Chapter 6 - Microscopic Examination of Urine Flashcards
1
Q
How much urine is needed for microscopic exam
A
10-15 mL (ave: 12 mL)
2
Q
Urine is centrifuged at ____ RCF for ____ mins
A
400 RCF; 5 mins
3
Q
Decant urine, ____ mL remains
A
0.5 to 1.0 mL
4
Q
Transfer _____ uL (or _____ mL) sediment to glass slide with ____ x ____ mm coverslip
A
20 uL; 0.02 mL; 22 x 22 mm
5
Q
Examin urine microscopically ____ LPF and ____ HPF under reduced light (how many fields observed routinely)
A
10 LPF, 10 HPF
6
Q
Quantitative measure of formed elements of urine using hemacytometer
A
Addis count
7
Q
Spn for Addis count
A
12 hour urine
8
Q
Urine preservative for Addis count
A
Formalin
9
Q
Normal values for Addis count of the following:
RBCs = ?
WBCs & ECs = ?
Hyaline casts = ?
A
0-500,000/12-hr urine
0-1,800,000/12-hr urine
0-5,000/12-hr urine
10
Q
Determine microscopic technique:
- For routine UA
- ID of Treponema pallidum
- Enhances visualization of translucent elements (forms halo)
- ID of chole in oval fat bodies, fatty casts & crystals
- Visualization of fluorescent microorganisms or those stained by a fluorescent dye
- 3-D microscopy-image & layer-by-layer imaging of a spn
- Differential interference-contrast microscope
- Modulation interference-contrast microscope
- Microscope that can be adapted to Nomarski or Hoffman
A
- Bright-field microscopy
- Dark-field microscopy
- Phase-contrast microscopy
- Polarizing microscopy
- Fluorescence microscopy
- Interference-contrast microscopy
- Nomarski
- Hoffman
- Bright-field microscopy
11
Q
Determine sediment stain:
- Lyses RBCs, enhances nuclei of WBCs
- Identifies WBCs, epithelial cells and casts
- Identifies bacterial casts
- Stains eos granules
- Stains DNA
- Identifies hemosiderin granules
- Stains nuclear membranes, mitochondria & cell membranes
- Identifies urinary eos
- Enhances nuclear detail; supravital stain
- Stains triglycerides and neutral fats orange-red
- Differentiates WBCs and RTE cells
- Delineates structure & contrasting colors of the nucleus & cytoplasm
- Distinguishes RBCs from WBCs, yeast, oil droplets & crystals
- Diff gram pos & gram neg bacteria
- Crystal violet + Safranin O
- Eosin Y + methylene blue
- Stains structures containing iron
A
- 2% acetic acid
- Sternheimer-Malbin
- Gram stain
- Hansel stain
- Phenathridine
- Prussian blue
- Carbocyanine
- Hansel stain
- Toluidine blue
- Lipid stains (oil red O and sudan III)
- Toluidine blue
- Sternheimer-Malbin
- 2% acetic acid
- Gram stain
- Sternheimer-Malbin
- Hansel stain
12
Q
Phenathridine stain color
A
Orange
13
Q
Carbocyanine stain color
A
Green
14
Q
Stains used by Sysmex UF-100 urine cell analyzer
A
Phenathridine & carbocyanine
15
Q
Normal value of RBCs in urine
A
0-2 or 0-3 / HPF
16
Q
Swollen RBCs
A. Hypertonic
B. Hypotonic
A
B
17
Q
Shrink RBCs
A. Hypertonic
B. Hypotonic
A
A.
