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Urinalysis & Body Fluids > Microscopic Urine Examination > Flashcards

Microscopic Urine Examination Flashcards

1
Q

ideal specimen

A

first morning

most concentrated & acidic

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2
Q

preparation of sediment

A

10-15 ml of well mixed urine less than 2 hr old
slow centrifuge
decant supernatant
one drop of sediment to slide w/ coverslip
examine

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3
Q

Sediment stains

A 
supravital - sternheimer-Malbin
acetic acid - lyses RBC
fat stains
gram stain
prussian blue
hansel stain
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4
Q

Microscopes

A

brightfield- most common
phase-contrast
polarizing: confirms cholesterol & crystals
interference contrast: 3D images

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5
Q

tips for microscopic examination of urine on brightfield

A

lower condenser
close iris
initially view 10x for casts
40x for rest of elements

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6
Q

epithelial cells

A

originate from any site within UT

indicative of infection/inflammation or contamination

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7
Q

squamous epithelial cells

A

large, flat cells with abundant cytoplasm
from vagina or lower portion of male urethra
indicative of vaginal contamination in female urine

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8
Q

Transitional (urothelial) epithelial cells

A

originate in blader, ureters, renal pelvis, renal calyces & upper urethra (males)
small, less cytoplasm; round or pear shaped
large numbers are indicative of bladder carcinoma
random urine is best
‘poached egg’ appearance

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9
Q

renal tubular epithelial cells

A 
found in tubules of nephron
slightly larger than WBC; round eccentric nucleus w/ scant cytoplasm 
indicative of tubular necrosis
stain can be helpful
'hard boiled cut in half'
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10
Q

oval fat bodies

A

lipid containing RTEs, highly refractile
usually seen with free floating fat droplets
occur when lipids pass across the glomerular membrane & are absorbed by the RTEs

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11
Q

RBCs

A

pale, smooth, biconcave small circles

sources of confusion: WBC, yeast, bubbles & oil droplets

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12
Q

hypotonic urine & RBCs

A

low specific gravity

swollen RBC

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13
Q

hypertonic urine & RBCs

A

high specific gravity

crenated RBCs

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14
Q

dysmorphic RBCs

A

glomerular origin

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15
Q

increased RBCs

A

along with RBC casts - renal bleeding

no casts or protein - bleeding below kidney or caused by menstrual contamination

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16
Q

positive dipstick for blood; no RBCs seen

A

RBCs lysed; released hemoglobin

false positive - detects peroxidases

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17
Q

negative strip for blood; RBCs seen

A

ascorbic acid interference causes false negatives

RBC look alikes: yeast or crystals

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18
Q

casts

A

unique to kidney
matrix of uromodulin (tamm-horsfall) protein !!!
factors:
increased protein, increased acidity, high specific gravity, urinary stasis of flow
final stages (4 stages) : waxy cast

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19
Q

casts general structure

A

nearly parallel sides
rounded or blunt ends
various sizes & shapes

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20
Q

hyaline casts

A

most frequently seen

colorless; serves as basis for all casts

21
Q

WBC cast

A

consists of neutrophils
proteinuria will usually also be present
renal infection
acute pyelonephritis (!)

22
Q

RBC casts

A

brown to colorless
contain RBCs
glomerulonephritis!

23
Q

epithelial casts

A

formed as a result of RTEs sloughing off in tubules

seen in tubular damage

24
Q

Granular casts

A

degenerative process changing cellular to granular
coarse to fine to waxy
represents disintegration of cellular casts
seen in periods of stress & exercise

25
Waxy casts
broken off ends w/ cracks & fissures seen in chronic renal disease thought to be final phase of cellular degeneration
26
Fatty casts
represent degeneration of RTE which contain fat | seen in nephrotic syndrome
27
size of casts
broad casts vs narrow casts wider diameter than other casts: usually granular or waxy formed in dilated tubules or collecting ducts
28
bacteria
normal urine is free of bacteria rods or cocci increased numbers may indicate UTI
29
yeast
``` ovoid, colorless cells budding & hyphae vary in size found in vaginal infection w/ urinary contamination UTI do not confuse with RBC ```
30
ways to differentiate yeast & RBC
use acetic acid to lyse RBCs | yeast are oval, budding & can be irregularly shaped
31
parasites
vaginal or fecal contamination Trichomonas vaginalis enterobius vermicularis shistosoma haematobium
32
crystals
can form in urine on standing | significant in freshly voided urine
33
factors influencing crystal formation
concentration of urine solute urine pH slow flow of urine
34
Calcium oxalate
colorless 'envelope' shape chinese folding paper game thing normal
35
uric acid crystals
diamond or football shaped; rosette yellow to red-brown or colorless polarizes into a variety of colors normal, gout, high purine metabolism
36
amorphous urates
``` non-crystalline amorphous forms may precipitate out when refrigerated appear pink macroscopically Na, K, Mg, Ca normal ```
37
bilirubin crystals
small clusters & fine needles indicate bilrubinuria form after urine is cooled so frequently not observed nor reported
38
cystine crystals (acid urine)
``` colorless, refractile HEXAGONAL PLATES like to stack on each other congenital cysitinosis congenital cystinuria ```
39
tyrosine crystals (acid urine)
very fine, highly refractile needles usually in sheaves (bales of hay) severe liver disease aminoaciduria tyrosinosis
40
Leucine crystals (acid urine)
oily, highly refractile spheroids w/ radial & concentric striations yellow/brown liver disease; often seen with tyrosine (!!!!)
41
cholesterol crystals (acid urine)
large, flat transparent plates with notched corners | will polarize a variety of colors
42
Hemosiderin crystals (acid urine)
yellow-brown granules | excessive deposits of iron-containing pigments in RTEs
43
Triple phosphate crystals (alkaline urine)
colorless prisms 3-6 sides 'coffin lids' may be fern -like normal or calculi
44
amorphous phosphate (alkaline urine)
phosphate salts in non crystalline form white macroscopically acetic acid will clear this out
45
calcium carbonate crystals (alkaline urine)
small, colorless DUMBELL or spherical usually form in large granular mass
46
calcium phosphate crystals (alkaline urine)
long, thin, colorless prisms with one pointed end or granular plats can rosette or star very common
47
Ammonium biurate crystals (alkaline urine)
yellow-brown spherical bodies w/ long, irregular spicules | 'thorny apples'
48
artifacts
powder, hair, cotton fibers, oils, lubricants, creams, bubbles & starch

Urinalysis & Body Fluids (8 decks)

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