Microscopic examination Of Urine Flashcards
1
Q
Most glomerular disorders are caused by:
A
Immunologic disorders
2
Q
Dysmorphic RBC casts would be a significant finding with
A
Good pasture syndrome
Acute glomerulonephritis
Henoch-Schönlein purpura
3
Q
Dysmorphic RBC casts would not be a significant finding with
A
Chronic pyelonephritis
4
Q
Occasional episodes of macroscopic hematuria over periods of 20 or more years are seen with :
A
IgA nephropathy
5
Q
Antiglomerular basement membrane antibody is seen with
A
Goodpasture syndrome
6
Q
Antineurophilic cystoplasmic antibody is diagnostic for:
A
Wegner Granulomatosis
7
Q
Respiratory and renal symptoms are associated with
A
IgA nephropathy
Wegener granulomatosis
Henoch-Schönlein purpura
8
Q
Respiratory and renal symptoms is not associated with
A
Goodpasture syndrome
9
Q
The presence of fatty casts is associated with
A
Nephrotic syndrome
Focal segmental glomerulosclerosis
Minimal change disease
10
Q
The presence of fatty casts is not associated with
A
Nephrogenic diabetes insipidus
11
Q
Highest levels of proteinuria are seen with
A
Nephrotic syndrome
12
Q
Ischemia frequently produces
A
Acute renal tubular necrosis
13
Q
A disorder associated with polyuria and low specific gravity is:
A
Nephrogenic diabetes insipidus
14
Q
An inherited disorder producing a generalized defect in tubular readsorption is:
A
Fanconi syndrome
15
Q
A teenage boy who develops gout in his big toe and has a high serum uric acid should be monitored for:
A
Uromodulin-associated kidney disease
16
Q
The only protein produced by the kidney is:
A
Uromodulin
17
Q
Presence of renal tubular epithelial cells and casts is an indication of:
A
Acute tubular necrosis
18
Q
Differentiation between cystitis and pyelonephritis is aided by the presence of
A
WBC casts
19
Q
Presence of WBCs and WBC casts with no bacteria is indicative of:
A
Acute interstitial nephritis
20
Q
End-stage renal disease is characterized by all of the following except:
A
Hypersthenuria
21
Q
Prerenal acute renal failure could be caused by:
A
Massive hemmorrhage
22
Q
The most common composition of renal calculi is
A
Calcium oxalate
23
Q
Urinalysis on a patient with a severe back pain being evaluated for renal calculi would be most beneficial if it showed:
A
Miscroscopic hematuria
24
Q
Warming of urine at 37deg C
A
Dissolves some crystals
25
Refrigeration of urine
Precipitation of amorphous urates/phosphates and other non-pathologic crystals
26
Centrifugation
5 minutes in 4000RCF
27
LPO detects
General composition of sediment
Casts
28
HPO indentifies
Urinary sediments
29
Sternheimer-Malbin stain
Most used in urinalysis
30
Crystal violet and Safranin O
Sternheimer-Malbin stain
31
Sedi stain and KOVA stain
Sternheimer-Malbin stain
32
Confirm.presence of triglycerides, neutral fats, and cholesterol
Lipid stains, Oil red O, Sudan III and Polarizing microscopy
33
Identification of bacterial casts
Gram stain
34
Crystal violet, Iodine, Alcohol Safranin
Gram stain
35
Purple/Violet
Gram(+) bacteria
36
Red
Gram(-) bacteria
37
Preferred stain for urinary eosinophils (In cases of drug-induced allergic reaction producing inflammation of the
renal interstitium)
Hansel stain
38
Methylene blue and Eosin Y
Hansel stain
39
Prussian blue stain
Stain for iron
40
Aids in identification of Treponema Pallidum
Dark-Field microscopy
41
Hyaline casts, mixed cellular casts, mucous threads and Trichomonas
Phase-Contrast microscopy
42
Cholesterol, oval fat bodies, fatty casts and crystals
Polarizing microscopy
43
Three dimensional microscopy
Interference contrast
44
Associated with damage to the glomerular membrane or vascular injury within the genitourinary tract
Red Blood Cell
45
Frequently associated with advanced glomerular damage but is also seen with damage to the vascular integrity of the urinary tract caused by trauma, acute infection or inflammation, and coagulation disorders.
Macroscopic hematuria
46
Critical to the early diagnosis of
glomerular disorders and malignancy of the urinary tract and to confirm the presence of renal calculi
Microscopic hematuria
47
Increased in urinary WBC which indicates the presence
of an infection or inflammation in the genitourinary system.
Pyuria
48
Drug-induced Interstitial Nephritis, UTI and renal
transplant rejection
Eosinophil
49
Resembles RBC
Lymphocytes
50
increased numbers in the early stages of renal transplant rejection
Lymphocytes
51
Used to enhance nuclear detail
Supravital staining/Addition of Acetic Acid
52
Largest cells found in urine sediment
Squamous EC
53
Originate from the lining of the renal pelvis, calyces,
ureters, and bladder, and from the upper portion of the
male urethra
Epithelial Cell
54
Smaller than squamous cells and appear in several forms, including spherical, polyhedral and caudate.