18
Q
Crenated RBCs
A. Hypertonic
B. Hypotonic
A
A
19
Q
Hemolyzed RBCs
A. Hypertonic
B. Hypotonic
A
B
20
Q
Ghost cell
A. Hypertonic
B. Hypotonic
A
B
21
Q
Fragmented, dysmorphic, w/ projections RBCs are seen in:
A
Glomerular membrane damage
22
Q
Remedy for sources of errors when observing RBC under microscope
A
2% acetic acid
23
Q
Presence of RBCs in the urine
A
Hematuria
24
Q
Presence of WBCs in the urine
A
Pyuria or leukocyturia
25
Normal value of WBCs in urine
0-5 or 0-8/HPF
26
Most predominant WBC in urine
Neutrophil
27
In _____ urine, neutrophils swell and granules undergo Brownian movement
A. Hypertonic
B. Hypotonic
B.
28
Neutrophils undergoing Brownian movement with no pathologic significance is referred to as
Glitter cells
29
Normal value of eos in urine
<1%
30
Significant value for eos in urine
>1%
31
Presence of eos in the urine is assoc with what disease?
drug-induced acute interstitial nephritis
32
Using Sternheimer-Malbin, glitter cells color _____
Pale blue
33
Using Sternheimer-Malbin, leukocytes color _____
Pale pink
34
Point of reference, sediment that serves as a basis in focusing microscope
Squamous epithelial cells
35
Largest cell w/ abundant, irreg cytoplasm & prominent nucleus
Squamous epithelial cells
36
The nucleus of squamous cell is about the size of ___
RBCs
37
Squamous epithelial cells come from?
Urethra, vaginal linings
38
Clue cells are squamous epithelial cells covered with _____
Gardnerella vaginalis
39
Rectangular, polyhedral, cuboidal or columnar w/ eccentric nucleus
Renal tubular epithelial cell
40
Spherical, polyhedral or caudate with centrally located nucleus
Transitional epithelial cell
41
Other names for transitional epithelial cells
Bladder cell, urothelial cell
42
Origin of transitional epithelial cell
Urinary bladder, ureter, renal pelvis, calyces, upper male urethra
43
Transitional epithelial cells are increased following _____ - may be seen singly, in pairs, or in clumps (syncytia)
Catheterization
44
Origin of RTE cells
Nephrons
45
Most clinically significant epithelial cell
RTE cell
46
RTE cells from the DCT may be mistaken for ____
WBCs
47
RTE value indicating tubular injury
>2 RTE/HPF
48
Lipid containing RTE cells
Oval fat bodies
49
Disease associated with lipiduria (oval fat bodies)
Nephrotic syndrome
50
What type of fat can’t be stained using lipid stains
Cholesterol
51
What type of fat can be stained using lipid stains
TAG and neutral fats
52
What type of fat can form maltese cross under polarizing microscope?
Cholesterol
53
What type of fat can’t form maltese cross under polarizing microscope?
TAG and neutral fats
54
RTE cell with non-lipid vacuoles
Bubble cell
55
Sediments observed in true UTI
Bacteria + WBCs
56
Most common cause of UTI
Enterobacteriaceae (ex: E. coli)
57
Diff amorphous urates or phosphates from bacteria
Bacteria are motile
58
Sediments observed during true yeast infection
Yeast + WBCs
59
Small, refractile oval structure that may or may not bud
Yeast
60
Smooth, non-nucleated, biconcave disks
RBCs
61
Increased number of this urine sediment indicate presence of infection or inflammation
WBCs
62
Yeast seen in DM and vaginal moniliasis
Candida albicans
63
Most frequently encountered parasite in urine
Trichomonas vaginalis
64
Parasite considered the most common fecal contaminant
Enterobius vermicularis egg
65
Blood fluke with terminal spine
Schistosoma haematobium egg
66
Agent of pingpong disease
T. vaginalis
67
How is T. vag reported?
Qualitative per HPF
68
Pear-shaped flagellate with jerky motility
T. vag
69
Parasite that can cause hematuria
S. haematobium egg
70
Parasite assoc with bladder cancer
S. haematobium egg
71
Specific urinary bladder cancer markers
Nuclear Matrix Protein (NMP) & Bladder Tumor Antigen (BTA)
72
Urine sediment that is oval, slightly tapered head, long, flagella-like tail
Spermatozoa
73
Thread-like structures, has low refractive index w/o clinical significance
Mucus threads
74
Major constituent of mucus threads
Tamm-Horsfall protein / uromodulin
75
Which sediments are not quantitated?
