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MTAP 1 > AUBF (urinary sediments) > Flashcards

AUBF (urinary sediments) Flashcards

1
Q

T/F
RBC can normally pass glomerulus

A

F
RBC normally cannot pass glomerulus

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2
Q

has a smooth, non-nucleated biconcave disk (7 mm) “donut” appearance

A

RBCs

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3
Q

RBCs in hypersthenuric (concentrated) urine

A

Crenated – shrinks due to water loss

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4
Q

RBCs in hyposthenuric (diluted) urine

A

Ghost cells (large empty cells)

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5
Q

result due to swelling from water absorption → lyse & Hgb released → cell membrane remains

A

Ghost cells (large empty cells)

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6
Q

RBCs present in GLOMERULAR BLEEDING

A

Dysmorphic RBCs (cellular protrusions, fragmented, varied sizes)

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7
Q

Its presence indicates damage to glomerular membrane or vascular injury within genitourinary tract

A

RBC

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8
Q

Dysmorphic RBC presence indicates this condition

A

Glomerular bleeding

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9
Q

T/F
No. of RBCs present is indicative of the extent of the damage/injury

A

T

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10
Q

Conditions where RBCs are seen in urine

A

Glomerular bleeding (dysmorphic)
Glomerular membrane damage / vascular integrity damage within genitourinary tract
Macro & Micro Hematuria

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11
Q

Type of hematuria wherein the urine appearance is cloudy, red-brown color and has intact RBCs microscopically

A

Macroscopic/Gross Hematuria

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12
Q

Type of hematuria wherein the urine appearance is in normal color and has intact RBCs microscopically

A

Microscopic Hematuria

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13
Q

Condition associated with ADVANCED GLOMERULAR DAMAGE

A

Macroscopic/Gross Hematuria

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14
Q

Condition associated with damage to vascular integrity of urinary tract (trauma, acute kidney infection/inflammation, coagulation disorder)

A

Macroscopic/Gross Hematuria

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15
Q

Presence of this condition is critical to:
- EARLY DX of glomerular disorders and urinary tract malignancy
- CONFIRM renal calculi (kidney stones)

A

Microscopic Hematuria

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16
Q

Significance of Macroscopic/Gross Hematuria

A
  • Advance glomerular damage
  • Damage to vascular integrity of urinary tract (trauma, acute kidney infection/inflammation, coagulation disorder)
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17
Q

Significance of Microscopic Hematuria

A
  • Critical to early dx of glomerular disorders and urinary tract malignancy,
  • Confirm renal calculi (kidney stones)
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18
Q

↑ urinary WBC (presence of infection/inflammation of the genitourinary system)

A

Pyuria

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19
Q

WBCs in urine

A

Neutrophil/PMN
Eosinophil
Mononuclear cells (monocyte/lympho)

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20
Q

predominant WBC

A

Neutrophil/PMN

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21
Q

contain granules; multilobed (2-5)

A

Neutrophil/PMN

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22
Q

Exhibited by neutrophil/PMN granules in hypotonic (absorbs water and swell) urine

A

Brownian Movement (appear as GLITTER CELLS)

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23
Q

appear as GLITTER CELLS due to Brownian movement

A

Neutrophil/PMN

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24
Q

Clin. significance of EOSINOPHIL presence in urine

A
  • Drug-induced interstitial nephritis
  • UTI
  • Renal transplant rejection
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25
Q

Urinary sediment increased during Drug-induced interstitial nephritis

A

Eosinophil

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26
Q

Urinary sediments increased during Renal transplant rejection

A

Eosinophil
Lymphocytes (early stages)

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27
Q

large mononuclear cell

A

Monocytes/macrophage

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28
Q

smallest WBC (close to RBC size, differs in pallor)

A

Lymphocytes

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29
Q

T/F
Primary concern in urinary WBC identification: Differentiation of mononuclear cells and disintegrating neutrophils from round renal tubular epithelial (RTE) cells (larger than WBCs with eccentric nucleus)

A

T

Mono: central nucleus
RTE: eccentric nucleus, LARGER

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30
Q

in urinary WBC identification, what is used to enhance nuclear detail of monocytes and RTE cells to differentiate resemblance?

