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AUBF Lecture > Lesson 4.1: Urinary Sediments - Cells/Casts/Parasites > Flashcards

Lesson 4.1: Urinary Sediments - Cells/Casts/Parasites Flashcards

1
Q

3 primary Formed Elements

A

RBCs
WBCs
Hyaline casts

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2
Q

Formed elements disintegrate rapidly in dilute _________ urine

A

alkaline

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3
Q

What may cause precipitation of amorphous urates and phosphates?

A

Refrigeration

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4
Q

What specimen collection procedure for urine minimizes external contamination of sediment?

A

Clean-catch midstream

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5
Q

False positive or False Negative

Dilute random specimens

A

False-negative

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5
Q

Technical Tip: Warm refrigerated urine specimens to 37C before centrifuging to dissolve amorphous urate crystals

A

Okay! Thanks gid!

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6
Q

For specimen volume, what is the standard amount of urine

A

10-15mL

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7
Q

In a urine specimen volume, how much is usually used?

A

12-mL

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8
Q

Centrifugation for __ minutes at a relative centrifugal force (RCF) of ____ produces an optimum amount of sediment with the least chance of damaging the elements

A

5 minutes
400 RCF

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8
Q

A uniform amount of urine and sediment should remain in the tube after decantation, a volume of ___ and ___ are frequently used

A

0.5 mL and 1.0 mL

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9
Q

Technical Tip: Commercial Systems are available that have tubes designed for decanting and provide a constant volume for suspension

A

Yehey! Esnupi!

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9
Q

Technical Tip: Recheck urine specimens for both technical and clerical errors in which the physical, chemical, and microscopic results do not correlate

A

WOW!

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10
Q

These sediment is usually present to provide a “Point-of-Reference”

A

Epithelial Cells

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11
Q

Volume of Sediment Examined

When using the conventional glass-slide method, the recommended volume is ___ covered by a 22 x 22 mm glass cover slip

A

20uL (0.02mL)

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11
Q

Microscopic examination should be performed in a consistent manner and include observation of a minimum of ___ fields under both low (10x) and high (40x) power

A

10 fields

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12
Q

Technical Tip: Use reduced light when bright-field and phase-contrast microscopy at both LPF (10x) and HPF (40x) magnifications are used for sediment examination

A

Thank you for the information, Strasinger!

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13
Q

Normal values for Addis Count

A

0 to 500,000 RBCs
0 to 1,800,000 WBCs and Epithelial Cells
0 to 5000 Hyaline casts

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13
Q

An example of a sediment element that has a refractive index very similar to urine

A

Hyaline casts

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14
Q

It is the first procedure to standardize the quantitation of formed elements in urine microscopic analysis

A

Addis Count

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15
Q

Urine Sediment Stain Characteristics

Action: Delineates structure and contrasting
colors of the nucleus and cytoplasm
Function: Identifies WBCs, epithelial cells, and casts

A

Sternheimer-Malbin Stain

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16
Q

Urine Sediment Stain Characteristics

Action: Enhances nuclear detail
Function: Differentiates WBCs from RTE cells

A

Toluidine blue

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17
Q

Urine Sediment Stain Characteristics

Action: Lyses RBCs and enhances nuclei of
WBCs
Function: Distinguishes RBCs from WBCs, yeast, oil droplets, and crystals

A

2% acetic acid

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18
Q

Urine Sediment Stain Characteristics

Action: Stain triglycerides and neutral fats orange-red; do not stain cholesterol
Function: Identify free fat droplets and lipid containing cells and casts

A

Lipid stains: Oil Red O and Sudan III

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19
Q

Urine Sediment Stain Characteristics

Action: Stains structures containing iron
Function: Identifies yellow-brown granules of hemosiderin in cells and casts

A

Prussian blue stain

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19
Q

Urine Sediment Stain Characteristics

Action: Methylene blue and eosin Y stains eosinophilic granules
Function: Identifies urinary eosinophils

A

Hansel stain

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20
Q

Sternheimer-Malbin stain consists of?

