microscope exam Flashcards
ghost cells
lysis/swelling of the RBCs
glitter cells
lysis/swelling of WBCs
hematuria
increased # of RBCs
pyuria
increased # of WBCs
pyuria is associated with…
an inflammatory process in or adjacent to the urinary tract
urine should not be left in refrigerated for more than ** hours
2 hours
yeast cells are smaller than?
RBCs and clump together
WBCs usually bigger than?
RBCs
where are RTEs found
from the tubules of the nephrons in the kidney
where are transitional cells found
from the renal pelvis, ureters, urinary bladder and proximal 2/3 of the urethra
where are squamous cells found
the terminal end of the urethra and from the vagina
increased # of RTEs in the sediment indicate?
inflammation within the kidney or lower urinary tract
due to:
- agents like heavy metals
- renal infections such as pyelonephritis (damage to kidney)
- blood is not reaching the kidney (necrosis)
RBCs companied with casts is an indication of?
bleeding from kidney
affect on urine sample sitting for over 2 hours
start to get bacterial growth
progressive loss of functioning nephrons that occurs over time?
chronic renal failure
WBC 30/HPF + RBC 10 - 15/HPF + bacteria?
urinary tract infection (notice no casts)
glucose interferences
false negative: high levels of ascorbic acid, improperly stored specimens
false positive: oxidizing agents like hydrogen peroxide or bleach contamination
bilirubin interferences
false negative: (same as glucose + nitrites) ascorbic acid, nitrites, improper storage
false positive: medications that induce colour in urine (phenazopyridine, indican, lodine)
false positive medication in bilirubin
phenazopyridine (UTI)
indican (over growth of anaerobic bacteria)
lodine (arthritis)
interferences of urobilinogen
false negative: nitrites, formalin, urine not at room temp or fresh
false positive: some drugs, atypical urines
what analytes does not react to tests?
urobilinogen and conjugated bilirubin
what analyte is insoluble and less reactive
conjugated bilirubin
what are the 3 ketone bodies & their percent
acetone 2%
acetoacetic acid 20%
B-hydroxybutyric acid 78%
ketonuria
elevated levels of ketone bodies in blood that results in their excretion into the urine
ketosis or ketoacidosis
diabetes mellitus and decreased carbohydrates supply
diabetes mellitus
body unable to use carbohydrates as an energy source, uses fat stores instead
symptoms of decreased carbohydrates
starvation, fever, prolonged exercise, dietary imbalance
interferences of ketones
false negative: improper storage specimens
false positive: highly pigmented urine, compounds containing free sulfhydral groups
what are the compounds containing free sulfhydral groups?
phthaleins (in laxatives) and levodopa (used to treat parkinsons)
low SG
dilute
- over hydration
- diabetes insipidus
- renal tubular damage
- diuretics
high SG
concentrated
- dehydration
- glycosuria
- proteinuria
-xray contrast dye
ketone interferences for SG
false low SG: (diluted urine) urines containing large amounts of nonionic solutes (ex glucose)
- these solutes are not readily detected on the dipstick
false high SG: (concentrated urine) patients that have elevated protein levels or patients with ketoacidosis (increased ketones)
if the pH of the urine is >6.5 how much do i add to the SG reader?
0.005
kohler illumination
provides optimum contrast and resolution by focusing and centring the light path by spreading it evenly over the field of view.
eye piece (ocular)
magnifies the image formed by the objective and produces a virtual picture
inter-pupillary adjustment
allows for individual adjustment for the distance between my pupils
ergonomic head and body tube
holds objectives and oculars in proper alignment
light path selector
pull out lever directs the image to a camera
revolving nose piece
holds the objectives and allows the changing from one objective to another
objective lenses
produces initial, magnified, real image of object
stage
platform on which a slide is placed for viewing
slider holder
holds a slide securely in position
coaxial stage controls
moves stage on horizontal plane; back and forth and side to side
condenser assembly
lens system that focuses light onto the specimen (includes aperture diaphragm, centring screws and height adjustment))
condenser aperture diaphragm
adjusted in kohler illumination to match the numerical aperture of the objective in use and improve resolution
condenser centering screws
adjuster in kohler to ensure light is in the center of the field of view
condenser height adjustment
adjusts the condenser position up or down. used in kohler to focus light onto specimen
coarse focus
moves the stage up and down for initial focusing. used only with low power objectives (10X)
fine focus
final focusing of specimen. may be used with all objective sizes
radiant field diaphragm (RFD)
controls the amount of light from the light source to the condenser lens
brightness control
adjusts the intensity of light
light source
electrical lamp located in the backside of the base
base and arm
supports the microscope parts
hpf for RBCs
3-5 hpf
hpf for WBCs
6-10 hpf
example of cellular casts
RTE, RBC, and WBC casts
example of non cellular casts
hyaline, granular, fatty, waxy casts
lipids/fats + massive proteinuria is what condition?
nephrotic syndrome
casts with long renal transit time is what condition?
waxy casts
increased WBCs + WBC casts + minimal proteinuria is what condition
pyelonephritis
epithelial casts are an indication of what condition?
tubular necrosis
miscellaneous elements are
yeast, bacteria, spermatozoa etc
if the SG is high what will happen?
