Microscopic Examination of Urine Flashcards
The main purpose is to identify and/or quantify
insoluble materials in the urine such as red blood cells (RBs), white blood cells (WBCs), epithelial cells, casts, bacteria, yeast, parasites, mucus, spermatozoa, crystals, and artifacts
MICROSCOPIC EXAMINATION
MICROSCOPIC EXAMINATION is where we detect and identify __________ materials.
INSOLUBLE
In ROUTINE ANALYSIS, _______ specimen must be utilized
FRESH
The refrigeration of urine can lead to the precipitation of _____________ (alkaline pH) and ______________ (acidic pH)
Amorphous phosphates; Amorphous urates
In the three step analysis, what should be done in order in urine testing?
Gross Appearance, Biochemistry, Microscopy
Before performing microscopic
examination is that the specimen must be ________________.
Centrifugation
Urine is prepared in ________ tube (conical vial), before microscopic examination?
Falcon Tube
The urine sample must be centrifuge at ______ rpm for ______ minutes at ______ temperature, to avoid lysis of the formed elements
1,800; 10; 15-30 degree celsius
T/F: In the Philippines, we are using Decislide as we are also using conventional microscopy.
False- In the Philippines, we are still not using
Decislide but we are still using conventional
microscopy
Identify the magnification of microscope:
Scanning: _____
LPO: _______
HPO: ______
4x ; 10x; 40x
The total magnification is evaluated by:
Magnification X Total Eyepiece
In determining cast counts at the microscope, what magnification should be used?
10x
In determining cellular counts, what magnification should be used?
40x
T/F: The condenser must be down at a certain level to have proper contrast of hyaline cast?
TRUE
T/F: HYALINE CAST can be mistaken with Squamous Epithelial Cells.
TRUE
If a formed element is approximated under LPO, but is mistakenly read and graded under HPO, then you’ll tend to have false ________ results; If a cellular element is supposed to be read under
HPO, but is mistakenly read under LPO, then there will
be a false ______ in results.
Decrease; Increase
T/F: In common laboratory practice, when using 10ml/5mL test tube, turning it over and decanting is usually done.
TRUE
Where does urine sediment gets trapped at the top or bottom?
BOTTOM
T/F: After centrifugation, urine sediments are discarded before examining microscopically?
FALSE: Do not discard the sediments. Make sure that you have adequate sediments to be examined microscopically.
When does urine reagent strip testing must be done? Is it BEFORE or AFTER centriugation?
BEFORE - Urine reagent strip testing is done in a homogenous specimen and not after centrifugation.
Performing urine reagent strip testing after centrifugation can cause _____.
FALSE DECREASE RESULT
Is there a standardized amount of resuspended urine
sample that needs to be dispensed?
There is no standardized amount.
Is there a difference in reading when you put
coverslip in the reading?
Yes, reading of cellular elements tends to be HIGHER if you do not use coverslip since your reading is not standardized.
T/F: The importance of using a coverslip is it distribute the cellular elements.
TRUE
IDEALLY, _____ of urine supernatant is
left, and a dropper is used to mix them with the
sediment
0.5mL - 1mL of urine
A product that enables the ease in the preparation of
smear sample and microscopic observation.
Urisystem Deci-slide
It eliminates the process of you applying a cover slip, you just directly apply the suspended urine sediment
Urisystem Deci-slide
T/F: We use stain in the laboratory especially
for routine urinalysis
FALSE: We don’t use stain in the laboratory especially for routine urinalysis
What kind of microscope is mostly used in examining urine sediments?
Bright field Microscope
The presence of blood in the urine
Hematuria
It is crenated or irregularly shaped RBC in Hematuria
HYPERSTHENURIC
Crenated cells are mistaken for ______.
WBC
Are known as Ghost Cells
HYPOSTHENURIC:
T/F: HYPOSTHENURIC must be examined under reduced light
TRUE
Red blood cells that are exposed in a
hypotonic solution
HYPOSTHENURIC: “GHOST CELLS”
This appears in glomerular bleeding as it passed through the tubules
DYSMORPHIC RBC
A dysmorphic RBC with multiple protrusions
ACANTHOCYTE
DYSMORPHIC RBC can be seen in average number in ________.
