M4: U1 Microscopic Examination of Urine Flashcards by sheyn grayz

specialized centrifuge procedure that produces monolayer of cellular constituents

cytocentrifugation

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chemical reaction used to identify presence of iron in body fluids

Rous/ Prussian Blue

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glycoprotein produced in the renal tubular cell of the thick ascending loop of henle and DCT

Tamm-Horsfall protein or uromodulin

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cellular pellet after urine centrifugation, normally free of crystals, contain less cells and low protein concentration

urinary sediment

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ability of a substance to refract light in 2 directions

birefringence/double refractile

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ability to remain in focus when switching to a different objective

parfocal

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standardized quantitation of formed elements using hemocytometer

addis count

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ideal specimen for sediment preparation

first morning urine, midstream clean catch

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elements that disintegrate in alkaline urine

WBC
RBC
hyaline casts

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Specimen volume for routine urinalysis

30 - 50 mL

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specimen volume for sediment preparation

10 to 15 mL or 12 mL

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minimum specimen volume accepeted for pediatric

6 mL

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volume when sediment preparation is counterindicated

3 ml

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centrifugation conditions for sediment preparation

400-450 x g for 5 mins

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formula of concentration factor

urine volume / sediment volume

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acceptable routine concentration factor

20-30

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probability of detecting elements present in low quantities

concentration factor

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routine volume of sediment examined

20 uL in 22x22 coverslip

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RBC appearance in hypertonic urine

crenated (with spicules)

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hypotonic or alkaline urine

swell, ghost cells (released hemoglobin)

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dysmorphic cells indicate

glomerular origin

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RBC with casts and protein indicate

glomerular or tubular bleeding

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RBC without casts or proteins

below kidney contamination, menstruation/hemorrhoids/drugs

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positive RBC in chemical tests but not microscopic indicate

hypotonic/alkaline
myoglobin/oxidizing agents
lysis w/in urinary tract

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positive RBC in microscopic but negative in chemical tests

lookalike or false negative due to ascorbic acid

stains RBC but not yeast and calcium oxalate

Sternheimer Malbin stain

negative in RBC but positive in calcium oxalate

light polarization

lyses RBC but not calcium oxalate and yeast

2% acetic acid

differentiates RBC from WBC through crenation

2% acetic acid and toluidine blue

lyse rapidly and leaves 50% within 2-3 hrs in dilute, hypotonic, alkaline urine

neutrophils

neutrophils with brownian movement of refractile cytoplasmic granules

glitter cells

indicates disintegration of neutrophils

fusion of nuclei and bleb formation (vacuoles in cell preiphery)

indicates degeneration of neutrophils in stained preparation

psudopod formation forming myelin forms

primary stain for eosinophils

HANSEL

high lymphocyte count indicates

renal transplant rejection

high eosinoohil count indicates

drug induced interstitial nephritis

leukocyte esterase and nitrite positive indicates

bacteuria

LE positive but microscopic WBC negative

WBC lysis/disintegration

microspic WBC positive but LE negative

look alike elements (RTE) below <10-25 WBC/uL diluted urine

differentiation of WBC vs RTE

supravital stains Wright/Pap stains acetic acid

largest epithelial cell found in urine

squamous epithelial cell

distinct characteristics of squamous epithelial cell

central nucleus (size of RBC) but can be anucleated or multinucleated thin, flagstone shaped can be folded or curled over

indication of degeneration of squamous epithelial cell

keratohyaline granules

squamous epithelial cell is normally high in:

women and uncircumcised men

origin of squamous epithelial cell

entire urethra of women distal portion of male urethra

this is a squamous epithelial cell covered with bacteria

clue cell

clue cells are covered with what specific type of bacteria

Gardnerella vaginalis

T/F : clue cells are reported in routine urinalysis

False, physician must request vaginal secretion analysis

what distinguishes transitional epithelial cell/ urothelial cells from other epithlial cells

centrally located nuclei appears in spherical, polyhedral or caudate form due to ability to absorb large amounts of water finely granular (as opposed to RTEC)

3 layers of transitional epithelium

superficial intermediate basal

most prevalent TEC, round or pear shaped

superficial

smaller TEC, round form

intermediate

columnar form of TEC

basal

TECs which may indiacte UTI and invasive urologic procedures

syncytia

most clinically signifcant epithelial cell

renal tubular epithelial cell

two origins of renal tubular epithelial cell

convoluted tubular cells collecting duct cells

two types of convoluted tubular cells

proximal distal

cigar shaped with granular cytoplasm and eccentric concoluted tubular cell

proximal convoluted tubule

has fat globules

proximal CT

smaller round convoluted tubule with eccentric nucleus

distal CT

2 types of collecting duct cells

small duct cells large duct cells

polyhedral/ cuboidal with single/large nuclei that occupies 60 to 70% of the cell

small duct cell

polyhedral/ cuboidal with single/large nuclei that occupies 60 to 70% of the cell

small columnar duct cell with eccentric nucleus

large duct cell

largest RTEC

proximal CT

smallest RTEC

large duct cells

deep yellow RTEC indicates absorption of

bilirubin

RTEC that absorbs hemoglobin

hemosiderin

yellow brown hemosiderin granukes is indicative of

PNH transfusion reactions

RTE cells/monocytes/ macrophages that absorbed lipids/fats in the glomerular filtrate

oval fat bodies

non lipod filled vacuoles

bubble cells

lipiduria is indiicative of

nephrotic syndrome acute tubular necrosis DM trauma

stains triglycerides nd neutral fats orange red

oil red O Sudan III

maltese cross in polarized microscopy

cholesterol

used to identify birefringent substances

polarized microscopy

used to visualize variations in refractive index for low refractile elements

phase contrast microscopy

light polarization: RBC

light polarization: uric acid crystals

Yes

light polarization: CASTS

light polarization: monohydrate calcium oxalate

YES

light polarization: MUCUS

light polarization: FIBER

YES

light polarization: BACTERIA

light polarization: PLASTIC FRAGMENTS

YES

light polarization: CELULAR DEBRIS

light polarization: AMOORPHOUS URATE

strong

light polarization: AMORPHOUS PHOSPHATE

WEAK

light polarization: MEMBRANE PHOSPHOLIPIDS

light polarization: FATTY CASTS

YES

light polarization: CHOLESTEROL GLOBULES

YES

light polarization: STARCH GRANULES

YES

used for Spirochetes Treponema pallidum

darkfield microscopy