Budding yeast, mycelia elements, trichomonas, sperm
76
Identify whether the following are graded per LPF or per HPF:
1. Crystals (normal)
2. RBCs
3. WBCs
4. Mucus threads
5. Casts (normal)
6. Bacteria
7. Epithelial cells
8. Oval fat bodies
9. crystals (abnormal)
10. Abnormal casts
11. Transitional epithelial cells
12. Yeast
13. RTE cells
14. Squamous epithelial cells
1. HPF
2. HPF
3. HPF
4. LPF
5. LPF
6. HPF
7. LPF
8. HPF
9. LPF
10. LPF
11. HPF
12. HPF
13. HPF
14. LPF
77
Identify how the ff sediments are reported:
1. Epithelial cells
2. Normal crystals
3. Bacteria
4. Mucus threads
5. Normal casts
6. RBCs
7. WBCs
8. Squamous epithelial cells
9. Transitional epithelial cells
10. Renal tubular epithelial cells
11. Oval fat bodies
12. Abnormal crystals
13. Abnormal casts
14. Yeasts
1. Rare, few, mod, many per LPF
2. Rare, few, mod, many per HPF
3. Rare, few, mod, many per HPF
4. Rare, few, mod, many per LPF
5. Numerical ranges per LPF
6. Numerical ranges per LPF
7. Numerical ranges per LPF
8. Rare, few, mod, many per LPF
9. Rare, few, mod, many per HPF
10. Average number per 10 HPFs
11. Average number per HPF
12. Average number per LPF
13. Average number per LPF
14. Rare, few, mod, many per HPF
78
Excretion of casts
Cylindruria
79
Sediment that is unique to the kidney
Casts
80
Casts are primarily formed in the?
DCT & collecting duct
81
Major constituent of casts
Uromodulin / Tamm-Horsfall protein
82
What produces uromodulin / Tamm-Horsfall protein?
RTE cells
83
Regarding cast production, gels more readily under conditions of ____, ____, and presence of ____ and ____.
Urine-flow stasis, acidity; presence of Na+ and Ca+
84
How would you observe casts under microscope?
Performed along the coverslip edges with subdued light
85
Order of cast degradation
Hyaline cast - cellular cast - coarse granular cast - finely granular casts - waxy cast
86
Prototype cast
Hyaline cast
87
Normal value for hyaline cast
0-2/LPF
88
Appearance of this cast indicates bleeding within the nephron
RBC cast
89
Cast that contains hgb from lysed RBCs
Blood cast
90
RBC cast can be easily identified by?
Orange-red color
91
Most frequently encountered cast
Hyaline cast
92
Physiologic causes of hyaline an RBC cast appearance in urine
Strenuous exercise
93
Pathologic cause of the appearance of hyaline and RBC casts
Glomerulonephritis
94
Cast that indicates inflammation or infection w/in nephron that resembles RTE cast
WBC cast
95
WBC cast may be diff from RTE casts by?
Phase microscopy, supravital stain
96
Clinical significance of RTE cell casts
Advanced tubular destruction, renal tubular damage
97
Cast identified by gram stain
Bacterial stain
98
Cells visible on the cast matrix are smaller, round and oval cells
RTE cell cast
99
Final degenerative form of all types of casts
Waxy cast
100
Clinical significance of waxy cast
Stasis of urine flow, chronic renal failure
101
Fatty cast clinical significance
Nephrotic syndrome
Others: toxic tubular necrosis, DM, crush injuries
102
Aka renal failure cast
Broad cast
103
Cast that is brittle, highly refractile, w/ jagged ends or cracks
Waxy cast
104
How would you diff a fatty cast containing chole from a fatty cast containing TAG/neutral fats?
