Microscopic Flashcards
May indicate the presence
of certain sediments
color
Pathologic or non-pathologic
causes of turbidity
Clarity
RBCs, RBC Cast
Blood
Casts, cells
Protein
Bacteria, WBCs
Nitrite
WBCs, WBC Casts, bacteria
LE
Yeast
Glucose
Quantitative measure of formed elements using a
hemocytometer
addis count
urine specimen for addis count?
12 hour urine
preservative for addis coubt?
NaF
Delineates
structure and
contrasting colors
of the nucleus
and cytoplasm
SternheimerMalbin
(CV + Safranin
O)
sediment stain: WBCs, ECs, and
casts
SternheimerMalbin
(CV + Safranin
O)
sediment stain: Enhances nuclear
detail
0.5% Toluidine
Blue
sediment stain: Differentiates
WBCs and RTE
cells (oval;
nucleus centered)
0.5% Toluidine
Blue
Lyses RBCs and
enhances nucleus
of WBCs
2% Acetic acid
Distinguishes
RBCs
from WBCs,
yeasts, oil
droplets and
crystals
2% Acetic acid
Stains TAG and
neutral fats
(orange-red)
Lipid stains
(ORO and Sudan
III)
Stain: Identifies free fat
droplets and lipidcontaining cells &
casts
Lipid stains
(ORO and Sudan
III)
Differentiates
Gram (-) to Gram
(+) bacteria
GS
sediment stain: casts
GS Differentiates
Gram (-) to Gram
(+) bacteria
Bacterial casts
GS
Stains
eosinophilic
granules
Hansel Stain
(Eosin Y +
Methylene blue)
sediment stain: urinary eosinophils
Hansel Stain
(Eosin Y +
Methylene blue)
Stains
sediments
containing iron
Prussian Blue
Identifies
hemosiderin
granules in casts
and cells
Prussian Blue
microscopy: Visualization of elements
with low refractive indices
(hyaline, mixed cellular cast,
MT, Trichomonas)
Phase-Contrast
Microscopy
microscope: Used for routine urinalysis
Bright-Field Microscopy
micro: Identification of cholesterol
molecules in OFB, fatty casts
and crystals
Polarizing Microscopy
micro: Identification of Treponema
spp
darkfield microscopy
micro;For fluorescent
microorganisms or those
stained with a fluorescent
dye
Fluorescence Microscopy
micro;3-D microscopy image and
layer-by-layer imaging of a
specimen
Interference-Contrast
Microscopy
*Bright Field microscopes
can be adapted
Interference-Contrast
Microscopy
differential microscopy
nomarski
modulation microscopy
hoffman
rbc normal value?
0-4/hpf
Smooth, non-nucleated, biconcave disks-shaped
sediment (7um in diameter)
RED BLOOD CELLS (HEMATURIA)
rbc in urine is called
hematuria
rbc in hypertonic urine
shrink
rbc in hypotonic urine
ghost cell or large empty cell
Glomerular bleeding/damage =
rbc casts
Sources of error of rbc in urine
Yeast, oil droplets, air bubbles,
CaOx monohydrate
remedy of RBC in urine
Addition of 2% HAc to lyse RBCs
Clinical Significance:
o Glomerular membrane damage, vascular
injury within GUT, glomerular bleeding,
glomerulonephritis, renal calculi,
malignancies, Schistosomiasis, strenuous
exercise
RED BLOOD CELLS (HEMATURIA)
wbc normal value in urine
0-5/hpf
predominant wbc in urine
neutrophils
Granulated and multilobed
Neutrophils (predominant)
Swells in hypotonic (dilute and alkaline) urine
Neutrophils (predominant)
granules undergo Brownian Movement
(Glitter Cells) *clinically insignificant
Neutrophils (predominant)
Shrinks in hypertonic (acidic) urine
Neutrophils (predominant)
eosinophils normal value range
<1%
clinical signi; (associated with drug-induced interstitial
nephritis)
eosinophils
Present in small amount
Mononuclear cells (Lympho, Mono, Macro, Histio)
An increase indicates an inflammatory
response or renal transplant rejection
Mononuclear cells (Lympho, Mono, Macro, Histio)
Clinical Significance:
- Infection or inflammation in the GUT
Mononuclear cells (Lympho, Mono, Macro, Histio)
Clinical Significance:Bacterial infection: cystitis,
pyelonephritis, prostatitis, urethritis
Mononuclear cells (Lympho, Mono, Macro, Histio)
Clinical Significance: - Non-bacterial infection:
glomerulonephritis, SLE, tumors
Mononuclear cells (Lympho, Mono, Macro, Histio)
Largest cell (30-
40 um) with
abundant,
irregular
cytoplasm and
prominent
nucleus
squamous epithelial cells
Folded cell may
resemble casts.