10 hpfs
The normal values for RBCs in high power field
Below 3 hpf
Hematuria is seen in:
Damage to the glomerular membrane; Vascular injury within the genitourinary tract
Gross-bleeding or Very red bleeding
Frank Hematuria
Advanced glomerular damage
Macroscopic hematuria
Early diagnosis of glomerular
disorders
Microscopic hematuria
Red blood cells are seen as biconcave cells with central depression, they appear as ______
HEMATURIA ; discoid cells
The most conspicuous and acts as a good marker that you are on the correct plane in HEMATURIA
Squamous epithelial cell
This can be mistaken for RBCs: ______, ________, ________ and _________.
Yeast cells; Oil droplets; Fat bodies/Fat globules and Air bubbles
It contains granules and multilobed nuclei
PYURIA OR LEUKOCYTURIA
This pyuria are circular and nucleated, they are mistaken for
renal tubular epithelial cells
The predominant WBC found in the urine sediment
NEUTROPHIL
Neutrophils exposed to hypotonic urine are known as ____________.
Glitter Cells
What stain is used in Glitter Cells causing a light blue color? This is used to identify the cellular elements in the urine
Sternheimer-Malbin stain
The Average Number seen in PYURIA
10 hpfs
The Normal Values for WBC seen in hpfs are?
0-8 hpf
T/F: All Pyuria are infection
FALSE - Not All
Signify and most commonly associated with Drug-induced interstitial nephritis (DIIN)
EOSINOPHILURIA
This stain is used for eosinophils which is technically methylene blue thus eosin y
EOSINOPHILURIA
Seen in early stages of renal transplant rejection and mistaken for renal transitional epithelial cell (RTE)
Lymphocytes
This EC is abundant, irregular cytoplasm and prominent nucleus; as it has a large cell with irregular borders
SQUAMOUS EPITHELIAL CELL
Clue cells is a indication of _________.
Gardnerella vaginalis (causative agent of bacterial vaginosis)
The most common EC in the urinary sediment
SQUAMOUS EPITHELIAL CELL
Spherical, polyhedral or caudate with CENTRALLY located nucleus
TRANSITIONAL EPITHELIAL CELL (UROTHELIAL CELLS)
It is smaller than squamous epithelial cells
TRANSITIONAL EPITHELIAL CELL (UROTHELIAL CELLS)
This term is referred as singly, in pairs, in clumps, in UROTHELIAL CELLS
Syncitia
An __________ TEC with with abnormal morphology indicates Malignancy or viral infection.
Increased
Most clinically significant epithelial cell as it originates from the kidney
RENAL TUBULAR EPITHELIAL CELLS (RTE)
Looks like FRIED EGG
RENAL TUBULAR EPITHELIAL CELLS (RTE)
Mistaken as lymphocyte wherein its shape: rectangular, polyhedral, cuboidal or columnar with
ECCENTRIC nucleus
RENAL TUBULAR EPITHELIAL CELLS
Can be sometimes mistaken for other shapes of transitional cells
RENAL TUBULAR EPITHELIAL CELLS (RTE)
A RTE that has rectangular and large in appearance
Proximal Convoluted Tubule (PCT)
A RTE that has spherical, circular, cuboidal and small cells
Distal Convoluted Tubule (DCT)
A more than 2 RTE/hpf is an indication of
TUBULAR INJURY (kidney damage)
An RTE with an oval fat body is an indication of __.
Nephrotic Syndrome
A bubble cell in RTE is an indication of
Acute Tubular Necrosis
An EC that is reported per LPF
SQUAMOUS EPITHELIAL CELL
An EC that is reported per HPF
TRANSITIONAL EPITHELIAL CELL
An EC is reported as per 10 HPF
Renal Tubular Epithelial Cells
Can sometimes looks like maltese cross, which can usually birefringence crystals or formed elements.
Nephrotic Syndrome
The characteristic elongated shape and
flattened on the sides (cylinder).
