Urine Microscopic Exam Flashcards
casts are composed of what protein
Tamm-Horsfall (uromodulin) protein excreted by renal tubular epithelial cells
casts are formed in the
distal convoluted tubule and collecting ducts (wider casts)
casts are reported as
number per low-power field
RBCs appear _____ in concentrated urine
crenated
RBCs appear _________ in dilute urine
larger empty cells (ghost cells)
______________ indicate glomerular bleeding
regular (dysmorphic) shapes)
RBCs sources of error
oil droplets, air bubbles, yeast cells (look for budding)
Urine RBCs clinical significance
glomerular membrane damage,Blleding in the urinary tract,renal calculi,malignancy
hemoglobinuria or myoglobinuria is indicated by
a clear red urine with a positive reagent strip RBC and no RBCs in the microscopic analysis
Eosinophils have red granules when stained with
Wright or Hansel stains
neutrophils that have swollen in dilute urine, resulting in Brownian movement of the granules in the cytoplasm
Glitter cells
describe glitter cells
neutrophils that have swollen in dilute urine, resulting in Brownian movement of the granules in the cytoplasm
WBCs sources of error
renal tubular epithelial cells, mononuclear lymphocytes, and monocytes
WBC urinalysis correlations
leukocyte esterase, nitrite, pH, and specific gravity (glitter cells)
WBCs CS
UTI (neutrophils),Drug-induced interstitial nephritis (eosinophils),malignancy (mononuclear cells)
largest cells in the urine sediment
Squamous cells.-represent normal sloughing of old lower genitourinary tract cells.*folded squamous cells may resemble urinary casts (look for a centrally located nucleus)
squamous epithelial cells covered with Gardnerella vaginalis bacteria, indicating a vaginal infection
Clue cells
Describe clue cells
squamous epithelial cells covered with Gardnerella vaginalis bacteria, indicating a vaginal infection
Transitional (urothelial) cells are found in
renal pelvis, ureters, bladder and male urethra.normally seen after catheterization procedures (often seen in clumps)
forms of transitional cells
spherical, caudate, and polyhedral.Spherical cells resemble renal tubular cells, except they have a centrally located nucleus.
increased transitional cells may indicate
malignancy
Renal tubular epithelial cells are found in
renal tubules and collecting duct.cell shape vary with location.Convoluted tubule cells are rectangular with coarse granules and may resemble a cast (look for a nucleus)Distal convoluted tubule cells are small and round, may resemble spherical transitional cells buth have an eccentric nucleus.Cells from collecting duct are cuboidal with at least one straight edge ad are frequently seen in clumps.
Renal Tubular Epithelial cells (RTE) CS
more than two RTE cells per HPF is significant.Tubular necrosis, often from poisoning or viral infections.RTE cells absorb filtrate and may be bilirubin stained (liver damage), contain hemosiderin granules (hemoglobin) or lipids.
RTE cells that have absorbed lipids
Oval fat bodies
describe oval fat bodies
RTE cells that have absorbed lipids.highly refractile.Seen in conjunction with free-floating lipids.confirm staining with oil red O, Sudan III, or polarized microscopy.
oval fat bodies CS
Nephrotic syndrome, diabetes mellitus, and crush injuries.
bacteria should be accompanied by
WBCs
bacteria sources of error
amorphous urates, phosphates, and old specimens with a high pH
bacteria CS
UTI
oval structures with buds or mycelia
yeast
describe yeast
oval structures with buds or mycelia
yeast should be accompanied by
WBCs
Yeast is associated with
acidic urine from patients with diabetes mellitus
yeast source of error
RBCs
yeast CS
DM, immunocompromised patients, vaginal infections
parasites in urine
Trichomonas vaginalis, Schistosoma haematobium, Enterobius vermicularis (fecal contamination)
describe Trichomonas vaginalis
exhibits rapid flagellar movement in wet preparations
urine parasites source of error
WBCs and renal tubular epithelial cells
urine parasites CS
sexually transmitted disease that is asymptomatic in males and causes a vaginal infection in females
strands of protein secreted by glands and renal tubular epithelial cells
Mucus
describe mucus
strands of protein secreted by glands and renal tubular epithelial cells
major protein of mucus
Tamm-Horsfall (uromodulin) protein
Mucus sources of error
clumps may resemble hyaline casts (look for the consistent shape of a cast)
Mucus CS
Mucus is of no clinical significance
precipitation of urine solutes affected by temperature, solute concentration, and pH
Crystals
describe crystals
precipitation of urine solutes affected by temperature, solute concentration, and pHmore abundant in refrigerated specimens.polarized microscopy aids in their identificationabnormal crystals are found only in acidic or normal urine.
