Microscopic Examination 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
Yeast
Glucose
Quantitative measure of formed elements using a
hemocytometer
ADDIS COUNT
Transfer (?) to glass slide with (?) coverslip
20 uL, 22 x 22 mm
WBCs, WBC Casts, bacteria
LE
Specimen used in Addis count?
12 hr urine
Decant urine to remain how many mL of urine?
0.5-1 mL remains
What mL of urine use in microscopic?
12 mL
Preservative used in Addis count?
NaF (Sodium Fluoride)
Delineates
structure and
contrasting colors
of the nucleus
and cytoplasm
Sternheimer-Malbin
Sternheimer-Malbin was made up of?
(CV + Safranin O)
Lyses RBCs and enhances nucleus of WBCs
2% Acetic acid
Enhances nuclear detail
0.5% Toluidine Blue
2 Example of lipid stains?
(ORO-oil red oil and Sudan III)
Stains TAG and neutral fats which results in what color?
Lipid stains
Stains eosinophilic granules
Hansel Stain
Differentiates
Gram (-) to Gram
(+) bacteria
Gram stain
Visualization of elements
with low refractive indices
(hyaline, mixed cellular cast,
MT, Trichomonas)
Phase-Contrast
Microscopy
Hansel Stain is made up of?
Eosin Y + Methylene blue)
Stains sediments containing iron
Prussian Blue
Function of Sternheimer-Malbin
WBCs, ECs, and
casts
Function of 2% Acetic acid
Distinguishes
RBCs
from WBCs,
yeasts, oil
droplets and
crystals
Function of 0.5% Toluidine
Blue
Differentiates
WBCs and RTE
cells (oval;
nucleus centered)
Function of GS
Bacterial casts
Function of Hansel Stain
Urinary
eosinophils
Function of Lipid stains
Identifies free fat
droplets and lipidcontaining cells &
cast
Identification of cholesterol
molecules in OFB, fatty casts
and crystals
Polarizing Microscopy
Interference-Contrast Microscopy for differential?
Nomarski
For fluorescent
microorganisms or those
stained with a fluorescent
dye
Fluorescence Microscopy
Function of Prussian Blue
Identifies
hemosiderin
granules in casts
and cells
Used for routine urinalysis
Bright-Field Microscopy
Identification of Treponema
spp
Dark-Field Microscopy
3-D microscopy image and
layer-by-layer imaging of a
specimen
Interference-Contrast
Microscopy
Interference-Contrast Microscopy for modulation?
Hoffman
Smooth, non-nucleated, biconcave disks-shaped
sediment and what it diameter?
RED BLOOD CELLS (HEMATURIA), 7 um
NV of RBC in urinary sediments
0-4 /HPF
in Hypotonic urine, RBC is?
ghost cell or large empty cell
Sources of errors in RBC?
Yeast, oil droplets, air bubbles,
CaOx monohydrate
in Hypertonic urine, RBC is?
crenated or shrink
Glomerular bleeding/damage means you have?
RBC casts
Remedy in RBC?
Addition of 2% HAc to lyse RBCs
Clinical Significance of RBC?
Glomerular membrane damage, vascular
injury within GUT, glomerular bleeding,
glomerulonephritis, renal calculi,
malignancies, Schistosomiasis, strenuous
exercise
RBC condition?
HEMATURIA
WHITE BLOOD CELLS condition?
PYURIA
NV of WBC?
0-5 /HPF
What is the predominant in WBC?
Neutrophils
Type of WBC that is Granulated and multilobed
Neutrophils
Neutrophils Swells in? and the granules undergo what movement?
hypotonic urine and granules undergo Brownian Movement
NV of eosinophil?
less than 1%
Clinically significant: urinary eosinophils
(associated with drug-induced interstitial
nephritis)
Eosinophils
Type of cells that present in small amount?
Mononuclear cells (Lympho, Mono, Macro, Histio)
An increase mononuclear cells indicates an?
inflammatory response or renal transplant rejection
Clinical Significance:
- Infection or inflammation in the GUT
- Bacterial infection: cystitis,
pyelonephritis, prostatitis, urethritis
- Non-bacterial infection:
glomerulonephritis, SLE, tumors
Mononuclear cells (Lympho, Mono, Macro, Histio)
SEC studded with Gardnerella vaginalis; associated with
bacterial vaginosis
CLUE CELLS
Largest cell epithelial cell? and what its size?
