AUBF urinary sediment Flashcards
RED BLOOD CELL appearance in urine
smooth, non-nucleated biconcave disc (7mm)
Hypersthenuric (concentrated) RBCs
Crenated (SP > 1.010)
Hyposthenuric (Diluted) RBCs
Sg: <1.010; Ghost cells (large empty cell)
Dysmorphic (Cellular protrusions, fragmented) RBCs cause
Glomerular bleeding
Urinary sediment:
Associated with damage to glomerular membrane or vascular injury within the genitourinary tract
The number of cells present is indicative of the extent of the damage/injury
Red blood cells
Macroscopic color in urine: red to brown color indication
Hematuria
Macroscopic:
Frequently associated with advanced glomerular damage but is also seen with damage to the vascular integrity of the urinary tract caused by trauma, acute infection or inflammation, and coagulation disorders
Hematuria
Microscopic:
Critical to early diagnosis of glomerular disorders and malignancy of the urinary tract and to confirm the presence of renal calculi (kidney stones)
Hematuria
Increased in urinary _____ indicates presence of an infection or inflammation in the genitourinary system
WBCs
Predominant WBCs in urine
neutrophil
Hypotonic (absorbs water and swell) - granules exhibit brownian movement; neutrophil appear as
glitter cells
Drug induced intersistitial nephritis (also seen in UTI, renal transplant rejection)
WBCs
Eosinophil
WBCs seen in early stages of renal transplant rejection
Lymphocytes
Difference of mononuclear cells and disintegrating neutrophils from round renal tubular epithelial (RTE) cells
RTE: usually larger than WBCs with and eccentrically located nucleus
Epithelial cell derived from the genitourinary system, normal, sloughing off
Squamous epithelial cells
Largest cells found in urine sediment
Squamous SC
Transitional epithelial (urothelial) cells appearance:
spherical, polyhedral, caudate
Cell that is different in shape due to its ability to absorb large amount of water
Transitional epithelial cells
Originate from the lining of the renal pelvis, calyces, ureters, and bladder, and from the upper portion of the male urethra
Transitional Epithelial cells
Synctia is seen in
catheterization
Vacuolated transitional epithelial cells indicates:
abnormal (malignancy/viral infection)
Present during tissue necrosis or destruction
Renal tubular epithelial cells
Renal Tubular Epithelial cell origin
PCT, DCT, CD
RTE origin:
Rectangular in shape; referred to as columnar or convulated cells; resembles cast
PCT (larger than any RTE cells)
RTE origin:
Smaller, round, or oval
Can be mistaken for WBC or spherical transitional EC
DCT
RTE origin:
Cuboidal and are never round
Collecting Duct RTE
Lipid containing RTE cells
Oval Fat Bodies
RTE cells containing NON-LIPID filled vacuoles (Acute Tubular Necrosis)
Bubble cells
Squamous EC covered with Gardnerella coccobacillus (bacterial vaginosis)
Clue cells
Most frequently bacteria associated with UTI
Enterobacteriaceae (gram-negative rods)
Small refractile oval structures (may or may not contain bud)
Yeast
Causes: DM, Vaginal Monillasis, immunocompromised individuals
Candida albicans
most encountered; STD, vaginal infection, prostate - asymptomatic
T. vaginalis
Bladder parasite
S. haematobium
pinworm, most common fecal containment
E. vermicularis
Significance of spermatozoa
Male infertility, retrograde ejaculation (sperm is expelled into bladder instead of urethra)
Major constituent of mucus
Uromodulin (Tamm-Horsfall glycoprotein)
Only found in urine; unique to kidney
Casts
Presence of urinary casts
Cylinduria
Formed in distal and collecting tubules of kidney
Casts
True geometrically structure or amorphous
Precipitation of urine solutes
Crystals
Artifact that has is highly refractile sphere with dimpled center
Starch
Artifact appear as spheres with a cell wall and occasional concentric circles
Pollen grains
Artifact that resemble casts; fibers polarized
Fibers/Hair
Appear as plant and meat fibers or as brown amorphous material
Fecal contamination
Most frequently seen urinary casts
Hyaline casts
Cast normally seen in dehydration, heat exposure, emotional stress
Hyaline casts
Pathologically increased in acute glomerulonephritis, pyelonephritis, chronic renal disease, CHF
Hyaline Cast
Color of hyaline cast in sternheimer-malbin stain
pink
Casts normally seen in people who does extraneous exercise
RBC casts, Hyaline casts
RBC casts color under LPF
Orange
RBCs degenerates into pigment, granular cast greater stasis in urine
Blood casts/Muddy brown casts
Indication: bleeding within the nephron
RBC casts
Associated with proteinuria and dysmorphic erythrocytes
Glomerular damage (glomerulonephritis)
Embedded in hyaline cast matrix; signifies infection within the nephron
WBC Casts
non-bacterial inflammation of WBC casts
Acute interstitial nephritis
Bacterial inflammation accompanied by WBC casts
Pyelonephritis
Upper UTI WBC cast
no presence of bacteria
Lower UTI (Cystitis) wbc casts
presence of bacteria
Bacterial casts containing bacilli both bound to the protein matrix
Pyelonephritis
Confirmation for bacterial casts
Gram stain
Indication of advance tubular obstruction, heavy metal/drug induced toxicity, viral infection, allograft rejection (accompanied by WBC cast)
Epithelial cells cast
Associated with Nephrotic syndrome, Tubular necrosis, Diabetes mellitus, crushed injuries
Fatty cast
Lipiduria contents
Fatty Casts + Oval fat Bodies + Free fat droplets
Casts containing multiple cell types
MIXED CELLULAR CASTS
Glomerulonephritis contents in mixed cellular casts:
RBC + WBC casts and/or WBC + RTE cells casts
Mixed cellular casts for pyelonephritis
WBC + Bacterial Cells Casts
Fragmented with jagged ends; have notches on sides
Waxy casts
Indication: extreme urine stasis (chronic renal failure)
Waxy casts
Represent as advanced stage of other casts (e.g., hyaline, granular, cellular) that are transformed during urinary stasis
Waxy casts
Indication: Destruction (widening) of tubular walls
Broad cast/Renal failure
Bile stained with waxy cast is associated with
Tubular necrosis due to viral hepatitis
