Lab Practical Flashcards
Epithelial Cells in Urine
Squamous
Transitional
Renal Tubular
Renal Tubular cells (RTEs)
olives
Small Cell, Big nucleus
Sq Epi Cells (SECs)
Apple Fritters
Big rigid shape
Transitional Epi Cells (TECs)
Donuts
Central Nucleus
Microscopic RBCs in Urine?
From any part of renal system
Large #s may indicate: Trauma, Tumors, Renal Calculi
Microscopic WBCs in Urine?
Pyuria
Suggest Infection, Cystitis, Pyelonephritis
Casts are formed where?
DCT and Collecting duct
Major component of casts?
Uromodulin
Hyaline Casts in urine?
Formed from protein gel in Renal tubule.
May contain cellular inclusions
Dissolve rapid in alkaline urine
Normal urine may have 1-2 per lpf.
Granular Casts in urine?
Casts W/ granules t/o matrix.
Quite refractile
Coarsely Granular Cast (Large Granules)
Small granules( fine granular cast).
Appear in normal and abnormal
RBC casts are?
Pathological
Indicates severe injury
RBC casts found in?
Acute glomerulonephritis
Lupus
Bacterial Endocarditis
Septicemias
RBC casts are granular containing?
Hgb from denatured RBCs
WBC Casts occur when?
WBCs are present in cast matrix
WBC Casts indicate?
Infection, most commonly Pyelonephritis.
Glomerular diseases
Epithelial Casts?
tubular damage, heavy metals, viral infections, drug toxicity, graft rejection, pyelonephritis
Formed in DCT
Fatty Casts?
Nephrotic Syndrome, Diabetes, Crush Injuries, Tubular necrosis
W/ OFBs and fat droplets
Highly refractile
Waxy Casts?
Brittle
Highly Refractile
Jagged edges, Notches
Dark pink
Renal Failure
Broad Casts?
Renal Failure casts
Destruction & widening of DCTs
Form in upper collecting duct
All types of casts can be broad.
Most common granular and waxy
Pathological Crystals found in Acidic Urine?
Uric acid crystals
Leucine/Tyrosine Crystals
Cystine Crystals
Cholesterol Crystals
Bilirubin Crystals
Uric Acid Crystals?
Chemo for Leukemia
Lesch-Nyhan Syndrome
Gout
Always polarize
“Whetstones”
Cystine Crystals?
Hexagonal plates
Cystine Crystals are seen in?
Genetic Defect
Cystinuria (Inability to reabsorb)
(Inborn error)
Homocystinuria
Confirm W/ Cyanide Nitroprusside
Cholesterol Crystals?
Notched corners of rectangular plates.
Highly birefringent- polarized
When do we see cholesterol crystals?
Refrigerated specimens
PTs W/ damage to their glomerular basement membrane.
Nephrotic Syndrome
Tyrosine Crystals?
Fine
Colorless-yellow needles
Clumps or Rosettes
Inherited Amino Acid disorder
Leucine Crystals?
Yellow-Brown spheres
Concentric Circles
Radial striations
Accompany Tyrosine crystals.
When do we see leucine/tyrosine crystals?
Together, usually in severe liver disease.
Bilirubin Crystals?
Clumped needles/granules
Yellow color
Bilirubin crystals are seen in?
Viral Hepatitis and tubular damage
Other pathological crystals?
Sulfonamide Crystals
Ampicillin Crystals
Sulfonamide Crystals?
Dehydration
Could cause tubular damage
Needles, sheaves of wheat
Colorless to yellow-brown
Ampicillin Crystals?
Colorless needles that form bundles following refrigeration.
Non-pathological Crystals in urine?
Amorphous Urates
Uric Acid (Can be pathological)
(Lesch-Nyhan Syndrome)
Acid Urates
Sodium Urates
Amorphous Urates?
Yellow-Brown granules
Sediment of urine pink due to pigment uroerythrin, attached to granules.
pH greater than 5.5
Calcium Oxalate Crystals?
Acidic or Neutral (N usually)
2 pyramid shape
Dumbbell shape
Major component of renal calculi
Sodium Urate Crystals?
Needle shape
Synovial fluid, during gout.
Appears in Urine
Non-pathological crystals in alkaline urine?
Amorphous Phosphates
Triple Phosphate
Calcium Phosphate
Calcium Carbonate
Ammonium Biurate
Amorphous Phosphates
Removed W/ acetic acid
Granular appearance
White precipitate after refrigeration
Triple Phosphate?
