UNIT 5 Flashcards
smooth,Non-nucleated biconcave
disks measuring approximately 7
microscopic RBC
Larger than RBCs, measuring an
average of about 12 mm in diameter
microscopic WBCs
The predominant WBC found in the
urine sediment
much easier to
identify than RBCs because they
contain granules and multilobed
nuclei
lyse rapidly in dilute
alkaline urine and begin to lose
nuclear detail.
neutrophils
Brownian movement of the
granules within these larger
cells produces a sparkling
appearance
○ no pathologic significance
glitter cells in hypotonic urine
Largest cells in the sediment with
abundant, irregular cytoplasm and
prominent nuclei about the size of an
RBC
●Hallmark (Point of Reference)
squamous cells
Rarely encountered, folded cells may
resemble casts and will begin to
disintegrate in urine that is not fresh.
squamous epithelial cells
increase in urinary WBCs
is called ______ and indicates
the presence of an infection
or inflammation in the
genitourinary system.
pyuria
Specimens containing an increased amount of mononuclear cells that cannot be
identified as epithelial cells should be referred for
cytodiagnostic urine testing
are usually larger than WBCs with an eccentrically located nucleus.
RTE
Rare, few, moderate, or man per
lpf
They are reported in terms of
low-power or high-power
magnification based on laboratory
protocol.
squamous epithelial
the first structures observed when the urine sediment is examined under lph.
squamous epithelial
cells originate from the linings of the vagina and female urethra and the lower portion of the male urethra.
○ represent normal cellular sloughing and have no pathologic significance.
squamous cells
are indicative of vaginal infection by the bacterium
clue cells
gardenella vaginalis
They appear as squamous epithelial cells covered with the
clue cells
gardenella coccobacillus
To be considered a clue cell, the bacteria should cover most of the cell surface and extend beyond the edges of the cell.
TRUE
Routine testing for clue cells is performed by examining a
vaginal wet preparation
Spherical, polyhedral, or caudate with
centrally located nucleus
transitional cells
These differences are caused by the
ability of transitional epithelial cells
to absorb large amounts of water.
TRUE
are the
most often seen TCs
in microscopic exams
spherical TC
The presence of a centrally located
rather than eccentrically placed nucleus,
and supravital staining, can aid in the
differentiation.
TRANSITIONAL CELLS
originate from the lining of the renal pelvis, calyces, ureters, and bladder, and from the upper portion of the male
urethra.
transitional epithelial cells
Increased numbers of transitional cells seen singly, in pairs, or in clumps (syncytia) are present following invasive urologic procedures such as
catheterization and are of no clinical significance
TRUE
Rectangular, columnar, round, oval or,
cuboidal with an eccentric nucleus
possibly bilirubin-stained or
hemosiderin-laden
RTE CELLS
Most often seen is the Round Oval
Cytoplasm is granular
RTE CELLS
bigger than WBC
RTE
larger than other RTE Cells.
Cytoplasm is coarsely granular
■ Resembles casts.
CELLS FROM PCT
are smaller than those from the PCT
Round or Oval
■ Can be mistaken for WBC and Spherical Transitional Epithelial Cells
CELLS FROM DCT
cuboidal and never round.
■ Presence of at least one straight edge differentiates them from spherical and polyhedral transitional cells.
COLLECTING DUCTS RTE
appears in groups of three or more are called
cells from collecting duct
renal fragments
most clinically significant of the epithelial cells.
RTE CELLS
presence of more than two RTE cells per high-power field indicates
tubular injury
Highly refractile RTE cells
●Polarizing Microscope
○Maltese Cross Formation
oval fat bodies - type of RTE cell
ovl fat bodies are confirmed using
sudan III or oil red O
used in specimen collection must be considered when only free-floating fat droplets are present.
lubricants
most frequently associated with damage to the glomerulus caused by the nephrotic syndrome
lipiduria
small spherical and rod-shaped
structures
●can be seen in stool smears either
rods or cocci
●Hallmark: motile
bacteria
Pear-shaped, motile, flagellated
trichomonas
most frequent parasite encountered in the urine
trichomonas
Small, oval, refractile structures with
buds and/or mycelia
yeast
In severe infections, they may appear as branched, mycelial forms
yeast
A true yeast infection should be accompanied by the presence of
WBCs
Single or clumped threads with a low
refractive index
mucus
Mucous Threads came
from.
genitalia
major constituent of mucus.
uromodulin
glycoprotein excreted by the RTE cells of the distal convoluted tubules and upper collecting ducts.
uromodulin
appears microscopically as thread-like structures with a low refractive index.
mucus
Subdued light is required when using bright-field microscopy
mucus
Mucus is more frequently present in _____ urine specimens
female
Mucus threads are reported as rare, few, moderate, or many per
lpf
Most common type of cast
○ consists almost entirely of uromodulin.
hyaline casts
Pathologically, hyaline casts are ______ in
acute glomerulonephritis, pyelonephritis, chronic renal
disease, and congestive heart failure.
increased
Tamm-Horsfall protein
Dehydration or exercise
hyaline casts
appear colorless in unstained sediments and have a
refractive index similar to that of urine; thus, they can easily be
overlooked if specimens are not examined under subdued light.
hyaline casts
Sternheimer-Malbin stain produces a ____ color in hyaline casts
pink
Always pathological
Glomerular Damage
Glomerulonephritis
Vasculitis
RBC CAST
have also been observed in healthy individuals following participation in
strenuous contact sports. _____ are easily detected under low power by their
orange-red color.