SEC (Surface Epithelial Cells), 30-40 um
Tye of EC that is folded cell may resemble casts. It also found in the ?
linings of vagina, female urethra, and lower portion
of male urethra
Spherical,
polyhedral or
caudate with
centrally located
nucleus
TEC (Transitional Epithelial Cells)
TEC is also called?
Urothelial
TEC can be found in what part of the urinary system?
From linings of
renal pelvis,
calyces, ureter,
urinary bladder
and upper
portion of male
urethra.
- Most clinically significant epithelial cell
RTE
-Significant numbers can be seen after catheterization (single, pairs, or in clumps {syncytia})
- Not usually seen
in urine
TEC
2 VARIATIONS OF RTE
Oval Fat Bodies
Bubble cells
- Oblong or round to oval or rectangular and contain an
eccentric nucleus and coarsely granulated cytoplasm
RTE
> 2 RTE/HPF indicates what disease?
TUBULAR DAMAGE
RTE cell with nonlipid-filled vacuoles and Seen in acute tubular necrosis
Bubble cells
Most frequently associated with UTI
BACTERIA
Most common bacteria causes UTI?
Enterobacteriaceae
Oval Fat Bodies use what stains?
Lipid Stains (TAG and Neutral fats)
Lipid-containing RTE cell and seen in lipiduria (nephrotic syndrome)
Oval Fat Bodies
Oval Fat Bodies use what microscope and what its appearnce?
Polarizing Microscope: maltese cross
- Most frequent parasite encountered in urine
- Pear-shaped flagellate (rapid darting motility)
T. vaginalis
- Blood fluke with terminal spine
- Causes hematuria; associated with bladder
cancer
S. haematobium ova (bladder)
T. vaginalis Method of reporting?
RFMoMa
parasite that is Most common fecal contaminant
E. vermicularis
S. haematobium ova (bladder) specimen used?
24hr unpreserved urine
Small, refractile oval structures that may or may not
bud
YEASTS
seen in DM patients and IMC PX
Candida albicans
True yeast infection
+ WBCs
(+) in RGT strip of glucose means?
YEASTS
- Major constituent: Tamm-horsfall protein or
Uromodulin - 95% water, mucin, CHONs, minerals, salts
and traces of lipid and nucleic acid
MUCUS THREAD
- Unique to the kidneys
- Primarily formed in the DCT and collecting ducts
- Seen primarily along the coverslip edges with subdued
light
CASTS (CYLINDRURIA)
Condition of cast?
CYLINDRURIA
CASTS reported as?
average number/10 lpfs
CASTS major constituents?
Uromodulin produced by RTE cells
- Aggregation and concentration of THP into fibrils that
attaches to RTE cells. - Interweaving of protein fibrils into a mesh-like pattern.
- (Possible) attachment of urinary sediments to the matrix
- Detachment and excretion
FORMATION OF CASTS
4 ORDER OF CAST DEGENERATION
- Hyaline
- Cellular
- Coarsely granular
- Waxy granular (kidney failure)
- Beginning of all casts
- Most frequently
seen cas
Hyaline cast
Hyaline cast NV
0-2/lpf
Hyalin cast: Exercise, dehydration, heat exposure, emotional
stress is Physioligic or Pathologic?
Physiologic
CLINS:
* Advanced tubular
destruction
* Allograft rejection
* Pyelonephritis (w/ WBC
casts)
RTE cell cast
(Hyaline cast) Acute glomerulonephritis, pyelonephritis, CHF, CRD is Physioligic or Pathologic?
Pathologic
CLINS:
* Glomerulonephritis
* Associated with
proteinuria and
dysmorphic RBCs
RBC cast
- Nephron bleeding
- Reporting: number
per lpf
RBC cast
What are you going to use in WBC cast to see it?
use phase contrast or a supravital stain
- Infection or
inflammation within
the nephron - May be confused
with EC casts
WBC cast
- Granules are derived
from the lysosomes
of RTE cells during
normal metabolism
Granular
cast
- Resemble granular
casts - Identific
Bacterial cast
It is cast that means Toxicity and Viral infections
RTE cell cast
- Identified using lipid
stains and polarizing
microscope
Fatty cast
- Final degenerative
form of all types of
casts. - Brittle, highly
refractile with jagged
edges
Waxy cast
What is the color of Waxy cast under the supra vital stain?
