KLUBSY: URINARY CASTS Flashcards
1
Q
term for the presence of urinary casts
A
Cylindriuria
2
Q
These are the only elements found in the urinary sediment that are unique to the kidney
A
Casts
3
Q
The major constituent/mould/template/ matrix of cast is …
A
UROMODULIN
4
Q
Uromodulin is secreted by …
A
by the RTE cells
5
Q
The protein (uromodulin) gets more readily under conditions of what?
A
- urine-flow stasis
- acidity
- presence of sodium and calcium
6
Q
T/F: Uromodulin protein is found in both normal and abnormal urine
A
T.
7
Q
Casts are formed where?
A
- DCT
- Collecting duct
8
Q
T/F: Examination of casts should be performed along the edges of the cover slip
A
T.
9
Q
Cylindroids are formed at where?
A
Formed at the ALH and DCT with tapered end or have a tail at the other tail
10
Q
These have the same significance as casts (hyaline cast)
A
Cylindroids
11
Q
These are products of incomplete cast formation, or cast disintegration
A
Cylindroids
12
Q
Ranking of cast formation from LEAST significant to the MOST significant
A
Hyaline cast > cellular cast > coarse granular cast > fine granular cast > waxy cast > broad cast
13
Q
These conditions promotes the disintegration of casts in the urine sediment
A
Hypotonic and alkaline urine
14
Q
These factors enhance cast formation
A
- Acid pH
- increased solute concentration
- urine stasis
- increased plasma proteins (particularly albumin)
15
Q
Most frequently seen cast which consists almost entirely of uromodulin
A
Hyaline cast
16
Q
Pro-cast
A
hyaline cast
17
Q
What color do Hyaline casts produce in Sternheimer-Malbin stain and KOVA stain?
A
Pink color
18
Q
Normal value for hyaline casts
A
0-2/lpf
19
Q
Physiologic increase of hyaline casts in these conditions:
A
- strenuous exercise
- dehydration
- heat exposure
- emotional stress
20
Q
Pathologic increase of hyaline casts in these conditions:
A
- Acute glomerulonephritis
- pyelonephritis
- chronic renal disease
- congestive heart failure
21
Q
typw of cast seen during bleeding in the nephron, especially associated with glomerulonephritis
A
RBC cast
22
Q
RBC casts are easily detected under low power by their distinctive color …
A
orange-red color
23
Q
These are more fragile than other casts
A
RBC casts
24
Q
These may exist as fragments or have a more irregular shape as the result of tightly packed cells adhering to the protein matrix
A
RBC casts
25
These casts have also been observed in healthy individuals following a participation in strenuous contact sports
RBC casts
26
The appearance of this in the urine signifies infection or inflammation within the nephron
WBC casts
27
They are the most frequently associated with pyelonephritis and are a primary marker for distinguishing pyelonephritis (upper UTI) from Cystitis (lower UTI)
WBC casts
28
They are present in non-bacterial inflammation such as acute interstitial nephritis and may accompany RBC casts in glomerulonephritis
WBC cast
29
T/F: WBC casts are visible under low power magnification but must be positively identified using HIGH POWER
T.
30
Staining and the use of this microscope technique can be helpful to enhance the nuclear detail needed for differentiating WBC cast from Epithelial casts
the use of phase microscopy
31
Their presence should be considered when WBC casts and many free WBCs and bacteria are seen in the sediment
Bacterial casts
32
Confirmation of bacterial casts is best made how?
By performing a Gram stain on the dried or cytocentrifuged sediment
33
These are seen in conjunction with oval fat bodies and free fat droplets in disorders causing lipiduria
Fatty casts
34
These are most frequently associated with the nephrotic syndrome, but are also seen in toxic tubular necrosis, DM, and crush injuries
Fatty cast
35
Confirmation of fatty casts is performed by ...
by using POLARIZED MICROSCOPY and Sudan III or Oil Red O fat stains
36
These are frequently seen in the urinary sediment and may be of pathologic or non pathologic significance
Coarsely and finely granular casts
37
What is the origin of the granules in non-pathologic conditions?
from the lysosomes excreted by RTE cells during normal metabolism
38
Granular casts are easily visualized under what objective?
LPO
*However, final identification should be performed using HPO to determine the presence of a cast matrix
39
Pathologic increase of granular casts
Glomerulonephritis and pyelonephritis
40
Physiologic increase of granular casts
Strenuous exercise
41
These are representative of extreme urine stasis, indicating chronic renal failure
Waxy cast
42
They are brittle, and highly refractive compared to hyaline cast
waxy cast
43
they often appear fragmented with JAGGED ends and have notches in their sides
Waxy casts
44
With these kind of stains, waxy casts stain a homogenous, dark pink
SUPRAVITAL stains
45
With supravital stains, waxy casts stain what color?
homogenous, dark pink
46
T/F: Waxy casts are MORE EASILY visualized than hyaline casts because of their HIGHER refractive index
T.
