Urinalysis Flashcards
What is pictured? What are some causes?
Red blood cells (crenated due to hypertonic urine).
Causes of hematuria: Renal or lwr UT disease
Ex: Urinary calculi, polycystic kidney, etc.
What is pictured? Possible causes?
RBCs, Distorted from passage through small holes of GBM.
Causes: Renal or lwr UT disease.
Ex: Urinary calculi, Polycystic kidney disease, etc.
What is pictured? Possible causes?
Neutrophils (WBCs) in urine.
Causes:
- Acute Glomerulonephritis
- Infection
What is pictured? Possible causes?
Oval fat bodies
Causes:
- Nephrotic syndrome
- Hyperlipidemia
What is pictured? Possible causes?
“Maltese cross” formation of oval fat bodies
Causes:
- Nephrotic syndrome
- Hyperlipidemia
What is pictured? Composition? Site of formation? Possible causes?
Hyaline cast
Gelled protein (Tamm-Horsfall protein from tubule cells)
Distal convoluted tubule
Causes: Tubular or GBM necrosis
What is pictured? Possible causes?
Hyaline Cast stained with bile (hyperbilirubinemia)
Causes:
- Hepatocellular disease
- Biliary obstruction
What is pictured? Composition? Site of formation? Possible causes?
RBC cast in urine
RBCs
Distal convoluted tubule
Causes: GBM or tubular damage (glomerulonephritis)
What is pictured? Composition? Site of formation? Possible causes?
RBC cast
RBCs
Distal convoluted tubule
Causes: GBM or tubular damage (glomerulonephritis)
What is pictured? Composition? Site of formation? Possible causes?
WBC cast
leukocytes
Causes:
- pyelonephritis
- interstitial nephritis
- acute glomerulonephritis
What is pictured? Composition? Site of formation? Possible causes?
Renal tubular epithelial cells
Severe tubular damage
Causes:
- Renal tubular epithelial cells
- necrosis
-pyelonephritis
2. Transitional epithelial cells from the
renal pelvis, ureter or bladder
-Inflammation
What is pictured? Composition? Site of formation? Possible causes?
Course Granular Cast
Degenerated epithelial cells
Cause:
- Cellular cast that has remained in nephron for some time
- Associated with Proteinuria
What is pictured? Composition? Site of formation? Possible causes?
Fine Granular Cast
Degeneration from epithelial cell cast then Coarse granular cast
Causes:
- Prolonged time in nephron
- Associated with Proteinuria
What is pictured? Composition? Site of formation? Possible causes?
Waxy cast
End stage degeneration of epithelial cell cast
Causes:
- Chronic nephron obstruction associated with advanced renal disease
What is pictured? Composition? Site of formation? Possible causes?
Broad waxy cast
Formed in dilated tubules
Suggest acute tubular necrosis
What is pictured? Composition? Site of formation? Possible causes?
Broad cast in urine
Formed in dilated tubules
Suggest acute tubular necrosis
What is pictured?
Candida (fungal infection)
What is pictured?
Trichomonas (Parasite)
What is pictured?
HSV (Viral infection)
What is pictured?
CMV (viral infection)
What is pictured? Possible causes?
Calcium oxalate crystals
Cause: Acidic urine from metabolic or respiratory acidosis
What is pictured? Possible causes?
Ammonium magnesium phosphate crystals (“coffin lid crystals”)
Cause: Alkaline urine from:
- respiratory or metabolic alkylosis
- UTIs from bugs that produce urease
What is pictured? Possible causes?
