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Hematology > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

Urine is an _ of plasma

A

Ultrafiltrate

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2
Q

Average daily filtered plasma

A

170,000mL

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3
Q

Average daily urine output

A

1,200 mL

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4
Q

Urine path

A

Kidney - ureter - bladder - urethra

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5
Q

kidney

A

formation

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6
Q

kidney

A

formation

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7
Q

ureter

A

transport

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8
Q

bladder

A

storage

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9
Q

urethra

A

excretion

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10
Q

functional unit of kidney

A

Nephron

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11
Q

how many nephrons in each kidney

A

1-1.5million in each kidney

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12
Q

Nephron function

A
  • renal blood flow
  • glomerular filtration
  • tubular reabsorption
  • tubular secretion
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13
Q

Renal Blood flow

A

Afferent ateriole - Globerulus - efferent ateriole - pertibular capilaries and vasa recta - renal vein

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14
Q

Glomerular filtration

A

Capillary Tuft within Bowman’s capsule (leads to renal tubules)

  • Performs non selective filtration
    1. plasma substances <70,0000 molecular weight are filtered
    2. filters approx 120mL/minute
  • Plasma filatrate passes through 3 layers:
    1. capillary wall membrane
    2. basement membrane ‘basal lamina’
    3. Visceral epithelium of Bowmans’ capsule
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15
Q

Nephron structure

A
  1. Bowman’s capsule
  2. Proximal Convoluted Tubule
  3. Decsending Loop of Henle
  4. Ascending Loop of Hnle
  5. Distal Convuluted Tubule
  6. Collecting Duct
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16
Q

Two forms of reabsorption

A

Active Transport
- substances must combine with a carrier protein in renal tubular cell membrane

Passive Transport
- Substance moves along gradient without a carrier protein

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17
Q

Nephron location: Proximal Convoluted tubule

A

Active transport
- sodium, glucose, amino acids, salts

Passive transport
- water, urea

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18
Q

Nephron location: Descending loop of henle

A

Passive transport: water

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19
Q

Nephron Location: ascending loop of henle

A

Active transport: chloride

Passive transport: urea, sodium

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20
Q

Distal convoluted tubule

A

Active transport: sodium

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21
Q

Nephron location: Collecting Duct

A

Passive transport: water

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22
Q

Nephron location: Collecting Duct

A

Passive transport: water

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23
Q

Tubular secretion

A

Elimination of waste products not filtered by the glomerulus
- ex: Medication bi-products

Regulation of acid- base balancein the body
- Secretion of H+ ions
- Hydrogen ions in filtrate bind:
1. Bicarbonate -> reabsorbed as CO2 and H2O
2. Phosphate - excreted as H2PO4
3. Ammonia - excreted as NH4+

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24
Q

Urine Specimen collections

A

Random
Midstream clean catch
Catherizied (most sterile)
24 hour (or timed)

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25
Q

Urine collection

A

Requires a clean, dry, leak-proof container

Must be labeled (NOT on the lid)
- patient name, MR#, Date/Time of collection, Preservative Used

Must be refrigereted until transported to lab

Preservative may be used
- depends on test methodology, time delay, and transport conditions

Protect the sample from light

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26
Q

Normal Urine Output

A

600 - 2000 mL/day

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27
Q

Oliguria

A

Decrease in urine output
- <400 mL/day for adults
- Indicates dehydration

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28
Q

Anuria

A

Cessation of urine flow
- Kidney damage or decreased blood flow to the kidneys

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29
Q

Nocturia

A

Increase in nocturnal excretion of urine (at night)

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30
Q

Polyuria

A

increased in daily urine volume
- > 2.5 L/day for adults
- Cause: Diabetes Mellitus and Diabetes Insipidus

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31
Q

Normal color of urine

A

Pale yellow, yellow, dark yellow

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32
Q

Color: Dark yellow color
Cause?

A

Concentrated specimen (ex: 1st pee in the morning)

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33
Q

Color: Amber
Cause:

A

Dehydration

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34
Q

Color: Orange
Cause?

A

Bilirubin, medications

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35
Q

Color: Yellow-green/yellow-brown

Cause?