47
Often referred to as renal failure casts
Broad cast
48
Broad casts are often referred to as...
renal failure casts
49
Thes emay result from tubular distension or, in the case of extreme urine stasis, from formation in the collecting ducts
Broad casts
50
The presence of broad casts indicated what?
Destruction (widening) of the tubular walls
51
T/F: ALL types of casts may occur in the broad form
T
52
Bile-stained broad, waxy casts are seen as the result of the tubular necrosis caused by what?
caused by viral hepatitis
53
Two most commonly seen broad casts:
1- granular
2- waxy
54
Granular, dirty, brown casts representing hemoglobin degradation products such as ??? may also be present
methemoglobin
55
They are associated with the acute tubular necrosis often caused by the toxic effects of massive hemoglobinuria
Granular dirty brown cast
56
These must be present in conjunction with other pathologic findings such as RTE cells and a positive rgnt strip test for blood
Granular dirty brown cast
57
These stains and techniques are helpful in delineating between epithelial and RTE casts
- Supravital staining
- phase-contrast microscopy
- Papanicolaou staining
58
What is the MOST reliable distinguishing characteristic of renal tubular cells?
their singular ROUND nuclei
59
These casts are associated with STRENUOUS EXERCISE/PHYSICAL ACTIVITY
- RBC casts
- Granular casts
- Hyaline casts
60
Cast look-a-likes: Mucus threads
can be misidentified as HYALINE CAST
61
Cast look-a-likes: Hyaline casts
Mucus threads
62
Cast look-a-likes: Waxy cast
Cotton threads or diaper fibers
63
Cast look-a-likes: Cotton threads or diaper fibers
Waxy cast
64
Sources of error: mucus, fibers, hair, increased lighting. What cast?
Hyaline cast
65
Sources of error: RBC clumps. What cast?
RBC cast
66
Sources of error: WBC clumps. What cast?
WBC casts
67
Sources of error: Granular casts. What cast?
Bacterial casts
68
Sources of error: WBC cast. What cast?
Epithelial / RTE casts
69
Sources of error: Artifacts such as clumps of small crystals, fecal debris, and columnar RTE cells. What cast?
Granular cast
70
Sources of error: Fibers and fecal material. What cast?
Waxy cast
71
Sources of error: Fecal debris. What cast?
Fatty cast
72
Sources of error: Fecal material, fibers. What cast?
Broad casts
73
Homogenous urinary casts:
-Hyaline
-waxy
74
Pigmented urinary casts:
-Bilirubin
-Myoglobin
- Hemoglobin
75
Broad casts are classified by ???
SIZE
76
Cellular inclusions:
- RBCs
- Leukocytes
- RTE cells
- Mixed cells
- Bacteria
77
How much of the urine sediment must be collected after decant in specimen prep?
0.5 to 1.0 mL
78
What is the recommended microscope technique for urine?
Brightfield - REDUCED LIGHTING
*reduced in order to observe sediments with a LOW REFRACTIVE INDEX
79
What is the purpose of stains?
for better visualization
80
the most commonly used stain in clinical microscopy for urine sediments
Sternheimer-Malbin
81
this stain can stain all sediments
Sternheimer-Malbin
82
Sternheimer-Malbin is a combination of what?
Crystal violet & safranin
83
what is the color of T. vaginalis using a KOVA or a Steinheimer Malbin?
Light blue-green / BLUE or GREEN
84
What is the color of the waxy cast whenever stained with Sternheimer-Malbin?
Pink
85
A simple stain used for staining the nucleus of the cell
a. KOVA
b. methylene blue
C. hansel
D. pak ganern
B. Methylene blue
*Hansel is a combination of Methylene blue + Eosin.
86
What kind of nucleus is present in RTE cells?
An eccentric nucleus
87
Stains H.pylori
0.5% Toluidine Blue
88
Stains mast cells and basophils
0.5% Toluidine Blue
89
Most sensitive stain for lipids
Sudan Black B
90
T/F: Cholesterol is a neutral fat
F.
NOT a neutral fat
91
Hansel stain is a combination of what?
Methylene Blue + Eosin Y
92
What value of eosinophils is considered as normal?
< 1%
93
What condition is associated with >1% eosinophils?
Interstitial nephritis
94
Computation of urinary eosinophil
(# of eosinophil / total WBC count) x 100
95
Compute:
Given: 10 eosinophil counted out of
100 WBCs counted
What is the value of urinary eosinophils?
10% (considered as significant since >1%)
(# of eosinophil / total WBC count) x 100
96
Used for confirmation of hemosiderinuria?
Prussian blue stain
97
A.k.a as Rous test
Prussian Blue stain
98
What stains can also distinguish urinary eosinophils in the absence of a Hansel stain?
Wright's stain or Giemsa stain
*but Hansel stain is PREFERRED
99
Stains the distinguish urinary eosinophils?
