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Phlebotomy > Urine Sediment > Flashcards

Urine Sediment Flashcards

Learn about urine sediment

1
Q

How many fields do we examine before quantitating urine sediment cells, etc.?

A

10 fields

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2
Q

Urine centrifugation settings for sediments: how long do you spin and what RCF?

A

400 RCF

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3
Q

What is used to determine centrifugal force?

A

RCF = 1.118 × 10−5 × radius in centimeters × RPM2

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4
Q

What lipid does not stain with Sudan III?

A

Cholesterol

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5
Q

Cytodiagnosis of urine is used to detect what?

A

Malignancies of the lower urinary tract - transplant rejection; viral, fungal, and parasitic infections; cellular inclusions; pathologic cases; inflammatory conditions

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6
Q

What constituents are reported under hpf?

A

RBCs, WBCs, transitional cells, RTE cells, oval fat bodies, bacteria, yeast, and trichomonas

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7
Q

What constituent is glucose a good chemical parameter to use for microscopically?

A

Yeast - increased glucose and acidic urine is ideal for yeast

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8
Q

What lipid is birefringent?

A

Cholesterol

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9
Q

Can lipid presence in urine be confirmed by polarized light?

A

Yes - cholesterol doesn’t stain but it does polaraize

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10
Q

How should light setting be when examining sediment?

A

Light should be reduced

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11
Q

RBCs in urine are associated with what conditions?

A

Bleeding in the genitourinary tract - renal calculi, glomerulonephritis, pyleonephritis, tumors, trauma, exposure to toxic chemicals, anticoagulants, strenuous exercise

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12
Q

What is a ghost RBC? When do we see them – what sp. gr. High/low? pH – high/low?

A

The cell membrane of a lysed RBC - they appear in low SG urine (hposthenuric)

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13
Q

Symptoms of renal calculi?

A

Sever lower back pain, hematuria, frequent painful urination with small urine volume

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14
Q

How can we differentiate between yeast, oil droplets, and rbcs?

A

Yeast may be budding; RBCs will lyse with addition of acetic acid, yeast will not; oil droplets and air bubbles are highly refractive when the fine adjustment is focused up and down, they may also appear in a different plane than other urine sediments

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15
Q

What is a glitter cell?

A

Swollen WBC - Brownian movement of the granules produces the sparkling appearance

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16
Q

What is pyuria?

A

The presence of WBCs (pus) in the urine

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17
Q

If we see WBCs in urine we should look for what else?

A

Bacteria

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18
Q

When do we see eosinophils in urine?

A

Drug-induced interstitial nephritis

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19
Q

What is an oval fat body?

A

RTE cells that have absorbed lipid in the filtrate

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20
Q

What type of epithelial cell lines bladder and ureters?

A

Transitional epithelial cells

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21
Q

Order of epithelial cells in urinary tract from urethra up through nephron: RTE, sq epi, transitional – put in order

A

Urethra: Squamous epithelial; Ureters, bladder renal pelvis, calyces: transitional (urothelial) epithelial cells; Renal tubules: RTE

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22
Q

What is a clue cell? What organism is associated with clue cells?

A

Squamous epithelial cells covered with the gram negative bacteria Gardnerella vaginalis

23
Q

What cell type indicates nephron damage?

A

RBC casts

24
Q

CCMS helps to prevent urine specimen contamination of what cell type?

A

Epithelial cells, particularly squamous epithelial cells

25
Q

What is the major component of cast matrix?

A

Uromodulin

26
Q

What parts of the kidney do casts form in? 2 type of tubules – name them.

A

Distal convoluted tubules and collecting ducts

27
Q

What condition favors cast formation?

A

Urinary stasis, acidity, and presence of sodium and calcium

28
Q

Differentiate between transitional and renal epithelial cells.

A

Transitional epithelial cells have a centrally located nucleus renal epithelial cells have eccentrically placed nuclei

29
Q

Differentiate waxy cast from hyaline cast?

A

Waxy casts are more easily visualized because they have a higher refractive index, they often appear fragmented with jagged ends and have notches in their sides

30
Q

What type of sediment component tells you it is upper vs lower urinary tract infection?

A

WBC casts distinguish pyelonephritis (upper UTI) from cystitis (lower UTI)

31
Q

Tubular damage may be identified by what cast in the urine?

A

RTE casts, broad and waxy casts, bilirubin crystals

32
Q

How can we tell the difference between a bacterial cast v granular cast?

A

A Gram stain can be used to identify a bacterial cast

33
Q

Extreme urinary stasis may result in the formation of what type of cast?

A

Waxy and broad casts

34
Q

What cast do we see in person who performs strenuous exercise?

A

RBC casts, hyeline casts, granular casts

35
Q

What do hyaline casts degenerate into? i.e., what type of cast?

A

Waxy cast

36
Q

What type of casts do we see in renal failure?

A

Waxy casts and broad casts

37
Q

Bleeding in the nephron – we should see what in urine?

A

RBC casts

38
Q

We see something that looks like a waxy cast but it could also be a fiber. How can we tell them apart?

A

Fibers are longer and more refractive, they often polarize, whereas casts, other than fatty casts, do not polarize

39
Q

We are not sure if the clump of cells is a cast or not. What should we look for?

A

Look for cast matrix to avoid mistaking a clump of cells for a cast

40
Q

Mucous can be confused with what type of cast?

A

Hyaline cast

41
Q

How does Trichomonas vaginalis catch our eye in a urine sediment?

A

Swims across field rapidly

42
Q

Why do some medications precipitate out into crystals in urine?

A

Inadequate patient hydration

43
Q

What parameters are used to identify crystals?

A

Normal vs abnormal, pH, color, appearance

44
Q

What are the nonpathogenic crystals in acidic urine?

A

Uric acid, amorphous urates, calcium oxalate (acid and neutral pH)

45
Q

Cystine crystals can be confused with what other crystal?

A

Uric acid crystals

46
Q

What are the pathologic crystals? Which ones are associated with liver disease?

A

Cystine, cholesterol, leucine, tyrosine, bilirubin, sulfonamides, radigraphic dye, ampicillin - Leucine, tyrosine, and billirubin are associated with liver disease

47
Q

What crystals are seen in alkaline urine?

A

Amorphous phosphates, calcium phosphate, triple phosphate, ammonium biurate, calcium carbonate

48
Q

What are the two forms we see calcium oxalate in? Describe them. The ingestion of ethylene glycol may cause the appearance of which form?

A

Dihydrate (evelopes), monohydrate (dumbbells) - Calcium oxalate in monohydrate form is an indication of ethylene glycol poisoning

49
Q

What differentiates amorphous phosphate from amorphous urates?

A

Amorphous phosphates are found in alkaline urine, amorphous urates are found in acid urine

50
Q

What are the 3 appearance forms of yeast in urine?

A

Budding, branched mycelial, refractile oval

51
Q

What is an easy way to ID urine artifact? What characteristic?

A

They are highly refractile or occur in a different microscopic plane than true sediment constituents. Fibers often polarize, whereas casts, other than fatty casts do not.

52
Q

Amorphous phosphates in alkaline urine may be confused with what other constituent?

A

Amorphous urates, which can be confused with casts

53
Q

Diabetics are more likely (not always) to have what in urine (not glucose)?

A

Yeast and possibly fatty casts

54
Q

What are dysmorphic rbcs? When do we see them?

A

Crenated, irregularly shaped - Glomerular bleeding, strenuous exercise, acanthocytic, blebs

Phlebotomy (3 decks)

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