A

Bilirubin oxidized to biliverdin

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36
Q

Color: green
Cause?

A

Pseudomonas infection

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37
Q

Color: blue-green
Cause?

A

Amtriptyline, robaxin, clorets, indcican, methylene blue, phenol

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38
Q

Color: pink/red
Cause?

A

RBCs, hemoglobin, myeglobin, prophyrins, beets, rifampin, menstrual contamination

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39
Q

Color: Brown/black
cause?

A

RBCs oxidized, methemoglobin, homogenistic acid, melanin, phenol derivatives, argyrol, methyldopa, levodopa, flagyl

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40
Q

Clarity: Clear Urine

A

no visible particles, transparent

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41
Q

Clarity: hazy urine

A

few particles, print easily seen through urine

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42
Q

Clarity: cloudy urine

A

many particles, print blurred through urine

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43
Q

clarity: turbid

A

Print cannot be seen through urine

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44
Q

Clarity: milky

A

may precpitate or be clotted

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45
Q

Chemical examimation

A
  • Dip reagent strip completely, but briefly into the well mixed specimen

Remove excess urine from the strip by running the edge on the container when withdrawing or blotting side on paper towel

Wait the specified amount of time for each reaction to take place

Compare the colored reactions against the manufactruerer’s chart

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46
Q

Leukocyte 120s

A

inflammation in urinary track

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47
Q

Nitrite 60s

A

UTI - Bacteria that reduce nitrate

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48
Q

Urobilonogen 60s

A

Prehepatic or hepatic conditions

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49
Q

Protein 60s

A

defective glomerular filtration barrier

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50
Q

pH 60s

A

renal tibular absorption/secretion problem

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51
Q

blood 60s

A

Hematuria
Hemoglobinuria
Myeoglobinuria

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52
Q

Specific gravity 45s

A

Low = Diabetes Insipidus

High = Adrenal Insufficiency, hepatic disease, congestive heart failure, dehydration

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53
Q

ketone 40s

A

Diabetes mellitus; inadequate intake/loss of carbohydrates

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54
Q

biliubin 30s

A

hepatic or posthepatic conditions

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55
Q

glucose 30s

A

diabetes mellitus, hormone disorders, end-stage renal disease

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56
Q

Hematuria (blood in urine)

A
  • renal calculi
  • gloerulonephritis
  • pyelonephritis
  • tumors
  • trauma
  • exposure to toxic chemicals
  • anticoagulants
  • strenuous excercise
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57
Q

Hemoglobinuria (blood in urine)

A
  • Transfusion reactions
  • hemolytic anemias
  • severe burns
  • infections/malaria
  • strenous excercise
  • brown recluse spider bite
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58
Q

Bilirubin

1.Prehaptic conditions
2.Hepatic conditions
3.Posthepatic conditions

A

1.Normal
2.Increased
3.Increased

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59
Q

Urobilinogen
1.Prehaptic conditions
2.Hepatic conditions
3.Posthepatic conditions

A
  1. Increased
  2. Increased
  3. Normal/absent
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60
Q

Prehepatic conditions examples

A
  • hemolysis
  • drugs and toxins
  • thalassemia
  • hemoglobinopathies
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61
Q

Hepatic conditions

A
  • Cirrhosis
  • Viral Hepatitis
  • Toxic Hepatitis
  • Intrahepatic Cholestasis
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62
Q

Post Hepatic conditions

A
  • Biliary obstructions
  • Gallstones
  • Tumors of the bile duct
  • Pancreatic carcinoma
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63
Q

Conirmatory test for Protein

A

Sulfosalicylyc acid precepitaiton test

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64
Q

Confirmatory test for specific gravity

A

refractometer

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65
Q

confirmatory test for ketone

A

Acetest

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66
Q

Confirmatory test for bilirubin

A

Icotest

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67
Q

Confirmatory test for glucose

A

Copper reduction test (clinitest)

68
Q

pH in urine - normal range

A

4.5 - 8.0
- First morning specimen usually slightly acidic (5.0-6.)

