Clinical Microscopy Flashcards by KM Guntayon

major organic component of urine

urea

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major inorganic component of urine

chloride (sodium comes second)

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organic substances in urine

urea
creatinine
uric acid
glucose
proteins
hormones
vitamins
metabolized medications

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inorganic substances in urine

chloride
sodium
potassium
sulfate
phosphate
ammonium
calcium
magnesium

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muscular tube that connects the pelvis of the kidney to the bladder

ureter

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cavity area that is an expansion of the ureter
functions to collect urine from the calyces for transport from the kidney to the ureter

renal pelvis

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_____ supplies blood to the renal artery, which in turn provides blood to the kidneys and the renal vein which functions to return the blood to the _____

abdominal aorta
inferior vena cava

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functional unit of the kidney
responsible for urine formation
comprised of a renal corpuscle and a tubular system

nephron

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renal corpuscles consisting of the ___ and ____

glomerulus
Bowman’s capsule

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tubular system

proximal convoluted tubule
loop of Henle
distal convoluted tubule
collecting duct

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____ is a tuft of capillaries that lie in a tubular depression called ____

glomerulus
Bowman’s capsule

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main function of glomerulus

filter the blood

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carries blood into the glomerulus

afferent arteriole

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carries blood away the glomerulus

efferent arteriole

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proximal convoluted tubule is located in the ____

cortex

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loop of Henle beings in the cortex with the ____ of the loop extending into the medulla where the bend of the loop that then becomes the ___ which ends in the cortex

descending limb
ascending limb

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distal convoluted tubule is located in the ____, and join together to direct the urine flow into the ___

cortex
collecting duct

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collecting duct joins with other collecting ducts forming a _____ to carry urine into a ___ of the renal pelvis

papillary duct
calyx

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in order to form the excrete urine, three processes function together

glomerular filtration
tubular reabsorption
tubular secretion

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glomerulus functions as a ___ to make an ultrafiltrate of plasma that is protein free

semipermeable membrane

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GFR is about ____ of filtrate formed per minute by the glomeruli
renal tubules will reabsorb all but __ of the filtrate, which will be passed in the urine

115-125 mL
1mL

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process by which filtered water, ions, and molecules leave the tubules for return to the blood via the peritubular capillaries

reabsorption

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process by which a substance from the blood is transported across the wall of the tubule into the filtrate

secretion

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responsibility for most of the reabsorption and secretion that occurs in the tubules

proximal convoluted tubule

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limitation as to how much solute can be reabsorbed

renal threshold

renal threshold for glucose

160-180mg/dL

descending limb of loop of Henle reabsorbs ____ ascending limb of loop of Henle reabsorbs ___ and ___

water sodium chloride

DCT reabsorbs ___

sodium

controls the reabsorption of water in DCT

anti-diuretic hormone

in DCT, secretion of __ and ___ occurs

hydrogen ions potassium

controls the reabsorption of sodium and water and secretion of K and H into the filtrate in DCT

aldosterone

final site for water reabsorption, to make urine more diluted or concentrated

collecting duct

controls the sodium and chloride reabsorption in collecting duct

aldosterone

in collecting duct, water reabsorption occurs by osmosis as well as in response to ___

ADH

secreted by the juxtaglomerular apparatus of the kidneys and catalyzes the conversion of angiotensinogen to angiotensin I

renin

stimulates the production of angiotensin II a hormone in the inactive form

angiotensin I

regulates renal blood by constriction of renal arterioles and secretion of aldosterone from the adrenal glands to facilitate retention of sodium

angiotensin II

made in the cortex of the adrenal glands acts on the kidneys by promoting the reabsorption of sodium from the filtrate into the blood and the secretion of potassium from the blood into the filtrate water will be reabsorbed along with sodium

aldosterone

secreted by the posterior pituitary gland, promotes water reabsorption from the filtrate into the blood primarily affects the reabsorption of water from the distal convoluted tubule and the collecting ducts

anti-diuretic hormone

promotes calcium reabsorption from the filtrate into the blood and excretion of phosphate ions from the blood into the filtrate

parathyroid hormone

alpha-globulin produced by the peritubular fibroblasts in the kidneys to stimulate red blood cell production in response to lowered oxygen levels