A

Crystal violet and Safranin O

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20
Q

This stain lyses RBCs but also enhances nuclear detail of WBCs and Epithelial cells

A

2% acetic acid (1 or 2 drops)

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20
Q

Urine Sediment Stain Characteristics

Action: Differentiates gram-positive and gram-negative bacteria
Function: Identifies bacterial casts

A

Gram stain

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21
Q

This is a Supravital Stain that is the most frequently used stain in urinalysis

A

Sternheimer-Malbin stain

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21
Q

Bacterial casts are easily confused with what cast?

A

Granular casts

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21
Q

Commercial names of Sternheimer-Malbin stain (2)

A

Sedi-Stain
KOVA

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22
Q

It is a metachromatic stain that provides enhancement of nuclear detail and can be useful in the differentiation between WBCs and RTE cells

A

0.5% solution of Toluidine blue

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22
Q

Hansel stain consists of?

A

Methylene blue
Eosin Y in methanol

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22
Q

What microscope is used to check for Cholesterol?

A

Polarizing microscopy

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23
Q

When using a stain for Triglycerides and Neutral Fats, it results in what color?

A

Orange-red

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24
Q

Preferred stain used for urinary “Eosinophils”

A

Hansel stain

Note: Wright’s stain and Giemsa stain can also be used

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24
Q

Eosinophiluria are usually found in cases of?

A

Renal transplant rejection
Pyelonephritis
Prostatitis
Cystitis

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24
Q

It is the most common type of microscopy performed in the urinalysis laboratory

A

Bright-Field microscopy

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25
Q

After episodes of hemoglobinuria, yellow-brown granules may be seen in RTE cells and casts or free-floating in the urine sediment

To confirm them as hemosiderin, what stain is used?

A

Prussian blue stain for iron

Note: It stains the hemosiderin granules a blue color

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26
Q

Light source, condenser, and field and iris diaphragms are part of what system?

A

Illumination system

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26
Q

Technical Tip: Use supravital stains to enhance the nuclei, cytoplasm, and cellular inclusions to aid in the identification of urine components

A

Sheesh!

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27
Q

Oculars, objectives, and coarse- and fine-adjustment knobs are part of the system?

A

Lens System

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28
Q

Enhances visualization of elements with “Low Refractive Indices”

Ex. hyaline casts, mixed cellular casts, mucous threads, and Trichomonas vaginalis

A

Phase-contrast microscopy

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29
Q

Aids in identification of cholesterol in oval fat bodies, fatty casts, and crystals

A microscopic technique

A

Polarizing microscopy

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30
Q

In what type of urine do RBCs shrink due to loss of water and may appear “crenated” or irregularly shaped

A

Hypersthenuria / concentrated

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30
Q

Produces a three-dimensional microscopy image and layer-by-layer imaging of a specimen

A

Interference-contrast

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30
Q

It is the ability of the lens to distinguish two small objects that are a specific distance apart

A

Resolution

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30
Q

Allows visualization of naturally fluorescent microorganisms or those stained by a fluorescent dye, including labeled antigens and antibodies

A

Fluorescence microscopy

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30
Q

Aids in identification of Treponema pallidum

A

Dark-field microscopy

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31
Q

In what type of urine do RBCs swell because they absorb water and lyse rapidly, releasing their hemoglobin and leaving only the cell membrane?

A

Hyposthenuria / diluted

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31
Q

When RBCs lyse, they are indicated as large empty cells and can be missed easily if specimens are not examined under reduced light, they are called as?

A

Ghost cells

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32
Q

What is the most difficult urine sediment to identify?

A

RBCs

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33
Q

Technical Tip: RBCs, particularly dysmorphic RBCs, are differentiated from yeast, which show budding, and from oil droplets and air bubbles, which are highly refractile, when the fine adjustment is focused up and down. They may appear in a different plane than other sediment constituents

A

Yessir!

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34
Q

Glomerular bleeding is usually associated with what type of RBCs?

A

Dysmorphic RBCs

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35
Q

What dysmorphic RBC is associated most closely with glomerular bleeding?