sec
Found in the
linings of vagina,
female urethra and lower portion
of male urethra
sec
Urothelial
tec
Spherical,
polyhedral or
caudate with
centrally located
nucleus
tec
From linings of
renal pelvis,
calyces, ureter,
urinary bladder
and upper
portion of male
urethra.
tec
Most clinically
significant
epithelial cell
rte
Oblong or
round to oval or
rectangular and
contain an
eccentric
nucleus and
coarsely
granulated
cytoplasm
Oblong or
round to oval or
rectangular and
contain an
eccentric
nucleus and
coarsely
granulated
cytoplasm
rte
SEC studded
with Gardnerella
vaginalis;
associated with
bacterial
vaginosis
CLUE CELLS:
Significant
numbers can be
seen after
catheterization
(single, pairs, or
in clumps
{syncytia})
tec
Not usually seen
in urine
tec
> 2 RTE/HPF
indicates
TUBULAR
DAMAGE
- Lipid-containing RTE cell
Oval Fat Bodies
Seen in lipiduria (i.e. nephrotic syndrome)
Oval Fat Bodies
Polarizing Microscope: maltese cross
Oval Fat Bodies
RTE cell with nonlipid-filled vacuoles
Bubble cells
Seen in acute tubular necrosis
Bubble cells
Most frequently associated with UTI
BACTERIA
Most common cause of bacteria; UTI?
Enterobacteriaceae
Most frequent parasite encountered in urine
T. vaginalis
o Pear-shaped flagellate (rapid darting motility)
T. vaginalis
Method of reporting of t. vaginalis
RFMoMa
Blood fluke with terminal spine
S. haematobium ova (bladder)
parasite Causes hematuria; associated with bladder
cancer
S. haematobium ova (bladder)
urine specimen for S. haematobium ova (bladder)
24hr unpreserved urine
Most common fecal contaminant
E. vermicularis
True yeast infection
yeast + WBC
Small, refractile oval structures that may or may not
bud
YEASTS
(+) in RGT strip (Glucose)
yeast
yeast that seen in DM patients and Immunocompromised patients
candida albicans
Major constituent of mucus thread
tamm horsfall protein
tamm horsfall protein is also known as
uromodulin
95% water, mucin, CHONs, minerals, salts
and traces of lipid and nucleic acid
: Tamm-horsfall protein
cast in urine is termed
Cylindruria
Unique to the kidneys
CASTS (CYLINDRURIA)
Primarily formed in the DCT and collecting ducts
CASTS (CYLINDRURIA)
- Seen primarily along the coverslip edges with subdued
light
CASTS (CYLINDRURIA)
reporting of casts?
average number/10lpfs
major constituent of cast
uromodulin produced by RTE cells
ORDER OF CAST DEGENERATION
- Hyaline
- Cellular
- Coarsely granular
- Waxy granular (kidney failure)
casts: Beginning of all casts
Hyaline
cast
Most frequently
seen cast
Hyaline
cast
normal values of hyaline cast
NV: 0-2/lpf
Cast? Physiologic:
- Exercise,
dehydration,
heat
exposure,
emotional
stress
Hyaline
cast
casts? Pathologic:
- Acute
glomerulonep
hritis,
pyelonephritis
, CHF, CRD
hyaline casts
cast: nephron bleeding
rbc cast
rbc cast reporting;
number per lpf
cast; glomerulonephritis
rbc cast
Associated with
proteinuria and
dysmorphic RBCs
rbc cast
cast; Infection or
inflammation within
the nephron
wbc cast
cast; May be confused
with EC casts
wbc cast
cast: use phase
contrast or a supravital
stain
wbc cast
cast; pyelonephritis
wbc cast
cast; interstitial nephritis
wbc cast
Glomerulonephritis (w/
RBC casts)
wbc casts
cast; toxicity
rte cell cast
cast; viral infection
RTE CELL CAST
cast; advanced tubular destruction
rte cell cast
cast; allograft rejection
rte cell casts
cast; pyelonephritis with wbc cast
rte cell casts
Resemble granular
casts
Bacterial
cast
cast: Identification using
GS
bacterial cast
cast; pyelonephritis with wbc and rte cell cast
bacterial cast
cast; containing bacilli both
within and bound to the
protein matrix
bacterial cast
cast; are derived
from the lysosomes
of RTE cells during
normal metabolism
Granular
cast
cast: * Glomerulonephritis
* Pyelonephritis
* Stress
* Strenuous exercise
granular cast
cast; Identified using lipid
stains and polarizing
microscope
fatty cast
cast: Nephrotic syndrome
fatty cast
cast: (lipiduria – OVB
fatty cast
cast; Toxic tubular necrosis
fatty cast
cast; Diabetes mellitus
fatty casts
cast; crush injuries
fatty cast
Final degenerative
form of all types of
casts
waxy cast
cast; Brittle, highly
refractile with jagged
edges
waxy cast
waxy cast is what color under supravital stain
dark pink
cast; stasis of urine flow
waxy cast
cast; chronic renal failure
waxy cast
Renal failure cast
Broad cast
All types of casts may
occur in the broad
form; most
common: ?