normal crystals seen in acidic urine
Uric acid crystals, amorphous urates, calcium oxalate
normal crystals seen in alkaline urin
triple phosphate crystals, amorphous phosphate crystals, calcium carbonate crystals, ammonium biurate crystals
abnormal crystals
cysteine, cholesterol, tyrosine, leucine, bilirubin, sulfonamide, ampicillin
yellow-brown, flat sided rhombic plates, wedges, and rosettes
uric acid crystals
describe uric acid crystals
yellow-brown, flat sided rhombic plates, wedges, and rosettes
uric acid crystals SOE
cysteine crystals (uric acid crystals polarize and cysteine crystals do not polarize)
uric acid crystals CS
patients receiving chemotherapy, Lesch-Nyhan disease
small spheres producing brick-dust (uroerythrin) or yellow-brown sediment
amorphous urates
describe amorphous urates
small spheres producing brick-dust (uroerythrin) or yellow-brown sediment
describe calcium oxalate crystals
may also be seen in alkaline urineThe dehydrate form is envelope shaped; clumps in fresh urine may indicate renal calculi.The monohydrate form is oval or dumbbell shaped; presence of this form indicates ethylene glycol (anti-freeze) ingestion
coffin-lid shaped
triple phosphate crystals
describe triple phosphate crystals
coffin-lid shapedassociated with a very high pH and bacteria found in old specimens
produce a white precipitate after refrigeration
amorphous phosphate crystals
dumbbell and spherical shapes. produce gas with acetic acid
Calcium carbonate crystals
describe calcium carbonate
dumbbell and spherical shapes. produce gas with acetic acid
yellow-brown thorny apple-shaped crystals.
ammonium biurate crystals
describe ammonium biurate crystals
yellow-brown thorny apple-shaped crystals.associated with old specimens with bacteria.
hexagonal flat plates
cystine crystals
describe cystine crystals
hexagonal flat plates.an inherited disorder that inhibits the reabsorption of cystine by the renal tubules (cystinuria); renal calculi form at an early age
rectangular plates with notched corners, highly birefringent under polarized light
cholesterol crystals
describe cholesterol crystals
rectangular plates with notched corners, highly birefringent under polarized light.seen in refrigerated urine and accompanied by fatty casts and oval fat bodies.Nephrotic syndrome.
yellow needle-shaped forms in clusters or rosettes
tyrosine crystals
describe tyrosine crystals
yellow needle-shaped forms in clusters or rosettes.Severe liver disease.
yellow-brown spheres with concentric circles
Leucine crystals
describe leucine cystals
yellow-brown spheres with concentric circles.seen in conjunction with tyrosine crystals. seen in sever liver disease.
bright yellow clumped needles and granules
bilirubin crystals
describe bilirubin crystals
bright yellow clumped needles and granules. liver damage often from viral infections that damage the renal tubules, preventing reabsorption of bilirubin
needle, rosette, and rhombic shapes
sulfonamide crystals
describe sulfonamide crystals
needle, rosette, and rhombic shapes.inadequately hydrated patients taking sulfonamide medications.
colorless needles that form clumps after refrigeration
ampicillin crystals
describe ampicillin crystals
colorless needles that form clumps after refrigeration.inadequately hydrated patients taking ampicillin