A

Acanthocytes

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35
Q

Microscopic vs Macroscopic Hematuria

A

Microscopic: >100 per hpf
Macroscopic: Urine is cloudy with a red to brown color

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36
Q

They are referred to as glitter cells because granules within these larger cells perform a Brownian movement that produces a sparkling appearance

A

Neutrophils

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37
Q

True or False

Glitter cells are of no pathologic significance

A

True

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37
Q

When WBCs are stained with Sternheimer-Malbin stain, they exhibit what color?

A

Light blue

37
Q

Technical Tip: Use a supravital stain to differentiate mononuclear cells and disintegrating neutrophils from RTE cells, which are usually larger than WBCs and have an eccentrically located nucleus

A

LEZGO!

38
Q

What percent of eosinophils found in urine is considered as significant?

A

more than 1%

38
Q

Their presence is associated with drug-induced interstitial nephritis (acute interstitial nephritis = AIN)

A

Eosinophils

38
Q

Primary concern in the identification of WBCs is the differentiation of mononuclear cells and disintegrating neutrophils from?

A

RTE Cells

38
Q

Because they are the smallest WBCs, they may resemble RBCs

A

Lymphocytes

38
Q

True or False

<5 WBCs per hpf are found in normal urine

A

True

39
Q

Nucleus of RTE cells are located where?

A

eccentrically located

39
Q

These are derived from the linings of the genitourinary system

A

Epithelial cells

40
Q

An increase in urinary WBCs is called _______ and indicates the presence of an infection or inflammation in the genitourinary system

A

Pyuria

40
Q

Differentiate the cause of Pyuria(increased urinary WBCs) if Bacterial or Non-Bacterial

Pyelonephritis
Prostatitis
Glomerulonephritis
Lupus erythematosus
Interstitial nephritis
Tumors
Cystitis
Urethritis

A

Bacterial:
- Pyelonephritis
- Prostatitis
- Cystitis
- Urethritis

Non-Bacteria
- Glomerulonephritis
- Lupus erythematosus
- Tumors
- Interstitial nephritis

41
Q

They represent normal sloughing of old cells and are classified as squamous, transitional (urothelial), and renal tubular

A

Epithelial cells

42
Q

They are the largest cells found in the urine sediment

A

Squamous Epithelial Cells

42
Q

Identify the cell

Abundant, irregular cytoplasm
Prominent nucleus about the size of RBC

A

Squamous Epithelial Cells

43
Q

These originate from the linings of the vagina and female urethra and the lower portion of the male urethra

A

Squamous Epithelial cells

43
Q

Technical Tip: Epithelial cells can be misidentified when they are folded and look like a cast or when they begin to disintegrate in urine that is not fresh

A

Salamat po sa impormasyon!

44
Q

Transitional cells are identified and enumerated using what magnification?

A

Hpf

44
Q

A variation of the squamous epithelial cell which DOES have a pathological significance

A

Clue cells

44
Q

Clue cells are indicative of vaginal infection by the bacterium __________.

They appear as squamous epithelial cells covered with __________

A

Gardnerella vaginalis

Gardnerella coccobacillus

45
Q

They are smaller than squamous epithelial cells and appear as:

spherical
polyhedral
caudate

A

Transitional Epithelial (Urothelial) Cells

45
Q

To be considered a clue cell, the bacteria should cover most of the cell surface by how many percent?

A

70%

45
Q

They originate from the lining of the renal pelvis, calyces, ureters, and bladder and from the UPPER PORTION of the male urethra

A

Transitional epithelial cells

46
Q

Why are spherical transitional cells much larger than polyhedral and caudate cells?

A

Because spherical cells have direct contact with the urine and absorb more water, thus making them larger.

46
Q

Nucleus of transitional cells are located where?

A

Centrally located

47
Q

Increased number of transitional cells seen in clumps are termed as?

