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Urinalysis (BIOL 380) > Quiz 3 > Flashcards

Quiz 3 Flashcards

0
Q

Specimen Preparation

A

Fresh and adequately preserved

Well mixed

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1
Q

What is the purpose of a microscopic examination?

A

To detect, identify, and semi-quantitate formed elements in the urine sediment

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2
Q

Specimen Volume

A

10-15 ml in conical tube (usually 12 ml)

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3
Q

Centrifugation

A

Do not use brake and cap all specimens usually 1500 rpm for 5 minutes

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4
Q

Sediment Preparation

A

Leave volume of 1.0 ml or 12:1 concentration
Aspirate supernate with pipette
Gently resuspend the sediment

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5
Q

Volume of Sediment Examined

A

Traditional – 1 drop with 22x22 glass cover slip; avoid overflow outside cover slip

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6
Q

Examination of Sediment

A

Bright field most common microscopy used
Reduce light and use continuous fine adjustment focusing
Exam under power (100x) at least 10 field
Identify using high power (400x) for at least 10-15 fields

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7
Q

Kova Stain

  1. Chemicals
  2. Identification
A

Most frequently used

  1. Crystal violet and Safranin O
  2. Identify WBCs, Epithelial, and Casts
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8
Q

2% Acetic Acid

  1. Purpose
  2. Identification
A
  1. Lyses RBCs

2. Distinguish WBC, yeast, oil droplets, and crystals

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9
Q

Lipid Stains

  1. Chemicals
  2. Identifies
A
  1. Oil Red O and Sudan III

2. Stains Triglycerides and neutral fats orange-red, but does not stain cholesterol

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10
Q

Prussian Blue Stain

1. Stain

A
  1. Stain hemosiderin blue
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11
Q

Cytodiagnostic Urine Testing

  1. What department?
  2. Type of stain?
  3. Clinical Significance
A
  1. Cytology Department
  2. Papanicolaou Stain
  3. Renal disease and malignancies of lower urinary tract
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12
Q

What is the normal value for RBC in the urine sediment?

A

0-2 RBC / hpf

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13
Q

What is the normal value for WBC in a urine sediment?

A

0-4 / hpf

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14
Q

What is the normal value of epithelial cells in the urine sediment?

A

Few epithelial cells

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15
Q

What is the normal value of hyaline casts in a urine sediment?

A

0-2 Hyaline casts / lpf

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16
Q

What is the normal amount of mucus found in a urine sediment?

A

Trace amounts

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17
Q

How do you calculate the amount of red blood cells in a microscopic?

A

Calculate average # in 10 hpf

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18
Q

Crenated Red Blood Cells

A

Hypersthenuric –> high osmotic pressure in urine

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19
Q

Ghost Cells

A

Lysed RBCs with only cell membrane left –> result of acetic acid

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20
Q

Dysmorphic Red Blood Cells

A

Indicative of glomerular damage

Vary in size and cellular background

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21
Q

Hematuria

A

Presence of RBC in urine

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22
Q

What does hematuria indicate?

A

Renal disease; bleeding in urinary tract; infection; tumor; strenuous exercise; trauma; inflammation; stones; catheterization

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23
Q

Pyuria

A

Presence of WBC in urine

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24
Q

How do you calculate white blood cells in a microscopic?

A

Calculate # / hpf (using at least 10 fields)

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25
Q

What white blood cell is most common in the urine?

A

Granulated, multilobed nucleated neutrophils

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26
Q

Glitter Cells

A

Neutrophils that have swelled due to a hypotonic urine

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27
Q

Eosinophils

A

Drug induced allergies

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28
Q

Mononuclear cells

A

Monocytes, lymphocytes, macrophages, histiocytes

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29
Q

What stain is used to enhance nuclear detail of white blood cells?

A

Supravital stains or acetic acid

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30
Q

What are white blood cells in the urine sediment indicative of?

A

Infection or inflammation of genitourinary system

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31
Q

What are epithelial cells in a urine sediment derived from?