A

Supravital staining or
Addition of Acetic Acid

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31
Q

Epithelial cells in urine

A

Squamous EC
Transitional / Urothelial EC
RTE Cell
Oval Fat Bodies
Bubble Cells

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32
Q

epithelial cells indicating normal sloughing off (NONPATHOLOGIC)

A

Squamous EC

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33
Q

Derived from genitourinary system linings – old cells of urethra

A

Squamous EC

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34
Q

Largest cells in urine sediment
* POINT OF REFERENCE

A

Squamous EC

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35
Q

Smaller than squamous EC (NONPATHOLOGIC)

A

Transitional / Urothelial EC

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36
Q

Dome/umbrella-like shaped; spherical eccentric nucleus

A

Transitional / Urothelial EC

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37
Q

FORMS of TRANSITIONAL/UROTHELIAL EC

A

spherical
polyhedral
caudate

(differences is caused by the ability to absorb large amount of water)

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38
Q

ORIGIN of TRANSITIONAL/UROTHELIAL EC

A

lining of renal pelvis, calyces, ureters, bladder; upper urethra (male)

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39
Q

clumps of transitional EC, appears following an invasive procedure (catheterization)

A

SYNCITIA

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40
Q

Abnormal morphology of transitional EC

A

Vacuolation/irregular nuclei

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41
Q

Indication of vacuolation/irregular nuclei of transitional EC

A

Malignancy
Viral infection

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42
Q

cells present in tissue destruction (necrosis)

A

RTE cells

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43
Q

Has hemosiderin granules in cytoplasm (+ Prussian Blue) → hemoglobinuria

A

RTE cells

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44
Q

Size and shape vary depending on the area of renal tubules they originate

A

RTE cells

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45
Q

ORIGINS of RTE cells

A

PCT
DCT
CD

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46
Q

RTE cells originating on this area are larger than any RTE cells origin

A

PCT

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47
Q

RTE cells originating on this area are rectangular (columnar/convoluted cells)

A

PCT

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48
Q

RTE cells originating on this area resembles CAST

A

PCT

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49
Q

RTE cells originating on this area are smaller, round, oval

A

DCT

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50
Q

RTE cells originating on this area are mistaken for WBC or spherical transitional EC

A

DCT

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51
Q

RTE cells originating on this area are Cuboidal, NEVER round

A

Collecting duct

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52
Q

RTE cells originating on this area forms groups of 3 or more → forming RENAL FRAGMENTS

A

Collecting duct

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53
Q

RTE cells + Lipids

A

Oval Fat Bodies

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54
Q

RTE cells + Non-lipid vacuoles

A

Bubble Cells

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55
Q

indication of bubble cells in urine

A

Acute tubular necrosis

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56
Q

present in urine during ACUTE TUBULAR NECROSIS

A

Bubble Cells (RTE cells + Non-lipid vacuoles)

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57
Q

Squamous EC covered with Gardnerella coccobacillus

A

Clue cells

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58
Q

Indication of clue cells presence

A

Bacterial vaginosis

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59
Q

Normally not present in urine (bladder is sterile) – may be a contamination or infection

A

Bacteria

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60
Q

Spherical-shaped bacteria

A

cocci

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61
Q

Rod-shaped bacteria

A

bacilli

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62
Q

Gram (-) rods
Most frequently associated with UTI

A

Enterobacteriaceae

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63
Q

Bacteria + WBCs indicates?

A

SIGNIFICANT UTI

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64
Q

what must be present to confirm a “SIGNIFICANT” UTI?

A

Bacteria + WBCs

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65
Q

Small refractile oval structures

A

Yeast
(may or may not contain bud → mycelial: severe)

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66
Q

Common specie of yeast in urine that causes human infections

A

Candida albicans

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67
Q

Indication of Candida albicans presence

A
  • DM (yeasts are sugar-loving)
  • Vaginal Moniliasis
  • Immunocompromised Individual
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68
Q

Common parasites in urine

A

Trichomonas vaginalis
Schistosoma haematobium
Enterobius vermicularis (pinworm)

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69
Q

Most frequent parasite encountered in urine – has jerking motility

A

Trichomonas vaginalis

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70
Q

Infection caused by this parasite is sexually transmitted

A

Trichomonas vaginalis

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71
Q

presence of this parasite causes vaginal inflammation; Asymptomatic in male urethra and prostate

A

Trichomonas vaginalis

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72
Q

Bladder parasite (ova) – has terminal spine

A

Schistosoma haematobium

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73
Q

parasite causing BLADDER CANCER

A

Schistosoma haematobium

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74
Q

Most common fecal contaminant

A

Enterobius vermicularis (pinworm)

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75
Q

T/F
Spermatozoa in Routine UA is reported

A

F
NOT REPORTED (unless MALE)

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76
Q

Spermatozoa is only significant in cases of?