Waxy and granular
- Bile-stained broad,
waxy casts are seen
as the result of the
tubular necrosis
caused by viral
hepatitis
Broad cast
cast; Extreme urine stasis
* Renal failure
Broad cast
cast; Hyaline matrix with
coloration due to
pigmentation
incorporation
Pigmented
cast
pigmented cast color with incorporated bilirubin
golden brown
pigmented cast color with hemoglobin or myoglobin
yellow to red brown
Casts containing
multiple cell types
Mixed
cellular
cast
Glomerulonephritis
(RBC and WBCs)
* Pyelonephritis (WBC,
RTE casts or WBC and
bacterial casts
Mixed
cellular
cast
Casts containing
urates, CaOx, and
sulfonamides are
occasionally seen
Crystal
cast
cast: Deposition of crystals
in the tubule or
collecting duct
Crystal
cast
Formed by precipitation of urinary solutes (organic
compounds, salts, medication)
CRYSTALS (CRYSTALLURIA)
Factors that contribute to crystal formation:
Temperature
Solute conc.
pH
all abnormal cast are found in what urine?
acidic urine
crystal: Brick dust
Amorphous
urates
crystal:Yellow-brown granules
Amorphous
urates
crystal: in Refrigerated specimens
Amorphous
urates
amorphous urates is pH
pH >5.5
crystal:Dissolved when warm
Amorphous
urates
crystal: Dissolved by acetic
acid
amorphous phosphate
crystal: the only normal crystal that is colored in acidic urine
amorphous urates
crystal:Clumps - formation of
renal calculi (stone)
CaOx
crystal:Increased in food rich in
oxalic acid (tomatoes,
asparagus, and ascorbic
acid)
CaOx
crystal: soluble in Heat and Alkali
fluid
Amorphous
urates
crystal: Mistaken as RBC
Caox
crystal kind of CaOx: colorless, octahedral
envelope or as two
pyramids joined at their
bases
Dihydrate (Wheddelite)
crystal kind of CaOx: most common form;
enveloped form
Dihydrate (Wheddelite)
crystal kind of CaOx: - oval or dumbbell shaped
Monohydrate (Whewellite)
crystal kind of CaOx: ethylene glycol
(antifreeze) poisoning (in
children & pets; sweet &
tempting)
Monohydrate (Whewellite
crystal: soluble in * Dilute HCl;
* Insoluble in HAc
CaOx
crystal kind of Caox; both are birefringent under polarizing microcsope
Monohydrate (Whewellite), Dihydrate (Wheddelite
crystal:“Cigarette-butt” in
appearance
Calcium
sulfate
crystal: soluble in * Acetic acid
calcium sulfate
crystal:Yellow-brown or
colorless elongated
prisms
Hippuric
acid crystals
crystal:* Less significant
Hippuric
acid crystals
crystal: soluble in * Water and Ether
Hippuric
acid crystal
crystal:Misidentified w/ cystine
crystals
Uric acid crystal
crystal: Leukemia patients
receiving
chemotherapy
Uric acid crystal
crystal: * Yellow-brown or
colorless
Uric acid crystal
crystal:Pleomorphic - rhombic,
four-sided flat plates
(whetstones), wedges,
and rosettes
Uric acid crystal
crystal: Increased levels of
purine and nucleic
acid
Uric acid crystal
crystal:Gout
Uric acid crystal
crystal: Resembles ammonium
biurate in alkaline urine
Acid urate crystal
crystal: chemotherapy
- Lesch-Nyhan
syndrome (orangesand in diapers
Uric acid crystal
crystal: Large granules and may
have spicules
Acid urate crystal
crystal: * Slender prisms arranged
in fan or sheaf-like
structures
Sodium
urate crystal
crystal: Synovial fluid during
episode of gout
Sodium urate crystal
crystal: * Granular
* Refrigerated samples – white
precipitate
Amorphous
phosphate
