CH. 6 - Microscopic Examination of Urine (Lecture) Flashcards
Increases overall visibility of sediment elements being examined using bright field microscopy by changing their refractive index.
Staining
The most frequently used stain in urinalysis; consists of crystal violet and safranin O
Sternheimer-Malbin
aka. Sedi-stain (Becton-Dickinson, Parsipanny, N.J.)
aka. KOVA stain (Hycor Biomedical, Inc, Garden Grove, Calif.)
A metachromatic stain that provides enhancement of nuclear detail
0.5% solution of toluidine blue
A stain that differentiates WBCs and Renal tubular epithelial (RTE) cells
Toluidine blue
A stain that delineates structure and contrasting colors of the nucleus and cytoplasm
Sternheimer-Malbin
A stain that identifies WBCs, epithelial cells, and casts
Sternheimer-Malbin
A stain that lyses RBCs and enhances nuclei of WBCs
2% acetic acid
A stain that distinguishes RBCs from WBCs, yeast, oil, droplets, and crystals
2% acetic acid
Stains triglycerides and neutral fats orange-red;
identifies free fat droplets and lipid-containing cells and casts
Lipid stains: Oil Red O and Sudan III
Differentiates gram+ and gram- bacteria; identifies bacterial casts
Gram stain
The preferred stain for urinary eosinophils
Hansel stain
Consists of methylene blue and eosin Y (stains eosinophilic granules)
Hansel stain
Stains hemosiderin granules a blue color
Prussian blue
Stains structures containing iron; identifies yellow-brown granules of hemosiderin in cells and casts
Prussian blue
Type of microscopy used when using lipid stains
Polarizing microscopy
Type of microscopy wherein objects appear dark against a clear background; most frequently used in the clinical laboratory
Bright-Field microscopy
The use of _____ aids in the identification of crystals and lipids. Both substances have the ability to rotate the path of the unidirectional polarized light beam to produce characteristic colors in crystals and Maltese cross formation in lipids.
Polarized light
A property indicating that the element can refract light in two dimensions at 90 degrees to each other
Birefringement
Type of microscopy that provides a three dimensional image showing very fine structural detail by splitting the light ray so that the beams pass through different areas of the specimen.
Interference contrast microscopy
Type of microscopy wherein an object appears bright against a dark background but without the diffraction halo associated with phase-contrast microscopy.
Interference contrast microscopy
A technique used in the clinical laboratory to enhance the visualization of specimens that cannot be seen easily viewed with a bright-field microscope.
Dark-field microscopy
Type of microscopy used for unstained specimens, and, in particular, to identify the spirochete Treponema pallidum
Dark-field microscopy
Used to detect bacteria and viruses within cells and tissues through a technique called immunofluorescence
Fluorescence microsopy
In the urine, these aapear as smooth, non-nucleated, biconcave disks measuring approximately 7mm in diameter; must be identified using HPO
RBCs
RBCs that vary with size, have cellular protrusions, or are fragmented are termed _____. Associated primarily with glomerular bleeding.
Dysmorphic
In concentrated (Hypersthenuric) urine, cells shrink due to loss of water and may appear _____ or irregularly shaped
Crenated
In dilute (Hyposthenuric) urine, the cells absorb water, swell. and lyse rapidly, releasing their hemoglobin and leaving only the cell membrane. These large empty cells are called
Ghost cells
The presence of RBC in the urine is associated with damage to the _____.
Glomerular membrane or vascular injury with the genitourinary tract
When macroscopic hematuria is present, what is the appearance of urine?
Urine appears cloudy with a red to brown color
Macroscopic hematuria is frequently associated with what diseases?
Advanced glomerular damage
Damage to vascular integrity of the urinary tract caused by trauma, acute inflammation or inflammation, and coagulation dsorders.
RBC and these casts may appear after strenuous exercise and are nonpathologic and disappear after rest.
RBC casts
Hyaline casts
Granular casts
What is the predominant WBC found in the urine sediment?
Neutrophil
Neutrophils are identified using what type of objective?
High power objective
How are neutrophils reported?
Average number seen per 10 hpfs
Neutrophils lyse rapidly in (alkaline/acidic) urine and begin to lose nuclear detail.
Alkaline
Brownian movement of the granules within the neutrophils exposed to hypotonic urine produce a sparkling appearance, these are referred to as _____.
Glitter cells
Neutrophils, when stained with Sternheimer-Malbin, will produce the color _____; on the other hand, neutrophils that were exposed to hypotonic urine will produce the color _____.
Violet; Light blue
The presence of this urine sediment is primarily associated with drug-induced interstitial nephritis; small numbers may be seen in UTI and renal transplant rejection.
Eopsinophils
What is the preferred eosinophil stain?
Hansel stain; Wright’s stain can also be used
The finding of more than .1% of eosinophils is considered significant. (T/F)
False (1%)
These are the smallest WBCs; may resemble RBCs.
They may be seen in the early stages of renal transplant rejection
Lymphocytes
What is the primary concern in the identification of WBCs?
Differentiation of mononuclear cells
Disintegrating neutrophils from renal tubular epithelial (RTE) cells.
What type of stain can be used to enhance the nuclear detail of WBCs?
Supravital staining
Addition of acetic acid
Usually fewer than 5 leukocytes per hpf are found in normal urine; however, higher numbers may be present in urine from (females/males).
Females
This type of WBC are capable of ameboid migration through the tissues to site of infection or inflammation.
Leukocytes
Term used to describe increase in urinary WBC.
Pyuria
Pyuria indicates the presence of an infection or inflammation in what body system?
Genitourinary
Enumerate some frequent bacterial infections that causes of pyuria.
Pyelonephritis
Cytitis
Prostatitis
Urethritis.
Enumerate some frequent nonbacterial infections that causes of pyuria.
Glomerulonephritis
Lupus erythematosus
Interstitial nephritis
Tumors
Unless present in large numbers or in abnirmal forms, these represent normal sloughing of old cells; these are not unusual to find in the urine because they are derived from the linings of the genitournary system.
Epithelial cells
What are the three types of epithelial cells seen in urine?
Squamous
Transitional (Urothelial)
Renal tubular
Largest epithelial cells found in the urine sediment.
They contain abundant, irregular cytoplasm and a prominent nucleus about the size of the RBC.
Squamous Epithelial cells
These are the first structures observed when the sediment is examined in under low-power magnification.
Squamous Epithelial cells
How is the presence of Squamous cells reported?
Rare, few, moderate, or many
Reported in terms of LPO or HPO
These epithelial cells originate from the lining of the vagina and female urethra and the lower portion of the male urethra.
Squamous Epithelial cells
These epithelial cells have no pathologic significance
Squamous Epithelial cells
To lessen the number of squamous cells present in the specimen, what type of urine sample must be collected?
Midstream clean-catch
This is a variation of squamous epithelial cells that are indicative of vaginal infection by the bacterium Gardnerella vaginalis.
Clue cells
These epithelial cells appear as squamous cells that are mostly covered with Gardnerella coccobacillus extending beyond the cell. Has a granular, irregular appearance.
Clue cells
What is the routine test for clue cells?
Vaginal wet preparation
This type of epithelial cells are smaller than squamous cells and appear in several forms including spherical, polyhedral, and caudate.
Transitional (Urothelial) Epithelial cells
What causes the different forms of the Transitional (Urothelial) Epithelial cells?
Their ability to absorb large amounts of water