A

Male infertility
Retrograde ejaculation (sperm in bladder, instead of urethra)

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77
Q

sperm in BLADDER, instead of urethra

A

Retrograde ejaculation

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78
Q

major constituent of mucus

A

Uromodulin

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79
Q

Thread-like structures (low refractive index) – must be viewed with low brightness

A

Mucus

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80
Q

T/F
Mucus is frequent in MALES

A

F
Mucus is frequent in FEMALES

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81
Q

Only element FOUND ONLY IN URINE: unique to the kidney

A

Casts

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82
Q

condition indicating urinary cast presence

A

CYLINDURIA

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83
Q

T/F
Cast width depends on the size of the tubule in which it is formed

A

T

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84
Q

Origin of CASTS

85
Q

core matrix of cast consists of?

A

Uromodulin/Tamm Horsfall protein

86
Q

True geometrically structure or amorphous materials

87
Q

Result of precipitation of urine solutes

88
Q

NOT normally present in freshly voided urine

A

Crystals

(RT –> ref, forms amorphous urates, crystals)

89
Q

Enumerate artifacts in urine

A

Starch
Oil droplets
Air bubbles
Pollen grains
Fibers/hair
Fecal contamination

90
Q

Artifacts that is defined as highly refractile sphere with dimpled center (resembles RBCs)

91
Q

Artifact that resembles fat globules

A

Oil droplets

92
Q

Spherical artifact with a cell wall and occasional concentric circles

A

Pollen grains

93
Q

Artifact that resembles casts
What is the point of difference?

A

Fibers/hair

Difference: POLARIZATION
Fibers (+)
Casts (-)

94
Q

artifact appearing as plant and meat fibers or as brown amorphous material

A

Fecal contamination

95
Q

URINARY CASTS

A

Hyaline cast
RBC cast
WBC cast
Bacterial cast
EC cast
Fatty cast
Mixed cellular cast
Granular cast
Waxy cast
Broad cast (renal failure cast)

96
Q

Most frequently seen urinary cast

A

Hyaline cast

97
Q

NORMAL hyaline cast

98
Q

Unstained hyaline cast color

99
Q

Hyaline cast stained with Sternheimer Malbin stain

A

pink (parallel/rounded ends)

100
Q

↑ hyaline cast in cylindroid form

A

CYLINDURIA

101
Q

Wrinkled appearance or convoluted shapes (disintegration) of hyaline cast signifies?

A

aging of cast matrix

102
Q

Hyaline cast is NORMALLY increased in:

A

“SHED”

  • Strenuous exercise
  • Heat exposure
  • Emotional stress
  • Dehydration
103
Q

Hyaline cast is PATHOLOGICALLY increased in:

A
  • Acute glomerulonephritis
  • Pyelonephritis
  • Chronic Renal disease
  • CHF
104
Q

RBC cast is aka

A

Blood cast / Muddy Brown cast

105
Q

Hyaline cast + RBC

A

RBC cast / Blood cast / Muddy Brown cast

106
Q

color of Blood cast / Muddy Brown cast in LPF

A

Orange-red

107
Q

RBC casts degenerate into pigment + GRANULAR cast indicates?

A

Greater stasis of urine
(severe damage to glomerulus)

108
Q

RBC cast is NORMALLY increased in:

A

Strenuous exercise

109
Q

RBC cast is PATHOLOGICALLY increased in:

A
  • Bleeding within the nephron
  • Glomerular damage (glomerulonephritis) – associated with proteinuria and dysmorphic RBCs
110
Q

cast present in urine during nephron bleeding

111
Q

cast presence during glomerular damage (glomerulonephritis)

112
Q

Associated with glomerular damage (glomerulonephritis)

A

RBC cast
proteinuria
dysmorphic RBCs

113
Q

Hyaline cast + WBCs

114
Q

Signifies infection or inflammation within the nephron

115
Q

WBC cast, no bacteria
Example?

A

Non-bacterial inflammation
Acute interstitial nephritis

116
Q

WBC cast + Bacteria
Example?