erythropoietin

inflammation of the glomerulus seen in children and young adults can follow a group A streptococcus respiratory infection, characterized by hematuria, proteinuria, WBCs and casts (RBC, granular, hyaline)

acute glomerulonephritis

a more serious condition than acute glomerulonephritis that may result in renal failure; urinalysis results would be similar to acute glomerulonephritis

rapid progressive glomerulonephritis

inflammation of the renal interstitium that may be caused by an allergic reaction to medication characterized by hematuria, proteinuria, WBCs and WCS casts

acute interstitial glomerulonephritis

thickening of the glomerular capillary walls and basement membrane characterized by hematuria and proteinuria

membranous glomerulonephritis

may be caused by renal blood pressure irregularities characterized by proteinuria (>3.5g/24h), hematuria, lipiduria, oval fat bodies, renal tubular epithelial cells and epithelial cell, fatty and waxy cts

nephrotic syndrome

affects a specific number of glomeruli, not the entire glomerulus, often seen in HIV patients characterized by hematuria and proteinuria

focal segmental glomerulosclerosis

results in a long term progressive loss of renal function characterized by hematuria, proteinuria, glucosuria, presence of casts, including broad casts

chronic glomerulonephritis (berger disease)

an infection of the renal tubules caused by a urinary tract infection characterized by hematuria, proteinuria, WBCs, bacteria and WBC and bacterial casts

acute pyelonephritis

chronic infection of the tubules and interstitial tissue that may progress to renal failure characterized by hematuria, proteinuria, WBCs, bacteria, and WBC, bacterial, granular, waxy and broad casts

chronic pyelonephritis

tubular necrosis caused by nephrotoxic agents and other disease processes, resulting in a failure of the kidneys to filter blood

renal failure

used to detect early renal disease

renal tubular reabsorption tests

examples of renal tubular reabsorption tests (also known as concentration tests)

osmolality specific gravity osmolar/free water clearance

measures the amount of solute dissolved in a solution evaluates renal concentrating ability, monitor the course of the renal disease and monitor fluid and electrolyte therapy

osmolality

depends on the solute dissolved in a solution and the density of this solute evaluates renal concentrating ability, monitor the course of the renal disease and monitor fluid and electrolyte therapy

specific gravity

used in the diagnosis of various types of diabetes mellitus measures renal clearance of solutes and substance-free water

osmolar/free water clearance

tubular secretion or renal blood flow test uses p-aminohippuric acid, a substance that is infused into the patient PAH is completely removed from the body, by a functional renal tissue

secretion test

used to assess renal waste removal and solute reabsorbing abilities decreased rate indicates compromised kidney function

glomerular tests

used to assess glomerular filtrate rate differ according to age and sex values decrease with age

creatinine clearance

not changed by diet or rate of urine flow

creatinine levels

creatinine clearance formula

creatinine clearance = urine creatinine x urine volume per 24 hours / plasma creatinine

specimen of choice for creatinine clearance

24-hour time urine

uses only blood creatinine and MDRD (modification of diet in renal disease) formula correction for gender and race required results only reported as a number if <60ml/min/1.73m2

eGFR

determined by the body's state of hydration

volume of urine

normal range of urine output in adult

1200-1500 mL/24 hours

decrease in urine output because of dehydration

oliguria

no urine output because of kidney damage or renal failure

anuria

increased urine output at night caused by reduction in bladder capacity resulting from pregnancy, stones or prostrate enlargement or increased fluid intake at night

nocturia

increased daily output may exceed 2L/day usually caused by such diseases as diabetes mellitus and diabetes insipidus, or ingestion of diuretics, caffeine and alcohol

polyuria

urine should be analyzed within ___ or preserve

2 hours

preserve urine: this will decrease bacterial growth but will cause precipitation of amorphous phosphates/urates

refrigeration

urine specimen types and collection times: concentrated specimen used for routine screening, pregnancy tests, and for detecting orthostatic proteinuria

first morning

urine specimen types and collection times: used for routine screening and microalbuminuria determination, time of collection not a consideration, patient cleans the external urinary meatus, urinates a small volume in the toilet and collects the rest of the voided sample

random midstream clean catch

urine specimen types and collection times: used for glucose monitoring usually the second voided specimen of the morning following this

fasting

urine specimen types and collection times: void 2 hours after eating, used to monitor glucose contet