Dark pink
- Casts containing
urates, CaOx, and
sulfonamides are
occasionally seen - Deposition of crystals
in the tubule or
collecting duct
Crystal
cast
- Renal failure cast
- All types of casts may
occur in the broad
form; most
common: WAXY &
GRANULAR
Broad cast
Bile-stained broad,
waxy casts are seen
as the result of the
tubular necrosis
caused by viral
hepatitis
Broad cast
- Hyaline matrix with
coloration due to
pigmentation
incorporation
Pigmented
cast
- Casts containing
multiple cell types
Mixed
cellular
cast
CLINS:
* Pyelonephritis -
Bacterial casts
containing bacilli both
within and bound to the
protein matrix
Bacterial
cast
CLINS:
* Glomerulonephritis
* Pyelonephritis
* Stress
* Strenuous exercis
Granular
cast
CLINS:
* Nephrotic syndrome
(lipiduria – OVB)
* Toxic tubular necrosis
* Diabetes mellitus
* Crush injuries
Fatty cast
CLINS:
* Extreme urine stasis
* Renal failure
Broad cast
CLINS:
* Stasis of urine flow
* Chronic renal failure
Waxy cast
In pigmented cast, Incorporated bilirubin color is?
(golden brown)
In pigmented cast, Hemoglobin or myoglobin color is?
(yellow to red brown)
Mixed cellular cast (WBC, RTE casts or WBC and bacterial casts)
Pyelonephritis
- Formed by precipitation of urinary solutes (organic
compounds, salts, medication)
CRYSTALS (CRYSTALLURIA)
Mixed cellular cast (RBC and WBCs)
Glomerulonephritis
Condition of Crystals?
CRYSTALLURIA
In crystals, ref temperature amorphous urates color?
pink ppt
- Casts containing urates, CaOx, and sulfonamides are
occasionally seen - Deposition of crystals in the tubule or collecting duct
Crystal cast
In crystals, ref temperature amorphous phosphate color?
white
Factors that contribute to crystal formation?
- Temperature
- Solute conc.
- pH
- all abnormal crystals are found in (pH)
acidic urine
- Brick dust
- Yellow-brown granules
- Refrigerated specimens
- pH >5.5
- Dissolved when warm
Amorphous
urates
Amorphous urates pH?
> 5.5
- Dissolved by acetic acid; only normal crystal that appears
colored
Amorphous phosphate
- Clumps - formation of
renal calculi - Increased in food rich in
oxalic acid (tomatoes,
asparagus, and ascorbic
acid) - Mistaken as RBC
CaOx
Type of CaOx that is:
- colorless, octahedral
envelope or as two
pyramids joined at their
bases
- most common form;
enveloped form
Dihydrate (Wheddelite)
Type of CaOx that is:
- oval or dumbbell shaped
- ethylene glycol
(antifreeze) poisoning (in
children & pets; sweet &
tempting
Monohydrate (Whewellite)
CaOx is soluble in? and insoluble in?
- Dilute HCl;
- Insoluble in HAc
“Cigarette-butt” in
appearance
Calcium sulfate
Calcium sulfate is soluble in?
Acetic acid
- Yellow-brown or
colorless elongated
prisms - Less significant
Hippuric acid
- rhombic, four-sided flat plates (whetstones), wedges,
and rosettes
Pleomorphic
- Large granules and may
have spicules - Resembles ammonium
biurate in alkaline urine - Less clinical
Acid urate
Hippuric acid is soluble in?
Water and Ether
- Yellow-brown or
colorless - Misidentified w/ cystine
crystals - Birefringent
- Increased amounts:
- Increased levels of
purine and nucleic
acid - Leukemia patients
receiving
chemotherapy - Lesch-Nyhan
syndrome (orangesand in diapers) - Gout
Uric acid
- Slender prisms arranged
in fan or sheaf-like
structures - Synovial fluid during
episode of gout
Sodium urate
- Colorless, flat rectangular
plates - Thin prisms often in(?)– resemble
sulfonamide crystals - Common constituent of
renal calculi
Calcium Phosphate /apatite, rosette formations
- Yellow-brown thorny apples
- Seen in old specimens
Ammonium
biurate
- Long slender prisms with one
end pointed; found in clusters
Dicalcium
phosphate
- Granular
- Refrigerated samples – white
precipitate
Amorphous phosphate
- Not clinically significant
- Bacteria splitting
- “Ammonium magnesium
phosphate” crystal - Colorless, prism-shape or
“coffin-lid” - Feathery appearance when
they disintegrate - Fern-leaf (Harr)
Triple phosphate /
Struvite
- Small, colorless, dumbbell-shaped
- Formation of gas (effervescence) after the
addition of acetic acid
Calcium
carbonate
What are the normal crystals in ACIDIC urine?