RBCs will appear shrunken or crenated
if the SG is low what happens
RBCs will be swollen or will rapidly break apart
the matrix of casts are primarily composed of
tamm-horsefall protein & uromodulin
the presence of casts in urine is what condition?
cylinduria
hyaline casts are
colourless and transparent
RBC casts are an indication of what condition?
glomerulonephritis
waxy casts typically have
cracked or notched outlines
free fat casts are
globular and a yellow brown colour
oval fat bodies are
RTEs in which fat has accumulated
crystals are found in urine when?
chemicals are present in excess of their solubility and the excess solutes in the urine form a solid
most crystals are
diagnostically insignificant
budding or branching is what cell?
yeast
irregular shapes with dark outlines is what cell?
artifact
what cell doesn’t have a nucleus?
RBCs
what cell is large, flat, and may be rolled?
squamous
what cell is nucleated, round or oval?
WBCs
what cell has a round central nucleus?
RTEs
what cell has a lumpy nucleus and granular?
transitional cell
amorphous phosphates are?
white precipitate and can NOT be dissolved when warmed
triple phosphate are?
described as “coffin lids”
what crystal is colourless dumbbells, retractile envelopes?
calcium oxalate
what crystal comes in a variety of shapes?
amorphous urates
what crystal has a pink precipitate and can be dissolved when warmed
uric acid
what abnormal crystal is delicate needles, red brown in colour?
bilirubin
what abnormal crystal is colourless transparent plates with notched corners?
cholesterol
what abnormal crystal is yellow, oily looking spheres with radial striations?
leucine
what abnormal crystal is colourless hexagonal plates?
cystine
what abnormal crystal is fine needles or sheaves?
tyrosine
what miscellaneous element has dark outline and irregular shapes and sizes?
artifacts
what miscellaneous element is same size as leukocytes, and motile due to flagella?
trichomonas vaginalis
what miscellaneous element is oval in shape, slightly smaller than RBCs, buds?
yeast
what miscellaneous element is long, ribbon like strands with tapered ends?
mucus threads
what miscellaneous element is not identified by motility, but by morphology?
spermatozoa
what are the 5 abnormal crystals?
bilirubin, leucine, tyrosine, cholesterol, cystine
what is the most common type of leukocyte seen in urine sediment?
neutrophil
what is the most common cast seen in microscopic urine examinations?
hyaline casts
is cholesterol found in acidic urine?
yes
are cystine crystals found in normal urine?
no
do amorphous urates or amorphous phosphates dissolve by warming the outside of the tube?
amorphous urates DO
the order of setting kohler
close RFD
open condenser aperture
raising condenser to highest position
the renal threshold of glucose is approximately
10mmol/L
which gland sits on the top of each kidney?
adrenal
dysuria
painful urination
daily volume of urine excretion for an average adult is
1000 mL to 2000 mL per day
where are urinary cast formed?
DCT and CD
which of the following sediment elements has clinical significance in a microscopic examination?
waxy granular cast
what is one way to differentiate between RBC and WBC?
check the leukocyte result on the chemical dipstick
which crystal appears as granular sediment in an acidic urine?
amorphous urates
which crystal is best describes as ‘coffin lid’ and are seen in alkaline urine?
triple phosphate
what portion of the spun urine is used for microscopic examination?
bottom 1mL sediment
what protein is the commercial reagent dipstick specific for?
albumin
which protein do renal tubular epithelial cells exude?
uromodulin
which hormone is being tested for using a urine pregnancy test kit
human chorionic gonadotropin
which enzyme activity is being measured on the leukocyte test strip on the commercial dipstick?
granulocytic esterase
key components involved in the kohler procedure
RFD, height adjustment & centering screws, and condenser aperture diaphragm
if cloudy urine what is the microscopic findings
WBC, RBC, bacteria, yeast, crystals, mucous
if red colour what is the microscopic findings
RBCs
if High SG what is the microscopic findings
crystals and CRENATED RBCs
if Low SG what is the microscopic findings
glitter cells
if acid pH what is the microscopic findings
crystals
if alkaline pH what is the microscopic findings
crystals, WBCs, bacteria
if glucose positive what is the microscopic findings
yeast
if protein positive what is the microscopic findings
casts, WBC, RBC, and bacteria
if nitrite positive and or leukocyte positive what is the microscopic findings
bacteria and WBCs
