clinical microscopy Flashcards
overall evaluation of renal function
urinalysis
basic functional unit of kidneys
nephron
what has glomerulus (tuft of capillaries), renal tubules (PCT, loop of Henle, DCT, collecting)
Nephron
3 processes of urine formation
- Glomerular Filtration
- Tubular Reabsorption
- Tubular Secretion
Function of the Nephron
- Filtration
- Reabsorption
what function of the nephron is described:
in the glomerulus, blood plasma and dissolved substances get filtered into the glomerular capsule
Filtration
what function is the nephron is described:
all along the renal tubule and collecting duct, water, ions, reabsorbed from the renal tubule lumen into the peritubular capillaries and ultimately into the blood.
Reabsorption
Types of urine Specimen
a. Early morning urine
b. Random urine
c. Fasting/post prandial urine
d. Timed urine
preferred because it is more concentrated from overnight retention in the bladder; good for protein analysis
early morning urine
collected any time of the day
random urine
for glucose determination
fasting/post prandial urine
for clearance test
timed urine
RU
a. types of specimen
b. method of collection
c. specimen handling
d.effects of unpreserved urine
- clean midstream catch
- catheterization
method of collection
- must be analyzed within 1 hour of collection if stored at room temperature
- refrigerate @ 2-8C for not more than 8 hours (uf delay examination)
specimen handling
- bacterial multiplication cause (+) nitrite test
- pH alkalinization leads to cast degeneration and RBC lysis
effects of unpreserved urine
- urease-producing organisms will degrade urea to ammonia
- loss of CO2
effects of unpreserved urine
steps in RU
A. Physical Examination
B. Chemical Examination: Reagent Strip Method
C. Microscopic Examination
under physical examination
a.1 color
a.2 odor
a.3 turbidity (transparency/clarity)
a.4 volume
a.5 specific gravity (SG)
- attributed to pigments: urochrome, urobilin, uroerythrin
- a rough indication if the state if hydration of an individual
Color
gross appearance
physical examination
when color is dark
it means it is more concentrated
purple color of urine
does not exist
- has little diagnostic significance; not included in the routine
- result
- aromatic dye to presence of volatile acids
- suggestive of freshness of the sample
odor
release of ammonia after bacterial degradation of urea; indicative of UTI
ammoniacal odor
diabetic urine - presence of ketones
fruity odor
isovaleric acidemia
sweaty feet odor
phenylketonuria
mousy odor
methioninr malabsorption
cabbage odor
- degree of cloudiness
- depends on pH and presence of dissolved solids
- reported as clear, slightly turbid, turbid cloudy
turbidity
smoky appearance of turbidity
hematuria
thread-like cloudiness of turbidity
mucus
indicates the balance between fluid ingestion and water lost from lungs,sweat, and intestines
volume
normal adult urine volume
750-2,000 mL/24 hrs
excessive urine exxcretion
polyuria
absence of urine output
anuria
weight of urine/ weight of water standard
specific gravity (SG)
methods of SG determination
- refractometer (total solid meter)
- urinometer or hydrometer
- dipstick
clinical correlation
high SG (specific gravity)
low SG
DM, congestive heart failure, dehydration, adrenal insufficiency, liver diseases, and nephrosis
High SG
DI, pyelonephirits, and glomerulonephritis
Low SG
refers to the negative logarithm of the hydrogen ion concentration
pH
normal pH of a random urine
4.5 8
Reagent strip test contain test pads impregnated with reagents that specifically react with a test analyte and register specific color change
chemical examination
color change is compred to a…
comparator chart
1-2 drops of urine sediments from a centrifuged urine is placed on a glass slide to examine under LPO and HPO
microscopic examination
Cellular elements (average of 10 microscopic fields)
a. RBC : Hematuria
b. WBC: Pyuria
c. Epithelial cells (EC)
d.Casts: Cylinduria or Cylindroiduria
seen in glomerulonephritis, severe exercise, menstrual blood contamination, vascular injury, renal/urinary calculi obstruction, pyelonephritis
RBC: Hematuria
seen in cases of pyelonephritis, UTI, inflammation
WBC: Pyuria
WBC enlarged showing a sparkling effect in their CYTOPLASMIC GRANULES and noticable BROWNIAN MOTION
glitter cells
cells sloughed off the lining of the nephrons and urinary tract
epithelial cells (EC)
3 types of epithelial cells
squamous cells (large & flat)
renal eepithelial cells (round & uninucleate)
transitional bladder EC (urothelial)
formed primarily within distal convoluted tubule & collecting duct
Casts: Cylinduria and Cylindroiduria
Casts: Cylinduria and Cylundroiduria precipitated cylindrical impressions of the nephrons composed of…
Tamm Horsfall mucoprotein uromucoid
types of casts
hyaline
wavy
granular to wavy
coarsely granular
finely granular
hyaline to fine granular
formed by the precipitation of urinr salts subjected to pH, temperature or concentration
Crystals