RBC CASTS
They are more fragile than other casts and may exist as fragments or have a more irregular shape as the result of tightly packed cells adhering to the protein
matrix.
RBC CASTS
Inflammation or infection
Pyelonephritis
Allergic interstitial nephritis
Nephrotic Syndrome
Post-streptococcal glomerulonephritis
WBC CASTS
are visible under low-power magnification but must be
positively identified using high power. Most frequently, ______
are composed of neutrophils; therefore, they may appear
granular, and, unless disintegration has occurred, multilobed
nuclei will be present.
WBC CASTS
Colorless, homogeneous
matrix
hyaline
presence of casts in urine
tamm-horsfall protein
cylinduria
Orange-red color, cast
matrix containing RBCs
RBC
highly refractile cast with
jagged ends and notches
waxy
The brittle, highly refractive cast matrix from which these casts derive their name is believed to be caused by degeneration of the hyaline cast matrix and
any cellular elements or granules contained in the matrix.
are more easily visualized than hyaline casts because of their higher refractive
index
waxy casts
With supravital stains, waxy casts stain a homogenous,
dark pink
Often referred to as renal failure casts,
broad
represent extreme urine stasis.
broad
Manner of Reporting: rare, few, moderate, or many per hpf
normal crystals
Manner of Reporting: averaged per lpf
abnormal crystals
presence of crystals in the urine
crystalluria
Color: Coffin-lids structure.
pH: Alkaline
triple phosphate
Color: Envelope shaped,
oval, dumbbell
pH: Acid/Neutral (alkaline)
calcium oxalate
Color: Yellow brown
(rosettes, wedges)
pH: Acid
uric acid
Color: Yellow
pH: Acid
Disorders: Liver Disease
● Present in hepatic
disorders producing
large amounts of bilirubin
in the urine.
bilirubin
COHORT C Color: Colorless
(Notched Plates)
pH: Acid
Disorders: Nephrotic
Syndrome
cholesterol
Color: Yellow
pH: Acid
Disorders: Liver Disease
● Hemolytic Disorders
● yellow-brown spheres
that demonstrate
concentric circles and
radial striations
LEUCINE
Color: Yellow-brown
(“Thorny Apples”)
pH: Alkaline
ammonium biurate
Color: Colorless
pH: Alkaline / neutral
calcium phosphate
Color: Colorless (hexagonal
plates)
pH: Acid
Disorders: Inherited cystinuria
cysteine
Color: Colorless - Yellow
pH: Acid / Neutral
Disorders: Liver Disease
tyrosine
appear as fine
colorless to yellow
needles that
frequently form
clumps or rosettes
● Usually seen in
conjunction with
leucine crystals in
specimens with
positive chemical
test results for
bilirubin.
tyrosine crystals
Color: Colorless to Yellow
pH: Acid/Neutral
Disorders: Infection
sulfonamide
primary cause of
sulfonamide
crystallization.
inadequate patient hydration
Shapes
○ Needles
○ Rhombics
○ Whetstone
○ Sheaves of Wheat
sulfonamide
Color: Colorless
(dumbbells)
pH: Alkaline
calcium carbonate
Sandlike
Similar structure with Urates that is why you need to
determine the pH in order to differentiate.
amorphous
Color: Colorless (flat plates)
pH: Acid
Disorders: Radiographic
radiographic dye
Color: Colorless (Needles)
pH: Acid / Neutral
Disorders:
● Precipitation of antibiotics is not frequently
encountered except for the rare observation of
ampicillin crystals following massive doses of this
penicillin compound without adequate hydration.
● ______appear as colorless needles that
tend to form bundles following refrigeration
ampicillin
used for routine urinalysis
bright field
enhances visualization of elements with low
refractive indices, such as hyaline casts, mixed
cellular casts, mucous threads, and
Trichomonas
phase contrast microscopy
Aids in identification of cholesterol in oval fat.
bodies, fatty casts, and crystals
polrizing microscopy
Aids in identification of Treponema pallidum,
Leptospira, Campylobacter jejuni, endospores
dark field microscopy
Allows visualization of. naturally fluorescent
microorganisms or those stained by a
fluorescent dye including labeled antigens and
antibodies
fluorescence microscopy
Produces a three-dimensional microscopy
image ang layer-by-layer imaging of a specimen
interference contrast
Identifies WBCs,
epithelial cells, and
casts
sternheimer malbin
Differentiates WBCs
from RTE cells
toluidine blue
Distinguishes RBCs
from WBCs, yeast, oil
droplets, and crystals
2% acetic acid
Identify free fat
droplets and
lipid-containing cells
and casts
oil red O and sudan III
Identifies bacterial
casts
gram stain
Identifies urinary
eosinophils
hansel
Identifies
yellow-brown granules
of hemosiderin in cells
and casts
prussian blue stain
Delineates structure
and contrasting colors
of the nucleus and
cytoplasm
sternheimer malbin
Enhances nuclear
detail
toluidine blue
Lyses RBCs and
enhances nuclei of
WBCs
2% acetic acid
Stain triglycerides and
neutral fats
orange-red; do not
stain cholesterol
lipid stains
stains
eosinophilic granules
methylene blue
eosin Y
Stains structures
containing iron
prussian blue stain
This method cannot be used for
initial sediment analysis because RBCs
are lysed by
2% acetic acid
Casts
average number per lpf
RBCs, WBCs
average number per hpf
Epithelial cells,
Crystals
semiquantitative terms
protein material produced by the glands and epithelial cells of the lower genitourinary tract and the RTE cells
mucus
