2S [LEC]: MISCROSCOPIC ANALYSIS Flashcards
Identify the epithelial cell:
Largest cells in the sediment with abundant, irregular cytoplasm and prominent nuclei
Squamous cells
Identify the epithelial cell:
Spherical, polyhedral, or caudate with centrally located nucleus
Transitional cells
Identify the epithelial cell:
Rectangular, columnar, round, oval, or cuboidal with an eccentric nucleus possibly bilirubin-stained or hemosiderin-laden
RTE cells
Folded squamous cells may resemble ___
Casts
Spherical forms of transitional cells may resemble ___
RTE cells
RTE cells may resemble ___
Granular casts
Most clinically significant epithelial cell in clinical microscopy of urine
RTE cells
Location of nucleus in RTE cells
Eccentric
Manner of reporting of RTE cells
Average number per HPFs
WBCs are often mistaken as ___
RTE cells
Microscopic finding that is described as ghost cells in hypotonic urine
Microscopic RBCs
Manner of reporting of microscopic RBCs and WBCs
Average number per 10 HPFs
If the specimen is hypertonic, what will be the appearance and state of RBCs?
Crenated
Appearance of microscopic RBCs with glomerular membrane damage
Dysmorphic
T/F: When a medtech finds lysed RBCs in hypotonic urine, this is reported as ghost cells
False (reported as RBCs only)
Manner of reporting of squamous epithelial cells
Semi-quantitative (rare, few, moderate, many per lpf)
Other term for transitional cells
Urothelial cells
Manner of reporting of transitional cells
Semi-quantitative in HPF
Squamous cells with G. vaginalis is called ___
Clue cells
Shape of RTE coming from distal convoluted tubule
Circular/ Oval
Shape of RTE coming from collecting ducts
Cuboidal
Microscopic findings in patients with renal tubular necrosis and damage
RTE cells
Normal RTE cell count
<0-2 per HPF
T/F: RTE cells can easily absorb liquids
True
If the RTE cell absorbs non-lipid, it is called ___
Bubble cell
If the RTE cell absorbs lipid, it is called ___
Oval fat bodies
The presence of lipid in oval fat bodies is confirmed through ___
Polarizing microscope
The presence of triglycerides in oval fat bodies is confirmed through ___
Oil Red O
Sudan III
High refractile RTE cells
Oval fat bodies
Patients with oval fat bodies should be correlated with what other findings?
Free fat droplets/ fatty casts
Oval fat bodies are present in patients with what condition?
Nephrotic syndrome
Small spherical and rod-shaped structure
Bacteria
The microscopic finding of bacteria in urine is correlated with what other findings?
Presence of WBCs
Manner of reporting of bacteria in urine
Semi-quantitative in HPF
Small, oval, refractile structures with buds and/or mycelia
Yeast
Pear-shaped, motile, flagellated
Trichomonas
Common microscopic finding in patients with strawberry cervix
Trichomonas
Chemical finding that is usually correlated with yeast cells
Glucose
Single or clumped threads with a low refractive index
Mucus
Common protein component of mucus
Tamm Horsfall Protein
Microscope that is usually used to visually analyze mucus threads
Phase-contrast
Normal hyaline cast count in urine
<2 per HPF
Most common type of cast
Hyaline cast
In what structure are casts produced?
Distal convoluted tubule
Presence of cast in the urine is known as ___
Cylindruria
A cast with irregular shape and tapered end is called ___
Cylindroids
Prototype of casts
Hyaline cast
What epithelial cell component is included in an epithelial cast?
RTE cells
Which type of casts are always considered pathological?
Red blood cell cast
Granular cast
Cast that can indicate vasculitis
Red blood cell cast
Granular cast
Cast that can indicate glomerular damage and glomerulonephritis
Red blood cell cast
Granular cast
Cast that can indicate inflammation or infection
WBC cast
Dehydrated and lysed cells can cause what type of cast based on appearance?
Coarsely granular cast
Cast that can indicate pyelonephritis
WBC cast
Cast that can indicate allergic interstitial nephritis
WBC cast
Cast that can indicate post-streptococcal glomerulonephritis
WBC cast
Cast that can indicate nephrotic syndrome
WBC cast
Remnants of the coarsely granular cast are from ___
Lysosome of RTE cells
Extended urine stasis transforms the cast into ___
Finely granular cast
Extended dehydration transforms into ___
Waxy cast
Cast that has a brittle characteristic that is a refractile and has a broken glass-appearance
Waxy cast
Waxy cast is commonly indicated in what condition?
Glomerulonephritis
Extreme urine stasis commonly has what finding?
