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UA Spring > Microscopic exam of urine pt 1 > Flashcards

Microscopic exam of urine pt 1 Flashcards

1
Q

RBCs normal value in urine

A

0-2 per hpf

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2
Q

How do RBCs look in concentrated urine?

A

Small and crenated bc hypertonic

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3
Q

How do RBCs look in dilute urine

A
  • Ghost cells = Swollen, lysed, membrane intact
  • Don’t count, just note
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4
Q

RBCs confused with

A
  • Yeast
  • Oil droplets
  • Air bubbles
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5
Q

Hematuria

A

RBC in urine

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6
Q

Explain how presence or absence of RBCs may not correlate with urine color or blood chemical result

A
  • 1-4 RBC/hpf but chem strip negative
  • Chem strip positive but no RBC seen microscopically due to RBC lysis, hemoglobin, or myoglobin
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7
Q

Acetic acid lyses ___ but not ____

A
  • RBCs
  • Yeast, WBCs, or oil droplets
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8
Q

Dysmorphic RBCs (cellular protrusions, vary in size, fragmented) big sign of ___

A
  • Glomerular bleeding
  • Rarely seen due to strenuous exercise
  • 2nd tech review required bc rare and looks like yeast
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9
Q

WBC normal value

A

0-5 per hpf

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10
Q

WBC size and usual identity

A
  • 12 microns
  • PMN
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11
Q

WBCS in hypertonic urine
How they look
Leukocyte esterase reaction

A
  • Shrink
  • Do not release granules, may be negative for leukocyte esterase strip test
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12
Q

WBC hyptonic urine

A

Swell

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13
Q

Glitter cells

A
  • WBCs in hypotonic urine swell, thus granules undergo Brownian movement to cause glittering
  • Not pathologically significant
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14
Q

Pyuria

A

Increased WBCs in urine

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15
Q

Causes of pyuria

A
  • Bacterial infection
  • Glomerulonephritis
  • Lupus erythematosus
  • Interstitial nephritis
  • Tumors
  • Parasites
  • Fungi
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16
Q

Mononuclear cells in urine

A
  • Less common to see
  • Lymphs (may resemble RBC), monocytes, macrophages, histocytes
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17
Q

Lymphs seen in urine when

A

Early stages of renal transplant rejection

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18
Q

What to do with urine that has a lot of mononuclear cells?

A

Refer to cytology

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19
Q

Eosinophils associated with

A
  • Drug-induced interstitial nephritis (primary reason)
  • UTI
  • Parasites
  • Renal transplant rejection
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20
Q

How to stain for eosinophils in UA

A

Hansel’s or Wright’s stain

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21
Q

Clinically significant eosinophil value

A

Eos > 1%

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22
Q

List 3 types of epithelial cells and their sources

A
  • Squamous (urethra/genitalia)
  • Transitional (upper urethra)
  • Renal tubule (PCT, DCT, Henle, collecting duct aka nephron)
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23
Q

ID this cell

A

RTE

24
Q

ID these cells

A

Squamous

25
Q

ID this cell

A

Transitional cell

26
Q

What cell am I describing
Largest cells in urinary sediment, nucleus about RBC size, easily seen under 10x, slough off, may look like casts, degenerate easily

A

Squamous cells

27
Q

Clue cells

A
  • Squamous cells with 75% bacteria
  • Indicate bacterial vaginosis (Gardnerella vaginalis)
28
Q

Are clue cells reported in hospitals?

A

Not usually, they are reported as normal squamous epithelial cells instead

29
Q

What cell am I describing
Central nuclei, numerous forms, well defined edge

A

Transitional epithelial cell!

30
Q

Transitional epithelial cell normal value

A

0-2 hpf

31
Q

Increased amounts of transitional epithelial cells due to

A

Catheterization, but not pathologic in this case

32
Q

Transitional epithelial cells with vacuoles or irregular nuclei may indicate

A

Viral infection, refer to cytology

33
Q

What cell am I describing
Cuboidal, columnar, or round, flattened edge, eccentric nuclei

A

RTE cells

34
Q

RTE normal value and clinically significant value

A
  • 0-2/hpf normal
  • RTE > 3/hpf indicates damage or necrosis to renal tubules (infection, drug toxicity, heavy metals, allergic reactions)
35
Q

Since RTE cells reabsorb glomerular filtrate, what elements can they contain?

A
  • Bilirubin = yellow color
  • Hemosiderin = yellow-brown granules
36
Q

Oval fat bodies

A
  • RTE cells that absorbed lipids from glomerular filtrate
  • Highly pathogenic and rare
37
Q

When are oval fat bodies typically seen

A

Seen along with free fat droplets and or fatty casts

38
Q

Lipiduria

A

Fat in urine

39
Q

Lipiduria associated with

A
  • Nephrotic syndrome (glomerular damage)
  • Tubular necrosis
  • Diabetes mellitus
  • Trauma (BM fat)
  • Oval fat bodies from histocytes instead of RTE, which are seen in lipid storage diseases
40
Q

How do you detect oval fat bodies under the microscope?

A
  • Stain with Oil Red O or Sudan III
  • Polarizing microscopy to see if there’s cholesterol
41
Q

Oval fat bodies easily confused with

A

Starch or certain crystals

42
Q

ID the following

A

Oval fat body

43
Q

What does cholesterol look like under polarizing microscopy?

A

Maltese cross

44
Q

If bacteria present, what reagent test strip results do you expect?

A
  • Nitrite positive or negative
  • Positive leukocyte esterase if WBC present
45
Q

Collection method for urine samples suspected to contain bacteria

A

Clean catch or random specimen

46
Q

Increased amounts of bacteria in urine suggest ___. What’s the follow-up test?

A
  • UTI
  • Do quantitative urine culture
47
Q

ID the element

A

Usually Candida albicans

48
Q

Yeast appears in

A
  • Diabetes mellitus (acid pH and more glucose)
  • Immunocompromised pts
  • Vaginal yeast infections
49
Q

If yeast are present, what other element should be present?

A

WBCs

50
Q

Major constituent of mucus

A

Tamm-Horsfall protein (uromodulin)

51
Q

Mucus refractive index

A
  • Low, making it hard to see
  • More frequent in female urines
52
Q

Mucus clinical significance

A

None for males or females

53
Q

ID the element

A

Mucus

54
Q

Increased amounts of semen may produce what positive result on chemical strip test?

A

Positive protein

55
Q

ID the element

A

Sperm

56
Q

What clinically insignificant causes of bacteria in urine are there?

A
  • Normal sloughing off normal flora from genitalia
  • Urine sat out more than 2 hrs

UA Spring (8 decks)

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