Fatty cast w/ chole - polarizing microscope
Fatty cast w/ TAG or neutral fats - lipid stains
105
What cast is described?
Hyaline matrix w/ coloration due to pigment incorporation
Pigmented cast
106
Golden-brown pigmented cast indicates?
Bilirubin
107
Yellow to red brown pigmented cast indicates?
Hgb or mgb
108
Cast containing multiple cell types
Mixed cellular cast
109
Casts containing urates, Ca Ox, and sulfonamides
Crystal casts
110
Factors that contribute to crystal formation
pH, temp, solute conc
111
How are crystals usually reported?
Rare, few, mod, many per HPF
112
How are abnormal crystals reported?
Average number per LPF
113
The first consideration when identifying crystals is?
Urine pH
114
Identify the ff normal crystals described:
1. Granular in appearance, white precipitate, soluble in dilute acetic acid
2. Cigarette butt appearance, soluble in acetic acid
3. Yellow-brown/colorless elongated prism, soluble in water and ether
4. Yellow-brown thorny apples
5. Seen in old spn
6. Increased in the presence of urea-splitting bacteria
7. Small, colorless, dumbbell or spherical shaped that forms gas (effervescence) after adding dilute acetic acid
8. Colorless, flat plates, thin prisms in rosette form
9. Colorless, prism-shaped or coffin lid; fern leaf
10. Feathery appearance when they disintegrate
11. Increased in foods rich in oxalic acid like tomato and asparagus and ascorbic acid
12. Can be mistaken as cystine crystals
13. Gold lemon shaped
14. Brick dust or yellow brown granules soluble in heat and alkali
15. Product of purine metabolism
16. Rosettes may resemble sulfonamide crystals
17. Increased in Lesch-Nyhan syndrome, chemotherapy and gout
18. Increased in ethylene glycol poisoning (anti-freeze agent)
19. Rhombic, wedge, hexagonal, 4-sided flat plate/whetstone, soluble in alkali
20. Pink sediment due to uroerythrin
21. Most pleomorphic
1. Amorphous phosphates
2. Calcium sulfates
3. Hippuric acid
4. Ammonium biurate
5. Ammonium biurate
6. Ammonium biurate & triple phosphate
7. Calcium carbonate
8. Calcium phosphate
9. Triple phosphate
10. Triple phosphate
11. Calcium oxalate
12. Uric acid
13. Uric acid
14. Amorphous urates
15. Uric acid
16. Calcium phosphate
17. Uric acid
18. Calcium oxalate
19. Uric acid
20. Amorphous urate
21. Uric acid
115
Identify whether the ff crystals can be seen in acidic or alkaline urine:
1. Hippuric acid
2. Calcium carbonate
3. Uric acid
4. Triple phosphate
5. Calcium phosphate
6. Calcium oxalate
7. Calcium sulfate
8. Ammonium biurate
9. Amorphous urate
10. Amorphous phosphate
1. Acidic
2. Alkaline
3. Acidic
4. Alkaline
5. Alkaline
6. Acidic
7. Acidic
8. Alkaline
9. Acidic
10. Alkaline
116
Weddellite
What form of Ca Ox?
What shape?
Dihydrate form
| Envelope / pyramidal
117
Whewellite
What form of Ca Ox?
What shape?
