Microscopic Examination of Urine

Question 1

Intact RBC

Answer 1

hematuria

normal: 0-3/hpf

Question 2

White blood cells

Answer 2

leukocyturia
normal: 0-5/hpf
only react in chemical exam if the WBC has granules in cytoplasm

Question 3

Squamous epithelial cells

Answer 3

superficial lining of urethra & vagina

increased # = poor collection technique

Question 4

Clue Cells

Answer 4

squamous epithelial cells w/ large amounts of bacteria adhering to them

Question 5

Transitional epithelial cells

Answer 5

line renal pelvis, ureters, BLADDER

nucleus:cytoplasm ~ 1:5

Question 6

Renal Tubular Epithelial Cells

Answer 6

line renal tubules

nucleus: cytoplasm - 1:1

Question 7

Oval Flat bodies

Answer 7

renal tubular epithelial cells w/ absorbed fats
pathology = can’t metabolize fats
protein strip test also usually positive (both for pathology)

Question 8

Where are casts formed?

Answer 8

Renal rubules

Question 9

Formation of casts enhanced by

Answer 9

acidity, increased solute concentration, urine stasis, presence of plasma proteins

Question 10

Order of casts youngest to oldest

Answer 10

hyaline/cellular -> granular -> waxy

Question 11

Hyaline casts

Answer 11

normal: 0-2/lpf

stress, dehydration, exercise

Question 12

RBC Cast

Answer 12

RBC inside hyaline casts

pathologic condition

Question 13

WBC Cast

Answer 13

WBC inside hyaline cats

pathologic condition

Question 14

Granular Cast

Answer 14

aged cellular cast

pathologic if increased

Question 15

Waxy Casts

Answer 15

yellow,gray -> colorless
prolonged stasis
pathologic

Question 16

Fatty cast

Answer 16

fat in the form of free fat droplets or oval fat bodies inside cast
-pathologic: neprhotic syndrome

Question 17

Crystals (general)

Answer 17

not normally found in fresh urine - pathologic

all clinically sig. crystals found in acidic urine

Question 18

Crystal formation enhanced by..

Answer 18

increased solute
urine pH
urine stasis
cool temps

Question 19

Normal Acid pH Crystals

Answer 19

amorphous urates
uric acid
calcium oxalate

Question 20

Normal alkaline pH crystals

Answer 20

amorphous phosphates
triple phosphate
ammonium biurate

Question 21

Tyrosine Crystals

Answer 21

colorless or yellow-brown delicate needles

liver disease, inborn error of metabolism

Question 22

Pathologic Crystals

Answer 22

cystine
tyrosine
leucine
cholesterol
bilirubin

Question 23

Cholesterol crystals

Answer 23

seen w/ proteinura, lipiduria

Question 24

bilirubin crystals

Answer 24

must confirm w/ positive ictotest

severe liver disease

Question 25

RBC > 3/hpf

Answer 25

damage to basement membrane of glomerulus, kidney infection, kidney stones

Question 26

WBC > 5/hpf

Answer 26

infection

Question 27

presence of squamous epithelial cells

Answer 27

poor collection technique
clue cells
vaginal contamination

Question 28

presence of transitional epithelial cells

Answer 28

lower UTI
collection by catheterization
malinancy

Question 29

presence of renal tubular epithelial cells

Answer 29

tubular necrosis

Question 30

presence of oval fat bodies

Answer 30

pathologic

can’t metabolize fats

Question 31

hyaline casts >2/lpf

Answer 31

dehydration
fever
emotional stress
strenuous exercise

Question 32

Acute post-streptococcal glomerulonephritis

Answer 32

1-2 weeks after strep
sudden onset of fever, malaise, HA, nausea
\+blood
\+protein (<1.0g/24hrs)
microscopic: RBC, RBC casts

Question 33

Nephrotic syndrome

Answer 33

pitting edema, azotemia, HTN. oliguria
+blood
+protein (>3.5g/24hrs)
microscopic: RBC, Oval fat bodies, fatty casts
blood: hypoproteinemia, increased lipids, increased sodium

Question 34

Diabetes Mellitus

Answer 34

polyuia
polydispisa
polyphagia
nocturia
\+glucose
\+protein
\+ketones
Microscopic: RBC, Yeast
Blood: increased glucose, ketones