A

Syncytia

48
Q

True or False

RTE cells vary in size and shape depending on the area of the renal tubules from which they originate

A

True

49
Q

Differentiate the 3 different RTE Cells

From PCT:
From DCT:
From collecting ducts:

A

PCT: Largest, rectangular shape, referred to as “columnar” or “convoluted cells”

DCT: Smaller than PCT cells, round or oval shape

Collecting Duct: cuboidal shape, never round

49
Q

True or False

RTE cells from the PCT are larger than other RTE cells

A

True

49
Q

RTE cells often are present as a result of _________

A

necrosis (tissue destruction)

50
Q

RTE cells from the collecting duct that appear in groups of 3 or more are called as?

A

Renal fragments

51
Q

How many RTE cells per hpf would indicate that there is Tubular injury?

A

more than 2 RTE cells

52
Q

What viral infection and bacterial infection causes necrosis of the renal tubules?

A

Viral: Hepatitis B
Bacterial: Pyelonephritis

52
Q

This is a parasite with:

pear-shaped flagellate
undulating membrane
rapid darting movement

A

Trichomonas trophozoite

52
Q

What type of RTE cells are particularly noticeable in cases of salicylate poisoning?

A

Cuboidal cells (Collecting ducts)

52
Q

What microscopic technique is used to aid in the visualization of bacteria?

A

Phase-contrast microscopy

52
Q

True or False

Salicylate poisoning causes necrosis of the tubules

A

True

53
Q

These are the most clinically significant of the epithelial cells

A

RTE cells

53
Q

To be considered as significant for UTI, bacteria should be accompanied by?

A

WBCs

54
Q

RTE cells appear “deep yellow” in cases of liver damage from viral hepatitis.

They absorb what substance in the filtrate that gives them a deep-yellow color?

A

Bilirubin

54
Q

Why is it not unusual for RTE cells to contain substances from the filtrate?

A

Because one of the functions of RTE cells is the reabsorption of glomerular filtrate

54
Q

These gram-positive bacteria are also capable of causing UTI

A

Staphylococcus
Enterococcus

54
Q

What yeast cells are primarily seen in the urine of patients who are either diabetic or immunocompromised, as well as in women with vaginal moniliasis?

A

Candida albicans

55
Q

Technical Tip: Check urine sediments that are negative for fat after staining using polarized light to observe the Maltese cross formation, which occurs when only cholesterol is present.

A

Hatdog!

55
Q

It is associated most frequently with damage to the glomerulus caused by nephrotic syndrome

A

Lipiduria

55
Q

True or False

Lipiduria is also seen with severe tubular necrosis, Diabete mellitus, and in trauma cases that cause release of bone marrow fat from the long bones

A

True

55
Q

They appear to represent injured cells in which the endoplasmic reticulum has dilated before cell death in cases of Acute Tubular Necrosis

RTE cells containing large, nonlipid-filled vacuoles

A

Bubble cells

56
Q

The most common parasite ova contaminant is from?

A

Enterobius vermicularis

56
Q

The bacteria associated with UTI most frequently are the?

A

Enterobacteriaceae (gram-negative rod)

57
Q

Technical Tip: Phase Microscopy is used to differentiate Trichomonas from WBC, transitional, and RTE cells

A

Kendrick > Drake

57
Q

The parasite encountered most frequently in the urine is?

A

Trichomonas vaginalis

58
Q

They are easily identified in the urine sediment by their:

Oval
Slightly tapered heads
Long, flagella-like tails

A

Sperematozoa

59
Q

A positive reagent strip test for _____ may be seen when increased amounts of semen are present

A

Protein

59
Q

It is a protein material produced by the glands and epithelial cells of the lower genitourinary tract and the RTE cells

A

Mucus

59
Q

Most frequently seen cast, which consists almost entirely of uromodulin

A

Hyaline Casts

60
Q

Immunologic analysis has shown that _________ is a major constituent of mucus

A

uromodulin

60
Q

Technical Tip: Mucous threads have irregular ends that help to distinguish clumps of mucus with hyaline casts

A

WRAHHHHHHHHH!

