Urine Microscopic Exam Flashcards by Jonel Focus

Its purpose is to detect and to identify insoluble materials present in the urine

MICROSCOPIC EXAMINATION

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all of these contribute formed elements to the urine

blood, kidney, lower genitourinary tract, and external contamination

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A standard amount of urine, usually between

10 and 15 mL

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volume that is frequently used because multiparameter reagent strips are easily immersed in this volume, and capped centrifuge tubes are often calibrated to this volume.

12-mL volume

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Centrifuge speed and time fpr optimum amount of sediment with the least chance of damaging the elements to correct for differences in the diameter of centrifuge heads

5 minutes at a relative centrifugal force (RCF) of 400

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A uniform amount of urine and sediment should remain in the tube after decantation (how much volume?)

0.5 amd 1 mL

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When using the conventional glass-slide method, the recommended volume is ______ covered by a ___ mm glass cover slip.

20μL(0.02mL)
22×22

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they represent normal sloughing of old cells.

Epithelial cells

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Three types of epithelial cells are seen in urine

squamous, transitional (urothelial), and renal tubular

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largest cells found in the urine sediment

Squamous Epithelial Cells

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They contain abundant, irregular cytoplasm and a prominent nucleus about the size of an RBC .

Squamous Epithelial Cells

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They are often the first structures observed when the urine sediment is examined under low-power magnification

Squamous Epithelial Cells

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Squamous Epithelial Cells commonly reported in terms of?

RFMM/LPF

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originate from the linings of the vagina and female urethra and the lower portion of the male urethra.

Squamous Epithelial Cells

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They represent normal cellular sloughing and have no pathologic significance.

Squamous Epithelial Cells

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Clue cells - indicative of vaginal infection by the bacterium?

Gardnerella vaginalis

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indicative of vaginal infection by the bacterium Gardnerella vaginalis

Clue cells

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smaller than squamous cells and appear in several forms, including spherical, polyhedral, and caudate.

Transitional EC

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Transitional EC appear in several forms including?

Spherical
polyhedral
caudate

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Transitional EC commonly reported in terms of?

RFMM/HPF

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originate from the lining of the renal pelvis, calyces, ureters, and bladder, and from the upper portion of the male urethra.

Transitional EC

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They are usually present in small numbers in normal urine, representing normal cellular sloughing. Increased numbers of these seen singly, in pairs, or in clumps (syncytia) are present following invasive urologic procedures such as catheterization and are of no clinical significance.

Transitional EC

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microscope Used for routine urinalysis

bright field microscopy

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microscope used for Enhances visualization of elements
with low refractive indices, such
as hyaline casts, mixed cellular
casts, mucous threads, and
Trichomonas

Phase-contrast
microscopy

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microscope that Aids in identification of cholesterol in oval fat bodies, fatty casts, and crystals

Polarizing microscopy

microscope that Aids in identification of Treponema pallidum

Dark-field microscopy

microscope that Allows visualization of naturally fluorescent microorganisms or those stained by a fluorescent dye including labeled antigens and antibodies

Fluorescence microscopy

microscope that Produces a three-dimensional microscopy image and layer by-layer imaging of a specimen

Interference contrast

often present as a result of tissue destruction (necrosis), the nucleus is not easily visible in unstained sediment.

Renal tubular epithelial cells

RTE cells are commonly reported as?

RFMM/HPF

The presence of more than two RTE cells per high-power field indicates

tubular injury

RTE cells absorb lipids that are present in the glomerular filtrate. They then appear highly refractile, and the nucleus may be more difficult to observe. They are usually seen in conjunction with free-floating fat droplets

Oval Fat Bodies

Identification of oval fat bodies is confirmed by staining the urine sediment with _____ fat stains and examining the sediment using polarized microscopy.

Sudan III or Oil Red O

appear as smooth, non-nucleated, biconcave disks measuring approximately 7 mm in diameter They must be identified using high-power (40×) objective (×400 magnification).

Red blood cells

RBCs are routinely reported as the

average number/10 hpfs

In concentrated (hypersthenuric) urine, the cells shrink due to loss of water and may appear

crenated or irregularly shaped.

In dilute (hyposthenuria) urine, the cells absorb water, swell, and lyse rapidly, releasing their hemoglobin and leaving only the cell membrane. These large empty cells are called _____ and can be easily missed if specimens are not examined under reduced light.

ghost cells

RBCs are frequently confused with ___

yeast cells, oil droplets, and air bubbles

RBCs that vary in size, have cellular protrusions, or are fragmented are termed _____ and have been associated primarily with glomerular bleeding.

dysmorphic

characterized by numerous small spiny projections

crenated erythrocytes

The predominant WBC found in the urine sediment is the

neutrophil

Neutrophils exposed to hypotonic urine absorb water and swell. Brownian movement of the granules within these larger cells produces a sparkling appearance, and they are referred to as

glitter cells

Sternheimer - Malbin stain =_____

stain light blue

The presence of urinary eosinophils is primarily associated with drug-induced ______

interstitial nephritis

Small numbers of eosinophils may be seen with ____ and ______

UTI renal transplant rejection

An increase in urinary WBCs is called

pyuria

frequent causes of pyuria.