69
Q

pH clinical significance in urine

A

Kidneys help maintaining acid/base balance. when this is disrupted, it helps us to identify problems with renal tubular reabsorption and secretion

70
Q

pH Interference in urine

A
  • No known substances interfere with this measurement
  • Runover from protein pad which has an acidic reagent –> false acidic reading
71
Q

Normal protein range in urine

72
Q

Protein principle in urine

A
  • Protein error of indicators
  • pH held constant by buffer, certain indicatory dyes realease hydrogen ions as a result of the presence of proteins and cause a color change from yellow.to blue-green
73
Q

Clinical significance of protein in urine

A
  • proteinuria (>30 mg/dL)

indicates defective glomerular filtration barrier

74
Q

Protein interference urine

A
  • Extreme alkaline or highly buffered urine -> false positive
  • overwhelms buggering capacity of reagent strip
75
Q

SSA - Sulfosalycylic Acid Preciptation test
(PROTEIN)

A
  • Cold precipitation test that reacts equally with all forms of protein
  • Sulfosalicylic acid is added to clear aupernatant (after centrifiguation)
  • Precipitation is graded to determoine protein concentration
  • interferences
    1. highly alkaline urine -> false negeative
    2. non-protein compound precipitation -> false positive
76
Q

Glucose in urine principle - 2 steps

A
  1. Glucose oxidase catalyzes a reaction between glucose and room air to produce gluconic acid peroxidase
  2. Peroxidase catalyzes the reaction between peroxide and chromogen to form an oxidized colored compound that represetns the presence of glucose
77
Q

Glucose in urine - Clinical signfiicance

A

Glucosuria - can be found in diabetees mellitus, hormone function disorders, and end-stage renal disease

78
Q

Gluocose interferences in urine (false positive)

A

strong oxidizing agents or contaminating peroxidases

79
Q

Glucose interfernces in urine

80
Q

Glucose interfernces in urine (false negative)

A

asorbic acid contamination or high specific gravity

81
Q

Copper reduction test (clinitest) - GLUCOSE confirmatory test (reducing sugar test )

A

Adantage - more sensitive than reagant strip and detects all reducing sugars

Process
- urine and water are added to clinitest tablet made with curpric sulfide
- redcuing substances will react forming cuprous oxide with a color reaction
- The color is read after 15 seconds

82
Q

Commonly found reducing sugars (clinitest)

A
  • galactose
  • fructose
  • pentose
  • lactose
  • glucose

Galactose in newborns (<2 years), represetns an “inborn error of metabolism”, that is life threatening

83
Q

Ketones in urine

A

Detects acetoacetate and less effectively acetone
- intermediate products of fat metabolism

Does not detect beta-hydroxybutyrate (often found in DKA)

Principle
- nitroferricynide reacts with acetoacetate in an alkaline medium to produce a color change from beige to purple

Clinical signfiicance
- evidence of fat metabolism - inability to metabolize carbohydrate for energy (diabetes mellitus), increased loss or inadequate intake of carbohydrates

Confirmatory test - Acetest

84
Q

Blood in urine

A

Principle
- pseudoperoxidase activity of hemoglobin catalizes a reacion between hydrogen peroxide and chromogen tetramethylbenzidine to produce an oxidized chromogen, which is a green- blue color

  1. Hematuria
  2. Hemoglobunuria
  3. Myeloginuria
85
Q

Interferences in blood urine
(FALSE positive)

A

Menstrual contamination or microbial peroxidases, soaps, detergents -> false positive

86
Q

Interferences in blood urine
(FALSE positive)

A

Menstrual contamination or microbial peroxidases, soaps, detergents -> false positive

87
Q

Interferences in blood urine (FALSE negative)

A

Ascorbic acid, or high specific gravity, or unmixed specimen or concentration of nitrite

88
Q

hematuria

A

presence of intact RBCs

89
Q

Hemoglobinuria

A

presence of free hemoglobin indicates RBC lysis

90
Q

myoglobinuria

A

Presence of myoglobin indicates muscle destruction

91
Q

Bilirubin in urine

A

Principle
- Diazo reaction of coupling between bilirubin and diaazonium salt
- Resulting Azodye causing a color change from light tan-beige to pink

