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AUBF > M4:U2 Urinary Casts > Flashcards

M4:U2 Urinary Casts Flashcards

1
Q

Casts are formed in

A

distal CT and collecting ducts

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2
Q

core matrix of casts

A

Tamm Horsfall protein

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3
Q

Tamm Horsfall protein origin

A

thick ascending loop of henle

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4
Q

presence of casts in urine

A

cylindruria

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5
Q

cast are always renal in origin, therefore they are indicators of

A

intrinsic renal disease

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6
Q

4 factors onvolved in urinary xast formation

A
  1. urinary stasis
  2. urine acidity
  3. high solute concentration
  4. presence of materials
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7
Q

causes enhancement of protein gelation and solute precipitation

A

urine acidity

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8
Q

casts that are well formed on one end and tapered on one end

A

cylindroids

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9
Q

three reasons fro cylindroid formation

A

incomplete cast formation
lumen width differs
casy disintegration

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10
Q

most common type of cylindroid

A

hyaline cast

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11
Q

rare type of cylindroid

A

fine granukar cast

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12
Q

2 major classifications of casts

A
  1. casts with homogenous matrix
  2. casts with cellular inclusions
  3. casts with inclusions
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13
Q

2 types of casts with homogenous matrix

A
  1. hyaline casts
  2. waxy casts
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14
Q

most commonly observed casts with low refractive index

A

hyaline casts

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15
Q

composition of hyaline casts

A

uromodulin

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16
Q

physiologic causes of hyaline casts presence

A

strenous exercises
dehydration
emotional stress
fever

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17
Q

considered sidekick of other casts in pyelonephritis, glomerulonephritis, chronic renal disease and CHD

A

hyaline casts

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18
Q

cast with ground glass/brittle appearance, well defined and jagged edges, and notches on the side

A

waxy casts

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19
Q

aka renal failure cast

A

waxy casts

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20
Q

waxy casts may be confirmed if it is accompanied by

A

hematuria
proteinuria
leukocyturia

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21
Q

waxy casts may be indicative of

A

acute renal disease
tubular inflammation
malignant hypertension
diabetic nephropathy
renal amyloidosis

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22
Q

5 types of casts with cellular inclusions

A

RBC cast
WBC cast
RTE cell cast
mixed cellular casts
bacterial casts

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23
Q

RBC cast appearance

A

characteristic yellow (unstained)
colorless/lavender (stengeimer malbin)

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24
Q

red-brown casts that originate from massive hemoglobinuria/myoglobinuria with urine stasis

A

muddy brown casts

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25
Q

aids in identification of RBC casts

A

phase/interference contrast
accompanied by RBCs

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26
Q

RBC casts in healthy individuals is suggestive of

A

athletic pseudonephritis
(caused by strenous execise and contact sports, return normal in 24 to 48 hrs)

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27
Q

highly refractile casts that is readily apparent with brightfield microscopy

A

WBC casts

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28
Q

WBC casts may be differentiated with RTEC casts through

A

increase in WBCs

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29
Q

WBC casts present with RTEC casts indicate

A

upper UTI

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30
Q

WBC casts with RBC casrs, bacteuria, proteinuria and hematuria

A

glomerular infections

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31
Q

WBC casts without bacteuria

A

acute interstitial nephritis

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32
Q

highly refractile, colorless casts often confused with WBC casts

A

RTEC casts

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33
Q

RTEC casts is indicative of

A

heavy metal/ chemical/ drug induced toxicity
viral infections
allograft rejections

