Clinical Microscopy Flashcards
Permits a detailed, in-depth assessment of renal status with an easily obtained specimen
Urinalysis
Serves as a quick indicator of an individual’s glucose status and hepatic or biliary function
Urinalysis
Urine Composition:
Normal ____ water, ___ solutes
95%, 5%
Inorganic solutes found in the urine are urea (protein, amino acid breakdown);
also creatinine and uric acid and the Organic solutes are chloride, sodium, potassium
True or False
False (Organic, Inorganic)
Formed elements not part of ultrafiltrate may indicate
disease. True or False
True
Determined by body’s state of hydration and influenced by fluid intake, nonrenal fluid loss, antidiuretic hormone (ADH) variations, excretion of
large amounts of dissolved solids
Urine Volume
<1 mL/kg/hr in infants, < 0.5 mL/kg/hr in children
< 400 mL/day in adults and causes dehydration, vomiting, diarrhea, burns, perspiration
Oliguria
Increased excretion of urine at night may indicate pregnancy
Nocturia
Increased urine output >2.5L in Adult >2.5-3mL/kg/day in children that may a result of Diabetes insipidus, Diabetes mellitus, diuretics
Polyuria
Complete cessation of urine flow and may indicate kidney damage, decrease blood flow to the kidney
Anuria
Increased volume caused by the need to excrete the excess glucose not reabsorbed from the ultrafiltrate; patients exhibit polydypsia; urine appears dilute with a high specific gravity
Diabetes mellitus
Decreased production or function of ADH causing decreased reabsorption of water from ultrafiltrate; urine is dilute with low specific gravity; patients also exhibit polydipsia
Diabetes insipidus
The patient’s name, ID number, date, time Time of collection are part of specimen labeling
True or False
True
Disposable, wide-mouth, and flat-bottom containers with screw caps are recommended for collecting the specimen
True or False
True
An insufficient quantity of urine is can be still tested
True or False
False (rejects)
Refrigerate the specimen if testing is delayed
True or False
True
The specimen should be tested within 2 hours of collection
True or False
True
When the specimen is not tested within 2 hours
Increased: glucose, ketones, bilirubin, urobilinogen,
RBCs, WBCs, casts
Decreased: color, turbidity, pH, nitrite, bacteria, odor
True or False
False
(Increased:color, turbidity, pH, nitrite, bacteria, odor Decreased: glucose, ketones, bilirubin, urobilinogen,
RBCs, WBCs, casts)
The ideal specimen preservation is _______ as it inhibits urease and preserves formed elements
bactericidal
Specimen preservation may cause precipitation of amorphous crystals
True or false
True
It preserves glucose and sediments well and it interferes with acid precipitation tests for protein
Thymol
Excellent sediment preservative, acts as a reducing agent, interfering with chemical tests for glucose, blood, LE, and copper function
Formalin
Preserves cellular elements and used for cytology studies
Saccomanno Fixative
Doesn’t interfere with urine tests and causes an odor
Phenol
Prevents glycolysis and a good preservative for drug analysis
CHOICES:
Phenol, Thymol, Sodium fluoride, Saccomanno Fixative, Formalin
Sodium fluoride
detection of orthostatic proteinuria
First morning
routine screening
First morning and Random
quantitative chemical tests, hormone studies
24-hour
Addis count
12-hour
urobilinogen determination
Afternoon specimen (2-4 pm)
diabetic screening/monitoring
Fasting/Second morning
accompaniment to blood samples in GTT
Glucose Tolerance
diagnosis of prostatic infection
Three-glass collection
bacterial culture
Catheterization
bacterial culture and cytology
Suprapubic aspiration
collection requires stringent protocols (COC); the temperature should be within
32.5- 37.7oC; blueing agent added to the toilet water reservoir in unwitnessed collection
Drug testing specimen
routine screening, bacterial culture
Midstream clean-catch
a process that provides documentation of proper sample identification
from the time of collection of the receipt of laboratory results
chain of custody
The normal color of urine varies from almost colorless, straw or light yellow to dark yellow, yellow-orange, or amber
