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Laboratory Diagnosis > Urinalysis- Microscopic > Flashcards

Urinalysis- Microscopic Flashcards

1
Q

Preservation
– Cells and casts begin to disintegrate in ___________
– Refrigeration for up to 48 hours (little loss of cells).

A

1 - 3 hrs . at room temp.

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2
Q

Abnormal Findings Per High Power Field (HPF) (400x)

A

– > 3 erythrocytes
– > 5 leukocytes
– > 2 renal tubular cells
– > 10 bacteria

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3
Q

Per Low Power Field (LPF) (200x)

A

– > 3 hyaline casts or > 1 granular cast
– > 10 squamous cells (indicative of contaminated specimen)
– Any other cast (RBCs, WBCs)

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4
Q

Abnormal finding AbPresence of:
– Fungal hyphae or yeast, parasite, viral inclusions
– Pathological crystals (leucine, tyrosine, cystine)
– Large number of uric acid or calcium oxalate crystals

A
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5
Q

Erythrocytes
“Dysmorphic” vs. “normal”

A

(> 10 per HPF)

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6
Q

Leukocytes
Neutrophils (glitter cells)
___________________
Eosinophils
Hansel test (special stain)

A

More than 1 per 3 HPF

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7
Q

Epithelial Cells
Renal tubular epithelial cells: _________________

A

Few are normal

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8
Q

 From renal tubules (proximal, distal, collecting ducts)
 Renal tubular epithelial cells must be enumerated using HPF
 The presence of more than_____________ indicates tubular injury and specimens should be referred for cytologic urine testing.
 Difficult to identify due to variability in appearance. Depending on the location.
 Small, dense, eccentrically placed nucleus is a characteristic

A

2 RTE/HPF

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9
Q

Transitional Cells
 Smaller than squamous epithelium
 Increase in TC exhibiting abnormal morphology such as vacuoles and irregular nuclei may be indicative of malignancy or viral infection.

A

Transitional Cells

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10
Q

 RTE that absorb lipids.
 Usually seen in free floating fat droplets.
 Usually stained by Sudan III or Oil Red O fat stains and examined in Polarized microscope.
 Will produce Maltese cross appearance on Polarized lights

A

Oval Fat Body

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11
Q

Bacteria
Bacteriuria

A

More than 10 per HPF

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12
Q

Yeasts
Candidiasis

A

Most likely a contaminant but should correlate with clinical picture.

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13
Q

Viruses
CMV inclusions

A

Probable viral cystitis

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14
Q

Erythrocyte Casts:

A

Glomerular diseases

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15
Q

Leukocyte Casts:

A

Pyuria, glomerular disease

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16
Q

Granular casts

A

Nonspecific (Tamm-Horsfall protein)

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17
Q

Hyaline casts

A

Nonspecific (Tamm-Horsfall protein)

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18
Q

Waxy casts

A

Nonspecific

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19
Q

Fatty casts (oval fat body casts)

A

Nephrotic syndrome

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20
Q

____________ are the only urine sediment that are unique to the kidney.
 Formed within the lumens of the distal convuluted tubules and collecting ducts.
 Their shape is representative of the tubular lumen
Dissolves quickly in dilute alkaline urine.
 Reported as the average number per 10 LPF
Casts are the only urine sediment that are unique to the kidney.
 Formed within the lumens of the distal convuluted tubules and collecting ducts.
 Their shape is representative of the tubular lumen
 Dissolves quickly in dilute alkaline urine.
 Reported as the average number per 10 LPF

A

Casts

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21
Q

 Major constituent of a Cast is______________, a glycoprotein excreted by the RTE of the DCT and CD.

A

Tamm-Horsfall protein

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22
Q

 Can be non pathologic or pathologic.

A

Granular Cast

23
Q

When is the granular cast nonpathologic?

A

 Non-pathologic if from the lysosomes excreted by RTE during normal metabolism. (extreme physical work)

24
Q

When is the granular cast pathologic?

A

 Pathologic if it represent disintegration of cellular casts and tubule cells or protein aggregates filtered by the glomerulus.

25
Q

 Frequently seen cast, consists almost entirely of Tamm Horsfall protein
 Normal 0-2/LPF

A

Hyaline Cast

26
Q

Hyalin cast can be seen in which diseases?

A

 Can be seen in Acute Glomerulonephritis, pyelonephritis, CRD and CHF.

27
Q

 Represent extreme urine stasis, indicating CRF
 Derived from the degenerating Hyaline and cellular cast.