Colorless prisms, coffin lids.
Highly alkaline urine or UTIs
Urea splitting bacteria
Calcium Crystals?
Calcium Phosphate
Calcium Cabonate
Calcium phosphate?
Colorless, flat rectangles and thin prisms in rosettes.
Calcium Carbonate?
Small colorless dumbbell and spherical shaped.
Gas produced W/ addition of acetic acid.
Ammonium Biurate?
Yellow Brown Spicule covered Spheres.
Only urate in alkaline urine
Thorny Apples
Hippuric Acid crystals?
Colorless or pale yellow
Acidic
Needles, Six-sided prisms, star-shaped clusters.
After ingestion of certain veggies and fruits W/ benzoic acid.
Bacteria in urine?
Bacteriuria
Contamination
UTI
Yeast
Vary in size
Colorless ovoid
Seen in: Diabetes, Pregnancy, Obesity, Debilitating conditions.
Trichomonas Vaginalis
Flagellate protozoan
Males and females
Reagent Strip Tests?
pH
Protein
Glucose
Ketones
Blood
Bilirubin
Urobilinogen
Nitrate
Leukocytes
SG
QC is done on reagent strips when?
+/- @ beginning of shift.
New bottle of strips
Questionable results
Strip integrity concern
Clinical Significance of urine pH
Respiratory or metabolic acidosis/ketosis
Respiratory or metabolic alkalosis urine is alkaline
Renal calculi formation
Treatment of urinary tract infections
Precipitation/identification of crystals
High-protein diets=acidic urine
Low-protein diets=alkaline urine
A pH above 8.5 is associated with a specimen that has been preserved improperly and indicates that a fresh specimen should be obtained to ensure the validity of testing
pH reactions are what kind?
Double-indicator system reaction
Methyl Red =
4-6 red/orange to yellow
acidic
Bromothymol Blue =
6-9 green-blue
Alkaline
What protein is checked in a urine reagent stick reading?
Albumin
3 products of fat metabolism?
Acetone
Acetoacetic acid
B-hydroxybutyrate
% of fat metabolism of acetone?
2%
% of fat metabolism of Acetoacetic acid?
20%
% of fat metabolism of
B-hydroxybutyrate?
78%
Primary reagent of Ketones?
Sodium Nitroprusside
Primarily measured?
Acetoacetic acid
What test is used to confirm a questionable ketone test?
Acetest Tablet test
Hematuria?
Damage to renal system.
Hemoglobinuria
lysis of RBCs
Hemosiderin, yellow-brown granules in sediment.
Myoglobinuria
Heme containing protein in muscle tissue due Rhabdomyolysis (muscle destruction), clear, red/brown urine.
Muscular trauma
Bilirubin in urine is an early indicator of?
Liver Disease
Conjugated urine appears in the urine with?
Bile duct Obstruction- backs up, excreted in urine, No urobilinogen.
Liver disease or damage- Hepatitis, cirrhosis.
Principle of bilirubin reaction?
Diazo reaction
False-positive Bilirubin tests?
Urine pigment
Pyridium (Phenazopyridine)
Drugs
False-negative Bilirubin tests?
Old specimens
Ascorbic acid
Nitrite- bind W/ diazo salt, block bilirubin reaction
Ictotest Tablets
Confirm bilirubin
Ictotest table positive?
blue to purple color
Early detection of liver disease and hemolytic disorders?
Urine urobilinogen greater than 1 mg/dL.
Also, seen liver disorders, hepatitis, cirrhosis, carcinoma
Why do hemolytic disorders have increased urobilinogen?
Excess bilirubin converted to urobilinogen & increases urobilinogen to liver.
Common results in urine W/ hemolytic disorders?
Negative Bilirubin
Strong Positive Urobilinogen
Multistix Urobilinogen reaction?
Ehrlich’s Aldehyde reaction
Erlich Reagent gives us what color for positive?
Light to dark pink
Chemstrip urobilinogen reaction?
diazo (azo-coupling) reaction.
Color range for Chemstrip?
White to pink
Nitrite has a rapid screening test for the presence of what?
UTI
Reasons for Nitrite testing?
Cystitis (Initial bladder infection)
Pyelonephritis (Tubules)
Evaluation of ABX therapy
Monitor PTs @ high risk for UTI.
Confirmation of nitrite testing with?
Urine culture W/ leukocyte esterase.
Infections are commonly caused by?
GN organisms
Most common GN organisms causing UTIs?