A

Derived from normal sloughing of old cells from the linings of the genitourinary system

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32
Q

Origin of Squamous Epithelial Cells

A

From linings of vagina, female urethra, lower portion of male urethra

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33
Q

Characteristics of squamous epithelial cells

A

Largest cell in urine sediment with abundant, irregular cytoplasm and prominent nucleus

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34
Q

Clue Cell

A

Squamous variation with pathological significance: Gardnerella vaginalis covers cell surface

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35
Q

Transitional Epithelial Cell: Origin

A

From lining of renal pelvis, calyces, ureters, bladder, and upper portion of male urethra

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36
Q

Characteristics of Transitional Epithelial Cells

A

Absorb large amounts of water causing a variety of forms (caudate, polyhedral, spherical, flat, cube shaped, columnar)

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37
Q

What is an increase in transitional epithelial cells indicative of?

A

Viral infection or malignancy

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38
Q

Origin of Renal Tubular Epithelial Cells

A

Proximal Convoluted Tubule
Distal Convoluted Tubule
Collecting Duct

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39
Q

Characteristics of RTE (proximal convoluted tubule)

A

Larger, rectangular (column)

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40
Q

Characteristics of RTE from Distal Convoluted Tubule

A

Smaller, round, or oval

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41
Q

Characteristics of RTE from Collecting Duct

A

Cuboidal (never round) with one straight edge

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42
Q

What are RTE cells indicative of?

A

Necrosis of renal tubules due to drugs, hemoglobin, and metal toxicity

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43
Q

Function of RTE cells

A

Reabsorption of glomerular filtrate and can contain filtrate substances such as bilirubin, hemosiderin, and oval fat bodies

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44
Q

Oval Fat Bodies

A

Lipids, highly refractile
Fat stains stain triglycerides and neutral fats
Cholesterol – polarized – Maltese cross formed

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45
Q

Bacteria

1. Types

A

Rod or cocci

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46
Q

What does bacteria indicate?

A

Upper or lower urinary tract infection especially if seen with WBCs, positive nitrite, and positive leukocyte esterase and should be cultured for identification

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47
Q

Characteristics of Yeast

A

Small, oval, refractile cells with or without buds or mycelia

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48
Q

What is the most common yeast infection?

A

Candida albicans

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49
Q

What increases your chances of a yeast infection?

A

Diabetes, pregnancy, immunocompromised patients, vaginitis

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50
Q

What is the most common parasite encountered?

A

Trichomonas vaginalis

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51
Q

Characteristics of spermatozoa

A

Tapered, oval head with long flagella-like tail

52
Q

What does urine do to sperm?

A

Toxic to sperm so rarely moving

53
Q

When is sperm found in urine in females and males?

A

Sexual intercourse, masturbation, nocturnal emissions

54
Q

Mucus

A

Protein produced by glands, epithelial cells of lower genitourinary tract, and RTE cells

55
Q

What is the main constituent of mucus?

A

Tamm-Horsfall Protein

56
Q

What are the characteristics of mucus under the microscope?

A

Single or clumped, long thread-like structures with low refractive index

57
Q

Cylindruria

A

Presence of urinary casts

58
Q

Where are casts formed?

A

Within the lumen of the distal convoluted tubules and collecting duct

59
Q

What are the overall characteristics of casts?

A

Parallel sides with rounded ends and may contain filtrate elements
(column like)

60
Q

What view (purpose) do casts show?

A

Microscopic conditions of the kidney

61
Q

What are casts a result of (how are they formed)?

A

Result of solidification of protein within the lumen of kidney tubule and may trap filtrate elements within its matrix

62
Q

What is the protein matrix of casts made out of?

A

Mainly Tamm-Horsfall protein

63
Q

What are the conditions for cast formation?

A

Protein gels more readily with urine flow stasis, acidity, and presence of Na and Cl

64
Q

What conditions cause casts secretions?

A

Stress and exercise

65
Q

What type of urine usually inhibits cast formation?

A

Dilute alkaline urine

66
Q

How are casts classified?

A

Based on their inclusions

67
Q

What cast is most frequently seen in the urine?

A

Hyaline casts

68
Q

What are the characteristics of a hyaline cast?