Clinical significance
- bile duct obstructions - ex. gallstones and pancreatic cancer
- liver damage - ex: hepatitis and cirrhosis

92
Q

bilirubin interferences in urine (false positive)

A

pigemneted materials or drugs

93
Q

bilirubin interferences in urine (false negative)

A

Ascorbic acid or elevated nitrites or old specimens

94
Q

Ictotest (bilirubin confirmatory test)

A
  • more senesitive than reagent pad
  • less interferences
  • process
    1. urine is dropped on special pad
    2. icto tables is placed on pad
    3. water is added
    4. color reaction occurs and read at 30 seconds
95
Q

Positive Ictotest (bilirubin)

A

blue to purple color

96
Q

Negative Ictotest(Bilirubin)

A

Pink to red

97
Q

urobilinogen in urine

A

Principle
- Diazo reaction of coupling between urobilinogen and diazonium salt
- resulting azodye causing a color change from light pink to dark pink

Clinical significance
- Increased Pre-hepatic or hepatic conditions
- decreased in post-hepatic conditions

98
Q

urobilinogen interferences in urine (false positive)

A
  1. Porphobilinogen, sulfamides, and p-aminosalicylyic acid
  2. highly pigmented urine
99
Q

Interferences - Uribilinogen in urine (false negative)

A

formalin or high levels of nitrites

100
Q

Nitrite in urine

A

Certain bacteria can reduce nitrate to nitrite

Principle
**- Greiss reaction ** nitrite at an acidic pH reacts with an aromatic amine to form diazonium compound that reacts with tetrahydrobenzoquinolin compounds to prouduce a pink-colored azodye

Clinical significance
- Urinary Tract Infection - UTI (E. coli, Proteus, enterobacter, klebsiella)

101
Q

Interferences Nitritie in urine
(false negative)

A

Urine not held in bladder at least four hours or bactera that do not have nitrate reducing enzyme. Absent diatery nitrates, absorbic aicd, high specific gravity, or antibiotics)

102
Q

Interferences nitrite in urine
(false positive)

A

highly pigmented or old urine

103
Q

Leukocyte esterase in urine

A

Leukocyte is present in granulocytes, monocytes, macrophages but NOT lymphocytes

Principle
- Leukocyte esterase catalyzes hydrolysis of embedded ester (pad) forming an aromatic compound
- aromatic compound combines with diazonium salt present in pad to produce purple azodye

Clinical signfiicance
- indicative of inflammation anywhere from kidneys to uthethra

104
Q

Leukocyte esterase interferences (false positive)

A

vaginal contamination or highly pigmented urine. Or strong oxidizing agent

105
Q

Leukocyte esterase interferences in urine (false negative)

A

high specific gravity or high glucose/protein levels. Absorbic acid or certain antibiotic drugs

105
Q

Leukocyte esterase interferences in urine (false negative)

A

high specific gravity or high glucose/protein levels. Absorbic acid or certain antibiotic drugs

106
Q

normal range for specific gravity of urine

A

1.002-1.035

107
Q

principle of SG in urine

A

Polyelectolytes ionizes, releasing hydrogen ions in proportion to the number of ions in the solution. Bromthymol blue measures change in pH

108
Q

Clinical signficance of SG in urine

A

Low SG - diabetes insipidus, and loss of tubular concentrating ability

High SG - adrenal insufficiency, hepatic disease, congestive heart failure, and excess water loss (vomitting, diarrhea, sweating)

109
Q

Interferences of SG in urine (false low SG)

A

high glucose, urea or pH

110
Q

Interferences of SG in urine (false high SG )

A

elevated proteins or ketones

111
Q

Specific gravity confirmatory testing

A

Refractometer

  • determines the concentration of dissolved particles in a specimen
  • Uses refractive index of light
112
Q

Specimen preperation

A
  • Urine is placed in a test tube
  • sample is centrifuged
  • supernatant is discarded leabing 1ml of sediment left
  • resuspend sedi ment
  • dispense drop onto center of slide (put on coverslip)
  • a kova slide can also be used (slide with premade cover slips and loading area)
  • scan slide on 10X or 40X
113
Q

all cells are reported with _ except for _ they are reported with _

A

40X
Squamous epithelial Cell
10X

114
Q

RBC

appearance
correlations

A

Appearance
- non nucleated biconcave disc (normal)

