Microscopic Examination Flashcards
Spx volume
10-15 mL
Ave: 12 mL
Centrifugation of spx
400 RCF for 5 mins
Centrifuge calibration
Every 3 months
Centrifuge disinfection
Weekly basis
Volume after decantation
0.5-1 mL
Volume of sediment examined
20 uL
Ave# / 10 HPF
Rbc
Oval fat bodies
Wbc
RTE cells
[ROWR]
Ave # / 10 LPF
Cast
Abnormal crystals
[Cast Crab]
RFMoMa/ 10 HPF
Transitional
Trichomonas
Bacteria
Yeast
Normal crystals
[TT- BaYN]
RFMoMa/ 10 LPF
Mucus threads
Squamous epithelial cells
[ Mucus Secs]
Used in routine urinalysis that appears dark against light bg
Bright- field
Enhance visualization of elements with LOW REFRACTIVE INDICES
phase contrast
Aids in identification of cholesterol in oval fat bodies, crystals, and fatty acids
Polarizing
Identification of T. palidum
Dark-field
3D image and layer-by-layer imahingtof spx
Interference contrast
Types of interference contrast
Nomarski and Hoffman
Identifies WBC, epithelial cell, and cast
Sternheimer-malbin
Example of Sternheimer-malbin
Crystal violet and safranin
It enhances nuclear details and differentiate WBC AND RTE cells
Toluidine blue
It stains TAG and neutral fats and identifies free fat droplets and lipid containing cell and cast
Oil Red O and Sudan 3
Use for gram pos and neg bacteria
Gram stain
Stains eosinophil granules
Hansel stain
Example of hansel stain
Methylene blue and Eosin Y
Stains structures containing iron and identifies yello-brown granules of hemosiderin
Prussian blue
RBC in HYPOTONIC urine appears
Swollen/ ghost cell/ shadow cells
RBC in HYPERTONIC urine appears
Crenated or shrink
Hypotonic means
Dilute urine
Hypertonic means
Concentrated urine
Norml value of RBC
0-2/3 per HPF
RBC are frequently confused with
Air bubbles
Yeast cell
Oil droplets
Calcium oxalate
[AYOC]
WBCs are usually distinguished from RBC by the addition of
2% HAc (acetic acid)
Increased WBC in urine
Pyuria
Normal value of WBC
0-5/8 per HPF
WBC in dilute hypotonic urine is called
Glitter cells
Why they are called glitter cells
Because of the Brownian movement it produces sparkling appearance
What stain is used for glitter cells
Sternheimer-malbin
Most predominant WBC in urine that has a characteristic if cytoplasmic ganules and multi-lobed nuclei
Neutrophils
T or F:
In hypertonic urine, thr WBC becomes smaller as water lost osmotically from the cell, but NOT crenated
True
Eosinophil is considered significant if
> 1%
Eosinophil is associated with
Drug induced interstitial nephritis
Stain used for eosinophils
Hansel stain
Renal transplant rejection in lymphocytes can readily identify using
Supravital stain or cytodiagnosis
WBC Look alikes
RTE cells
Dead trichomonas
Crenated RBC
It is the largest epithelials cells that has abundcant irregular cytoplasm with central nucleus
SECs
How to examined SECs
LPO
T or F:
SECs are considered most frequently seen and least significant
True
What do u call the SECs covered with Gardnerella vaginalis/ Mobiluncus
Clue cells
Epithelial cells that appears spherical, caudate, or polyhedral with central nucleus
TECs
T or F:
TECs has the ability to reabsorb large quantity of water
True
Epithelial cells that are round and slightly large with single eccentrically nucleus
RTE cell
Presence of > 2/HPF indicates
Tubular injury
T or F:
RTE cells are the most clinically significant epithelial cell
True
Precursor of oval fat bodies
RTE cells
Lipid containing RTE cells found in lipiduria
Oval fat bodies
Oval fat bodies exhibit ________ under polarized light
Maltese cross appearance
Identification of oval fat bodies is confirmed by
Sudan 3 or Oil Red O
RTE cellz containing large, non lipid filled vacuoles
Bubbles cell
It is a RTE/ TEC that are infected with BK strains
Decoy cells
What cells produces uromodulin
RTE cells
Major constituent of cast
Uromodulin
Where does cast primarily formed
DCT and collecting ducts
It is the ONLY urine sediments that are UNIQUE TO THE KIDNEY
Cast
Presence of urinary cast is called
Cylinduria
It resembles cast but with TAPRED END that is a product of incomplete cast formation
Cylindroids
What produces cylindroids
ALH and Collecting duct
Degeneration of cast
Hyaline cast –>
Cellular cast –>
Coarsely granular –>
Finely granular –>
Waxy cast
It is the MOST FREQUENTLY seen cast in urine
Hyaline cast
Normal value of hyaline cast in urine
0-2/ lpf
Hyaline cast consist almost entirely ______
Uromodulin
T or F:
Hyaline cast is considered a prototype cast
True
Using sternheimer-malbin and KOVA stain, hyaline cast produces what color?