CASTS
CYLINDURIA is formed within the ________ and ___________.
Distal convoluted tubule and Collecting duct
The ONLY FORMED ELEMENTS that are UNIQUE
to the KIDNEY.
CASTS
CASTS is casually examined in under ____ power magnification
LOW
T/F: Casts is reported high low power field
FALSE - Low
CASTS is composed of mostly the ________.
UROMODULIN/ TAMM HORSFALL PROTEIN
A Prototype cast
HYALINE CASTS
The normal values for Hyaline casts is ____ /lpf
0-2 / lpf
The color stain for Hyaline Cast when Sternheimer-Malbin is used.
Light Pink
The clinical significance of Hyaline Cast, if the levels are more than > 2/ lpf
● Glomerulonephritis
● Pyelonephritis
● Congestive heart failure
● Chronic renal disease
True cellular casts must already be formed in
Distal convoluted tubule and Collecting duct
Bleeding within nephron/kidney
RBC CAST
Have a slight ORANGE-ISH stain compared to the
other casts
RBC CAST
T/F: It is a TRUE RBC CAST, if there are no free-floating RBCs
FALSE
We can utilize this to differentiate lower UTI from upper UTI
WBC CAST
Primary marker for distinguishing pyelonephritis (upper UTI) from cystitis (lower UTI)
WBC CAST
It is wherein EOSINOPHILS predominate, this would present a WBC cast without bacteria or free-floating WBC.
Acute interstitial nephritis
This to check if the WBCs are from eosinophils
Acute Interstitial Nephritis
Renal Tubular Epithelial cells (RTE)
It is a marker of advanced tubular destruction
The predominant cell for glomerulonephritis is ________.
RBC
The predominant cell for pyelonephritis is _________.
WBC
Derived from lysosomes of RTE cells
GRANULAR CAST
It is caused by toxic effects of hemoglobinuria, leading to eventually renal failure
Acute Tubular Necrosis
DARK-BROWN casts representing degradation products of hemoglobin such as the methemoglobin
GRANULAR CAST
T/F: Fine and coarse granular casts cannot be pathologic.
FALSE - can be and cannot be.
T/F: There is no need to differentiate fine granular casts from coarse granular casts. We just report it as granular casts.
TRUE
It is usually in LIPIDURIA
FATTY CAST
T/F: FATTY CAST can be stained with Sternheimer-Malbin stain.
FALSE - cannot
In fatty cast, this maltese cross appearance, this seen under polarizing microscope.
Oil Red O / Sudan III.
A maltese cross appearance signifies
a. cholesterol
b. triglyceride
A. cholesterol
It is the clinical significance demonstrating Toxic (severe) tubular necrosis.
Fatty Cast
It is a chronic renal failure cast
BROAD CAST
Indicates destruction or WIDENING of the tubular walls
BROAD CAST
The most common type of Broad Cast
Granular and Waxy
Usually a marker of extreme urine stasis
WAXY CAST
It is the final degenerative form of all types of cast
WAXY CAST
It entails that the cast is already old and it’s edges are starting to be destroyed.
Fragmented with jagged ends
Waxy casts stain a homogenous in supravital stain.
DARK PINK
Factors that contribute to crystal formation
pH, Temperature, Solute Concentration
Normal crystals is read in
HPO
Abnormal crystals is read in
LPO
Dissolve upon heating or by adding a weakly alkaline
solution:
Amorphous urates
Amorphous urates is found in
Acidic urine
Dissolve in dilute acetic acid:
amorphous phosphates
Amorphous phosphates is found in
alkaline urine
There are dumbbell shape, appearance of a cross,
diamond
DIHYDRATE (WHEDDELITE) or MONOHYDRATE (WHEWELLITE)
The only crystal seen in acidic -neutral and alkaline urine.
DIHYDRATE (WHEDDELITE) or MONOHYDRATE (WHEWELLITE)
Calcium Oxalate Crystals is found in
Acidic Urine
Increased intake of Vitamin C or Ascorbic acid & Exposure to chemicals leading to chemical toxicity
CALCIUM OXALATE CRYSTALS
Cigarette-butt
CALCIUM SULFATE CRYSTALS IN URINE
Calcium Phosphate is found in ____.