  • crenated in hypertonic (concentrated) urine
  • ghOst cells in hypOtonic (diluted urine)
  • Dysmorphic (irregular) with glomerular membrane damage

Correlations
- color, clarity, strip - blood reaction

115
Q

RBC clinical significance

A
  • damage to the glomerular membrane
  • vascular injury within the genitourinary tract
  • malignancy of the urinary tract
  • renal calculi
  • menstrual contamination
116
Q

common misinterpretation RBC

A

air bubbles
yeast

if, acetic acid is added, RBC will lyse

117
Q

WBC appearance (larger than RBC)

A
  • Granulated, multilobed neutrophils
  • Glitter cells in hypotonic urine (brownian motion)
  • mononuclear cells with abundant cytoplasm
118
Q

WBC correlations

A

clarity, strip - leukocyte esterase, nitrite

119
Q

WBC clinical significnace

A

pyuria - increase in urinary WBC

Indicative of infection or inflammation in genitourinary system

120
Q

predominant WBC in urine - Neutrophil

A

indicativeof bacterial infections

121
Q

predominant WBC in urine - Eosinophil

A

indicative of drug-undice interstital nephritis or renal transplant rejection

122
Q

predominant WBC in urine - Mononuclear (non-granulocytic cells)

A

indicative of early stage renal transplant rejection

123
Q

WBC common misinterpreations

A

renal tubular epithelial cell

124
Q

Epithelial cell - squamous

  • appearance
  • reporting
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance
    Largest cell in sediment with abundant, irregular cytoplasm and prominent nuclei
  • reporting
    Graded on low power field (lpf) ( 10X)
  • correlations
    Clarity
  • clinical signficance
    normal cellular sloughing
  • misinterpreations
    casts
125
Q

Epithelial Cells - Transitional

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance
    Spherical, polyhedral, caudate with centrally located nucleus
  • correlations
    clarity strip - blood
  • clinical signficance
    normal ceullar sloughing (bladder and up urinary system), catherization, malignancy, viral infection
  • misinterpreations
    Renal tubular Epi Cells (RTE)
126
Q

Renal Tubular Epithelial Cell (RTE)

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance
    Rectangular; columnar; round; oval or cuboidal with an eccentric nucleus.
    Possibly bilirubin - stained
    Hemosiderin - laden
  • correlations
    -color, clarity, strip - protein, bilirubin (hepatitis), blood
  • clinical signficance
    Cells from the renal tubules of nephron; indicative of tubular injury or tubular necrosis
  • misinterpreations
    Transitional Epi cell or granular casts
127
Q

Oval fat bodies

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance
    Highly refractile RTE cells; mau observe maltese cross in cholesteral oval fat bodies
  • correlations
    clarity, strip - blood, protein
    microscopic - free fat droplets
  • clinical signficance
    RTE has aborbed lipids; indicative of nephrotic syndrome, severe tubular necrosis, diabetes mellitus, and traume causing bone marrow fat release
  • misinterpreations
    Usually confrimed with polarized microscopy or fat stains
128
Q

Cast formation

A

**Uromodulin (Tamm-Horsfall protein) ** is excreted by RTE cells of the distal convoluted tubule and upper collecting duct

other proteins in the ultrafiltrate join the matrix

protein matrix “gels” more readily in cases of urine-flow stasls, acidity and the presence of sodium and calcium

129
Q

Hyaline cast

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A

appearance - colorless homogenous matrix

correlations - strip (protein and blood)

clinical significance - glomerulonephritis, pyelonephritis, chronic renal disease, congestive heart failure, and stress and excercise

misinterpretations - mucus, fiber, hair, bright ligting

130
Q

RBC cast

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance - orange/red color; cast matrix containing RBCs
  • correlations - microcopic RBC / Strip- blood, protein
  • clinical signficance -glomerulonphritis, strenous excercise
  • misinterpreations - RBC clumps
131
Q