pyelonephritis, cystitis, prostatitis, and urethritis

WBC commonly reported as

average numbe/hpf

usually present as a result of vaginal, urethral, external genitalia, or collection-container contamination

bacteria

bacteria commonly reported as

FMM/hpf

lower UTI termed as

cytitis

upper UTI termed as

Pyelonephritis

small, refractile oval structures that may or may not contain a bud. In severe infections, they may appear as branched, mycelial forms

Yeast

Yeast cells are reported as

RFMM/HPF

Yeast cells, primarily _____, are seen in the urine of diabetic patients, immunocompromised patients, and women with vaginal moniliasis

Candida albicans

Trichomonas reported as

RFMM/hpf

parasite associated with bladder cancer

Schistosoma haematobium

parasite assocuated with fecal contaminant

Enterobius veremicularis

easily identified in the urine sediment by their oval, slightly tapered heads and long, flagella-like tails

Spermatozoa

occasionally found in the urine of both men and women following sexual intercourse, masturbation, or nocturnal emission.

Spermatozoa

a major constituent of mucus

uromodulin

a glycoprotein excreted by the RTE cells of the distal convoluted tubules and upper collecting ducts.

uromodulin

appears microscopically as thread-like structures with a low refractive index.

Mucus

Mucus threads are reported as

RFMM/hpf

more frequently present in female urine specimens. It has no clinical significance when present in either female or male urine.

mucus

are the only elements found in the urinary sediment that are unique to the kidney

Casts

They are formed within the lumens of the distal convoluted tubules and collecting ducts, providing a microscopic view of conditions within the nephron

Casts

Their shape is representative of the tubular lumen, with parallel sides and somewhat rounded ends, and they may contain additional elements present in the filtrate.

Casts

Hyalin cast reported as

Average number/lpf

Rbc cast reported as

average number/lpf

WBC cast reported as

average number/lpf

formed by the precipitation of urine solutes, including inorganic salts, organic compounds, and medications (iatrogenic compounds).

Crystals

Normal urinary crystals

Uric acid amorphous urates Calcium ixalate amorphous phosphates calcium phosphates triple phosphate ammonium biurate calcium carbonate

Urice acid pH and Color

acid yellow brown (rosettes, wedges)

Amorphous urates pH and color

acid brick dust or yellow

Calcium oxalate

acid/neutral colorless (envelopes, oval, dumbell)

Amorphous phosphates pH and color

alkaline/neutral white-colorless

calcium phosphate pH and color

alkaline/neutral colorless

triple phosphate pH and color

alkaline colorless (coffin lids)

Ammonium biurate pH and color

alkaline yellow-brown (thorny apples)

calcium carbonate pH and color

alkaline colorless (dumbells)

abnormal urine crystals

Cystine cholesterol leucine tyrosine bilirubin sulfonamides radiographic dye ampicillin

Cysteine pH, color and disorders

acid colorless (hexgonal plates) inherited cystinuria

cholesterol pH, color and disorders

ACid Colorless (notched platees) nephrotic syndrome

leucine pH, color and disorders

acid/neutral yellow (concentric circles) liver disease

tyrosine pH, color and disorders

acid/neutral colorless-yellow (needles) liver disease

bilirubin pH, color and disorders

acid yellow liver disease

sulfonamides pH, color and disorders

acid/neutral varied infection treatment

radiographic dye pH, color and disorders

acid colorless (flat plates) radiographic procedure

ampicillin pH, color and disorders

acid/neitral colorless (needles) infection treatment

The most frequently seen cast

hyaline cast

the presence of urinary casts is termed

cylindruria

most common crystals seen in acidic urine

urates (amorphous urates, uric acid, acid urates, sodium urates)

The most common form of calcium oxalate crystals is the _____ that is easily recognized as a colorless, octahedral envelope or as two pyramids joined at their bases

dihydrate calcium oxalate

represent the majority of the crystals seen in alkaline urine

phosphates (amorphous phosphate, triple phosphate, calcium phosphate)

they are easily identified by their prism shape that fre quently resembles a “coffin lid

Triple phosphate (ammonium magnesium phosphate)

crystals that is found in the urine of persons who inherit a metabolic disorder that prevents reabsorption of ____ by the renal tubules (cystinuria).

cystine crystals

They are associated with disor ders producing lipiduria, such as the nephrotic syndrome, and are seen in conjunction with fatty casts and oval fat bodies.

cholesterol crystals

crystals associated with liver disorder

leucine tyrosine bilirubin

most frequently encountered artifacts include

starch oil droplets air bubbles pollen grains fibers fecal contamination