2-hour postpandrial

urine specimen types and collection times: for creatinine clearance or for quantifying other analytes including sodium and potassium

24-hour

urine specimen types and collection times: collected from a tube placed through the urethra into the bladder, used for bacterial culture and routine screening

catheterized

urine specimen types and collection times: genital area cleansed with a detergent and urine collected in the middle of urination, used for bacterial culture and is the preferred collection method for routine analysis because it is the most concentrated sample of the day

midstream clean-catch

urine specimen types and collection times: needle inserted into the bladder through the abdominal wall; used for bacterial culture and cytologic testing

suprapubic aspiration

normal color of urine is derived from ___, which is a pigmented substance excreted at a constant rate increased production can result from thyroid disease or a fasting urine sample

urochrome

formed from the oxidation of urobilinogen as urine stands, adds minimally to the normal yellow color

urobilin

colorless/pale yellow random specimen may indicate this condition as a result with increased urine excretion

diabetes insipidus or diabetes mellitus

this medication is prescribed for UTI resulting thick orange urine will mask chemical and microscopic analysis

pyridium (phenazopyridine)

red/pink urine may signify the presence of these in urine

blood, hemoglobin, myoglobin, porphyrins

these can cause green/blue urine

medications: amitriptyline, indicant and phenols infections caused by pseudomonas

brown/black color may signify the presence these in urine

denatured hemoglobin melanin homogentisic acid

visual inspection of urines

clarity

urine clarity: indicates the absence of significant numbers of formed elements

clear

urine clarity: may be due to the presence of low numbers of formed eleements

hazy/slightly cloudy

urine clarity: in acid urine, may be due to amorphous urates showing a slight pink color, calcium oxalate crystals, or uric acid crystals; in alkaline urine, if the sample is white, may be due to amorphous phosphates and carbonates

cloudy

urine clarity: may be due to the presence of large numbers of formed elements

turbid

maple syrup odor in urine

maple syrup urine disease

sweaty or fruity odor in urine

ketone bodies (diabetic ketosis)

determines the kidney's ability to reabsorb essential chemicals and water from the glomerular filtrate detects dehydration and ADH abnormalities density of a substance compared with the density of a similar volume of deionized water a similar temperature and is influenced by the number of particles dissolved and by the particle size

specific gravity

first renal function to become impaired

reabsorption

measures a refractive index by comparing the velocity of light in air to the velocity of light in a solution does not require temperature corrections

refractometer

plasma filtrate entering the glomerulus has a SG of ___

1.010

normal random urine ranges from ___ (average)

1.015 - 1.025

fixed SG of 1.010 , indicates loss of concentrating and diluting ability

isosthenuric urine

SG < 1.010

hyposthenuric urine

SG > 1.010

hypersthenuric urine

SG: loss of the kidney's ability to concentrate urine or presence of disease such as diabetes insipidus, glomerulonephritis and pyelonephritis, or normally if the person has a large fluid intake

low SG

SG: may result from adrenal insufficiency, diabetes mellitus, hepatic disease, congestive heart failure, and dehydration due to vomiting, diarrhea, low fluid intake, or strenuous exercise

high SG

method of choice for the chemical analysis of urine used for the following tests: pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leukocytes, creatinine, and specific gravity

reagent strips

acid-base balance of the body is primarily regulated by the ___ and ___

lungs kidneys

provide regulation through secretion of hydrogen ions via ammonium ions, hydrogen phosphate and organic weak acid facilitate reabsorption of bicarbonate from the convoluted tubules

kidneys

pH of urine ranges from __ for random urines and from ___ for the first morning void

4.5-8.0 5.0-6.0

acid pH in urine can be caused by:

high protein diets after normal sleep respiratory/metabolic acidosis uncontrolled diabetes mellitus

alkaline urine can be caused by:

excreted after meals in response to gastric HCl vomiting increased consumption of vegetables renal tubular acidosis respiratory/metabolic alkalosis and UTIs

for urine pH, the reagent strip uses ___ to detect changes in pH at pH 5.0, the pad is __ and __ at pH 9.0

methyl red/bromothymol blue orange blue

reagent strip uses ___ to detect protein in urine indicator is ____ in the absence of protein and the pad changes from shades of ____ when abnormal amounts of protein (albumin) are present