Waxy/Broad cast
Cast that resembles the shape and size of the collecting duct
Broad cast
The broad cast is also known as ___
Renal failure cast
If there is nephrotic syndrome, the renal tubules may not be able to reabsorb, which may cause ___ cast
Fatty cast
Colorless, homogenous matrix of cast
Hyaline cast
Orange-red color, cast matrix containing RBC
RBC cast
If the waxy cast is present in the renal tubule for a long time, this might form ___
Broad cast
The only type of cast that is normally seen in urine
Hyaline cast
Presence of underdeveloped cast is called ___
Cylindroid
Casts are identified in which objective?
LPO
Presence of crystal in the urine
Crystalluria
Stress and exercise can cause the appearance of which cast?
RBC cast
Cast that is seen in upper UTI or pyelonephritis and acute interstitial nephritis
WBC cast
Bacilli bound to protein matrix
Bacterial cast
Coarse and fine granules in a cast matrix
Granular cast
RTE cells attached to protein matrix
Epithelial cells
Bacterial casts will only be seen in what condition?
Pyelonephritis
Fat droplets and oval fat bodies attached to protein
Fatty cast
Precursor form of oval fat bodies
RTE cells with lipid
Highly refractile cast with jagged ends and notches
Waxy cast
Manner of reporting of normal urine crystals
Semi-quantitative per HPF
T/F: Urine crystals are usually not pathologic
True (it will be pathologic only in increased amount)
Manner of reporting of abnormal urine crystals
Average per LPF
The single most important factor to differentiate crystals
pH
All abnormal crystals are found at what pH?
Acidic
Identify the urine crystal:
Yellowish with whetstone/ diamond shape
Uric acid
Patients with Lesch Nyhan Syndrome will commonly have what microscopic finding?
Uric acid
Identify the urine crystal:
Colorless, prism-shaped, seen in acidic pH
Hippuric acid
Identify the urine crystal:
Precipitated in refrigerator
Amorphous urate (acidic), Amorphous phosphate (alkaline)
T/F: Amorphous urates and amorphous phosphates are dissolved when heated
False (amorphous phosphate requires chemical to be dissolved, such as acetic acid)
pH range where calcium oxalate can be seen
Any (acidic, neutral, alkaline)
Identify the urine crystal:
Coffin/ prism crystals in basic urine
Triple phosphate
Identify the urine crystal:
Known as magnesium ammonium phosphate seen in urea-splitting bacteria
Triple phosphate
Identify the urine crystal:
Envelope-shaped, seen in basic urine
Calcium oxalate
The x-mark in the calcium oxalate is seen in which form?
Dihydrate form
Which calcium oxalate form is seen in ethylene glycol poisoning?
Monohydrate form
The spherical/ dumbbell-shaped calcium oxalate is seen in which form?
Monohydrate form
Identify the urine crystal:
Thorny apple-shaped, seen in neutral/ alkaline pH
Ammonium biurate
Ammonium biurate could be transformed into uric acid-like crystal in the addition of what substance?
Glacial acetic acid
Identify the urine crystal:
Prisms in rosette, mostly confused with sulfonamide crystals
Calcium phosphate
Calcium phosphate is soluble in what substance?
Acetic acid
Identify the urine crystal:
Seen in alkaline pH with varying shapes and produces gas/ fume formation with the addition of diluted acetic acid
Calcium carbonate
Presence of cysteine in the urine
Cystinuria
An inborn error in metabolism has which crystals in the urine as an indication?
Leucine, Cysteine
Identify the urine crystal:
Colorless, hexagonal in shape
Cysteine
Reagent used to distinguishes cysteine crystals, producing a red color
Sodium nitroprusside
Liver disorder crystals
Leucine
Bilirubin
Tyrosine
Identify the urine crystal:
Yellowish-brown, clumps of needle
Bilirubin
Identify the urine crystal:
Colorless, clumps of needle
Tyrosine
Identify the urine crystal:
With concentric radial striations
Leucine
What normal crystal is usually confused with sulfonamide crystal?
Calcium phosphate
Identify the urine crystal:
Described as broken glasses
Cholesterol crystal
The appearance of cholesterol crystal in the urine is confused with precipitated ___
Radiographic contrast media
Artifact that is confused with RBC that has a thick ring and is irregularly-shaped when dried
Air bubbles
Artifact that has a depression in the middle
Starch granule
Possible scenario with plant fiber in the urine
Fecal contamination
Remnants of RBC membrane
Ghost cells
WBCs in hypotonic urine appear as ___
Glitter cells
Microscope used in observing mucus thread
Phase-contrast microscope
Common bacteria found in bacterial casts
Bacilli
A normal urine crystal found in alkaline pH that is described as struvite
Triple phosphate
Manner of reporting of abnormal crystals in the urine
Average number per lpf
Shape of the RTE coming from DCT
Round/ Oval
Shape of the RTE coming from renal tubule
Columnar/ Rectangular
Shape of the RTE coming from collecting duct
Cuboidal
