Urine - Sediment Exam Flashcards
(59 cards)
1
Q
Urine Amount
A
- Minimum of 6 mL needed
- 12-15 mL best
- If below 6 mL, note on report
2
Q
Normal Cell Amounts
Urine Sediment
A
- RBCs = <2-3 cells / HPF
- WBCs = 0-1 cells / HPF
- Epithelial Cells = occasional / HPF
3
Q
RBC Appearance / Changes
Urine Sediment
A
Appearance changes based on pH, SG, and time elapsed
* crenation = high SG
* swell or lyse = low SG or alkaline urine
* can be confused with fat or yeast
4
Q
A
RBCs in Urine Sediment
5
Q
WBC
Urine Sediment
A
- Most are neutrophils
- Larger than RBCs, but smaller than renal epithelial cells
- Culture if excessive seen, even without bacteria
6
Q
WBC Appearance / Changes
Urine Sediment
A
Changes based on SG
* shrink = high SG
* swell = low SG
7
Q
A
WBC in Urine Sediment
8
Q
Epithelial Cells
Normal Urine Sediment
A
- Normal = few (older cells sloughing off)
- Increased = inflammation
9
Q
Types of Epithelial Cells
A
- Squamous
- Transitional
- Renal
10
Q
Squamous Epithelial Cells
A
- Origin of distal urethra, vagina, vulva, prepuce
- Usually not significant
- Collected in voided samples
11
Q
Squamous Epithelial Cell Appearance
A
- Large, flat, thin cels
- Straight edges with distinct corners
- Small, round nucleus
12
Q
A
Squamous Epithelial Cells
13
Q
Transitional Epithelial Cells
A
- Origin in bladder, ureters, renal pelvis, proximal urethra
- Normal = low (0-1 / HPF)
- Increased = cystitis or pyelonephritis / catheterization
14
Q
Transitional Epithelial Cells Appearance
A
- Round or pear-shaped
- Granular with small nuclei
15
Q
Clumping Transitional Epithelial Cells
A
- Indicative of Transitional Cell Carcinoma (especially if no WBC)
- Neoplastic
- Carcinoma can have cells be different size
- Can be caused by catheterization
- Chemotherapy and radiation needed for treatment
16
Q
A
Transitional Epithelial Cells
17
Q
Renal Epithelial Cells
A
- Origin in renal tubules
- Normal = rare, 0-1 / HPF
- Increased = Kidney disease
18
Q
Renal Epithelial Cell Appearance
A
- Smallest
- Slightly larger than WBCs
- Round with large nucleus
- Non-granular to finely granular
19
Q
A
Renal Epithelial Cells
20
Q
Casts
Urine Sediment
A
- Form in lumen or distal/collecting tubules
- Localize injury to kidney
- Any seen indicate abnormality - implies some degree of renal damage
- Dissolve in alkaline urine
- Number is not indicative of renal disease severity
21
Q
Casts Appearance
General
A
- Cylindrical structures
- Parallel sides
- Width is same as tubule lumen
22
Q
Hyaline Casts
A
- Composed of mucoprotein
- Seen with mild renal injury and glomerular leakage
- Easier to identify with staining
23
Q
Hyaline Casts Appearance
A
- Clear, colorless, and somewhat transparent
- Rounded end
24
Q
A
Hyaline Casts
25
Granular Casts
* Older epithelial cell casts that degenerated and can no longer be identified as individual cells
* Coarsely = early stage
* Finely = late stage (form waxy casts)
* Most common type
26
Granular Casts
27
Cellular Casts
May be red, white, or epithelial cell in composition
* red = indicate renal hemorrhage or inflammation
* white = indicate renal inflammation
* epithelial = indicate acute tubular degeneration
Increased = severe kidney disease or acute nephritis
28
Cellular Casts
29
Waxy Casts
* Indicate chronic tubular degeneration
* Must be distinguished from hyaline casts
* Essentially means kidney has shut down
30
Waxy Cast Appearance
Wide with square ends when compared to hyaline casts
31
Waxy Casts
32
Progression of Casts
| Not as Severe - Severe
* Hyaline
* Cellular
* Granular
* Waxy
33
Urinary Crystals
* Form due to their elements secreted into urine by normal renal activity
* Type depends on pH, concentration, temp, solubility of elements
34
Struvite Crystals
* Also known as triple phosphate (magnesium ammonium phosphate)
* Form in alkaline urine
* "Coffin lids"
35
Struvite Crystals
36
Calcium Oxalate Crystals
* Can be Dihydrate or Monohydrate
* Form in acidic or neutral urine
37
Dihydrate Calcium Oxalate Crystals
* Small square crystals
* Contain an "X" through center
38
Monohydrate Calcium Oxalate Crystals
* Small and dumbbell-shaped or elongated
* Pointed at end
* Seen with ethylene glycol toxicity
39
Dihydrate Calcium Oxalate Crystals
40
Monohydrate Calcium Oxalate Crystals
41
Cystine Crystals
* 6-sided, colorless, and thin
* Renal tubule dysfunction
* Inherited metabolic defect
42
Cystine Crystals
43
Ammonium Biurate Crystals
* Round with long irregular spikes
* Brown color
* See with any pH
* Common with liver disease
44
Ammonium Biurate Crystals
45
Uric Acid Crystals
* Usually diamond or rhomboid shape
* Yellow or yellow-brown
* Uncommon, except for in Dalmatians
46
Uric Acid Crystals
47
Amorphous Crystalline Material
Phosphate
* alkaline urine
Urate
* acidic urine
Both contain granular precipitates
48
Amorphous Crystals
49
Leucine Crystals
* Wheel or pin-cushion shaped
* See with liver disease
50
Leucine Crystals
51
Tyrosine Crystals
* Dark with needle-like projections
* See with liver disease
52
Tyrosine Crystals
53
Pathological Crystals
* Cystine
* Tryocine
* Leucine
54
Bacteria
Only observed with contamination
* Cocci = round shape
* Bacilli = rod shape
* Quantitate on Low Power Field
55
Parasites
Urinary parasites or result of fecal contamination
* bladder worm = p. plica
* kidney worm = d. renale
56
Bladder worm (p. plica)
57
Kidney Worm (d. renale)
58
Mucus Threads
* Twisted ribbon
* Confused with casts - not well delineated edges
* Indicate urethral irritation or genital secretion contamination
59
Mucus Thread