61
Q

Major constituent of casts

A

Uromodulin

61
Q

The presence of urinary casts is termed as?

A

Cylindruria

61
Q

It is a glycoprotein excreted by the RTE cells of the thick ascending loop of henle and by DCT

A

uromodulin

62
Q

It appears microscopically as “thread-like” structures with a low-refractive index that is why subdued light is required when using bright-field microscopy

A

Mucus

62
Q

These are the only elements found in the urinary sediment that are unique to the kidney

A

Casts

63
Q

Casts formed at the junction of the ALH and DCT produce structures with a “tapered end” called as?

A

cylindroids

63
Q

These casts may result from tubular distension or in the case of extreme urine stasis, from formation in the collecting ducts

A

Broad casts

63
Q

RBC casts are associated primarily with damage to the __________ that allows passage of the cells through the glomerular membrane

A

glomerulus (glomerulonephritis)

63
Q

Sternheimer-Malbin stain produces what color in Hyaline casts?

A

Pink

63
Q

Technical Tip: Use a lower light when using bright-field microscopy to identify hyaline casts because the matrix of the cast has a low refractive index, which can cause hyaline casts to be missed

A

WOWST!

64
Q

True or False

Any damage to the nephron capillary structure can cause their formation

A

True

65
Q

Technical Tip: RBCs in the urine sediment and a positive reagent strip test for blood, as well as intact RBCs in the cast matrix, must be present to identify a RBC cast

A

SHEEEEEESH

65
Q

WBC casts are associated most frequently with what upper UTI?

A

Pyelonephritis

66
Q

This is a primary marker for distinguishing pyelonephritis (upper UTI) from cystitis (lower UTI)

A

WBC casts

67
Q

WBC casts are also present in nonbacterial inflammations such as ___________ and may accompany RBC casts in _________

A

acute interstitial nephritis

glomerulonephritis

67
Q

Bacterial casts containing bacilli both within and bound to the protein matrix are seen in _________

A

pyelonephritis

68
Q

Technical Tip: The presence of a WBC cast is diagnostic for pyelonephritis and would not be present in cystitis

A

They not like us!

68
Q

Technical Tip: Free-floating WBCs must be in the urine sediment and well-defined WBCs present in the cast to classify a WBC cast

A

Grabeeeeee!

69
Q

Bilirubin-stained RTE cells are seen in cases of?

A

Hepatitis or Liver damage

70
Q

Fatty casts are associated most frequently with what disease?

A

Nephrotic syndrome

71
Q

Mixed cellular cast mostly encountered in pyelonephritis

A

WBC and RTE casts

or

WBC and Bacterial casts

71
Q

Fatty casts, aside from nephrotic syndrome, can also be seen in?

A

Toxic tubular necrosis
Diabetes mellitus
Crush injuries

72
Q

True or False

Fats can be stained with Sternheimer-Malbin stains (Supravital stains)

A

False, it can only be stained with Oil Red O or Sudan III or by polarized microscopy

72
Q

Technical Tip: A hyaline cast with a few granules within the matrix does not constitute a granular cast

A

STRASINGER WRAH!!!!!!

73
Q

Mixed cellular casts encountered most frequently in glomerulonephritis are?

A

RBC and WBC casts

74
Q

The origin of the granules in casts (granular casts) in nonpathological conditions appear to be from the ________ excreted by RTE cells during normal metabolism

A

lysosomes

75
Q

These are representative of extreme urine stasis, indicating chronic renal failure usually seen in in conjunction with other types of casts associated with conditions caused by renal failure, such as hyaline, granular, and cellular

A

Waxy Casts

75
Q

These casts are formed from the disintegration or degeneration of the hyaline cast matrix or granules from the matrix

A

Waxy casts

76
Q

With supravital stain, like in the KOVA stain, the waxy cast shows what color?

A

Dark Pink

77
Q

They are often referred to as “RENAL FAILURE CASTS”

A

Broad Casts

77
Q

What are the 2 casts that represent extreme urine stasis?

A

Broad casts and Waxy casts

AUBF Lecture (7 decks)

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