A

Bacterial inflammation
Pyelonephritis

117
Q

primary marker for distinguishing pyelonephritis from cystitis

118
Q

upper UTI

A

Pyelonephritis

119
Q

lower UTI

120
Q

T/F
Bacterial casts may be PURE or mixed with WBCs

121
Q

Indication of bacterial cast

A

Bacterial inflammation: Pyelonephritis (DIAGNOSTIC)

122
Q

Consists of bacterial casts containing bacilli both within and bound to the protein matrix

A

Pyelonephritis

123
Q

Diagnostic for pyelonephritis

A

Bacterial cast

124
Q

Bacterial cast may resemble this cast

A

GRANULAR CAST

125
Q

Performed to differentiate BACTERIAL cast from GRANULAR cast

A

Gram staining

126
Q

Considered as significant EC cast

A

cast containing RTE cells

127
Q

Indication of EC cast containing RTE cells

A
  • Advance tubular obstruction
  • Heavy metal, chemical, or drug toxicity
  • Viral infection
  • Allograft rejection (EC cast + WBC cast)
128
Q

EC cast + WBC cast in urine

A

Allograft rejection

129
Q

Fatty casts + Oval fat bodies + Free fat droplets

130
Q

Fatty cast is frequently associated with:

A
  • Nephrotic Syndrome
  • Tubular necrosis
  • DM
  • Crash injuries
131
Q

Casts containing multiple cell types

A

Mixed cellular cast

132
Q

RBC + WBC casts &/or WBC + RTE cell casts

A

GLOMERULONEPHRITIS

133
Q

WBC + Bacterial cell casts

A

PYELONEPHRITIS

134
Q

What must be found in urine to diagnose GLOMERULONEPHRITIS?

A

RBC + WBC casts &/or
WBC + RTE cell casts

135
Q

What must be found in urine to diagnose PYELONEPHRITIS?

A

WBC + Bacterial cell casts

136
Q

Result of cellular disintegration

A

Granular cast

137
Q

T/F
Increased cellular metabolism during strenuous exercise accounts for the transient increase of granular casts that accompany the increased hyaline cast

138
Q

Grainy appearance, broken cast matrix

A

Granular cast

139
Q

Fragmented with jagged ends; notches on sides

140
Q

Color of waxy cast in Supravital staining:

A

Homogenous dark pink

141
Q

Indication of WAXY cast

A

Extreme urine stasis (Chronic renal failure)

142
Q

Represent as ADVANCED STAGE of other casts that are transformed during urinary stasis

143
Q

aka broad cast

A

Renal failure cast

144
Q

INDICATION of BROAD CAST

A

Destruction or widening of tubular walls
Extreme urine stasis

145
Q

indication of BILE-STAINED BROAD & WAXY CAST

A

Tubular necrosis due to viral hepatitis

146
Q

pH of uric acid

147
Q

Appearance:
Rhombic, Wedges, Rosettes, 4-sided flat plates (whetstones), 6-sided plates (resembles cystine)

Yellow-brown color to colorless

148
Q

Resembles CYSTINE crystals

149
Q

distinguishing feature of uric acid from Cystine crystals

A

HIGHLY BIREFRINGENT

150
Q

URIC ACID is significantly increased in:

A

Gout
Lesch-Nyhan Syndrome

151
Q

pH of amorphous urates

152
Q

Colorless to yellow-brown granules

A

Amorphous urates

153
Q

Macroscopic (sediment): orange-pink precipitate (“brick-dust”)

A

Amorphous urates

154
Q

Resembles Amorphous phosphates and FECAL contaminants

A

Amorphous urates

155
Q

Composition of Amorphous urates

A

Ca, Mg, Na, K

156
Q

What will happen to amorphous urates when refrigerated?

A

forms a PINK sediment (uroerythrin + urates)

157
Q

added to convert amorphous urates to URIC acid

158
Q

pH of amorphous phosphates

159
Q

Macroscopic (sediment): White to
beige precipitate

A

Amorphous phosphates

160
Q

What will happen to amorphous phosphates when refrigerated?

A

forms WHITE sediment

161
Q

pH of Calcium Oxalate

A

Acid, Alk, Neutral

162
Q

Forms of CaOx

A

Dihydrate (MOST COMMON)
Monohydrate

163
Q

colorless, octahedral envelope or 2 pyramids joined at their base

A

Dihydrate CaOx

164
Q

Oval or Dumbbell shaped CaOx

A

Monohydrate CaOx

165
Q

formed due to Ethylene Glycol “Anti-freeze” Poisoning

A

Monohydrate CaOx

166
Q

Seen in majority of renal calculi (kidney stones)