ACCHUAS
- Amorphous urates
- CaOx
- Calcium sulfate
- Hippuric acid
- Uric acid
- Acid urate
- Sodium urate
What are the normal crystals in ALKALINE urine
- Amorphous phosphate
- Ammonium biurate
- Calcium Phosphate/apatite
- Dicalcium phosphate
-Triple phosphate / Struvite - Calcium carbonate
basic calcium phosphate
Hydroxyapatite
calcium hydrogen phosphate
Brushite
COLOR: URIC ACID
Yellow-brown
COLOR: CYSTINE
Colorless
SOLUBILITY IN AMMONIA: Uric acid
Soluble
Solubility in
ammonia: Cystine
Soluble
Solubility in dilute
HCl: Uric Acid
Insoluble
Solubility in dilute
HCl: Cystine
Soluble
Birefringence: Uric Acid
Birefringent
Birefringence: Cystine
Not Birefringent
nitroprusside
reaction: Uric acid
Negative
nitroprusside
reaction: Cystine
Positive
ASSOCIATED WITH LIVER DISEASES:
Oily
-looking
yellow
-brown
spheres with
concentric circles
and radial
striations
Leucine
Appearance of leucine in ASSOCIATED WITH LIVER DISEASES
Oily looking yellow brown spheres
ASSOCIATED WITH LIVER DISEASES:
Fine colorless to
yellow needles
that frequently
form clumps or
rosettes
Tyrosine
ASSOCIATED WITH LIVER DISEASES:
Usually seen in
conjunction with
leucine crystals
in specimens with
positive chemical
test results for
bilirubin
Tyrosine
ASSOCIATED WITH LIVER DISEASES:
Inherited disorders
of amino
-acid
metabolism
Tyrosine
Appearance of Tyrosine in associated with liver diseases
Fine colorless to
yellow needles
that frequently
form clumps or
rosettes
ASSOCIATED WITH LIVER DISEASES:
Hepatic disorders
Bilirubin
ASSOCIATED WITH LIVER DISEASES:Clumped needles
or granules with
the characteristic
yellow color of
bilirubin
Bilirubin
Appearance of Bilirubin in ASSOCIATED WITH LIVER DISEASES
Clumped needles
or granules with
the characteristic
yellow color of
bilirubin
- Colorless, hexagonal
plates - Mistaken as uric acid
crystals
Cystine
- Rectangular plates
with notched edges
(staircase pattern)
Cholesterol crystals
- Nephrotic syndrome
(lipiduria) - Seen in conjunction
with fatty casts and
oval fat bodies - Soluble in
Chloroform
Cholesterol crystals
a metabolic disorder that
prevents reabsorption
of cystine by the renal
tubules
Cystinuria
accumulation of cystine
in cells
Cystinosis
CLIN.SIG:
Nephrotic syndrome
(OFB, fatty casts,
choles.cryst)
Cholesterol crystal
- ## Colorless to yellowbrown needles
–
“sheaves of wheat” - Rosettes, arrowheads,
petals, or round
*
Mistaken as calcium
phosphate crystals
Sulfonamide
(acid/neutral)
- Colorless needles that
form bundles after
refrigeration - Precipitation of
antibiotics following
massive doses without
adequate hydration - Overdose of penicillin
drugs
Ampicillin
(acid/neutral)
TO DIFFERENTIATE
FROM PHOSPHATE
CRYST:
Lignin Test: - Newspaper:
Urine + 25%
HCl
= (+)
Yellow
Diazo reaction
CLIN sig:
* Possible tubular
damage
* Primary cause:
inadequate patient
hydration
Sulfonamide
(acid/neutral
- Nephrotic syndrome
(lipiduria) - Seen in conjunction
with fatty casts and
oval fat bodies - Soluble in
Chloroform
Cholesterol
crystal
