Urine Sediment

Question 1

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

Answer 1

10 fields

Question 2

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

Answer 2

400 RCF

Question 3

What is used to determine centrifugal force?

Answer 3

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

Question 4

What lipid does not stain with Sudan III?

Answer 4

Cholesterol

Question 5

Cytodiagnosis of urine is used to detect what?

Answer 5

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

Question 6

What constituents are reported under hpf?

Answer 6

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

Question 7

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

Answer 7

Yeast - increased glucose and acidic urine is ideal for yeast

Question 8

What lipid is birefringent?

Answer 8

Cholesterol

Question 9

Can lipid presence in urine be confirmed by polarized light?

Answer 9

Yes - cholesterol doesn’t stain but it does polaraize

Question 10

How should light setting be when examining sediment?

Answer 10

Light should be reduced

Question 11

RBCs in urine are associated with what conditions?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

Symptoms of renal calculi?

Answer 13

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

Question 14

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

Answer 14

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

Question 15

What is a glitter cell?

Answer 15

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

Question 16

What is pyuria?

Answer 16

The presence of WBCs (pus) in the urine

Question 17

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

Answer 17

Bacteria

Question 18

When do we see eosinophils in urine?

Answer 18

Drug-induced interstitial nephritis

Question 19

What is an oval fat body?

Answer 19

RTE cells that have absorbed lipid in the filtrate

Question 20

What type of epithelial cell lines bladder and ureters?

Answer 20

Transitional epithelial cells

Question 21

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

Answer 21

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

Question 22

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

Answer 22

Squamous epithelial cells covered with the gram negative bacteria Gardnerella vaginalis

Question 23

What cell type indicates nephron damage?

Answer 23

RBC casts

Question 24

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

Answer 24

Epithelial cells, particularly squamous epithelial cells

Question 25

What is the major component of cast matrix?

Answer 25

Uromodulin

Question 26

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

Answer 26

Distal convoluted tubules and collecting ducts

Question 27

What condition favors cast formation?

Answer 27

Urinary stasis, acidity, and presence of sodium and calcium

Question 28

Differentiate between transitional and renal epithelial cells.

Answer 28

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

Question 29

Differentiate waxy cast from hyaline cast?

Answer 29

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

Question 30

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

Answer 30

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

Question 31

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

Answer 31

RTE casts, broad and waxy casts, bilirubin crystals

Question 32

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

Answer 32

A Gram stain can be used to identify a bacterial cast

Question 33

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

Answer 33

Waxy and broad casts

Question 34

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

Answer 34

RBC casts, hyeline casts, granular casts

Question 35

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

Answer 35

Waxy cast

Question 36

What type of casts do we see in renal failure?

Answer 36

Waxy casts and broad casts

Question 37

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

Answer 37

RBC casts

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

Mucous can be confused with what type of cast?

Answer 40

Hyaline cast

Question 41

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

Answer 41

Swims across field rapidly

Question 42

Why do some medications precipitate out into crystals in urine?

Answer 42

Inadequate patient hydration

Question 43

What parameters are used to identify crystals?

Answer 43

Normal vs abnormal, pH, color, appearance

Question 44

What are the nonpathogenic crystals in acidic urine?

Answer 44

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

Question 45

Cystine crystals can be confused with what other crystal?

Answer 45

Uric acid crystals

Question 46

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

Answer 46

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

Question 47

What crystals are seen in alkaline urine?

Answer 47

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

Question 48

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

Answer 48

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

Question 49

What differentiates amorphous phosphate from amorphous urates?

Answer 49

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

Question 50

What are the 3 appearance forms of yeast in urine?

Answer 50

Budding, branched mycelial, refractile oval

Question 51

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

Answer 51

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.

Question 52

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

Answer 52

Amorphous urates, which can be confused with casts

Question 53

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

Answer 53

Yeast and possibly fatty casts

Question 54

What are dysmorphic rbcs? When do we see them?

Answer 54

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