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MEDL 203 > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

when do you do microscope exams on urine?

A

When levels of blood, leukocytes and/or proteins are greater than trace.

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2
Q

How do you start a microscopic examination of urine?

A

Centrifuging the sample

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3
Q

What’s the ideal volume for an urine examination?

A

8-12mL

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4
Q

What do you do with the supernatant of centrifuged urine?

A

You pour it away till there’s ~1mL left.

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5
Q

How many RBC/HPF is considered normal in some urine samples?

A

3-5 RBC

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6
Q

What’s HPF?

A

High powered field; 40x

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7
Q

What’s LPF?

A

Low powered field; 10x

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8
Q

What do you look for on LPF?

A

Casts

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9
Q

What do you look for under HPF?

A

Cells and other elements (ex. Epidermis cells)

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10
Q

How many fields are examined to find an average number of cells and elements?

A

10 fields

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11
Q

What is hematuria?

A

An increased # of RBC in urine

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12
Q

An increased # of red cells with red blood cell casts = ?

A

Source of hematuria is most likely renal.

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13
Q

An increase in red cells without red blood cell casts = ?

A

Source of hematuria is somewhere in the urinary tract but not the kidney

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14
Q

What affects the morphology of red cells?

A

specific gravity (SG) and the pH

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15
Q

What happens to RBC when the sg is high?

A

RBC will appear shrunken or crenated

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16
Q

What happens to the RBC when the specific gravity is low?

A

RBCs will be swollen or rapidly break apart

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17
Q

What happens to the RBC when the pH is very alkaline (basic)?

A

RBCs will be swollen or rapidly break apart

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18
Q

How do you confirm that there is RBC in urine?

A

The blood portion of a dipstick should indicate that there’s 6-10/HPF

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19
Q

What is considered a normal amount of leukocytes in urine?

A

6-10/HPF

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20
Q

Leukocytes are more predominant in urine samples of men. (T/F)

A

False

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21
Q

What is pyuria?

A

It is the increased number of leukocytes in urine

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22
Q

How can you identify a neutrophil?

A

The multi-lobed nucleus

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23
Q

What can be viewed in urine samples of those who just finished a strenuous exercise or are stressed?

A

Slight pyuria and proteinuria

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24
Q

What does pyuria usually indicate?

A

Inflammatory process in or adjacent to the urinary tract

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25
Q

Large numbers of leukocytes in clumps indicates?

A

Acute infection of the urinary tract

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26
Q

What does large numbers of leukocytes and clumps as well as minimal proteinuria and leukocyte casts indicate?

A

Pyelonephritis

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27
Q

What does large numbers of leukocytes and clumps as well as minimal proteinuria and with NO leukocyte casts indicate?

A

Lower UTI

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28
Q

What is considered “heavy” pyuria?

A

> 50/HPF

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29
Q

What happens to leukocytes when the urine is concentrated and acidic?

A

They shrink

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30
Q

What do RBCs usually get mixed up with?

A

Yeast, leukocytes and urate crystals

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31
Q

What happens to leukocytes when the urine is dilute or alkaline?

A

The cells swell up or rapidly lyse

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32
Q

What percentage do leukocytes decrease by within two hours of collection when urine is too alkaline and dilute, and not refrigerated?

A

~60%

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33
Q

What are glitter cells?

A

When the leukocytes are swelling and showing what is called Brownian movement of granules in the cytoplasm of the cells

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34
Q

How do you confirm leukocytes in the urine?

A

When the dipstick shows at least 10/HPF

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35
Q

What are the three types of epithelial cells in urine?

A
  1. Renal tubular epithelial (RTE)
  2. Transitional
  3. Squamous
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36
Q

What does SG being low mean?

A

Urine is dilute

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37
Q

What does SG being high mean?

A

> 1; the urine is very concentrated

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38
Q

Why do RBC/leukocytes swell when the SG is low?

A

The water from the urine is moving into the cells

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39
Q

Why do RBC/leukocytes shrink when SG is high?

A

The water from the cells are moving out into the urine.

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40
Q

where do squamous cells originate from?

A

Tubules of the nephrons

41
Q

Where do transitional cells originate?

A

Renal pelvis, ureters, urinary bladder and two-thirds of the urethra

42
Q

Where do squamous cells originate from?

A

Terminal end of urethra and vagina

43
Q

What types of epithelial cells would you find in healthy individuals?

A

Renal tubular epi cells and transitional epi cells

44
Q

An increase in renal tubular epi cells and transitional epi cells indicate what?

A

Inflammation within kidney or lower urinary tract

45
Q

What typically causes RTE to increase in numbers?

A
  • agents like heavy metal that damage RTEs
  • renal infections like pyelonephritis
  • decrease blood supply to kidney
46
Q

What causes the increase in transitional epithelial cells?

A

Early pyelonephritis, kidney stones, bladder infection or catheterization trauma

47
Q

Is squamous epithelial cells indicative of anything?

A

Usually not; usually vaginal contamination

48
Q

Where are casts formed?

A

In the lumen of the distal convoluted tubule (DCT) or the collecting duct (CT)

49
Q

What are casts?

A

Cylindrical mold of the tubular lumen

50
Q

What is the matrix of casts usually composed of?