A

Waxy Cast

28
Q

 Seen in conjunction with oval fat bodies and free fat droplets in disorders causing lipiduria.
 Frequently associated with nephrotic syndrome, toxic tubular necrosis, DM, and crash injuries.

A

Fatty Cast

29
Q

What are the crystals that can be found in urine?

A

Crystals

– Urate

o Ammonium biurate

o Uric acid

– Triple Phosphate

– Calcium Oxalate

– Amino Acids

o Leucine

o Cystine

o Tyrosine

– Sulfonamide

30
Q

 Normal crystal
 Present in Acid/neutral pH
 They are colorless, enveloped shape
Dumbbell shape (2nd photo)

A

Calcium Oxalate Crystals

31
Q

 Normal crystal
Alkaline pH
 Colorless (coffin lids)

A

Triple Phosphate Crystals

32
Q

 Normal crystals
 Most commonly seen as amorphous urates, uric acid, acid urates and sodium urates.
 Appear reddish to brown and are the only normal crystals found in acidic urine that appear colored.

A

Urate cyrstals

33
Q
A

Urate crystal

34
Q

 Abnormal crystal
 Acidic/neutral urine
 Fine colorless to yellow
needles that frequently form clumps
or rosettes
 Associated with liver
disorders

A

Tyrosine Crystals

35
Q
A

Tyrosine cystal

36
Q

 Abnormal crystal
Acid urine
 Colorless, hexagonal
plates may be thick or thin.
 Associated with
hereditary cystinuria

A

Cystine Crystals

37
Q
A

cystine crystal

38
Q

 Normal Crystal
 Alkaline Urine
 Yellow brown crystals
(“thorny apple”)

A

Ammonium Biurate Crystals

39
Q
A

Ammonium Biurate

40
Q

 Abnormal crystal
 Acid urine
 Colorless notched plates
 Disorders producing lipiduria like nephrotic syndrome.

A

Cholesterol Crystals

41
Q
A

Cholesterol crystal

42
Q

Uses and Limitations of Urine Protein Detection Significance

A

– Proteinuria and the nephrotic syndrome.
Limitations
– Interference: highly alkaline urine.
– Much more sensitive to albumin than other proteins (e.g. immunoglobulin light chains).

43
Q

Other Tests For Urine Protein determination

A

– Sulfosalicylic acid (SSA) turbidity test.
– Urine protein electrophoresis (UPEP)
– Bence Jones protein
 Alkaline urine overrides the acid buffer system, producing a rise in pH and a color change unrelated to protein concentration.

44
Q

 ____________ is a bile pigment that results from the degradation of hemoglobin.
 Produced in the intestine from the reduction of bilirubin by intestinal bacteria.

A

Urobilinogen:

45
Q

for porphobilinogen

A

Watson-Schwartz and Hoesch screening test f

46
Q

Uses and Limitations of Urobilinogen Detection Significance
\

A

– High: increased hepatic processing of bilirubin
– Low: bile obstruction

47
Q

Limitations Urobilinogen
– Interference: prolonged exposure of specimen to oxygen (urobilinogen —> urobilin)
– Cannot detect low levels of urobilinogen

A
48
Q

Uses and Limitations of Nitrite Detection Significance
– Gram negative bacteriuria

A

Nitrite

49
Q

Limitations in Nitrite Determination

A

Limitations
– Interference: bacterial overgrowth
– Only able to detect bacteria that reduce nitrate to nitrite
Other Tests
– Correlate with leukocyte esterase and
– Urine microscopic examination (bacteria)

50
Q

 Ability of certain bacteria to reduce nitrate, which is a normal constituent of the urine, to nitrite.
 It is detected by________________
 Test is standardized to correspond with a quantitative bacterial culture criterion of 100,000 organisms per milliliter.

A

Greiss reaction.

51
Q

 The _____________ detects the presence of esterase in the granulocytic white blood cells. Neutrophils are most frequently associated with bacterial infection.
 Esterases are also present in Trichomonas and histiocytes.
 Action of LE to catalyze the hydrolysis of an acid ester to produce an aromatic compound and acid.
 It will then combine with diazonium salt to produce a purple azodye.

A

Leukocyte Esterase

52
Q

Uses and Limitations of Leukocyte Esterase Detection Significance

A

– Pyuria
– Acute inflammation
– Renal calculus

Note : Limitations
– Interference: oxidizing agents, menstrual contamination
Other Tests
– Urine microscopic examination (WBCs and bacteria)
– Urine culture

53
Q
A

Laboratory Diagnosis (4 decks)

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