M4:U2 Urinary Casts Flashcards
1
Q
Casts are formed in
A
distal CT and collecting ducts
2
Q
core matrix of casts
A
Tamm Horsfall protein
3
Q
Tamm Horsfall protein origin
A
thick ascending loop of henle
4
Q
presence of casts in urine
A
cylindruria
5
Q
cast are always renal in origin, therefore they are indicators of
A
intrinsic renal disease
6
Q
4 factors onvolved in urinary xast formation
A
- urinary stasis
- urine acidity
- high solute concentration
- presence of materials
7
Q
causes enhancement of protein gelation and solute precipitation
A
urine acidity
8
Q
casts that are well formed on one end and tapered on one end
A
cylindroids
9
Q
three reasons fro cylindroid formation
A
incomplete cast formation
lumen width differs
casy disintegration
10
Q
most common type of cylindroid
A
hyaline cast
11
Q
rare type of cylindroid
A
fine granukar cast
12
Q
2 major classifications of casts
A
- casts with homogenous matrix
- casts with cellular inclusions
- casts with inclusions
13
Q
2 types of casts with homogenous matrix
A
- hyaline casts
- waxy casts
14
Q
most commonly observed casts with low refractive index
A
hyaline casts
15
Q
composition of hyaline casts
A
uromodulin
16
Q
physiologic causes of hyaline casts presence
A
strenous exercises
dehydration
emotional stress
fever
17
Q
considered sidekick of other casts in pyelonephritis, glomerulonephritis, chronic renal disease and CHD
A
hyaline casts
18
Q
cast with ground glass/brittle appearance, well defined and jagged edges, and notches on the side
A
waxy casts
19
Q
aka renal failure cast
A
waxy casts
20
Q
waxy casts may be confirmed if it is accompanied by
A
hematuria
proteinuria
leukocyturia
21
Q
waxy casts may be indicative of
A
acute renal disease
tubular inflammation
malignant hypertension
diabetic nephropathy
renal amyloidosis
22
Q
5 types of casts with cellular inclusions
A
RBC cast
WBC cast
RTE cell cast
mixed cellular casts
bacterial casts
23
Q
RBC cast appearance
A
characteristic yellow (unstained)
colorless/lavender (stengeimer malbin)
24
Q
red-brown casts that originate from massive hemoglobinuria/myoglobinuria with urine stasis
A
muddy brown casts
25
aids in identification of RBC casts
phase/interference contrast
accompanied by RBCs
26
RBC casts in healthy individuals is suggestive of
athletic pseudonephritis
(caused by strenous execise and contact sports, return normal in 24 to 48 hrs)
27
highly refractile casts that is readily apparent with brightfield microscopy
WBC casts
28
WBC casts may be differentiated with RTEC casts through
increase in WBCs
29
WBC casts present with RTEC casts indicate
upper UTI
30
WBC casts with RBC casrs, bacteuria, proteinuria and hematuria
glomerular infections
31
WBC casts without bacteuria
acute interstitial nephritis
32
highly refractile, colorless casts often confused with WBC casts
RTEC casts
33
RTEC casts is indicative of
heavy metal/ chemical/ drug induced toxicity
viral infections
allograft rejections
34
casts that are a combination of multiple cell types
mixed cellular casts
35
RBC + WBC casts are indicative of
glomerulonephritis
36
WBC + RTEC/ bacteria is indicative of
pyelonphritis
37
homogenous RBC casts are diagnostic of
glomerulonephritis
38
homogenous WBC casts are diagnostic of
pyelonephritis
39
bacilli within and bound to protein matrix
bacterial casts
40
resemble granular casts
bacterial casts
41
clinical significance of bacterial cast
pyelonephritis
42
2 types of casts with inclusions
granular casts
fatty casts
43
two types of granular casts
coarse and fine
44
appearance of fine granular casts
colorless/gray/pale yellow
less compact and less dense
45
appearance of coarse granular casts
datker due to densitiy but may also be colorless
46
origin of fine granular casts
by products id lysosome and protein metabolism
47
origin of coarse granular casts
degeneration of cellular casts
48
formation of waxy casts
degeneration of cellular casts
prolonged urine stasis
breakdown into fine granules
degenerate into waxy casts
49
casts that are mistaken as fecal debris
fatty casts
50
fatty casts, upon prolonged storage or cooling becomes
cholesterol crystals
51
clinical significance of fatty casts
nephrotic syndrome
toxic tubular necrosis
lipid nephrosis
chronic GN
Kimmelstiel-Wilson's sydrome (diabetic nephropathy)
lupus
crush injuries
52
3 casts w/ noncellular inclusions that indicate tubular damage
hemosiderin granules
sulfonamide crystals
calcium oxalate crystals
53
most frequent broad casts
granular and waxy casts
54
clinical significance of broad casts
dilated tubules
significant urinary stasis
chronic renal disease
55
clinical significant when found in freshly voided urine
crystals
56
factors affecting crystal formation
concentration of solute in urine
urine pH
urine flow
temperature
57
inorganic salts mostly precipitate in
alkaline or neutral urine
58
organic salts mostly precipiate in
acidic urine
59
acidic or alkaline urine:
amorphous urates
Acidic
60
acidic or alkaline urine:
amorphous phosphate
alkaline
61
acidic or alkaline urine:
acid urates
acidic
62
acidic or alkaline urine:
triple phosphate (ammonium magnesium phosphate)
alkaline
63
acidic or alkaline urine:
monosodium urates
acidic
64
acidic or alkaline urine:
calcium phosphate
alkaline
65
acidic or alkaline urine:
calcium oxalate
acidic
66
acidic or alkaline urine:
uric acid crystals
acidic
67
acidic or alkaline urine:
ammonium biurate
alkaline
68
calcium carbonate
alkaline
69
small yellow brown sand like granules, that are macroscopically pink
amorphous urates
70
amorphous urates and amorphous phosphates differ in solubility at 60 degrees C : AU are _____ while AP are _____
heat soluble
heat insoluble
71
amorphous urates form at below pH ___
5.5
72
small, yellow brown balls of sphere found in acidic urine
acid urates
73
solubility caharcteristic of acid urates
dissolve at 60 degrees celsius
74
colorless/ light yellow, pencil- like prisms (ends are not pointed) in singles and clusters
monosodium urates
75
solubility characteristic of monosodium urates
dissolve at 60 degrees celsius
76
crystals found in synovial fluid in px with gout
monosodium urate
77
most frequently observed crystals originating from ascorbic acid in citrus, vegetables, and cocoa/tea/coffee
calcium oxalate
78
calcium oxalates are increased in :
ethylene glycol ingestion
DM
renal calculi
liver disease
79
more common form of calcium oxalate:
dihydrate form
80
octahedral/ pyramidal/ enveloped crystals
dihydrate calcium oxalate
81
small dumbbell shaped crystal without point of constriction
monihydrate calcium oxalate
82
uric acid crystals only form below pH
5.7
83
uric acid crystals originate from
catabolism of purines
84
increased amounts of uric acid crystals indicate
Lesch Nyhan syndrome
gout
chemotherapy (cytotoxic drug administration)
85
can be seen in variety of shapes, particularly rhombic/diamond form, whetstones/cubes, barrels or rosettes
uric scid crystals
86
yellow to golden brown crystals with teong birefringence
uric acid crystals
87
fine colorless grains of sands that are white or gray macroscopically
amorphous phosphate
88
associated with renal calculi, and UTI if found with WBC
triple phosphate
89
3-6 sided prism withh coffin lod shape
triple phosphate
90
feathery or fern shaped crystal in prolonged storage
triple phosphate
91
wedge like prism shaped crystals in rosette form that has one tapered end and one squared end "stellar phosphates"
dibasic calcium phosphate
92
irregular granular flat plates/sheets that float on top and are weakly birefringent
monobasic calcium phosphate
93
confused with sulfonamide crystals in neutral pH
dibasic calcium phosphate
94
crystal that resemble large degenerating squamous epithelial cells
monobasic calcium phosphate
95
rare crystal formed from normal urine solutes
magnesium phosphate
96
large, flat, colorless, rectangular/rhomboid plates with norched or eroded edges
magnesium phosphate
97
found in iatrogemic induced alkalinazation and inadequate hydration
ammonium biurate
98
solubility characteristic of calcium phosphate
souble.in dilute acetic acid
99
solubility characteristic of ammonium biurate
soluble in acetic acid and 60 degrees celsius
100
tiny, colrless dumbbell shaped crystals with point of constriction
calcium carbonate
101
produces effervescence when acetic acid is added
calcium carbonate
102
5 abnormal urine crystals of metabolic origin
bilirubin
cystine
tyrosine
leucine
cholesterol
103
yellow brown, small clusters of fine needles
bilirubin crystals
104
clear, colorless hexagonal plates that are refractile
cystine crystals
105
solubility characteristics of cystine
dissolve in alkali and Hcl
106
colorless/ yellow, fine delicate needles, with dark centers
tyrosine
107
solu ility caharcteristics of tyrosine crystals
soluble in ammonium hydroxide and HCl
insolu le in acetic acid
108
present in Oasthoise urine disease
tyrosine
109
yellow to brown concentric circles/radial striations that resemble fat globules
leucine
110
also found in cystinuria but more soluble thatn tyrosine
leucine
111
crystal seen in nephrotic syndrome with chyluria
cholesterol crystal
112
flat rectangular plates with notched corners
cholesterol
113
crystal soluble in chloroform and ether
cholesterol crystal
114
5 abnormal crystals of iatrogenic origin
hippuric acid
ampicillin
indinavir
sulfamethoxazole/sulfonamide
RCM
115
yellow brown elongates prisms/plates in clusters
hippuric acid
116
colorless long thin needles in small clusters that is rare with adequate hydration
ampicillin
117
slender feather like / wing like crystals
indinavir
118
colorless to brown bundle of needles with eccentric or central constriction like a fan
sulfonamide
119
mistaken as cholesterol but occur in large numbers in one field of view
radiographic contrast media
120
flat elongated rectangular plates that occur in sheaves or singly
radiographic contrast media
121
parasites seen in fecal contamination
Giardia lamblia
Enterobius vermicularis eggs
122
parasites seen in uncontaminated urine
Schistosoma haematobium eggs
Trichomonas vaginalis