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34
Q

casts that are a combination of multiple cell types

A

mixed cellular casts

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35
Q

RBC + WBC casts are indicative of

A

glomerulonephritis

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36
Q

WBC + RTEC/ bacteria is indicative of

A

pyelonphritis

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37
Q

homogenous RBC casts are diagnostic of

A

glomerulonephritis

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38
Q

homogenous WBC casts are diagnostic of

A

pyelonephritis

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39
Q

bacilli within and bound to protein matrix

A

bacterial casts

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40
Q

resemble granular casts

A

bacterial casts

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41
Q

clinical significance of bacterial cast

A

pyelonephritis

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42
Q

2 types of casts with inclusions

A

granular casts
fatty casts

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43
Q

two types of granular casts

A

coarse and fine

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44
Q

appearance of fine granular casts

A

colorless/gray/pale yellow
less compact and less dense

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45
Q

appearance of coarse granular casts

A

datker due to densitiy but may also be colorless

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46
Q

origin of fine granular casts

A

by products id lysosome and protein metabolism

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47
Q

origin of coarse granular casts

A

degeneration of cellular casts

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48
Q

formation of waxy casts

A

degeneration of cellular casts
prolonged urine stasis
breakdown into fine granules
degenerate into waxy casts

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49
Q

casts that are mistaken as fecal debris

A

fatty casts

50
Q

fatty casts, upon prolonged storage or cooling becomes

A

cholesterol crystals

51
Q

clinical significance of fatty casts

A

nephrotic syndrome
toxic tubular necrosis
lipid nephrosis
chronic GN
Kimmelstiel-Wilson’s sydrome (diabetic nephropathy)
lupus
crush injuries

52
Q

3 casts w/ noncellular inclusions that indicate tubular damage

A

hemosiderin granules
sulfonamide crystals
calcium oxalate crystals

53
Q

most frequent broad casts

A

granular and waxy casts

54
Q

clinical significance of broad casts

A

dilated tubules
significant urinary stasis
chronic renal disease

55
Q

clinical significant when found in freshly voided urine

A

crystals

56
Q

factors affecting crystal formation

A

concentration of solute in urine
urine pH
urine flow
temperature

57
Q

inorganic salts mostly precipitate in

A

alkaline or neutral urine

58
Q

organic salts mostly precipiate in

A

acidic urine

59
Q

acidic or alkaline urine:
amorphous urates

A

Acidic

60
Q

acidic or alkaline urine:
amorphous phosphate

A

alkaline

61
Q

acidic or alkaline urine:
acid urates

A

acidic

62
Q

acidic or alkaline urine:
triple phosphate (ammonium magnesium phosphate)

A

alkaline

63
Q

acidic or alkaline urine:
monosodium urates

A

acidic

64
Q

acidic or alkaline urine:
calcium phosphate

A

alkaline

65
Q

acidic or alkaline urine:
calcium oxalate

A

acidic

66
Q

acidic or alkaline urine:
uric acid crystals

A

acidic

67
Q

acidic or alkaline urine:
ammonium biurate

A

alkaline

68
Q

calcium carbonate

A

alkaline

69
Q

small yellow brown sand like granules, that are macroscopically pink

A

amorphous urates

70
Q

amorphous urates and amorphous phosphates differ in solubility at 60 degrees C : AU are _____ while AP are _____

A

heat soluble
heat insoluble

71
Q

amorphous urates form at below pH ___

A

5.5

72
Q

small, yellow brown balls of sphere found in acidic urine

A

acid urates

73
Q

solubility caharcteristic of acid urates

A

dissolve at 60 degrees celsius

74
Q

colorless/ light yellow, pencil- like prisms (ends are not pointed) in singles and clusters

A

monosodium urates

75
Q

solubility characteristic of monosodium urates

A

dissolve at 60 degrees celsius

76
Q

crystals found in synovial fluid in px with gout

A

monosodium urate

77
Q

most frequently observed crystals originating from ascorbic acid in citrus, vegetables, and cocoa/tea/coffee

A

calcium oxalate

78
Q

calcium oxalates are increased in :

A

ethylene glycol ingestion
DM
renal calculi
liver disease

79
Q

more common form of calcium oxalate:

A

dihydrate form

80
Q

octahedral/ pyramidal/ enveloped crystals

A

dihydrate calcium oxalate

81
Q

small dumbbell shaped crystal without point of constriction

A

monihydrate calcium oxalate

82
Q

uric acid crystals only form below pH

A

5.7

83
Q

uric acid crystals originate from

A

catabolism of purines

84
Q

increased amounts of uric acid crystals indicate

A

Lesch Nyhan syndrome
gout
chemotherapy (cytotoxic drug administration)