E. coli
Proteus species
Enterobacter species
Klebsiella species
UTIs are more common in?
Women by 8x
Nitrite reaction is?
Greiss reaction
W/ diazonium salt forms pink azodye.
False negatives in nitrite?
High SG
High ascorbic acid level
Presence of ABX
Large #s of nitrite converting bacteria
Leukocyte Esterase?
detection of leukocytes.
Detects lysed WBCs
Microscopic if possitive
Increased WBCs indicate?
UTI
Also seen W/: Trichomonas, Chlamydia, Yeast, interstitial nephritis.
Positive leukocytes is what color?
Purple
Leukocyte esterase catalyzes?
Hydrolysis of acid esterase
False-positive Leukocyte esterase?
Strong oxidizers
Formalin
Highly pigmented urine
False-negative Leukocyte?
High concentrations of: Protein, Glucose, oxalic acid, ascorbic acid.
Presence of ABX
Crenation from high SG
SG
Bromothymol Blue measures pH change.
What color in SG is alkaline?
green.
What color in SG is acidic?
Yellow
Physical Exam consists of?
Color
Clarity
SG
Uroerythrin
pink pigment, attaches to amorphous urates in refrigerated specimens.
Urobilin
oxidation of urobilinogen, causing orange-brown color in older specimens.
Abnormal Urine colors?
Dark yellow/Amber/Orange
Red/pink/brown
Brown/Black
Blue/Green
Dark yellow and amber?
Normal=concentrated urine
Abnormal=bilirubin
Foamy when shaken due to bilirubin.
Increased bilirubin in urine indicates possible?
Viral hepatitis
Yellow-Orange color?
Photooxidation of large amounts of Urobilinogen.
No yellow foam when shaken.
Photooxidation of bilirubin to biliverdin causes what color?
yellow-green
Phenazopyridine causes?
Thick orange pigment
Brown color urine?
Oxidation of Hgb to methemoglobin.
A fresh brown urine specimen can indicate?
Glomerular bleeding
Myoglobin breakdown color?
Reddish-brown
Oxidation of porphobilinogen to porphyrias is?
Port Wine
Cloudy red urine?
RBCs
Clear red urine?
Hemoglobin
Melanin turns what color after sitting at room temp?
Black
Homogentisic Acid (Alkaptonuria) turns black in what pH of urine?
Alkaline
Blue, green, and purple in catheter bags is indicators of?
Bacterial infection
Clear clarity?
No visible particulates, transparent.
Hazy clarity?
Few particulates, print easily seen through urine.
Cloudy clarity?
Many particulates, print blurred
Turbid
Print not seen
Milky
Precipitate or clotted
Amorphous phosphates and carbonates cause what in alkaline urine?
White cloudiness
Refrigerated Specimens turn urates and carbonates what colors? (2 types of urates)
Amorphous phosphates-White
Carbonates- White
Amorphous Urates- Pink
Most common pathological turbidity cause?
RBCs, WBCs, Bacteria
Isosthenuric has SG of?
1.010 (Plasma ultrafiltrate)
Hyposthenuric SG is?
Lower than 1.010
Hypersthenuric
SG higher than 1.010
Normal SG range?
1.002-1.035
Most common normal range of SG?
1.015-1.025
Osmolality
the # of particles present.
SG
The # of particles present in a solution and the density of the particles.
The SG reagent strip reaction is based on?
Dissociation constant
Microscopic Exam procedure
Examination
1. Position the slide on the mechanical stage of the microscope.
2. Use the low power objective to get the field into focus.
3. Scan the slide under low power to get an “overall impression.” Then observe 10-15 low power fields, checking for casts and mucous threads.
4. Using high power, check another 10-15 fields for epithelial cells, red blood cells, white blood cells, crystals, sperm, bacteria, yeast, and parasites. Check with available pictures and diagrams to aid in identification.
5. Use the “Urinalysis Reporting Standardization Guide” to aid in quantitation and reporting of urine microscopic sediment.
Reporting of microscopic exam?
Color
Clarity
Quantifying microscopic elements
Quantifying Microscopic Elements?
- Find the name of the element in the far-left column.
- Note whether the element is counted using low power (10X/lpf) or high power (40X/hpf).
- Use the block of information under the “Enumerated As” to report the urine sediment.
Casts require special consideration; they are counted using 10X, but you may have to go to 40X to identify them.
What is a quick way to determine more than 200 RBCs/field?
Split the field into quarters.
Count 1 quarter.
Over 50 in that quarter, indicates over 200
