Urine Microscopic Exam

Question 1

casts are composed of what protein

Answer 1

Tamm-Horsfall (uromodulin) protein excreted by renal tubular epithelial cells

Question 2

casts are formed in the

Answer 2

distal convoluted tubule and collecting ducts (wider casts)

Question 3

casts are reported as

Answer 3

number per low-power field

Question 4

RBCs appear _____ in concentrated urine

Answer 4

crenated

Question 5

RBCs appear _________ in dilute urine

Answer 5

larger empty cells (ghost cells)

Question 6

______________ indicate glomerular bleeding

Answer 6

regular (dysmorphic) shapes)

Question 7

RBCs sources of error

Answer 7

oil droplets, air bubbles, yeast cells (look for budding)

Question 8

Urine RBCs clinical significance

Answer 8

glomerular membrane damage,Blleding in the urinary tract,renal calculi,malignancy

Question 9

hemoglobinuria or myoglobinuria is indicated by

Answer 9

a clear red urine with a positive reagent strip RBC and no RBCs in the microscopic analysis

Question 10

Eosinophils have red granules when stained with

Answer 10

Wright or Hansel stains

Question 11

neutrophils that have swollen in dilute urine, resulting in Brownian movement of the granules in the cytoplasm

Answer 11

Glitter cells

Question 12

describe glitter cells

Answer 12

neutrophils that have swollen in dilute urine, resulting in Brownian movement of the granules in the cytoplasm

Question 13

WBCs sources of error

Answer 13

renal tubular epithelial cells, mononuclear lymphocytes, and monocytes

Question 14

WBC urinalysis correlations

Answer 14

leukocyte esterase, nitrite, pH, and specific gravity (glitter cells)

Question 15

WBCs CS

Answer 15

UTI (neutrophils),Drug-induced interstitial nephritis (eosinophils),malignancy (mononuclear cells)

Question 16

largest cells in the urine sediment

Answer 16

Squamous cells.-represent normal sloughing of old lower genitourinary tract cells.*folded squamous cells may resemble urinary casts (look for a centrally located nucleus)

Question 17

squamous epithelial cells covered with Gardnerella vaginalis bacteria, indicating a vaginal infection

Answer 17

Clue cells

Question 18

Describe clue cells

Answer 18

squamous epithelial cells covered with Gardnerella vaginalis bacteria, indicating a vaginal infection

Question 19

Transitional (urothelial) cells are found in

Answer 19

renal pelvis, ureters, bladder and male urethra.normally seen after catheterization procedures (often seen in clumps)

Question 20

forms of transitional cells

Answer 20

spherical, caudate, and polyhedral.Spherical cells resemble renal tubular cells, except they have a centrally located nucleus.

Question 21

increased transitional cells may indicate

Answer 21

malignancy

Question 22

Renal tubular epithelial cells are found in

Answer 22

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.

Question 23

Renal Tubular Epithelial cells (RTE) CS

Answer 23

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.

Question 24

RTE cells that have absorbed lipids

Answer 24

Oval fat bodies

Question 25

describe oval fat bodies

Answer 25

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.

Question 26

oval fat bodies CS

Answer 26

Nephrotic syndrome, diabetes mellitus, and crush injuries.

Question 27

bacteria should be accompanied by

Answer 27

WBCs

Question 28

bacteria sources of error

Answer 28

amorphous urates, phosphates, and old specimens with a high pH

Question 29

bacteria CS

Answer 29

UTI

Question 30

oval structures with buds or mycelia

Answer 30

yeast

Question 31

describe yeast

Answer 31

oval structures with buds or mycelia

Question 32

yeast should be accompanied by

Answer 32

WBCs

Question 33

Yeast is associated with

Answer 33

acidic urine from patients with diabetes mellitus

Question 34

yeast source of error

Answer 34

RBCs

Question 35

yeast CS

Answer 35

DM, immunocompromised patients, vaginal infections

Question 36

parasites in urine

Answer 36

Trichomonas vaginalis, Schistosoma haematobium, Enterobius vermicularis (fecal contamination)

Question 37

describe Trichomonas vaginalis

Answer 37

exhibits rapid flagellar movement in wet preparations

Question 38

urine parasites source of error

Answer 38

WBCs and renal tubular epithelial cells

Question 39

urine parasites CS

Answer 39

sexually transmitted disease that is asymptomatic in males and causes a vaginal infection in females