A

Colorless, homogenous, semitransparent with low refractive index with varied morphology

69
Q

What do hyaline casts consist of?

A

Tamm-Horsfall Protein

70
Q

What causes an increase of hyaline casts in the urine?

A

Exercise, dehydration, heat exposure, emotional stress

71
Q

What do a large number of hyaline casts indicate?

A

Glomerulonephritis, pyelonephritis, chronic renal disease, and congestive heart failure

72
Q

What are the characteristics of red blood cell casts?

A

Orange-red color with casts matrix containing RBCs

73
Q

What are red blood cell casts associated with pathologically?

A

Bleeding within the nephron and glomerulus damage as well as strenuous exercise and contact sports

74
Q

What are WBC casts associated with pathologically?

A

Associated with infection (pyelonephritis) or inflammation (acute interstitial nephritis) in nephron

75
Q

What stain do you use to ID white blood cell casts?

76
Q

Bacterial Casts (definition)

A

Bacilli in and bound to protein matrix

77
Q

What are bacterial casts indicative of?

A

Pyelonephritis

78
Q

Epithelial Casts (definition)

A

RTE cells are attached to protein matrix

79
Q

What are Epithelial casts indicative of?

A

Advanced renal tubular damage

80
Q

Fatty Casts Definition

A

Fat droplets and oval fat bodies attached to protein matrix (lipiduria)

81
Q

What are the characteristics of fatty casts?

A

Highly refractile

Contain yellow-brown fat droplets

82
Q

What are fatty casts associated with pathologically?

A

Nephrotic Syndrome

83
Q

Granular Casts Definition

A

Coarse and fine granules in cast matrix

84
Q

What are nonpathological granular casts?

A

Lysosomal granules excreted from RTE cells during normal metabolism and also seen with strenuous exercise and stress

85
Q

What are pathological granular casts?

A

Granules from disintegration of cellular casts and tubular cells or protein aggregates filtered by glomerulus as seen with glomerulonephritis and pyelonephritis

86
Q

Waxy Casts Characteristics

A

Brittle, highly refractile with jagged ends and notches, may have cracks

87
Q

What do waxy casts indicate?

A

Chronic renal failure and extreme stasis of urine flow

88
Q

What is the cause of waxy casts?

A

Caused by disintegration of hyaline or granular casts during stasis

89
Q

Broad casts characteristics

A

Wider than normal cast matrix

90
Q

What are broad casts indicative of?

A

Extreme urine stasis and renal failure

91
Q

What is the cause of broad casts?

A

Broad destruction or widening of tubular walls

92
Q

How are crystals formed?

A

Result of precipitation of urine solutes

93
Q

What affects precipitation of crystals in the urine?

A

Temperature, solute concentration, and pH

94
Q

What level of specific gravity is associated with crystals?

A

High Specific gravity

95
Q

What are abnormal crystals associated with pathologically?

A

Liver disease, inborn metabolic errors renal damage

96
Q

What characteristics of crystals help to identify them?

A

pH
Shapes and colors
Polarized microscopy
Solubility characteristics

97
Q

What type of urine are all abnormal crystals found in?

98
Q

What are the normal crystals found in acidic urine?

A

Amorphous urates
Uric acid crystals
Acid Urates and Sodium Urates
Calcium Oxalate

99
Q

Amorphous Urates

  1. pH?
  2. Characteristics
  3. How to get rid of?
A
  1. Acid
  2. Yellow to brown granules; refrigerated specimens pink sediment
  3. Warm specimen
100
Q

Uric Acid Crystals

  1. pH?
  2. Characteristics?
  3. Associated with what chemicals?
  4. Seen in patients with…
A
  1. Acid
  2. Variety of shapes (rhombic, wedges, 4-sided flat, rosettes, needles); yellow-brown; highly birefringent
  3. Increase in purines and nucleic acids
  4. Gout and leukemic patients undergoing chemotherapy
101
Q