Alkaline Urine
Rosette Apatite
CALCIUM PHOSPHATE
It is mistaken as sulfonamide.
CALCIUM PHOSPHATE
T/F: Calcium phosphate is soluble in acetic acid
TRUE
Dumbbell (Effervescence after HAc)
CALCIUM CARBONATE
This indicates Gouty arthritis
URIC ACID CRYSTALS
URIC ACID CRYSTALS is found in
acidic, slightly acidic, and neutral urine
Also known as Nyhan’s syndrome, Kelley-Seegmiller
syndrome and Juvenile gout
LESCH-NYHAN SYNDROME
a hereditary disorder or purine metabolism,
characterized by mental retardation, self mutilation of the fingers and lips by biting, impaired renal function and abnormal physical development
LESCH-NYHAN SYNDROME
It is caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HPRT)
LESCH-NYHAN SYNDROME
Looks the same having 6 sides
URIC ACID OR CYSTINE
T/F: Uric Acid is colorless while Cystine is Yellow-brown
FALSE: Uric Acid is Yellow-brown while Cystine is colorless
Birefringence of Cystine
Non birefringent
Cyanide- nitroprusside reaction of Uric Acid ____ and Cystine _____.
Negative; Positive
Thorny Apple Crystal
AMMONIUM BIURATE
Coffin-Lid Crystal
TRIPLE PHOSPHATE
Bilirubin Crystals is found in
Acidic urine
Bilirubin Crystals is pigmented with _______.
Yellowish brown granules
Bilirubin Crystals is pigmented with _______.
Yellowish brown granules
LEUCINE CRYSTAL is found in
Acidic Urine
Spheroids with concentric striations
LEUCINE CRYSTAL
Colorless or yellow, fine silky needles in sheaves or clumps. It is seen in liver disease and tyrosinemia (an inborn error of
metabolism)
TYROSINE CRYSTALS
Yellow-brown sheaves of wheat with central bindings, striated sheaves with eccentric bindings, round forms with radial striations etc.
SULFONAMIDE CRYSTALS
Occurs following sulfonamide therapy
SULFONAMIDE CRYSTALS
Staircase crystal : Notched plate
CHOLESTEROL
Cause of HIGH specific gravity in the urine
RADIOGRAPHIC DYE
It is an indicative of nephrotic syndrome or progressive/progression of kidney
damage
CHOLESTEROL
The accumulation of crystals [non pathologic] such as calcium oxalate, calcium phosphate, uric acid , cholesterol, and cystine crystals may lead to _________.
Kidney stones or renal calculi
Asymmetric “Maltese cross” in polarized light
STARCH GRANULE
This can be confused with fat bodies/fatty casts; Irregularly round with dark striation to the center
STARCH GRANULE
Most commonly trace from contamination from the rubber gloves
Starch polarized
Contains large spherical, highly refractile fat droplets; Polarized light show “Maltese-cross” pattern; Associated with marked proteinuria and nephrotic syndrome
FATTY CAST
The diagnostic feature of the spine at the terminal end of an oval structure. (Schistosoma haematobium)
METAZOANS (MULTICELLULAR) PARASITES
Enterobius vermicularis: D-shaped ova or egg
METAZOANS (MULTICELLULAR) PARASITES
The most common that can be found in urine from both males and females is Trichomonas vaginalis.
PROTOZOANS (UNICELLULAR) PARASITES
This can be found in urine sample is Acanthamoeba.
PROTOZOANS (UNICELLULAR) PARASITES
Acanthamoeba keratitis (most common) is the destruction of the eyes
PROTOZOANS (UNICELLULAR) PARASITES
Most commonly due to grease in the slide (dirty slide)
Oil droplets
May be mistaken as oil droplets or protozoan
elements
Air bubbles
This looks like cholesterol crystals
Talcum Powder Particles and Glass Fragments / Glass Shards
The following medical procedures or
intake of therapeutic drugs can formed this crystals
Radiographic dye,
ampicillin, sulfonamide