Monohydrate form
| Dumbbell / oval
118
Crystal that appears in an acidic urine but soluble in acetic acid
Calcium sulfate
119
Crystal that is soluble in water & ether
Hippuric acid
120
Identify the following abnormal urinary crystals:
1. Resembles sofa pillow
2. Fine colorless to yellow needles in clumps or rosettes
3. Rectangular plate w/ notch in 1 or more corners (staircase pattern)
4. Soluble in 10% NaOH (Chole or radio dye)
5. Soluble in chloroform (Chole or radio dye)
6. Clumped granules or needles w/ bright yellow color
7. Needles, sheaves of wheat, rosettes, arrowheads, petals or round
8. Colorless needles, that tend to form bundles following refrigeration
9. Mistaken as calcium phosphate crystals
10. Precipitated with tyrosine after adding alcohol
11. Crystals increased in liver disease
12. Crystal increased in nephrotic syndrome
13. yellow-brown spheres w/ concentric circles & radial striations
14. Lignin test positive & diazo rxn positive
15. Soluble in acetone
16. Colorless hexagonal plates
17. Increased in cystinuria and cystinosis
1. Leucine
2. Tyrosine
3. Cholesterol and radiographic dye
4. Radiographic dye
5. Cholesterol
6. Bilirubin
7. Sulfonamide
8. Ampicillin
9. Sulfonamide
10. Leucine
11. Bilirubin, Leucine, Tyrosine
12. Cholesterol
13. Leucine
14. Sulfonamide
15. Sulfonamide
16. Cystine
17. Cystine
121
Other names of triple phosphate
Struvite, Magnesium ammonium phosphate
122
Other name for calcium phosphate
Apatite
123
How would you diff cystine from uric acid crystals in terms of color?
UA: yellow-brown
Cystine: colorless
124
How would you diff cystine from uric acid crystals in terms of solubility in HCl?
UA: insoluble
Cystine: soluble
125
How would you diff cystine from uric acid crystals in terms of birefringence?
UA: birefringent
Cystine: not birefringent
126
How would you diff cystine from uric acid crystals in terms of solubility in ammonia?
You cannot. Both are soluble in ammonia
127
How would you diff cystine from uric acid crystals in terms of cyanide-nitroprusside rxn?
UA: neg
Cystine: pos
128
How would you diff cholesterol from radiographic dye crystals?
Check px history, correlate w/ other UA results like SG (>1.040 for radio dye)
Others: chole is soluble to ether, radio dye is soluble to 10% NaOH
129
How would you diff sulfonamides from calcium phosphates?
CP: soluble in acetic acid
Sulfo: positive lignin test & positive diazo rxn
130
Spheres w/ dimpled center
Starch granules
131
Name 4 sediments that form maltese cross
Oval fat bodies (contains chole)
Fatty casts (contains chole)
Fat droplets (contains chole)
Starch granules
132
What does the term chemical sieving mean?
Macroscopic screening / microscopic exam
133
What does RCF stand for?
Relative centrifugal force
134
Formula for RCF
10^-5 x radius (in cm) x RPM^2
135
The most frequently used stain in UA
Sternheimer-Malbin stain
136
The recommended spn for cytodiagnostic urine testing
First morning
137
The ______ system is located in the objective & is adjusted to be near the spn
First lens
138
The _____ system, the ocular lens, is located in the eyepiece
Second lens
139
The ability of the lens to distinguish 2 small objects that are a specific distance apart
Resolution
140
Most microscopes are designed to be ____, indicating that they require only minimum adjustment when switching among objectives
Parfocal
141
If any optical surface of the microscope becomes coated with dust, it should be carefully removed with a?
Camel-hair brush
142
Optical surfaces of microscope should be cleaned with?
Lens paper
143
The ability of an element to refract light in 2 dimensions at 90 deg to each other
Birefringence
144
What type of microscope can be adapted for polarizing microscopy?
Bright-field
145
______ microscope is easily adapted for dark-field microscopy by replacing the condenser w/ dark-field condenser that contain opaque disk
Bright-field
146
Of all the urine sediment elements, ____ are the most difficult for students to recognize
RBCs
147
Dysmorphic RBCs most closely assoc w/ _____ (what dse) appear to be acanthocytes
Glomerular bleeding
148
Other forms of calcium phosphate include ____ (basic calcium phosphate) & ____ (calcium hydrogen phosphate)
Hydroxyapatite
| Brushite