Epithelial Cell
55
Lipid containing RTE cells
Oval Fat Bodies
56
Squamous EC covered with Gardnerella coccobacillus
(Bacterial Vaginosis)
Clue cells
57
Bacteria accompanied with WBC
Significant UTI
58
Small Refractile oval structures (may or may not contain bud)
Yeast
59
most frequent parasite
encountered in the urine. Asymptomatic for male
Trichomonas vaginalis (ST):
60
bladder parasite (ova). Bladder
Cancer
Schistosoma haematobium
61
most common fecal contaminant
Enterobius vermicularis
62
Significant: Male infertility, Retrograde Ejaculation (Sperm is
expelled into bladder instead of urethra)
Spermatozoa
63
Uromodulin: major constituent
Thread-like structures (Low Refractive Index)
Frequently seen in Females
Mucus
64
Presence of urinary cast
Cylinduria
65
: True geometrically structure or amorphous
materials
Crystals
66
appear as spheres with a cell wall and occasional concentric circles
Artifacts
67
Pathologically increased in: Acute glomerulonephritis,
Pyelonephritis, Chronic Renal Disease, CHF
Hyaline
68
Glomerular damage (glomerulonephritis) is associated with proteinuria and dysmorphic erythrocytes
RBC Casts
69
Non-Bacterial inflammation
Acute Interstitial Nephritis
70
Bacterial inflammation
Pyelonephritis
71
May resemble granular cast
Bacterial Casts
72
Frequently Associated with: Nephrotic syndrome
Fatty Casts
73
Significantly increased in: Gout, Lesch-Nyhan Syndrome
Uric Acid
74
Prism shape, resembles “COFFIN-LID”
Triple Phosphate/Ammonium Magnesium Phosphate
75
Most often encountered in: OLD SPECIMEN associated with
ammonia produced by ammonia spitting bacteria
Ammonium Biurate
76
Formation of kidneys stones at an early stage
Cystine
77
Inadequate px hydration which is the primary cause of
Sulfonamide crystalization
Sulfonamides
78
Immune-mediated
Glomerular
79
INCREASED permeability of the GLOMERULI to the passage of plasma proteins (ALBUMIN)
Heavy PROTEINURIA (3.5g/day)
HYPOPROTEINEMIA (Plasma albumin usually <3g/dL – LIVER SYNTHESIS unable to compensate for the large amount of protein EXCERETED in the urine
HYPERLIPIDEMIA (INCREASED plasma levels of TRIGLYCERIDES, CHOLESTEROL, PHOSPHOLIPIDS & VLDL)
Nephrotic Syndrome
80
One cause: Post-Streptococcal Infection → known as: ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS (Group A βhemolytic Streptococci – those with M PROTEIN in their cell wall induces this type of nephritis)
Blood: ELEVATED ASO Titer
NON-AGN: non-streptococcal agent (bacteria:pneumococci, viruses:mumps,Hepa B, parasitic infection:malaria)
Acute Glomerulonephritis
81
SCLEROSIS of the GLOMERULI
FOCAL (Occurring in some glomeruli); SEGMENTAL (Affecting a
specific area of the glomerulus)
Predominant Feature: PROTEINURIA
Focal Segmental Glomerulonephritis
82
Cellular Proliferation of the MESANGIUM along with LEUKOCYTE INFILTRATION & THICKENING OF THE GLOMERULAR BASEMENT MEMBRANE
Membranoproliferative Glomerulonephritis
83
Most prevalent type of glomerulonephritis world wide
Deposition of IgA in the GLOMERULAR MESANGIUM
IgA Nephropathy
84
Development: Slow and Silent
80%: have previously some form of glomerulonephritis
20%: form of glomerulonephritis that has been unrecognized
Chronic Glomerulonephritis
85
Follows a HYPOTENSIVE event that result in decrease
perfusion of the kidneys followed by renal tissue ischemia
3 Principal Cause:
1.Sepsis
2.Shock
3.Trauma
Acute Tubular Necrosis: ISCHEMIC ATN
86
exposure to NEPHROTOXIC AGENTS
Acute Tubular Necrosis: TOXIC ATN
87
normal solutes or substances that become toxic when their concentration in the bloodstream is excessive:
a. hemoglobin – hemoglobinuria – severe hemolytic events
b. myoglobin – myoglobinuria - rhabdomyolyis
c. uric acid
d. immunoglobulin light chain
ENDOGENOUS NEPHROTOXIN
88
substances ingested or absorbed
a. therapeutic agents
b. anesthetics
c. radiographic contrast media
d. chemotherapeutic drugs
e. recreational drugs