True or False
True
The normal smell of urine is rancid
True or False
False ( faint aromatic due to volatile acids; becomes ammoniacal as the specimen stands)
The normal transparency of urine is clear with no visible particulates
True or False
True
few particulates and print easily seen through urine
Hazy
many particulates and print blurred through urine
Cloudy
print cannot be seen through urine
Turbid
may precipitate or be clotted
Milky
The specific gravity of normal urine should be 1.050-1.3
True or False
False (1.005- 1.030 )
The normal pH level of random urine is 4.5-8.0
True or False
True
The normal pH level of protein is <30 mg/dL or <150 mg/day
True or False
True
Intravascular hemolysis; muscle injury; severe infection and inflammation; multiple
myeloma
CHOICES:
Post-renal, Renal (tubular), Pre-renal, Renal (glomerular)
Pre-renal
Diabetic nephropathy, amyloidosis, glomerulonephritis, autoimmune disorders,
toxic agents, hypertension, strenuous exercise, pre-eclampsia, dehydration, orthostatic proteinuria
CHOICES:
Post-renal, Renal (tubular), Pre-renal, Renal (glomerular)
Renal (glomerular)
Fanconi syndrome, toxic agents, severe viral infections
CHOICES:
Post-renal, Renal (tubular), Pre-renal, Renal (glomerular)
Renal (tubular)
lower UTI; injury or trauma; menstrual contamination; prostatic fluid; spermatozoa; vaginal secretions
CHOICES:
Post-renal, Renal (tubular), Pre-renal, Renal (glomerular)
Post-renal
The normal amount of glucose in the urine is <15 mg/dL
True or False
True
Diabetes Mellitus, endocrine disorders, pancreatic disorders, CNS disorders, disturbance in metabolism, liver disease, drugs, gestational diabetes mellitus
Hyperglycemia-associated
Renal tubular dysfunction, tubular necrosis, Fanconi syndrome, osteomalacia,
pregnancy
Renal-associated
Reported as average count/HPF and seen in urinary tract infection or inflammation
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
WBC
Reported as average count/HPF and seen in cases glomerulonephritis, severe exercise, menstrual blood contamination, renal calculi,
malignancy
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
RBC
reported qualitatively (rare, few, moderate, many) and the cells sloughed off the lining of nephrons and urinary tract
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
Epithelial cells
Formed primarily within distal convoluted tubule and
collecting duct
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
Cast
Seen with other pathological casts in cases of AGN, CGN, APN, and CHF
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
Hyaline cast
seen in glomerulonephritis and damage to the capillary structure of the nephrons
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
Red blood cell cast
Seen in pyelonephritis (+WBCs and bacteria) and interstitial nephritis
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
White blood cell cast
Advanced tubular destruction, associated with exposure to toxic agents
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
RTE cell cast
Indicates stasis of urine flow
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
Granular cast
Extreme urine stasis, indicating CRF; the final phase of cast degeneration
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
Waxy cast
Extreme urine stasis and destruction of the tubular walls
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
Broad cast
Seen in lipiduria in conjunction with oval fat bodies and free fat droplets
CHOICES:
RBC, WBC, Cast, Epithelial cells, Hyaline cast, White blood cell cast, Red blood cell cast, RTE cell cast, Fatty cast, Granular cast, Waxy cast, Broad cast
Fatty cast
polymorphic; Increased in gout, leukemia, and Lesch-Nyhan syndrome
Uric acid
sand grain-like; Commonly seen in refrigerated specimens
Amorphous urates
envelop shaped Ethylene glycol poisoning, renal Calculi
Calcium oxalate
sand shaped like and seen in refrigerated specimens
Amorph phosphates
colorless thin prisms, plates, needles and a common constituent of renal calculi
Calcium phosphate
used to assess digestive tract infections
fecalysis