WBC cast

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance - cast matrix containing WBCs
  • correlations - Microscopic: WBC, Strip: protein, leukocyte esterase
  • clinical signficance - pyelonephritis, actute interstial nephritis
  • misinterpreations - WBC clumps
132
Q

Bacterial Cast

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance - Bacilli bound to protein matrix
  • correlations - Microscopic: bacteria, WBC casts, WBCs. Strip - Leukocyte esterase, nitrite, protein
  • clinical signficance - pyelonephritis
  • misinterpreations - granular casts
133
Q

Epithelial cell cast

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance - RTE cells attached to protein matrix
  • correlations - Microscopic - RTE cells. Strip - protein
  • clinical signficance - renal tubular damage
  • misinterpreations - WBC cast
134
Q

Granular cast

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance - course and fine granules in a cast matrix
  • correlations - microscopic: cellular cast, RBCs, WBCs. Strip: protein
  • clinical signficance - Glomerulonpehritis, Pyelonephritis, Stress and excercise
  • Misinterpreations - Clumps of small crystals, columnar RTE cells
135
Q

Waxy cast

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A

Appearance - hihgly refractile cast with jagged ends and notches

correlations - cellular casts, granular casts, WBCs, RBCs. Strip - protein

Clinical significnce - stasis of urine flow, chronic renal failure

misinterpretations - fibers and fecal material

136
Q

Fatty cast

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance - fat droplets and oval fat bodies attached to protein matrix
  • correlations - Microscopic: free fat droplets, oval fat bodies. Strip- protein
  • clinical signficance - Nephrotic syndrome, toxic tubular necrosis , diabetes mellitus, crush injuries
  • misinterpreations - fecal debris
137
Q

Broad cast

  • appearance
  • correlations
  • clinical signficance
  • misinterpreations
A
  • appearance - wider than normal matrix cast
  • correlations - microscopic: WBCs, RBCd, grnular casts, waxy casts. Strip: protein
  • clinical signficance - extreme urine stasis, renal failure
  • misinterpreations - fecal material, fibers
138
Q

Normal urinary crystals

A

Types
- uric acid
- amorphous urates
- calcium oxalate
- amorphours phosphates
- calcium phosphate
- triple phosphate
- ammonium biurate
- calcium carbonate

139
Q

Reporting of normal urinary crystals

A

High power field (hpf) (40x)

140
Q

Uric acid crystal (NORMAL)

Urine pH
Color/shape
Clinical significance

A

Urine pH - acidic
Color/shape
- yellow-brown / variable shapes (rhombic, four sided flat plates, wedges, and rosettes)

Clinical significance
- increased levels of purines and nucleic acids; chemotherapy patients; Lesch-Nyhan syndrome patients; gout

141
Q

Amorphous urates

Urine pH
Color/shape
Clinical significance

A

Urine pH - acidic
Color/shape
- brick dust or yellow brown/fine particles

Clinical significance
- refrigeration

142
Q

Calcium oxalate crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH
- acidic / neutral / sometimes alkaline

Color/shape
- colorless / envelope, oval, dumbbell

Clinical significance
- Renal calculi; antifreeze poisoning; diet high in oxalic acid (tomatoes, aspargus, ascorbic acid)

143
Q

Amorphous phosphates

Urine pH
Color/shape
Clinical significance

A

Urine pH - alkaline/neutral
Color/shape - white-colorless/fine dust particles
Clinical significance - refrigeration

144
Q

Calcium phosphate crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - alkaline/neutral
Color/shape - colorless/variable: rectangles, thin prisms, rosette formation
Clinical significance - no clinical significance, but are common constituent in renal calculi

145
Q

Triple phosphate crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - alkaline
Color/shape - colorless/ coffin lids
Clinical significance - no clinical significance, but often found with urea-splitting bacteria

146
Q

Ammonium Biurate Crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - alkaline
Color/shape - yellow-brown / thorny apples
Clinical significance - found in old specimens and often present with ammonia

147
Q

Calcium carbonate crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - alkaline
Color/shape - colorless/dumbbells
Clinical significance - no clinical significance