85
Q

can be seen in variety of shapes, particularly rhombic/diamond form, whetstones/cubes, barrels or rosettes

A

uric scid crystals

86
Q

yellow to golden brown crystals with teong birefringence

A

uric acid crystals

87
Q

fine colorless grains of sands that are white or gray macroscopically

A

amorphous phosphate

88
Q

associated with renal calculi, and UTI if found with WBC

A

triple phosphate

89
Q

3-6 sided prism withh coffin lod shape

A

triple phosphate

90
Q

feathery or fern shaped crystal in prolonged storage

A

triple phosphate

91
Q

wedge like prism shaped crystals in rosette form that has one tapered end and one squared end “stellar phosphates”

A

dibasic calcium phosphate

92
Q

irregular granular flat plates/sheets that float on top and are weakly birefringent

A

monobasic calcium phosphate

93
Q

confused with sulfonamide crystals in neutral pH

A

dibasic calcium phosphate

94
Q

crystal that resemble large degenerating squamous epithelial cells

A

monobasic calcium phosphate

95
Q

rare crystal formed from normal urine solutes

A

magnesium phosphate

96
Q

large, flat, colorless, rectangular/rhomboid plates with norched or eroded edges

A

magnesium phosphate

97
Q

found in iatrogemic induced alkalinazation and inadequate hydration

A

ammonium biurate

98
Q

solubility characteristic of calcium phosphate

A

souble.in dilute acetic acid

99
Q

solubility characteristic of ammonium biurate

A

soluble in acetic acid and 60 degrees celsius

100
Q

tiny, colrless dumbbell shaped crystals with point of constriction

A

calcium carbonate

101
Q

produces effervescence when acetic acid is added

A

calcium carbonate

102
Q

5 abnormal urine crystals of metabolic origin

A

bilirubin
cystine
tyrosine
leucine
cholesterol

103
Q

yellow brown, small clusters of fine needles

A

bilirubin crystals

104
Q

clear, colorless hexagonal plates that are refractile

A

cystine crystals

105
Q

solubility characteristics of cystine

A

dissolve in alkali and Hcl

106
Q

colorless/ yellow, fine delicate needles, with dark centers

A

tyrosine

107
Q

solu ility caharcteristics of tyrosine crystals

A

soluble in ammonium hydroxide and HCl
insolu le in acetic acid

108
Q

present in Oasthoise urine disease

A

tyrosine

109
Q

yellow to brown concentric circles/radial striations that resemble fat globules

A

leucine

110
Q

also found in cystinuria but more soluble thatn tyrosine

A

leucine

111
Q

crystal seen in nephrotic syndrome with chyluria

A

cholesterol crystal

112
Q

flat rectangular plates with notched corners

A

cholesterol

113
Q

crystal soluble in chloroform and ether

A

cholesterol crystal

114
Q

5 abnormal crystals of iatrogenic origin

A

hippuric acid
ampicillin
indinavir
sulfamethoxazole/sulfonamide
RCM

115
Q

yellow brown elongates prisms/plates in clusters

A

hippuric acid

116
Q

colorless long thin needles in small clusters that is rare with adequate hydration

A

ampicillin

117
Q

slender feather like / wing like crystals

A

indinavir

118
Q

colorless to brown bundle of needles with eccentric or central constriction like a fan

A

sulfonamide

119
Q

mistaken as cholesterol but occur in large numbers in one field of view

A

radiographic contrast media

120
Q

flat elongated rectangular plates that occur in sheaves or singly

A

radiographic contrast media

121
Q

parasites seen in fecal contamination

A

Giardia lamblia
Enterobius vermicularis eggs

122
Q

parasites seen in uncontaminated urine

A

Schistosoma haematobium eggs
Trichomonas vaginalis

AUBF (12 decks)

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