tetrabromophenol blue

normal urine will contain less than ____ of protein or ____

10mg/dL 100mg/24 hour

tamm-horsfall

uromodulin

very diagnostic for renal disease and many indicate tubular reabsorption problems, increased low-molecular weight proteins, and glomerular membrane damaged caused by toxic agents, lupus or streptococcal glomerulonephritis

urine protein

produced due to proliferative disorder of plasma cells as seen in multiple myeloma light chain monoclonal immunoglobulins

bence-jones protein

useful for patients with renal complications of diabetes mellitus

microalbumin evaluation

performed only for comparison with the protein level to rule out microalbuminuria

creatinine testing in a random urine

sensitivity of the creatinine method for urine specimen

10mg/dL

this causes false negative result in the creatinine method

ascorbic acid

most commonly used to detect and monitor diabetes mellitus (urine)

glucose testing

glucosuria is seen in these conditions

DM fanconi syndrome advanced tubular disease central nervous system damage thyroid disorders pregnancy

reagent strip for glucose testing: glucose + oxygen catalyzed by glucose oxidase to form ___ and ____ (which then when combined with chromogen, catalyzed by peroxidase to form an oxidized colored chromogen and water)

gluconic acid hydrogen peroxide

glucose testing: this method utilizes a reduction reaction, in which glucose (or other reducing substances) reduces copper sulfate (blue) to cuprous oxide (various shades of yellow to green) mainly used to detect the presence of galactose in urine for patients with galactosemia

copper reduction test (Benedict's, Clinitest tablet)

cause of false positive results from copper reduction test

antibiotics ascorbic acid reducing sugars

ketones being detected in the urine three intermediate products of fatty acid metabolism

acetone acetoacetic acid beta-hydroxy-butyric acid

(T/F) normal urine contains no ketones

true

causes of ketonuria

uncontrolled diabetes mellitus insulin dosage monitoring electrolyte imbalance dehydration

methodology of ketone testing: reagent strips use ____ to measure acetoacetic acid and the addition of ____ permits the measurement of acetone and acetoacetic acid

sodium nitroprusside (nitroferricyanide) glycine

causes of false positives for ketone testing in urine

pigmented urine dyes phenylketones

causes of false negatives for ketone testing in urine

bacterial breakdown of acetoacetic acid

methodology of ketone testing: nitroprusside and glycine tablet to detect ketones, gives an enhanced color reaction, permits serial dilutions to be done

acetest

methodology of ketone testing: enzymatic method uses ____ to detect the presence of ____

beta-hydroxybutyrate dehydrogenase beta-hydroxybutyric acid

intact RBCs in the urine

hematuria

causes of hematuria

renal calculi glomerulonephritis pyelonephritis tumors trauma toxins exercise menstruation pregnancy

hemoglobin in the urine

hemoglobinuria

causes of hemoglobinuria

transfusion reactions hemolytic anemia severe burns infections exercise

presence of heme-containing compound found in the muscles in the urine

myoglobinuria

causes of myoglobinuria

muscle trauma coma convulsions muscle wasting diseases extensive exercise

to screen for myoglobinuria, use ___ to precipitate hemoglobin out of the urine

ammonium sulfate

reagent strip detects the ___ activity of hemoglobin or myoglobin chromogen is ____, which forms a green-blue color when oxidized

pseudoperoxidase tetramethylbenzidine

blood in urine: this pattern on the reagent strip occurs when low numbers of intact RBCs lyse upon touching the reagent strip pad, releasing hemoglobin

speckled pattern

false positives for detecting blood in the urine

vegetable peroxidase e. coli peroxidase

false negatives for detecting blood in the urine

high levels of ascorbic acid and nitrites formalin preservative captopril

degradation product of hemoglobin pigmented yellow compound

bilirubin

one of the metabolic products formed when hemoglobin is degraded converted to bilirubin by reiticuloendothelial system

protoporphyrin

bilirubin binds to ___ for transport to the liver as unconjugated bilirubin

albumin

in the liver, bilirubin is conjugated with ____ to form ___

glucuronic acid bilirubin diglucoronide

bilirubin diglucoronide goes into the intestines and is reduced to ___ via bacterial action and excreted in the feces as ___, which gives feces their brown color