A

Calcium oxalate

167
Q

pH of Calcium phosphate

168
Q

Appearance: Colorless, flat rectangular plates/prisms in rosette forms

A

Calcium phosphate

169
Q

Resembles Sulfonamide crystals if in NEUTRAL pH

A

Calcium phosphate

170
Q

Used to distinguish Calcium phosphate from sulfonamide crystals

A

addition of DILUTE ACETIC ACID:
Calcium phosphate - (dissolved)
Sulfonamide crystals - (remain)

171
Q

pH of Triple phosphate

172
Q

Appearance: Prism, resembles “COFFIN-LID”, “FERN-LIKE” form can be induced by addition of AMMONIA

A

Triple phosphate

173
Q

aka Triple phosphate

A

Ammonium magnesium phosphate

174
Q

appearance of triple phosphate induced after addition of ammonia

175
Q

pH of ammonium biurate

176
Q

Appearance: THORNY APPLES – spicule-covered spheres

A

Ammonium biurate

177
Q

Most often encountered in OLD SPX (ammonia produced by urea-splitting bacteria)

A

Ammonium biurate

178
Q

Crystal that dissolves at 60ºC

A

Ammonium biurate

179
Q

Added to convert Ammonium biurate to URIC ACID

A

Glacial acetic acid
Conc. HCl

180
Q

pH of Calcium carbonate

181
Q

Appearance: Small, colorless dumbbell of spherical shapes

A

Calcium carbonate

182
Q

Resembles Monohydate CaOx and amorphous materials

A

Calcium carbonate

183
Q

Added to distinguish monohydrate caox and amorphous materials from Calcium carbonate

A

ACETIC ACID
(GAS FORMATION – observe for effervescence or bubbles)

184
Q

NORMAL URINARY CRYSTALS

A

Uric acid
Amorphous urates
Amorphous phosphates
Calcium oxalate
Calcium carbonate
Calcium phosphate
Triple phosphate
Ammonium biurate

185
Q

ABNORMAL URINARY CRYSTALS

A

Cystine
Cholesterol
Radiographic Dye/RCM
Sulfonamides
Ampicillin
Leucine
Tyrosine
Bilirubin

186
Q

Abnormal urinary crystals are most often found in this pH

A

ACIDIC urine

187
Q

Abnormal urinary crystals are rarely found in this pH

A

NEUTRAL urine

188
Q

Colorless, Hexagonal plates (thick or thin) crystals

189
Q

Test for confirmation of Cystine in urine

A

Cyanide-Nitroprusside Test

190
Q

Metabolic disorder that prevents reabsorption of cysteine by renal tubules

A

Cystinuria

191
Q

Rectangular plates with notch on one or more corners

A

Cholesterol

192
Q

Can be seen in: NEPHROTIC SYNDROME in conjunction with FATTY CASTS and OVAL FAT BODIES

A

Cholesterol

193
Q

What must be present to diagnose NEPHROTIC SYNDROME?

A

Cholesterol
Fatty cast
Oval fat bodies

194
Q

Colorless, flat plates
Similar to CHOLE crystals

A

Radiographic Dye/RCM

195
Q

Used to distinguish RCM from CHOLE crystals

A

RCM: Markedly ELEVATED SG

196
Q

Colorless to yellow-brown, needles, rhombic, whetstones, “SHEAVES OF WHEAT” and rosettes

A

Sulfonamides

197
Q

T/F
Sulfonamides dissolves in dilute acetic acid

A

F
Sulfonamides does not dissolve upon addition of DILUTE ACETIC ACID

198
Q

Primary cause of sulfonamide presence

A

patient hydration (damage nephrons)

199
Q

this crystal appearance must be correlated with medical history

A

sulfonamides

200
Q

Colorless needles (tend to form bundles following refrigeration)

A

Ampicillin

201
Q

Precipitation of antibiotics following massive
dosage of penicillin compound without adequate hydration

A

Ampicillin

202
Q

Yellow-brown spheres (concentric circles with radial striations)

203
Q

Should be accompanied by: TYROSINE CRYSTALS

204
Q

Fine, colorless to yellow needles (in clumps or rosettes)

205
Q

Seen in conjunction with:
LEUCINE CRYSTALS & (+)
BILIRUBIN (chem test)

206
Q

Yellow, clump needles or granules

207
Q

must be accompanied by (+) Bilirubin in urine strip

208
Q

Abnormal crystals signifying LIVER disorder

A

Leucine
Tyrosine
Bilirubin

MTAP 1 (13 decks)

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