- Hansel stain
- Giemsa stain
- Wright's stain
100
What should be replaced in a bright field microscopy to make it dark-field?
replace the condenser
101
How to convert bright-field to phase contrast?
change the objective lens and condenser
102
what microscope will produce a halo of light?
phase contrast microscope
103
What sediments have a LOW REFRACTIVE INDEX?
- Casts (except for waxy casts since highly refractile)
- mucous threads
- Trichomonas
104
Microscope used for HIGHLY REFRACTILE SEDIMENTS?
Polarizing microscopy
105
Microscope used to identify positive birefringence
Polarizing microscopy
106
What is the direction for a POSITIVE BIREFRINGENCE?
Clockwise direction
*pag KUMONTRA ka, NEGATIBO ka
107
What is the direction of a NEGATIVE BIREFRINGENCE?
Counterclockwise
*pag KUMONTRA ka, NEGATIBO ka
108
What must be incorporated to convert a brightfield microscopy into a polarizing microscope?
install 2 polarizing filters in a CROSSED configugration (magkasalungat yung dalawang polarizied filters)
109
what microscope is used to identify Treponema pallidum?
Dark field microscope
110
For identification of T. pallidum, what is the preferred microscope?
Dark field
111
For identification of T. pallidum, what is an alternative microscope in the absence of dark field microscope?
Phase contrast OR fluoresence micrscope
112
What type of prism is incorporated to convert bright-field to differential interference contract microscopy?
WOLLASTON PRISM
113
What type of microscope if the Hoffman and Normaski?
Ineterference contrast
*2nd answer: Brightfield microscope
114
what stains are used in fluorescence microscopy?
Fluorescent dyes/Fluorochrome/Fluorophores
115
How many filters is incorporated to modify the brightfield microscope into a fluorscence microscope?
2 filters
116
What are the 3 groups in the PARTS OF A MICROSCOPE?
- Lens system
- Illumination system
- Body
117
What are the parts of a microscope in the LENS system?
- Oculars
- Objectives
- Adjustment knobs
*"OOA"
118
What are the parts of a microscope in the ILLUMINATION system?
- Condenser
- Light source
- Stage field
- Iris diaphragm
*"CLSI"
119
What are the parts of a microscope in the BODY system?
- Base
- Body tube
- Nose piece
*"BBN"
120
What color is the LPO?
Yellow
121
What color is the HPO?
Blue
122
What color is the OIO?
White
123
Which of the ff. can be used to clean the lens of the microscope?
a. lens paper
b. xylene
c. cotton dipped in soap with water
d. aota
A. lens paper
124
What is the purpose of xylene in cleaning the microscope?
to remove the oil in OIO
*but using xylene is no longer recommended since it destroys the adhesive that holds the lens and is toxic
125
What is used to clean the lens of a microscope?
1 - lens paper
2 - commercial cleaning lens solution
3- alcohol-based solution
126
what is used to remove dust particles in the microscope?
camel hair brush
127
If the urine is hypotonic, what is the appearance of RBCs?
swOOOOOOOOOOllen
*hypOOOOOOtonic = swOOOOOOllen
128
If the urine is hypertonic, what is the appearance of RBCs?
cRRRRRRRRenated
*hypeRRRRRRRRtonic = cRRRRRRenated or echinocytes
129
If patient has glomerular disorders, what is the appearance of RBCs in the urine?
Dysmorphic RBCs (acanthocytes)
130
This is known as the hour-glass shaped crystal
Monohydrate calcium oxalate crystals
131
What protein is unique to the kidney?
Uromodulin
132
This can confirm diseases of renal origin
Casts
133
This sediment is unique to the kidney
Casts
134
These are casts with tapered end or have a tail at the other tail
Cylindroids
135
Cylindroids are formed where?
ALH and DCT
136
These casts are present in chronic kidney disorders
- waxy cast
- broad cast
137
these casts are present in acute kidney disorders
- Hyaline cast
- cellular cast
- Coarse granular cast
- fine granular cast
138
The presence of waxy casts or broad casts is indicative of what?
Chronic kidney disorders
139
The presence of hyaline casts, cellular casts, coarse granular casts, or fine granular casts is indicative of what disorders?
Acute chronic disorders
140
These kidney disorders are progressive and irreversible
Chronic kidney disorders
141
All casts should be reported how?
as lpf
142
This specific type of cast confirms the presence of infections from renal origin
WBC casts
143
T/F: Upper UTI = (+) cast
T
144
T/F: Lower UTI = (+) casts
F.
negative for casts
145
Urinary casts seen in cases of strenuous exercise/physical activity
- hyaline casts
- granular casts
- RBC casts
146
This is formed when there is urinary stasis
waxy casts
147
This is misidentified as hyaline casts
waxy casts
148
What is the color of waxy casts when stained?
PINK
*same with hyaline casts
149
What tests should be performed to differentiate RTE cast vs WBC casts?
1-supravital staining (Toluidine blue)
2- phase contrast microscope
3- Papanicolaou staining
150
Cylindroids have the same significance as what casts?
Hyaline casts
151