urobilinogen urobilin

bilirubinuria may result from these conditions

hepatitis cirrhosis biliary obstruction early liver disease

____ bilirubin is water soluble and excreted in urine

conjugated

____ bilirubin is not water soluble and cannot be excreted in urine

unconjugated

bile duct obstruction: urine bilirubin urine urobilinogen

(+) N

hemolytic disease urine bilirubin urine urobilinogen

(-) (+)

reagent strip for bilirubin test uses ___

diazonium salt reaction

false positives for bilirubin reagent strip test

pigmented urine due to medications, indican and lodine

false negatives for bilirubin reagent strip test

specimen too old excessive exposure to light ascorbic acid nitrite

formed from hemoglobin metabolism produced from the reduction of bilirubin by bacteria in the small intestines

urobilinogen

increased urobilinogen in the urine can indicate these conditions

early liver disease hepatitis hemolytic diseases

reagent strip for urobilinogen test uses ___ or ___

ehrlich's reagent diazo dye

false positives for the urobilinogen reagent strip test

pigmented urine

false negatives for the urobilinogen reagent strip test

improper storage high levels of nitrite

rapid test for UTIs used for evaluation of UTI antibiotic therapy

nitrite

a positive nitrite can indicate these conditions

cystitis pyelonephritis

reagent strip for nitrite test, reacts with an aromatic amine to form a ____, which then reacts with a dye to produce a ___ color

diazonium salt pink

false positives for the nitrite reagent strip test

old urine samples containing bacteria pigmented urine

false negatives for the nitrite reagent strip test

ascorbic acid antibiotics bacteria that do not reduce nitrate diet low in nitrates inadequate time in a bladder for reduction of nitrate to nitrite heavy concentration of bacteria that reduces nitrate all the way to nitrogen

indicate possible UTI and inflammation of urinary tract in urine specimen

leukocytes

reagent strip reaction: an ____ reacts with leukocyte esterase to form an aromatic compound that reacts with a diazonium salt, forming a ___ color

acid ester purple

false positives for the leukocytes reagent strip test

elevated protein or ketone levels

false negatives for the leukocytes reagent strip test

urine pH>6.5

in urine testing, monitors hydration and dehydration, loss of renal tubular concentrating ability and diabetes insipidus

specific gravity

reagent strip reaction for specific gravity: ionization of ___ in an alkaline solution produces hydrogen ions proportionally to the ions present in the solutions, causing a change in pH that is detected as a decrease in pH thus causing a color change of ___

bromothymol blue

false positives for specific gravity test

elevated protein or ketone levels

false negatives for specific gravity test

urine pH >6.5

normal urine contains: __ RBCs (hpf) __ WBCs (hpf) __ hyaline casts (lpf) __ epithelial cells (hpf)

0-2 0-5 0-2 several

increased RBCs in urine is associated with these conditions

infections toxins cancer circulatory problems renal calculi menstrual contamination trauma exercise

RBCs in normal urine appear as colorless disks while in concentrated urine they shrink and appear crenated; in dilute or alkaline urine, RBCs swell and lyse with release of hemoglobin, leaving an empty cells which appears as a ___

ghost cell

this can be used to lyse RBCs as they can be confused with yeast cells or oil droplets

dilute acetic acid

pyuria can be an indication for:

bacterial infections pyelonephritis cystitis prostatitis urethritis

predominant WBC appearing in the urine with cytoplasmic granules and multilobed nuclei

neutrophils

WBCs swell in dilute alkaline urine producing ____, which have a sparkling appearance due to the ____ of the granules

glitter cells brownian movement

when seen in urine may indicate a drug induced nephritis or renal transplant rejections

eosinophils

these cells are vey common in the urine and usually not clinically significant but excessive numbers of these cells may suggest the sample has not been collected properly by the clean-catch method

squamous epithelial cells

line the lower urethra and vagina in women and the urethra in males largest of the cells found in the sediment with abundant, irregular cytoplasm and a central nucleus the size of the rbcs

squamous epithelial cells

in the presence of a vaginal infection ___ may appear squamous epithelial cells covered with Gardnerella vaginalis

clue cells

most significant epithelial cells in the urine small eccentric nucleus cell size and shape vary from rectangular, larger cells in the proximal convoluted tubules to cells slightly larger than a WBC-shaped cuboidal or columnar originating from the collecting duct cytoplasm varies with the PCT being coarsely granulated and the CD being very finely granulated

renal tubular epithelial cells (RTE)

this is suggested when >5 RTE cells/hpf are present

tubular injury

tubular injury can indicate these conditions

renal cancer renal tubular damage pyelonephritis toxic and allergic reactions viral infection