Pink
Cast matrix that contains RBC and appears orange-red color
RBC cast
RBC cast is associated in the
Bleeding within the nephron
Cast matrix containing WBC
WBC cast
T or F:
WBC cast signifies infection or inflammation within the nephron
True
WBC cast are associated with
Pyelonephritis and Acute Interstitial Nephritis
Predominant WBC seen in acute pyelonephritis Nephritis
Eosinophils
It helps differentiate WBC cast from RTE cells
Supravital stain and Phase contrast
RTE cellz attached to protiein matrix
Epithelial cell cast
Non specific marker of tubular injury
Epithelial cell cast
Considered renal failure cast according to brunzel
Waxy cast
Appearance of waxy cast
Fragmented with jagged ends and have notches in their sides
It is the FINAL degeneration form of all thpe of cast
Waxy cast
Using supravital stain, eaxy cast appears what color
Homogeneous dark pink
Seen in conjunction with oval fat bodies and free fat droplets causing lipiduria
Fatty cast
T or F:
Fatty cast can be stained using sternheimer-malbin
False
Polarize microscopy can identify ……
cholesterol on fatty cast ( shows Maltese cross formation)
Sudan 3 and Oil Red O can identify …..
TAG and neutral fats on fatty cast
It appears maltese cross formation
Fatty cast and Oval fat bodies
Types of Granular cast
Coarsely and Finely
Two most commonly seen broad cast in urine
Granular and waxy
Considered as renal failure cast according to strasinger
Broad cast
Broad cast indicates….
Destruction (widening) of the tubular walls
Where does broad cast produce
DCT and collecting duct due to anuria
Bile stained broad and waxy cast are seen as the result of
Tubular necrosis in viral hepatitis
Urine sediments that have uromodulin as the major constituent
Mucus and Cast
Ribnonlike structure produced by glands and epithelial cells in genitourinary tract and RTE cell
Mucus
Mucus threads can be confused with
Hyaline cast
In order to be considered significant in UTI, bacteria should be accompanied by
WBC
Bacteria is confirmed with
Positive urine culture
T or F:
Presence of bacteria may indicate lower and upper UTI
True
It is a smooth, colorless with DOUBLY REFRACTILE WALLS
Yeast cell
Yeast cell often shows
Budding
Yeast can be condused with
RBC
How to differentiate yeast cell and RBCA
Add 2% acetic acid which can lyse
Most common yeast cell
Candida albicans
True yeast infxn should be accompanied with
WBC
________ is used to identify T. vaginalis when no moving
Phase microscopy ( to enhance visualization of the flagella or undulating membrane)
Formed by precipitation of urine solutes
Crystals
Most valuable in the identification of crystals
pH
Brick dust or yellow brown crystals that produces pink sediment
Amorphous urates
Yellow- brown color that has a rhombic or whetstone or diamond-shaped crystals
Uric Acid
Most pleomorphic of all crystals
Uric acid
Uric acid can be seen in px with
Gout
Lesch Nyhan Syndrome
Chemotherapy
[GLC]
Most frequently observed crystals
Calcium oxalate
2 forms of CaOx
Dihydrate/ Wheddelite
Monohydrate/ Whewellite
What is the shaped of Wheddelite CaOx
Octahedral or enveloped shaped
What is the shape of Whewellite CaOx
Dumbbell or ovoid shaped
Whewellite may resemble as
RBC
CaOx is associated with
Renal calculi
Ethylene glycol poisoning
Food high in oxalic acid
Pencil-like prism with blunt end crystals
Monosodium urates
Ball or sphere shaped that resembles biurates and leucine
Acid urates
Cigarette -butt apperance that almost identical to CaOx
Calcium sulfate
Colorless or yellowish needle or slender prism occuring in sheaves
Sodium urates
Colorless ELONGATED prism
Hipouric acid
Mnemonics for NORMAL ACIDIC URINE
SHeesh— MACCAU
Microscopically indistinguishable from amorphous urates
Amorphous phosphate
Amorphous phosphate produces
White precipitates
Only urate found in alkaline urine that has a sphere with striations ( THORNY APPLES)
Ammonium biurates
Crystal commonly seen in OLD URINE SAMPLES
Ammonium biurates
Ammonium biurates resembles
Sulfonamide crystals
Formation of gas (effervescence) after adding acetic acid
Calcium carbonate
Common constituent of renal calculi
Calcium phosphate
Calcium phosphate is also known as
Apatite
Alkaline urine that has the presence of urea- splitting bacteria
Ammonium biurates and
Triple phosphate
Coffin lid or fern-like crystals
Triple phosphate
Triple phosphate is also known as
Struvite
Triple phosphate is associated with
Staghorn calculi
Mnemonics for Normal Alkaline Urine
CACAT
Colorless, hexagonal plates of crab
Cysteine
Cysteine is associated with
Sulfur odor
Crab that is Flat rectangular plates with notched corners ( staircase patter or broken window panes)
Cholesterol
Cholesterol resembles as
Radiographic contrast media
Cholesterol is associated with
Nephrotic syndrome
Crab that appears fine delicate needles or sheaves
Tyrosine
Tyrosine is associated with
liver disease
Crab that appears oily looking spheres with a delicate radiating and concentric striation
Leucine
T or F:
Leucine is precipitated with cholesterol after adding alcohol
False ( with tyrosine)
Leucine is associated with
Liver disease
Oasthouse urine disease
MSUD
Yellow or ruby red clumped needle crab
Bilirubin
Positive bilirubin reagent strip
Diazo reaction
Test used for sulfonamide
Lignin test
Lignin test
Urine + 25% HCl = yellow-orange color
Refrigeration forms bundles
Ampicillin
Feather like crystals that aggregate into wing like bundles
Indavir sulfate
Resembles cholesterol crystals
Radiographic dye
