– Large number of uric acid or calcium oxalate crystals

Question 5

Erythrocytes
“Dysmorphic” vs. “normal”

Answer 5

(> 10 per HPF)

Question 6

Leukocytes
Neutrophils (glitter cells)
___________________
Eosinophils
Hansel test (special stain)

Answer 6

More than 1 per 3 HPF

Question 7

Epithelial Cells
Renal tubular epithelial cells: _________________

Answer 7

Few are normal

Question 8

 From renal tubules (proximal, distal, collecting ducts)
 Renal tubular epithelial cells must be enumerated using HPF
 The presence of more than_____________ indicates tubular injury and specimens should be referred for cytologic urine testing.
 Difficult to identify due to variability in appearance. Depending on the location.
 Small, dense, eccentrically placed nucleus is a characteristic

Answer 8

2 RTE/HPF

Question 9

Transitional Cells
 Smaller than squamous epithelium
 Increase in TC exhibiting abnormal morphology such as vacuoles and irregular nuclei may be indicative of malignancy or viral infection.

Answer 9

Transitional Cells

Question 10

 RTE that absorb lipids.
 Usually seen in free floating fat droplets.
 Usually stained by Sudan III or Oil Red O fat stains and examined in Polarized microscope.
 Will produce Maltese cross appearance on Polarized lights

Answer 10

Oval Fat Body

Question 11

Bacteria
Bacteriuria

Answer 11

More than 10 per HPF

Question 12

Yeasts
Candidiasis

Answer 12

Most likely a contaminant but should correlate with clinical picture.

Question 13

Viruses
CMV inclusions

Answer 13

Probable viral cystitis

Question 14

Erythrocyte Casts:

Answer 14

Glomerular diseases

Question 15

Leukocyte Casts:

Answer 15

Pyuria, glomerular disease

Question 16

Granular casts

Answer 16

Nonspecific (Tamm-Horsfall protein)

Question 17

Hyaline casts

Answer 17

Nonspecific (Tamm-Horsfall protein)

Question 18

Waxy casts

Answer 18

Nonspecific

Question 19

Fatty casts (oval fat body casts)

Answer 19

Nephrotic syndrome

Question 20

____________ are the only urine sediment that are unique to the kidney.
 Formed within the lumens of the distal convuluted tubules and collecting ducts.
 Their shape is representative of the tubular lumen
 Dissolves quickly in dilute alkaline urine.
 Reported as the average number per 10 LPF
Casts are the only urine sediment that are unique to the kidney.
 Formed within the lumens of the distal convuluted tubules and collecting ducts.
 Their shape is representative of the tubular lumen
 Dissolves quickly in dilute alkaline urine.
 Reported as the average number per 10 LPF

Answer 20

Casts

Question 21

 Major constituent of a Cast is______________, a glycoprotein excreted by the RTE of the DCT and CD.

Answer 21

Tamm-Horsfall protein

Question 22

 Can be non pathologic or pathologic.

Answer 22

Granular Cast

Question 23

When is the granular cast nonpathologic?

Answer 23

 Non-pathologic if from the lysosomes excreted by RTE during normal metabolism. (extreme physical work)

Question 24

When is the granular cast pathologic?

Answer 24

 Pathologic if it represent disintegration of cellular casts and tubule cells or protein aggregates filtered by the glomerulus.

Question 25

 Frequently seen cast, consists **almost entirely of Tamm Horsfall protein**  Normal **0-2/LPF**

Answer 25

Hyaline Cast

Question 26

Hyalin cast can be seen in which diseases?

Answer 26

 Can be seen in Acute Glomerulonephritis, pyelonephritis, CRD and CHF.

Question 27

 Represent **extreme urine stasis**, indicating **CRF**  Derived from the **degenerating Hyaline and cellular cast.**

Answer 27

Waxy Cast

Question 28

 Seen in **conjunction with oval fat bodies** and **free fat droplets in disorders causing lipiduria.**  Frequently associated with **nephrotic syndrome, toxic tubular necrosis, DM, and crash injuries.**

Answer 28

Fatty Cast

Question 29

What are the crystals that can be found in urine?