A

Uromodulin; Tamm-Horsfall protein (THP)

51
Q

What type of cells synthesizes uromodulin?

A

Renal tubular epithelial cells

52
Q

What is the renal tubular section of the urinary tract system?

A

It is the fat portion of the ascending loop of Henle and the DCT

53
Q

Is uromodulin found in plasma?

A

No

54
Q

How do you determine if a renal disease is in its late stages?

A

Casts have large diameters due to the enlargement of renal tubules

55
Q

What are broad casts and chronic renal failure casts?

A

Casts that are 2-6 times wider than ordinary casts

56
Q

What are the classification of casts?

A

Hyaline, red blood cell, leukocyte, epithelial, granular, waxy and fatty

57
Q

What characteristics do hyaline casts have?

A

They’re colourless and transparent

58
Q

What kind of casts are most commonly seen in urine samples?

A

Hyaline casts

59
Q

What are RBC casts commonly associated with?

A

Glomerulonephritis

60
Q

What’s the difference between RBC casts and hemoglobin casts?

A

Hemoglobin casts contain disintegrated and lysed RBC

61
Q

What is the most common wbc found in leukocyte casts?

A

Neutrophil

62
Q

What are granular casts?

A

When neutrophils disintegrate into granular debris.

63
Q

What is the most common cause of leukocyte casts?

A

Renal infection; pyelonephritis

64
Q

What type of epithelial cells are found in epithelial casts?

A

Renal tubular epithelial cells

65
Q

What do epithelial casts indicate?

A

Tubular necrosis

66
Q

What damages renal tubules?

A
  • viruses
  • nephrotoxic agents
  • organ rejection after a kidney transplant
67
Q

What’s the difference between coarse and fine granular casts?

A

Coarse granular casts are formed when cells disintegrated into granular debris.

Fine granular casts are by-products of RTE protein metabolism and binds to uromodulin. Also moser common

68
Q

What does the presence of both fine and coarse granular casts indicate?

A

Significant renal diseases

69
Q

What are waxy casts?

A

Opaque and paraffin-like with cracked/notched outlined casts that are late-stage of hyaline or granular casts

70
Q

What do waxy casts indicate?

A

Long renal transit time; chronic renal disease, nephrotic syndrome or organ transplant rejection

71
Q

What’s the difference between free fat and oval fat casts?

A

Free fat is globular and glistens. Whereas, oval fat bodies are RTEs that fat has accumulated

72
Q

What kind of stain could be used for fat casts?

A

Sudan IV dye

73
Q

What is commonly seen in urine for Nephrotic syndrome?

A

Massive proteinuria and fats

74
Q

How are crystals formed?

A

When chemicals are present in the urine at an excess amount in comparison to their solubility.

75
Q

What are examples of crystals found in acid urine?

A
  • calcium oxalate
  • uric acid
  • amorphous urates
76
Q

What are some examples of crystals found in alkaline urine?

A
  • tripe phosphate
  • amorphous phosphates
  • calcium carbonate
  • calcium phosphate
  • calcium oxalate
77
Q

What pH are abnormal crystals found in?

A

Acidic urine

78
Q

What are some examples of abnormal crystals?

A

Cystine, leucine, tyrosine, cholesterol and bilirubin

79
Q

What is a distinctive characteristic of amorphous urates?

A

Appear to be pink precipitate

80
Q

What does a large amount of uric acid in urine indicate?

A

Gout

81
Q

What are triple phosphate usually associated with?

A

Chronic UTI

82
Q

What does cystine crystals usually mean?

A

The patient has cystinuria

83
Q

What is cystinuria?

A

Inborn error of metabolism where cysteine is not reabsorbed

84
Q

What’s the characteristic of cystine?

A

Hexagonal plates

85
Q

What are some characteristics of leucine?

A

Yellow, spheres with radial striations

Has a maple syrup odour

86
Q

What does leucine crystals indicate?

A

Maple syrup disease = error in leucine metabolism

87
Q

What are some characteristics of tyrosine?

A

They look like fine needles and often found with leucine crystals

88
Q

What does tyrosine usually indicate?

A

Severe liver disease = cirrhosis or viral hepatitis

89
Q

What do cholesterol crystals look like?

A

Plates with notched corners

90
Q

What do cholesterol crystals indicate?

A

Nephrotic syndrome or severe UTI

91
Q

What’s the difference between calcium phosphate and bilirubin crystals?

A

Calcium phosphate is found in alkaline urine while bilirubin is found in acidic urine.

CP has blunt ends and are colourless where bilirubin is delicate and pointy ended and red-brownish!

92
Q

What suggests contamination when you see bacteria in urine?

A

Bacteria without leukocytes and increased amount of squamous cells

93
Q

What do mucus threads look like?

A

Long ribbon-like strands with tapered ends

94
Q

What amount of RBC found in urine is normal?

A

3-5/hpf

95
Q

What amount of leukocytes are considered normal?

A

6-10/hpf

96
Q

What amount of squamous epithelial cells is considered normal?

A

6-10

97
Q

What gives urine its yellow/amber colour?

A

Pigment urochrome and urobilin

98
Q

What is the minimum amount of urine for routine urinalysis?

A

8mL

99
Q

What’s the average amount of urine collected for a 24-hr test?

A

1500mL/day

MEDL 203 (3 decks)

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