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Urinalysis > Sediment Analysis > Flashcards

Sediment Analysis Flashcards

1
Q

what is the core protein of urinary casts? Two names, former and new

A

Used to be called Tamm-Horsfall; now uromodulin

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2
Q

where are urinary casts formed?

A

the lumen of the renal tubule

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3
Q

In urinalysis, squamous epithelial cells with large numbers of bacteria adhering are termed?

A

clue cells

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4
Q

Under what type of microscopy do cholesterol droplets in urine exhibit a Maltese cross pattern?

A

polarizing

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5
Q

what are oval fat bodies?

A

either renal tubule epithelial cells which have absorbed fat droplets that escaped through the glomerular membrane, or macrophages containing the lipids which are larger than the RTEs

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6
Q

why are oval fat bodies clinically significant?

A

they indicate a damaged glomerular basement membrane; should report in number per HPF

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7
Q

How do cholesterol droplets in lipiduria appear under polarizing microscopy?

A

as 4 quadrants with a “Maltese cross” pattern

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8
Q

what do cholesterol crystals in urine represent?

A

crystallized free cholesterol in the urine

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9
Q

name some conditions that could cause oval fat bodies or fatty hyaline casts?

A

nephrotic proteinuria, polycystic kidney disease, Fabry disease

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10
Q

what is the most used supravital (stains living cells) stain of urine sediment?

A

Sternheimer-Malbin- for id’ing blood cells, casts and other formed elements

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11
Q

what is a Sedi-stain

A

a modified Sternheimer-Malbin, stabilized

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12
Q

what is the usefulness of Sudan III or Oil Red-O stains?

A

confirms present of fat in urine, orange or red stain

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13
Q

what is Prussian blue used to identify in urine?

A

hemosiderin, which can be free-floating or in epithelials or casts

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14
Q

this stain aids in i.d. of eosinophils in urine

A

Hansel stain- methylene blue and eosin-Y plus methanol

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15
Q

what does toluidine blue stain aid in the identification of?

A

white blood cells versus renal tubular epithelial cells

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16
Q

what type of microscopy can entail a difficulty to identify low-refractile constituents of urine and what can help?

A

brightfield; can use lower light OR USE PHASE CONTRAST instead

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17
Q

name some difficult to view elements of urine and what microscopy can enhance viewing

A

hyaline casts, RBC ghost cells, and bacteria: phase-contrast microscopy

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18
Q

what can appear similar to cholesterol under polarizing microscopy and what clues you that it is not?

A

starch granules and some drug-induced crystals can appear as pseudo-Maltese cross but have quadrants of UNEQUAL SIZE.

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19
Q

what are the components of the Sternheimer-Malbin stain? what kind of stain is it?

A

crystal violet and safranin; it’s a supravital stain

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20
Q

what components of urine do NOT polarize light?

A

RBCs, casts, mucus, bacteria, cells, cell debris such as mmbrn phospholipids

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21
Q

what urine components DO POLARIZE light?

A

monohydrate calcium oxalate crystals, fibers, amorphous crystals urates strongly, phosphates weakly or negatively; cholesterol and starch granules

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22
Q

what is in the HAnsel stain?

A

methylene blue and eosin-Y in methanol

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23
Q

what type of microscopy is good for translucent/ low refractility components such as hyaline casts. bacteria, ghost RBCs?

A

phase contrast

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24
Q

what is polarizing microscopy best for viewing?

A

fat, esp cholesterol, in urine

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25
Q

are casts in urine normal? what about transitional and squamous cells?

A

0 to 2 per LPF only; yes, a few

26
Q

how would you differentiate yeast from RBCs in urine?

A

yeast varies in size more, and tends to be spherical or ovoid not biconcave; also, it often has BUDDING

27
Q

If lotion or oil contaminates a urine specimen, it can mimic RBC appearance. Differentiate:

A

the droplets will vary in size but look uniform otherwise and be highly refractile. The chemical blood test will be negative

28
Q

what can cause ghost RBCs?

A

dilute and/or alkaline urine, bc it can cause hemoglobin to leak and leave a pale empty membrane

29
Q

how do RBCs appear in hypertonic urine?

A

crenated, they dehydrate. “burr cell-like”.

30
Q

how do renal collecting duct cells appear diff from WBCs in brightfield viewing?

A

they have polygonal shape

31
Q

what are glitter cells and in what type of urine sample found?

A

swollen spherical WBCs with refractile cytoplasmic granules; found in hypotonic urine

32
Q

two ways to confirm lipid inclusions in urine?

A

polarizing microscopy, or fat stains like Sudan III or Oil Red

33
Q

When may transitional epithelial cells increase in urine samples?