f. industrial chemicals
EXCOGENOUS NEPHROTOXIN
89
Impaired ability to REABSORBED GLUCOSE
Renal Glucosuria
90
Impaired ability to REABSORBED SPECIFIC AMINO ACIDS
Cystinuria (Cystine
and Dibasic AA)
Hartnup Disease (Monoamino – Monocarboxylic AA)
91
Impaired ability to REABSORB SODIUM
Bartter’s Syndrome
92
Impaired ability to REABSORB BICARBONATE
Renal Tubular Acidosis Type II
93
Impaired ability to REABSORB CALCIUM
Idiopathic Hypercalciuria
94
Excessive REABSORPTION of CALCIUM
Hypocalciuric Familial Hypercalcemia
95
Excessive REABSORPTION of SODIUM
Gordon’s Syndrome
96
EXCESSIVE REABSORPTION of PHOSPHATE
Pseudohypo parathyroidism
97
Generalized LOSS OF PROXIMAL TUBULAR FUNCTION NOT REABSORBED form the ULTRAFILTRATE & EXCRETED in the URINE: (AA, Glucose, Water, Phosphorous, Potassium, & Calcium)
Fanconi Syndrome
98
Impaired ability to REABSORB PHOSPHATE
Familial Hypophosphatemia
(Vitamin D Resistant Rickets)
99
Impaired ability to REABSORB CALCIUM
Idiopathic Hypercalciuria
100
Impaired ability to ACIDIFY URINE
Renal Tubular Acidosis, Types I and IV
101
Impaired ability to RETAIN SODIUM
Renal Salt-Losing Disorder
102
Impaired ability to CONCENTRATE URINE
Nephrogenic Diabetes
103
Excessive reabsorption of SODIUM
Liddle’s Syndrome
104
Inability to REABSORB INORGANIC PHOSPHATES
Renal Phosphaturia
105
Urethra (Urethritis)
Bladder (Cystitis)
Painful Urination (Dysuria)
Burning Sensation
Frequent urge to urinate
LOWER UTI
106
Renal Pelvis Alone (Pyelitis)
Renal Pelvis including Interstitium (Pyelonephritis)
Upper UTI
107
Bacterial infection that involves the renal tubules,
interstitium, & renal pelvis
Mechanism:
1. Movement of bacteria from the lower urinary tract to the kidney
2. Localization of the bacteria from the bloodstream in the kidneys
(hematogenous infection)
Acute Pyelonephritis
108
Develops when permanent inflammation of
renal tissue causes permanent scarring that involves the renal calyces
and pelvis
Chronic Pyelonephritis
109
Allergic response to the interstitium of the kidney
Most common cause: Acute Allograft Rejection of a transplanted kidney
Acute Interstitial Nephritis
110
Candida species (e.g. Candida albicans) – normal
flora of GIT & vagina
Proliferation of yeasts due to: changes in pH, adversely disrupted by antibiotics
Yeast Infections
111
URINE SODIUM CONCENTRATION IS LOW – INCREASED AMOUNT OF SODIUM BEING REABSORBED
pre-renal
112
INCRASED URINARY EXCRETION OF SODIUM
Renal
113
Progressive LOSS of RENAL FUNCTION
“END-STAGE RENAL DISEASE” / “END-STAGE KIDNEYS”
Chronic Renal Failure
114
Alkaptonuria (Homogentesic Acid)
MSUD
Melanoma (Melanin)
PKU
Ferric Chloride test
115
Alkaptonuria (Homogentesic Acid)
Ammoniacal Silver Nitrite/Benedict's Test
116
Tyrosinuria
Nitrosonaphthol Test
117
Porphyria (Porphobilinogen)
Hoesch Test/Watson-Schartz Test
118
Inborn errors of metabolism Result from: INHERITED DEFECT
Primary Aminoaciduria
119
SEVERE LIVER DISEASE or GENERALIZED TUBULAR
DYSFUNCTION
Secondary Aminoaciduria
120
DEPOSITION OF CYSTINE in the LYSOSOMES of cells throughout the body
Cystinosis
121
Most common & SEVERE FORM of Cystinosis
Nephropathic Cystinosis
122
RARE FORM of Cystinosis
Intermediate Cystinosis/Ocular Cystinosis
123
Autosomal Recessive
Cystinuria
124
Deficient Enzyme: Branched-Chain α-Keto Acid Dehydrogenase (BCKD)
Maple Syrup Urine Disease
125
INCREASED urinary excretion of PHENYLPYRUVIC ACID (a ketone) and its metabolites
Urine, Sweat & Breath: Characteristic MOUSY/MUSTY ODOR
Phenylketonuria
126
Excretion of large amount of HOMOGENTISIC ACID (HGA) in the urine
Alkaptonuria
126
Excretion of large amount of HOMOGENTISIC ACID (HGA) in the urine
Alkaptonuria
127
Increased amount of TYROSINE in the urine → occurs when → tyrosine levels in PLASMA is abnormally high
Tyrosinuria
128
Increased excretion of urinary melanin
Melanuria
129
Defective melanin production
Hypomelanosis / Albinism