Question 40

strands of protein secreted by glands and renal tubular epithelial cells

Answer 40

Mucus

Question 41

describe mucus

Answer 41

strands of protein secreted by glands and renal tubular epithelial cells

Question 42

major protein of mucus

Answer 42

Tamm-Horsfall (uromodulin) protein

Question 43

Mucus sources of error

Answer 43

clumps may resemble hyaline casts (look for the consistent shape of a cast)

Question 44

Mucus CS

Answer 44

Mucus is of no clinical significance

Question 45

precipitation of urine solutes affected by temperature, solute concentration, and pH

Answer 45

Crystals

Question 46

describe crystals

Answer 46

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.

Question 47

normal crystals seen in acidic urine

Answer 47

Uric acid crystals, amorphous urates, calcium oxalate

Question 48

normal crystals seen in alkaline urin

Answer 48

triple phosphate crystals, amorphous phosphate crystals, calcium carbonate crystals, ammonium biurate crystals

Question 49

abnormal crystals

Answer 49

cysteine, cholesterol, tyrosine, leucine, bilirubin, sulfonamide, ampicillin

Question 50

yellow-brown, flat sided rhombic plates, wedges, and rosettes

Answer 50

uric acid crystals

Question 51

describe uric acid crystals

Answer 51

yellow-brown, flat sided rhombic plates, wedges, and rosettes

Question 52

uric acid crystals SOE

Answer 52

cysteine crystals (uric acid crystals polarize and cysteine crystals do not polarize)

Question 53

uric acid crystals CS

Answer 53

patients receiving chemotherapy, Lesch-Nyhan disease

Question 54

small spheres producing brick-dust (uroerythrin) or yellow-brown sediment

Answer 54

amorphous urates

Question 55

describe amorphous urates

Answer 55

small spheres producing brick-dust (uroerythrin) or yellow-brown sediment

Question 56

describe calcium oxalate crystals

Answer 56

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

Question 57

coffin-lid shaped

Answer 57

triple phosphate crystals

Question 58

describe triple phosphate crystals

Answer 58

coffin-lid shapedassociated with a very high pH and bacteria found in old specimens

Question 59

produce a white precipitate after refrigeration

Answer 59

amorphous phosphate crystals

Question 60

dumbbell and spherical shapes. produce gas with acetic acid

Answer 60

Calcium carbonate crystals

Question 61

describe calcium carbonate

Answer 61

dumbbell and spherical shapes. produce gas with acetic acid

Question 62

yellow-brown thorny apple-shaped crystals.

Answer 62

ammonium biurate crystals

Question 63

describe ammonium biurate crystals

Answer 63

yellow-brown thorny apple-shaped crystals.associated with old specimens with bacteria.

Question 64

hexagonal flat plates

Answer 64

cystine crystals

Question 65

describe cystine crystals

Answer 65

hexagonal flat plates.an inherited disorder that inhibits the reabsorption of cystine by the renal tubules (cystinuria); renal calculi form at an early age

Question 66

rectangular plates with notched corners, highly birefringent under polarized light

Answer 66

cholesterol crystals

Question 67

describe cholesterol crystals

Answer 67

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.

Question 68

yellow needle-shaped forms in clusters or rosettes

Answer 68

tyrosine crystals

Question 69

describe tyrosine crystals

Answer 69

yellow needle-shaped forms in clusters or rosettes.Severe liver disease.

Question 70

yellow-brown spheres with concentric circles

Answer 70

Leucine crystals

Question 71

describe leucine cystals

Answer 71

yellow-brown spheres with concentric circles.seen in conjunction with tyrosine crystals. seen in sever liver disease.

Question 72

bright yellow clumped needles and granules

Answer 72

bilirubin crystals

Question 73

describe bilirubin crystals

Answer 73

bright yellow clumped needles and granules. liver damage often from viral infections that damage the renal tubules, preventing reabsorption of bilirubin

Question 74

needle, rosette, and rhombic shapes

Answer 74

sulfonamide crystals

Question 75

describe sulfonamide crystals

Answer 75

needle, rosette, and rhombic shapes.inadequately hydrated patients taking sulfonamide medications.

Question 76

colorless needles that form clumps after refrigeration

Answer 76

ampicillin crystals

Question 77

describe ampicillin crystals

Answer 77

colorless needles that form clumps after refrigeration.inadequately hydrated patients taking ampicillin