Acid Urates

  1. pH?
  2. Characteristics?
A
  1. Acid

2. Large granules and may have spicules

102
Q

Sodium Urates

  1. pH?
  2. Characteristics?
A
  1. Acid

2. Needle-like and found in synovial fluid with gout

103
Q

Calcium Oxalate Crystals

  1. pH?
  2. Characteristics?
  3. Types?
  4. Associated with…
A
  1. Acid
  2. Colorless, Birefringent
  3. Dihydrate and monohydrate
  4. Renal calculi formation associated with foods and high in oxalic acid such as asparagus
104
Q

Normal Crystals in Alkaline Urines

A
  1. Amorphous Phosphates
  2. Triple Phosphates
  3. Calcium Phosphates
  4. Calcium Carbonate
  5. Ammonium Biurate
105
Q

Amorphous Phosphates

  1. pH?
  2. Characteristics?
A
  1. Alkaline

2. Granular, white to colorless under microscope; white precipitation in refrigerator

106
Q

Triple Phosphate Crystals

  1. pH?
  2. Characteristics?
  3. Associated with?
A
  1. Alkaline
  2. Colorless with prism or “coffin-lid” shape; birefringent
  3. Urea-splitting bacteria
107
Q

Calcium Phosphate

A

Colorless, flat rectangular plates or thin prisms in rosettes

108
Q

Calcium Carbonate

A

Birefingent; colorless with dumbbell or spherical shape; formed from gas with acetic acid

109
Q

Ammonium Biurate

A

Yellow-brown “thorny apples”

Seen in old specimens

110
Q

Abnormal Urine Crystals are found in what type of urine?

111
Q

What are the abnormal urine crystals?

A
  1. Cystine
  2. Cholesterol
  3. Radiographic Dye
  4. Tyrosine
  5. Leucine
  6. Bilirubin
  7. Sulfonamide
  8. Ampicillin
112
Q

Cystine Crystals

  1. Characteristics
  2. Associated with what pathological issue
A
  1. Colorless, hexagonal plates, do not polarize

2. Renal calculi formation

113
Q

Cystinuria

A

Inherited metabolic disorder that prevents reabsorption of cystine in renal tubules

114
Q

Cholesterol Crystals

  1. Characteristics
  2. Associated with?
A
  1. Highly birefringent; rectangular plate with one or more notches in corners
  2. Lipiduria (nephrotic syndrome)
115
Q

Radiographic Dye Crystals

1. Characteristics

A
  1. Highly Birefringent and specific gravity is elevated
116
Q

Tyrosine Crystals

  1. Characteristics
  2. Seen with..
  3. Pathological issue
A
  1. Fine colorless to yellow needles and frequently arranged as clumps or rosettes
  2. Leucine crystals and (+) bilirubin
  3. Severe liver damage and an inherited amino acid metabolism disorder
117
Q

Leucine Crystals

  1. Characteristics
  2. Pathological issue
A
  1. Yellow-brown spheres with concentric circles or radial striations
  2. Severe liver disorder
118
Q

Bilirubin

1. Associated with pathologically??

A
  1. Severe liver damage, renal tubular damage, viral hepatitis
119
Q

Sulfonamide Crystals

  1. What is the drug sulfonamide used for?
  2. What is indicative of sulfonamide crystals?
A
  1. Treatment for UTI and patients with dehydration

2. Suggest renal tubular damage

120
Q

Ampicillin Crystals

1. Pathologically

A
  1. Seen with patients with dehydration
121
Q

Artifacts

  1. Characteristics
  2. Types
A
  1. Highly refractile; different microscope planes

2. Starch granules; oil droplets; air bubbles; pollen grains; hair and fibers; fecal artifacts

122
Q

Starch Granules

1. Characteristics

A
  1. Highly refractile with dimple in the middle
123
Q

Oil Droplets

1. Cause?

A

Immersion oil, lotions, creams

124
Q

Air Bubbles (cause)

A

Cover slip placement

125
Q

Pollen grains (cause and appearance)

A

Seasonal, large size sphere with cell wall

126
Q

Hair and Fibers

  1. Cause
  2. Characteristics
A
  1. Clothing and diapers

2. Polarize

127
Q

Fecal Artifacts

1. Cause

A
  1. Plant, meat fibers, brown amorphous material in a variety of sizes and shapes

Urinalysis (BIOL 380) (4 decks)

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