148
Q

Abnormal urinary crystals

A
  • Cystine
  • Cholesterol
  • Leucine
  • Tyrosine
  • Bilirubin
  • Sulfonamides
  • Radiographic dye
  • Ampicillin
149
Q

reporting of abnormal urinary crystals

A

High power field (hpf) 40X

150
Q

Cystine Crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - acidic

Color/shape - colorless/hexagonal plates

Clinical significance - cystinuria patients (increased tendency to form renal calculi)

151
Q

Cholesterol Crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - acidic

Color/shape - colorless/ “notched” plates “utah”

Clinical significance - refrogerated specimen (otherwise lipids would stay droplet form); Nephrotic syndrome, often seen with fatty casts and oval fat bodies.

152
Q

Leucine Crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - Acidic / neutral
Color/shape - Yellow/Concentric circles “Tree rings”
Clinical significance - Liver disorders

153
Q

Tyrosine Crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - Acidic /neutral
Color/shape - Colorless-yellow / needles
Clinical significance - liver disorders, amino-acid metabolism disorders

154
Q

Bilirubin crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - Acidic
Color/shape - Yellow/ “uneven sweet gum pod”
Clinical significance - liver disorders

155
Q

Sulfonamide Crystal

Urine pH
Color/shape
Clinical significance

A

Urine pH - Acidic/Neutral

Color/shape - varied colors/ “glassy needles”

Clinical significance - dehydration; UTI medication administration

156
Q

Radiographic dye

Urine pH
Color/shape
Clinical significance

A

Urine pH - Acidic
Color/shape - colorless/ rectangles or thicker needles
Clinical significance - recent procedure, check medical history

157
Q

Ampicillin

Urine pH
Color/shape
Clinical significance

A

Urine pH - Acidic /neutral

Color/shape - colorless/needles “pick up sticks”. Refrigeration forms bundles

Clinical significance - antibiotic prescription

158
Q

Microorganisms ar reported on

A

40X

  • bacteria
  • yeast
  • trichomonas vaginalis
159
Q

Bacteria

Appearance
Correlations
Clinical Significance
Misinterpretations

A

Appearance
- small spherical and rod-shaped structures

Correlations
- Microscopic: WBCs
- Strip: pH, Nitrite, Leukocyte Esterase

Clinical Significance
- Contamination or indicative of upper/lower UTI

Misinterpretations
- Amorphous phosphates
- Urates

160
Q

Yeast

Appearance
Correlations
Clinical Significance
Misinterpretations

A

Appearance
- small, oval, refractile structures with buds and/or mycelia (branching hyphae)

Correlations
- microscopic -WBCs
- strip - glucose, leukocyte esterase

Clinical Significance
- yeast infection (commonly found in diabetic pateints)
- glucose present in ruine

Misinterpretations
- RBCs

161
Q

Trichomonas Vaginalis

Appearance
Correlations
Clinical Significance
Misinterpretations

A

Appearance
- pear shapes
- motile
- flagellated

Correlations
- microscpic: WBCs
- Strip : Leukocyte esterase

Clinical Significance
- trichomonas infection

Misinterpretations
- WBC, RTE

162
Q

Miscellaneous urine sediment

A
  • mucus
  • spermatozoa
  • artifacts
163
Q

mucus

  • Appearance
  • reporting
  • correlations
  • clinical significance
  • misinterpretations
A

Appearance
- single or clumped threads with a low refractive index

reporting - graded per lpf (10x)

correlations - none

clinical significance - none, but more often in female patients

misinterpretations - hyaline casts

164
Q

Spermatozoa

Appearance
Reporting
Correlations
Clinical significance
Misinterpretations

A

Appearance
- tapered oval head with long, thin tail

Reporting
- present or absent

Correlations
- strip: protein

Clinical significance
- in male, can be found in cases of male infertility due to retrograde ejaculation
- often found with recent sexual intercourse (both), masturbation (male), or nocturnal emission male)

Misinterpretations
- none

165
Q

Urine Artifacts

A

considered contaminants and are not pathologic

  • starch granules (from powdered gloves or talc)
  • oil (immersion oil)
  • air bubbles
  • pollen grains
  • fibers
  • fecal debris

Hematology (36 decks)

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