RTE cells that contain large, non lipid-filled vacuoles can be seen in renal tubular necrosis associated with the dilation of the endoplasmic reticulum before the death of injured cells

bubble cells

RTE cells that have absorbed lipids that are highly refractile and stain with Sudan III or oil red O may indicate nephrotic syndrome

oval fat bodies

RTE cells: histiocytes in the urine may indicate lipid-storage disease cells are filled with fat and are larger than oval fat bodies

miscellaneous cells

formed elements in the urine unique to the kidneys

casts

term for casts in the urine

cylindruria

casts are formed within the lumen of the ____ taking on a shaped similar to the tubular lumen

distal convoluted tubules collecting duct

major constituent of casts and is poorly detected in reagent strip methods made by the RTE cells that line the DCT and upper CD

uromodulin tamm-horsfall glycoprotein

most commonly seen cast due to exercise, dehydration, heat and emotional stress but can be associated with acute glomerulonephritis, pyelonephritis, chronic renal disease, and congestive heart failure colorless, with varied morphology

hyaline cast

cellular casts containing erythrocytes associated diseases: a bleeding within the nephron, damage to glomerulus or renal capillaries as found in post-streptococcal infections following strenuous contact sports

RBC cast

cellular cast containing wbc associated diseases: infection or inflammation within the nephron primarily contain neutrophils thus appearing granular with multilobed nuclei

WBC cast

associated diseases: pyelonephritis bacilli contained within the cast and bound to the surface, mixed cast containing bacteria and wbcs may occur

bacterial cast

associated diseases: advanced renal tubular damage, seen in heavy metal, chemical, or drug toxicity, viral infections and allograft rejection contain RTE cells

epithelial cell cast

associated diseases: the granular appearance may result from glomerular precipitants such cellular casts or protein aggregates seen with hyaline casts following stress and exercise can be coarse or fine

granular casts

contains surface protein, granules adhere to the cast matrix, formed from degeneration of granular casts associated diseases: chronic renal failure with significant urine statis can have cracks or fissures on the sides

waxy cast

seen with oval fat bodies in disease states that result in lipiduria associated diseases: nephrotic syndrome, toxic tubular necrosis, dm highly refractile, contains yellow-brown fat droplets

fatty cast

identification of fatty cast is by sudan III stain or polarized light, which shows a characteristic ____

maltese cross formation

formed in the dct and cd due to anuria associated disease: suggests renal failure all types of casts can occur

broad cast

most common types of cast that can form a broad cast

granular cast waxy cast

not present in normal sterile urine associated with lower and upper UTI can be distinguished from amorphous crystals by their motility

bacteria

associated diseases when present in urine: UTI, vaginal infections, dm, and immunocompromised individuals can be confused with erythrocytes

yeast

protein substance produced by the RTE cells and the urogenital glands not considered clinically significant thread like structures with low refractive index, view under reduced light

mucus

most common parasite in the urine

trichomonas vaginalis

formed by the precipitation of urine salts, organic compounds and medications

crystals

all clinically significant crystals are in a ___ and ___ urine

acidic neutral

acidic urine crystals: formed from the urate salts of sodium, potassium, magnesium and calcium no clinical significance small, yellow to brown granules usually in large amounts, may make other urine elements will dissolve at alkaline pH or by heating above 60degC

amorphous urates

acidic urine crystals: seen in gout, with chemotherapy for leukemia, and in lesch-nyhan syndrome appear yellow to orange/brown but can be colorless pleomorphic shapes

uric acid

acidic urine crystals: found in such foods as tomatoes, asparagus, spinach, berries, and oranges metabolite of ascorbic acid

oxalic acid

acidic urine crystals: colorless, dehydrated for, appears as octahedral envelope or two pyramids, joined at their bases, monohydrate form appears as dumbbell or oval-shaped associated with renal calculi formation or ingestion of ethylene glycol

calcium oxalate

acidic urine crystals: abnormal crystals that are formed when urine bilirubin exceeds its solubility, and they appear as fine needles or granules that are yellow to brown in color most often seen in liver disease especially in viral hepatitis when there is renal tubular damage