A

with UTI or inflammation; can see SHEETS of them after procedures such as catheterization or cystoscopy

34
Q

other name for transitional cells

A

urothelial

35
Q

what are decoy cells? why so named?

A

transitional or renal tubular cells infected with the polyomavirus of the BK strain, BKV; potential mis-ID as malignant

36
Q

describe a decoy cell

A

“comet like” transitional or renal epithelial cell infected with Polyomavirus, BKV. Nucleus eccentric, abnormal chromatin (ground glass), cytoplasmic vesicles

37
Q

difference in appearance between spherical urothelial cells and tubular epithelial cells:

A

former have central nucleus, latter is eccentric

38
Q

what is the most commonly seen cast in urine sediment? what is it composed of?

A

hyaline casts, low refractility, made mainly of a homogenous uromodulin protein matrix

39
Q

what is a normal number of hyaline casts and when may it be increased?

A

two or fewer is normal. Increases mayb occur from extreme stress, exercise, dehydration, or accompanying pathologic casts in other diseases

40
Q

what is a major difference between hyaline and waxy casts on brightfield ?

A

waxy casts have a high refractive index so are readily visible, with well defined edges and possible blunt or sharp or uneven ends

41
Q

how do waxy casts appear differently than hyaline with a Sternheimer-Malbin stain?

A

they are a darker pink with a diffuse ground-glass look; also more broad from being in a dilated tubule

42
Q

what do waxy casts imply?

A

prolonged stasis and tubular obstruction; they represent an advanced stage of the other casts types (hyaline, granular, cellular) that are transformed during stasis over 48 hours

43
Q

In whom are waxy casts most frequent?

A

pts with chronic renal failure; also in acute or in malignant hypertension

44
Q

what kind of inclusions can be found in casts?

A

RBCs, WBCs, renal tubular cells, mixed cells, bacterial casts

45
Q

before reporting an RBC cast what must be observed floating in the sediment?

A

free-floating RBCs

46
Q

what are muddy brown casts aka and how formed?

A

blood casts, form if urine stasis is sufficient then the RBC casts degenerate into pigmented granular casts

47
Q

how do WBC casts appear diff than RBC?

A

cells are more refractile and readily apparent

48
Q

what do oval fat bodies in fatty casts indicate?

A

renal tubular cell death, a significant pathologic condition

49
Q

what should each be accompanied by on the chemical tests: RBC casts, leuko casts, bile-pigmented casts

A

RBC casts: chem blood positive or accounted for if negative before reporting the cast. Leukocyte casts: may have + leuko esterase, nitrite form bacteriuria. Bile pig: pos chem bilirubin , or for Hmg/myoglobin, + for blood

50
Q

When are urine crystals always cilnically significant?

A

in freshly voided urine, bc that means they formed in vivo, not on standing. Crystals formed in nephrons can cause damage

51
Q

what helps ID look-alike crystals?

A

the pH at which they are present

52
Q

What are normal crystals in acid urine; and in alkaline….

A

acid: amorphous urates (yellow-brown grans, pink sediment), uric acid, and calcium oxalate
alkaline: amorphous phosphates (white ppt in urine), triple phosphate, ammonium biurate, calcium carbonate

53
Q

how do triple phosphate crystals appear?

A

“coffin lid”, 3 to 6 sided prisms

54
Q

how do acid urate crystals appear? when are they present, and what often misidentified as?

A

small yellow-brown balls, can be mistaken for leucine crystals; present in neutral to slight acidity but not usually in fresh urine

55
Q

acid urates dissolve at?

A

60 C

56
Q

describe monosodium urate crystals

A

colorless to light yellow, narrow pencil like, can be in small clusters, ends not pointy. Present in acid pH

57
Q

most common uric acid crystal shapes:

A

rhomoid/diamond, or cubes, barrels, or clustered into rosettes, with lamination

58
Q

uric acid crystal color

A

yellow to golden brown

59
Q

describe the two calcium oxalate crystal forms

A

monohydrate: small and ovoid (barrelish)
dihydrate: “envelope”/ octahedral forms

60
Q

what about the small calcium oxalate crystals help distinguish them from RBCs?

A

thy are strongly birefringent under polarizing microscopy

61
Q

what kind of poisoning may cause calcium oxalate crystals?

A

antifreeze

62
Q

differentiate calcium phosphate and magnesium phosphate crystals. Both grow in alkaline or neutral urine

A

Ca: occur as dibasic with rosettes of wedges or bundles of needles, colorless, or monobasic as sheets
Mg: large colorless, elongated rectangular or rhomboid

Urinalysis (6 decks)

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