Answer 29

Crystals – Urate o Ammonium biurate o Uric acid – Triple Phosphate – Calcium Oxalate – Amino Acids o Leucine o Cystine o Tyrosine – Sulfonamide

Question 30

 Normal crystal  Present in A**cid/neutral pH**  They are **colorless, enveloped shape**  **Dumbbell shape (**2nd photo)

Answer 30

Calcium Oxalate Crystals

Question 31

 Normal crystal  **Alkaline pH**  Colorless **(coffin lids)**

Answer 31

Triple Phosphate Crystals

Question 32

** Normal crystals**  Most commonly seen as **amorphous urates**, **uric acid, acid urates and sodium urates.**  Appear **reddish to brown** and are the **only normal crystals found in acidic urine that appear colored.**

Answer 32

Urate cyrstals

Question 33

Answer 33

Urate crystal

Question 34

 Abnormal crystal  Acidic/neutral urine  Fine colorless to yellow **needles that frequently form clumps or rosettes**  Associated with **liver disorders**

Answer 34

Tyrosine Crystals

Question 35

Answer 35

Tyrosine cystal

Question 36

 Abnormal crystal  **Acid** urine  Colorless, **hexagonal** plates may be thick or thin.  Associated with **hereditary cystinuria**

Answer 36

Cystine Crystals

Question 37

Answer 37

cystine crystal

Question 38

 Normal Crystal  Alkaline Urine  Yellow brown crystals **(“thorny apple”)**

Answer 38

Ammonium Biurate Crystals

Question 39

Answer 39

Ammonium Biurate

Question 40

 Abnormal crystal  Acid urine  Colorless **notched plates**  Disorders producing **lipiduria like nephrotic syndrome.**

Answer 40

Cholesterol Crystals

Question 41

Answer 41

Cholesterol crystal

Question 42

Uses and Limitations of Urine Protein Detection Significance

Answer 42

– Proteinuria and the nephrotic syndrome. Limitations **– Interference: highly alkaline urine**. – Much **more sensitive to albumin** than other proteins (e.g. immunoglobulin light chains).

Question 43

Other Tests For Urine Protein determination

Answer 43

– Sulfosalicylic acid (SSA) turbidity test. – Urine protein electrophoresis (UPEP) – Bence Jones protein  Alkaline urine overrides the acid buffer system, producing a rise in pH and a color change unrelated to protein concentration.

Question 44

 ____________ is a bile pigment that results from the degradation of hemoglobin.  Produced in the intestine from the reduction of bilirubin by intestinal bacteria.

Answer 44

Urobilinogen:

Question 45

for porphobilinogen

Answer 45

Watson-Schwartz and Hoesch screening test f

Question 46

Uses and Limitations of Urobilinogen Detection Significance \

Answer 46

– High: increased **hepatic processing of bilirubin** – Low: **bile obstruction**

Question 47

Limitations Urobilinogen – Interference: prolonged exposure of specimen to oxygen (urobilinogen ---\> urobilin) – Cannot detect low levels of urobilinogen

Question 48

Uses and Limitations of Nitrite Detection Significance – Gram negative bacteriuria

Answer 48

Nitrite

Question 49

Limitations in Nitrite Determination

Answer 49

Limitations – Interference: bacterial overgrowth – **Only able to detect bacteria that reduce nitrate to nitrite** Other Tests – Correlate with leukocyte esterase and – Urine microscopic examination (bacteria)

Question 50

 Ability of certain bacteria to reduce nitrate, which is a normal constituent of the urine, to nitrite.  It is detected by\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_  Test is standardized to correspond with a quantitative bacterial culture criterion of 100,000 organisms per milliliter.

Answer 50

Greiss reaction.

Question 51

 The \_\_\_\_\_\_\_\_\_\_\_\_\_ detects the **presence of esterase** in the **granulocytic white blood cells**. Neutrophils are most frequently associated with bacterial infection.  Esterases are also present in **Trichomonas and histiocytes.**  Action of LE to catalyze the hydrolysis of an acid ester to produce an aromatic compound and acid.  It will then combine with diazonium salt to produce a purple azodye.

Answer 51

Leukocyte Esterase

Question 52

Uses and Limitations of Leukocyte Esterase Detection Significance

Answer 52

– Pyuria – Acute inflammation – Renal calculus Note : Limitations – Interference: oxidizing agents, menstrual contamination Other Tests – Urine microscopic examination (WBCs and bacteria) – Urine culture