crystal: * Yellow-brown thorny apples
Ammonium
biurate
crystal: Seen in old specimens
Ammonium
biurate
crystal: Colorless, flat rectangular
plates
Calcium
Phosphate
/apatite
crystal:Thin prisms often in rosette
formations – resemble
sulfonamide crystals
Calcium
Phosphate
/apatite
crystal: Common constituent of
renal calculi
Calcium
Phosphate
/apatite
crystal: * Insoluble by heat
Calcium
Phosphate
/apatite
crystal kind of calcium phosphate; – basic
calcium phosphate
Hydroxyapatite –
crystal: calcium hydrogen
phosphate
Brushite
crystal: Long slender prisms with one
end pointed; found in clusters
Dicalcium
phosphate
crystal:Bacteria splitting
Triple
phosphate /
Struvite
crystal: * “Ammonium magnesium
phosphate” crystal
Triple
phosphate /
Struvite
crystal: Colorless, prism-shape or
“coffin-lid”
Triple
phosphate /
Struvite
crystal: Feathery appearance when
they disintegrate
Triple
phosphate /
Struvite
crystal: Fern-leaf (Harr)
Triple
phosphate /
Struvite
crystal: Small, colorless, dumbbellshaped
Calcium
carbonate
crystal:Formation of gas
(effervescence) after the
addition of acetic acid
Calcium
carbonate crystal
crystal: Colorless, hexagonal
plates
Cystine
a
metabolic disorder that
prevents reabsorption
of cystine by the renal
tubules
Cystinuria
crystal:* Mistaken as uric acid
crystals
Cystine
accumulation of cystine
in cells
- Cystinosis
crystal:
crystal: * Rectangular plates
with notched edges
(staircase pattern)
Cholesterol
crystal
crystal:* Nephrotic syndrome
(lipiduria)
Cholesterol
crystal
crystal:* Nephrotic syndrome
(OFB, fatty casts,
choles.cryst)
Cholesterol
crystal
crystal: Seen in conjunction
with fatty casts and
oval fat bodies
Cholesterol
crystal
crystal:Rosettes, arrowheads,
petals, or round
Sulfonamide
crystal: * Soluble in
Chloroform
Cholesterol
crystal
vcrystal: * Colorless to yellow
brown needles
Sulfonamide
(acid/neutral)
crystal:*
Mistaken as calcium
phosphate crystals
Sulfonamide
crystal test:- Newspaper:
Urine + 25%
HCl
= (+)
Yellow
Lignin test of sulfonamide
crystal:Possible tubular
damage
Sulfonamide
crystal: Primary cause:
inadequate patient
hydration
Sulfonamide
crystal:* Colorless needles that
form bundles after
refrigeration
Ampicillin
crystal:Precipitation of
antibiotics following
massive doses without
adequate hydration
Ampicillin
crystal:Overdose of penicillin
drugs
Ampicillin crystal
Uric acid color?
yellow brown
cystine color?
colorless
Oily
-looking
yellow
-brown
spheres with
concentric circles
and radial
striations
LEUCINE
- Fine colorless to
yellow needles
that frequently
form clumps or
rosettes
TYROSINE
- Usually seen in
conjunction with
leucine crystals
in specimens with
positive chemical
test results for
bilirubin
TYROSINE
- Inherited disorders
of amino
-acid
metabolism
TYROSINE
Hepatic
disorders
BILIRUBIN
Clumped needles
or granules with
the characteristic
yellow color of
bilirubin
BILIRUBIN
Cystine is positive in what reaction?
Cyanide nitroprusside reaction
Cystine or uric acid: solubility in dilute hcl?
Cystine
Associated with liver disease: concentric needles with radial striation
Leucine
Crystal: sheaves of wheat
Sulfonamide
Tubular damage in rte cell is indicated by?
> 2rte/hpf
ncreased in food rich in
oxalic acid
CaOx
• Mistaken as RBC
CaOx
tomatoes,
asparagus, and ascorbic
acid)
CaOx