bilirubin

acidic urine crystals: abnormal crystals that appear fine delicate needles, colorless to yellow, found in clumps or rosettes associated with severe liver disease and in inherited diseases that affect amino acid metabolism may be seen with leucine crystals in urine that tests positive for bilirubin

tyrosine

acidic urine crystals: abnormal crystals that appear yellow to brown, oily-looking spheres with concentric circles and radial striations, may be found with tyrosine crystals associated with severe liver disease and in inherited diseases that affect amino acid metabolism

leucine

acidic urine crystals: abnormal crystals that appear colorless, hexagonal plates result from congenital disorder that inhibits renal tubular reabsorption of cysteine other amino acids such as lysine, arginine and ornithine will also be present but they are more soluble so not visible associated with renal calculi formation

cystine

acidic urine crystals: abnormal crystals that appear clear, flat, rectangular plates with a notch in one or more corners more commonly seen following refrigeration seen with fatty casts and oval fat bodies associated with nephrotic syndrome and other disorders that produce lipiduria

cholesterol

acidic urine crystals: appear colorless in the form of needles sometimes may form bundles from medications

ampicillin crystals

acidic urine crystals: appear colorless to yellow-brown in the form of needles, sheaves of wheat, fan formation or rosettes from medications

sulfonamides crystals

acidic urine crystals: resemble cholesterol correlate with increased specific gravity > 1.050

radiographic dyes

alkaline urine crystals: identical in appearance to amorphous urates and generally colorless refrigerated samples appear as a white sediment soluble in acetic acid and will not dissolve when heated above 60 deg C not clinically significant

amorphous phospate

alkaline urine crystals: colorless, three-to-six sided prism often resembling a coffin lid not clinically significant, may be associated with UTI

triple phosphate ammonium magnesium phosphate

alkaline urine crystals: colorless, thin prisms or rectangular plates not clinically significant; may be associated with renal calculi formation

calcium phosphate

alkaline urine crystals: normal crystal commonly seen in old urine samples converts to uric acid crystals if acetic acid added and dissolves at 60 deg C yellow to brown with irregular thorny projections (thorny apples)

ammonium biurate

alkaline urine crystals: appear as small, colorless crystals having dumbbell or spherical shapes not clinically significant

calcium carbonate

presence of phenylalanine in the urine which indicates defective metabolic conversion of phenylalanine to tyrosine, which is caused by a gene failure to produce phenylalanine hydroxylase occurs in 1:10,000 births and if undetected will result in severe mental retardation mousy odor associated with phenylpyruvate because of increased ketones

phenylketonuria

conditions that cause tyrosinosis

transitory tyrosinemia premature infants with an underdeveloped liver acquired severe liver disease

tyrosinosis screening test: ___ confirmatory test: ___

nitrosonaphthol chromatography

genetic defect resulting in failure to produce homogentisic acid oxidase, which causes accumulation in blood and urine produces brown pigment deposits in body tissue that can lead to arthritis, liver, and cardiac problems

alkaptonuria

screening tests for alkaptonuria

ferric chloride tube test (blue) benedict's test (yellow) alkalinization of fresh urine (urine darkens)

indicates malignant melanoma produced from tyrosine hence urine darkens upon standing

melanuria

caused by low levels of branched-chained keto acid decarboxylase inhibits metabolism of leucine, isoleucine and valine if untreated causes severe mental retardation, convulsions, acidosis, and hypoglycemia

maple syrup urine disease

screening test for maple syrup urine disease

2,4-dinitrophenylhydrazine

arise from enterochromaffin cells of the GI tract produce increased blood serotonin, whose major urinary excretion product is 5-hydroxyindole acetic acid

argentaffinoma

this is used to detect argentaffinoma

1-nitrose-2-maphthol (purple)

CSF is made by the brain's ____ as an ultrafiltrate of plasma

third choroid plexus

supplies nutrients to nervous tissue, removes wastes and cushions the brain and spinal cord against trauma

CSF

how much CSF is produced each hour

20mL

total adult volume of CSF

140-170mL

total neonate volume of CSF

10-60mL

lumbar puncture is done where to collect CSF

3-4 or 4-5 lumbar vertebrae

CSF collection: tube#1

chemistry and serology (glucose, protein, antibodies)

