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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
Q

Waxy casts

A

broken off ends w/ cracks & fissures
seen in chronic renal disease
thought to be final phase of cellular degeneration

26
Q

Fatty casts

A

represent degeneration of RTE which contain fat

seen in nephrotic syndrome

27
Q

size of casts

A

broad casts vs narrow casts
wider diameter than other casts: usually granular or waxy
formed in dilated tubules or collecting ducts

28
Q

bacteria

A

normal urine is free of bacteria
rods or cocci
increased numbers may indicate UTI

29
Q

yeast

A 
ovoid, colorless cells
budding & hyphae
vary in size
found in vaginal infection w/ urinary contamination
UTI
do not confuse with RBC
30
Q

ways to differentiate yeast & RBC

A

use acetic acid to lyse RBCs

yeast are oval, budding & can be irregularly shaped

31
Q

parasites

A

vaginal or fecal contamination
Trichomonas vaginalis
enterobius vermicularis
shistosoma haematobium

32
Q

crystals

A

can form in urine on standing

significant in freshly voided urine

33
Q

factors influencing crystal formation

A

concentration of urine solute
urine pH
slow flow of urine

34
Q

Calcium oxalate

A

colorless ‘envelope’ shape
chinese folding paper game thing
normal

35
Q

uric acid crystals

A

diamond or football shaped; rosette
yellow to red-brown or colorless
polarizes into a variety of colors
normal, gout, high purine metabolism

36
Q

amorphous urates

A 
non-crystalline amorphous forms
may precipitate out when refrigerated
appear pink macroscopically
Na, K, Mg, Ca
normal
37
Q

bilirubin crystals

A

small clusters & fine needles
indicate bilrubinuria
form after urine is cooled so frequently not observed nor reported

38
Q

cystine crystals (acid urine)

A 
colorless, refractile
HEXAGONAL PLATES
like to stack on each other
congenital cysitinosis
congenital cystinuria
39
Q

tyrosine crystals (acid urine)

A

very fine, highly refractile needles usually in sheaves (bales of hay)
severe liver disease
aminoaciduria
tyrosinosis

40
Q

Leucine crystals (acid urine)

A

oily, highly refractile spheroids w/ radial & concentric striations
yellow/brown
liver disease; often seen with tyrosine (!!!!)

41
Q

cholesterol crystals (acid urine)

A

large, flat transparent plates with notched corners

will polarize a variety of colors

42
Q

Hemosiderin crystals (acid urine)

A

yellow-brown granules

excessive deposits of iron-containing pigments in RTEs

43
Q

Triple phosphate crystals (alkaline urine)

A

colorless prisms 3-6 sides ‘coffin lids’
may be fern -like
normal or calculi

44
Q

amorphous phosphate (alkaline urine)

A

phosphate salts in non crystalline form
white macroscopically
acetic acid will clear this out

45
Q

calcium carbonate crystals (alkaline urine)

A

small, colorless
DUMBELL or spherical
usually form in large granular mass

46
Q

calcium phosphate crystals (alkaline urine)

A

long, thin, colorless prisms with one pointed end or granular plats
can rosette or star
very common

47
Q

Ammonium biurate crystals (alkaline urine)

A

yellow-brown spherical bodies w/ long, irregular spicules

‘thorny apples’

48
Q

artifacts

A

powder, hair, cotton fibers, oils, lubricants, creams, bubbles & starch

Urinalysis & Body Fluids (8 decks)

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