Mircoscopic examination of urine Flashcards

1
Q

How much urine is used?

A

12 mL

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2
Q

Centrifugation

A

speed: 400-450 g for 5 minutes, no brake.

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3
Q

urine volume to resuspend sediment ration

A

12:1 ratio desired

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4
Q

Low power objective?

A

10x objective, examine perimeter of cover-slip, look for squamous epithelial cells, casts, and mucus. Scan minimum of 10 fields

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5
Q

high power objective?

A

40x, examine center area and look for RBC/WBC< transitional and renal tubular epithelial cells, bacteria, yeast, sperm, trichomonads, crystals

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6
Q

Red blood cells:

A

intact RBC: hematuria

normal: 0-3/hpf
abnormal: damage to basement membrane of glomerulus, kidney infection, kidney stones, trauma

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7
Q

What do RBC look like?

A

smooth biconcave discs, no nucleus

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8
Q

Crenate RBC

A

seen in concentrated urine( high SG), water leaves RBC

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9
Q

Ghost RBC

A

occurs in dilute urine when RBC swells and water enters cell and burst

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10
Q

What do RBC resemble?

A

yeast, oil droplets, air bubbles, calcium oxalate crystals, WBC

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11
Q

WBC: leukocytes

A

indicates infection. normal: 0-5, neutrophil is predominant type of WBC found in urine

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12
Q

what do WBC’s look like?

A

spherical, contain segmented nucleus, granules, 2x larger than RBC, can be found in clumps

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13
Q

What happens to WBC in dilute urine?

A

WBC swell and lyse, GLitter cells

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14
Q

what happens to WBC in concentrated urine?

A

WBC become smaller, do not crenate

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15
Q

what can WBCs resemble?

A

renal tubular epithelial cells, crenated RBCS

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16
Q

WBC physical and chemical correlation?

A

physical exam: odor/clarity
chemical: positive reagent strip for leukocyte esterase, non-granular WBC will not react with reagent strip reaction (false negative)

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17
Q

Why are epithelial cells in urine?

A

normal sloughing, inflammation, renal disease, common contaminant in femal species

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18
Q

squamous epithelial cells

A

most common type, largest, originates in superficial lining of urethra and vagina, increased numbers may mean poor collection technique

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19
Q

Transitional epithelial cells

A

originates in lining of renal pelvis, ureters, bladder, and upper urethra. Increased numbers may indicate urinary tract infection, or collection by catheterization, and malignancy

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20
Q

renal tubular epithelial cells

A

originates in lining of renal tubules, increased numbers indicate tubular necrosis

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21
Q

squamous epithelial cells under microscope

A

enumerate using low power, cells are thin and flat, central nucleus, fine granulation in cytoplasm

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22
Q

clue cells

A

squamous epithelial cells with large amount of bacteria adhering to them, “shaggy”, originates in vaginal mucosa, indicates bacterial vaginal infection

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23
Q

transitional epithelial cells unde rmicroscope

A

most common type is from bladder, larger than WBC< nucleus to cytoplasm ration is 1:5, nucleus in center, use high power

24
Q

renal tubular epithelial cell under microscope

A

shape varies, usually slightly larger than WBC< nucleus is eccentric, nucleus to cytoplasm ration 1:1, high power objective,

25
Q

oval fat bodies

A

RTE cell with absorbed fat, , maltese cross to verify, may also see free floating fat droplets, indicates pathology, use high power

26
Q

casts:

A

normal: few hyaline or few granular casts
abnormal: increased number and type of cast significant. RBC/WBC always pathologic
only formed in kidney

27
Q

what is in a cast?

A

consists of uromodulin matrix, formerly called Tamm-Horsfall protein, does not react with protein reagent strip test

28
Q

what enhances cast formation?

A

acidity of urine, increased solute concentration, decreased urine flow rate, presence of plasma proteins

29
Q

characteristics of casts

A

cylindrical, cigar shape, parallel sides, vary in length and width, mucus and fibers can be misidentified as casts

30
Q

Cast identification/calssification

A

enumerate using low power objective; identify using high power objective

31
Q

what is the youngest cast?

A

hyaline

32
Q

what is the oldest cast

A

waxy

33
Q

hyaline cast

A

hard to see in bright field microscopy, most common cast, normal: 0-2, increased amounts seen in dehydration, fever, emotional stress, strenuous exercise

34
Q

RBC cast

A

RBC inside a hyaline cast, , cast may appear yellow to reddish-brown, always pathologic

35
Q

WBC cast

A

WBC inside hyaline cast, look for lobed nucleus, always pathologic

36
Q

granular cast

A

aged cellular cast: fine or coarse granules, pathologic if increased

37
Q

waxy cast

A

highly retractile, homogeneous texture, well defined edges, blunt uneven ends, may see cracks along length of cast, may appear yellow to gray to colorless. pathologic: prolonged stasis

38
Q

fatty cast

A

highly refactile, fatin form of free fat droplets or oval fat bodies inside cast, use polarized microscopy, pathologic finding, often seen in nephrotic syndrome

39
Q

crystals

A

not normally found in fresh urine, if in fresh urine is pathologic, usually found in acidic urine

40
Q

what enhances crystal formation

A

increased concentration of solute, urine pH, urine stasis, temperature

41
Q

Normal acid pH crystals

A

amorphous urates, uric acid, calcium oxalate

42
Q

amorphous urate

A

normal acid pH crystal, look like sand, often seen after urine is refrigerated, pink sediment after urine centrifugation

43
Q

uric acid crystals

A

acid pH urine, many forms, multicolored when polarized, diamond shaped most common form

44
Q

calcium oxalate crystals

A

acid pH urine, most frequently observed crystal in urine, most common form is octahedryl shape “envelope”, multicolored when polarized

45
Q

normal alkaline pH crystals

A

amorphous phosphates, triple phosphate, ammonium biurate

46
Q

amorphous phosphates

A

no distinct form, sand like, alkaline pH urine, seen after urine is refigerated

47
Q

triple phosphate crystals

A

most frequently seen in alkaline urine, colorless, prisms, coffin lid crystals

48
Q

ammonium biurate crystals

A

alkaline pH urine, yellow spheres with spicules on surface, thorny apple crystals, significant if fresh urine

49
Q

pathologic crystals:

A

cystine, tyrosine, leucine, cholesterol, bilirubin

50
Q

cystine crystals

A

colorless hexagonal plates, do not polarize, can be confused with uric acid crystals. Rare

51
Q

cholesterol crystals

A

clear, large, flat, rectanglue plates with notched corners, multicolored when polarized,also should see proteinuria and lipiduria

52
Q

leucine crystals

A

yellow-brown spheres with concentric circles on surface (tree trunk), can resemble free fat globules

53
Q

tyrosine crystals

A

colorless or yellow-brown fine delicate needles

54
Q

bilirubin crystals

A

yellow-brown small clusters of needles or granules, must confirm with positive ictotest, when present in urine, indicate large amount is present

55
Q

bacteria

A

most often rod-shaped, vary in size, use high power, presence may indicate UTI/contamination, usually alkaline pH

56
Q

yeast and mycelial elements

A

budding forms or singly, ovoid and more refractile than RBC, will not lyse iwth acetic acid or KOH,

57
Q

trichomonas vaginalis

A

round to lemon pear shape, undulating membrane and flagella, STD,