CSF collection: tube#2

microbiology (culture and sensitivity)

CSF collection: tube#3

hematology

normal CSF fluid appearance

clear and colorless

cloudy CSF appearance indicates presence of WBCS, RBCs, protein or bacteria which are seen in these conditions

meningitis hemorrhage disorders of the blood brain barriers

causes of bloody CSF appearance

subarachnoid hemorrhage traumatic tap

xanthochromic CSF

increased hemoglobin, bilirubin, protein, immature liver in premature infants

CSF glucose

60-70% of the patient's plasma glucose

CSF total protein is assayed using this

trichloroacetic acid precipitation or Coomassie brilliant blue

normal CSF contains ___ WBCs/uL, and what cells do predominate

0-5 lymphocytes and monocytes

presence of PMNs in CSF may indicate this

bacterial meningitis (cerebral abscesses)

early cells forms in CSF can be associated with ___

acute leukemia

plasma cells in CSF can be associated with these conditions

multiple sclerosis lymphocytic reactions

used in microbiology testing of CSF to detect Cryptococcus neoformans, which is possible complication of AIDs

india ink

used in microbiology testing of CSF to detect bacteria

gram stain and culture

used to evaluate infertility, post-vasectomy and forensic medicine cases should be collected in sterile containers after 3-day period of no-sexual activity

seminal fluid

normal semen analysis volume: viscosity: appearance: pH: sperm count: motility: morphology:

volume: 2-5mL viscosity: no clumps or strings, liquefied after 30-60m appearance: translucent, gray-white color pH: 7.2-8.0 sperm count: 20-160 million/mL motility: 50-60% grade 2, motile with strong forward progression morphology: oval shaped head with a long, flagellar tail

plasma ultrafiltrate, joint fluid functions as a lubricant and nutrient transport to articular cartilage normal color is clear to straw colored

synovial fluid

most crystals found in synovial fluid are associated with what kind of deposits

uric acid (gout) calcium phosphate

gastric fluid collection is performed by ____ analysis involves physical appearance, volume, titratable acidity and pH for toxicology and for the diagnosis of Zollinger Ellison syndrome

gastric fluid

term for needle aspiration of amniotic fluid

amniocentesis

for genetic studies but may be used to check bilirubin, fetal bleeding, infection, fetal lung maturity or meconium content

amniotic fluid

level of phospholipids will ___ as the fetus lung mature

increase

clear or yellow fluid contained between the parietal and visceral membranes laboratory analysis includes cell counts, gram stains, gross color examination and specific gravity

peritoneal fluid

serous membrane that covers the walls of the abdomen and pelvis

peritoneum

aspiration of peritoneal fluid

peritoneocentesis or paracentesis

aspiration of pericardial fluid

pericardiocentesis

aspiration of pleural fluid

thoracentesis

increase in volume in peritoneal, pleural or pericardial fluids

effusion

if the mechanism for effusion is non-inflammatory fewer than 10,000 cells/uL and less than 3g/dL protein

transudate

inflammatory effusions higher than 1000 cells per uL and more than 3g/dL

exudate

used in the detection of GI bleeding, liver and biliary duct disorders, malabsorption syndromes and infections

fecal analysis

fecal analysis: black tarry stools

upper GI bleeding iron therapy

fecalysis: red stool

lower GI bleeding

fecal analysis: steatorrhea

fat malabsorption

fecal analysis: ribbon-like stools

bowel obstruction

fecal analysis: mucus

colitis

fecal analysis: clay-colored, pale stool

bile-duct obstruction/obstructive jaundice

suggestive of steatorrhea

>60 droplets/hpf

detects fat malabsorption disorders by staining fecal fats with ___ or ___

sudan III oil red

fecal analysis: undigested straited muscle fibers may indicate what condition

pancreatic insufficiency in cystic fibrosis

used for early detection of colorectal cancer (guaiac test)

occult blood

occult blood test: pseudoperoxidase activity of hemoglobin reacts with hydrogen peroxide to oxidize a colorless reagent to a colored product (blue)

orthotoluidine

occult blood test: least sensitive and most common

gum guaiac

occult blood test: use of an anti-hemoglobin to react with the patient's hemoglobin has the advantage of not requiring any special diet before sample collection

immunological

special fecal analysis: DNA test detects ___ which is associated with colorectal cancer

K-ras mutation