Tyrosine crystals (can also form cystine or leucine crystals)
Cause: Severe liver disease
Cause of red/brown urine
Food dyes
Beets
Drug
Hemoglobin
Cause of yellow-brown or green-brown urine
Bile pigments
(bilirubinuria)
Cause of Turbid urine
Recipitation of salts
Cells
Ammonia-smelling urine
bateria
Musty-smelling urine
Phenylketonuria
Pungent and aromatic-smelling urine
cirrhosis
Acetone-smelling urine
ketonuria
Significance of high/low Specific gravity of urine
Proportion to urine osmolality
High value = dehydration
or
diabetes (high volume + glucosuria)
Low value = overhydration
or
renal tubular injury
Causes of proteinuria (>150mg/day)
>150mg/day = nephritic syndrome
> 3.5g/day = nephrotic syndrome
Persistant protein
Causes of proteinuria >3.5g/day
> 3.5g/day = nephrotic syndrome
Causes of Glucosuria
diabetes
Cushings syndrome
Glycogen storage diseases
renal tubular disease
Liver disease
Causes of Bilirubinuria
hepatocellular disease
biliary obstruction
Causes of urobilinogen in urine
hemolytic anemia
hepatocellular disease
Causes of ketouria
Diabetic ketosis
Severe calorie restriction
(complete metabolization of FAs)
Positive nitrite test signifies
Bacteriuria (gram negative)
Positive leukocyte esterase test signifies
detects whole or lysed WBCs
pyuria (infection)
Causes of hematuria
renal or lwr UT disease
Causes of hemoglobinuria
UT bleeding with hemolysis
or
intravascular hemolysis
Causes of myoglobinuria
traumatic muscle injury
burns
muscle disease
severe exercise
Composition and Cause of chylous effusion
fluid rich in protien, triglycerides, and LDLs
leakage of thoracic duct
Causes of serosanguineous pericardial exudate
TB
neoplasia
uremia (failure of renal excretory function)
Viral infection
Cause of glucose lvl <40mg/dL in CSF
Bacterial infection
Amylase lvl in pleural effusions >125u/l
Pancreatitis
Malignancy
WBC>500uL in peritoneal effusion
bacterial peritonitis
Indications for lumbar pucture
Meningitis
Encephalitis
CNS leukemia
subarachnoid hemorrage
How to distinguish between traumatic puncture or hemhorrage if there is blood in the CSF
Sequential collection
Traumatic = less bloody in each successive tube
Hemorrhage = equally bloody
common cause of xanthochromia in CSF
xanthochromia = colored supernatant
Cause: RBC lysis
When does clotting occur in CSF?
traumatic puncture
Elevated CSF protein
TB meningitis
Meningeal inflammation
Causes of Neutrophil pleocytosis in CSF
meningitis by pyogenic bugs
Causes of Lymphocyte pleocytosis in CSF
Viral or syphilitic meningitis
meningoencephalitis
Causes of Eosinophilic pleocytosis in CSF
parasites
coccidioidomycosis
Causes of low protein in CSF
leakage of CSF
Causes of elevated CSF proteins
meningitis
meningoencephalitis
Brain abcess
degenerative CNS disease
neoplasia
diabetic neuropathy
Causes of elevated IgG in CSF
MS
infection
Cause of increased C-reactive protein in CSF
bacterial infection
What is hypoglycorrhachia? Possible causes in CSF?
low glucose lvls
Bacterial or fungal infections (CSF)
Positive VDRL serology test in CSF
syphilis
Causes of positive Nucleic acid amplification tests
enteroviruses
herpesviruses
arboviruses
Diagnose the patient:
200-750 mm Hg, faint xanthochromia, purulent with 500-20,000 cells/ìl, neutrophilic
pleocytosis, 15–50 mg/dL protein, 0-45 mg/dL glucose
Bacterial meningitis
Diagnose by microscopic examination, serology, culture
Diagnose the patient:
150-750 mm Hg, faint xanthochromia, opalescent with 25-500 cells/ìl, lymphocytic
pleocytosis, 45-500 mg/dL protein, 0-45 mg/dL glucose
TB meningitis
Diagnose by microscopic examination and culture
Diagnose the Patient:
130-750 mm Hg, may be xanthochromic, clear, cloudy, or turbid with 5-5000 cell/ìl,
mixed or lymphocytic pleocytosis, 20-200 mg/dL protein, normal glucose
Aseptic (viral) meningitis
Diagnose by culture, NAAT, serology
Diagnose the Patient:
Normal to 300 mm Hg, colorless, clear, 10-150 cells/ul, lymphocytic pleocytosis, 45-150
mg/dL protein, normal glucose
Neurosyphilis
Diagnose by microscopic examination, serology
Diagnose the Patient:
Normal-450 mm Hg, colorless, clear, 10-150 cells/ìl, lymphocytic pleocytosis, 15-110
mg/dL protein, normal glucose
Viral meningoencephalitis
Diagnose by culture, NAAT, serology
