Urine Microscopic Eval (Exam 1) Flashcards
Are RBCs under the microscope intact or lysed?
intact
Presence of RBCs under microscope could indicate what?
-tumors like bladder cancer
-kidney stones
-glomerulonephritis
-infections
-trauma
-acute tubular necrosis
-prostatitis
-pyelonephritis
Presence of WBCs under microscope most commonly is caused by?
UTIs
cystitis occurs where?
bladder
pyelonephritis occurs where?
kidneys
What are the 2 types of UTIs based on location?
cystitis (bladder) and pyelonephritis (kidney)
Are UTIs worse in the bladder or kidney?
kidney
Bacteria may be found in urine due to contamination from….
skin
What is the fancy word for yeast/fungal infection?
candida or candida albicans
What would cause yeast in urine (seen under microscope)?
-diabetes
-immunocompromised patients
-vaginal yeast infection
-indwelling catheters
What would you see under microscope for fungal/yeast infection?
budding yeast with hyphae present
What are the 3 types of epithelial cells found in urine?
1) squamous
2) transitional (urothelium)
3) renal tubular epithelium (RTE)
large number of what epithelial cell is due to skin contamination?
squamous epithelium (comes from lower urethra in males and females or vagina)
Which epithelial cell is the largest type of epithelium in urine?
squamous
What is the appearance of squamous epithelium in urine under microscope?
large, fried egg appearance
What is the most common type of epithelial cell found in urine?
squamous cell
Is squamous cell epithelium found in urine pathological?
no!!!!
When would someone have increased squamous epithelium in the urine?
dehydration
What are the 2 epithelial cells that are pathological when found in urine?
1) transitional (urothelium)
2) renal tubular epithelium (RTE)
Where is transitional epithelium (urothelium) normally found?
mucosal lining of ureters, urethra, and urinary bladder
Is it okay to have transitional epithelium in urine?
only trace amounts, after that it could indicate urothelial carcinoma
Is it okay to have renal tubular epithelium (RTE) in urine?
only trace amounts
Where is renal tubular epithelium normally found?
single layer of cells lining the renal tubules
What may cause increased renal tubular epithelium (RTE) in urine?
-acute tissue necrosis
-myoglobin
-drugs
-sepsis
-transfusion reaction
-injury to renal tubular/kidney
-active renal disease
What are oval fat bodies?
renal tubular epithelium (RTE) or macrophages filled with fat or lipid droplets like cholesterol and TGs
Oval fat bodies are often seen with _____________ and _______________ in the urine sediment and are associated with MASSIVE PROTEINURIA
test q
fatty casts, fat droplets
How do we measure the exact amount of protein in urine?
24 hour urine for protein
What causes oval fat bodies?
-nephrotic syndrome
-long bone fractures (fat from bone marrow is leaking out of medullary cavity)
-crash injuries
Urinary casts is unique to what organ?
kidney
Where are urinary casts formed?
DCT and collecting ducts of nephrons
Are urinary casts cellular or acellular?
both it depends
What are urinary casts mostly composed of?
mucoprotein called uromodulin/Tamm horsfall protein
What are the 4 types of acellular casts?
1) hyaline
2) muddy granule
3) waxy
4) fatty casts
What is the most common type of cast?
hyaline cast
When do we see hyaline casts?
when normal individuals are dehydrated or did vigorous exercise
When do we see muddy colored granular casts?
in acute tubular necrosis patients and rhabdomyolysis
Which casts are the final stage of degeneration of fine granules in granular casts?
test q
waxy cats
When do we see waxy casts?
test q
-renal failure
-long standing kidney disease
-very low urine flow (end stage renal disease)
Which casts are formed by the breakdown of lipid rich epithelial cells?
fatty casts
Which casts are hyaline casts with fat globule inclusions?
fatty casts
Which cast is pathognomonic for nephrotic syndrome?
test q!!!!!!!!!!!!!!!
fatty casts
What are the 3 cellular casts?
1) RBCs
2) WBCs
3) renal tubular epithelial casts
Are RBC casts pathological?
test q
yes
When would we see RBC casts?
test q
-glomerulonephritis/ kidney infection
-goodpasture’s syndrome
-SLE
-nephritic syndrome
WBC casts is indicative of?
inflammation or infection like interstitial nephritis, nephritic syndrome, post streptococcal acute glomerulonephritis, or PYELONEPHRITIS***
When would we see renal tubular epithelial casts?
in patients with acute tubular necrosis
T/F: crystals by themselves cause no symptoms until they form stones
true
T/F: there are no symptoms with stones until they obstruct urinary tract
true
What are the 3 types of non-pathological crystals?
1) calcium oxalate
2) uric acid
3) triple phosphate / coffin lid/ struvite stones
Which crystals are hexagonal shape?
calcium oxalate
What is the most common type of crystal?
calcium oxalate
Renal calculi are most commonly made of what crystal?
calcium oxalate
Which crystal is found in gout?
uric acid
What are the 5 crystals of pathological clinical significance?
1) leucine
2) tyrosine
3) cystine
4) cholesterol
5) bilirubin crystals
Which crystal is found in infections with proteus sp.?
triple phosphate / coffin lid/ struvite stones
Which crystal is found with maple syrup urine disease?
test q
leucine crystals
Which crystal is found with severe liver disorders/disease?
test q
severe= tyrosine crystals
less severe= bilirubin crystals
Which crystal is found in cystinuria?
test q
cystine crystals
Which crystal is found in nephrotic syndrome or kidney failure along with lipiduria with fatty casts and oval fat bodies?
cholesterol crystals
Where is a UTI?
infection anywhere in urinary system
Cystitis is inflammation of the bladder usually caused by bacterial infection. What are the signs and symptoms?
-dysuria
-pyuria
-frequency
-foul odor
-may have low grade fever
What would have these lab findings?
-WBCs in urine
-nitrite positive (usually)
-leukocyte esterase positibe
-bacteria in microscope
-potential proteinuria and hematuria
-WBCs in CBC is normal
cystitis
Cystitis is most often caused by E.coli. Where is E.coli normally found in our body?
bowel flora
Cystitis can progress to….
kidneys (pyelonephritis) and become septic
Pyelonephritis
